Systematic review of efficacy and safety of pemetrexed in non-small-cell-lung cancer

Introduction Lung cancer accounts for 20 % of cancer deaths in Spain. The most frequent subtype (87 %) is non-small cell lung cancer (NSCLC). Pemetrexed is a recently marketed drug added to NSCLC therapeutic arsenal. It seems to have become one of the most used options for the treatment of this condition over the last 3 years. Aim of the review To evaluate the efficacy and safety of pemetrexed in NSCLC, in the different therapy lines. Method A systematic search of published literature was conducted using the main databases (MEDLINE, EMBASE, the Cochrane Library and the Center for Reviews and Dissemination) and subsequently a search of referenced literature was performed. We included clinical trials, meta-analyses and systematic reviews. The evaluation of the quality of the articles was performed by pairs using specific assessment scales, Critical Appraisal Skills Program (CASP) adapted for CASP Spain. Then we extracted data on efficacy and safety according to the treatment line assessed. Results We identified 277 references. Finally, nine clinical trials and a meta-analysis complied with inclusion criteria. In first-line induction, treatment with pemetrexed associated with a platinum was similar in terms of efficacy to other alternative chemotherapy regimens, except in patients with non-squamous histology, in whom survival was higher in the experimental group. In maintenance treatment, greater efficacy was seen with pemetrexed in patients with non-squamous histology. In second-line treatment, there were no significant differences in terms of efficacy and safety for pemetrexed treatment versus other chemotherapy options. The most frequent adverse reactions were: hematological, gastrointestinal and neurological. All were significantly less frequent with pemetrexed versus other alternative therapies, except for liver toxicity. Conclusions Due to the high degree of uncertainty as to its efficacy in certain subgroups of patients, including conflicting data; to its recent incorporation, and therefore lack of safety data in the medium and long term, and the high budgetary impact of its incorporation into health systems, it seems reasonable to optimize its use, identifying those patients who may benefit most.     

Association of gray matter volumes with general and specific dimensions of psychopathology in children

Childhood is an important time for the manifestation of psychopathology. Psychopathology is characterized by considerable comorbidity which is mirrored in the underlying neural correlates of psychopathology. Both common and dissociable variations in brain volume have been found across multiple mental disorders in adult and youth samples. However, the majority of these studies used samples with broad age ranges which may obscure developmental differences. The current study examines associations between regional gray matter volumes (GMV) and psychopathology in a large sample of children with a narrowly defined age range. We used data from 9607 children 9–10 years of age collected as part of the Adolescent Brain Cognitive Development^SM Study (ABCD Study^®). A bifactor model identified a general psychopathology factor that reflects common variance across disorders and specific factors representing internalizing symptoms, ADHD symptoms, and conduct problems. Brain volume was acquired using 3T MRI. After correction for multiple testing, structural equation modeling revealed nearly global inverse associations between regional GMVs and general psychopathology and conduct problems, with associations also found for ADHD symptoms (p_fdr-values ≤ 0.048). Age, sex, and race were included as covariates. Sensitivity analyses including total GMV or intracranial volume (ICV) as covariates support this global association, as a large majority of region-specific results became nonsignificant. Sensitivity analyses including income, parental education, and medication use as additional covariates demonstrate largely convergent results. These findings suggest that globally smaller GMVs are a nonspecific risk factor for general psychopathology, and possibly for conduct problems and ADHD as well.Subject terms: Human behaviour, Risk factors, Neuroscience     

Calidad de vida en personas con depresión y comorbilidad física desde una perspectiva de género

ObjetivoEl objetivo del estudio es describir la percepción de la calidad de vida relacionada con la salud de personas con depresión y comorbilidad física bajo una perspectiva de género. Se incluyeron 380 individuos mayores de 49 años con, al menos, una patología de las siguientes: diabetes, enfermedad obstructiva pulmonar crónica y cardiopatía isquémica, reclutadas en 31 equipos de atención primaria de Cataluña. La calidad de vida se midió con la escala EuroQol (EQ-5D). Además, se recogieron variables sociodemográficas, gravedad de depresión, índice de privación económica y ámbito de residencia. Se evaluó la relación ajustada entre el sexo y las dimensiones de calidad de vida, mediante una regresión logística multivariante.ResultadosEl 81,3% fueron mujeres; la media de edad fue de 68,4 años (DE: 8,8), La media de la escala visual analógica fue de 57,8 (DE: 17,4) en hombres y 55,8 (DE: 18,6) en mujeres. La media del EQ-Health Index fue de 0,74 (DE: 0,17) en hombres y 0,65 (DE: 0,21) en mujeres (p = 0,001). La probabilidad de presentar problemas en las dimensiones del EQ-5D mostró el sexo como factor de más peso (mujer = 1/hombre = 0) en: autocuidado OR: 2,29 (IC 95% 1,04 a 5,07) y actividades cotidianas OR: 3,09 (IC 95% 1,67 a 5,71). La movilidad se asoció con la edad OR: 1,87 (IC 95% 1,22 a 2,86), el ámbito de residencia con el dolor OR: 2,51 (IC 95% 1,18 a 5,34) y el Beck Depression Inventory (BDI) con la ansiedad/depresión OR: 4,77 (IC 95% 1,77 a 12,88).ConclusiónLa percepción en la calidad de vida de las mujeres con depresión y comorbilidad física es inferior a la de los hombres, siendo en ambos casos inferior a la de población general.Palabras clave: Calidad de vida, Depresión, Comorbilidad física, Género, Atención Primaria     

Digital thoracic drainage: a new system to monitor air leaks in pediatric population

Introduction

New digital thoracic drainage systems allow an objective measurement of air leakage. They have proven their usefulness in the postoperative thoracic surgery in adults, but there is little experience with its use in the pediatric population. The objective of our study is to analyze their safety and effectiveness in the postoperative period of the pediatric patients.