Clara Martín-Ontiyuelo

The acquisition of driver mutations in non-tumoral cells appears to be very important during the carcinogenesis of adenocarcinoma (ADC). Recent studies suggest that cancer-related mutations may not necessarily be present only in malignant cells, but also in histologically “healthy cells”.Objective: to demonstrate the presence of EGFR or KRAS mutations in non-tumoral lung cells in subjects with ADC and negative mutational status.Results: mutations in EGFR or KRAS oncogenes were identified in the normal lung in 9.7% of the subjects. Exon 21 substitution L858R in EGFR was detected in two cases while the exon 19 deletion E746-A750 in the EGFR, the G12C and G12D substitutions in the KRAS were detected once. One patient presented three different mutations in the normal lung parenchyma (EGFR_L858R, KRAS_G12C and KRAS_G12D). The negative-mutation status of the tumor and the mutations detected in the “normal lung” were confirmed using highly sensitive and specific TaqMan PCR (CAST-PCR). No differences were found in terms of progression, progression-free survival or overall survival during the 18 months follow-up.Conclusions: These results confirm the presence of driver mutations in the histologically normal lung parenchyma cells in the absence of mutations coexisting with the primary tumor.

Background The intravenous administration of antibiotics remains the route of choice at patient admission. Although the early-oral switch once the clinical stability has been achieved, has demonstrated to be effective and safe in other settings, its implementation in the pneumology ward has not been studied. Purpose To assess the effectiveness and safety of an early-oral antimicrobial switch protocol in the pulmonology ward. Material and methods Quasi-experimental study performed in a 400-bed tertiary hospital. The protocol was implemented in March 2018 and therefore two groups were identified: intervention group (March to August 2018) and control group (March to August 2017). All patients admitted to the pneumology ward were treated with intravenous antibiotics that, in turn, were available orally: therefore, amoxicillin/clavulanate, fluoroquinolones, trimethoprim-sulfamethoxazole, clindamycin and azithromycin were included. Results A total of 200 patients were included. Main clinical outcomes are summarised in table 1. Conclusion The implementation of an early-oral antimicrobial switch protocol in the pneumology ward is effective and safe. The early-oral antibiotic switch could decrease the days of catheterisation and the potential related adverse outcomes, with a shortening in the length of stay. References and/or acknowledgements None. No conflict of interest.

There is evidence that iron plays a key role in the adequate functioning of skeletal muscle. While it has been demonstrated that nonanemic iron deficiency (NAID) affects exercise tolerance and response to exercise training in patients with COPD, the impact on daily physical activities (DPAs) remains unknown. Eighteen COPD patients with NAID (ferritin PP6 hours) was higher in patients with NAID compared with controls (73% vs 37%, P3 metabolic equivalents of task, at least 30 minutes) was lower in this group (66% vs 100%, P<0.05). The presence of iron deficiency was associated with reduced DPA in COPD patients. Further studies are needed to evaluate iron reposition and their impact on the level of physical activity in these patients.

BACKGROUND METHODS More than 60% of patients with lung cancer are diagnosed at advanced stages. The introduction of targeted therapies requires molecular diagnosis to guide treatment. The aim of this study was to evaluate the feasibility of performing mutational analysis with brushing specimens obtained by radial-miniprobe endobronchial ultrasound (R-EBUS) plus fluoroscopy-guided bronchoscopy in patients with peripheral pulmonary adenocarcinoma. Brushing specimens were deposited on cytological slides and were conserved in Roswell Park Memorial Institute (RPMI) culture medium. DNA was isolated to perform a mutational analysis with real-time quantitative polymerase chain reaction and Sanger sequencing for epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene homolog (KRAS). RESULTS CONCLUSIONS Thirty patients with adenocarcinoma were prospectively included. In 100% of the patients, the molecular study was viable with brushing specimens. In 16 (53.3%), KRAS or EGFR mutations were detected: 10 KRAS mutations (33.3%) and 6 EGFR mutations (20%). In a comparison with histological samples, a correlation of 86.6% was detected, and only 2 patients with wild-type results from brushing specimens presented with an EGFR mutation in histological samples. Brushing specimens conserved in RPMI medium and obtained by R-EBUS plus fluoroscopy-guided bronchoscopy are valid for molecular studies. They allow the detection of EGFR/KRAS mutations in patients with peripheral adenocarcinoma. In addition, invasive techniques are avoided, the risk of complications is reduced, and the obtained samples are optimized.

Background The incidence of Enterococcus faecium infections has increased over the past years and is currently the third major microorganism implicated in nosocomial bacteraemia. Nevertheless, the best treatment available is yet to be established, especially in vancomycin-susceptible E. faecium. In this setting, a correct dosage is essential, as inappropriate dosage has been associated with a higher risk of treatment failure. Purpose Our objective was to describe the dosage adequacy of antibiotics used in the treatment of E. faecium bacteraemia. Material and methods Retrospective observational study performed in a 400-bed university teaching hospital from June 2011 to June 2016. Patients with E. faecium isolation from at least one positive blood culture were included. Dosage adequacy was assessed by infectious-diseases-trained pharmacists, who reviewed antimicrobial prescriptions daily and recommended an appropriate dose adjustment in the first 24 to 72 hours of treatment. Inappropriate dosage was considered if it was out of therapeutic range according to plasmatic levels when available, or if an adjustment was needed according to weight or renal function (based on John Hopkins antibiotic guide and data sheet). Categorical variables were presented as percentages and continuous variables as mean (±SD). Seventy patients were included Sixty (85.7%) males, 17 (24.3%) critically ill, mean age 69.8 (±13.5) years. Thirty (42.3%) patients received an inappropriate dosage, 19 (63.3%) of them were underdosed. Conclusion Almost 43% of patients were inappropriately dosed in E. faecium bacteraemia, mainly because of underdosing. These data demonstrate the large proportion of inappropriate doses, which highlights the importance of an adequate review of medication and therapeutic drug monitoring in order to assure efficacy and prevent toxicities. No conflict of interest

Background: Vertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known. Objective: To assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF. Methods: Clinical characteristics and quality care indicators were assessed in two one-year periods, one retrospective (exploratory) and one prospective (validation), in all consecutive patients hospitalized for ECOPD. Diagnosis of VCF was based on the reduction of >20% height of the vertebral body evaluated in standard lateral chest X-ray (three independent observers). Results: From the 248 patients admitted during the exploratory phase, a third had at least one VCF. Underdiagnosis rate was 97.6%, and patients with VCF had more admissions (normalized for survival), longer hospital stays, and higher mortality than patients without (4 [25th–75th percentiles, 2–8] vs 3 [1–6] admissions, PP PPConclusion: Although VCF is frequently underdiagnosed in patients hospitalized for ECOPD, it is strongly associated with a worse prognosis and quality care outcomes.