Uuskula A.,University of Tartu |
Raag M.,University of Tartu |
Folch C.,Institute catala dOncologia ICO |
Prasad L.,University of Porto |
And 6 more authors.
AIDS | Year: 2014
Aims: To describe HIV-related risk behaviours, HIV testing and HIV status among people who inject drugs (PWIDs) in the 2000 in European countries with highprevalence HIV epidemics among PWID. Methods: Data from 12 cross-sectional studies among PWID from seven countries were used. Meta-analysis was used to synthesize the data and meta-regression to explain heterogeneity [in addition to deriving adjusted odds ratios (AORmeta)]. Results: Data on 1791 PWID from western (the West) and 3537 from central and eastern (the East) European countries were available. The mean age of participating PWIDs was 30.6 years (SD 7.9), 75% were men, and 36% [95% confidence interval 34-37%) were HIV-infected (30% West, 38% East); 22% had not previously been tested for HIV. The prevalence of reported high-risk behaviour was significantly higher among PWID from the East. Comparison of HIV-infected and uninfected PWID within countries yielded similar results across all countries: HIV-infected PWID were less likely to be sexually active [AORmeta 0.69 (0.58-0.81)], reported less unprotected sex [AORmeta 0.59 (0.40-0.83)], but reported more syringe sharing [AORmeta 1.70 (1.30- 2.00)] and more frequent injecting [AORmeta 1.40 (1.20-1.70)] than their HIVuninfected counterparts. Conclusion: Despite the absolute differences in reported risk behaviours among PWID in western and eastern Europe, the associations of risk behaviours with HIV status were similar across the sites and regions. There is a substantial potential for further HIV transmission and acquisition based on the continuous risk behaviours reported. HIV prevention and harm reduction interventions targeting PWID should be evaluated. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Reggiori G.,IRCCS Instituto Clinico Humanitas |
Puxeu Vaque J.,Institute Catala dOncologia ICO |
Calle C.,Kantonsspital |
Scorsetti M.,IRCCS Instituto Clinico Humanitas |
And 2 more authors.
Medical Physics | Year: 2012
Purpose: Pretreatment quality assurance data from four centers, members of the European TrueBeam council were analyzed with different verification devices to assess reliability of flattening filter free beam delivery for intensity modulated radiotherapy (IMRT) and RapidArc (RA) techniques. Methods: TrueBeam® (Varian Medical System) is a new linear accelerator designed for delivering flattened, as well as flattening filter free beams. Pretreatment dosimetric validation of plan delivery was performed with different verification devices and responses to high dose rates were tested. Treatment planning was done in Eclipse planning system (PRO 8.9, AAA 8.9). evaluation was performed with (dose difference) 3 and (distance to agreement) 3 mm scoring the gamma agreement index (GAI, of field area passing the test). Two hundred and twenty-four patients with 1-6 lesions in various anatomical regions and dose per fraction ranging from 1.8 Gy to 25 Gy were included in the study; 88 were treated with 6 MV flattening filter free (X6FFF) beam energy and 136 with 10 MV flattening filter free (X10FFF) beam. Gafchromic films in solid water, delta4, arccheck, and matrixx phantom were used to verify the dose distributions. Additionally, point measurements were performed using a PinPoint chamber and a Farmer chamber. Results: Dose calculation as well as dose delivery was equally accurate for IMRT and RA delivery (IMRT: GAI 99.3 (±1.1); RA: GAI 98.8 (±1.1) as well as for the two beams evaluated (X6FFF: GAI 99.1 (±1.0); X10FFF: GAI 98.8 (±1.2). Only small differences were found for the four verification devices. A point dose verification was performed on 52 cases, obtaining a dose deviation of 0.34. The GAI variations with number of monitor units were statistically significant. Conclusions: The TrueBeam FFF modality, analyzed with a variety of verification devices and planned with Eclipse planning system is dosimetrically accurate (within the specified limits 3 mm/3) for both X6FFF and X10FFF beam energy. © 2012 American Association of Physicists in Medicine.
Climent M.A.,Instituto Valenciano Of Oncologia Ivo |
Piulats J.M.,Institute Catala dOncologia ICO |
Sanchez-Hernandez A.,Hospital Provincial Of Castellon |
Arranz J.A.,Hospital General Universitario Gregorio Maranon |
And 7 more authors.
Critical Reviews in Oncology/Hematology | Year: 2012
Prostate cancer is the most prevalent urogenital malignancy. However, despite initial disease control using androgen deprivation, most of patients eventually develop progressive disease that is resistant to further hormone manipulation. For these patients with castration-resistant prostate cancer (CRPC), and particularly patients with metastatic disease, options have been limited, and prognosis is grim. However, as newer regimens and agents become available, higher rates of objective and biochemical response are being achieved, providing renewed hope for the management of these patients. With the aim of facilitating the treatment of these patients, the Spanish Oncology Genitourinary Group (SOGUG) has issued a series of the recommendations which have been collected in this review. Each recommendation is accompanied by the appropriate level of evidence and grade of recommendation on the basis of the characteristics of the data available. © 2012 Elsevier Ireland Ltd.
Diez M.,Institute Salud Carlos III |
Oliva J.,Institute Salud Carlos III |
Sanchez F.,Institute Salud Carlos III |
Vives N.,Institute Catala dOncologia ICO |
And 3 more authors.
Gaceta Sanitaria | Year: 2012
Objective: To describe the incidence of new HIV diagnoses and its trend in Spain. Methods: All new HIV diagnoses notified to the case-registries of 15 autonomous regions (64% of the total Spanish population) in 2009 were analyzed. To evaluate trends from 2004 to 2009, data from only nine regions were available. Clinical-epidemiological data were obtained from the notification forms. Distributions of new HIV diagnoses and late diagnoses according to several variables were performed. The Poisson distribution was used to evaluate trends. Results: In 2009, 2264 new HIV diagnoses were notified, mostly in men (80%). The median age at diagnosis was 36 years (interquartile range 29-43) and 37.6% of affected individuals were immigrants, mostly from Latin-America and sub-Saharan Africa. The most common transmission category (42.5%) was men who have sex with men (MSM) followed by the heterosexual and parenteral modes of transmission (34.5% and 8.1%, respectively). The median CD4 count at diagnosis was 347 (interquartile range: 152-555), and CD4 count was <350 in 50.2% of patients. From 2004 to 2009, the mean incidence rate of new HIV diagnoses was 91.14 per million inhabitants; an increasing trend for rates in MSM, as well as a decreasing trend for the parenteral mode of transmission, were observed. Conclusions: In Spain, the epidemiology of HIV infection has changed since the mid-1990s. Currently, the most frequent transmission category is sexual transmission, particularly among MSM, and immigrants are an important part of the epidemic. Heterogeneous trends for the three main transmission categories were observed from 2004 to 2009. © 2011 SESPAS.
Segura P.P.,Hospital Clinico San Carlos |
Gil M.,Lhospitalet Of Llobregat |
Balana C.,Institute Catala dOncologia ICO |
Chacon I.,Hospital Virgen Of La Salud |
And 3 more authors.
Journal of Neuro-Oncology | Year: 2012
There is a current unmet medical need for treatment of leptomeningeal metastases (LMD). To analyze the efficacy and safety of systemic temozolomide (TMZ) for first-line treatment of patients with LMD associated with solid tumors, a phase II, non-randomized, multicenter, prospective study was conducted. The planned duration of treatment was a maximum of six cycles (24 weeks) or until unacceptable toxicity was reported. One cycle of oral TMZ (100 mg/m2 daily) consisted of one week on treatment/one week off treatment for four weeks. The study was stopped early because of poor accrual. Nineteen patients (median age 51(33-72); 32 % male) were enrolled. The LMD source was breast cancer (53 %) and non-small-cell lung cancer (37 %). Previous treatment was chemotherapy (100 %), surgery 74 %, radiotherapy 79 %, and hormone therapy 42 %. The average last dose of TMZ received by patients was 171 mg and only one patient required dose reduction. Three of 19 patients (15.8 %) had clinical benefit and 16 of 19 patients (84.2 %) progressed. Of the two patients completing the study (six cycles, 24 weeks), one had a partial response and the other stable disease. Median survival was 43 days (95 % CI 28.7-57.3); there were 18 deaths. Median TTP was 28 days (95 % CI 14-42). The most common adverse event was vomiting (52.6 %); nine patients (47.4 %) reported at least one serious adverse event but only one episode of thrombocytopenia was drug related. Median Karnofsky score remained at or above 70 % throughout the study, and was 75 % at the end of the study. First-line TMZ was well tolerated, and did not adversely affect the quality of life of patients with LMD. Future studies are needed to verify the efficacy results of this pilot trial. © 2012 Springer Science+Business Media, LLC.
PubMed | d Subdireccio General de Drogodependencies and Institute Catala dOncologia ICO
Type: Journal Article | Journal: AIDS care | Year: 2016
Including HCV and HIV rapid tests in harm reduction programmes (HRP) for people who inject drugs (PWID) can increase detection of these infections in high-risk populations who do not seek conventional health care.To assess acceptability and feasibility of rapid HIV and HCV tests in HRP; to identify HIV and HCV prevalence rates in HRP; to identify the percentage of PWID with a reactive test that attend hospital for confirmation and follow-up. Rapid oral tests for HCV and HIV were offered to users of 13 HRP from both mobile units and facility-based centres. A total of 172 HCV and 198 HIV tests were performed, with a refusal rate of 1.7% and 10.4%, respectively. Injectors made up 64.9% of all drug users and 35.1% did not inject drugs. Overall, 20.3% of HCV tests and 2.5% of HIV test were reactive. Only 24 of the 35 reactive HCV could be confirmed (68.6%) and one was false-negative. Of the five HIV reactive cases, only two could be confirmed (40%) with 1 false-positive case. Acceptability of rapid HIV and HCV tests among HRP users was high. The usefulness of oral rapid tests in HRP has been demonstrated, especially in mobile HRP.
Marin M.,Institute Catala dOncologia ICO |
Gudiol C.,Hospital Universitari Of Bellvitge |
Gudiol C.,Institute Salud Carlos IIII |
Ardanuy C.,Hospital Universitari Of Bellvitge |
And 7 more authors.
Clinical Microbiology and Infection | Year: 2015
The purpose of this study was to identify factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection (BSI). All episodes of BSI occurring in adult neutropenic patients with haematologic malignancies or solid tumours were prospectively recorded from January 2006 to December 2013. We analysed the factors influencing mortality in both groups of patients. We documented 602 consecutive episodes of BSI; 510 occurred in patients with haematologic malignancies and 92 in patients with solid tumours. The overall case-fatality rates were 12% and 36%, respectively. Independent risk factors associated with a higher case-fatality rate in patients with haematologic malignancies were: intensive care unit admission (odds ratio (OR), 15.2; 95% confidence interval (CI), 5.4-42.7), advanced neoplasm (OR, 8.7; 95% CI, 2.9-25.7), corticosteroid therapy (OR, 7.0; 95% CI, 3-16.4), multidrug-resistant Gram-negative BSI (OR, 3.8; 95% CI, 1.2-11.8) and a Multinational Association for Supportive Care in Cancer risk score of <21 (OR, 3.1; 95% CI, 1.3-7.4). By contrast, coagulase-negative staphylococci BSI (OR, 0.04; 95% CI, 0.004-0.5) and empirical antibiotic combination therapy (OR, 0.1; 95% CI, 0.05-0.3) were found to be protective. Independent risk factors for overall case-fatality rate in patients with solid tumours were: shock at presentation (OR, 14.3; 95% CI, 3.2-63.8), corticosteroid therapy (OR, 10; 95% CI, 2.3-44) and advanced neoplasm (OR, 7.8; 95% CI, 1.4-41.4). Prognostic factors identified in this study may help to detect those patients at higher risk of death in each group. Medical intervention addressing some of these factors might improve the outcome of BSI in neutropenic patients with haematologic malignancies or solid tumours. © 2015 European Society of Clinical Microbiology and Infectious Diseases.
PubMed | Hospital General Universitario Gregorio Maranon, Institute Catala dOncologia ICO, Hospital Universitario Of La Princesa and Medical Manager Takeda
Type: Journal Article | Journal: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico | Year: 2016
To ascertain the level of agreement and achieve a consensus among cancer pain specialists in Spain with regard to the optimal definition, diagnosis, and management of breakthrough cancer pain (BTcP).Two-round Delphi methodology survey (February-May 2013) using seven-point Likert scales (ranging from 1 strongly disagree to 7 strongly agree) was carried out. Mean scores >5 or <3 indicated, respectively, agreement or disagreement. Scores from 3 to 5 indicated no consensus.A total of 126 experienced specialists were surveyed. Response rates were 68% in round 1 and 90% in round 2. Agreement (mean Likert score) was strongest for the proposed BTcP definition (6.6), the use of oral (6.1), and intranasal (6.0) transmucosal fentanyl, the need for early assessment after BTcP treatment initiation, and the need to improve staff knowledge of BTcP. Broad agreement was also reached regarding the need to systematically screen all cancer patients for BTcP (5.9). Most respondents (82%) considered strong opioids to be appropriate treatment. In contrast, no consensus was reached regarding strong opioid treatment for baseline pain as a prerequisite for BTcP diagnosis.Consensus was strong for most treatment, and diagnostic aspects were evaluated in the study. However, several important issues remain unresolved, particularly whether the diagnostic criteria must include strong opioids for background pain. Nurses awareness and understanding of BTcP was considered insufficient, and more training is needed in this area. Overall, agreement among specialists was good, but more work is needed to better define the optimal diagnostic features and treatments for this condition.
Berdiel-Acer M.,Institute Catala dOncologia ICO |
Berdiel-Acer M.,Autonomous University of Barcelona |
Cuadras D.,Hospital Universitari Of Bellvitge Idibell |
Diaz-Maroto N.G.,Institute Catala dOncologia ICO |
And 8 more authors.
Molecular Cancer Research | Year: 2014
The differential gene expression patterns between normal colonic fibroblasts (NCF), carcinoma-associated fibroblasts from primary tumors (CAF-PT), and CAFs from hepatic metastasis (CAF-LM) are hypothesized to be useful for predicting relapse in primary tumors. A transcriptomic profile of NCF (n = 9), CAF-PT (n = 14), and CAF-LM (n = 11) was derived. Prediction Analysis of Microarrays (PAM) was used to obtain molecular details for each fibroblast class, and differentially expressed transcripts were used to classify patients according to recurrence status. A number of transcripts (n = 277) were common to all three types of fibroblasts and whose expression level was sequentially deregulated according to the transition: NCF → CAF-PT → CAF-LM. Importantly, the gene signature was able to accurately classify patients with primary tumors according to their prognosis. This capacity was exploited to obtain a refined 19-gene classifier that predicted recurrence with high accuracy in two independent datasets of patients with colorectal cancer and correlates with fibroblast migratory potential. The prognostic power of this genomic signature is strong evidence of the link between the tumor-stroma microenvironment and cancer progression. Furthermore, the 19-gene classifier was able to identify low-risk patients very accurately, which is of particular importance for stage II patients, who would benefit from the omission of chemotherapy, especially T4N0 patients, who are clinically classified as being at high risk. © 2014 American Association for Cancer Research.
PubMed | Institute Catala dOncologia ICO, University of Barcelona and Hospital Universitari Of Bellvitge
Type: Journal Article | Journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases | Year: 2015
The purpose of this study was to identify factors influencing mortality in neutropenic patients with haematologic malignancies or solid tumours with bloodstream infection (BSI). All episodes of BSI occurring in adult neutropenic patients with haematologic malignancies or solid tumours were prospectively recorded from January 2006 to December 2013. We analysed the factors influencing mortality in both groups of patients. We documented 602 consecutive episodes of BSI; 510 occurred in patients with haematologic malignancies and 92 in patients with solid tumours. The overall case-fatality rates were 12% and 36%, respectively. Independent risk factors associated with a higher case-fatality rate in patients with haematologic malignancies were: intensive care unit admission (odds ratio (OR), 15.2; 95% confidence interval (CI), 5.4-42.7), advanced neoplasm (OR, 8.7; 95% CI, 2.9-25.7), corticosteroid therapy (OR, 7.0; 95% CI, 3-16.4), multidrug-resistant Gram-negative BSI (OR, 3.8; 95% CI, 1.2-11.8) and a Multinational Association for Supportive Care in Cancer risk score of <21 (OR, 3.1; 95% CI, 1.3-7.4). By contrast, coagulase-negative staphylococci BSI (OR, 0.04; 95% CI, 0.004-0.5) and empirical antibiotic combination therapy (OR, 0.1; 95% CI, 0.05-0.3) were found to be protective. Independent risk factors for overall case-fatality rate in patients with solid tumours were: shock at presentation (OR, 14.3; 95% CI, 3.2-63.8), corticosteroid therapy (OR, 10; 95% CI, 2.3-44) and advanced neoplasm (OR, 7.8; 95% CI, 1.4-41.4). Prognostic factors identified in this study may help to detect those patients at higher risk of death in each group. Medical intervention addressing some of these factors might improve the outcome of BSI in neutropenic patients with haematologic malignancies or solid tumours.