Clinical Unmet Needs and Treatment Patterns of Paediatric Psoriasis Patients: A Real-World Evidence Study in Spain

BACKGROUND AND OBJECTIVE

Real-world evidence of paediatric psoriasis (PsO) is lacking in Spain. The purpose of this study was to identify physician-reported disease burden and current treatment patterns in a real-world paediatric PsO patient cohort in Spain. This will enhance our understanding of the disease and contribute to the development of regional guidelines.

MATERIAL AND METHOD

This retrospective analysis of a cross-sectional market research survey assessed the clinical unmet needs and treatment patterns in patients with paediatric PsO in Spain, as reported by their primary care and specialist physicians, using data collected as part of the Adelphi Real World Paediatric PsO Disease-Specific Program (DSP™) between February and October 2020.

RESULTS

Survey data from 57 treating physicians were included (71.9% [N=41] dermatologists, 17.6% [N=10] general practitioners/primary care physicians, and 10.5% [N=6] paediatricians); the final analysis included 378 patients. At sampling, 84.1% (318/378) of patients had mild disease, 15.3% (58/378) had moderate disease and 0.5% (2/378) had severe disease. Retrospectively reported physician-judged severity at the time of PsO diagnosis recorded 41.8% (158/378) of patients with mild disease, 51.3% (194/378) with moderate disease and 6.9% (26/378) with severe disease. Overall, 89.3% (335/375) of patients were currently receiving topical PsO therapy, while 8.8% (33/375), 10.4% (39/375) and 14.9% (56/375) of patients were currently receiving phototherapy, conventional systemics and biologics, respectively.

CONCLUSIONS

These real-world data reflect the current burden and treatment landscape of paediatric PsO in Spain. The management of paediatric PsO patients could be improved by further educating healthcare professionals and developing regional guidelines.

Differences in intraoperative and surgical outcomes between normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs) and hypertensive PPGLs: results from the PHEO-RISK STUDY

PURPOSE

To compare the intraoperative and surgical outcomes of normotensive pheochromocytomas and sympathetic paragangliomas (PPGLs), hypertensive PPGLs and non-PPGL adrenal lesions.

METHODS

This a retrospective multicenter cohort study of patients with PPGLs from 18 tertiary hospitals. A control group of histologically confirmed adrenocortical adenomas (non-PPGL group) was selected to compare intraoperative and surgical outcomes with of the normotensive PPGLs.

RESULTS

Two hundred and ninety-six surgeries performed in 289 patients with PPGLs were included. Before surgery, 209 patients were classified as hypertensive PPGLs (70.6%) and 87 as normotensive PPGLs. A higher proportion of normotensive PPGLs than hypertensive PPGLs did not receive alpha presurgical blockade (P = 0.009). When we only considered those patients who received presurgical alpha blockers (200 hypertensive PPGLs and 76 normotensive PPGLs), hypertensive PPGLs had a threefold higher risk of intraoperative hypertensive crisis (OR 3.0 [95% 1.3-7.0]) and of hypotensive episodes (OR 2.9 [95% CI 1.2-6.7]) than normotensive PPGLs. When we compared normotensive PPGLs (n = 76) and non-PPGLs (n = 58), normotensive PPGLs had a fivefold higher risk of intraoperative complications (OR 5.3 [95% CI 1.9-14.9]) and a six times higher risk of postoperative complications (OR 6.1 [95% CI 1.7-21.6]) than non-PPGLs.

CONCLUSION

Although the risk of intraoperative hypertensive and hypotensive episodes in normotensive PPGLs is significantly lower than in hypertensive PPGLs, normotensive PPGLs have a greater risk of intraoperative and postoperative complications than non-PPGL adrenal lesions. Therefore, it is recommended to follow the standard of care for presurgical and anesthetic management of PPGLs also in normotensive PPGLs.

Key issues for implementation of Genomics in Healthcare: a Policy Brief

Issue/problem

Healthcare (HC) can significantly benefit from genomic information for earlier, accurate diagnosis, effective personalized treatment with less adverse events, and accurate profiling of individuals for disease prevention. However, European countries are currently at variable maturity stages regarding the implementation of genomic medicine (GM) in healthcare, hindering the equitable delivery of personalized medicine to citizens across borders.

Description of the problem

The European 1+Million Genomes Initiative (1+MG) aims to provide cross-border access to quality genomic information and related clinical data, to advance data-driven research and HC solutions to benefit citizens. This initiative is encouraging countries to develop national GM strategies, but guidance for successful implementation is needed. In this context, the Beyond 1 Million Genomes, a supporting action to the 1+MG initiative, organized three Country Exchange Visits (CEV) to discuss critical issues, share experiences and best practices, for the implementation of sustainable GM strategies in healthcare.

Results

The United Kingdom, Estonia and Finland, which have advanced GM programs, hosted CEV describing progress and lessons learnt. Representatives of 1+MG signatory countries participated in these events and were able to present country level progress. The resulting Policy Brief (PB) captures key issues discussed at the CEVs, with real-life examples, and proposes policy recommendations for the successful implementation of GM in European healthcare systems.

Lessons

Sustainable GM implementation in HC systems requires: 1) Patient and citizens trust and engagement; 2) Sustainable infrastructure and data regulation, with solid ethical and legal frameworks; 3) Capacity building of healthcare professionals; 4) A strong ecosystem involving all stakeholders, and encouraging synergies between healthcare, research and industry to promote continuous innovation.

Key messages

• The implementation of GM in healthcare will take countries further towards making personalized medicine a reality, with remarkable health and socioeconomic benefits for patients and healthcare systems.

• Promoting cooperation, capacity building and sharing of best practices is crucial to reduce asymmetries between countries, which constrains effective and equitable cross-border personalized medicine.

Addictive behaviours during the COVID-19 pandemic: results from a nationwide study in Portugal

Background

Evidence shows that individuals can engage in maladaptive behaviours as a response to a pandemic context, which can compromise their health and wellbeing. This project aims to characterize self-reported changes in addiction-related behaviours and associated factors in the adult population during the first COVID-19 lockdown, in Portugal.

Methods

Cross-sectional study, with an online survey conducted between May 22 and July 20, 2020, targeting a non-probabilistic sample of adults (18 years of age or more) dwelling in Portugal (mainland and autonomous regions). The following data were collected: alcohol drinking, smoking, use of cannabis and other substances, gambling, and sugar-sweetened food intake, work-related variables, and sociodemographics. After data cleaning and weighting (by sex, age group, NUTS II and educational level), logistic regression models were conducted to assess potential determinants of addiction-related behaviours.

Results

Overall, 3.982 individuals participated in the study (79.1% women; mean age of 45.15 years). Women, young adults (18-34 years) and individuals with difficulties in work-life balance had higher odds for self-reported increase of sweets intake. Men, young adults (18-34 years) and those with work-life balance difficulties presented higher odds for alcohol drinking increase. Those unemployed (or with suspended activity or in layoff) and those with lower income had higher odds for gambling behaviour increase.

Conclusions

Some segments of the Portuguese population reported to have increased their engagement in addictive-related behaviours, during the COVID-19 lockdown, which can have negative consequences for mental health. The study of the correlates of maladaptive responses under this scenario is pivotal to inform public health interventions and alleviate the potential deleterious impacts of this pandemic.

Key messages

COVID-19 pandemic can increase maladaptive coping behaviours in some segments of the population. Public health interventions are needed to mitigate the negative consequences of this pandemic.

How ready are European healthcare systems regarding the use of genomics in medicine? The Beyond 1 Million Genomes (B1MG) Maturity Level Model

The adoption of genomics by healthcare systems is crucial to fulfill the potential of Personalised Medicine for patients and citizens. This is a challenging undertaking, and requires from healthcare systems extensive adjustments in key issues, such as technical infrastructure, health professional competences or ethical and legal frameworks. The starting point requires an effective identification of specific challenges and barriers to the development and sustainability of each healthcare system regarding the efficient use of genomic data in medical or preventive care. For this purpose, we developed a Maturity Level Model (MLM) covering key aspects of genomic medicine programmes, including governance, ethics and legislation, genomics standards and best practices, clinical infrastructure and workforce organization, economic aspects and others. The alignment of healthcare systems to this MLM allows the identification of gaps and needs for progression within the model, and to systematically chart a path towards optimization of genomic data integration in mainstream healthcare.

Mental health during the COVID-19 pandemic in Portugal

Background

Mental health is being impacted by COVID-19, as a result of both the globalized perception of health risk and the massive social and economic measures, required to control the pandemic. A main goal of this study, the SM-COVID19, was to characterize the mental health of the general population and to identify vulnerable groups, during the first lockdown in Portugal.

Methods

Cross-sectional online survey, conducted between May 22 and July 20, 2020, with a nationwide non-probabilistic sample of adults residing in Portugal (≥18 years old). Data were collected with sound psychometric scales for symptoms of anxiety, depression and post-traumatic stress disorder (PTSD), work-life balance, resilience, work-related variables, and sociodemographics. Logistic regression models were used to assess risk and protective factors for mental health suffering.

Results

Overall, 3982 individuals participated in the study (female, 79.1%; mean age, 45.15±12.31 years; 71.0% completed higher education studies). The prevalence of symptoms of moderate to severe anxiety was 26.5% (95% Confidence Interval (CI): 24.0-29.1), of depression symptoms was 26.0% (95%CI, 23.6-28.7), and of PTSD symptoms was 26.5% (95%CI, 24.0-29.2). Moreover, more than one third of the respondents (41.2%; 95%CI: 38.3-44.1) reported symptomatology for at least one of these three psychiatric disorders. Women, individuals who suspended their professional activity (or in layoff or unemployed) during the lockdown, and those with difficulties in managing work and family demands had higher odds for psychological suffering.

Conclusions

The COVID-19 pandemic is a public health crisis with major interpersonal, social and economic impacts at the individual level. Mental health and wellbeing are being severely affected, as confirmed by the high prevalence of symptoms of psychological suffering herein. Mental health protection measures need to be defined and implemented, mainly targeting the most vulnerable groups.

Key messages

COVID-19 pandemic is associated with high prevalence of anxiety, depression and PTSD. Observed mental health inequities imply effective vulnerable-groups-focused mental health promotion programs.

Baseline description of the Spanish Academy of Dermatology infantile haemangioma nationwide prospective cohort. Comparison of patients treated with propranolol in routine clinical practice with previous pivotal clinical trial data

BACKGROUND

There are several therapeutic options for infantile haemangiomas (IH). Propranolol is used according to a pivotal trial. We aimed to describe the characteristics of IH in clinical practice, including the therapies used, and to compare the characteristics of patients treated with propranolol with those of the trial to assess its external validity.

METHODS

Consecutive patients attending 12 Spanish hospitals from June 2016 to October 2019 were included (n=601).

RESULTS

The mean age was 3.9 (SD:1.9) months, with a 2:1 female-to-male ratio. Most IHs were localized (82%, 495), superficial (64%, 383) and located in the face (25%, 157) and trunk (31%, 188). Median size was 17 (IR: 10-30) x 12 (IR: 7-20) mm. Complications were found in 16 (3%) patients. Treatment was initiated for 52% (311). Most patients received timolol (76%, 237); propranolol was reserved for complications or high-risk IHs. Aesthetic impairment was the main reason for starting therapy (64%, 199). Several characteristics of the patients and IHs treated with propranolol are similar to those of the pivotal clinical trial, but 1/3 of IHs did not reach the minimum diameter to meet the inclusion criteria, and important prognostic information was not reported.

CONCLUSIONS

As most patients receive treatment for aesthetic impairment, there is a need to better understand the aesthetic results of therapies and to increase evidence on the use of timolol, which is currently the most common therapy. Propranolol is being used in a population generally similar to that of the trial; however, this statement cannot be definitely confirmed.

Capillary malformation-arteriovenous malformation syndrome: a multicentre study

BACKGROUND

Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is a rare syndrome with characteristic skin lesions that are associated with fast-flow vascular malformations (FFVMs) in one-third of patients. Few case series have been described, and none in Spain.

AIM

To identify the prevalence of dermatological parameters, FFVMs and associated features in a large series of patients with CM-AVM.

METHODS

We conducted an observational study of patients with CM-AVM syndrome diagnosed in 15 Spanish hospitals over 3 years. The main clinical, radiological, genetic findings and associated diseases were analysed.

RESULTS

In total, 64 patients were assessed. In 26.5% of cases, the diagnosis was incidental. In 75% of patients, there was one significantly larger macule, which we termed the 'herald patch'. FFVMs were detected in 34% of the patients, with 30% located on the skin, 7.8% in the brain and in 1.5% in the spine. There was a positive family history in 65% of the 64 patients. Genetic analysis was performed for RASA1 mutations in 57 patients, of whom 42 (73%) had a positive result. All 4 patients tested for EPHB4 mutations had a positive result. No tumour lesions were detected in the series, except for five infantile haemangiomas.

CONCLUSIONS

Our data on clinical lesions, associated FFVM, family history and genetics are similar to those previously published in the literature. An extensive data analysis failed to demonstrate any statistically significant association between the presence of an FFVM and any clinical, familial or genetic parameter that could predict its onset, although a link between the presence of a herald patch on the midline face and the presence of a brain FFVM was observed. We did not detect any genotype-phenotype correlation.

SPECT/CT with 99mTc-sestamibi for the evaluation of skeletal muscle perfusion after electrical muscle stimulation in athletes

Objective

The purpose of this study was to evaluate the effects of electrical muscle stimulation (EMS) on muscles, using ^99mTc-sestamibi SPECT/CT.

Materials and Methods

We prospectively enrolled 20 consecutive male professional water polo players. The mean age was 25 years (range, 18-36 years). All athletes underwent ^99mTc-sestamibi SPECT/CT of the thigh (rectus femoris and vastus medialis muscle groups) before and after EMS. Images were quantified to identify increases in perfusion after EMS.

Results

Before EMS, there were no significant differences between the right and left thigh (rectus femoris and vastus medialis muscles) in terms of perfusion (p = 0.4). However, the comparison between the pre- and post-EMS analyses of the same muscle groups showed significant differences in radiotracer uptake (p < 0.001), with a mean increase in perfusion of 128% for the rectus femoris muscle group (95% CI: 0.86-1.61) and 118% for the vastus medialis muscle group (95% CI: 0.96-1.79).

Conclusion

^99mTc-sestamibi SPECT/CT is an objective means of evaluating blood flow in muscles submitted to EMS, which appears to promote significant increases in such blood flow.

Comparación agronómica y cualitativa de 3 clones preseleccionados de la variedad tinta Bruñal, en Valladolid (España), en el periodo 2015–2016

La variedad de vid tinta Bruñal está localizada mayoritariamente en la Denominación de Origen (D.O.) Arribes, ubicada en las provincias de Zamora y Salamanca. Presenta características, tanto de tipo morfológico, tal como el tamaño reducido de baya y de racimo, como de tipo cualitativo, tal como el alto contenido de polifenoles en el hollejo, que han propiciado un gran interés para su desarrollo y difusión comercial. El programa de prospección de la variedad Bruñal en la D.O. Arribes, iniciado en 2002 por parte del ITACYL, permitió identificar numerosas cepas de dicha variedad que se encontraban aisladas en viñedos heterogéneos de elevada edad. Tras varios años de trabajo, evaluando aspectos morfológicos y agronómicos en los viñedos originales, se llevó a cabo una primera preselección de cepas procedentes de diferentes viñedos que pudieran presentar cierta variabilidad genética, con el ánimo de iniciar un proceso que desembocase en una selección clonal, una vez que la variedad Bruñal fue incluida en el Registro de Variedades Comerciales de vid del MAGRAMA, el que se reconocen las sinonimias Albarín Tinto y Baboso Tinto (B.O.E. 71, 24-marzo-2011). La primera preselección clonal de Bruñal se llevó a cabo a través de la plantación de 10 cepas de cada uno de los tres clones previamente elegidos en viñedos originales, en una colección del ITACYL ubicada en Valladolid. Se ha llevado a cabo un estudio del comportamiento vegetativo, productivo y cualitativo de los tres clones, injertados sobre 110R, durante el período 2015-2016, sobre cepas, conducidas en espaldera, con un marco de plantación de 2.7 × 1.4 m, y podadas en cordón Royat bilateral. El clon CL-89 resultó más productivo, con un incremento medio del 16% respecto al CL-128, el cual, a su vez, fue un 47% más productivo que el CL-96. Las diferencias observadas en el rendimiento se debieron principalmente a la variación en el peso del racimo, que, a su vez, se debió mayormente al número de bayas del mismo. El peso de madera de poda mostró claras diferencias entre clones, de manera que el clon CL-128 resultó más vigoroso que el CL-96, con un incremento medio de peso del 19% respecto a éste, el cual fue más vigoroso que el CL-89, con un incremento medio del 38% respecto a éste. La variación del peso de sarmiento fue la causa determinante de las diferencias en el peso de madera de poda. En cuanto a la calidad de uva, el clon CL-96 mostró mayor capacidad de intensificación de la maduración tecnológica, acumulando más azúcares e incrementando el pH, aunque reduciendo el IPT. El clon CL-89 presentó cierta tendencia contraria al CL-96, con menos azúcares, ácido málico y potasio, pero sorprendentemente mayor valor de IPT. El clon CL-128 mostró un comportamiento intermedio en general, aunque destacó por su mayor acidez total y contenido en ácido málico. Atendiendo a las diferencias observadas entre clones, existe la posibilidad de conjugarlas con los objetivos de las nuevas plantaciones de Bruñal.

Impact of 68GA-PSMA PET / CT on treatment of patients with recurrent / metastatic high risk prostate cancer - a multicenter study

Purpose:

The purpose of our study was to evaluate the clinical impact of ⁶⁸Ga-PSMA PET / CT in the setting of biochemical recurrence of prostate cancer.

Materials and Methods:

We retrospectively evaluated 125 prostate cancer patients submitted to the ⁶⁸Ga-PSMA PET / CT due to biochemical recurrence. The parameters age, Gleason score, PSA levels, and the highest SUVmax were correlated to potential treatment changes. The highest SUVmax values were correlated with age and Gleason score. The median follow-up time was 24 months.

Results:

⁶⁸Ga-PSMA PET / CT led to a treatment change in 66 / 104 (63.4%) patients (twenty-one patients were lost to follow-up). There was a significant change of treatment plan in patients with a higher Gleason score (P = 0.0233), higher SUVmax (p = 0.0306) and higher PSA levels (P < 0.0001; median PSA = 2.55 ng / mL).

Conclusion:

⁶⁸Ga-PSMA PET / CT in prostate cancer patients with biochemical recurrence has a high impact in patient management.

Formation of copper nanoparticles in LTL nanosized zeolite: spectroscopic characterization

The state of copper species stabilized in nanosized LTL zeolite subjected to various post-synthesis treatments was unveiled by a range of spectroscopic techniques. FTIR and UV-Vis studies demonstrated that the reduction process of copper in the LTL nanosized zeolite leads to the formation of different species including Cu²⁺, Cu⁺ and Cu nanoparticles (Cu NPs). The adsorption of probe molecules (NO and CO) was used to selectively monitor the copper species in the LTL nanosized zeolite upon oxidation and reduction post-synthesis treatments. Both the Cu²⁺ and Cu⁺ species were probed by NO and CO, respectively. The amount of Cu⁺ in the LTL zeolite nanocrystals was about 43% as determined by FTIR, while the amount of Cu NPs was about 55% determined by the UV-Vis spectroscopic characterization. These results were complemented by EPR, ²⁹Si and ⁶³Cu MAS NMR spectroscopic data. The EPR spectroscopy was further applied to monitor the effective reduction of the Cu²⁺ species and their re-oxidation, while the ⁶³Cu MAS NMR verified the presence of Cu NPs in the LTL nanosized zeolite crystals.

Pyridine Based Antitumour Compounds Acting at the Colchicine Site

Antimitotics binding at the colchicine site of tubulin are important antitumour and vascular disrupting agents. Pyridines and azines are privileged scaffolds in medicinal chemistry and in recent years many colchicine site ligands (CSL) have incorporated them into their structures with the aim of improving their pharmacokinetic and pharmacodynamics properties. CSL have been classified according to their chemical structures and the chemical structures of the pyridine and azine containing antimitotic compounds are described. The designed principles behind the structural modifications and the achieved effect on the biological activity upon inclusion of these heterocycles are also discussed. Lessons from the achievements and failures have been extracted and future perspectives delineated.

Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism

ESSENTIALS: When high probability of pulmonary embolism (PE), sensitivity of computed tomography (CT) is unclear. We investigated the sensitivity of multidetector CT among 134 patients with a high probability of PE. A normal CT alone may not safely exclude PE in patients with a high clinical pretest probability. In patients with no clear alternative diagnosis after CTPA, further testing should be strongly considered.

BACKGROUND

Whether patients with a negative multidetector computed tomographic pulmonary angiography (CTPA) result and a high clinical pretest probability of pulmonary embolism (PE) should be further investigated is controversial.

METHODS

This was a prospective investigation of the sensitivity of multidetector CTPA among patients with a priori clinical assessment of a high probability of PE according to the Wells criteria. Among patients with a negative CTPA result, the diagnosis of PE required at least one of the following conditions: ventilation/perfusion lung scan showing a high probability of PE in a patient with no history of PE, abnormal findings on venous ultrasonography in a patient without previous deep vein thrombosis at that site, or the occurrence of venous thromboembolism (VTE) in a 3-month follow-up period after anticoagulation was withheld because of a negative multidetector CTPA result.

RESULTS

We identified 498 patients with a priori clinical assessment of a high probability of PE and a completed CTPA study. CTPA excluded PE in 134 patients; in these patients, the pooled incidence of VTE was 5.2% (seven of 134 patients; 95% confidence interval [CI] 1.5-9.0). Five patients had VTEs that were confirmed by an additional imaging test despite a negative CTPA result (five of 48 patients; 10.4%; 95% CI 1.8-19.1), and two patients had objectively confirmed VTEs that occurred during clinical follow-up of at least 3 months (two of 86 patients; 2.3%; 95% CI 0-5.5). None of the patients had a fatal PE during follow-up.

CONCLUSIONS

A normal multidetector CTPA result alone may not safely exclude PE in patients with a high clinical pretest probability.

Rectal carcinoma in pregnancy--a case report

The authors present a case of a pregnant woman suffering from colorectal cancer in order to contribute to the knowledge regarding this situation and to optimise its management. Rectal cancer in pregnancy is a rare disease, challenging clinicians as there are no generally accepted guidelines regarding diagnosis or treatment. Early diagnosis remains to be the key. When the disease is particularly aggressive, the prognosis remains poor despite pregnancy cessation and radical therapy.

Early-onset acral basal cell carcinomas in Gorlin syndrome

Two patients are reported in whom early-onset, distal papules with a histopathological diagnosis of basal cell carcinoma were the first manifestation of Gorlin syndrome (GS). These lesions showed no progression and remained stable through follow-up. Two different PTCH1 gene mutations were detected in the two patients, and thus a phenotype-genotype correlation of this manifestation of GS was not possible.