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BACKGROUND: Merkel cell carcinoma (MCC) is an uncommon skin cancer that in more than 90 % of cases develops within the head and neck region. MCC is an aggressive disease with a dismal prognosis before the advent of immunotherapy. Avelumab, an anti-PDL1 agent is approved since 2017 for the treatment of advanced MCC after demonstrating a high response rate and favorable impact in survival. METHODS: Next generation sequencing (NGS) of the primary tumor biopsy from initial diagnosis (Foundation One CDx, Roche Diagnostics) as well as from plasma samples (Foundation One Liquid, Roche Diagnostics) obtained before and during treatment with avelumab were performed. RESULTS: We present the case of a patient with a metastatic MCC developing in the left parotid gland / pre-auricular area in an 80-year-old male with a long-lasting history of high UV exposure. After two cycles of avelumab 10 mg/kg/q2wk a near complete metabolic response and a major radiological response occurred in parallel to a brisk reduction in the ctDNA tumor fraction as well as variant-allele frequencies (VAFs) of all the mutations detected before the start of avelumab. CONCLUSION: Avelumab may achieve rapid and major responses in metastatic MCC. Our study demonstrates that ctDNA mirrors radiological responses and may serve as an ideal companion for diagnosis and disease monitoring in MCC.

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El odontólogo tiene un papel muy importante no solo en la detección precoz del cáncer oral, sino en el cuidado del paciente oncológico. Los tratamientos de quimioterapia y radioterapia producen efectos adversos en la cavidad oral, y el mantenimiento de la salud a ese nivel es esencial para prevenir y minimizar dichos efectos. Las complicaciones orales más comunes en pacientes con tratamiento oncológico son la mucositis, la hiposialia, las alteraciones del gusto, la osteonecrosis, el sangrado de la mucosa oral y las infecciones por inmunodepresión. El manejo de estas complicaciones comprende la identificación de la población de riesgo, el inicio de las intervenciones antes del tratamiento oncológico y el manejo oportuno de las lesiones provocadas por el mismo. Es imprescindible llevar a cabo una evaluación de la cavidad oral antes del tratamiento oncológico, realizando los tratamientos odontológicos que estén indicadas para así reducir las complicaciones durante y después del tratamiento antineo-plásico (AU)

The dentist has a very important role not only in the early detection of oral cancer, but also in the care of the oncological patient. Chemotherapy and radiotherapy treatments produce adverse effects in the oral cavity, and the maintenance of health at this level is essential to prevent and minimise these effects. The most common oral complications in patients with oncological treatment are mucositis, hyposalivation, taste alterations, osteonecrosis, bleeding of the oral mucosa and infections due to immuno-suppression. The management of these complications includes the identification of the population at risk, the commencement of interventions before the oncological treatment and the timely management of the lesions caused by it. It is essential to carry out an evaluation of the oral cavity before the oncological treatment, performing dental treatments that are indicated in order to reduce the complications during and after the antineoplastic treatment (AU)

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OBJECTIVE: This study aims to investigate the influence of estimated glomerular filtration rate (eGFR) with two equations (and by one or two separate measurements), on the prevalence of chronic kidney disease (CKD) and its association with blood pressure, and cardiovascular and metabolic risk factors. METHODS: Between January 2010 and October 2011, the Ibermutuamur CArdiovascular RIsk Assessment project included 128 588 workers (77.2% men, mean age 39.3 years, range 16-75), who underwent two consecutive yearly medical check-ups and had information for eGFR according to the MDRD-IDMS and CKD-EPI equations (serum creatinine was measured by a isotope-dilution mass spectrometry traceable method in a single central laboratory). CKD was defined by an eGFR less than 60 ml/min per 1.73 m. Subclinical (occult) renal disease was defined as an eGFR less than 60 ml/min per 1.73 m in patients with serum creatinine below 1.3 mg/dl and below 1.2 mg/dl in men and women, respectively. RESULTS: In this working population, prevalence of CKD was very low, but two to six times lower when two separate eGFRs below 60 ml/min per 1.73 m were used. The prevalence of CKD was significantly lower with the CKD-EPI compared to the MDRD-IDMS equation. The same applies to occult CKD. In male workers, occult CKD was practically nonexistent.Multivariate analyses show that blood pressure, total serum cholesterol, and serum glucose (positively), and high-density lipoprotein and low-density lipoprotein (negatively) were associated with CKD, with both equations. Another metabolic factor (waist circumference) was only associated (positively) with CKD defined by the CKD-EPI equation, which appears to be associated with most components of the metabolic syndrome. CONCLUSIONS: The CKD-EPI formula, calculated on the basis of two reported blood samples, may provide the most specific definition of CKD.

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AIM: To study the prevalence, risk factors, and vascular disease associated with moderate and severe hypertriglyceridemia in an active working population. DESIGN AND METHODS: Cross-sectional study of 594,701 workers from all Spanish geographical areas, occupation sectors, ages, and sexes who underwent a yearly routine checkup. Data collected from participants included age, sex, anthropometric measurements, vascular risk factors, lipidic profile and basic biochemical analysis, from a fasting blood sample. A cardiovascular risk assessment was performed. RESULTS: The study population included 428,334 males and 166,367 females, mean age 36+/-10 years. A total of 95,673 (16%) workers had mild hypertriglyceridemia (HTg) (Tg 150-399mg/dL), 7,081 (1.1%) had moderate HTg (400-999mg/dL), and 224 (0.03%) had severe HTg (>or=1000mg/dL). Of workers with hypertriglyceridemia, 90% were male. Age, obesity, type 1 and 2 diabetes, alcohol consumption, and vascular disease were associated with hypertriglyceridemia. Cardiovascular risk gradually increased for each HTg category. Amongst risk factors, the major independent predictor of mild-HTg was obesity (OR 2.42, CI 95% 2.37-2.48), whereas diabetes was a predictor of moderate HTg (OR 3.64, CI 95% 3.17-4.18) and severe HTg (OR 7.35, CI 95% 4.27-12.66). In multivariate analyses, HTg was gradually associated with vascular disease, even after adjusting for other risk factors. CONCLUSION: In this working population, preventive programs for HTg and associated vascular disease should consider obesity-diabetes control as its first objective.

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OBJECTIVE: To investigate the prevalence of metabolic syndrome in the Spanish working population and determine how the prevalence varies according to occupation and sex. RESEARCH DESIGN AND METHODS: This was a cross-sectional study of 259,014 workers (mean age 36.4 years, range [16-74]; 72.9% male) who underwent a routine medical checkup. The Adult Treatment Panel III (2001) definition for metabolic syndrome was used. RESULTS: The prevalence of metabolic syndrome was 11.6% (95% CI 11.5-11.7) in male subjects and 4.1% (4.0-4.2) in female subjects and increased with age. The prevalence of metabolic syndrome varied in the different categories of occupational activity depending on the sex considered. Among female subjects, the age-adjusted prevalence of metabolic syndrome was higher in blue-collar than in white-collar workers, but this difference was not evident among male workers. CONCLUSIONS: The prevalence of metabolic syndrome varies in the different categories of occupational activity in the Spanish working population. This variation also depends on sex.

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INTRODUCTION AND OBJECTIVES: The routine medical check-up provides a good opportunity for screening workers early for cardiovascular risk factors. The aim of the present study was to investigate the prevalence of cardiovascular risk factors in the Spanish working population. METHODS: The study included 216 914 working people (mean age 36.4 years, range 16-74 years, 73.1% male) undergoing routine medical check-up, which involved a structured questionnaire, physical examination, and standard serum biochemical analysis. RESULTS: Cardiovascular disease had been diagnosed previously in 0.7% of workers, hypertension in 6.2%, diabetes in 1.2%, and dyslipidemia in 8.9%. Routine check-up showed that 49.3% (51.3% of males and 43.8% of females) were smokers, 22.1% (27.0% of males and 8.8% of females) had high blood pressure (< or =140/90 mm Hg), 15.5% (18.3% of males and 13.3% of females) were obese (body mass index > or =30), 6.2% (7.8% of males and 1.9% of females) were hyperglycemic (blood glucose >110 mg/dL), and 64.2% had dyslipidemia (total cholesterol > or =200 mg/dL, LDL cholesterol > or =160 mg/dL, triglycerides > or =200 mg/dL, or HDL cholesterol < 40 mg/dL in males or < 50 mg/dL in females). When compared with workers in the service sector and after adjustment for potential confounders, workers in manufacturing, and particularly those in construction, had higher prevalences of both high blood pressure and smoking. CONCLUSIONS: The prevalence of cardiovascular risk factors in the Spanish working population is high, particularly in males and in certain types of employment.

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Introducción y objetivos. Los reconocimientos de la salud de los trabajadores constituyen una oportunidad de detección precoz de factores de riesgo vascular. El presente estudio investiga la prevalencia de factores de riesgo vascular en la población laboral española. Métodos. Se incluyó a 216.914 trabajadores (edad media, 36,4 años; intervalo, 16-74 años; el 73,1% eran varones) en los que se realizó un reconocimiento en una mutua laboral, que incluyó un cuestionario estructurado, una exploración física y determinaciones bioquímicas. Resultados. Tenían diagnóstico previo de enfermedad cardiovascular el 0,7%, de hipertensión arterial el 6,2%, de diabetes el 1,2% y de dislipidemia el 8,9%. Durante el reconocimiento se detectó la presencia de tabaquismo en el 49,3% (el 51,3% varones y el 43,8% mujeres), presión arterial elevada (≥ 140/90 mmHg) en el 22,1% (el 27,0% varones y el 8,8% mujeres), obesidad (índice de masa corporal ≥ 30) en el 15,5% (el 18,3% varones y el 13,3% mujeres), hiperglucemia (> 110 mg/dl) en el 6,2% (el 7,8% varones y el 1,9% mujeres) y alguna forma de dislipidemia (colesterol total ≥ 200 mg/dl, cLDL ≥ 160 mg/dl, triglicéridos ≥ 200 mg/dl o cHDL < 40 mg/dl en varones o < 50 mg/dl en mujeres) en el 64,2%. Con respecto al sector «servicios», y tras ajustar por factores de confusión, los trabajadores del sector industria y sobre todo de la construcción mostraron una mayor prevalencia de elevación de la presión arterial y, especialmente, de tabaquismo. Conclusiones. Hay una alta prevalencia de factores de riesgo en la población laboral española, especialmente en varones y en determinados sectores de actividad (AU)

Introduction and objectives. The routine medical check-up provides a good opportunity for screening workers early for cardiovascular risk factors. The aim of the present study was to investigate the prevalence of cardiovascular risk factors in the Spanish working population. Methods. The study included 216 914 working people (mean age 36.4 years, range 16-74 years, 73.1% male) undergoing routine medical check-up, which involved a structured questionnaire, physical examination, and standard serum biochemical analysis. Results. Cardiovascular disease had been diagnosed previously in 0.7% of workers, hypertension in 6.2%, diabetes in 1.2%, and dyslipidemia in 8.9%. Routine check-up showed that 49.3% (51.3% of males and 43.8% of females) were smokers, 22.1% (27.0% of males and 8.8% of females) had high blood pressure (≥140/90 mm Hg), 15.5% (18.3% of males and 13.3% of females) were obese (body mass index ≥30), 6.2% (7.8% of males and 1.9% of females) were hyperglycemic (blood glucose >110 mg/dL), and 64.2% had dyslipidemia (total cholesterol ≥200 mg/dL, LDL cholesterol ≥160 mg/dL, triglycerides ≥200 mg/dL, or HDL cholesterol <40 mg/dL in males or <50 mg/dL in females). When compared with workers in the service sector and after adjustment for potential confounders, workers in manufacturing, and particularly those in construction, had higher prevalences of both high blood pressure and smoking. Conclusions. The prevalence of cardiovascular risk factors in the Spanish working population is high, particularly in males and in certain types of employment (AU)

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