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Background CDK4/6 inhibitors plus endocrine therapies are the current standard of care in the first-line treatment of HR+/HER2-negative metastatic breast cancer, but there are no well-established clinical or molecular predictive factors for patient response. In the era of personalised oncology, new approaches for developing predictive models of response are needed. Materials and methods Data derived from the electronic health records (EHRs) of real-world patients with HR+/HER2-negative advanced breast cancer were used to develop predictive models for early and late progression to first-line treatment. Two machine learning approaches were used: a classic approach using a data set of manually extracted features from reviewed (EHR) patients, and a second approach using natural language processing (NLP) of free-text clinical notes recorded during medical visits. Results Of the 610 patients included, there were 473 (77.5%) progressions to first-line treatment, of which 126 (20.6%) occurred within the first 6 months. There were 152 patients (24.9%) who showed no disease progression before 28 months from the onset of first-line treatment. The best predictive model for early progression using the manually extracted dataset achieved an area under the curve (AUC) of 0.734 (95% CI 0.687–0.782). Using the NLP free-text processing approach, the best model obtained an AUC of 0.758 (95% CI 0.714–0.800). The best model to predict long responders using manually extracted data obtained an AUC of 0.669 (95% CI 0.608–0.730). With NLP free-text processing, the best model attained an AUC of 0.752 (95% CI 0.705–0.799). Conclusions Using machine learning methods, we developed predictive models for early and late progression to first-line treatment of HR+/HER2-negative metastatic breast cancer, also finding that NLP-based machine learning models are slightly better than predictive models based on manually obtained data.

To identify subgroups with good progress over an extended period, we used diagnostic screening, tumour palpability, tumour phenotype, and node involvement.We identified patients with good progress by means of a descriptive, observational and retrospective study.Of 746 patients diagnosed with node-negative breast cancer between 2001 and 2015: 110 (14.75%) had non-palpable screening-diagnosed tumours; 88 (80%) were endocrine-sensitive, 10 (9.10%) were triple-negative and 11 (10%) were HER2. Only 3 patients developed metastases, and there were 4 deaths: 2 from breast cancer and 2 from other causes. The distant recurrence-free interval (DRFI) was 95.60%: 100% in 34 endocrine-sensitive histological grade 1 (equivalent to luminal A) tumours, and 94.40% (95% CI 86.76-102.04) in 54 grade 2-3 (luminal B) tumours. In triple-negative and HER2 cases, it was 100%. In tumours1 cm it was 100%, and1 cm it was 95.50% (95% CI 79.42-100.98).Patients with non-palpable tumours detected by mammogram screening have ultralow risk. The good progress in the luminal A, triple-negative, HER2, and less than 1 cm subgroups may explain the efficacy of the treatment but it also makes them candidates to de-escalation of their treatment.

The COVID-19 pandemic has caused a profound change in health organizations at both the primary and hospital care levels. This cross-sectional study aims to investigate the impact of the COVID-19 pandemic in the annual rate of new cancer diagnosis in two university-affiliated hospitals. This study includes all the patients with a pathological diagnosis of cancer attended in two hospitals in Málaga (Spain) during the first year of pandemic. This study population was compared with the patients diagnosed during the previous year 2019. To analyze whether the possible differences in the annual rate of diagnoses were due to the pandemic or to other causes, the patients diagnosed during 2018 and 2017 were also compared. There were 2340 new cancer diagnosis compared to 2825 patients in 2019 which represented a decrease of −17.2% (p = 0.0001). Differences in the number of cancer patients diagnosed between 2018 and 2019 (2840 new cases, 0.5% increase) or 2017 and 2019 (2909 new cases, 3% increase) were not statistically significant. The highest number of patients lost from diagnosis in 2020 was in breast cancer (−26.1%), colorectal neoplasms (−16.9%), and head and neck tumors (−19.8%). The study of incidence rates throughout the first year of the COVID-19 pandemic shows that the diagnosis of new cancer patients has been significantly impaired. Health systems must take the necessary measures to restore pre-pandemic diagnostic procedures and to recover lost patients who have not been diagnosed.

Central sensitization symptoms and pain-related fear avoidance are two common problems in breast cancer survivors. Non-pharmacologic interventions such as therapeutic exercise and patient education can be effective in this population. This study aimed to: (1) analyze the benefits of a therapeutic exercise and educational program on central sensitization symptoms and pain-related fear avoidance in breast cancer survivors, and (2) explore the association between pain-related fear avoidance and central sensitization symptoms. A single group pre-post intervention study was conducted. Patients were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The intervention consisted of a therapeutic exercise and educational program that lasted 12 weeks, twice a week, for 1 hour. Two instruments were used: the Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale. A total of 82 breast cancer survivors participated in the study. Pre-post change on Central Sensitization Inventory was statistically significant (p = .007). There was a trend towards a significant difference for the Spanish Fear Avoidance Components Scale (p = .062). There was a statistically significant correlation between pain-related fear avoidance and central sensitization symptoms (r = 0.536, p The current study has provided preliminary evidence on the benefits of this intervention in pain-related fear avoidance and central sensitization symptoms in breast cancer survivors. The Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale demonstrated responsiveness to change.

Endometrial cancer is one of the most common gynaecological malignancies worldwide. Histologically, two types of endometrial cancer with morphological and molecular differences and also therapeutic implications have been identified. Type I endometrial cancer has an endometrioid morphology and is estrogen-dependent, while Type II appears with non-endometrioid differentiation and follows an estrogen-unrelated pathway. Understanding the molecular biology and genetics of endometrial cancer is crucial for its prognosis and the development of novel therapies for its treatment. However, until now, scant attention has been paid to environmental components like the microbiome. Recently, due to emerging evidence that the uterus is not a sterile cavity, some studies have begun to investigate the composition of the endometrial microbiome and its role in endometrial cancer. In this review, we summarize the current state of this line of investigation, focusing on the relationship between gut and endometrial microbiome and inflammation, estrogen metabolism, and different endometrial cancer therapies.

Resumen Introduccion El trabajo por procesos asistenciales integrados (PAI) introduce criterios de calidad para su monitorizacion. En este estudio se presenta un modelo de evaluacion de las normas de calidad de los PAI en Andalucia, en atencion primaria (AP) y atencion especializada (AE) en 2 momentos temporales, y algunos de los resultados obtenidos en el Hospital Universitario Virgen de las Nieves (HUVN) y en el Distrito Metropolitano (DM). Material y metodos Estudio descriptivo acerca del modelo de monitorizacion de las normas de calidad de algunos PAI, en AP y en AE, utilizando datos procedentes de la historia clinica digital en AP, y de las auditorias de las historias clinicas en AE (muestreo por lotes y tablas de la distribucion binomial). Resultados Se obtienen los resultados de la monitorizacion de las normas de calidad en atencion primaria (DM) y en atencion especializada (HUVN) y se elabora un sistema integrado de monitorizacion conjunta. Se presentan resultados de los siguientes PAI (cancer de mama, cancer de cervix, embarazo, parto y puerperio, hipertrofia benigna de prostata/cancer de prostata y cuidados paliativos). Se presentan resultados de la practica enfermera en algunas actuaciones. Se evalua la informacion obtenida y se realizan propuestas de mejora. Conclusiones El diseno y la utilizacion de metodologia de evaluacion es un requisito para conocer los resultados de las actuaciones y tomar decisiones para mejorar. Hay que mejorar y adaptar los sistemas de informacion asistenciales a las necesidades de informacion de los PAI. La evaluacion conjunta es una etapa mas en el circulo de mejora de la calidad de los procesos asistenciales integrados.

Fundamento: La psitacosis se puede transmitir de pájaros infectados a seres humanos, siendo causa de neumonía atípica. El objetivo de este trabajo es determinar origen de un brote de psitacosis, las características de los sujetos expuestos, y describir las medidas para controlarlo. Métodos: Estudio descriptivo. Comunicación al Sistema de Vigilancia Epidemiológica y Delegación de Agricultura, realizándose las actuaciones pertinentes (inspección, toma de muestras, desinfección e inmovilización cautelar de aves), clausura del establecimiento; definición de caso y encuesta epidemiológica. Análisis de frecuencias. Resultados: 17 personas tuvieron contacto con animales sospechosos (53% varones/47% mujeres), de ellos 9 (edad media: 30) presentaron síntomas (100% fiebre, cuadro pseudogripal 44,4%). Se realizó serología para C. psitacci a 11 de los 17 sujetos expuestos (68,75%), resultando positiva en dos de ellos (18,18%). En el estudio de tejido pulmonar del fallecido se comprobó la presencia de DNA de C. psitacci. La confirmación diagnóstica entre personas sintomáticas fue del 33% (3/9). La Delegación de Agricultura impuso cuarentena a 22 núcleos zoológicos. De las 70 muestras tomadas (60: cloacas de animales y 10 aves), presentaron antígeno positivo 7 (10%), siendo la detección de ácidos nucleicos por PCR positiva en una de ellas. Conclusiones: La exposición a aves enfermas en los establecimientos implicados originó el brote, siendo el foco común de contagio de carácter laboral. La adecuada coordinación/colaboración entre las Delegaciones de Salud y Agricultura permitió evitar la aparición de casos nuevos.

The addition of 1,8-naphthyridine (naph) to a solution of [Mn(OClO3)(naph)(CO)3] at room temperature affords the octahedral complex [Mn (η1-naph)(η2-naph)(CO)3]ClO4 (1). This complex can also be obtained when naph is added to a solution of [Mn(OClO3) (CO)5]. When naph is reacted with [Mn(OClO3)(CO)5] at − 80°C and with 1 : 1 molar ratio, [Mn(η1-naph)(CO)5]ClO4 (3) is obtained. This complex changes into (1) at temperatures above 0°C. The crystal structure of [Mn(η1-naph)(η2-naph) (CO)3]ClO4 (monoclinic, space group P21/a, a = 16.006(3) A, b = 12.024(2) A, c = 13.004(2) A, β = 109.85 (2)°, Z = 4) shows that the manganese atom displays a slightly distorted octahedral coordination being linked to three facial carbonyl ligands, to two nitrogen atoms of a bidentate 1,8-naphthyridine (η2-naph) and to another nitrogen atom of a monodentate 1,8-naphthyridine (η1-naph). A detailed variable temperature 1H NMR study shows this structure persist in solution at low temperature. At higher temperature the complex is fluxional and there is a rapid exchange of the coordination modes of the two naph ligands: the bidentate becomes monodentate and the monodentate bidentate. The mechanism is intramolecular, the rate-limiting step being the opening of the four-membered ring formed by the metal and the η2-naph.

Fundamento: Actualmente se sabe muy poco de las características de las personas diagnosticadas de fibromialgia, su grado de incapacidad y la respuesta del sistema sanitario. Los objetivos de este trabajo son: conocer el perfil sociodemográfico, clínico y psicosocial de las y los pacientes con fibromialgia; describir la respuesta que obtienen del sistema sanitario, y estudiar la repercusión de este síndrome en las actividades habituales de las personas que lo padecen, incluyendo las del ámbito laboral. Métodos: Estudio descriptivo transversal. La información se recogió mediante encuesta telefónica realizada a personas diagnosticadas de fibromialgia en el Hospital Universitario Virgen de las Nieves de Granada durante el año 2003. Resultados: El 92,1% de las personas entrevistadas eran mujeres. La fibromialgia causó baja laboral en el 31,4% de los casos. El 64% percibía su salud como mala o muy mala. La fibromialgia se asoció a otras enfermedades en un 52,3% de los casos. El médico de familia es el especialista consultado antes del diagnóstico en el 92,1%. El 50,5% tenía antecedentes de trastorno psiquiátrico, presentándolo en el momento de la entrevista el 36,4%. El 71% de la muestra recibía apoyo familiar, señalando un fuerte impacto del síndrome en su entorno un 70,1% de los casos. Conclusiones: La fibromialgia fue diagnosticada mayoritariamente en mujeres. Causa una mala percepción del estado de salud y situaciones de incapacidad laboral, afectando negativamente al entorno familiar de la persona que la padece.

To analyze the information that women have on hormone replacement therapy (HRT), the sources of this information and how it is related to prescription.We performed a cross-sectional study through a telephone survey. Information was collected on prescription of HRT, knowledge of HRT and of its health benefits, risks and type of risk, and sources of information.371 interviews (80% of the original sample) were completed. 66% of the sample reported knowledge of the benefits of HRT and 42% learnt of them from health professionals. 36% thought that HRT could pose health risks. 91% of the women prescribed this treatment reported knowledge of its benefits compared with 57% of those not prescribed it (OR = 7.32; 95% CI, 2.86-18.74). Health professionals were the main source of information about these benefits among women prescribed HRT (93%) (OR = 83,47; 95% CI, 26.83-278.63). 57% of the women prescribed HRT reported knowledge of its risks compared with 28% of those not prescribed this therapy (OR = 3.11; 95% CI, 1.59-6.05).Women prescribed HRT were better informed than those not prescribed this therapy. Among users, more than 90% mentioned some benefits, but 43% reported not knowing about its risks. Information on the benefits of HRT was mainly provided by health professionals whereas information on the risks was provided by both health professionals and the mass media.

Objetivos: Analizar la información que tienen las mujeres sobre la terapia hormonal sustitutiva (THS), de quién proviene esta información y cómo se relaciona con la prescripción. Métodos: Estudio descriptivo transversal mediante encuesta telefónica. En relación con la THS, se recogió información sobre su prescripción, el conocimiento sobre la misma y las fuentes de información, sus beneficios y riesgos para la salud y el tipo y fuente de información sobre éstos. Resultados: Se realizaron 371 entrevistas (el 80% de la muestra seleccionada originalmente). El 66% de las mujeres refería conocer los beneficios y el 42% los conocía a través de los profesionales sanitarios. El 36% de las encuestadas creía que la THS tenía riesgos para la salud. El 91% de las mujeres a las que se les prescribe este tratamiento refiere conocer sus beneficios, frente a sólo el 57% de las mujeres a las que no se les prescribe (odds ratio [OR] = 7,32; intervalo de confianza [IC] del 95%, 2,86-18,74). Los profesionales sanitarios son la principal fuente de información de estos beneficios entre las mujeres que reciben la prescripción (93%) (OR = 83,47; IC del 95%, 26,83-278,63). El 57% de las mujeres a las que se les prescribe este tratamiento refieren conocer sus riesgos, frente al 28% de las mujeres a las que no se les prescribe (OR = 3,11; IC del 95%, 1,59-6,05). Conclusiones: Las mujeres a las que se les prescribe THS tienen un nivel de información superior. La inmensa mayoría de las usuarias menciona algún beneficio, pero un 43% refiere desconocer los riesgos que implica su uso. En cuanto a la fuente de información, los aspectos beneficiosos del tratamiento se conocen mayoritariamente a través de los profesionales sanitarios, mientras que los riesgos se conocen tanto a partir de los profesionales sanitarios como de los medios de comunicación. Objectives: To analyze the information that women have on hormone replacement therapy (HRT), the sources of this information and how it is related to prescription. Methods: We performed a cross-sectional study through a telephone survey. Information was collected on prescription of HRT, knowledge of HRT and of its health benefits, risks and type of risk, and sources of information. Results: 371 interviews (80% of the original sample) were completed. 66% of the sample reported knowledge of the benefits of HRT and 42% learnt of them from health professionals. 36% thought that HRT could pose health risks. 91% of the women prescribed this treatment reported knowledge of its benefits compared with 57% of those not prescribed it (OR = 7.32; 95% CI, 2.86-18.74). Health professionals were the main source of information about these benefits among women prescribed HRT (93%) (OR = 83,47; 95% CI, 26.83-278.63). 57% of the women prescribed HRT reported knowledge of its risks compared with 28% of those not prescribed this therapy (OR = 3.11; 95% CI, 1.59-6.05). Conclusions: Women prescribed HRT were better informed than those not prescribed this therapy. Among users, more than 90% mentioned some benefits, but 43% reported not knowing about its risks. Information on the benefits of HRT was mainly provided by health professionals whereas information on the risks was provided by both health professionals and the mass media.

The coordination behavior of the amines naphthyridine (naph), pyridazine (pyr), pyrazine (pz) and 3,5-dimethylpyrazole (3,5-DMP) towards the iron fragment [CpFe(CO)2]+ (Cp = η5-C5H5) has been studied. The compounds obtained were characterized and their variable temperature (VT) 1H NMR and 57Fe Mossbauer spectra investigated.

Three new pyridazine complexes of manganese(I): [MnBr(pyr)2(CO)3] (1), [Mn(pyr)(CO)5][ClO4] (2) and [Mn(pyr)3(CO)3][ClO4] (3) (pyr=pyridazine) have been prepared and their i.r. and variable-temperature1H n.m.r. spectra investigated.