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BackgroundSodium-glucose co-transporter 2 (SGLT2) inhibitors are used in patients with type-2 diabetes (T2DM), either alone or in combination with other anti-diabetic drugs, when these medicines together with exercise and diet do not provide adequate control of the diabetes. Dapagliflozin, empagliflozin and canagliflozin are the three SGLT2 inhibitors approved by the European Medicines Agency. SGLT2 inhibitors are associated with a significantly higher risk of recurrent genital and urinary tract infections (UTIs) than placebo and other active anti-diabetics, which may cause treatment discontinuations.PurposeTo evaluate SGLT2 inhibitors’ discontinuation due to recurrent UTIs, in patients with T2DM.Material and methodsA 1 year retrospective, observational study was performed. Patients with an active prescription of SGLT2 during the first 6 months of the study period were selected. Patients that interrupted SGLT2 treatment during the following 6 months were included in our study. The following data was collected: sex, age, cause of discontinuation, antibiotic and/or antifungal drugs prescribed for UTIs and duration of SGLT2 treatment.ResultsSix hundred and ninety-one patients with an SGLT2 inhibitor prescription were selected, of which 17 patients (2.5%) interrupted SGLT2 treatment due to recurrent UTIs during the study period, were included in our study. Median treatment duration was 8.8 (2.2–13) months. Ten patients (58.8%) received dapaglyfozin, five patients (29.4%) empaglyfozin and two patients(11.8%) canaglifozyn. Eighty-two per cent (14) of the patients were females: mean age 63. Thirty patients interrupted treatment: 17 (2.5%) because of recurrent UTIs, 13 (2%) because of other medication-related problems. Eight patients had urinary infections, seven patients genital infections and two patients had both genital and urinary infections. UTIs were not specifically monitored during clinical trials. The only available data showed a treatment interruption in 0.7% of the patients who had been treated with canaglifozine. In our study, canaglifozine was interrupted due to UTIs in 1.6% (2/123) of the patients, dapaglifozine in 2.8% (10/351) and empaglifozine in 2.3% (5/217). Only one patient had had previous UTIs. 76.47% (13) of the patients needed antibiotic/antifungal prescriptions: 38.5% (5) fosfomycin, 23.1% (3) ciprofloxacyn, 30.8% (4) clotrimazole, 7.7% (1) fluconazole and 7.7% (1) clindamycin.ConclusionPatients in treatment with SGLT2 inhibitors have an increased risk of UTIs. Recurrent UTIs significantly impair quality of life. Personal history of UTIs should be considered before initiating SGLT2 inhibitors.No conflict of interest

BackgroundIt is considered that 30% to 50% of antibiotic prescriptions in the Emergency Department (ED) are inappropriate. Urinary tract infections (UTI) are one of the most commonly diagnosed infections in the ED.PurposeTo assess the appropriateness of antibiotic prescriptions for UTI in the ED of a tertiary hospital.Material and methodsObservational, retrospective study which included patients who attended the ED, during November 2016, with an antibiotic prescription and an UTI discharge diagnosis. To assess the appropriateness of antibiotic prescriptions, they were compared to local empirical antibiotic treatment guidelines. Data were collected from the medical records of patients.ResultsOne hundred and eighty-four antibiotic prescriptions for UTI were included, representing 27.2% (676) of all antibiotics prescribed during the period of study. One hundred and thirty-eight females (75%), mean age 45.8±20.3. Patients’ diagnoses were: 61.4% (113) acute or recurrent lower UTI in females, 17.4% (32) UTI in males, 13% (24) pyelonephritis, 5.4% (10) catheter-related infections, 2.2% (four) prostatitis and 0.5% (one) bacteriuria.Prescribed antibiotics were: 32.1% (59) fosfomycin trometamol, 20.7% (38) ciprofloxacin, 14.1% (26) amoxicillin/clavulanate, 6.5% (12) cefixime, 5.8% (10) cefuroxime, 5.4% (10) calcium fosfomycin, 4.9% (nine) norfloxacyn, 4.3% (eight), cefditoren, 2.7% (five) levofloxacin, 2.2% (four) amoxicillin, 1.1% (two) asymptomatic ceftibuten and 0.5% (one) doxycycline.In 90.8% (167) of the prescriptions, the use of an antibiotic drug was indicated. When indicated, an appropriate antibiotic was selected in 61.7% (103/167) of the prescriptions, with an appropriate dosage and duration of antibiotic treatment in 77.7% (80/103) and 68% (70/103) of the prescriptions, respectively.In 16.3% (30) and 39.7% (73) of the analysed episodes, patients required previous or subsequent medical assistance (Emergency Department, ambulatory care and hospitalisation) for UTI, respectively.ConclusionOur results show a low appropriateness of antibiotic prescriptions mainly due to an incorrect selection of the antibiotic, dosage and duration. There is also an overuse of broad spectrum antibiotics: amoxicillin/clavulanate and ciprofloxacin. More than one-third of the patients needed subsequent medical assistance.Adherence to local empirical antibiotic treatment guidelines for UTI treatment should be enhanced, as the basis of a series of strategies to optimise antibiotic prescriptions in this area.No conflict of interest

This document describes the technique and technology currently used to apply cryosurgery, a technic based on low temperatures for medical purposes that allows the controlled destruction of pathological cells and tissues. Cryosurgery is an effective and innocuous process that is painless, safe and economical, applied to multiple specialities in which it provides alternatives to its traditional methods. A search was carried out for articles and bibliographic reviews referring to Cryosurgery and from whose information this technical note was obtained. Research on the application of Cryosurgery presents solid evidence of its benefits. Therefore, it has been used in several countries and health campaigns, showing excellent results, so it is advisable to implement it in health systems.

Background and importance Ibrutinib treatment has been associated with the development of unwanted cardiovascular (CV) and bleeding events, which may lead to the loss of a line of treatment in patients with so few therapeutic options. Aim and objectives The objective of this study was to evaluate the rate of events related to cardiovascular toxicity during treatment with ibrutinib. Material and methods Observational, retrospective study carried out between July 2015 and September 2021, which included all patients treated with ibrutinib. Clinical and demographic variables: age at the start of treatment, sex, diagnosis, previous therapeutic lines, duration of treatment, death, dose reduction and suspension of treatment. Previous CV risk factors were recorded: diabetes mellitus (DM), arterial hypertension (AHT), dyslipidaemia; and the underlying CV pathologies: heart failure (HF), atrial fibrillation (AF), ventricular tachyarrhythmia (VT). The appearance of new CV events related to ibrutinib treatment was recorded: AF, HF, VT, AHT and bleeding events. The rates of their appearance were calculated, excluding patients who had been treated for a period of less than 6 months.Results A total of 66 patients were included (median age 72.7 (47-90) years, 68.2% men). 75.8% suffered from chronic lymphocytic leukaemia, 10.6% from mantle cell leukaemia, 12.1% from Waldenstrom macroglobulinemia and non-Hodgkin lymphoma as off-label use. 34.8% first-line treatment, 33.3% second-line, 15.1% third-line, 10.6% fourth-line, 6.1% fifth and subsequent lines. The mean duration of treatment was 22.6 [7.3-80.2] months. 63.6% keep the treatment going, 21.2% progressed and 15.5% died during treatment. 37.9% (25) did not have any risk factor at the beginning of the treatment, 22.7% (15) had two basic risk factors, and 10.6% (7) had three risk factors. 9.1% (6) had underlying CV pathology. During treatment, 34.8% (23) of patients developed some CV episode associated with ibrutinib use: 13.6% (9) AHT, 12.1% (8) AF, 7.6% (5) bleeding events, 1.5% (1) HF and 1.5% (1) VT. The dose was reduced in 2 patients and ibrutinib was suspended in 2 patients (3%). Conclusion and relevanceThis study shows that 65% of patients do not develop any type of cardiovascular toxicity. Only a small percentage of patients need a dose reduction or suspension of treatment due to cardiovascular adverse events, requiring a multidisciplinary approach in the proper management of the drug.