Economic evaluations of radioembolization with yttrium-90 microspheres in liver metastases of colorectal cancer: a systematic review

BACKGROUND

Transarterial radioembolization with yttrium-90 (Y-90 TARE) microspheres therapy has demonstrated positive clinical benefits for the treatment of liver metastases from colorectal cancer (lmCRC). This study aims to conduct a systematic review of the available economic evaluations of Y-90 TARE for lmCRC.

METHODS

English and Spanish publications were identified from PubMed, Embase, Cochrane, MEDES health technology assessment agencies, and scientific congress databases published up to May 2021. The inclusion criteria considered only economic evaluations; thus, other types of studies were excluded. Purchasing-power-parity exchange rates for the year 2020 ($US PPP) were applied for cost harmonisation.

RESULTS

From 423 records screened, seven economic evaluations (2 cost-analyses [CA] and 5 cost-utility-analyses [CUA]) were included (6 European and 1 USA). All included studies (n = 7) were evaluated from a payer and the social perspective (n = 1). Included studies evaluated patients with unresectable liver-predominant metastases of CRC, refractory to chemotherapy (n = 6), or chemotherapy-naïve (n = 1). Y-90 TARE was compared to best supportive care (BSC) (n = 4), an association of folinic acid, fluorouracil and oxaliplatin (FOLFOX) (n = 1), and hepatic artery infusion (HAI) (n = 2). Y-90 TARE increased life-years gained (LYG) versus BSC (1.12 and 1.35 LYG) and versus HAI (0.37 LYG). Y-90 TARE increased the quality-adjusted-life-year (QALY) versus BSC (0.81 and 0.83 QALY) and versus HAI (0.35 QALY). When considering a lifetime horizon, Y-90 TARE reported incremental cost compared to BSC (range 19,225 to 25,320 $US PPP) and versus HAI (14,307 $US PPP). Y-90 TARE reported incremental cost-utility ratios (ICURs) between 23,875 $US PPP/QALY to 31,185 $US PPP/QALY. The probability of Y-90 TARE being cost-effective at £ 30,000/QALY threshold was between 56% and 57%.

CONCLUSIONS

Our review highlights that Y-90 TARE could be a cost-effective therapy either as a monotherapy or when combined with systemic therapy for treating ImCRC. However, despite the current clinical evidence on Y-90 TARE in the treatment of ImCRC, the global economic evaluation reported for Y-90 TARE in ImCRC is limited (n = 7), therefore, we recommend future economic evaluations on Y-90 TARE versus alternative options in treating ImCRC from the societal perspective.

Risk factors for mental health disorders during the COVID-19 pandemic in Spain: A cohort study

Background

Data comparing the populations’ mental health from before, during and after the pandemic is needed. We aim to assess the risk factors for the first-onset and persistence of major depressive disorder (MDD) and suicidal thoughts and behaviours (STB) during the first year of the pandemic among the Spanish general population.

Methods

Cohort study through two online surveys from before the pandemic (N = 2,005, October/November 2019) and 12-months later (N = 1,357) on an adult Spanish, nationally representative, population-based sample. Multiple logistic regression models were used to assess the association between socio-demographic, COVID-19 related variables and healthcare received during the pandemic with the onset and persistence of MDD and STB.

Results

Women have more than 3-fold risk for the onset (OR 3.18; CI95% 1.40 -7.22) and persistence (OR 8.62; CI95% 1.74-42.48) of MDD. Studying and working at the same time (OR 10.13; CI95% 2.17-47.35) and having close relatives/friends with COVID-19 infection (OR 14.84; CI95% 1.91-115.18) or death (OR 5.26; CI95% 1.56-17.73) due to COVID-19 are risk factors for MDD onset. Sick-leave (OR 17.19; CI95% 2.65-112.56) and unemployment (OR 7.01; CI95% 1.85-26.43) increased the risk for MDD persistence. Death of friends/colleagues due to COVID-19 (OR 8.40; CI95% 1.47-48.07) increased the risk for STB onset, and being on sick-leave (OR 7.91; CI95% 1.80-34.66) for STB persistence.

Conclusions

During the COVID-19 pandemic, women were consistently more at risk of having worse mental health than men. Direct and indirect consequences caused or aggravated by the pandemic are common risk factors for the increased risk for the onset and persistence of both MDD and STB. Identification of high-risk subgroups and risk factors for MDD and STB among the Spanish general population will allow the developing and implementing of evidence-driven strategies for reducing the long-term impact of the pandemic in populations’ mental health.

Key messages

• The pandemic consequences, whether due to having had COVID-19, having close people affected or who have died from the infection and the social consequences increase the risk for worse mental health.

• Evidence-driven strategies for reducing the long-term impact of the pandemic in populations’ mental health should be a public health priority.

Economic evaluations of radioembolization with Itrium-90 microspheres in hepatocellular carcinoma: a systematic review

Background

Transarterial radioembolization (TARE) with yttrium-90 microspheres is a clinically effective therapy for hepatocellular carcinoma (HCC) treatment. This study aimed to perform a systematic review of the available economic evaluations of TARE for the treatment of HCC.

Methods

The Preferred Reported Items for Systematic reviews and Meta-Analyses guidelines was followed by applying a search strategy across six databases. All studies identified as economic evaluations with TARE for HCC treatment in English or Spanish language were considered. Costs were adjusted using the 2020 US dollars based on purchasing-power-parity ($US PPP).

Results

Among 423 records screened, 20 studies (6 cost-analyses, 3 budget-impact-analyses, 2 cost-effectiveness-analyses, 8 cost-utility-analyses, and 1 cost-minimization analysis) met the pre-defined criteria for inclusion. Thirteen studies were published from the European perspective, six from the United States, and one from the Canadian perspectives. The assessed populations included early- (n = 4), and intermediate-advanced-stages patients (n = 15). Included studies were evaluated from a payer perspective (n = 20) and included both payer and social perspective (n = 2). TARE was compared with transarterial chemoembolization (TACE) in nine studies or sorafenib (n = 11). The life-years gained (LYG) differed by comparator: TARE versus TACE (range: 1.3 to 3.1), and TARE versus sorafenib (range: 1.1 to 2.53). Of the 20 studies, TARE was associated with lower treatment costs in ten studies. The cost of TARE treatment varied widely according to Barcelona Clinic Liver Cancer (BCLC) staging system and ranged from 1311 $US PPP/month (BCLC-A) to 71,890 $US PPP/5-years time horizon (BCLC-C). The incremental cost-utility ratio for TARE versus TACE resulted in a 17,397 $US PPP/Quality-adjusted-Life-Years (QALY), and for TARE versus sorafenib ranged from dominant (more effectiveness and lower cost) to 3363 $US PPP/QALY.

Conclusions

Economic evaluations of TARE for HCC treatment are heterogeneous. Overall, TARE is a cost-effective short- and long-term therapy for the treatment of intermediate-advanced HCC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-022-02396-6.

Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort

OBJECTIVE

Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19.

METHODS

This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments.

RESULTS

One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant.

CONCLUSIONS

Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.

Diagnostic utility and therapeutic impact of PET/CT [18F]F-Fluoromethylcholine -Choline in the biochemical recurrence of prostate cancer

OBJECTIVE

To assess the diagnostic capability of PET/CT with [¹⁸F]F-Fluoromethylcholine in prostate cancer (PC) with biochemical recurrence and its therapeutic impact.

MATERIAL AND METHODS

We included 108 patients, diagnosed with PC with biochemical criteria for recurrence. A PET/CT Choline scan was performed by dynamic pelvic and whole body study at 60min post-tracer injection. The relationship between the positive studies and the PSA value was analysed by classifying patients into three groups (<1.2/1.2-2/>2ng/ml), and the diagnostic capacity was assessed with respect to pelvic MRI and the impact on the therapeutic decision.

RESULTS

The location of recurrence was identified in 85 of 108 patients (78.7%): 34 local, 47 pelvic lymph nodes and 58 distant lesions, including retroperitoneal, mediastinal lymph nodes and distant organ lesions (bone and lung). Second tumors were diagnosed in 4 patients. No significant differences were found in the percentage of positive studies depending on primary treatment. Patients with PSA>2ng/ml showed a higher percentage of disease detection than patients with a lower PSA level, with significant differences (p<0.0001). PET/CT [¹⁸F]F-Choline was able to detect local disease, not previously known from MRI, in 29.41% of patients. PET/CT Choline had an impact on therapeutic management in 67 of 108 patients (62%).

CONCLUSIONS

PET/CT with [¹⁸F]F-Fluoromethylcholine is a useful tool in the detection of locoregional and disseminated disease of PC treated with suspicion of recurrence, providing a change in therapeutic management in 62% of patients.

Phenotypic spectrum of neonatal CHARGE syndrome

INTRODUCTION

CHARGE syndrome is a genetic disorder of wide phenotypic variability, of autosomal dominant in heritance, caused by pathogenic variants in the CHD7 gene.

OBJECTIVE

To describe the broad pheno typic spectrum of neonatal CHARGE syndrome, heterozygous for the CHD7 gene, and the usefulness of genome sequencing in diagnostic confirmation, considering differential diagnoses.

CLINICAL CASE

34-week preterm newborn, with severe prenatal history of polyhydramnios, increased nuchal trans- lucency, and hyperechogenic cardiac focus, with a TORCH study that ruled out congenital infection. Peripheral facial paralysis, choanal atresia, multiple dysmorphisms, congenital heart disease, and bilateral retinochoroidal coloboma were observed at birth. The neuroimaging study showed hypo plasia of the cochlea and bilateral semicircular canals, and pontocerebellar hypoplasia. The auditory evoked potentials showed deep right-sided sensorineural hearing loss and left anacusis. The patient developed hypocalcemia and immunological alterations, confirming hypoparathyroidism and thy mus hypoplasia. The karyogram was normal and 22q11.2 microdeletion was excluded through mul tiplex ligation-dependent probe amplification (MPLA). A pathogenic variant in the CHD7 gene was detected that confirmed the clinical suspicion of CHARGE syndrome.

CONCLUSIONS

The overlap of clinical characteristics of CHARGE syndrome requires molecular genetic confirmation, considering differences in evolution, therapies, and recurrence risks with other genetic syndromes.

Post-mortem toxicology in the diagnosis of sudden death in young and middle-aged victims

OBJECTIVE

We aimed to investigate the impact of the toxicological results found in cases of sudden death (SD) and to correlate the clinical, autopsy and genetic findings with the toxicology results.

MATERIALS AND METHODS

Consecutive SD in people aged between 16 and 50 years with medico-legal autopsies and toxicology studies were included over a 3-year period. The comparison between the toxicological data and demographic characteristics, clinical circumstances, autopsy, and genetic results were taken into account.

RESULTS

101 cases were finally included. They were predominately males (84%) and the mean age was 39.8 years. 52 (51.5%) cases had positive toxicological findings and in 25 cases (24.8%), toxic compounds were considered the first cause of death. Ethanol was the most frequently identified agent (69%), following by licit drugs (56%) and drugs of abuse (39%). Cases with positive toxicology were younger than those with negative results (37.9±9.1 vs. 41.9±7.8; p=0.02). Patients with more than 3 comorbidities showed an association with positive toxicological results (n=14 vs. n=3; p=0.017). The genetic study was performed in 70 (69.3%) SD cases. We identified pathogenic or likely pathogenic variants in 17.1% cases and uncertain significance variants in 42.8% cases. 58% of these variants were probably related to the cause of death.

CONCLUSIONS

A large fraction of SD victims had positive toxicological findings and a quarter of deaths were directly caused by toxic substances. The identification of the factors that trigger SD provides a good approach to contribute in avoiding future episodes.

Abstract P4-11-04: Palliative care and older women with advanced breast cancer in Mexico

Background: Mexico is an upper-middle income country, as other developing regions, there is an accelerated aging of the population that will double the absolute number of new breast cancer (BC) cases by 2035. Unfortunately, the incidence of stage III and IV in women older than 65 years old represented 45% of new cases (higher than high-income regions); also, 21% had diabetes, 41.1% hypertension and 71% overweight/obese. These factors make our older adults patients with BC a high-risk population of recurrence and dead from disease.

Objective: Describe the characteristics of older women with BC that received palliative care in a multidisciplinary setting.

Patients and Methods:A cross-sectional, retrospective, descriptive of 178 patients with advanced breast cancer, older than 65 years from our data based, that were referred to palliative service during 2010-2016 at National Cancer Institute, Mexico. Statistical analysis was done with STATA V12.0. We described clinical, pathological and sociodemographic characteristics of this older women with advanced BC and analyzed the risk factors that influence dead. Approval from IRB was obtained.

Results:The median age was 75 years old (range 69-82), 71(41%) was widows, 51(29%) had none education, 93(52%) had elementary school. Highlights that 93 (52%) of the patients evaluated had any income source. Diabetes was present in 43(24%), hypertension in 81 (46%) and cardiopathy in 17(10%) of cases. ECOG-2 were 58 (33%) patients, ECOG-3 was in 47 (26%)patients and ECOG-4 was reported in 19 (11%). None patient had geriatric assessment. Affected metastasis sites were bone 90 (51%), lung 66 (37%), central nervous system 31 (17%), liver 27 (15%). 69 (62%) patients had hormonal receptor positive, 17 (15%) triple negative, 12 (11%) HER2positive and 13(12%) of the cases were triple positive, 41 (74%) patients had Ki-67 higher than 50%. Polypharmacy was identified in 77 (43%) of the patients. The median survival after the admission in the palliative service was 2 months (IQR 0-10). After a logistic regression univariate Ki-67&gt;20% (OR 10.25), triple negative (OR 1.5), HER2 positive (OR 2.3), influence negative survival.

Conclusions: Management of BC in the elderly is complex. Our data show that we have highly vulnerable population. Additionally, we found an unfortunate late reference to palliative care services that limited the impact of the multidisciplinary approach. We need to identify the barriers that influence this delay. Health care provides have a challenge in early reference of older women with advanced breast cancer patients to the palliative care and need to think in integrate to the multidisciplinary team a geriatrician with oncology perspective.

Citation Format: Cabrera-Galeana P, Sánchez N, Verastegui E, Rodriguez C, Bargallo E, Monreal E, Allende S. Palliative care and older women with advanced breast cancer in Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-11-04.

Multimodal approach in radioguided surgery in a case of multiple paraganglioma

The case involves a 34-year-old woman who underwent surgical removal of a retroperitoneal paraganglioma adjacent to the left kidney's lower pole, previously visualized by CT and MRI. The ¹²³I-MIBG scan was positive for this lesion and, in addition, another uptake was observed located caudally at the level of L5 and of smaller size and less intensity. The second lesion was not considered for surgical removal, due to its lack of morphological definition. One week after surgical intervention, the patient presented difficult-to-control high blood pressure. A second ¹²³I-MIBG scan was performed. The previously described second image was more intense in this study, and surgery was planned to remove it. A combination of techniques including freehand-SPECT and a portable hybrid gamma camera (with optical camera) were used pre-operatively to identify the location of the lesion. The combination of intra-operative laparoscopic gamma probe and portable hybrid gamma camera enabled the tumor to be located, excised, and its complete removal to be monitored. The histopathology analysis confirmed a second paraganglioma.

Hybrid-fusion SPECT/CT systems in parathyroid adenoma: Technological improvements and added clinical diagnostic value

Nuclear medicine traditionally employs planar and single photon emission computed tomography (SPECT) imaging techniques to depict the biodistribution of radiotracers for the diagnostic investigation of a range of disorders of endocrine gland function. The usefulness of combining functional information with anatomy derived from computed tomography (CT), magnetic resonance imaging (MRI), and high resolution ultrasound (US), has long been appreciated, either using visual side-by-side correlation, or software-based co-registration. The emergence of hybrid SPECT/CT camera technology now allows the simultaneous acquisition of combined multi-modality imaging, with seamless fusion of 3D volume datasets. Thus, it is not surprising that there is growing literature describing the many advantages that contemporary SPECT/CT technology brings to radionuclide investigation of endocrine disorders, showing potential advantages for the pre-operative locating of the parathyroid adenoma using a minimally invasive surgical approach, especially in the presence of ectopic glands and in multiglandular disease. In conclusion, hybrid SPECT/CT imaging has become an essential tool to ensure the most accurate diagnostic in the management of patients with hyperparathyroidism.

Radioguided surgery and the GOSTT concept: From pre-operative image and intraoperative navigation to image-assisted excision

Radio-guided surgery has been developed for application in those disease scheduled for surgical management, particularly in areas of complex anatomy. This is based on the use of pre-operative scintigraphic planar, tomographic and fused SPECT/CT images, and the possibility of 3D reconstruction for the subsequent intraoperative locating of active lesions using handheld devices (detection probes, gamma cameras, etc.). New tracers and technologies have also been incorporated into these surgical procedures. The combination of visual and acoustic signals during the intraoperative procedure has become possible with new portable imaging modalities. In daily practice, the images offered by these techniques and devices combine perioperative nuclear medicine imaging with the superior resolution of additional optical guidance in the operating room. In many ways they provide real-time images, allowing accurate guidance during surgery, a reduction in the time required for tissue location and an anatomical environment for surgical recognition. All these approaches have been included in the concept known as (radio) Guided intraOperative Scintigraphic Tumour Targeting (GOSTT). This article offers a general view of different nuclear medicine and allied technologies used for several GOSTT procedures, and illustrates the crossing of technological frontiers in radio-guided surgery.

A COMBINED APPROACH WITH SMOS AND MODIS TO MONITOR AGRICULTURAL DROUGHT

A synergistic fusion of the Soil Moisture and Ocean Salinity (SMOS) L2 soil moisture with the Moderate Resolution Imaging Spectroradiometer (MODIS)-derived land surface temperature (LST) and several water/vegetation indices for agricultural drought monitoring was tested. The rationale of the calculation is based on the inverse relationship between LST and vegetation condition, related in turn with the soil moisture content. All the products were time-integrated, including the lagged response of vegetation. The product aims to detect and characterize soil moisture drought conditions and, particularly, to identify potential short-term agricultural droughts among them. The new index, so-called the Soil Moisture Agricultural Drought Index (SMADI), was retrieved at 500 m spatial resolution at the Soil Moisture Measurement Stations Network of the University of Salamanca (REMEDHUS) area from 2010 to 2014 at 8-days temporal scale. SMADI was compared with other agricultural indices in REMEDHUS through statistical correlation, affording a good agreement with them, and depicting a suitable description of the drought conditions in this area during the study period.

Quantitative volcanic susceptibility analysis of Lanzarote and Chinijo Islands based on kernel density estimation via a linear diffusion process

Risk management stakeholders in high-populated volcanic islands should be provided with the latest high-quality volcanic information. We present here the first volcanic susceptibility map of Lanzarote and Chinijo Islands and their submarine flanks based on updated chronostratigraphical and volcano structural data, as well as on the geomorphological analysis of the bathymetric data of the submarine flanks. The role of the structural elements in the volcanic susceptibility analysis has been reviewed: vents have been considered since they indicate where previous eruptions took place; eruptive fissures provide information about the stress field as they are the superficial expression of the dyke conduit; eroded dykes have been discarded since they are single non-feeder dykes intruded in deep parts of Miocene-Pliocene volcanic edifices; main faults have been taken into account only in those cases where they could modified the superficial movement of magma. The application of kernel density estimation via a linear diffusion process for the volcanic susceptibility assessment has been applied successfully to Lanzarote and could be applied to other fissure volcanic fields worldwide since the results provide information about the probable area where an eruption could take place but also about the main direction of the probable volcanic fissures.

Involvement of D1 and D2 dopamine receptor in the retrieval processes in latent inhibition

RATIONALE

Contemporary theories propose that latent inhibition (LI) is due to a process of interference with the context playing a key role as recovery cue. Physiological studies have demonstrated that LI is a process dependent on striatal dopamine. D2 dopamine receptors have been specifically associated with its expression, while D1 receptor has shown a limited function. However, to evaluate the role of dopamine receptors in LI, it is necessary to analyse their activity during recovery phase, where the mechanisms involved in interference processes are performed.

OBJECTIVE

The experiments studied the involvement of the dopaminergic system in the retrieval process of LI. We analysed the effect of the systemic administration of dopaminergic D1 (SCH-23390) and D2 (sulpiride) antagonist during the test phase on LI and on its contextual specificity.

METHODS

Animals were pre-exposed to saccharin solution and conditioned with a LiCl administration in conditioning phase. Dopaminergic antagonist drugs were administered during the test phase. Experiment 2 used the same context in all the phases. Experiment 3 used a new context during conditioning and test phase.

RESULTS

The D2 antagonist increased the LI effect and, in turn, diminished the normally suppressant effect of the context shift on LI. The opposite effect was observed under the D1 antagonist administration. This drug disrupted LI and enhanced the effect that the context shift had on this cognitive process.

CONCLUSIONS

D2 receptor had a relevant role on retrieval processes of pre-exposure learning, while D1 receptor was related with the contextual control of conditioning.

[Roux-en-Y gastric bypass for treatment of patients with DM type 2 and BMI of 30 to 35 Kg/m²]

BACKGROUND

The incidence of obesity and its most feared comorbidity, diabetes mellitus type 2, is increasing and there would not seem to be any medical treatment to help control these pandemics. However, there is a bariatric surgery technique, the Roux-en-Y Gastric Bypass (RYGB), which is safe and not only helps control excess weight, but produces encouraging results in the control and remission of diabetes.

METHODS

We present 15 selected patients with a BMI between 30 and 35 kg/mt² and diabetes type 2 who underwent a laparoscopic RYGB with of one-year follow-up.

RESULTS

A total of 14 women and one man were operated with the following average values: age: 37 years, weight: 88.3 kg, BMI: 32.8 kg/mt², blood glucose: 120 ± 38.8 mg%, HbA1c: 7.6 ± 0.73. Forty percent (40%) suffered from high blood pressure and 33.3% were dyslipidemic. Average surgical time was 75 minutes, hospital length of stay was two days, and there was a low rate of complications and no mortality. Diabetes remission was achieved in 93% of cases with significant drops in blood glucose and HbA1c (p ≤ 0.05 and p ≤ 0.001 respectively), dyslipidemia was 100% controlled and hypertension was 83.3% controlled.

CONCLUSIONS

RYGB in selected patients with obesity type 1 and diabetes mellitus type 2 is a safe and effective technique for metabolic control and obesity control.

Pollution profiles and physicochemical parameters in old uncontrolled landfills

The long-term effectiveness of the geological barrier beneath municipal-waste landfills is a critical issue for soil and groundwater protection. This study examines natural clayey soils directly in contact with the waste deposited in three landfills over 12 years old in Spain. Several physicochemical and geological parameters were measured as a function of depth. Electrical conductivity (EC), water-soluble organic carbon (WSOC), Cl(-), NH(4)(+), Na(+) and exchangeable NH(4)(+) and Na(+) were used as parameters to measure the penetration of landfill leachate pollution. Mineralogy, specific surface area and cationic-exchange capacities were analyzed to characterize the materials under the landfills. A principal component analysis, combined with a Varimax rotation, was applied to the data to determine patterns of association between samples and variables not evident upon initial inspection. The main factors explaining the variation in the data are related to waste composition and local geology. Although leachates have been in contact with clays for long time periods (13-24 years), WSOC and EC fronts are attenuated at depths of 0.2-1.5m within the clay layer. Taking into account this depth of the clayey materials, these natural substrata (>45% illite-smectite-type sheet silicates) are suitable for confining leachate pollution and for complying with European legislation. This paper outlines the relevant differences in the clayey materials of the three landfills in which a diffusive flux attenuation capacity (A(c)) is defined as a function (1) of the rate of decrease of the parameters per meter of material, (2) of the age and area of the landfill and (3) of the quantity and quality of the wastes.

Study of biodiesel production from animal fats with high free fatty acid content

The aim of this work was to obtain biodiesel from animal fats, an inedible feedstock. Three different types of fats were used to produce biodiesel; their main characteristic was high free fatty acid content. Animal fats were transesterified with acid catalyst and basic catalyst with and without pre-esterification. Biodiesel of 89.0 wt.% ester content was obtained by acid-transesterification (9 wt.%H2SO4, 6:1 methanol:fats molar ratio, 60 °C, 48 h). Pre-esterification conditions were studied for different fats and acid catalysts: 0.5 wt.%H2SO4 or 1.0 wt.%p-TsOH, 6:1 methanol:fats molar ratio, 65 °C and 4 h made it possible to obtain fats with acid value less than 0.5% FFA. Pre-treatment was effective for fats with different FFA content. Alkali transesterification of esterified fats resulted in a product with 97.3 wt.% ester content. Biodiesel quality was evaluated and most of properties were well within EN 14214.

[Indications of hepatectomy for iatrogenic biliary injury.]

BACKGROUND

The most efficient surgical procedure to treat bile duct injuries is a Roux en Y hepatoyeyunoanastomosis (RY-HYA). A small group of patients who have undergone a RY-HTA develop cholangitis without jaundice, with proven permeability of the anastomosis.

OBJECTIVE

To describe our experience in this subgroup of patients.

PATIENTS AND METHODS

355 patients received surgical treatment for BDI with a RY-HYA. Medical charts of patients diagnosed with segmentary cholangitis involving a single hepatic lobe were reviewed. Segmentary cholangitis with intra-hepatic abscess was diagnosed through computer tomography, endoscopic retrograde cholangiopancreatography or by percutaneous transhepatic cholangiography.

RESULTS

We found 10 patients with segmentary cholangitis within the 355 cases in our series. Eight of them received treatment with a right hepatectomy and two of them with a left hepatectomy. In every patient, the hepatoyeyunoanastomosis was dismantled during the reoperation, corroborating the presence of a wide and permeable anastomosis. Surgical exploration was conducted through the hepatic ducts. After the affected lobe hepatectomy a new hepatoyeyunoanastomosis was performed. Out of the 10 patients one died (mortality 10%) due to hepatic cirrhosis. In the rest of the group a satisfactory resolution of the segmentary cholangitis was observed.

CONCLUSIONS

In our series, 3% of the patients required a mayor hepatectomy for the persistent cholangitis to resolve, despite the presence of a functional bilioenteric anastomosis. Segmentary cholangitis must be suspected in patients with normal levels of direct bilirubin and abnormal liver function tests with clinical manifestations of cholangitis.

Evolution of Drug use After Enforcing a Protocol in a Medium Stay Unit. Results Four Years Later

Aims:

Comorbidity between drug misuse and mental disorders affects negatively in the prognosis of psychistric illness, so it’s important to guarantee drug abstinence at least during hospitalization. This is even more significant in a medium stay unit because patients are more serious and resistant to treatment.

In February 2003, a multidisciplinary group was formed to evaluate the situation of drug use in a psychiatric hospital and a drug screening protocol was then created.

We evaluate if with the protocol, drug use decreases during hospitalization in a medium stay unit in a psychiatric hospital.

Methods:

We first compared drug use (positive results in urine samples) from 2000 to 2002 (before protocol: urine samples collected when there’s drug misuse suspicion) with the period after the protocol was enforced (from 2003 to 2006). Afterwards, we analyzed if drug use during hospitalization continues decreasing in 2007.

In the protocol urine samples are collected when there’s a past misuse history, consumption suspicion, randomly and every time they leave for home.

Results:

It is proved that drug use decreases during hospitalization since the new protocol came into force. Drug use continues reducing since the enforcement of the drug screening protocol.

Conclusion:

The introduction and exhaustive completion of a protocol designed to decrease drug misuse in a psychiatric hospitalization unit, provokes a high reduction of drug use, and each year, the reduction of drug misuse is higher. So we think it’s convenient to generalize this kind of measures.

Efficacy of a Drug Screening Protocol

Aims:

Comorbidity between drug misuse and mental disorders affects negatively in the prognosis of psychiatric illness, so it’s important to guarantee drug abstinence during hospitalization.

The Hospital of Zamudio contains short and medium stay units. Patients are referred to medium stay units when disorders are more serious or the symptoms are resistant to treatment.

In February 2003, a multidisciplinary group was formed to evaluate the situation of drug use in a psychiatric hospital and a drug screening protocol was then created.

We evaluate if the enforcement of the protocol, has decreased drug use during hospitalization.

Methods:

It’s compared, retrospectively, drug use (positive results in urine samples) since the screening drug protocol was enforced (2003) to 2007. Urine samples are collected when there’s a past misuse history, consumption suspicion, randomly and every time the patient leave for home. It’s also compared the differences between short and medium stay units.

Results:

It’s proved that drug use decreases during hospitalization since the new protocol came into force in a medium stay unit. This drug protocol is not useful in a short stay unit.

Conclusions:

The introduction and completion of this protocol provokes a high reduction of drug use in a medium stay unit. This design seems not to be adequate to short stay units. Probably, collecting urine samples when patients came into a short unit gives false positive results because these patients don’t come from other hospitalization units as in the case of medium stay unit.

Differences Between Patients of a Medium Stay Unit Depending on the Derivation Unit

Aims:

The medium stay unit of the hospital of Zamudio is a psychiatric hospitalization unit where serious patients are admitted, specially those with psychotic and affective disorders. The complexity of the pathology extends the average stay of hospitalization with an average of 60 days to improve.

There are 2 derivation units from which medium stay takes patients:

•

Methods:

It is analyzed, retrospecitvely, the profile of patients in a medium stay unit comparing the derivation unit they come from in 2007.

Results and conlusions:

There are no statistically significant differences in the number of patients derived from the diverse units.

The sociodemographic and administrative profile of the patients is similar in both groups: a single middle aged (between 45-50 years old) that is hospitalized knowlingly (63%). The average stay at hospital is 55 days.

Attending to the clinical profile we concluded that patients derived from the Hospital of Zamudio suffer from Bipolar disorder as main diagnosis. The rest of disorders remain similar comparing both units.

Incidence and prevalence of amyotrophic lateral sclerosis in Uruguay: a population-based study

OBJECTIVE

To determine the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in the Republic of Uruguay.

METHODS

The study was performed in Uruguay (3,241,003 inhabitants) during a 2-year period (2002-2003). To ensure complete case ascertainment, multiple sources of information were used, including all the neurologists, other medical specialties, general physicians, neurophysiology laboratories, hospital medical records and death certificates. ALS diagnosis was based on El Escorial criteria. Although all patients with motor neuron disease were enrolled in the follow-up, only probable and definite cases are included in the study.

RESULTS

Between January 1st, 2002, and December 31st, 2003, 89 new patients were diagnosed with probable or definite ALS. The mean annual incidence rate was 1.37 per 100,000 persons. The incidence was higher for men (1.95) than for women (0.84) with a male to female ratio of 2:1. For both, the incidence increased throughout the years showing a peak in the 65-74 age group among men and the 55-64 age group among women. Mean age at onset of ALS disease was 58.7 years. The estimated mean annual incidence for ALS calculated by the capture recapture method was 1.42 (95% CI, 1.13-1.72). On December 31st, 2002, the crude prevalence was 1.9 per 100,000 inhabitants.

CONCLUSIONS

ALS incidence is within a narrow range across countries despite the genetic, environmental and socioeconomic differences when similar prospective design, diagnosis criteria and data analyses are applied.

Does Helicobacter pylori have a pathogenic role in bronchiectasis?

AIM

To investigate the presence of Helicobacter pylori (H. pylori) in bronchial biopsies of patients with bronchiectasis, by histochemical and immunochemical staining.

SETTING

800-bed tertiary university hospital.

METHODS

Observational study.

PATIENTS

forty-six patients with bronchiectasis in a stable clinical condition and 8 control patients.

INTERVENTIONS

Serum samples determination of IgG levels for H. pylori by ELISA. Immunostaining with an anti-H. pylori antibody (NCL-HPp, Novocastra) of bronchial mucosa obtained by fiberoptic bronchoscopy from both patients with bronchiectasis and controls.

RESULTS

Twenty-one out of 46 patients with bronchiectasis (46%) had positive serology for H. pylori. We obtained 40 bronchial biopsies in patients with bronchiectasis and 8 bronchial biopsies in control patients. No evidence of H. pylori was obtained in the bronchial samples of both patients and controls.

CONCLUSIONS

The results of our study could not demonstrate the presence of H. pylori in bronchial specimens from patients with bronchiectasis.

Neuropatía auditiva secundaria a la mutación Q829X en el gen de la otoferlina (OTOF) en un lactante sometido a screening neonatal de hipoacusia

We report an infant with auditory neuropathy secondary to the Q829X mutation in the gene encoding otoferlin (OTOF). Included in a universal newborn hearing screening program, the subject passed the otoacoustic emission (OAEs) test. Given that the infant had a familial history of deafness auditory brainstem response (ABR) testing was performed, revealing a profound hearing impairment. The genetic study confirmed that the subject was homozygous for the Q829X mutation in OTOF. The patient underwent a cochlear implant, obtaining satisfactory results. The moderately high prevalence of this mutation in the Spanish population could produce a significant false negative rate in newborn hearing screening programs using OAEs.

[Mycobacterial infections in HIV-infected patients in Cali, Colombia]

The prevalence of mycobacterial infections was determined in a sample of 155 individuals infected with human immunodeficiency virus (HIV) who were treated in the Social Security Institute (SSI) of Cali, Colombia. A tuberculin test (2 TU PPD RT23) was used, and the presence of mycobacteria was checked through direct microscopy and culturing blood, urine, feces, and gastric aspirate. When clinically indicated, samples of cerebrospinal fluid, bone marrow, and sputum were also examined and cultivated. The absence of reactivity to tuberculin was significantly more frequent in the patients than in the controls (91.3%, compared to 57.4%; chi 2 = 33, P = 0). The prevalence of tuberculosis was 6.5%, in comparison with 0.04% among a group of HIV-negative ISS members (exact binomial 95% confidence interval: 0.0313% to 0.1154%). Nontuberculous mycobacteria (NTM), present in 43 patients, were significantly more frequent than Mycobacterium tuberculosis (27.7%, versus 6.5%; chi 2 = 24.78, P = 0.000,001), but they caused illness only in some cases. The most common species were those of the M. avium-intracellulare complex. M. avium-intracellulare and M. fortuitum had a total prevalence of 7.1% and were the most-prevalent NTM that caused disease in these patients (4.5%); they were also responsible for three cases of disseminated infection. Clinical disease caused by M. tuberculosis or NTM and complete tuberculin anergy were associated with stage-IV HIV infection and with CD4 lymphocyte counts < or = 400/microL. However, the lack of immunocellular response, shown by limited tuberculin reactivity, was found beginning with the asymptomatic HIV carrier stage. The progressive deterioration of the immune system of HIV-positive patients is the determining factor in the high morbidity and mortality with mycobacteria infections and requires prompt chemoprophylaxis or treatment.

Ring A reductions of progestins are not essential for estrous behavior facilitation in estrogen-primed rats

In Experiment 1 six dose levels (range 0.66-2000 microg) of progesterone (P) and two synthetic progestins with a double bond at C6: megestrol acetate (MA) and chlormadinone acetate (CA), which cannot be reduced at C5, were injected to estrogen-primed (2 microg estradiol benzoate 42 h earlier) ovariectomized (ovx) rats. The three progestins elicited significant lordosis and proceptive behaviors. Potency analysis showed that MA was the most potent progestin for stimulating estrous behavior, followed by P and CA. These results suggest that ring A reduction of progestins to 5alpha/5beta metabolites is not essential for the facilitation of estrous behavior in ovx estrogen-primed rats. Progestins with the 3-ketone group and a double bond at C4 can also be reduced at C3 to yield 3alpha-hydroxysteroid metabolites potentially capable of stimulating estrous behavior. In Experiment 2, the relevance of the formation of 3alpha-hydroxysteroid metabolites for estrous behavior facilitation was tested by concurrently injecting indomethacin (1.5 mg), a blocker of 3alpha-hydroxysteroid oxidoreductase, with 400 microg of P, MA, or CA to ovx estrogen-primed rats. Indomethacin failed to block the stimulatory effect of these progestins on estrous behavior. These results suggest that 3-ketosteroid reduction is also not essential for estrous behavior facilitation by progestins.

The aberrant cell walls of boron-deficient bean root nodules have no covalently bound hydroxyproline-/proline-rich proteins

B-deficient bean (Phaseolus vulgaris L.) nodules examined by light microscopy showed dramatic anatomical changes, mainly in the parenchyma region. Western analysis of total nodule extracts examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed that one 116-kD polypeptide was recognized by antibodies raised against hydroxyproline-rich glycoproteins (HRGPs) from the soybean (Glycine max) seed coat. A protein with a comparable molecular mass of 116 kD was purified from the cell walls of soybean root nodules. The amino acid composition of this protein is similar to the early nodulin (ENOD2) gene. Immunoprecipitation of the soybean ENOD2 in vitro translation product showed that the soybean seed coat anti-HRGP antibodies recognized this early nodulin. Furthermore, we used these antibodies to localize the ENOD2 homolog in bean nodules. Immunocytochemistry revealed that in B-deficient nodules ENOD2 was absent in the walls of the nodule parenchyma. The absence of ENOD2 in B-deficient nodules was corroborated by performing hydroxyproline assays. Northern analysis showed that ENOD2 mRNA is present in B-deficient nodules; therefore, the accumulation of ENOD2 is not affected by B deficiency, but its assembly into the cell wall is. B-deficient nodules fix much less N2 than control nodules, probably because the nodule parenchyma is no longer an effective O2 barrier.