Neuroendocrine tumors (NETs) are an unusual family of neoplasms with a wide and complex spectrum of clinical behavior. Here, we present the first report of a National Cancer Registry of ...gastroenteropancreatic neuroendocrine tumors from a Southern European country.
Data was provided online at www.retegep.net by participating centers and assessed for internal consistency by external independent reviewers.
The study cohort comprised 907 tumors. The most common tumor types were carcinoids (55%), pancreatic nonfunctional tumors (20%), metastatic NETs of unknown primary (9%), insulinomas (8%) and gastrinomas (4%). Forty-four percent presented with distant disease at diagnosis, most often those from small intestine (65%), colon (48%), rectum (40%) and pancreas (38%), being most unusual in appendix primaries (1.3%). Stage at diagnosis varied significantly according to sex, localization of primary tumor, tumor type and grade. Overall 5-year survival was 75.4% (95% confidence interval 71.3% to 79.5%) and was significantly greater in women, younger patients and patients with hormonal syndrome and early stage or lower grade tumors. Prognosis also differed according to tumor type and primary tumor site. However, stage and Ki-67 index were the only independent predictors for survival.
This national database reveals relevant information regarding epidemiology, current clinical practices and prognosis of NETs in Spain, providing valuable insights that may contribute to understand regional disparities in the incidence, patterns of care and survival of this heterogeneous disease across different continents and countries.
INTRODUCTIONIschaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and ...hypercoagulability secondary to the infection.METHODSWe describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients.RESULTSThe association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental.CONCLUSIONSSystemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.
6ER-005 Drug wastage: a hidden cost of cancer care Pousada Fonseca, AB; García Martinez, D; Vázquez Castillo, MJ ...
European journal of hospital pharmacy. Science and practice,
03/2024, Letnik:
31, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
Background and ImportanceOur country’s legislation bans the return of dispensed drugs to Pharmacy Services, potentially leading to increased costs for the National Health System.Aim and ObjectivesTo ...estimate the cost of pill wastage due to dose modifications and discontinuation for oral anticancer drugs.Material and MethodsRetrospective economic evaluation carried out in an intermediate complexity hospital. Using the electronic medical record, dispensations of oral anticancer drugs between July 2022 and July 2023 were identified.The following variables were collecteddrug, date of dispensing, tablets dispensed, date the patient needs to return to the pharmacy, treatment interruption and cause, date of interruption and leftover tablets.The laboratories’ sales prices were used to calculate the costs. We calculated the potential number of dispensations that the wastage could have covered by dividing the total wastage by the median price per dispensation.Dose modifications were not taken into account in drugs which had pill strengths divisible at each dose-reduction level.Unmarketed drugs in our country were excluded.Results1239 dispensations were identified. The most dispensed drugs were enzalutamide 40 mg with 308 dispensations (25%) ribociclib 200 mg with 219 (18%), niraparib 100 mg with 143 (12%) and lenvatinib 10 mg with 66 (5%). The median number of days for which medication was dispensed was 30 IQI 28–35. The median price per dispensing was €3,173 IQI 1,866–4,445 and the total annual expenditure was €3,759,172.63 (5%) dispensations were interrupted. The most frequent causes were disease progression for 33 drugs (52%) and toxicity for 19 (30%). The median price per dispensing was €3,173 IQI 1,155–4,445 and the total price was €186,327.In 34 of the interruptions (54%) patients had tablets remaining. The median wastage per patient was €1,393 IQI 645–2,503 and the total wastage was €56,459 (1.5% of the annual expenditure and 30.3% of the discontinued treatments).Seventeen dispensations (1.4%) could have been covered with the total cost of pill wastage.Conclusion and RelevanceAlthough few treatments were discontinued, significant economic wastage occurred due to drug prices. To minimise it, it has been suggested that companies refund money for unused tablets and manufacture appropriate pill strengths¹. Additionally, hospital pharmacists could be empowered to decide on the return of medications.References and/or Acknowledgements1. https://pubmed.ncbi.nlm.nih.gov/37471095/Conflict of InterestNo conflict of interest.
Ischaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability ...secondary to the infection.
We describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients.
The association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental.
Systemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.
Se ha comunicado la asociación de ictus isquémico y COVID-19, con mayor frecuencia en aquellos pacientes más graves. Sin embargo, se desconoce en qué medida podría estar en relación con la inflamación sistémica e hipercoagulabilidad producidas en el contexto de la infección.
Descripción de cuatro pacientes atendidos en nuestro Centro por ictus isquémico y diagnóstico de COVID-19, clasificándolos según el grado de probabilidad causal entre el estado de hipercoagulabilidad y el ictus isquémico. Revisión de la literatura sobre los posibles mecanismos implicados en la etiopatogenia del ictus isquémico en este contexto.
Dos pacientes se consideraron con alta probabilidad causal: presentaban infartos corticales, sin patología cardioembólica ni arterial significativa, con parámetros de inflamación sistémica e hipercoagulabilidad; las otras dos pacientes eran de edad avanzada y el ictus isquémico se consideró cardioembólico, con una probable asociación casual de COVID-19.
La inflamación sistémica, junto con la posible acción directa del virus, provocaría disfunción endotelial, generando un estado de hipercoagulabilidad que podría considerarse una causa potencial de ictus isquémico. Sin embargo, puesto que los mecanismos del ictus pueden ser múltiples, se precisan estudios más amplios que evalúen esta hipótesis. Mientras tanto, el estudio etiológico del ictus en pacientes con COVID-19 debe ser sistemático atendiendo a los protocolos vigentes, con las adaptaciones necesarias en relación con las circunstancias clínicas y epidemiológicas de la actual pandemia.
Inactivation of the tumor suppressor Merlin, by deleterious mutations or by protein degradation via sustained growth factor receptor signaling-mediated mechanisms, results in cell transformation and ...tumor development. In addition to these mechanisms, here we show that, miRNA-dependent negative regulation of Merlin protein levels also promotes cell transformation. We provide experimental evidences showing that miR-146a negatively regulates Merlin protein levels through its interaction with an evolutionary conserved sequence in the 3´ untranslated region of the NF2 mRNA. Merlin downregulation by miR-146a in A549 lung epithelial cells resulted in enhanced cell proliferation, migration and tissue invasion. Accordingly, stable miR-146a-transfectant cells formed tumors with metastatic capacity in vivo. Together our results uncover miRNAs as yet another negative mechanism controlling Merlin tumor suppressor functions.
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