BackgroundOsteoarthritis (OA) is the most prevalent joint disease and the leading cause of disability from 60 years onwards. In fact, 14,8% of the Spanish population has OA.ObjectivesThis study aimed to analyze the indications and average doses prescribed in the treatment of knee osteoarthritis in Primary Care in Spain.MethodsThe EMARTRO study was designed as an observational, multicenter, transversal study to compare probability of suffering a comorbidities based on presence of symptomatic knee OA visited by GPs. Sociodemographic, anthropometric, clinical parameters and clinical variables of interest were recorded. The prescribed medications and doses indicated in syntomatic knee OA were analyzed in patients included in the EMARTRO study.ResultsA total of 1173 patients were included, of whom 646 had knee OA. Patients with OA had a mean (SD) BMI of 30.9 (5.1), systolic blood pressure 132.8 (14.5) and diastolic blood pressure 77.9 (9.1) mm Hg. They also had a mean of 4.3 (1.9) comorbidities, the most frequent were hypertension 358 (62.2%), dyslipidemia 336 (58.3%), diabetes mellitus II 126 (21.9%), and gastroesophageal reflux 110 (19.1%). As for the symptomatology, the patients presented a mean (SD) pain in Huskisson's VAS of 65.18 (15.27) mm and algofunctional Lequesne score of 11.35 (4.86).Patients were treated with a mean of 2,2 medications. The 45.5% of osteoarthritic patients were treated as monotherapy, 35.5% were taking 2 medications for osteoarthritis, 15.3% 3 and 3.7% 4 or more medications. It should be noted, taking into account the high levels of pain, that 15% of the patients did not receive any treatment.Regarding prescribed medications for knee OA, 378 (58.2%) patients were treated with paracetamol at a mean daily dose (SD) of 1,150.5 (1,815.5) mg; 232 (35.9%) received NSAIDs, with metamizole being the most prescribed at doses 1,092 (538) mg, ibuprofen at doses 1,136 (528,8) mg and naproxen at doses 941,8 (238,5) mg. Next, 131 (20.3%) patients were treated with opioids, tramadol being the most frequent at doses 102.7 (49.7) mg; 87 (13.3%) with SYSADOA being chondroitin sulphate the most frequent at doses 758.7 (247.7) mg. Finally, 87 (13.3%) of the patients were treated with COX-2, mainly with etoricoxib at doses of 69.3 (27.1) mg.ConclusionsAlthough the patients presented many concomitant pathologies, it is frequent to approach osteoarthritis in polytherapy. In addition, despite the high symptomatology, patients are treated primarily with a mild analgesic such as paracetamol at doses lower than those recommended. It is paradoxical the high prescription of NSAIDs in a population with a high prevalence of cardiovascular and gastrointestinal pathologies as well as an increase in the prescription of opioids.Disclosure of InterestM. Herrero Barbero Employee of: Bioiberica, S. Gimenez: None declared, J. Vergara: None declared, E. Viles I Lladό Employee of: Bioiberica, H. Martinez Employee of: Bioiberica, G. Rodríguez Roca: None declared, L. Sánchez Employee of: Bioiberica, J. A. Díaz Muñoz: None declared, ...
High-grade gliomas (HGG) are the most common primary brain malignancies and account for more than half of all malignant primary brain tumors. The new 2021 WHO classification divides adult HGG into four subtypes: grade 3 oligodendroglioma (1p/19 codeleted, IDH-mutant); grade 3 IDH-mutant astrocytoma; grade 4 IDH-mutant astrocytoma, and grade 4 IDH wild-type glioblastoma (GB). Radiotherapy (RT) and chemotherapy (CTX) are the current standard of care for patients with newly diagnosed HGG. Several clinically relevant molecular markers that assist in diagnosis and prognosis have recently been identified. The treatment for recurrent high-grade gliomas is not well defined and decision-making is usually based on prior strategies, as well as several clinical and radiological factors. Whereas the prognosis for GB is grim (5-year survival rate of 5–10%) outcomes for the other high-grade gliomas are typically better, depending on the molecular features of the tumor. The presence of neurological deficits and seizures can significantly impact quality of life.
All melanoma patients must be confirmed histologically and resected according to Breslow. Sentinel node biopsy must be done when tumor is over 1 mm or if less with high-risk factors. Adjuvant therapy with interferon must be offered for patients with high-risk melanoma and in selected cases radiotherapy can be added. Metastatic melanoma treatment is guided by mutational BRAF status. BRAF wild type patients must receive anti-PD1 therapy and BRAF mutated patients BRAF/MEK inhibitors or anti-PD1 therapy. Up to 10 years follow up is recommended for melanoma patients with dermatologic examinations and physical exams.
Although this was a heavily pretreated cohort, pembrolizumab activity at the approved dose and schedule was confirmed in the clinical setting with long-term responders, also including patients with brain metastases.
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