Due to the anatomical continuity of the uterine cavity with the cervix, genomic exploitation of material from routine Pap smears and other noninvasive sampling methods represent a unique opportunity ...to detect signs of disease using biological material shed from the upper genital tract. Recent research findings offer a promising perspective in the detection of endometrial cancer, but certain questions need to be addressed in order to accelerate the implementation of novel technologies in a routine screening or clinical setting. We discuss here new perspectives on detection of endometrial cancer using genomic and other biomarkers in minimally invasive sampling methods with a special focus on public health classic screening criteria, highlighting current gaps in knowledge.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Introducción: el tabaquismo es un grave problema de salud pública, el 23 % de los españoles mayores de 15 años fuma a diario y el 2,4 % es fumador ocasional. El farmacéutico comunitario (FC) es un ...profesional sanitario accesible y cercano a la población que puede desempeñar una importante labor en cesación tabáquica. Es fundamental realizar estudios de investigación que demuestren el impacto de la intervención del FC en tabaquismo y ayuden a definir un protocolo de actuación que pueda implantarse de manera generalizada en cualquier farmacia comunitaria de nuestro país. Material y métodos: el protocolo se utilizó en un estudio prospectivo controlado no aleatorizado de 12 meses de seguimiento en paciente fumador mayor de 18 años que acudía a la farmacia comunitaria con una prescripción médica para dejar de fumar, haciendo una consulta para dejar de fumar o paciente que se detecta como fumador. El estudio se diseñó para desarrollarse en 100 farmacias con farmacéuticos capacitados a través del programa CESAR (grupo intervención) que realizaban una intervención estructurada y 100 farmacias con farmacéuticos no capacitados (grupo control) que realizaban una intervención habitual. Cada una de las farmacias debía reclutar un total de 5 pacientes, lo que supondría un total de 1.000 casos. Resultados: en el estudio participaron 182 FC (grupo intervención: 102, grupo control: 80), la mayoría de los cuales desarrollaban su actividad profesional en farmacias de barrio. Se incorporaron 1.078 pacientes (grupo intervención: 800, grupo control: 278), con una distribución homogénea por sexos y una edad media de 49 años.
Abstract
BACKGROUND AND AIMS
Chronic kidney disease (CKD) is a common problem in patients over 60 years of age. It´s necessary to control the administration of nephrotoxic drugs and to adjust the ...dosage of drugs eliminated by kidneys. Community pharmacists can improve risk stratification and management of stage 3A chronic kidney disease 1. Using a point-of-care technology 2 screening to identify CKD in a community pharmacy is feasible. Then, a drug dosing adjustment service for elderly patients with renal impairment can increase the proportion of adequate drug dosing and improve the drug-related problems of the patient 3. This study was designed and executed together between pharmacists, primary care physicians and nephrologists, as they all contribute to complete and efficient patient management.
The purpose of this study is to prove the community pharmacy's capabilities in the detection of nephrotoxic drugs and dose adjustment in CKD patients together with the prescriber for better patient management.
METHOD
Before we've started the study, we've run a precision and method comparison testing to internally validate the StatSensor Express POC meter used in this study. Briefly, it has been done by measuring 35 blood samples against a reference method in a hospital central laboratory. The data were analyzed using statistical methods, as recently published. 4.
The inclusion criteria for this study were defined as follows. Patients over 60 years old that have been prescribed with at least one nephrotoxic drug or drugs that may need dose adjustment. The identified patients were invited for capillary blood creatinine test (StatSensor Express, Nova Biomedical). Glomerular filtration rate (eGFR) is calculated using CKD-EPI. If eGFR <60 mL/minute the medication is analyzed. Depending on the results, the patients are referred to the Primary Care physicians with the proposed treatment changes. The decisions are recorded and analysed to complete the study, as shown in the result section.
RESULTS
552 patients in 15 pharmacies were included. 179 (32.4%) eGFR <60 had prescribed a total of 1552 drugs of which 32 (2.1%) are nephrotoxic and their withdrawal is proposed. 110 (7.1%) are used at doses higher than those recommended and their adjustment is requested. They correspond to 23 (12.8%) and 64 (35.8%) patients respectively, and 17 of them (9.5%) to both. Total of 70 (39.1%) patients.
The physicians accept the withdrawal of 9 (28.1%) nephrotoxic drugs and the adjustment/withdrawal of the dose of 30 (27.3%) corresponding to 8 and 23 patients respectively, and 6 of them to both. Total of 25 (35.7%) patients.
It equals to a change proposal in 142 (9.1%) of the analysed drugs that use 70 (12.7%) of the 552 patients included. About 39 (2.5%) were modified in 25 (4.5%) patients.
CONCLUSION
Chronic kidney disease (CKD) is a major health problem with an increasing incidence and prevalence worldwide, particularly in elderly patients. Elderly patients often require multiple and complex treatments involving many different drug types, among them drugs that are known to be nephrotoxic. In individuals with underlying but undiagnosed kidney impairment, they can have both acute and chronic effects on kidney function.
Our results show that almost 10% of total patients included in this study would benefit from a proposed change in treatment if an objective determination of their kidney function was made available.
In the pharmacy setting, where these patients are frequently presented with their prescriptions, this information should and can be provided. Our study suggests a potential interest for generalized POC eGFR determination in pharmacies in order to allow more accurate and efficient patient management in an appropriately targeted population. Specific attention must be given to cost-effectiveness, taking into account both the higher price of POC testing and the burden of kidney injury attributable to nephrotoxic drugs.
We conclude that the community pharmacy can be a valuable partner for Primary Care physicians in CKD patient management.
Arterial stiffness is considered to be an intermediate marker with independent prognostic value. The objective of this study is to assess whether the estimation of arterial stiffness can improve CV ...risk stratification compared to SCORE in patients at community pharmacies.
Observational prospective epidemiological study in which consecutive individuals entering a participating Community Pharmacy are offered a voluntary measurement of blood pressure and estimation of pulse wave velocity by oscillometry (AGEDIO, IEM®) to stratify their CV risk according to SCORE compared to the use of arterial stiffness.
After nine months of recruitment, data from 923 patients (570 women, 353 men) were collected. 16/122 (13.1%) patients under 40 years and 72/364 (19.8%) over 65 years of age presented pathological stiffness and could be classified as high-risk, even though being out of the age-range of SCORE. Of the 437 (47.3%) patients who were susceptible to calculating SCORE, 42/437 patients (9.6%) presented pathological arterial stiffness. Cholesterol values were available in 281 patients (64.3%). Among them, according to SCORE, only 6 (2.1%) fell into the high-risk category.
More than half of the subjects who randomly enter a community pharmacy had ages that make it impossible to calculate the CV risk by SCORE. Among them, arterial damage was detected in 18.1%. Of the other half, 9.6% presented arterial damage and, therefore, high CV risk, when SCORE only detected it in 2.1%. Therefore, estimating arterial stiffness in community pharmacies markedly improves detection of high CV risk compared to SCORE.
La rigidez arterial es un marcador intermedio con valor pronóstico independiente. Nuestro objetivo es valorar si la estimación de la rigidez arterial puede mejorar la estratificación del riesgo cardiovascular (CV) en comparación con SCORE.
Estudio epidemiológico observacional prospectivo en el que se ofrece a pacientes consecutivos que entran en una farmacia participante la medición voluntaria de la presión arterial y de la velocidad de onda de pulso estimada por oscilometría (AGEDIO, IEM®) para estratificar su riesgo CV según SCORE o según la presencia de rigidez arterial.
Tras 9 meses de reclutamiento, presentamos datos de 923 pacientes (570 mujeres, 353 hombres). Dieciséis/122 (13,1%) pacientes <40años y 72/364 (19,8%) >65años presentaron rigidez arterial patológica y fueron clasificados de alto riesgo, aun hallándose fuera del rango de edad de SCORE. De los 437 (47,3%) pacientes evaluables por SCORE, 42/437 pacientes (9,6%) mostraron rigidez elevada. Los valores de colesterol estaban disponibles en 281 de estos pacientes (64,3%). Entre ellos, según SCORE, solo 6 (2,1%) eran de la categoría de alto riesgo.
Más de la mitad de sujetos que entran aleatoriamente en una farmacia comunitaria tenían edades situadas fuera de los rangos de SCORE, imposibilitando el cálculo del riesgo CV con SCORE. En este grupo se constató daño arterial en el 18,1%. En la otra mitad, el 9,6% presentaron daño vascular y, consecuentemente, riesgo elevado, mientras que SCORE solo detectó riesgo elevado en el 2,1%. Por tanto, la estimación de la rigidez arterial en farmacias comunitarias mejora claramente la detección de riesgo CV elevado en comparación con SCORE.
To compare the cost-effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy versus laparoscopic surgery for benign-appearing ovarian endometrioma.
Prospective, cohort pilot ...study.
Multiple centers, Spain.
Forty patients with suspected ovarian endometrioma identified by US, with a maximum diameter of 35 to 100 mm, of whom 33 met inclusion criteria.
The study group (n = 17) underwent US-guided aspiration plus sclerotherapy with ethanol, and the control group (n = 14) underwent laparoscopic cystectomy.
Recurrence, complications, and direct costs were compared. One of 17 sclerotherapy patients recurred (5.9%) compared with 4 of 14 laparoscopic surgery patients (28.6%) (odds ratio 0.18, 0.01-1.53). No serious adverse effects (Clavien-Dindo ≥ III) were observed in the sclerotherapy group; 1 patient in the surgery group had a Clavien-Dindo IIIb complication. Median hospital direct costs were significantly lower in the sclerotherapy group than those in the surgery group-266 euros versus 2189 euros.
Ethanol sclerotherapy seems to be cost-effective for endometrioma and also appears to reduce complications. In this pilot study, recurrence was not higher than with conventional surgery.
The clinical impact on fertility in carriers of
and
mutations remains unclear. The aim of this study was to assess ovarian reserve as measured by anti-mullerian hormone levels in
or
mutation ...carriers, as well as to investigate the impact of anti-mullerian hormone levels on reproductive outcomes.
The study involved a cohort of women who tested positive for
and
screening or were tested for a BRCA1 or BRCA2 family mutation. Blood samples were collected for anti-mullerian hormone analysis and the reproductive outcomes were analyzed after a mean follow-up of 9 years. Participants were classified into
mutation-positive versus
mutation-negative. Controls were healthy relatives who tested negative for the family mutation. All patients were contacted by telephone to collect data on reproductive outcomes. Linear regression was used to predict anti-mullerian hormone levels by
status adjusted for a polynomial form of age.
Results of anti-mullerian hormone analysis and reproductive outcomes were available for 135 women (
mutation-negative, n=66;
mutation-positive, n=32;
mutation-positive, n=37). Anti-mullerian hormone curves according to BRCA status and adjusted by age showed that
mutation-positive patients have lower levels of anti-mullerian hormone as compared with
-negative and BRCA1 mutation-positive. Among the women who tried to conceive, infertility was observed in 18.7% of
mutation-negative women, in 22.2% of
mutation-positive women, and in 30.8% of
mutation-positive women (p=0.499). In the multivariable analysis, there were no factors independently associated with infertility.
mutation-positive carriers showed more diminished anti-mullerian hormone levels than
mutation-positive and
mutation-negative women. However, these differences do not appear to have a negative impact on reproductive outcome. This is important to consider at the time of reproductive counseling in women with
or
mutations.
•The selection of relevant biomarkers to develop efficient secondary prevention strategies for cancer can be a challenge.•Computational methods may aid in the selection of relevant genomic biomarkers ...in endometrial cancer.•A signature of 5 point mutations only identified 35.4% of all endometrial cancers.•By evaluating the top 50 most representative point mutations, up to 81.9% can be identified in the TCGA dataset.
The current availability of genomic information represents an opportunity to develop new strategies for early detection of cancer. New molecular tests for endometrial cancer may improve performance and failure rates of histological aspirate-based diagnosis, and provide promising perspectives for a potential screening scenario. However, the selection of relevant biomarkers to develop efficient strategies can be a challenge.
We developed an algorithm to identify the largest number of patients with endometrial cancer using the minimum number of somatic mutations based on The Cancer Genome Atlas (TCGA) dataset.
The algorithm provided the number of subjects with mutations (sensitivity) for a given number of biomarkers included in the signature. For instance, by evaluating the 50 most representative point mutations, up to 81.9% of endometrial cancers can be identified in the TCGA dataset. At gene level, a 92.9% sensitivity can be obtained by interrogating five genes.
We developed a computational method to aid in the selection of relevant genomic biomarkers in endometrial cancer that can be adapted to other cancer types or diseases.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
“Haz de tu vida un sueño y de tu sueño una realidad”. Esta perla de sabiduría del autor de El principito, Antonie de Saint-Exupéry, refleja como pocas el genio de todos aquellos pioneros que fueron ...capaces de transformar su presente anticipándose al futuro. Francisco Martínez, fundador y primer presidente de SEFAC, se empeñó en hacer realidad su sueño, nuestro sueño, hace casi ya 20 años. Preocupado y sorprendido al constatar que en ningún congreso farmacéutico se presentaban comunicaciones firmadas por farmacéuticos comunitarios, contactó con colegas de todas partes de la geografía española que compartían su visión para levantar SEFAC, la única sociedad de ámbito nacional creada por y para el farmacéutico comunitario.
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