Single-cell mutation analysis of clonal evolution in myeloid malignancies.

Myeloid malignancies, including acute myeloid leukaemia (AML), arise from the expansion of haematopoietic stem and progenitor cells that acquire somatic mutations. Bulk molecular profiling has suggested that mutations are acquired in a stepwise fashion: mutant genes with high variant allele frequencies appear early in leukaemogenesis, and mutations with lower variant allele frequencies are thought to be acquired later1-3. Although bulk sequencing can provide information about leukaemia biology and prognosis, it cannot distinguish which mutations occur in the same clone(s), accurately measure clonal complexity, or definitively elucidate the order of mutations. To delineate the clonal framework of myeloid malignancies, we performed single-cell mutational profiling on 146 samples from 123 patients. Here we show that AML is dominated by a small number of clones, which frequently harbour co-occurring mutations in epigenetic regulators. Conversely, mutations in signalling genes often occur more than once in distinct subclones, consistent with increasing clonal diversity. We mapped clonal trajectories for each sample and uncovered combinations of mutations that synergized to promote clonal expansion and dominance. Finally, we combined protein expression with mutational analysis to map somatic genotype and clonal architecture with immunophenotype. Our findings provide insights into the pathogenesis of myeloid transformation and how clonal complexity evolves with disease progression.

A Community Health Worker Intervention for Diabetes Self-Management Among the Tz'utujil Maya of Guatemala.

Despite the high prevalence of diabetes in rural Guatemala, there is little education in diabetes self-management, particularly among the indigenous population. To address this need, a culturally relevant education intervention for diabetic patients was developed and implemented in two rural communities in Guatemala. An evaluative research project was designed to investigate if the structured, community-led diabetes self-management intervention improved selected health outcomes for participants. A one-group, pretest-posttest design was used to evaluate the effectiveness of the educational intervention by comparing measures of health, knowledge, and behavior in patients pre- and postintervention. A survey instrument assessed health beliefs and practices and hemoglobin A1c (HgA1c) measured blood glucose levels at baseline and 4 months post initiation of intervention (n = 52). There was a significant decrease (1.2%) in the main outcome measure, mean HgA1c from baseline (10.1%) and follow-up (8.9%; p = .001). Other survey findings were not statistically significant. This study illustrates that a culturally specific, diabetes self-management program led by community health workers may reduce HgA1c levels in rural populations of Guatemala. However, as a random sample was not feasible for this study, this finding should be interpreted with caution. Limitations unique to the setting and patient population are discussed in this article.

Non-viral expression of chimeric antigen receptors with multiplex gene editing in primary T cells.

Efficient engineering of T cells to express exogenous tumor-targeting receptors such as chimeric antigen receptors (CARs) or T-cell receptors (TCRs) is a key requirement of effective adoptive cell therapy for cancer. Genome editing technologies, such as CRISPR/Cas9, can further alter the functional characteristics of therapeutic T cells through the knockout of genes of interest while knocking in synthetic receptors that can recognize cancer cells. Performing multiple rounds of gene transfer with precise genome editing, termed multiplexing, remains a key challenge, especially for non-viral delivery platforms. Here, we demonstrate the efficient production of primary human T cells incorporating the knockout of three clinically relevant genes (B2M, TRAC, and PD1) along with the non-viral transfection of a CAR targeting disialoganglioside GD2. Multiplexed knockout results in high on-target deletion for all three genes, with low off-target editing and chromosome alterations. Incorporating non-viral delivery to knock in a GD2-CAR resulted in a TRAC-B2M-PD1-deficient GD2 CAR T-cell product with a central memory cell phenotype and high cytotoxicity against GD2-expressing neuroblastoma target cells. Multiplexed gene-editing with non-viral delivery by CRISPR/Cas9 is feasible and safe, with a high potential for rapid and efficient manufacturing of highly potent allogeneic CAR T-cell products.

Development and validation of an infrared-artificial intelligence software for breast cancer detection.

Aim: In countries where access to mammography equipment and skilled personnel is limited, most breast cancer (BC) cases are detected in locally advanced stages. Infrared breast thermography is recognized as an adjunctive technique for the detection of BC due to its advantages such as safety (by not emitting ionizing radiation nor applying any stress to the breast), portability, and low cost. Improved by advanced computational analytics techniques, infrared thermography could be a valuable complementary screening technique to detect BC at early stages. In this work, an infrared-artificial intelligence (AI) software was developed and evaluated to help physicians to identify potential BC cases. Methods: Several AI algorithms were developed and evaluated, which were learned from a proprietary database of 2,700 patients, with BC cases that were confirmed through mammography, ultrasound, and biopsy. Following by evaluation of the algorithms, the best AI algorithm (infrared-AI software) was submitted to a clinic validation process in which its ability to detect BC was compared to mammography evaluations in a double-blind test. Results: The infrared-AI software demonstrated efficiency values of 94.87% sensitivity, 72.26% specificity, 30.08% positive predictive value (PPV), and 99.12% negative predictive value (NPV), whereas the reference mammography evaluation reached 100% sensitivity, 97.10% specificity, 81.25% PPV, and 100% NPV. Conclusions: The infrared-AI software here developed shows high BC sensitivity (94.87%) and high NPV (99.12%). Therefore, it is proposed as a complementary screening tool for BC.

High-Dimensional Immunophenotyping with 37-Color Panel Using Full-Spectrum Cytometry.

A comprehensive study of the cellular components of the immune system demands both deep and broad immunophenotyping of numerous cell subsets in an effective and practical way. Novel full-spectrum technology reveals the complete emission spectrum of each dye maximizing the amount of information that can be obtained on a single sample regarding conventional flow cytometry and provide an expanded knowledge of biological processes. In this chapter, we describe a 37-color protocol that allows to identify more than 45 different cell populations on whole blood samples of SARS-CoV-2-infected patients.

Implementation of clinical practice guidelines for the timely detection and diagnosis of eating disorders in adolescents and adults in the outpatient and priority department of a public psychiatric hospital in Colombia. / Implementación de una guía de práctica clínica para la detección oportuna y el diagnóstico de trastornos de la conducta alimentaria en adolescentes y adultos en el servicio de consulta externa y prioritaria de un hospital mental público de Colombia.

OBJECTIVE: To implement clinical practice guidelines (CPGs) for the timely detection and diagnosis of eating disorders in adolescents and adults in the priority outpatient department of a public psychiatric hospital in Barranquilla, Colombia. Barriers to access to the implemented guidelines were identified. METHODS: For the identification of evidence-based CPGs to be implemented, systematic searches were carried out in international databases of development agencies or compilers of clinical practice guidelines, and in databases that contained scientific literature on issues related to eating disorders. CONCLUSIONS: The two guidelines shortlisted for the final selection by consensus of a multidisciplinary team at the hospital were the "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders" and the "Guía de práctica clínica sobre trastornos de la conducta alimentaria de Catalunya", the latter being finally chosen by consensus. There are not yet CPGs implemented for health professionals in the priority outpatient department of Colombian hospitals for eating disorders.

XPG mRNA expression levels modulate prognosis in resected non-small-cell lung cancer in conjunction with BRCA1 and ERCC1 expression.

BACKGROUND: Molecular markers can help identify patients with early-stage non-small-cell lung cancer (NSCLC) with a high risk of relapse. Excision repair cross-complementing 1 (ERCC1), Xeroderma pigmentosum group G (XPG), and breast cancer 1 (BRCA1) are involved in DNA damage repair, whereas ribonucleotide reductase M1 (RRM1) is implicated in DNA synthesis. Expression levels of these molecules might therefore have a prognostic role in lung cancer. PATIENTS AND METHODS: We examined ERCC1, RRM1, XPG, and BRCA1 mRNA levels by real-time quantitative polymerase chain reaction in 54 patients with stage IB-IIB resected NSCLC. A strong correlation was observed between the 4 genes. RESULTS: For patients with low BRCA1, regardless of XPG mRNA expression levels, disease-free survival (DFS) was not reached. For patients with intermediate/high BRCA1 and high XPG, DFS was 50.7 months. However, for patients with intermediate/high BRCA1 and low/intermediate XPG, DFS decreased to 16.3 months (P = .002). Similar differences were observed in overall survival, with median survival not reached for patients with low BRCA1, regardless of XPG levels, or for patients with intermediate/high BRCA1 and high XPG. Conversely, for patients with intermediate/high BRCA1 levels and low/intermediate XPG levels, median survival dropped to 25.5 months (P = .007). CONCLUSION: BRCA1 and XPG were identified as independent prognostic factors for both median survival and DFS. High BRCA1 mRNA expression confers poor prognosis in early NSCLC, and the combination of high BRCA1 and low XPG expression still further increases the risk of shorter survival. These findings can help optimize the customization of adjuvant chemotherapy.

Three-gene expression signature predicts survival in early-stage squamous cell carcinoma of the lung.

PURPOSE: Adjuvant treatment may improve survival in early-stage squamous cell carcinoma (SCC) of the lung; however, the absolute gain is modest and mainly limited to stage II-IIIA. Current staging methods are imprecise indications of prognosis, but high-risk patients can be identified by gene expression profiling and considered for adjuvant therapy. EXPERIMENTAL DESIGN: The expression of 29 genes was assessed by reverse transcriptase quantitative PCR in frozen primary tumor specimens obtained from 66 SCC patients who had undergone surgical resection. Expression values were dichotomized using the median as a cutoff value. We used a risk score to develop a gene expression model for the prediction of survival. RESULTS: The univariate analysis of gene expression in the training cohort identified 10 genes with significant prognostic value: CSF1, EGFR, CA IX, PH4, KIAA0974, ANLN, VEGFC, NTRK1, FN1, and INR1. In the multivariate Cox model, CSF1 (hazard ratio, 3.5; P = 0.005), EGFR (hazard ratio, 2.7; P = 0.02), CA IX (hazard ratio, 0.2; P < 0.0001), and tumor size >4 cm (hazard ratio, 2.7; P = 0.02) emerged as significant markers for survival. The high prognostic value of a risk score based on the expression of the three genes (CSF1, EGFR, and CA IX) was positively validated in a separate cohort of 26 patients in an independent laboratory (P = 0.05). CONCLUSIONS: The three-gene signature is strongly associated with prognosis in early-stage SCC. Positive independent validation suggests its suitability for selecting SCC patients with an increased risk of death who might benefit from adjuvant treatment.

Perfil de los adultos mayores institucionalizados en relación de las variables biopsicosociales y clínicas en América Latina

El envejecimiento es la consecuencia de daños moleculares y celulares a través del tiempo; se caracteriza por su diversidad factorial debido a que elementos ambientales, sociales, protectores y agresores presentes en el individuo a lo largo de su vida se interrelacionan y se asocian a cambios y transiciones los cuales generan un descenso gradual de capacidades físicas-psíquicas de este, que causa la aparición de necesidades en el adulto mayor, que muchas veces no pueden ser suplidas por su círculo familiar ni social. En este caso, la institucionalización se presenta como un conjunto de requisitos que pueden surgir del sujeto desde el momento en que ingresa a la vejez. La presente es una revisión de la literatura existente que tuvo como. Objetivo: identificar cada uno de los factores epidemiológicos, sociodemográficos, clínicos, psicosociales y de calidad de vida del adulto mayor institucionalizado. Por ello, se abordan definiciones, conceptos y epidemiología de la situación actual del envejecimiento mundial, factores asociados a la institucionalización de adultos mayores; sus patologías más comunes, la funcionalidad y el grado de dependencia, su importancia y los instrumentos para su medición, entre otros, así como el impacto en su calidad de vida. Se ha encontrado que los adultos mayores experimentan cambios biopsicosociales durante este período, que dependen de su estilo de vida, sistemas sociales y familiares, y que afectan continuamente sus diferentes áreas de funcionamiento, pierden su autonomía, alteran su calidad de vida y su percepción de esta.

Aging is the consequence of molecular and cellular damage over time; it is characterized by its factorial diversity due to environmental elements, social, protective and aggressors present in the individual throughout his life are interrelated and associated with changes and transitions which generate a gradual decrease in physical-psychic capacities of this, which causes the appearance of needs in the elderly, which often cannot be supplied by their family or social circle. In this case, institutionalization is presented as a possible recourse to the demands that arise in the subject from his entry into the senescence. The present is a review of the existing literature that aimed to identify each of the epidemiological, sociodemographic, clinical, psychosocial and quality of life factors of the institutionalized elderly. Therefore, it addresses definitions, concepts and epidemiology of the current situation of global aging, factors associated with the institutionalization of older adults; their most common pathologies, functionality and degree of dependence, their importance and the instruments for their measurement, among others, as well as the impact on their quality of life. It is concluded that older adults in this period experience biopsychosocial changes that depend on lifestyle, social and family system and continuously influence its various areas of operation, loss of autonomy, that alters your quality of life and your perception of it.

Prevalencia de complicaciones en pacientes mastectomizadas por cáncer de mama

Introducción: la mujer de hoy exige una cirugía lo más efectiva, segura y estética posible. Objetivo: determinar la prevalencia de las complicaciones posquirúrgicas en pacientes mastectomizadas por cáncer de mama. Materiales y métodos: se realizó un estudio cuantitativo, observacional y descriptivo en un universo de 137 pacientes sometidas a mastectomía, por cáncer de mama comprobado histológicamente, en 2019, en los hospitales General Provincial Carlos Manuel de Céspedes y Clínico Quirúrgico Docente Celia Sánchez Manduley, de Granma. Se evaluaron las variables edad, extensión de la mastectomía, lateralidad, aparición de complicaciones, tipo de complicación, estadio tumoral y diagnóstico histológico. Resultados: la media de edad de las pacientes mastectomizadas fue de 56,53 años, y la mastectomía radical modificada fue el proceder quirúrgico más realizado (76 mamas). La incidencia de complicaciones fue del 52,17 % (1,24 % intraoperatoria), siendo la complicación de mayor prevalencia el linfedema (29,63 %). En relación con el tipo histológico, el carcinoma ductal infiltrante sin especificar (77,54 %) fue el más frecuente, y con los estadios tumorales, el IIIB (22,46 %) y el IV (22,46 %) fueron los de mayor prevalencia. La incidencia de las complicaciones aumentó en la medida en que se elevó el estadio tumoral. Conclusiones: la incidencia de las complicaciones posquirúrgicas en la mastectomía fue elevada, relacionándose con el estadio tumoral.

Introduction: today's woman demands the most effective, secure and esthetic surgery possible. Objective: to determine the prevalence of post-surgery complications in patients mastectomized by breast cancer Materials and methods: a quantitative, observational and descriptive study was carried out in a universe of 137 patients who underwent a mastectomy by histologically proven breast cancer, in 2019, in the General Provincial Hospital Carlos Manuel de Cespedes and in the Clinical Surgical Teaching Hospital Celia Sanchez Manduley, of Granma. The variables age, extension of mastectomy, laterality, appearance of complications; type of complication, tumoral stage and histologic diagnosis were evaluated. Results: the mean age of mastectomized patients was 56.53 years, and modified radical mastectomy was the most performed procedure (76 mammae). The incidence of complications was 52.17% (1.24% intra-operatory), being lymphedema (29.63%) the most prevalent complication. In relation to the histologic type, unspecified infiltrating ductal carcinoma (77.54%) was the most frequent one, and tumoral stages IIIB (22.46%) and IV (22.46%) were the most prevalent. The incidence of complications increased as the tumor stage increased. Conclusions: the incidence of postsurgical complications in mastectomy was high, in relation with the tumor stage.

Anxiety, Self-esteem and Body Image in Girls with Precocious Puberty. / Ansiedad, autoestima e imagen corporal en niñas con diagnóstico de pubertad precoz.

Currently, the age of onset for pubertal changes is decreasing, especially in girls, which may have an impact on psychosocial factors such as anxiety, self-esteem and body image. The aim of the present study is to compare these variables in two groups: a group of 15 girls with precocious puberty and a group of 16 girls of the same age without precocious puberty. A non-experimental descriptive design was used and the State-Trait Anxiety Inventory for Children (STAIC) and Self-Description Questionnaire (SDQ) were used to measure variables. Significant differences were found in Anxiety and Body Image levels between groups, but there were no differences in Self-Esteem levels. In conclusion, the findings show girls with early onset pubertal changes present high anxiety levels and negative body image compared to girls who start pubertal changes at the normal time.

Botryoid odontogenic cyst: clinical and pathological analysis in relation to recurrence.

OBJECTIVES: Botryoid odontogenic cyst (BOC) is considered as an unusual multilocular variant of lateral periodontal cyst (LPC). Review of the literature indicates that this lesion has higher risk of recurrence than LPC, but objective reasons are still unknown. The aim of this study is identify main clinical and pathological variables associated with the risk of recurrence. STUDY DESIGN: A complete literature review about cases of BOC was made, from its first description up to the year 2006. A total of 67 cases of BOC were identified from year 1973 (first case) to the last publication in 2005. RESULTS: 85.2% of the BOCs were located in the jaw, affecting to women (54.8% of the cases) in the fifth decade of the life. This lesion shows a well- circumscribed unilocular (60%) or multilocular (40%) radiolucency. Recurrence rate of cases with follow-up data was 32,4%. CONCLUSIONS: Size and multilocular patterns could be the main factors associated to recurrence in BOC.

Systematic comparison of two whole-genome amplification methods for targeted next-generation sequencing using frozen and FFPE normal and cancer tissues.

Sequencing key cancer-driver genes using formalin-fixed, paraffin-embedded (FFPE) cancer tissues is becoming the standard for identifying the best treatment regimen. However, about 25% of all samples are rejected for genetic analyses for reasons that include too little tissue to extract enough high quality DNA. One way to overcome this is to do whole-genome amplification (WGA) in clinical samples, but only limited studies have tested different WGA methods in FFPE cancer specimens using targeted next-generation sequencing (NGS). We therefore tested the two most commonly used WGA methods, multiple displacement amplification (MDA-Qiagen REPLI-g kit) and the hybrid or modified PCR-based method (Sigma/Rubicon Genomics Inc. GenomePlex kit) in FFPE normal and tumor tissue specimens. For the normalized copy number analysis, the FFPE process caused none or very minimal bias. Variations in copy number were minimal in samples amplified using the GenomePlex kit, but they were statistically significantly higher in samples amplified using the REPLI-g kit. The pattern was similar for variant allele frequencies across the samples, which was minimal for the GenomePlex kit but highly variable for the REPLI-g kit. These findings suggest that each WGA method should be tested thoroughly before using it for clinical cancer samples.

Mobile Genome Express (MGE): A comprehensive automatic genetic analyses pipeline with a mobile device.

The development of next-generation sequencing (NGS) technology allows to sequence whole exomes or genome. However, data analysis is still the biggest bottleneck for its wide implementation. Most laboratories still depend on manual procedures for data handling and analyses, which translates into a delay and decreased efficiency in the delivery of NGS results to doctors and patients. Thus, there is high demand for developing an automatic and an easy-to-use NGS data analyses system. We developed comprehensive, automatic genetic analyses controller named Mobile Genome Express (MGE) that works in smartphones or other mobile devices. MGE can handle all the steps for genetic analyses, such as: sample information submission, sequencing run quality check from the sequencer, secured data transfer and results review. We sequenced an Actrometrix control DNA containing multiple proven human mutations using a targeted sequencing panel, and the whole analysis was managed by MGE, and its data reviewing program called ELECTRO. All steps were processed automatically except for the final sequencing review procedure with ELECTRO to confirm mutations. The data analysis process was completed within several hours. We confirmed the mutations that we have identified were consistent with our previous results obtained by using multi-step, manual pipelines.

Prevalencia de complicaciones posquirúrgicas en pacientes sometidos a reparación quirúrgica de hernias inguinales

RESUMEN La hernia inguinal es una enfermedad frecuente no exenta de complicaciones. Con el objetivo de determinar la prevalencia de las complicaciones posquirúrgicas en pacientes con hernia inguinal; se realizó un estudio cuantitativo, transversal y descriptivo en un universo de 86 pacientes intervenidos quirúrgicamente por hernia inguinal en el año 2019; Hospital General Mariano Pérez Balí, Granma. Se evaluaron las variables: edad, sexo, tipo de hernia inguinal, lateralidad, técnica quirúrgica y complicaciones constatadas. En un total de 86 pacientes con hernia inguinal la edad media fue de 53,81 años. El sexo masculino representó el 95,34 % del total de pacientes, las hernias tipo II de Nyhus representaron el 46,24 %. Las técnicas de hernioplastias fueron empleadas en la reparación del 54,84 % del total de hernias reparadas particularmente la técnica de Lichtenstein. El 66,66 % de las hernias inguinales sometidas a reparación quirúrgica no presentaron complicaciones mientras que el 11,83 % se complicaron de forma aguda con funiculitis. Se concluye que la incidencia de las complicaciones posquirúrgicas en la hernia inguinal fue elevada.

ABSTRACT Inguinal hernia is a common disease not free of complications. In order to determine the prevalence of postoperative complications in patients with inguinal hernia; a quantitative, cross-sectional and descriptive study was carried out in a universe of 86 patients who underwent surgery for inguinal hernia in 2019; Mariano Pérez Balí General Hospital, Granma. The variables were evaluated: age, sex, type of inguinal hernia, laterality, surgical technique and verified complications. In a total of 86 patients with inguinal hernia the mean age was 53,81 years. Male sex represented 95,34 % of all patients, Nyhus type II hernias represented 46,24 %. Hernioplasty techniques were used to repair 54,84 % of all hernias repaired, particularly the Lichtenstein technique. The 66,66 % of the inguinal hernias undergoing surgical repair did not present complications while 11,83 % were acutely complicated with funiculitis. It isconcluded that the incidence of postoperative complications in inguinal hernia was high.

RESUMO A hérnia inguinal é uma doença frequente que não está isenta de complicações. A fim de determinar a prevalência de complicações pós-operatórias em pacientes com hérnia inguinal; foi realizado um estudo quantitativo, transversal e descritivo em um universo de 86 pacientes submetidos à cirurgia de hérnia inguinal em 2019; Hospital Geral Mariano Pérez Balí, Granma. Foram avaliadas as variáveis: idade, sexo, tipo de hérnia inguinal, lateralidade, técnica cirúrgica e complicações encontradas. Em um total de 86 pacientes com hérnia inguinal, a média de idade foi de 53,81 anos. O sexo masculino representou 95,34% do total de pacientes, as hérnias tipo II de Nyhus representaram 46,24%. As técnicas de hernioplastia foram utilizadas no reparo de 54,84% de todas as hérnias reparadas, principalmente a técnica de Lichtenstein. 66,66% das hérnias inguinais foram submetidas a correção cirúrgica sem complicações, enquanto 11,83% foram agudamente complicadas com funiculite. Conclui-se que a incidência de complicações pós-operatórias em hérnia inguinal foi alta.

Apendicitis aguda traumática. Reporte de caso / Traumatic acute appendicitis. A case report

RESUMEN Se presenta el caso de un hombre de 37 años sin antecedentes de dolor abdominal, o padecimiento de alguna enfermedad, que recibió un golpe directo con objeto romo (bate de béisbol) en el cuadrante inferior derecho del abdomen. Asistió a consulta con dolor abdominal selectivo en fosa ilíaca derecha, de aproximadamente 29 horas de evolución, que comenzó después de un trauma abdominal cerrado. Al examen físico se constata signo de Blumberg positivo, punto de McBurney doloroso con hiperestesia cutánea y cierto grado de defensa muscular. En los exámenes complementarios se comprueba leucocitosis y predominio de neutrófilos, con desviación a la izquierda. Se decidió realizar laparotomía exploratoria y se constató en el transoperatorio apendicitis aguda flegmonosa. La etiología traumática en la apendicitis aguda es un diagnóstico por exclusión que debe ser considerado en condiciones específicas.

ABSTRACT We present a 37 year-old man with no antecedents of abdominal pain, or suffering from other illnesses who received a direct blow with a blunt object (baseball bat) in the right lower quadrant of the abdomen. The patient was seen in consultation with a selective abdominal pain in his right iliac fossa, with approximately 29 hours of evolution that began after a closed abdominal trauma. A positive Blumberg sign, a painful McBurney's point with cutaneous hyperesthesia and certain grade of muscular defense were verified on physical exam. Leukocytosis and prevalence of neutrophils with left deviation were proven on complementary exams. An exploratory laparotomy was decided and a phlegmonous acute appendicitis was verified during the periprocedural period. Traumatic etiology in acute appendicitis is a diagnosis for exclusion that should be considered under specific conditions.

Mortalidad por necrosectomía pancreática abierta / Morality due to Open Pancreatic Necrosectomy

Introducción: La necrosectomía pancreática abierta es una técnica quirúrgica empleada en la infección de la necrosis. Objetivo: Identificar los factores relacionados con el pronóstico en pacientes operados con el diagnóstico de pancreatitis aguda necrotizante. Método: Se realizó una cohorte prospectiva en enfermos operados con el diagnóstico de pancreatitis aguda necrotizante, en la Unidad de Cuidados Intensivos del Hospital General Universitario "Carlos Manuel de Céspedes" de Bayamo, Granma, en el período 2018 - 2020. Se incluyeron 61 pacientes con este diagnóstico. Se estudiaron variables demográficas, clínicas, humorales y quirúrgicas. Se utilizó una estrategia bivariado y multivariado. Resultados: En el análisis bivariado se destacó la influencia de la edad (RR 3,34 IC 95 por ciento 0,17-0,68) y el índice de severidad tomográfica (RR 1,85 IC 95 por ciento 0,66-2,37), la disfunción múltiple de órganos (RR 5,06 IC 95 por ciento 1,08-2,15), la cirugía precoz (2,78 IC 95 por ciento 1,00-3,34) y la infección de la necrosis (RR 6,60 IC 95 por ciento 1,01-5,23). En el modelo de regresión logística multivariado quedaron incluidos como variables independientes asociadas al pronóstico la disfunción múltiple de órganos (RR 6,58 IC 95 por ciento 2,40-18,08) y la infección de la necrosis (RR, 14,20 IC 95 por ciento 5,93 -34,01) Conclusiones: El análisis de la mortalidad evidenció que los factores que demostraron asociación significativa fueron la disfunción múltiple de órganos y la infección de la necrosis(AU)

Introduction: Open pancreatic necrosectomy is a surgical technique used in necrosis infection. Objective: To identify the factors related to prognosis in patients operated on under the diagnosis of acute necrotizing pancreatitis. Methods: A prospective cohort study was carried out in patients operated on under the diagnosis of acute necrotizing pancreatitis, in the intensive care unit of Carlos Manuel de Céspedes General University Hospital of Bayamo, Granma, Cuba, in the period 2018-2020. Sixty-one patients with this diagnosis were included. Demographic, clinical, humoral and surgical variables were studied. A bivariate and multivariate strategy was used. Results: In the bivariate analysis, the influence of age (relative risk [RR]=3.34; 95 percent confidence interval [CI]: 0.17-0.68) and tomographic severity index (RR=1.85; 95 percent CI: 0.66-2.37), as well as multiple organ dysfunction (RR=5.06; 95 percent CI: 1.08-2.15), early surgery (RR=2.78; 95 percent CI: 1.00-3.34) and necrosis infection (RR=6.60; 95 percent CI: 1.01-5.23) were highlighted. In the multivariate logistic regression model, multiple organ dysfunction (RR=6.58; 95 percent CI: 2.40-18.08) and infection of necrosis (RR=14.20; 95 percent CI: 5.93-34.01) were included as independent variables associated with prognosis. Conclusions: Mortality analysis evidenced that the factors that showed significant association were multiple organ dysfunction and necrosis infection(AU)

Perfil clínico de pacientes con urticaria crónica en el Hospital Militar Principal, Guinea-Bisáu / Clinical profile of patients with chronic urticaria at the Main Military Hospital, Guinea-Bissau / Perfil clínico dos doentes com urticária crónica no Hospital Militar Principal, Guiné-Bissau

RESUMEN Introducción: La urticaria crónica es una enfermedad heterogénea delimitada de la piel caracterizada por el desarrollo de ronchas o habones. Objetivo: Determinar las características clínicas y el tratamiento farmacológico indicado en pacientes con diagnóstico de urticaria crónica. Método: Se realizó un estudio cuantitativo, prospectivo, observacional y descriptivo en un universo de 48 pacientes con diagnóstico de urticaria crónica, Hospital Militar Principal, Guinea-Bisáu, 2018-2020. Se midieron las variables: edad, sexo, tipo de urticaria, tiempo de evolución, comorbilidad y tratamiento utilizado en la primera y última consulta registrada, así como la actividad de la enfermedad. Resultados: La edad media fue de 38,52 años con predomino del sexo femenino. El tiempo medio de evolución de la enfermedad fue de 4,67 años y el 70,83 % no presentó angioedema. La urticaria crónica espontánea fue el tipo predominante. La ciproheptadina fue el tratamiento más indicado al inicio del tratamiento y al término del seguimiento su uso se incrementó. El montelukast fue el otro medicamento que incremento su uso al término del seguimiento. La actividad de la enfermedad se redujo con el tratamiento a índices reconocidos como urticaria crónica espontánea controlada. Conclusiones: La urticaria crónica en Guinea-Bisáu tiene una prevalencia y manifestaciones clínicas acorde a lo reportado a nivel mundial con esquemas de tratamiento susceptibles de modificaciones según el inicio del uso de medicamentos recomendados como ciclosporina u omalizumab.

ABSTRACT Introduction: Chronic urticaria is a heterogeneous demarcated skin disease characterized by the development of wheals or hives. Objective: Determination of the clinical characteristics and the pharmacological treatment indicated in patients diagnosed with chronic urticaria. Method: A quantitative, prospective, observational and descriptive study was conducted in a total of 48 patients (the universe) diagnosed with chronic urticaria, Main Military Hospital, Guinea-Bissau, 2018-2020. The following variables were used: age, sex, type of urticaria, time of evolution, comorbidity and treatment used in the first and last recorded consultation, as well as disease activity. Results: The mean age was 38.52 years with a female predominance. The mean time of evolution of the disease was 4.67 years and 70.83% did not present angioedema. Chronic spontaneous urticaria was the predominant type. cyproheptadine was the treatment most indicated to be used at baseline and at the end of treatment follow-up its use increased. montelukast was the other drug that increased its use at the end of follow-up. With the treatment used disease activity was reduced up to rates recognized as controlled chronic spontaneous urticaria. Conclusions: Chronic urticaria in Guinea-Bissau has prevalence and clinical manifestations in line with those reported worldwide, with treatment regimens susceptible to modifications depending on the early use of recommended drugs such as cyclosporine or omalizumab.

RESUMO Introdução: A urticária crônica é uma doença heterogênea delimitada da pele caracterizada pelo desenvolvimento de urticária ou urticária. Objetivo: Determinar as características clínicas e o tratamento farmacológico indicado em pacientes com diagnóstico de urticária crônica. Método: Estudo quantitativo, prospectivo, observacional e descritivo realizado em um universo de 48 pacientes com diagnóstico de urticária crônica, Hospital Militar Principal, Guiné-Bissau, 2018-2020. As variáveis foram mensuradas: idade, sexo, tipo de urticária, tempo de evolução, comorbidade e tratamento utilizado na primeira e última consulta registrada, bem como a atividade da doença. Resultados: A média de idade foi de 38,52 anos com predomínio do sexo feminino. O tempo médio de evolução da doença foi de 4,67 anos e 70,83% não apresentavam angioedema. A urticária crônica espontânea foi o tipo predominante. A ciproeptadina foi o tratamento mais indicado no início do tratamento e ao final do seguimento seu uso aumentou. O montelucaste foi a outra droga que aumentou seu uso ao final do seguimento. A atividade da doença foi reduzida com o tratamento para taxas reconhecidas como urticária crônica espontânea controlada. Conclusões: A urticária crônica na Guiné-Bissau tem prevalência e manifestações clínicas compatíveis com a relatada mundialmente, com esquemas de tratamento que podem ser modificados dependendo do início do uso de medicamentos recomendados como ciclosporina ou omalizumabe.

Reacciones anafilácticas y alérgicas durante procedimientos médicos o quirúrgicos en dos hospitales de Guinea Bissau

RESUMEN Introducción: la seguridad durante los procedimientos médicos o quirúrgicos se ve amenazada por la anafilaxia. Objetivo: evaluar el cuadro clínico, método de estudio y eventual resultado de la reexposición en pacientes con reacciones anafilácticas y alérgicas durante procedimientos médicos o quirúrgicos. Materiales y métodos: se realizó un estudio cuantitativo, observacional y descriptivo en 11 pacientes con diagnóstico de anafilaxia en el curso de una intervención quirúrgica o proceder médico, en los hospitales Militar Principal y Nacional Simão Méndes, de Guinea Bissau, entre 2018 y 2020. Se evaluaron las variables: edad, sexo, procedimiento, método anestésico, antecedentes alérgicos, gravedad de la anafilaxia y agente causal. Resultados: de los 11 pacientes estudiados, 10 tuvieron reacciones en procedimientos quirúrgicos. La media de edad fue de 46,09 años, con una relación por sexo de 0,57 casos masculinos por cada caso femenino. Cinco pacientes (45,45 %) desarrollaron el grado máximo de severidad de la anafilaxia. Los agentes anestésicos fueron la causa de la anafilaxia en dos de los cuatro pacientes sometidos al método de anestesia general y en dos de los cinco sometidos al método de anestesia regional. Por su parte, el látex resultó ser el agente causal en el 45,45 % de los pacientes. Conclusiones: la apropiada identificación de las reacciones anafilácticas durante su aparición, constituye la piedra angular de la actuación médica. En cualquier caso, conllevará estudios alergoanestésicos posteriores que definan el agente causal.

ABSTRACT Introduction: safety during medical or surgical procedures is threatened by anaphylaxis. Objective: to evaluate the clinical characteristics, study method and eventual outcome of re-exposure in patients with anaphylactic and allergic reactions during medical or surgical procedures. Materials and methods: a quantitative, observational and descriptive study was carried out in 11 patients with a diagnosis of anaphylaxis in the course of a surgical intervention or medical procedure, in the Main Military Hospital and the National Hospital Simão Méndes, of Guinea Bissau between 2018 and 2020. The evaluated variables were: age, sex, procedure, anesthetic method, allergic history, severity of anaphylaxis and causal agent. Results: of the 11 patients studied, 10 had reactions in surgical procedures. The mean age was 46.09 years with a sex ratio of 0.57 male cases for each female case. Five patients (45.45 %) developed the maximum degree of anaphylaxis severity. Anesthetic agents were the cause of anaphylaxis in two of the four patients who underwent the general anesthesia method, and in two of the five who underwent the regional anesthesia method. Latex was found to be the causal agent in 45.45 % of the patients. Conclusions: the proper identification of anaphylactic reactions during their appearance is the cornerstone of medical action. In any case, subsequent allergo-anesthetic studies would be needed to define the causative agent.