Identification of host endotypes using peripheral blood transcriptomics in a prospective cohort of patients with endocarditis.

OBJECTIVES: Host responses to infection are a major determinant of outcome. However, the existence of different response profiles in patients with endocarditis has not been addressed. Our objective was to apply transcriptomics to identify endotypes in patients with infective endocarditis. METHODS: A total of 32 patients with infective endocarditis were studied. Clinical data and blood samples were collected at diagnosis and RNA sequenced. Gene expression was used to identify two clusters (endocarditis endotype 1 [EE1] and endocarditis endotype 2 [EE2]). RNA sequencing was repeated after surgery. Transcriptionally active cell populations were identified by deconvolution. Differences between endotypes in clinical data, survival, gene expression, and molecular pathways involved were assessed. The identified endotypes were recapitulated in a cohort of COVID-19 patients. RESULTS: A total of 18 and 14 patients were assigned to EE1 and EE2, respectively, with no differences in clinical data. Patients assigned to EE2 showed an enrichment in genes related to T-cell maturation and a decrease in the activation of the signal transducer and activator of transcription protein family pathway, with higher counts of active T cells and lower counts of neutrophils. A total of 14 patients (nine in EE1 and five in EE2) were submitted to surgery. Surgery in EE2 patients shifted gene expression toward a EE1-like profile. In-hospital mortality was higher in EE1 (56% vs 14%, P = 0.027), with an adjusted hazard ratio of 12.987 (95% confidence interval 3.356-50). Translation of these endotypes to COVID-19 and non-COVID-19 septic patients yielded similar results in cell populations and outcome. CONCLUSIONS: Gene expression reveals two endotypes in patients with acute endocarditis, with different underlying pathogenetic mechanisms, responses to surgery, and outcomes.

Detection of minimal residual disease in acute myeloid leukemia: evaluating utility and challenges.

This study discusses the importance of minimal residual disease (MRD) detection in acute myeloid leukemia (AML) patients using liquid biopsy and next-generation sequencing (NGS). AML prognosis is based on various factors, including genetic alterations. NGS has revealed the molecular complexity of AML and helped refine risk stratification and personalized therapies. The long-term survival rates for AML patients are low, and MRD assessment is crucial in predicting prognosis. Currently, the most common methods for MRD detection are flow cytometry and quantitative PCR, but NGS is being incorporated into clinical practice due to its ability to detect genomic aberrations in the majority of AML patients. Typically, bone marrow samples are used for MRD assessment, but using peripheral blood samples or liquid biopsies would be less invasive. Leukemia originates in the bone marrow, along with the cfDNA obtained from peripheral blood. This study aimed to assess the utility of cell-free DNA (cfDNA) from peripheral blood samples for MRD detection in AML patients. A cohort of 20 AML patients was analyzed using NGS, and a correlation between MRD assessment by cfDNA and circulating tumor cells (CTCs) in paired samples was observed. Furthermore, a higher tumor signal was detected in cfDNA compared to CTCs, indicating greater sensitivity. Challenges for the application of liquid biopsy in MRD assessment were discussed, including the selection of appropriate markers and the sensitivity of certain markers. This study emphasizes the potential of liquid biopsy using cfDNA for MRD detection in AML patients and highlights the need for further research in this area.

Corrigendum: Personalized monitoring of circulating tumor DNA with a specific signature of trackable mutations after chimeric antigen receptor T-cell therapy in follicular lymphoma patients.

[This corrects the article DOI: 10.3389/fimmu.2023.1188818.].

Personalized monitoring of circulating tumor DNA with a specific signature of trackable mutations after chimeric antigen receptor T-cell therapy in follicular lymphoma patients.

Background: CART therapy has produced a paradigm shift in the treatment of relapsing FL patients. Strategies to optimize disease surveillance after these therapies are increasingly necessary. This study explores the potential value of ctDNA monitoring with an innovative signature of personalized trackable mutations. Method: Eleven FL patients treated with anti-CD19 CAR T-cell therapy were included. One did not respond and was excluded. Genomic profiling was performed before starting lymphodepleting chemotherapy to identify somatic mutations suitable for LiqBio-MRD monitoring. The dynamics of the baseline mutations (4.5 per patient) were further analyzed on 59 cfDNA follow-up samples. PET/CT examinations were performed on days +90, +180, +365, and every six months until disease progression or death. Results: After a median follow-up of 36 months, all patients achieved a CR as the best response. Two patients progressed. The most frequently mutated genes were CREBBP, KMT2D and EP300. Simultaneous analysis of ctDNA and PET/CT was available for 18 time-points. When PET/CT was positive, two out of four ctDNA samples were LiqBio-MRD negative. These two negative samples corresponded to women with a unique mesenteric mass in two evaluations and never relapsed. Meanwhile, 14 PET/CT negative images were mutation-free based on our LiqBio-MRD analysis (100%). None of the patients had a negative LiqBio-MRD test by day +7. Interestingly, all durably responding patients had undetectable ctDNA at or around three months after infusion. Two patients presented discordant results by PET/CT and ctDNA levels. No progression was confirmed in these cases. All the progressing patients were LiqBio-MRD positive before progression. Conclusion: This is a proof-of-principle for using ctDNA to monitor response to CAR T-cell therapy in FL. Our results confirm that a non-invasive liquid biopsy MRD analysis may correlate with response and could be used to monitor response. Harmonized definitions of ctDNA molecular response and pinpointing the optimal timing for assessing ctDNA responses are necessary for this setting. If using ctDNA analysis, we suggest restricting follow-up PET/CT in CR patients to a clinical suspicion of relapse, to avoid false-positive results.

Real-life disease monitoring in follicular lymphoma patients using liquid biopsy ultra-deep sequencing and PET/CT.

In the present study, we screened 84 Follicular Lymphoma patients for somatic mutations suitable as liquid biopsy MRD biomarkers using a targeted next-generation sequencing (NGS) panel. We found trackable mutations in 95% of the lymph node samples and 80% of the liquid biopsy baseline samples. Then, we used an ultra-deep sequencing approach with 2 · 10-4 sensitivity (LiqBio-MRD) to track those mutations on 151 follow-up liquid biopsy samples from 54 treated patients. Positive LiqBio-MRD at first-line therapy correlated with a higher risk of progression both at the interim evaluation (HRINT 11.0, 95% CI 2.10-57.7, p = 0.005) and at the end of treatment (HREOT, HR 19.1, 95% CI 4.10-89.4, p < 0.001). Similar results were observed by PET/CT Deauville score, with a median PFS of 19 months vs. NR (p < 0.001) at the interim and 13 months vs. NR (p < 0.001) at EOT. LiqBio-MRD and PET/CT combined identified the patients that progressed in less than two years with 88% sensitivity and 100% specificity. Our results demonstrate that LiqBio-MRD is a robust and non-invasive approach, complementary to metabolic imaging, for identifying FL patients at high risk of failure during the treatment and should be considered in future response-adapted clinical trials.

Corrigendum: Personalized monitoring of circulating tumor DNA with a specific signature of trackable mutations after chimeric antigen receptor T-cell therapy in follicular lymphoma patients.

[This corrects the article DOI: 10.3389/fimmu.2023.1188818.].

Falsos positivos del cribado de trisomía 21 y 18 del primer trimestre y complicaciones obstétricas / Adverse outcomes in pregnancies with false positive trisomy 21 and 18 screening results

OBJETIVO: Analizar si los casos positivos de cribado combinado de trisomía 21 (t21) o trisomía 18 (t18) en ausencia de aneuploidía (falsos positivos- FP) se relacionan con complicaciones de la gestación, ajustando por factores demográficos y clínicos de riesgo. MATERIAL Y MÉTODOS: Estudio retrospectivo de casos y controles anidado en una cohorte de pacientes que acudieron para cribado del primer trimestre. Los casos fueron las pacientes con FP de riesgo combinado de t21 superior a 1/270 o riesgo de t18 superior a 1/100. Se consideraron complicaciones de la gestación: óbito fetal, parto prematuro menor de 34 semanas o prematuro menor de 37 semanas, preeclampsia, retrasos de crecimiento, pequeño para la edad gestacional (CIR, PEG) y diabetes gestacional (DG). Se ajustó por obesidad, edad, paridad, tabaquismo, y técnicas de reproducción asistida. RESULTADO: Se obtuvieron 204 casos de FP, 149 FP para trisomía 21, 41 para trisomía 18, y 14 FP para ambos riesgos. Se encontró asociación estadísticamente significativa de FP t21 con óbito fetal (OR=3,5; ic95% 1,4-8,7; p=0,01), parto prematuro menor de 37 semanas (OR=2,2; IC95% 1,4-3,4; p=0,001), preeclampsia (OR =2,6; IC95% 1,17-6,1; p=0,02), PEG (OR =2,2; IC95% 1,2-4,1; p=0,02), CIR (OR=2,8; IC95% 1,6-5,1; p=0,001), y DG (OR=2,1; IC95% 1,2-3,7; p=0,01). Los FP t18 se asociaron con óbito (OR=8,9; IC95% 2,9-27; p=0,002). CONCLUSIÓN: Los FP del cribado del primer trimestre, para trisomía 21 y trisomía 18, se asocian con resultados obstétricos adversos.

We have studied whether positive cases of combined trisomy 21 (t21) or 18 (t18) screening in the absence of aneuploidy (false positives -FP-) are related to pregnancy complications adjusting for demographic and clinical risk factors. METHODS: Retrospective case-control study nested in a cohort of patients who came for first trimester aneuploidy screening. The cases were patients with FP combined risk of t21 (greater than 1/270) or t18 risk (greater than 1/100). The control group was a sample of patients with low-risk screening. We considered pregnancy complications: stillbirth, premature delivery before 34 and 37 weeks, preeclampsia, growth retardation, small for gestational age (FGR, SGA), and gestational diabetes (GD). Or were adjusted for obesity, age, parity, smoking, and assisted reproduction techniques. RESULTS: 204 cases of FP were obtained, 149 FP for trisomy 21, 41 for trisomy 18, and 14 FP for both risks. A statistically significant association between t21 FP was found with stillbirth (OR = 3.5; 95% CI 1.4-8.7; p = 0.01), preterm delivery less than 37 weeks (OR = 2.2; 95% CI 1.4-3.4; p = 0.001), preeclampsia (OR = 2.6; 95% CI 1.17-6.1; p = 0.02), SGA (OR = 2.2; 95% CI 1, 2-4.1; p = 0.02), FGR (OR = 2.8; 95% CI 1.6-5.1; p = 0.001), and GD (OR = 2.1; 95% CI 1.2 −3.7; p = 0.01). FP t18s were associated with fetal loss (OR= 8.9 (95% CI 2.9-27) p = 0.002. CONCLUSION: FP from first trimester screening for t21 and t18 are associated with adverse obstetric outcomes.

El estilo de vida saludable en los estudiantes de Nutriología: realidad y percepción / Healthy Lifestyles in Nutrition Students: Reality and Perception

Resumen Antecedentes: las carreras universitarias de la salud deben promover estilos de vida sanos. Objetivo: identificar la relación entre el perfil del estilo de vida, la percepción del estilo de vida saludable y la percepción sobre la carrera de Nutriología de los estudiantes de la Universidad Autónoma de Tlaxcala. Materiales y métodos: tipo de estudio transversal y correlacional. Se evaluaron 145 estudiantes de ambos sexos con tres instrumentos aplicados en un mismo momento. Los datos se reportaron en medianas y se compararon con la prueba U de Mann-Whitney. Se realizaron las pruebas de correlación entre las tres variables con r de Pearson. Resultados: el perfil del estilo de vida tuvo una puntuación diferenciada por sexo (p=0,002); la percepción de estilos de vida saludable (p=0,123) y la percepción de su disciplina (p=0,775) fueron similares entre sexos. Sobresale que el estilo de vida se correlacionó positivamente con la percepción de este (r=0,35; p=0,002). La percepción del estilo de vida se relaciona con la percepción de la carrera (r=0,202; p=0,015), pero no se encontró correlación entre el estilo de vida y la percepción de la disciplina (r=0,08; p=0,34). Conclusiones: a mayor perfil de estilo de vida satisfactorio más alta es la percepción de un estilo de vida saludable.

Abstract Background: University majors that focus on health should promote healthy lifestyles. Objective: Identify the relationship between actual lifestyles, perceptions of healthy lifestyles, and perceptions surrounding being a Nutrition major in the Autonomous University of Tlaxcala. Materials and Methods: Cross-sectional and cor relational study. 145 students, both male and female, were evaluated with the application of three tools simul taneously. Data were reported as medians and were compared using the Mann-Whitney U test. Correlation tests were performed between the three variables using Pearson's r. Results: Lifestyles of students varied by male vs. female (p=0.002). Healthy lifestyle perceptions (p = 0.123) and students' perception of their discipline (p = 0.775) were similar for both genders. It can be highlighted that lifestyle was positively correlated with the perception of it (r = 0.35; p = 0.002). Lifestyle perception was correlated with the perception of their major of study (nutrition) (r = 0.202; p = 0.015), but no correlation was found between lifestyle and discipline perception (r=0.08; p=0.34). Conclusions: The higher the profile of a satisfying lifestyle, the higher the perception of a healthy lifestyle.

The effect of diet on oxidative stress and metabolic diseases-Clinically controlled trials.

Oxidative stress is associated with several chronic diseases. It is acknowledged that molecules damaged by reactive oxygen species activate the inflammatory process and that this response increases the production of free radicals. Modifications in a diet can improve or decrease redox state markers. The aim of this revision was to provide an update of clinical controlled trials, to assess changes in diet and markers of oxidative stress in subjects with metabolic diseases. They were investigated randomized controlled intervention studies (RCTs) published in MEDLINE (U.S. National Library of Medicine, National Institutes of Health) that were conducted in subjects with obesity, hypertension, diabetes, or dyslipidemia; with dietary intervention; where markers of oxidative stress have been evaluated and published in the last 5 years. Food antioxidants, hypocaloric diets with loss of adipose tissue, substitution of animal protein by vegetable, and changes in the microbiota improve antioxidant status in people with chronic disease. PRACTICAL APPLICATIONS: Hyperglycemia in diabetes mellitus and adipose tissue in obesity are known to trigger oxidative stress. Oxidative stress, in turn, decreases insulin sensitivity and favors an inflammatory state producing adhesion molecules. Oxidative stress and adhesion molecules, can increase blood pressure and oxidation of lipoproteins, that ultimately could lead to a cerebrovascular event. Consumption of high-antioxidant and polyphenol foods increases plasma antioxidant capacity and decreases oxidative stress markers in people with diabetes, obesity, hypertension, and hypertriglyceridemia. In addition, weight loss caused by caloric restriction with or without exercise increases the endogenous antioxidant capacity. Therefore, it is likely that the combination of a hypocaloric diet with a high content of antioxidants and polyphenols will have a greater effect. Other dietary changes with antioxidant effect, such as the substitution of animal for vegetable protein or the addition of fiber, might be mediated by changes in the microbiota. However, this aspect requires further study.

RNA-Seq analysis reveals that spring viraemia of carp virus induces a broad spectrum of PIM kinases in zebrafish kidney that promote viral entry.

PIM kinases are a family of serine/threonine protein kinases that potentiate the progression of the cell cycle and inhibit apoptosis. Because of this, they are considered to be proto-oncogenes, and they represent an interesting target for the development of anticancer drugs. In mammals, three PIM kinases exist (PIM-1, PIM-2 and PIM-3), and different inhibitors have been developed to block their activity. In addition to their involvement in cancer, some publications have reported that the PIM kinases have pro-viral activity, and different mechanisms where PIM kinases favour viral infections have been proposed. Zebrafish possess more than 300 Pim kinase members in their genome, and by using RNA-Seq analysis, we found a high number of Pim kinase genes that were significantly induced after infection with spring viraemia of carp virus (SVCV). Moreover, analysis of the miRNAs modulated by this infection revealed that some of them could be involved in the post-transcriptional regulation of Pim kinase abundance. To elucidate the potential role of the 16 overexpressed Pim kinases in the infectivity of SVCV, we used three different pan-PIM kinase inhibitors (SGI-1776, INCB053914 and AZD1208), and different experiments were conducted both in vitro and in vivo. We observed that the PIM kinase inhibitors had a protective effect against SVCV, indicating that, similar to what is observed in mammals, PIM kinases are beneficial for the virus in zebrafish. Moreover, zebrafish Pim kinases seem to facilitate viral entry into the host cells because when ZF4 cells were pre-incubated with the virus and then were treated with the inhibitors, the protective effect of the inhibitors was abrogated. Although more investigation is necessary, these results show that pan-PIM kinase inhibitors could serve as a useful treatment for preventing the spread of viral diseases.

Influencia de la calidad de vida laboral sobre el desempeño de trabajadores de hospitales públicos de México: una visión desde la gestión directiva / Influence of the labor quality of life on the employee performance of public hospitals from Mexico: a vision based on the team management

Resumen: Objetivo: Evaluar la relación entre calidad de vida laboral (CVL) y el desempeño organizacional (DO) de trabajadores de siete hospitales públicos, a partir del análisis de la influencia de la gestión directiva (GD) como mediadora de esta relación. Material y métodos: Se realizó un estudio transversal en 866 profesionales y directivos de hospitales públicos de Tlaxcala y de la Ciudad de México. La CVL fue medida con un instrumento validado, el DO con 34 indicadores y la GD con un instrumento diseñado para este estudio. Resultados: Los puntajes de gestión directiva, CVL, DO y GD fueron significativamente menores en los trabajadores de Tlaxcala. Los participantes que percibieron adecuada GD incrementaron 2.7 veces más la probabilidad de percibir elevada CVL y los participantes categorizados en elevada CVL presentaron 69% mayor probabilidad de tener adecuado DO. Conclusiones: La adecuada GD se asoció con una mejor CVL, lo que mostró ser una variable mediadora de la relación positiva entre CVL y DO.

Abstract: Objective: To assess the relationship between labor quality of life (LQL) and organizational workers performance (OWP) from seven public hospitals, analyzing the influence of the personnel management (PM) as mediator of this relationship. Materials and methods: A cross-sectional study was conducted in 866 professionals and managers of public hospitals from Tlaxcala and Mexico City. The LQL was assessed with a validated questionnaire, OWP with 34 indicators, and PM with an instrument designed for this study. Results: Mean scores of LQL, were significantly lower among workers from Tlaxcala. Participants who perceived an adequate PM, they increased at 2.7 times their likelihood of having highest LQL, and participants categorized in the high LQL presented 69% higher likelihood of having an adequate OWP. Conclusions: The appropriate PM was associated with greater LQL, showing to be a mediator variable between the positive relationship of CVL and the OWP.

Intervalo de nacimiento entre gemelos como determinante del resultado neonatal precoz / Inter-twin delivery interval as a determinant of early neonatal outcome

INTRODUCCIÓN Y OBJETIVOS: La mayoría de las sociedades científicas recomiendan el parto vaginal del segundo gemelo siempre que el primer gemelo esté en presentación cefálica. En estos casos existe controversia cuánto tiempo transcurrido entre el parto de ambos es determinante en el resultado adverso del segundo gemelo. El objetivo de este estudio es examinar cómo influye dicho intervalo en el resultado perinatal precoz en nuestro Centro y el coste de las estancias neonatales y maternas. MÉTODOS: Estudio de cohortes retrospectivo entre mayo de 2014 y diciembre de 2018. Se comparó el resultado neonatal adverso estableciendo puntos de corte de intervalo entre el nacimiento de 10 y 30 minutos. Así mismo, se examinó la relación de otras variables del parto con el desenlace neonatal y se calcularon los costes de las estancias neonatales y maternas. RESULTADOS: Se incluyeron 128 partos gemelares vaginales asistidos en el Hospital Universitario Nuestra Señora de la Candelaria. Se evidenció triple tasa de resultado neonatal adverso en el grupo de más de 10 minutos (p=0,026 y OR 2,4) y tres veces peor en el de más de 30 minutos (p=0,013 y OR 6,4). Se obtuvo una correlación lineal negativa significativa entre el intervalo intergemelar y el pH umbilical. La prematuridad y el bajo peso al nacer fueron predictores de un mal desenlace neonatal. CONCLUSIONES: No parece recomendable que el intervalo intergemelar se prolongue más allá de los 30 minutos. Es seguro recomendar el parto vía vaginal en gestaciones gemelares siempre que el primero esté en presentación cefálica.

INTRODUCTION AND OBJECTIVES: Most scientific societies recommend vaginal delivery of the second twin when the first twin is in cephalic presentation. In these cases, there is controversy over how much inter-twin interval is decisive in the adverse outcome of the second twin. The aim of this study is to examine whether inter-twin delivery interval affects immediate perinatal outcome and the cost of neonatal and maternal stays. METHODS: Retrospective cohort study including 128 twin vaginal births attended in the Hospital Universitario Nuestra Señora de la Candelaria between May 2014 and December 2018. We compared the presence of composite adverse neonatal outcome by establishing interval cut-off points between birth of 10 and 30 minutes. Likewise, the relationship of other delivery associated variables with neonatal outcome was examined. Health care costs were calculated. RESULTS: There was a higher rate of composite adverse neonatal outcome in the 10 minute-group (p = 0.026, OR 2.4) and three times higher in the 30 minute-group (p = 0.013, OR 6.4). A significant negative linear correlation was obtained between birth interval and umbilical artery pH. Prematurity and low birth weight were predictors of a poor neonatal outcome. CONCLUSION: Our data suggests that inter-twin delivery interval shouldn't be prolonged beyond 30 minutes. Vaginal delivery is a safe option in twin gestations providing the first twin is in a cephalic presentation, regardless of the second twin presentation.

Austerity, healthcare provision, and health outcomes in Spain.

The recession that started in the United States in December 2007 has had a significant impact on the Spanish economy through a large increase in the unemployment rate and a long recession which led to tough austerity measures imposed on public finances. Taking advantage of this quasi-natural experiment, we use data from the Spanish Ministry of Health from 1996 to 2015 to provide novel causal evidence on the short-term impact of changes in healthcare provision and regulations on health outcomes. The fact that regional governments have discretionary powers in deciding healthcare budgets and that austerity measures have not been implemented uniformly across Spain helps isolate the impact of these policy changes on health indicators of the Spanish population. Using Ruhm's (Q J Econ 115(2):617-650, 2000) fixed effects model, we find that medical staff and hospital bed reductions account for a significant increase in mortality rates from circulatory diseases and external causes, but not from other causes of death. Similarly, mortality rates do not seem to be robustly affected by the 2012 changes in retirees' pharmaceutical co-payments and access restrictions for illegal immigrants. Our results are robust to changes in model specification and sample selection and are primarily driven by accidental and emergency deaths rather than in-hospital mortality, which suggests a larger role for decreases in accessibility rather than decreases in healthcare quality as impact channels.

Validez de las Escalas de Braden y EVARUCI en Pacientes Hospitalizados en una Unidad de Cuidados Intensivos / The validity of the Braden and EVARUCI Scales in Hospitalized Patients in an Intensive Care Unit

Resumen Con el fin de establecer diferencias entre las escalas de valoración de riesgo de desarrollo de ulceras por presión (Braden y EVARUCI) en pacientes críticos, como los que se encuentran hospitalizados en las unidades de cuidado intensivo. Se realizó la validez de ambas escalas determinando la sensibilidad, especificidad y valores predictivos. Para el estudio se seleccionaron consecutivamente pacientes mayores de edad, sin ulceras por presión en cualquier estadio, que ingresaron para ser hospitalizados con diagnóstico de cualquier patología. Se determinó que no hubo una verdadera diferencia entre la sensibilidad de ambas escalas, que la especificidad de la escala de EVARUCI fue mayor al igual que el valor predictivo positivo y no se evidenció diferencias significativas en el valor predictivo negativo. Se pudo concluir que la escala de EVARUCI es un instrumento predictor valido para la detección del riesgo de desarrollo de UPP ya que además valora aspectos, como nivel de consciencia, estado hemodinámico, soporte de oxígeno, movilidad, temperatura, saturación, entre otros.

Abstract With the final purpose to establish difference between the titration scales of risk development pressure ulcers (Braden y EVARUCI) in critical patients, as those who are hospitalized in intensive care units. The validity of both scales was performed to determining the sensibility, the specificity and predictive values. For the study were selected consecutively patients of legal age, without pressure ulcers at any stage, who were admitted to be hospitalized with the diagnostic of any pathology. It was determined that there was not real difference between sensibility of both scales, that specificity of the scale of EVARUCI was higher like the positive predictive and evidence no significant differences in the negative predictive value. It was concluded that the scale of EVARUCI is the valid predictive instrument for the detection of the risk development for pressure ulcers, as besides valued aspects, like the level of consciousness, hemodynamic status, oxygen support, movility, tempeture, saturation, among others.

Caracterización clinicoepidemiológica de pacientes con tumores epiteliales cutáneos no melanoma / Clinical and epidemiological characterization of patients with epithelial cutaneous non melanoma tumors

Se realizó un estudio descriptivo, retrospectivo y transversal de 87 pacientes con tumores cutáneos no melanoma, atendidos en el Servicio de Dermatología del Hospital Clinicoquirúrgico Docente Dr Joaquín Castillo Duany de Santiago de Cuba, desde enero de 2012 hasta igual mes de 2014 con el objetivo de caracterizarles según variables clínicas y epidemiológicas de interés para la investigación. La información se recogió de las historias clínicas y de los informes de anatomía patológica. Como medidas de resumen para variables cuantitativas y cualitativas se utilizaron la media, la frecuencia absoluta y la relativa. En la serie predominaron el carcinoma basocelular (60,0 por ciento), el sexo masculino, los pacientes de piel blanca y los mayores de 50 años de edad; asimismo, la cabeza resultó ser la región topográfica más afectada y la forma clínica nodular la más frecuente. Según la ocupación, los agricultores y los albañiles estuvieron mayormente relacionados con este tipo de cáncer de piel.

A descriptive, retrospective and cross-sectional study of 87 patients with non melanoma cutaneous tumors, assisted in the Dermatology Service of Dr Joaquín Castillo Duany Clinical Surgical Hospital in Santiago de Cuba was carried out from January, 2012 to the same month of 2014 with the objective of characterizing them according to clinical and epidemiological variables of interest for the investigation. The information was collected from the medical records and from the pathology reports. For quantitative and qualitative variables, means, absolute frequency and the relative frequency were used as summary measures. In the series, the basocelular carcinoma (60,0 percent), male sex, the white skin patients and those older than 50 years prevailed; also, the head turned to be the most affected topographical region and the most frequent nodular clinical type. According to the occupation, farmers and bricklayers were mostly related to this type of skin cancer.

Diagnóstico y pronóstico prenatal de los linfangiomas fetales. Reporte de dos casos / Diagnosis and prenatal prognosis of fetal lymphangioma. Two cases reports

Resumen ANTECEDENTES: Los linfangiomas fetales son malformaciones del sistema linfático que representan 4% de todos los tumores vasculares en los recién nacidos vivos, con una incidencia de 1.2-2.8‰. CASOS CLÍNICOS: Se comunican dos casos clínicos poco frecuentes, por su localización y extensión, de linfangiomas fetales. En ambas pacientes el diagnóstico se estableció mediante estudio ecográfico, durante el tercer trimestre, en gestaciones de bajo riesgo. La alteración no se relacionó con malformaciones estructurales adicionales, trastornos cromosómicos ni genéticos. La resonancia magnética confirmó el diagnóstico de la enfermedad. En una de las madres, el tamaño del feto determinó la vía de finalización del embarazo (parto). La cirugía fue el tratamiento de elección, con evolución satisfactoria en una paciente y la otra permanece a la espera de una nueva intervención quirúrgica, pues aún manifiesta recidivas. En la actualidad, el desarrollo psicomotor, ponderal y estructural de las pacientes es adecuado. CONCLUSIÓN: La ecografía es un estudio decisivo para establecer el diagnóstico y seguimiento de los linfangiomas fetales.

Abstract BACKGROND: Fetal lymphangiomas are malformations of the lymphatic system, representing 4% of all vascular tumors in living newborns, with an incidence of 1.2-2.8‰. CLINICAL CASE: Two uncommon clinical cases, due to their location and extension, of fetal lymphangiomas are reported. In both patients, the diagnosis was established by ultrasound study, during the third trimester, in low risk gestations. The alteration was not related to additional structural malformations, chromosomal or genetic disorders. Magnetic resonance confirmed the diagnosis of the disease. In one mothers, the size of the fetus determined the route of termination of pregnancy (delivery). Surgery was the treatment of choice, with satisfactory evolution in one patient and the other remains awaiting a new surgical intervention, because it still manifests recurrences. At present, the psychomotor, weigth and size development of the patients is adequate. CONCLUSION: Ultrasound is critical for diagnosis and monitoring of this type of malformations.

Validación de una escala para medir la calidad de vida laboral en hospitales públicos de Tlaxcala / Validation of a scale to assess the labour quality of life in public hospitals from Tlaxcala

Resumen: Objetivo: Validar un instrumento para medir la calidad de vida laboral en hospitales públicos (CVL-HP) de Tlaxcala, México. Material y métodos: El instrumento fue validado en 669 trabajadores de seis hospitales de la Secretaría de Salud de Tlaxcala, México. Se evaluó validez de contenido por consulta a expertos, de constructo mediante análisis factorial, de criterio por comparación con otras escalas y la confiabilidad con Alpha de Cronbach. Resultados: El análisis factorial descubrió cuatro dimensiones: “bienestar individual”, “condiciones y medio ambiente de trabajo”, “organización” y “bienestar logrado a través del trabajo”. La confiabilidad fue de 0.921. Los trabajadores con mejor CVL-HP fueron menores de 50 años, de contrato, con menor antigüedad laboral, personal de jornada acumulada diurna y aquéllos con licenciatura. Conclusiones: La escala CVL-HP mostró ser psicométricamente válida y confiable. Se recomienda probar esta escala en otras instituciones públicas y privadas, y relacionarla con indicadores de desempeño y gestión de los servicios de salud.

Abstract: Objective: To validate a scale for assessing the labour quality of life in public hospitals (LQL-PH) from Tlaxcala, Mexico. Materials and methods: The instrument was validated among 669 health workers from six hospitals from the Ministry of Health of Tlaxcala, Mexico. Content validity was by inquiry to experts, construct validity by factor analysis, criterion validity by comparing with other scales, and reliability with Cronbach’s Alpha. Results: The factor analysis uncovered four dimensions: “individual welfare”, “conditions and labour environment”, “organization”, and “well-being accomplished by the work”; reliability was 0.921. Workers who perceibed better LQL-PH were: under 50 years old, with temporary contract, with less seniority in job, with work schedule at daytime of weekends, and those with academic degree. Conclusions: LQL-PH showed to be an instrument phsycometrically valid and reliable. It’s recommendable to prove this scale in other public and private health institutions, as well as its relationship with key health care indicators of labour performance and management.

Mecanismos de resistencia en micobacterias de crecimiento rápido / Resistance mechanisms of rapid growing mycobacteria

Las Micobacterias de crecimiento rápido (MCR) son patógenos oportunistas capaces de ocasionar infecciones en piel, pulmonares y diseminadas. En Venezuela existe un incremento de estas infecciones derivadas de procedimientos invasivos, entre ellas cirugías estéticas. El tratamiento de esas infecciones requiere la administración de al menos dos antibióticos por varios meses. En la presente revisión se describe los mecanismos de resistencia a los antibióticos que se han reportado en las MCR, principalmente las tres especies que frecuentemente se han asociado a infecciones en piel: M. abscessus, M. chelonae y M. fortuitum. Los factores más importantes relacionados a la resistencia en los esquemas de tratamiento son: cambios relacionados en la permeabilidad de la membrana al antibiótico, la inactivación enzimática y modificaciones del sitio blanco. En MCR se han evidenciado la presencia de betalactamasas con actividad penicilinasas y cefalosporinasas y de acetil-transferasas que pueden modificar los aminoglicósidos. Las modificaciones de las regiones ARNr 23S y ARNr 16S han permitido explicar, en parte, la resistencia a macrólidos y aminoglicósidos. La metilación de los sitios blanco de acción de los macrólidos es otro factor importante, sobre todo en especies como M. abscessus. Éste último mecanismo explica la falla terapéutica que se ha reportado en pacientes tanto en infecciones pulmonares como en infecciones en piel. Es necesario ampliar el estudio sobre los mecanismos de resistencia en estas especies, tomando en consideración las complicaciones que llevan estas infecciones y los tiempos prolongados de tratamientos pudiendo generar efectos secundarios en los pacientes y la frustración cuando ocurre la falla terapéutica.

The rapid growing mycobacteria (RGM) are opportunist pathogens able to cause skin, pulmonary and disseminated infections. In Venezuela there is an increase in the prevalence of these infections especially following esthetic surgery. The treatment of such infections is cumbersome requiring the administration of at least two antibiotics for several months. In the present review we describe the principal antibiotic resistance mechanisms reported for RGM, particular for the species most frequently associated with skin and soft tissue infection: M. abscessus, M. chelonae and M. fortuitum. The most important factors associated with resistance to antibiotics are impermeability of the cell membrane, enzymatic inactivation and changes in the target site. In RGM the presence of the beta-lactamases with penicillinases and cephalosporinase activity has been demonstrated and the presence of acetyl-transferases which can modify aminoglycosides. Changes in the 23S rRNA and 16S rRNA regions has allowed to explain, partly macrolide and aminoglycoside resistance. Mutation in the macrolide target site is another important resistance mechanism, particularly for the species group M. abscessus. This last mechanism can explain treatment failure reported in the patients with pulmonary or skin infection. We conclude that there is a need for more extensive studies about the mechanisms of antibiotic resistance of RGM; taking into account the complications of these infections, the prolonged treatment long time, producing secondary effects and the frustrations of patient and physician caused by therapeutic failures.

Pneumothorax as atypical presentation of bronchial carcinoid.

We present a case of pneumothorax associated with an endobronchial carcinoid tumor in a 18-year-old man with dyspnea and chest pain. Additional tests were done, identifying in the chest roentgenogram a complete left pneumothorax with persistent leak, which was confirmed by computed tomography of the chest, and also finding an endobronchial lesion that limited the complete reexpansion of the left lung. Surgical excision was performed, and the lesion was identified as a typical bronchial carcinoid, with satisfactory outcome after the intervention.

Nesidioblastosis: hipoglucemia hiperinsulínica persistente en un recién nacido / Nesidioblastosis: persistent hyperinsulinemic hypoglycemia in a newborn

Se presenta el caso clínico de un recién nacido a término por parto distócico (cesárea), debido a una toxemia gravídica, con antecedente de polihidramnios, que manifestó dificultad respiratoria a los pocos minutos del nacimiento y fue ingresado en el Hospital Infantil Norte Dr Juan de la Cruz Martínez Maceira de Santiago de Cuba. Le fueron detectadas cifras de glucemia muy bajas que, evolutivamente, trajeron aparejadas convulsiones tónico-clónicas generalizadas, cuyas frecuencias no se lograban disminuir. Se le diagnosticó una hipoglucemia hiperinsulínica persistente (nesidioblastosis) y fue trasladado a La Habana para recibir tratamientos clínico y quirúrgico definitivos. Actualmente es atendido por un equipo médico multidisciplinario

The case of a term infant by dystocia (cesarean section) due to pregnancy toxemia with history of polyhydramnios is presented, who had respiratory distress a few minutes after birth and he was admitted to Dr Juan de la Cruz Martínez Maceira Northern Children Hospital of Santiago de Cuba. Very low blood glucose levels were detected that progressively caused tonic-clonic seizures, which frequencies could not be reduced. He was diagnosed with persistent hyperinsulinemic hypoglycemia (nesidioblastosis) and was transferred to Havana to receive definitive clinical and surgical treatments. Currently, he is treated by a multidisciplinary medical team