Hospital General Universitario Gregorio Marañón

About: Hospital General Universitario Gregorio Marañón is a healthcare organization based out in Madrid, Spain. It is known for research contribution in the topics: Population & Transplantation. The organization has 11975 authors who have published 12386 publications receiving 244847 citations.

A candidate gene study of capecitabine-related toxicity in colorectal cancer identifies new toxicity variants at DPYD and a putative role for ENOSF1 rather than TYMS

Abstract: Conclusions: DPYD harbours rare and common capecitabine toxicity variants. The toxicity polymorphism in the TYMS region may actually act through ENOSF1.

COVID-19 infection in children and adolescents with cancer in Madrid.

Abstract: To the Editor: The incidence of COVID-19 is remarkably less in the pediatric population than in the adult population, with children accounting for 1-5% of diagnosed cases,1-3 0.8% in Madrid.4 Although children with cancer are considered a high-risk population, data specifically addressing the pediatric oncology population are still limited.3,5 We present a case series of all pediatric oncology patients infected with COVID-19 in Madrid to date to provide updated epidemiological data and to describe the most relevant clinical features and outcomes. All pediatric oncology patients (0-18 years) with proven infection of COVID-19 inMadrid up toApril 15, 2020were identified and included. Approval was obtained by the local Ethics Committee. The total number of current pediatric oncology patients in the Madrid region was estimated through 2015-2019 data from the Madrid Tumor Registry “RTMAD.”6 The main patient (n = 15) characteristics are shown in Table 1. Median agewas 10.6 years (range 0.6-18.6). The cancer types included hematological malignancies (73%, 11) and solid tumors (27%, four). Four patients (27%) had received hematopoietic stem cell transplantation (median interval to COVID-19 infection: 209 days, range 113749). Most patients (60%, nine) had received chemotherapy in the 15 days prior to the COVID-19 infection. Chemotherapy had to be interrupted or delayed in six (40%). Seven (47%) patientswere hospitalized due to the COVID-19 infection, four (27%) were already hospitalized (nosocomial infection), and four (27%) were managed in the outpatient clinic. The most frequent symptoms were fever (67%, 10) and cough (40%, six). Two patients were asymptomatic. Chest radiographs were performed inmost patients (93%, 14), with pathological findings in 57% (8/14). Noteworthy laboratory findings includedmedianwhite blood cell count at diagnosis of 3195 (range 9010 690), median lymphocyte count of 580 (range 0-6310), and median D-dimer 291 ng/mL (range 0.7-2620). Most patients received hydroxychloroquine (73%, 11), three of them in different combinations (including azithromycin, tocilizumab, lopinavir-ritonavir, corticoids, remdesivir; Table 1). Four (29%) patients did not receive any treatment.NoCOVID-19 treatment-related severe adverse events were identified. Two patients required oxygen therapy (nasal cannula, <2 LPM), one of them still requiring support. All patients presented favorable clinical outcomes so far, although four of them remained hospitalized. Themedian hospital stay due to the infection was 8 days (range 3-26). Given that the estimated total number of pediatric oncology patients in theMadrid region is 1140, we observed a COVID-19 infection rate of 1.3% among this patient population over the first 2months of the pandemic. This study is particularly relevant for several reasons. First, it presents all pediatric oncology patients infected with COVID-19 in Madrid, one of the epicenters of the pandemic. Second, it provides an accurate estimation of the real incidence for this patient population, as both the total number of susceptible patients and the total number of infected patients are well known. For the former, the robustness of the local tumor registry (RTMAD)was the key; for the latter, the well-established collaboration network among pediatric oncologists in Madrid enabled the identificationof all infectedpatients. Furthermore, the fact that children with cancer are considered high-risk patients for the COVID-19 infection leads to thorough and repeated testing in this population, even in asymptomatic patients. This is not the case for the general pediatric population, as most healthy children are not being tested for COVID-19 unless they require hospitalization. Hence, we believe the accuracy of the calculated infection prevalence among pediatric oncology patients to be notably reliable, as opposed to estimations in the general pediatric population or in other subpopulations. Additionally, all patients were tested by polymerase chain reaction, which continues to be the gold standard and, in our opinion, should not be substituted by rapid serology-based testing in the pediatric oncology population.7 The COVID-19 infection prevalence among adult cancer patients has been reported to be higher than in the general population (1% vs 0.29%).8 No robust data exist to date regarding the infection prevalence in pediatric cancer patients. In our series, the estimated 1.3% is difficult to compare with the general pediatric population, estimated 0.8% inMadrid,4 since the latter is likely to be underestimated. In spite of these limitations, the incidence seems higher in children and adolescents with cancer. A worrisome finding is the high proportion of patients (27%) that presentedwith nosocomial infection. The infection rates of health care professionals in Spain have been among the highest in the world,9,10 whichmay explain the proportion of nosocomial infection. The clinical, radiological, and laboratory findings are similar to previously published data for the general pediatric population.1,3 Although there is no solid evidence for the treatment of the COVID19 infection beyond support therapy in children with cancer, hydroxychloroquine was the most frequently used drug in our series, with a good safety profile. Remarkably, all patients had favorable outcomes so

Early resolution of Ogilvie's syndrome with intravenous neostigmine : A simple, effective treatment

Abstract: PURPOSE: Our aim was to assess the value of a parasympathomimetic drug (neostigmine) in the early resolution of acute colonic pseudo-obstruction (Ogilvie's syndrome). METHODS: A prospective study was undertaken in 18 consecutive patients (mean age, 76 (range, 31–87) years) with acute colonic pseudo-obstruction. After a varying period of conservative treatment in all cases, 16 patients with persistent, massive abdominal distention were given intravenous neostigmine. RESULTS: A rapid and satisfactory clinical and radiologic decompression of the large bowel was obtained in 12 patients (75 percent) after a single dose of the drug; another patient had complete resolution after a second dose, and the other 3 patients had only partial resolution, in one of them after a second dose of the drug. No patient required surgical decompression of the bowel. CONCLUSION: These results give support to the theory of excessive parasympathetic suppression in most cases of Ogilvie's syndrome. The treatment with intravenous neostigmine has proved very effective, preventing in many cases prolonged periods of uncomfortable and potentially hazardous conventional conservative management and avoiding surgical treatment in a consecutive series of patients.

Mechanisms of Residual Lumen Stenosis After High-Pressure Stent Implantation A Quantitative Coronary Angiography and Intravascular Ultrasound Study

Abstract: Background —Intravascular ultrasound (IVUS) studies have demonstrated that stents are frequently suboptimally expanded despite the use of high pressures for deployment. The purpose of this study was to identify the mechanisms responsible for such residual lumen stenosis. Methods and Results —Fifty-seven lesions from 50 patients treated with high-pressure (median±interquartile range, 14±2 atm) elective (44 de novo, 13 restenotic lesions) stenting were prospectively studied (29 Wiktor, Medtronic; 28 Palmaz-Schatz, Cordis Corp). Balloon subexpansion was calculated as the difference between maximal and minimal balloon cross-sectional areas at peak pressure measured by automatic edge detection; elastic recoil was calculated as the difference between minimal measured balloon size and IVUS-derived minimal lumen area within the stent. Angiographic residual diameter stenosis was 10±13% (reference diameter, 3.1±0.7 mm; balloon to artery ratio, 1.12±0.23) and IVUS-derived stent expansion was 80±28%. However, although balloon nominal size was 9.6±1.3 mm[2][1] and maximal balloon size measured inside the coronary lumen was 12.5±3.2 mm2, final stent minimal lumen area was only 7.1±2.2 mm2. Balloon subexpansion of 4.0±1.8 mm[2][1] (33%) and elastic recoil of 1.6±2.3 mm[2][1] (20%) (both P <0.0001) were the two mechanisms responsible for residual luminal stenosis. Wiktor stent and peak inflation pressure correlated with balloon subexpansion, whereas Wiktor stent, de novo lesion, and minimal lumen area at baseline correlated with elastic recoil. Conclusions —Despite high-pressure deployment, lumen dimensions after stenting are only 57% of maximal achievable. Inadequate balloon expansion and elastic recoil are responsible for residual lumen stenosis, suggesting that plaque characteristics and stent resistance deserve further investigation. [1]: #ref-2