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Vitamina D. Què n'has de saber? [fullet]
No full textVitamina D; Suplements; AdultsVitamina D; Suplementos; AdultosVitamin D; Supplements; AdultsInfografia sobre la vitamina D, elaborada en el marc de la campanya “Pastilles, només les necessàries”. Ofereix informació clau per a un ús adequat de la vitamina D en persones grans i en situació de fragilitat.Infografía sobre la vitamina D, elaborada en el marco de la campaña “Pastilles, només les necessàries”. Ofrece información clave para un uso adecuado de la vitamina D en personas mayores y en situación de fragilidad.Infographic on vitamin D, created as part of the campaign “Pastilles, només les necessàries”. It provides key information for the appropriate use of vitamin D in older adults and individuals in a situation of frailty
Estimating the Value of Aztreonam-Avibactam in Treating Metallo-beta-Lactamase-Producing Enterobacterales Infections in Spain Using the STEDI AMR Value Framework
Get PDFAntimicrobial resistance; Carbapenem-resistance; Cost effectivenessResistencia antimicrobiana; Resistencia a carbapenémicos; Coste-efectividadResistència antimicrobiana; Resistència a carbapenèmics; Cost-efectivitatIntroduction
Treatments for serious infections caused by multidrug-resistant gram-negative bacteria, including metallo-β-lactamase-producing Enterobacterales (MBL-EB), are limited and aztreonam with avibactam (ATM-AVI) is the first β-lactam/β-lactamase inhibitor combination active against MBL-EB approved in Europe and approved for reimbursement by the Spanish National Health System (NHS). This study aims to estimate the value of adding ATM-AVI as a new first-line treatment into the current strategy (ATM–AVI → cefiderocol → colistin + meropenem) in patients with hospital-acquired/ventilator-associated pneumonia (HAP/VAP) and complicated intra-abdominal infections (cIAI), caused by MBL-EB from the Spanish NHS perspective.
Methods
A dynamic disease transmission model was developed to assess the value of ATM-AVI considering the transmission, diversity and enablement components of the value framework for antibiotics, called STEDI (spectrum, transmission, enablement, diversity, insurance). Transmission and diversity value were described by estimating direct population-level impact on treatment outcomes and resistance development. Enablement value was estimated by linking population-level improvements in antimicrobial effectiveness into improved prophylactic effectiveness. Inputs for efficacy, resistance, adverse events, and costs were sourced from the REVISIT study, literature and expert opinion. A 10-year infection transmission horizon was used; quality-adjusted life years (QALYs) were estimated over a lifetime and valued using a willingness-to-pay (WTP) threshold of €25,000/QALY gained to calculate the net monetary benefit (NMB). Costs and benefits were discounted at a rate of 3%.
Results
Over 10 years, the intervention strategy introducing ATM-AVI was dominant, leading to a 2.96% proportional reduction in resistance, 19,533 fewer infections and 4662 lives saved (47,319 QALYs gained) and a cost saving of €40.5 million. The NMB was €1.22 billion.
Conclusions
In Spain, ATM-AVI is a highly cost-effective and urgently needed treatment option for patients with MBL-EB including HAP/VAP and cIAI infections. Using the novel STEDI framework unlocks the considerable value of a new antibiotic which is essential to support incentives for the development of new antimicrobials.This work was supported by Pfizer Inc which provided support for the model development, analysis, medical writing and Rapid Service fees for this study
Breastfeeding after breast cancer in young BRCA carriers
Get PDFBreastfeeding; Breast cancer; BRCA carriersLactancia materna; Cáncer de mama; Portadoras de BRCALactància materna; Càncer de mama; Portadores de BRCABackground
We investigated safety of breastfeeding after breast cancer in patients carrying germline BRCA pathogenic or likely pathogenic variants.
Methods
This was an international, multicenter, hospital-based, retrospective cohort study including BRCA carriers diagnosed with stage I–III invasive breast cancer at age 40 years or younger between January 2000 and December 2020 (NCT03673306). Locoregional recurrences and/or contralateral breast cancers, disease-free survival (DFS), and overall survival (OS) were compared between patients who breastfed after delivery and those who did not.
Results
Among 4732 patients included from 78 centers worldwide, 659 had a pregnancy after breast cancer diagnosis, of whom 474 delivered a child. After excluding patients with uptake of bilateral risk-reducing mastectomy prior to delivery (n = 225) or unknown breastfeeding status (n = 71), 110 (61.8%) breastfed (median duration 5 months) and 68 (38.2%) did not breastfeed. Compared to patients in the no breastfeeding group, those who breastfed were more frequently nulliparous at breast cancer diagnosis (61.8% vs 45.6%) and did not report prior smoking habit (71.8% vs 57.4%). After a median follow-up of 7.0 years following delivery, 7-year cumulative incidence of locoregional recurrences and/or contralateral breast cancers was 29% in the breastfeeding group and 36% in the no breastfeeding group (adjusted subdistribution hazard ratio [HR] = 1.08, 95% CI = 0.57 to 2.06). No difference in DFS (adjusted hazard ratio [aHR] = 0.83, 95% CI = 0.49 to 1.41) nor in OS (aHR = 1.32, 95% CI = 0.31 to 5.66) was observed.
Conclusions
Breastfeeding did not appear to be associated with a higher risk of developing locoregional recurrences or contralateral breast cancers, emphasizing the possibility of achieving a balance between maternal and infant needs without compromising oncological safety.The study was partly supported by the Italian Association for Cancer Research (“Associazione Italiana per la Ricerca sul Cancro”, AIRC; MFAG 2020 ID 24698) and the 2022 Gilead Research Scholars Program in Solid Tumors with a focus on breast cancer. The funders of the study had no role in study design, data collection, analysis, interpretation, writing of the report, or decision to publish the manuscript and they had no access to the data. M.L. received support from the European Society for Medical Oncology (ESMO) for a translational research fellowship at the Institut Jules Bordet in Brussels, Belgium, at the time this study was initiated. H.J.K. receives support from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant HC20C0135). A.H.P. receives support from the Breast Cancer Research Foundation and Susan G. Komen. K.A.P. is an Australian National Health and Medical Research Council leadership fellow. Data collection for most Australian participants was through the kConFab Follow-Up Study with support from Cancer Australia and the National Breast Cancer Foundation (PdCCRS 1100868), Cancer Australia (809195), the Australian National Breast Cancer Foundation (IF 17), the Australian National Health and Medical Research Council (454508, 288704, and 145684), the US National Institutes of Health (1RO1CA159868), the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania, and South Australia, and the Cancer Foundation of Western Australia
Plain language summary of the EVOKE-01 study of sacituzumab govitecan vs docetaxel in patients with non-small cell lung cancer
Get PDFSacituzumab govitecan; Docetaxel; Non-small cell lung cancerSacituzumab govitecan; Docetaxel; Càncer de pulmó de cèl·lules no petitesSacituzumab govitecan; Docetaxel; Cáncer de pulmón de células no pequeñasWhat is this summary about?There are few treatment choices for people with non-small cell lung cancer (NSCLC) when it gets worse after prior treatments. Available treatments lead to poor survival outcomes and severe side effects.This summarizes the results of a study called EVOKE-01. This study compared a newer medicine called sacituzumab govitecan (brand name: TRODELVY®) with a commonly used chemotherapy called docetaxel. People in the study had NSCLC that was advanced or had become metastatic after being treated with other medicines that contain platinum plus an immunotherapy.What were the results?After a median of 13 months of observation in the study, people with advanced or metastatic NSCLC who were treated with sacituzumab govitecan did not live significantly longer than those who were treated with docetaxel. However, similar to docetaxel, many people were helped by sacituzumab govitecan treatment, and patients taking sacituzumab govitecan appeared to live somewhat longer than those who were given docetaxel.People were helped no matter what type of NSCLC they had. The positive effects of sacituzumab govitecan treatment were more obvious in people whose disease did not get better after their last immunotherapy. People given sacituzumab govitecan had fewer severe side effects. Fewer had to stop sacituzumab govitecan treatment, compared with those who were given docetaxel. People who got sacituzumab govitecan in this study had similar side effects as people who took sacituzumab govitecan in other studies. Shortness of breath is a key symptom of NSCLC. People who got sacituzumab govitecan took longer to have shortness of breath compared with people who got docetaxel. This suggests that sacituzumab govitecan controlled the disease better than docetaxel.What do the results mean?This study suggested that some people with advanced or metastatic NSCLC might live slightly longer when treated with sacituzumab govitecan than with docetaxel, especially those whose cancer did not respond to earlier treatment with immunotherapy. In this study, about the same number of people who got sacituzumab govitecan or docetaxel had any side effects. Fewer people had severe/life-threatening side effects or had to stop treatment because of side effects with sacituzumab govitecan than docetaxel. These results support future studies of sacituzumab govitecan as a potential treatment for people with previously treated advanced or metastatic NSCLC.Plain language summary of publication writing and editorial support was provided by Miranda Bader-Goodman, PhD, and Ebenezer M. Awuah-Yeboah, BS, of Ashfield MedComms, an Inizio company, and funded by Gilead Sciences, Inc. The authors had full control of this summary and provided their final approval of all content
Indirect comparative efficacy and safety of tirzepatide 10 and 15 mg versus semaglutide 2.4 mg for the management of obesity and overweight in patients with type 2 diabetes
Get PDFType 2 diabetes; Weight managementDiabetis tipus 2; Control del pesDiabetes tipo 2; Control de pesoAims
This indirect treatment comparison (ITC) compared the efficacy and safety of tirzepatide with semaglutide for managing obesity or overweight in participants with type 2 diabetes (T2D), informed by the pivotal trials SURMOUNT-2 and STEP 2.
Materials and Methods
Participants had body mass index (BMI) ≥ 27 kg/m2, with ≥1 unsuccessful prior dietary weight reduction effort and glycated haemoglobin (HbA1c) 7%–10% on stable therapy. A heterogeneity assessment confirmed that study and patient baseline characteristics were similar. Bucher ITCs compared tirzepatide 10 and 15 mg once-weekly (QW) to semaglutide 2.4 mg QW via placebo, all adjunct to a reduced-calorie diet and increased physical activity.
Results
Tirzepatide 10 and 15 mg were associated with statistically significant greater reductions in weight, BMI and HbA1c versus semaglutide. Tirzepatide 15 mg was associated with statistically significant greater odds versus semaglutide of ≥5% and ≥15% weight reduction and statistically significant improvements in several cardiometabolic risk factors, including waist circumference, fasting plasma glucose and triglycerides. Both tirzepatide doses showed non-significant trends of greater improvements in high-density lipoprotein, low-density lipoprotein, systolic blood pressure and diastolic blood pressure versus semaglutide as well as a generally comparable safety profile to semaglutide.
Conclusions
In this ITC versus semaglutide 2.4 mg, tirzepatide 10 and 15 mg were associated with statistically significant greater weight, BMI and HbA1c reduction and tirzepatide 15 mg with statistically significant improvements in multiple cardiometabolic risk factors crucial in managing obesity or overweight among patients with T2D. Both tirzepatide doses also had a generally similar safety profile to semaglutide.Eli Lilly and Compan
Retreatment with oxaliplatin-based regimens in refractory metastatic colorectal cancer: characterization of high-response patients
Get PDFOxaliplatin; Rechallenge; ReintroduceOxaliplatinore; Desafío; ReintroducirOxaliplatí; Repte; ReintroduirBackground
Oxaliplatin, a key agent used for managing metastatic colorectal cancer (mCRC), is often discontinued due to cumulative toxicity. Its reintroduction in later treatment lines remains a common clinical practice, despite the absence of robust prospective trials supporting this therapeutic strategy. This study aimed to evaluate the efficacy of oxaliplatin rechallenge in refractory mCRC and to identify patient characteristics predictive of improved outcomes with this approach.
Patients and methods
We retrospectively analyzed patients treated with oxaliplatin in the third- or fourth-line setting at Vall d’Hebron Hospital between 2015 and 2021. Outcomes included overall response rate (ORR), disease control rate (DCR), and median progression-free survival (PFS). Patients achieving median PFS >6 months were classified as best-responders. Factors affecting PFS were analyzed with a Cox regression model. Amplicon-seq analysis of 61 genes was carried out using Illumina technology.
Results
Of 735 patients receiving third- or fourth-line treatment, 102 (14%) received oxaliplatin retreatment (69% in third line; 31% in fourth line). Median PFS was 4.0 months (95% CI 3.29-5.03 months), with an ORR of 12% and DCR of 39%. Twenty-eight patients (27%) were best-responders. Predictors of efficacy included response to first-line oxaliplatin, planned oxaliplatin discontinuation, and an oxaliplatin-free interval of at least 22.0 months. No significant associations were identified between molecular alterations and prognostic subgroups.
Conclusions
Oxaliplatin-based reintroduction therapy is a viable strategy in mCRC, particularly for patients with a favorable prior response and prolonged oxaliplatin-free intervals. However, identifying more precise biomarkers is essential to improve patient selection and maximize treatment efficacy
Socioeconomic impact of chronic delta hepatitis in Spain: Indirect costs of work absenteeism, presenteeism, and premature mortality
Get PDFSocioeconomic impact; Chronic delta hepatitis; Work absenteeismImpacte socioeconòmic; Hepatitis delta crònica; Absentisme laboralImpacto socioeconómico; Hepatitis delta crónica; Absentismo laboralIntroduction: Patients with chronic delta hepatitis (CDH) exhibit higher levels of morbimortality than those with hepatitis B only, generating higher indirect costs for society. The aim of this study was to estimate the loss of productivity and costs resulting from work absenteeism and presenteeism as well as premature mortality among patients with CDH in Spain.
Methods: Patients with CDH in their working age (between 20-65 years) were estimated by an epidemiological flow model that incorporated the prevalence of infection with the hepatitis B and D viruses. To calculate the costs (year-2023) of absenteeism and presenteeism (over a time horizon of 1 year) as well as premature mortality (i.e., the period from death to expected retirement age), as measured in years of productive life lost (YPLL), the human capital method was used. Specific variables pertaining to the Spanish labour market (working population with hepatitis D virus (HDV), working days, average number of hours worked and gross annual salary) were considered for each sex and age group and distinguished based on infection status. All parameters were obtained from the literature and Spanish databases.
Results: A total of 1,313 CDH patients of working ages (59% men, 41% women) and 97 patients who performed unpaid housework were identified. A total of 300,113 working hours were lost per year (29,015 hours/absenteeism and 271,098 hours/presenteeism), which entailed total annual costs of €4.5M (€536,400/absenteeism and €3.9M/presenteeism) related to CDH. Among patients of working ages, CDH was estimated to cause 28 annual deaths at a cost of €8.2 M, resulting in 449 YPLL at an average cost of €18,297/YPLL. The indirect costs were estimated to be € 12.7M.
Conclusions: CDH entails significant economic burdens for society. Consideration of the indirect costs associated with CDH is crucial with respect to the design of public health policies and interventions.Gilead Sciences Spai
Efectividad de la observación directa en la mejora de la higiene de manos en hospitalización
Get PDFHigiene de mans; Personal sanitari; Seguretat del pacientHand hygiene; Health personnel; Patient safetyHigiene de manos; Personal sanitario; Seguridad del pacienteObjetivo: Analizar la evolución del cumplimiento de la HM tras la implementación de observaciones sistemáticas en distintas unidades de hospitalización de un hospital comarcal, comparando los resultados obtenidos entre 2024 y 2025.
Metodología: Estudio observacional, descriptivo y prospectivo, basado en observaciones directas de oportunidades de HM en unidades de hospitalización durante los años 2024 y 2025 mediante cortes transversales. La recogida de datos se basó en el formulario estandarizado de la OMS y se completó in situ por observadores formados en la metodología.
Resultados: Se observaron 1487 oportunidades de HM entre agosto de 2024 y mayo de 2025. El cumplimiento global fue del 67,32%, con un incremento significativo respecto al año anterior (59,45% en 2024 vs. 72,31% en 2025; p<0,05).
Conclusiones: La implementación de observaciones directas basadas en la metodología de los 5 momentos de la OMS contribuyó a una mejora significativa en el cumplimiento de la HM y a una reducción del uso inadecuado de guantes en hospitalización. Esta estrategia demostró ser útil no solo como herramienta de medición y evaluación, sino también como elemento de sensibilización y de impulso a la mejora continua de las prácticas seguras en la atención sanitaria
Estudio prospectivo multicéntrico de casos y controles del exposoma en melanoma
Get PDFExposome; Melanoma; DietExposoma; Melanoma; DietaExposoma; Melanoma; DietaUV radiation is the main etiological agent of skin cancer. Other factors such as pollution, diet and lifestyle are also contributing factors. Our aim was to investigate the association between melanoma and exposome factors in the Spanish population with a prospective multicenter case–control study. Case group included patients with melanoma while the control group included people who attended the consultations as companions without a past medical history of skin cancer. A total of 73 melanoma patients and 126 controls were included. The former group included more outdoor workers, a history of skin cancer, drug use (acetylsalicylic acid, antidepressants and ACE inhibitors, p < 0.05), more sun exposure (p < 0.001) and more sunburns (p = 0.04). Controls used shade (p = 0.04) or clothing (p < 0.001) and the sun protection factor (SPF) used 15 years earlier was higher (p = 0.04). Melanoma-related exposome factors are associated with sun exposure, drug intake and food. Prevention strategies should target specific populations, such as outdoor workers by promoting sun-safe behaviors and healthy lifestyle habits since childhood.La radiación ultravioleta es el principal agente etiológico del cáncer de piel. Otros factores como la contaminación, la dieta y el estilo de vida también pueden contribuir. Nuestro objetivo fue investigar la asociación del melanoma y los factores del exposoma en la población española con un estudio prospectivo de casos y controles multicéntrico. Se incluyeron 73 pacientes con melanoma y 126 controles. El grupo melanoma tenía más trabajadores al aire libre, antecedentes de cáncer de piel, consumo de fármacos (ácido acetilsalicílico, antidepresivos e IECA, p < 0,05), estaba más expuesto al sol (p < 0,001) y sufría más quemaduras (p = 0,04). Los controles utilizaron la sombra (p = 0,04) o la ropa (p < 0,001) y el factor de protección solar (FPS) utilizado 15 años antes fue mayor (p = 0,04). Los factores del exposoma asociados a melanoma están relacionados con la exposición solar, la toma de fármacos y los alimentos. Las estrategias de prevención deberían dirigirse a poblaciones específicas, como trabajadores al aire libre, promoviendo conductas seguras frente al sol, además de estilos de vida saludables desde la infancia
Predictors of therapeutic failure in GH and prolactin co-secreting pituitary adenomas
Get PDFGrowth hormone; Prolactin co-secreting pituitary adenoma; Surgical remissionHormona del creixement; Adenoma hipofisari cosecretor de prolactina; Remissió quirúrgicaHormona del crecimiento; Adenoma hipofisario cosecretor de prolactina; Remisión quirúrgicaAim
To evaluate which factors are associated with a higher probability of failure to surgical and first-generation somatostatin receptor ligands (fgSRLs) treatment in patients with growth hormone and prolactin co-secreting pituitary adenomas (GH&PRL-PAs).
Methods
Acromegaly patients with GH&PRL-PAs included in the ACRO-SPAIN study were enrolled. GH&PRL-PAs were defined as tumors with serum PRL levels above the upper limit of normal and positive immunostaining for GH and PRL, or with PRL levels ≥100 ng/mL when immunostaining data were not available.
Results
A total of 126 acromegaly patients with GH&PRL-PAs who underwent transsphenoidal pituitary surgery were included, and 42.1% (n = 53) were biochemically cured at the immediate postoperative evaluation. Knosp grade >2 (odds ratio (OR) 3.48, 95% CI 1.28–9.38), higher serum GH (OR 1.01, 95% CI 1.01–1.08) and IGF-1 (OR 1.60, 95% CI 1.05–2.45) levels were associated with a lower probability of surgical cure. Sixty-eight patients received first-line medical therapy as follows: fgSRLs in monotherapy (n = 22), fgSRL plus cabergoline (n = 37), cabergoline in monotherapy (n = 7) and pegvisomant in monotherapy (n = 2). Among the cases treated with fgSRL in monotherapy, 18.2% (n = 4/22) were resistant. We identified as predictors of fgSRL resistance (in monotherapy and combined with cabergoline) a Knosp grade >2 (OR 8.75, P = 0.003), high GH levels at acromegaly diagnosis (OR 1.02, P = 0.031) and higher postoperative GH levels (OR 1.05, P = 0.006), but no predictors of response to fgSRL in monotherapy were identified.
Conclusion
The clinical predictors of surgical failure and of fgSRL resistance in patients with GH&PRL-PAs are similar to those described in acromegaly without PRL, co-secretion.
Significance statement
In this article focused on GH&PRL pituitary adenomas, we found that a Knosp grade >2, and higher serum GH and IGF-1 levels were associated with a lower probability of surgical cure in these tumors. Regarding the response to fgSRL in monotherapy, 18% of the patients with GH&PRL pituitary adenomas were classified as resistant. Knosp grade >2 (OR 8.75, P = 0.003), high GH levels at acromegaly diagnosis (OR 1.02, P = 0.031), and higher postoperative GH levels (OR 1.05, P = 0.006) were predictors of non-response to fgSRL (monotherapy or combined with cabergoline), while no predictors of response to fgSRL in monotherapy were identified. Thus, we concluded the clinical predictors of surgical failure and of fgSRL resistance in patients with GH&PRL-PAs are similar to those described in acromegaly without PRL co-secretion.This work was funded by Sociedad Española de Endocrinología y Nutrición (SEEN): ‘Impacto de la co-secreción de prolactina en la expresión de marcadores moleculares y en la respuesta al tratamiento con análogos de somatostatina y agonistas dopaminérgicos en pacientes con acromegalia’