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BACKGROUND: Hyperprolactinaemia (HyperPRL) induced by psychotropic drugs is a high-prevalence consequence which has repercussions in psychical and mental health in the psychiatric population, so this research had the objective to expand which sociodemographic and clinical features are associated with prolactin (PRL) elevation in patients treated with antidepressant and/or antipsychotic drugs. METHODS: An observational, cross-sectional, comparative and retrolective study was conducted on 300 patients who received clinical attention in a third level of psychiatric care unit in Mexico during 2017. These patients have been reported to show PRL levels greater than 25 ng/mL among women and greater than 20 ng/mL among men. In the same way, sociodemographic and clinical variables were collected, as well as psychiatric diagnosis and type of psychopharmacological treatment used by the patients. RESULTS: HyperPRL was more frequent in women (80.7%) than men (19.3%). The mean levels of PRL were 68.94 ± 62.28 ng/mL with higher levels in women (71.9 ± 67.3, p=.02). Regarding the treatment, 78.3%, 71.3% and 49.7% consumed antipsychotics, antidepressants, and both drugs, respectively. The relationship between hyperPRL (>100 n/mL) and typical antipsychotics was dose-dependent (33.23 ± 13.24 mg, p=.01). In the multivariate regression models according to the type of treatment, as well as the demographic and clinical features, hyperPRL was associated independently with the use of antipsychotic treatment, pituitary adenoma and hypertension (R2=0.05). CONCLUSIONS: HyperPRL is a complex clinical syndrome frequent in the psychiatric population with detrimental long-term consequences, as well as its relationship with the use of psychotropic drugs as in the case of antipsychotics. Effective actions should be implemented in the prevention, approach and treatment of this condition paying special attention to the accompanying medical comorbidities.

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The measurement of circulating tumour markers (TMs) for the diagnosis or monitoring of breast cancer has sometimes been considered of limited utility. In addition to the overinterpretation of irrelevant changes in marker levels, the characteristics of the patient, the disease or other pathologies that can modify them are often not considered in their evaluation. On the other hand, there are recent data on the relationship of TMs with molecular subtypes and on their prognostic value, the knowledge of which may improve their clinical utility. This consensus article arises from a collaboration between the Spanish Society of Laboratory Medicine (SEQCML) and the Spanish Society of Medical Oncology (SEOM). It aims to improve the use and interpretation of circulating TMs in breast cancer. The text summarizes the current knowledge and available evidence on the subject and proposes a series of recommendations mainly focussed on the indication, the frequency of testing and the factors that should be considered for correctly interpreting changes in the levels of TMs.

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PURPOSE: The Spanish Society of Medical Oncology (SEOM) has carried out a study to analyse the conditions of access to oncology drugs in clinical practice in Spain. For the first time, the access of predictive biomarkers has also been analyzed. METHODS: A questionnaire was sent to 146 hospitals in Spain to collect information on the process of approval of 11 oncology drugs of an unquestionable clinical benefit and five predictive biomarkers of mandatory determination for specific treatments. RESULTS: Results highlight the still existing differences in the access of oncology drugs, as well as the newly identified differences in the access to predictive biomarkers between Autonomous Communities (AACC) in Spain, as well as between different hospitals within the same Autonomous Community. Conclusions The SEOM considers it necessary to reduce the differences identified, increase homogeneity, and improve conditions of access to oncology drugs and biomarkers, and makes proposals to address these issues.

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AIM: To define recommendations that permit safe management of antineoplastic medication, minimise medication errors and improve the safety of cancer patients undergoing treatment. METHODS: By reviewing the literature and consulting the websites of various health organisations and agencies, an expert committee from the Spanish Society of Hospital Pharmacy and the Spanish Society of Medical Oncology defined a set of safe practices covering all stages of providing cancer therapy to patients. The Spanish Society of Oncology Nursing revised and endorsed the final list. RESULTS: In total, 68 recommendations arranged in five sections were defined. They include issues concerning the training of health professionals, the technological resources needed, treatment planning, informing the patient and his/her family, the processes of prescribing, preparing, dispensing and administering cancer therapy (orally, parenterally or intrathecally), assessing patient adherence and treatment toxicity. CONCLUSIONS: It is essential for healthcare establishments to implement specific measures designed to prevent medication errors, in order to ensure the safety of cancer patients treated with antineoplastic medication.

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Febrile neutropenia (FN) is a common dose-limiting toxicity of chemotherapy, with a profound impact on the evolution of patients with cancer, due to the potential development of serious complications, mortality, delays, and decrease in treatment intensity. This article seeks to present an updated clinical guideline, with recommendations regarding the diagnosis, prevention, and treatment of febrile neutropenia in adults with solid tumors. The aspects covered include how to properly approach the risk of microbial resistances, epidemiological aspects, considerations about the initial empirical approach adapted to the risk, special situations, and prevention of complications. A decision-making algorithm is included for use in the emergency department based on a new, validated tool, the Clinical Index of Stable Febrile Neutropenia, which can be used in patients with solid tumors who appear stable in the initial phase of neutropenic infections, and can help detect those at high risk for complications in whom early discharge must be avoided.

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Breast cancer is the most common cancer in women in our country and it is usually diagnosed in the early and potentially curable stages. Nevertheless, around 20-30% of patients will relapse despite appropriate locoregional and systemic therapies. A better knowledge of this disease is improving our ability to select the most appropriate therapy for each patient with a recent diagnosis of an early stage breast cancer, minimizing unnecessary toxicities and improving long-term efficacy.

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Observational studies using registry data make it possible to compile quality information and can surpass clinical trials in some contexts. However, data heterogeneity, analytical complexity, and the diversity of aspects to be taken into account when interpreting results makes it easy for mistakes to be made and calls for mastery of statistical methodology. Some questionable research practices that include poor analytical data management are responsible for the low reproducibility of some results; yet, there is a paucity of information in the literature regarding specific statistical pitfalls of cancer studies. In addition to proposing how to avoid or solve them, this article seeks to expose ten common problematic situations in the analysis of cancer registries: convenience, dichotomization, stratification, regression to the mean, impact of sample size, competing risks, immortal time and survivor bias, management of missing values, and data dredging.

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AIM: To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology. METHODS: Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days. RESULTS: The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P = 0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events. CONCLUSIONS: Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.

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Despite the fact that thromboembolism is relatively common in oncology patients and that the interrelationship between thrombotic risk and specific mechanisms of tumorigenesis has long been known, many cardinal elements of prevention and treatment remain unresolved. Among the existing knowledge gaps, the need to validate the Ay scale and compare it to the Khorana index, develop, and standardize the use of predictive biomarkers for thrombotic risk, conduct clinical trials in thromboprophylaxis adapted to thrombotic risk, evaluate the efficacy and safety of direct anticoagulants, select patients who can benefit from anticoagulants for antitumor treatment, validate the EPIPHANY study decision tree to choose patients with low-risk pulmonary embolism, and accumulate more practical experience in special situations (rethrombosis, prolonged therapy beyond 6 months, etc.) are especially remarkable. These gray areas surrounding cancer-related thromboembolism explain why it continues to be a relatively common cause of serious events, at times interfering significantly with the development of new tumor-fighting strategies.

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Since its publication more than 15 years ago, the MASCC score has been internationally validated any number of times and recommended by most clinical practice guidelines for the management of febrile neutropenia (FN) around the world. We have used an empirical data-supported simulated scenario to demonstrate that, despite everything, the MASCC score is impractical as a basis for decision-making. A detailed analysis of reasons supporting the clinical irrelevance of this model is performed. First, seven of its eight variables are "innocent bystanders" that contribute little to selecting low-risk candidates for ambulatory management. Secondly, the training series was hardly representative of outpatients with solid tumors and low-risk FN. Finally, the simultaneous inclusion of key variables both in the model and in the outcome explains its successful validation in various series of patients. Alternative methods of prognostic classification, such as the Clinical Index of Stable Febrile Neutropenia, have been specifically validated for patients with solid tumors and should replace the MASCC model in situations of clinical uncertainty.

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INTRODUCTION: The Children Yale-Brown Obsessive- Compulsive Scale (CY-BOCS) constitutes a very good instrument for the evaluation of obsessive-compulsive disorder (OCD) symptoms, by a clinical interview administered to the patient and parent, that includes summary score of the clinician. OBJECTIVE: We are proposing a Spanish version of instrument, which is rated during a brief clinical interview to the parents and the patients. We are presenting data reliability and validity using two out-patient samples. METHODS: After the translation to Spanish, a back translation and adaptation to Spanish of the CY-BOCS, twenty eight out-patients (75 % male) with a mean age 12.1 (+/- 2.7) from two clinical settings on Mexico City evaluated. Reliability was evaluated by computing the internal consistency (Cronbach's alpha) on all interviews. assess interrater agreement, the interviews were videotaped and scored by three independent raters and all of them included both the child and the parent interview. The CY-BOCS total scored was correlated with the K-SADS-PL diagnosis. RESULTS: The CY-BOCS total score for all subjects was 16.5 +/- 9.8. Cronbach's alpha coefficient was 0.87; Pearson correlation of total CY-BOCS score with the K-SADS-PL diagnosis was 0.60 (p < or = 0.05). The intraclass correlations coefficients for the parents, youngsters and clinician 0.96, 0.94 and 0.92, respectively. CONCLUSIONS: The Spanish version of the CY-BOCS reliable and valid instrument, useful for both clinicians and researchers in child and adolescent OCD assessment.

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BACKGROUND: Osteoporosis (OP) and its fractures are a major problem due to their impact in morbidity and mortality in the elderly. Although this entity is well studied in other countries, OP and its fractures have not been evaluated carefully in our population. The objective was to assess risk factors for osteoporotic hip fracture in Mexicans. METHODS: A total of 295 subjects, 152 cases and 143 controls, were studied. Cases were patients with hip fracture, of both sexes and 45 years of age or older. Controls were healthy subjects who were in hospital waiting rooms accompanying patients without hip fractures. A questionnaire covering known possible risk factors for osteoporotic hip fracture was administered by the same evaluator to all subjects. Pelvic roentgenograms, anterior-posterior view, were obtained in both cases and controls to perform the Singh index and the cortical index of the femur. RESULTS: Fractures were present in (72.2%) of women. Weight and any alcohol ingestion were associated with an increased risk of hip fracture. The odds ratio (OR) for low weight by the Quetelet Index was 4.03 (95% CI 1.93-8.39) p < 0.001. Any alcohol intake was associated with an OR of 1.73 (95% CI 1.04-2.90) p < or = 0.03 for the total group, and 2.78 (95% CI 1.25-6.14) p < or = 0.003 for women. Controls had a significantly higher mean daily calcium intake compared to cases (mean, SD 575.9 +/- 297.2 vs. 490.4 +/- 245.5, p < or = (0.007). Family history, smoking, physical activity, pregnancies, breastfeeding or concomitant diseases were not associated with risk of hip fracture. CONCLUSIONS: This study confirmed the risk factors for osteoporotic hip fracture in Mexicans, previously shown for other ethnic groups. Further research in different factors, such as rate of bone turnover, anthropometric dimensions, and genetic studies (osteoporosis gene) are needed in order to define the differences among ethnic groups.

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Estudio comparativo realizado en la ciudad de México, en el que se analizan factores de riesgo para el desarrollo de osteopenia (OP) y la relación que existe entre OP y fracturas de la cadera. Las variables analizadas fueron: edad, sexo, peso, talla, hábitos de tabaquismo y alcoholismo, número de embarazos, lactancia, historia familiar de fracturas, actividad física, enfermedades intercurrentes y hábitos nutricionales relacionados con la ingestión de calcio. Se estudiaron 152 casos y 143 controles, lo que hace una muestra total de 295 individuos. Se aplicó un cuestionario por un encuestador único, en el que se integró acerca de los factores de riesgo comúnmente conocidos. Se utilizó como método de análisis estadístico la Chi cuadrada y la regresión logística. Los resultados más sobresalientes fueron los siguientes: 1)Las mujeres más viejas y menos pesadas tuvieron mayor riesgo de sufrir fracturas (R.R. 0.08). 2)El sobrepeso establece un menor riesgo de fracturas (R.R. 0.04). 3)No hubo diferencia (p < 0.05) entre las mujeres que amamantanron a sus hijos y las que no lo hicieron, asimismo tampoco hubo diferencias entre el número de embarazos y el amamantamiento a sus hijos. 4)El alcoholismo es un factor de riesgo importante (p < 0.05) para las fracturas. 5)Los grupos estudiados tuvieron una ingesta de soló tercio de la cantidad de calcio recomendado, y 6)Hubo una diferencia estadísticamente significativa de menor ingestión de calcio (p < 0.05) en favor de los casos

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