Acute Retinal Necrosis: Experience in a Reference Center in Santander - Colombia.

INTRODUCTION: Acute retinal necrosis (ARN) is a severe eye disease demanding swift treatment to prevent blindness. Early action involving antiviral medications and corticosteroids is crucial for optimal visual outcomes. OBJECTIVE: We present an ARN case series showcasing treatment experience and results. METHODOLOGY: Patients diagnosed with ARN based on SUN Working Group 2021 criteria were included; all underwent comprehensive eye exams, PCR analysis, and imaging. RESULTS: Eight patients were studied; PCR confirmed ARN in six. Induction treatment, either oral valacyclovir (5/8) or intravenous acyclovir (3/8), lasted 10-14 days. Maintenance included oral valacyclovir (6/8), oral valganciclovir (2/8) for six months, along with intravitreal ganciclovir. Visual outcomes were similar for oral and intravenous therapies; poor baseline acuity and macular involvement tend to result in a worse final acuity. CONCLUSIONS: Swift treatment is vital to ARN management. Our findings emphasize effective treatment strategies' role in visual prognosis. ABBREVIATIONS: ACV: Acyclovir; BCVA: Best Corrected Visual Acuity; CMV: Cytomegalovirus; EBV: Epstein Barr Virus; FTA-ABS: Fluorescent treponemal antibody absorption test; HSV 1-2: Herpes simplex virus 1-2; HIV: Human Immunodeficiency Virus; IV-ACV: Intravenous- Acyclovir; PCR: Polymerase Chain Reaction;Tg: Toxoplasma gondii; VZV: Varicella Zoster Virus; VCV: Valacyclovir; VDRL: Venereal disease research laboratory test.

Risk factors for ophthalmologic involvement and ocular findings in patients diagnosed with fungemia in a high-complexity hospital in the city of Medellín, Colombia.

PURPOSE: To describe the demographic clinical characteristics and to identify the risk factors of patients diagnosed with fungemia and secondary intraocular involvement. METHODS: Retrospective cohort of 97 patients diagnosed with fungemia and with or without involvement of the posterior segment. Demographic, clinical and ophthalmological variables were identified to establish the risk of retinal seeding. RESULTS: An incidence of ocular involvement of 22.68% was obtained and no clear risk factor was found for subsequent showings in patients with fungemia. A risk trend was only found in patients with diabetes with an OR: 2.85; CI 95%: (0.80-10.12) and history of HIV with an OR: 2.29 CI95%: (0.85-6.12). CONCLUSIONS: In this first cohort carried out in Colombia according to our search, findings were obtained that agree with those of other authors worldwide, where there is no evidence of a decrease in incidence compared with older studies and the absence of risk factors for the compromise of the posterior pole in patients with fungemia.KEY MESSAGESSystematic fundus evaluation by an ophthalmologist in patients with candidaemia is a recommended practice based on low-quality evidence.The identification of real risk factors for retinal compromise in fungemia would allow us to be more selective with the population to be evaluated.Fungemia generally occurs in critically ill patients, where access and availability of ophthalmology evaluation are a resource that is not always available.

Cytokine release syndrome after haploidentical hematopoietic cell transplantation: an international multicenter analysis.

Haploidentical related donor transplantation (haplo-HCT) is associated with cytokine release syndrome (CRS). We conducted a multicenter retrospective study to analyze risk factors for CRS and outcomes after haplo-HCT. We included 451 patients from four academic centers receiving both peripheral blood and bone marrow grafts. Severe CRS was more common with PB vs. BM grafts (19.5% vs 4.9%, OR 2.9, p = 0.05). Multivariable analysis identified recipient CMV sero-positivity, prior transplant, HCT-CI score and donor-recipient sex mismatch as risk factors for severe CRS. Outcomes were analyzed with no CRS as the comparison group. Overall survival (OS) was superior with mild CRS (HR 0.64, p = 0.05) and worst with severe CRS (HR 2.12, p = 0.0038). Relapse risk was significantly decreased in both mild CRS (HR 0.38, p < 0.0001) and severe CRS (HR 0.17, p < 0.0001) groups. The risk of non-relapse mortality was notably higher in severe CRS group (HR 8.0, p < 0.0001), but not in mild CRS group. Acute GVHD was similar among groups. Chronic GVHD at 1 year was 18.5% for no CRS, 23% for mild CRS, and 4.3% for severe CRS (p = 0.0023), with the competing risk of early mortality and short follow up of surviving patients contributing to the low chronic GVHD rates in the severe CRS group.

Measurable Residual Disease Assessment and Allogeneic Transplantation as Consolidation Therapy in Adult Acute Lymphoblastic Leukemia in Colombia.

INTRODUCTION: Detectable minimal residual disease (MRD) after therapy for acute lymphoblastic leukemia (ALL) is the strongest predictor of hematologic relapse. The objective of the study was to assess disease-free survival (DFS) and overall survival (OS) of patients with ALL according with MRD status at the end of induction therapy in a Colombian population. PATIENTS AND METHODS: We assessed a retrospective cohort to compare DFS and OS in adults with de novo ALL according to MRD status at the end of induction chemotherapy, and the type of postinduction consolidation strategy used. RESULTS: A total of 165 adults with ALL were included in the MRD part of the study, 73 patients in the MRD-negative group and 92 in the MRD-positive group. Median DFS for the MRD-positive group was 11 months (95% confidence interval, 11.7-22.2) and was not reached for the MRD-negative group (P < .001). At 3 years, DFS was 18% and 55%, respectively (P < .001). The median OS for MRD-positive patients was 16 months (95% confidence interval, 8.8-23.15) and was not reached in the MRD-negative group. At 3 years, OS was 26% and 51% for the former and latter group, respectively. Among subjects who did not receive a transplant, median DFS was 21 months for MRD-negative patients and 9 months for MRD-positive patients (P < .001). The median DFS was not reached in either group, whereas 3-year DFS was 64% for MRD-negative and 70% for MRD-positive patients who underwent transplantation in first remission (P = .861). CONCLUSION: MRD status at the end of induction is an independent prognostic factor for DFS and OS in adult ALL. Allogeneic transplantation in first remission could overcome the adverse prognostic impact of MRD.

Hemorrhagic Cystitis after Haploidentical Transplantation with Post-Transplantation Cyclophosphamide: Protective Effect of MESNA Continuous Infusion.

Hemorrhagic cystitis (HC) is an important complication after haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with post-transplantation cyclophosphamide (PT-CY). Sodium 2-mercaptoethanesulfonate (MESNA) can prevent bladder injury when given with PT-CY. However, the best way to deliver MESNA is not known. This study assessed the incidence of HC after haplo-HSCT with PT-CY with 2 different methods of MESNA administration. The cumulative incidence of HC was lower in patients who received MESNA as a continuous infusion compared with those who received it as an intermittent bolus (5.6% versus 27.8%; P = .01). MESNA administration as an infusion was associated with a lower risk of developing HC (hazard ratio [HR], .19; 95% confidence interval [CI], .04 to .86; P = .02) on univariate analysis. This effect remained significant after adjustment in multivariate analysis (HR, .21; 95% CI, .04 to .88; P = .03). MESNA delivered as a continuous infusion is a simple and potentially useful way to prevent HC after PT-CY.

Food security in indigenous and peasant populations: a systematic review. / Seguridad alimentaria en poblaciones indígenas y campesinas: una revisión sistemática.

Food security and the vulnerability among indigenous and peasant populations has become a topic of interest to public health all around the world, leading to the investigation about measurement, classification and factors that determine it. This systematic review aims to describe the situation of food security in indigenous and peasant communities, and the methods used for evaluation. The literature search was performed on the Pub Med (5), ScienceDirect (221) and Scopus (377) databases searching for publications between 2004 and 2015, a total of 603 items were located with the search engines. At the end of the screening process and after adding the items found in the gray literature, 25 papers were obtained to write the review. In the 11 years evaluated between 2004 and 2015, scientific activity around the theme was poor with just 4.54% of the publications on this subject, but for 2011 the percentage increased to 13 publications, 63%. Various factors that influence the development of food insecurity are climate change, the diversity of agriculture, globalization and market westernization.

Seguridad alimentaria en poblaciones indígenas y campesinas: una revisión sistemática / Food security in indigenous and peasant populations: a systematic review

Resumen La seguridad alimentaria y su vulnerabilidad en poblaciones indígenas y campesinas, se ha convertido en un tema de interés para la salud pública alrededor de todo el mundo, en asuntos como medición, clasificación y factores que la determinan. Esta revisión sistemática tiene como propósito describir la situación de la seguridad alimentaria en comunidades indígenas y campesinas, y los métodos empleados para su evaluación. La búsqueda de la literatura se realizó en las bases de datos PubMed (5), ScienceDirect (221) y Scopus (377), buscando publicaciones entre los años 2004 y 2015, con un total de 603 artículos arrojados por las rutas de búsqueda. Al final del proceso de tamización y sumados los artículos encontrados en la literatura gris se obtuvieron 25 artículos para escribir la revisión. En los 11 años evaluados, entre el 2004 y el 2015, la actividad científica alrededor del tema fue escasa con apenas un 4,54% de las publicaciones en este tema, pero para el año 2011 el porcentaje de publicaciones aumentó hasta un 13,63%. Se encontraron diversos factores que tienen influencia en el desarrollo de la inseguridad alimentaria, entre ellos está el cambio climático, la diversidad de la agricultura y la globalización y occidentalización del mercado.

Abstract Food security and the vulnerability among indigenous and peasant populations has become a topic of interest to public health all around the world, leading to the investigation about measurement, classification and factors that determine it. This systematic review aims to describe the situation of food security in indigenous and peasant communities, and the methods used for evaluation. The literature search was performed on the Pub Med (5), ScienceDirect (221) and Scopus (377) databases searching for publications between 2004 and 2015, a total of 603 items were located with the search engines. At the end of the screening process and after adding the items found in the gray literature, 25 papers were obtained to write the review. In the 11 years evaluated between 2004 and 2015, scientific activity around the theme was poor with just 4.54% of the publications on this subject, but for 2011 the percentage increased to 13 publications, 63%. Various factors that influence the development of food insecurity are climate change, the diversity of agriculture, globalization and market westernization.

Cost-effectiveness analysis of interventions for prevention of invasive aspergillosis among leukemia patients during hospital construction activities.

OBJECTIVES: Invasive Aspergillosis (IA) is a serious problem among hematological patients and it is associated with high mortality. This situation can worsen at times of hospital construction, however there are several preventive measures available. This work aims to define the cost-effectiveness of some of these interventions. PATIENTS AND METHODS: A decision tree model was used, it was divided into four arms according to each 1 of the interventions performed. A cost-effectiveness incremental analysis comparing environmental control measures, high efficiency particulate absorption (HEPA) filter installation and prophylaxis with posaconazole was done. Probabilistic and deterministic sensitivity analyses were also carried out. RESULTS: Among 86 patients with 175 hospitalization episodes, the incidence of IA with environmental protection measures, antifungal prophylaxis and hospitalization in rooms with HEPA filters was 14.4%, 6.3% and 0%, respectively. An Incremental Cost Effectiveness Ratio analysis was performed and it was found that HEPA filtered rooms and environmental protection measures are cost saving interventions when compared with posaconazole prophylaxis (-$2665 vs -$4073 vs $42 531 US dollars, respectively) for IA episode prevented. CONCLUSION: The isolation of inpatients with acute leukemia during hospital construction periods in HEPA filtered rooms could reduce the incidence of IA and might be a cost-effective prevention strategy.

Trastorno depresivo mayor: una mirada genética / Major depressive disorder: a genetic view

Resumen El trastorno depresivo mayor es una enfermedad que se caracteriza por la presencia de diferentes síntomas, que van desde no poder comer o dormir, hasta el no disfrute de las actividades que antes resultaban placenteras, ideas de minusvalía y suicidio. Las investigaciones del campo de las neurociencias y de las enfermedades psiquiátricas en especial, tienden cada vez más a buscar los posibles orígenes genéticos que expliquen su desarrollo y progresión. En esta revisión de la literatura se presenta lo reportado en estudios que no solo describen la enfermedad desde los trastornos neurofisiológicos, sino también desde alteraciones genéticas y epigenéticas, con el fin de brindar un mayor entendimiento de las bases moleculares y fisiopatológicas de esta patología psiquiátrica.

Abstract Major depressive disorder is a disease that is characterized by the presence of different symptoms, ranging from not being able to eat or sleep, to not enjoy activities that were previously pleasurable, ideas of disability and suicide. Research in the field of neurosciences and psychiatric diseases in particular, increasingly tend to seek the possible genetic origins that explain the development and progression of them. In this review of the literature, is presented what has been reported in studies, that not only describe the disease from its neurophysiological disorders, but also from the genetic and epigenetic alterations, in order to provide a better understanding of the molecular and physiopathological bases of this psychiatric pathology.

Fever after peripheral blood stem cell infusion in haploidentical transplantation with post-transplant cyclophosphamide.

OBJECTIVE/BACKGROUND: Noninfection-related fever can occur after peripheral blood stem cell infusion in haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide. The objective of this study was to analyze the incidence of fever and characterize some clinical features of affected patients. METHODS: A retrospective case-series study with 40 patients who received haploidentical hematopoietic stem cell transplantation was carried out. RESULTS: Thirty-three patients (82.5%) developed fever; no baseline characteristic was associated with its development. Median time to fever onset was 25.5h (range, 9.5-100h) and median peak temperature was 39.0°C (range, 38.1-40.5°C). Not a single patient developed hemodynamic or respiratory compromise that required admission to the intensive care unit. Fever was not explained by infection in any case. Ninety-one percent of the febrile episodes resolved within 96h of cyclophosphamide administration. No significant difference in overall survival, event-free survival, or graft versus host disease-free/relapse-free survival was found in the group of febrile individuals after peripheral blood stem cell infusion. CONCLUSION: Fever after peripheral blood stem cell infusion in this clinical setting was common; it usually subsides with cyclophosphamide administration. The development of fever was not associated with an adverse prognosis.

Prevención de la infección por Streptococcus del grupo B en gestantes / Prevention of Group B Streptococcal Infection in Pregnant Women / Prevenção da infecção pelo Streptococcus do grupo B as mulheres grávidas: Revisão do tema

Introducción: La infección neonatal por Streptococcus del Grupo B en mujeres gestantes es un problema creciente a nivel mundial y tiene múltiples consecuencias para el recién nacido, su prevención impacta directamente la morbi-mortalidad neonatal. Objetivo: Brindar al lector información relevante sobre la importancia clínica, nuevos métodos de tamizaje y formas de prevención de la infección por Streptococcus del Grupo B en gestantes, que será de utilidad para evitar complicaciones del binomio materno-fetal. Metodología: En esta revisión de la literatura, se estudiaron 53 artículos, abordando evidencia tanto en el ámbito local e internacional, utilizando las bases de datos PubMed, ScienceDirect y Google Scholar, dentro los criterios de búsqueda se tuvo en cuenta el año de publicación, incluyendo artículos que fueron publicados a partir del año 2011. Resultados: La comunidad internacional ha desarrollado guías y planes de prevención; en la actualidad, para una profilaxis y prevención adecuada se proponen diversos métodos, partiendo del tamizaje para las maternas, uso de antibióticos durante el embarazo y parto, además del desarrollo de vacunas maternas para prevenir infecciones. Conclusiones: La colonización por Streptococcus del Grupo B en gestantes y el riesgo que conlleva para el recién nacido y su madre, exige una constante actualización en técnicas de tamizaje, prevención y manejo. Numerosos avances en estos campos vienen llevándose a cabo en los últimos años y su fortalecimiento y desarrollo será clave para impactar positivamente la morbi-mortalidad materno-fetal. [Martínez-Sánchez LM, Restrepo-Arango M, Sánchez-Díaz E, Marín-Cárdenas JS,Gallego-González D,Vélez-Peláez MC. Prevención de la infección por Streptococcus del grupo B en gestantes. MedUNAB 2017; 20(2): 182-189].

Introduction: The neonatal infection by Group B Streptococcus in pregnant women is a growing problem worldwide and has multiple consequences for the newborn, so its prevention directly impacts neonatal morbimortality. Objective: To provide the reader with relevant information about the clinical importance, new screening methods and ways to prevent Group B Streptococcus infection in pregnant women which will be useful to avoid complications in the pairing of maternal-fetal. Methodology: In this review of literature, 53 articles were studied addressing local and international evidence by using PubMed, ScienceDirect and Google Scholar databases; within the search criteria the year of publication was taken into account to do so, thus articles published from 2011 were included. Results: The international community has developed guidelines and prevention plans for this infection. Currently, for an adequate prophylaxis and prevention, various methods are proposed such as the screening for expectant mothers, the use of antibiotics during pregnancy and childbirth, and the development of maternal immunization to prevent infections as well. Conclusions: The colonization by Group B Streptococcus in pregnant women and the risk that this entails to the newborn and his/her mother requires constant updating in techniques for screening, prevention and management of it. Numerous advances in these fields of study have been carried out in recent years, and this strengthening and its development will be the key to impact, in a positive way, the maternal-fetal morbimortality. [Martínez-Sánchez LM, Restrepo-Arango M, Sánchez-Díaz E, Marín-Cárdenas JS,Gallego-González D, Vélez-Peláez MC. Prevention of Group B Streptococcal Infection in Pregnant Women. MedUNAB 2017; 20(2): 182-189].

Introdução: A infecção neonatal pelo Streptococcus do Grupo B em mulheres grávidas é um problema crescente no mundo inteiro e tem múltiplas conseqüências para o recém-nascido. Sua prevenção afeta diretamente a morbidade e mortalidade neonatal. Objetivo: Oferecer ao leitor a informação relevante sobre a importância clínica, os novos métodos de seleção e as formas de prevenir a infecção por Streptococcus do Grupo B em mulheres grávidas, o que será muito útil para evitar as complicações tanto para a mãe quanto para o feto. Metodologia: Nesta revisão da literatura, foram estudados 53 artigos, ressaltando as evidências tanto no nível local como internacional y se utilizaram os bancos de dados em PubMed, ScienceDirect e Google Scholar. Um dos critérios da pesquisa foi verificar o ano da publicação e incluir somente os artigos publicados a partir de 2011. Resultados: Atualmente, a comunidade internacional desenvolveu diretrizes e planos de prevenção para a profilaxia e a prevenção adequada, propondo diversos métodos como: Atriagem materna, o uso de antibióticos durante a gravidez e o parto, além do desenvolvimento das vacinas maternas para preveniras infecções. Conclusões: A colonização por Streptococcus do Grupo B em mulheres grávidas e o risco que isso implica para o recém-nascido e sua mãe, requer uma atualização constante nas técnicas da triagem, da precaução e do tratamento. São numerosos os avanços realizados, nesta área, nos últimos anos. O seu fortalecimento e desenvolvimento são fundamentais para interferir positivamente na doença e na mortalidade materno-fetal. [Martínez-Sánchez LM, Restrepo-Arango M, Sánchez-Díaz E, Marín-Cárdenas JS, Gallego-González D, Vélez-Peláez MC. Prevenção da infecção pelo Streptococcus do grupo B nas mulheres grávidas: Revisão do tema. MedUNAB 2017; 20(2): 182-189].

Impacto clínico de la contaminación aérea / Clinical impact of air pollution

La contaminación del aire se considera actualmente un problema global tanto en países en desarrollo como en los desarrollados. Sustancias que invaden nuestros espacios son componentes de la contaminación aérea que causan un fuerte impacto negativo en la salud para quienes se encuentren expuestos, no solo en los sistemas cardiovascular y respiratorio, sino que están siendo relacionados con la etiología de patologías en todo el organismo, con disminución en la esperanza de vida e incluso, aumento de la mortalidad y alteraciones del material genético. Esta revisión de la literatura tiene como fin recopilar por medio de una búsqueda las implicaciones que tienen los componentes de la contaminación atmosférica en la salud de quienes están expuestos, desde el punto de vista clínico y molecular. Para la búsqueda se utilizaron los descriptores DeCS creado por BIREME: contaminación del aire, sistema cardiovascular, enfermedades respiratorias. Fueron consultadas las siguientes bases de datos: PubMed, ScienceDirect y Scopus. Dentro de los criterios de búsqueda se tuvo en cuenta el año de publicación y que el idioma original fuera inglés o español. Se concluyó que el estudio de las diferentes partículas y las consecuencias que conlleva la exposición a estas, es de vital importancia para el desarrollo de mecanismos de control, prevención y tratamiento; ya que estas mismas tiene la capacidad de generar patologías que van desde algo tan tangible como las afecciones pulmonares y la enfermedad cardiaca oclusiva, hasta cambios epigenéticos que afectan la salud...(AU)

Air pollution is now considered a global problem in developing and developed countries.Substances that invade our spaces are components of air pollution that cause a strong negative impact on health for those who are exposed in the cardiovascular and respiratory systems, and also is related to the etiology or worsening of countless diseases throughout the body, with decrease in life expectancy and even increased mortality and alterations of genetic material. This literature review aims to collect through a literature search the implications of the components of air pollution on the health of those exposed, from the point of clinical and molecular level. For the search where used the MeSH descriptors created by BIREME: air pollution, cardiovascular system, respiratory diseases. They were consulted the following databases: PubMed, Science Direct and Scopus. Within the search criteria took into account the year of publication and that the original language was English or Spanish. It was concluded that the study of the different particles and the consequences associated with exposure to these, it is vital for the development of control mechanisms, prevention and treatment; since the same has the ability to generate conditions ranging from something as tangible as pulmonary diseases and occlusive heart disease, to epigenetic changes that affect health...(AU)

Recuento de células CD34+ en sangre periférica como predictor de adecuada recolección de progenitores hematopoyéticos para trasplante autólogo / Peripheral blood CD34+ cell count as a predictor of adequacy of hematopoietic stem cell collection for autologous transplantation / Contagem de células CD34+ em sangue periférico como preditor de adequada recolecção de progenitores hematopoiéticos para transplante autólogo

Introducción: para llevar a cabo un trasplante autólogo se deben movilizar los progenitores hematopoyéticos a la sangre periférica y posteriormente recolectarlos por aféresis. El recuento de células CD34+ es una herramienta para determinar el mejor momento para la recolección. Objetivo: evaluar la asociación entre el recuento de células CD34+ en sangre periférica y la recolección exitosa de progenitores hematopoyéticos. Materiales y métodos: evaluación de una prueba predictiva para determinar la utilidad del recuento de células CD34+ en sangre periférica como predictor del éxito de la recolección de progenitores hematopoyéticos en pacientes a los que se les va a hacer un trasplante autólogo. Resultados: se incluyó a 77 pacientes (mediana de edad: 49 años; rango: 5-66); el diagnóstico predominante fue linfoma (53,2 %). El porcentaje de pacientes con recolección exitosa de progenitores fue proporcional al número de células CD34+ en sangre periférica al finalizar la movilización. Proponemos que se deben tener más de 15 células CD34+/μL en sangre periférica para lograr una adecuada recolección de progenitores hematopoyéticos. Conclusión: el recuento de células CD34+ en sangre periférica es una herramienta útil para predecir la recolección exitosa de progenitores hematopoyéticos.

Introduction: In order to carry out an autologous transplantation, hematopoietic stem cells should be mobilized to peripheral blood and later collected by apheresis. The CD34+ cell count is a tool to establish the optimal time to begin the apheresis procedure. Objective: To evaluate the association between peripheral blood CD34+ cell count and the successful collection of hematopoietic stem cells. Materials and methods: A predictive test evaluation study was carried out to establish the usefulness of peripheral blood CD34+ cell count as a predictor of successful stem cell collection in patients that will receive an autologous transplantation. Results: 77 patients were included (median age: 49 years; range: 5-66). The predominant baseline diagnosis was lymphoma (53.2 %). The percentage of patients with successful harvest of hematopoietic stem cells was proportional to the number of CD34+ cells in peripheral blood at the end of the mobilization procedure. We propose that more than 15 CD34+ cells/μL must be present in order to achieve an adequate collection of hematopoietic stem cells. Conclusion: Peripheral blood CD34+ cell count is a useful tool to predict the successful collection of hematopoietic stem cells.

Introdução: para levar a cabo um transplante autólogo se devem mobilizar os progenitores hematopoiéticos ao sangue periférico e posteriormente os coletá-los por aféreses. A contagem de células CD34+ é uma ferramenta para determinar o melhor momento para a recolecção. Objetivo: avaliar a associação entre a contagem de células CD34+ em sangue periférico e a recolecção exitosa de progenitores hematopoiéticos. Materiais e métodos: avaliação de uma prova preditiva para determinar a utilidade da contagem de células CD34+ em sangue periférico como preditor do sucesso da recolecção de progenitores hematopoiéticos em pacientes aos que se lhes vá fazer um transplante autólogo. Resultados: se incluiu a 77 pacientes (média de idade: 49 anos; faixa: 5-66); o diagnóstico predominante foi linfoma (53,2 %). A porcentagem de pacientes com recolecção exitosa de progenitores foi proporcional ao número de células CD34+ em sangue periférico ao finalizar a mobilização. Propomos que se devem ter mais de 15 células CD34+/μL em sangue periférico para conseguir uma adequada recolecção de progenitores hematopoiéticos. Conclusão: A contagem de células CD34+ em sangue periférico é uma ferramenta útil para prever a recolecção exitosa de progenitores hematopoiéticos.

Linfoma primario del corazón: causa poco común de síndrome de falla cardiaca / Primary cardiac lymphoma: an uncommon cause of heart failure

Resumen Objetivo: Describir una causa poco común de síndrome de falla cardiaca aguda como lo es el linfoma primario del corazón. Métodos: Presentación de un caso con antecedentes y cuadro clínico de ingreso, manejo instaurado y desenlace. Resultados y conclusiones: Los tumores cardiacos malignos son bastante infrecuentes, más aún el linfoma cardiaco, por lo que no se considera en el diagnóstico diferencial del médico. Se presenta un nuevo caso en la literatura del linfoma cardiaco manifestado como síndrome de falla cardiaca aguda

Abstract Motivation: To describe an uncommon cause of acute cardiac failure such as primary cardiac lymphoma. Methods: Presentation of a case with medical history and clinical records of admission, established management and outcomes. Results and conclusions: Malignant cardiac tumours are quite infrequent, even more so with cardiac lymphoma, which is why they usually are not taken into consideration by physicians when making a differential diagnosis. A new case of cardiac lymphoma manifesting as acute cardiac failure syndrome is presented in the literature.

Streptococcus spp. en el embarazo, patología y avances en su detección temprana / Streptococcus spp. in pregnancy, pathology and advances in early detection

El Streptococcus spp ha adquirido mucha importancia a nivel mundial debido a la gran patogenicidad de sus diferentes especies. Una de ellas es el Streptococcus del Grupo B que comúnmente se encuentra a nivel vaginal en mujeres embarazadas, lo que puede ocasionar una contaminación al recién nacido en el momento del parto. Solo un pequeño porcentaje de estos neonatos desarrollan la infección y pueden llegar a presentar sepsis, meningitis, neumonía neonatal, entre otras complicaciones, así como secuelas neurológicas permanentes, retraso en el crecimiento y muerte. Debido a esto, se han implementado estrategias preventivas, en las que se incluyen pruebas de tamizaje para su detección temprana y evitar el riesgo de infección. En las últimas décadas se ha incrementado el uso de técnicas moleculares para su diagnóstico precoz y tratamiento temprano, de manera de disminuir la morbimortalidad atribuida al Streptococcus del Grupo B.

Streptococcus spp has acquired great importance due to the high pathogenicity of its different species around the world. The Group B Streptococcus is commonly found in the vaginal area of pregnant women, which at delivery may lead to contamination of the newborn. Only some of these infants develop the infection and may present sepsis, meningitis, neonatal pneumonia, among other complications, including permanent neurological sequelae, delayed growth and death. Preventive strategies include screening and early detection to avoid the risk of infection. In recent decades the use of molecular techniques for early diagnosis and treatment has increased that would decrease morbidity and mortality attributed to Group B Streptococcus.

Resultados del tratamiento del linfoma de células del manto con varios regímenes de inmunoquimioterapia: estudio retrospectivo / Results of mantle cell lymphoma treated with various immunochemotherapy regimens: A retrospective stud

Objetivos: Describir las características clínicas y los resultados del tratamiento inicial de los pacientes con linfoma de células del manto atendidos en el Instituto Nacional de Cancerología (INC) entre los años 2007 y 2011. Métodos: Estudio descriptivo y retrospectivo, tipo serie de casos basado en fuentes secundarias institucionales. Resultados: Se incluyeron 41 pacientes con una edad promedio de 60,5 años (DE ±10,5) y que tenían en su mayoría un estado funcional adecuado. La mayor parte tenía enfermedad avanzada al momento de la presentación (85%). El compromiso de la médula ósea y la afectación extranodal fueron frecuentes, encontrándose en 73% y 39% respectivamente. El diagnóstico histopatológico de la malignidad se realizó en tejido ganglionar en la mayoría de los casos (56%). Los esquemas de quimioterapia de primera línea empleados con más frecuencia fueron R-CHOP y R-HyperCVAD, en 37% y 29% de los casos respectivamente. Tras la quimioterapia de primera línea se logró alcanzar una respuesta completa en 64% de los pacientes, la mediana de duración de la primera remisión fue 9 meses (RIQ0,9 - 15). La neutropenia febril fue una complicación común presentándose en 42% de los casos. Dieciocho individuos recibieron quimioterapia de segunda línea, los esquemas más frecuentemente empleados fueron R-DHAP y R-HyperCVAD. Conclusiones: Las características clínicas de los pacientes son similares a las descritas en series de referencia. Las tasas de respuesta completa y la duración de la primera remisión son inferiores a las publicadas por otros grupos con esquemas similares de tratamiento. © 2014 Instituto Nacional de Cancerología.

Objective: To describe the clinical features and the treatment results achieved with the initial therapy among patients with mantle cell lymphoma treated at the National Cancer Institute (INC) between 2007 and 2011. Methods: Descriptive study, based on secondary institutional sources. Results: A total of 41 patients were included, with a mean age of 60.5 years (Standard deviation SD ± 10.5) and a good functional status. Most of them had advanced disease at initial presentation (85%). Bone marrow involvement and extra-nodal disease were frequent, as they were seen in 73% and 39% of the patients, respectively. Histopathological diagnosis of the malignancy was mainly made on lymph node tissue (56%). First line chemotherapy regimens used with an increased frequency were R CHOP and R- HyperCVAD, in 37% and 29% of the cases, respectively. After first line therapy, a complete response was achieved in 64% of the patients, median duration of the first remission was 9 months (Interquartile range IQR 0.9 - 15). Febrile neutropenia was a frequent complication, seen in 42% of the cases. Eighteen individuals received a second line of chemotherapy, with R DHAP and R HyperCVAD being the regimens most commonly administered. Conclusions: The clinical features of the patients are similar to those described in larger series of patients with the disease described elsewhere. The rate of complete responses, as well as the duration of the first remission after chemotherapy, is inferior when compared with the results of other groups that used similar treatment regimens.

General features and epidemiology of lymphoma in Colombia. A multicentric study.

The relative frequency of the non-Hodgkin lymphoma (NHL) subtypes varies around the world. The objective of this study was to describe the general features of patients with lymphoma in Colombia. A total of 819 patients with a new diagnosis of lymphoma were included. Nighty-nine (12 %) of them had Hodgkin lymphoma (HL) and 720 (88 %) had NHL. Most cases had advanced stage disease at presentation (63.6 %). Diffuse large B cell lymphoma (DLBCL) was the most frequent diagnosis; it was seen in 40 % of patients with NHL and in 35 % of patients in the whole series. Overall survival rates at 3 years were 77 % for HL and follicular lymphoma, 54 % for DLBCL, and 45 % for T cell lymphomas. In conclusion, the distribution of specific NHL subtypes is similar to what has been reported previously in other tropical countries.

Bloodstream infections in adult patients undergoing cord blood transplantation from unrelated donors after myeloablative conditioning regimen.

The incidence, epidemiology, and risk factors of bloodstream infection (BSI) and their impact on transplant outcomes after umbilical cord blood transplantation (UCBT) are not well defined. Between May 1997 and December 2012, 202 isolates in 189 episodes of BSI were registered in 134 of 241 patients who underwent single-unit myeloablative UCBT. Cumulative incidence (CI) of developing at least 1 episode of BSI was 21%, 29%, 34%, 42%, and 52% at days +7, +14, +30, +100, and +365, respectively. The median time of onset for the first BSI episode was day +10 (range, day -7 to +1217). Early BSI before day 7 was associated with increased nonrelapse mortality (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1 to 2.3; P = .04), whereas BSI before day 14 was an independent adverse risk factor for neutrophil recovery (RR, .6; 95% CI, .5 to .9; P = .002). A higher CD8(+) cell dose of the graft was the only variable independently associated with reduced risk of BSI (RR, .1; 95% CI, .02 to .7; P = .02). The gram-negative rod (GNR) to gram-positive bacteria ratio was .9 before day +30 and 1.6 thereafter (P = .03). Escherichia coli (31%) and Pseudomonas sp. (28%) were the most frequently isolated among GNR. The overall crude mortality rate was 12% at day 7 and was higher for GNR (18%) compared with gram-positive bacteria (7%) (P = .03). These findings emphasize the importance of preventing bacterial infections during conditioning and the very early post-UCBT period.