RESUMO
PURPOSE: Biomarkers as screening for precision medicine is a fundamental step. The purpose of this article is twofold. First, to highlight the existing barriers in the implementation of Precision Medicine in Spain, with a special emphasis on barriers in access to the determination of biomarkers. Second, to provide a Roadmap that can help implement Precision Medicine equitably at the national level and optimize the use of biomarkers. METHODS: A systematic review of literature (SRL) and a focus group (FG) with multidisciplinary experts has been carried out in 2023. Participants were contacted individually, and discourse analysis was processed anonymously. RESULTS: We carried out a quantitative (SRL) and a qualitative approach (FG). The discourse analysis and roadmap were sent individually to each expert for approval. CONCLUSIONS: The potential of Precision Medicine has not been fulfilled in Spain. While several regional initiatives are in place, a national plan or strategy around Precision Medicine and use of biomarkers is lacking. In a general context of rapid progress at a global and European level, including the 2021 Europe's Beating Cancer Plan, it is time to define and implement a National Plan to make the promise come true. While some comparable countries within Europe - such as the UK or France - are mature enough to adopt such strategies, in Spain there is still a long way to go. We consider that the different strands of work outlined in the Roadmap can be used as basis for such purpose.
Assuntos
Biomarcadores Tumorais , Oncologia , Neoplasias , Medicina de Precisão , Humanos , Espanha , Biomarcadores Tumorais/análise , Neoplasias/diagnóstico , Grupos FocaisRESUMO
In Peru, new cases of asymptomatic HCV infection are reported with certain frequency in patients with or without antecedents of blood transfusion. Although serologic screening has improved notoriously in the last years, there is still a population of polytransfused patients with high HCV risk (e.g. hemodialyzed patients), making up a major reservoir. Based on this premise, we decided to study the risk of the health worker population in Peru as another major HCV risk group. A total of 2,769 health workers from 7 Public Hospitals and 2 Private Hospitals in the City of Lima and from 7 Public Hospitals in 4 major/main cities of Peru (Chiclayo, Trujillo, Arequipa, and Cusco) were studied. All those workers, who due to their area of work had higher contact with blood and/or blood derivatives (Surgery, ICU, Traumatology, Gynecology, Gastroenterology, Hemodialysis and Laboratories-Blood Banks) were studied. The studied population accounts for 30% of the total health worker population in these services. All serums underwent the EIA-3 test (HCV-Cobas-Core, Lab. Roche, USA). The positive results were confirmed by RT-HCV (Ampiclor, Roche). The positive serums were confirmed by PCR and the positive results with high viral load underwent HCV genotyping (AMPICLOR-Roche Diagnostic, IGEN Diagnostic USA). Of the 2,769 health workers studied in Peru, 32 were positive for HCV antibodies (1.16% of the total number). Lima showed a prevalence slightly higher than the provinces: 26 out of 2,112 vs. 6 out of 657, or 1.23% vs. 0.91%, respectively. The higher risk is assumed by professional with higher level of contact with blood: 2 physicians (Hemodialysis), 5 nurses (HD) and Lab-Blood Bank technicians. The physicians and nurses share the same risk. If we segregate Lima from provinces, it can be seen that the highest risk is in Lima (1.34% compared to 1.07% in provinces). There is a major risk in health workers and the figures are slightly above those that were suspected for Peru (between 0.4 and 1.0). Finally, we can conclude that the group with the highest HCV risk among health workers is the group specialized in hemodialysis, followed by laboratory (1.79%), surgery (1.40%), and gastroenterology (0.8%). This is the first report at national level of HCV sero-prevalence in Peru.
Assuntos
Hepatite C/epidemiologia , Recursos Humanos em Hospital , Adolescente , Adulto , Idoso , Portador Sadio , Feminino , Gastroenterologia , Genótipo , Unidades Hospitalares de Hemodiálise , Hepacivirus/genética , Anticorpos Anti-Hepatite C/análise , Humanos , Técnicas Imunoenzimáticas , Laboratórios , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Reação em Cadeia da Polimerase , Fatores de Risco , Estudos Soroepidemiológicos , Centro Cirúrgico HospitalarRESUMO
Partiendo de la importancia que la Organización Mundial de la Salud y el Centro para el Control de las Enfermedades le atribuyen a la protección de los trabajadores de la salud contra la hepattis viral tipo B (VHB), en 1993 el Instituto Peruano del Seguro Social (hoy ESSALUD), orientó la vacunación del personal de riesgo en los 4 hospitales nacionales, mediante la vacuna cubana Heberbiovac HB (20 mg, esquema 0-1-2 meses). El propósito fue evaluar la persistencia de los anticuerpos en los vacunados después de 6 años de la inmunización y la posible existencia de marcadores de infección por el virus B. Se estudiaron los sueros de 144 trabajadores de la salud, para una cobertura de 70,24 % en relación con los seroprotegidos en el estudio inicial. Para la detección de los marcadores en el suero se emplearon métodos inmunoenzimáticos comerciales. El AgsHB y el anti-AgcHB fueron negativos en todas las muestras serológicas, por lo que se afirmó que en ninguno de los vacunados hubo evidencias de infección por este virus. El anti-AgsHB fue positivo, todos presentaban seroconversión, con seroprotección e hiperrespuesta de 91,6 y 43,7 %, respectivamente. El tiempo de vida media del anti-AgsHB (t ½) es de 3 años, se pronosticó que los niveles de anticuerpos serían superiores a 10 UI/L hasta después de 15 años de finalizado el esquema. Los menores de 40 años tuvieron niveles de seroprotección e hiperrespuesta significativamente mayores; las mujeres se mantuvieron en categorías de respuesta superiores. Se recomendó evaluar la memoria pos-refuerzo en los casos de seroconversión, no seroprotegidos, y extender el trabajo con ESSALUD a otros hospitales del país.
On the basis of the importance given by the Health World Organization and the Disease Control Center to the protection of health workers against viral hepatitis B(HBV), the Peruvian Institute of Social Security(presently ESSALUD) instructed in 1993 the vaccination of health personnel at risk in 4 national hospitals by using the Cuban vaccine called Herberbiovac HB(20 mg, 0,1,and 2 month schedule). The purpose was to evaluate the persistence of antibodies in the immunized workers six years after the immunization program and the possible presence of HB virus infection markers. Sera from 144 health workers were studied covering 70.24% of seroprotected subjects in comparison with seroprotected subjects in the initial study. Conventional immunoenzymatic methods were used to detect markers in the serum, HbsAg and antibodies to HbcAg were negative in all the serological samples, an outcome that showed that any of the vaccinated persons had traces of HB virus infection. The anti-HbsAg was positive, seroconversion was 100% whereas seroprotection and hyperesponse amounted to 91.6 and 43.7% respectively. The mean lifetime of anti-HbsAg is 3 years but it was predicted that the levels of antibodies would reach over 10 UI/L after 15 years of the vaccination schedule completion. Subjects aged under 40 years had significantly higher levels of seroprotection and hyperesponse, being females those in the higher response categories. The evaluation of the post-vaccination reinforcement immunological response in seroconverted non-seroprotected cases and the extension of the work with ESSALUD to other hospitals in the country were recommended.
RESUMO
Este estudio fué realizado en los trabajadores de una fundición que estaban expuestos, entre otros contaminantes atmosféricos, principalmente a humos de plomo. Entre 1,468 trabajadores observados, se encontró 138 casos de plumbismo, 3 de los cuales tenían sólo 30 días de trabajo. Los resultados más importantes del estudio clínico y de laboratorio en los 138 casos de plumbismo fueron: dolor abdominal (61.6%), cefalea (42.0%), debilidad (33.3%), vómitos (18.8%), ribete de Burton (56.5%), ictericia (42.0%), palidez (41.3%), hiperreflexia (21.0%), disminución de la fuerza muscular (15.9%) . Del estudio comparado con un grupo patrón de 100 trabajadores no expuestos a humos de plomo y sanos al examen médico, se ha encontrado disminución significante en la hemoglobina, hematocrito, y hematíes de los individuos con plumbismo. La media aritmética de plomo en sangre total fué de 0. 162 mgrs. por 100 grs. y de 0.507 mgrs. por litro de orina, en muestras de 100 cc. Existen trabajadores intoxicados por plomo, con incapacidad potencial, desempeñando sus ocupaciones.
This study was made ina smelter foundry where the workers were exposed to Jead fumes and other atmospheric contaminants. It was found that 138 of 1,468 individuals examined had lead poisoning. Three of the positive cases were in persons who had been working in the smelter only a month . The most important findings encountered in the above mentioned cases were: abdominal pains (61.6%), headache (42.0%), generalized weakness (33.3%), emesis (18.8%), lead line (56.5%), jaundice (42.0%), pallor (41.3%), hyperactive reflexes (21.0%), and loss of muscular strength (15.9%). In comparison wíth a control group of 100 healthy workers not exposed to lead fumes, it was observed that there existed a significant reduction in hemoglobin, hematocrit and erythrocyte among individuals with lead poisoning. The average lead content of whole blood was found to be 0.162 mgrs./100 grs., and 0.507 mgrs. of lead per liter of urine. In this study 138 unsuspected cases of lead poisoning were found in employees who were at work in the smelter.