Abo Blood Group, Atherothrombotic Comorbidities, and COVID-19: A Case-Control Study of their Association in the Mexican Population.

BACKGROUND: COVID-19 has been associated with negative results in patients with A blood group and with a better evolution in O blood group individuals. AIM: Because the evidence regarding ABO blood groups and COVID was empirically not that clear in our country, we tested the association regarding COVID-19 and blood groups. MATERIAL AND METHODS: Adult patients were enrolled in this prospective, case-control, observational multicenter study. Patients with a confirmed diagnosis of COVID-19 were assigned to one of three groups based on the clinical presentation of the infection. Age, gender, ABO and Rh blood groups, body mass index, history of diabetes mellitus or high blood pressure, and smoking were recorded directly or from their clinical charts. ABO blood group was obtained from 5,000 blood donors (50% each gender). Atherothrombotic variables were compared with a nation-wide data collection. RESULTS: A total of 2,416 patients with COVID-19 were included (women:39.6%; men:60.4%). There were no significant differences between cases and controls in terms of age. O blood group was the most frequently found in healthy donors and COVID-19 patients, but this blood group was significantly higher in COVID-19 patients vs. healthy donors. ABO blood group was not associated with the final health status in COVID-19 patients. Obesity, diabetes mellitus, hypertension and smoking were significantly more frequent among COVID-19 patients. CONCLUSION: The proposed protective effect of the O blood group in COVID-19 patients could not be reproduced in the Mexican population while some atherothrombotic risk factors had a significant effect on the clinical evolution.

Epidemiology and Clinical Characteristics of Non-Hodgkin Lymphoma in Mexico.

BACKGROUND: There is no epidemiological registry in Mexico. The information about the epidemiology in our country is obtained by these types of studies, such as multicentric studies. A lot of improvements in the survival in non-Hodgkin lymphoma patients had occurred in the last 20 years. The access to treatment in these types of pathology could change the prognostic factors in Mexican Mestizos patients. The primary objective of the study was to learn what the most frequent histological varieties of non-Hodgkin lymphoma in Mexico are. The secondary objectives included clinical characteristics, treatments used, treatment response, disease-free survival and overall survival. METHODS: A retrospective, descriptive study of consecutive cases was carried out in 14 hospitals across 14 Mexican states with patients diagnosed with non-Hodgkin lymphoma using the World Health Organization (WHO) 2008 criteria. Inclusion criteria included: ≥ 18 years of age, male or female, any clinical stage at diagnosis, who had received any chemotherapy regimen, with a known outcome. Descriptive statistics was performed for all variables, and survival was assessed using Kaplan-Meier curves. RESULTS: Totally, 609 patients were enrolled, of which 545 were B-cell lymphomas and 64 were T-cell lymphomas. Median ages were 61 and 50, respectively. B-cell lymphomas were more common in males with 52.1%, and 65.5% of T-cell lymphomas occurred in females. For B-cell lymphomas, the two most frequent histological subtypes were diffuse large B-cell lymphoma in 63.9%, followed by follicular lymphoma at 18%. Meanwhile, 50% of T-cell lymphomas were of the T/natural killer (NK) subtype, and 87.1% of the patients received a CHOP-like regimen. Radiotherapy was given to 31% of B-cell Lymphomas and 46.9% of T-cell lymphomas. Overall survival at 9 years was 84.6% for B-cell lymphomas, and 73.4% for T-cell lymphomas. CONCLUSIONS: Diffuse large B-cell lymphoma constitutes the most frequent subtype for B-cell lymphomas in Mexico. The most frequent T-cell lymphoma is the NK/T histological subtype.

Optimal large-scale CD34+ enrichment from a leukapheresis collection using the clinimacs prodigy platform.

Optimization of Hematology Patient's treatment: It is possible to obtain a 100% CD34+ recovery after CD34+ selection using the CliniMACS Prodigy.

Retrospective Multicenter Study of Extracorporeal Photopheresis in Steroid-Refractory Acute and Chronic Graft-versus-Host Disease.

Extracorporeal photopheresis (ECP) is an established treatment strategy in steroid-refractory graft-versus-host disease (GVHD). This study's main objective was to analyze the clinical response and impact of ECP therapy in steroid dose reduction. A retrospective observational series of 113 patients from 7 transplantation centers was analyzed. Sixty-five patients (58%) had acute GVHD (aGVHD), and 48 (42%) had chronic GVHD (cGVHD). All ECP procedures were performed with the off-line system. The median number of procedures until achievement of initial response was 3 for both patients with aGVHD and those with cGVHD. ECP was the second-line therapy in 48% of the aGVHD cases and in 50% of the cGVHD cases. 71% of the cases of aGVHD were grade III-IV, and 69% of the cases of cGVHD were severe. The overall response rate on day 28 was 53% (complete response [CR] rate, 45%) in the patients with aGVHD and 67% (CR, 23%) in those with cGVHD. Skin was the most frequently involved organ, with a response rate of 58% (CR, 49%) in the patients with aGVHD and 69% (CR 29%) in those with cGVHD. At the end of ECP treatment, 60% of patients treated for aGVHD who responded were able to stop steroid therapy, with a median dose reduction of 100%. Significant differences in overall survival were observed for patients responding to ECP with aGVHD (hazard ratio [HR], 4.3; P < .001) and with cGVHD (HR, 4.8; P = .003). Our data indicate that ECP is a valid therapeutic alternative in patients with steroid-refractory aGVHD and cGVHD, permitting significant steroid dosage reductions.

ABO-mismatched marrow processing for transplantation: Comparative results of 80 procedures performed with Cobe Spectra and Spectra Optia.

BACKGROUND: removal of incompatible red blood cells (RBCs) or plasma is usually required to avoid hemolysis during infusion of ABO incompatible bone marrow (BM) allogeneic transplants. This process often involves separation of buffy coat (BC) by centrifugation in automated devices. We have evaluated the Spectra Optia™ (Optia) apheresis system to determine its effectiveness in BC concentration, volume reduction and RBCs depletion of ABO-incompatible BM compared with our previous method using Cobe Spectra™ (Cobe). MATERIALS AND METHODS: 28 processes were performed with Optia and 52 with Cobe. We compared volume reduction, RBCs depletion, and recovery of total nucleated cells (TNCs), mononuclear cells (MNCs), CD34+ and CD3+ cells in the final product. Hematopoietic engraftment was ascertained. We used Saphiro-Wilks and Kolmorgorov- Smirnov tests to test normality and Mann-Whitney's U test to compare means between both groups. RESULTS: We found statistically significant differences favoring Optia versus Cobe in TNCs recovery (62% vs. 37%), CD34+ cell recovery (98 vs 84%), volume reduction (91 vs 84%), and RBCs depletion (99 vs. 97%), but not in processing time or time to engraftment. CONCLUSION: Optia achieves high RBCs and volume depletion of BM, while providing excellent CD34+ recovery in clinical routine. Some parameters compare favorably with Cobe Spectra.

Segmentation of skin lesions in dermoscopy images using fuzzy classification of pixels and histogram thresholding.

BACKGROUND AND OBJECTIVE: To ensure proper functioning of a Computer Aided Diagnosis (CAD) system for melanoma detection in dermoscopy images, it is important to accurately detect the border of the lesion. This paper proposes a method developed by the authors to address this problem. METHODS: The algorithm for segmentation of skin lesions in dermoscopy images is based on fuzzy classification of pixels and subsequent histogram thresholding. RESULTS: This method participated in the 2016 and 2017 ISBI (International Symposium on Biomedical Imaging) Challenges, hosted by the ISIC (International Skin Imaging Collaboration). It was tested against two public databases containing 379 and 600 images respectively, and compared using the same defined metrics (Accuracy, Dice Coefficient, Jaccard Index, Sensitivity and Specificity) with the rest of participating state-of-the-art work, obtaining good results: (0.934, 0.869, 0.791, 0.870 and 0.978) and (0.884, 0.760, 0.665, 0.869 and 0.923) respectively, ranking 9th and 15th out of a total of 21 and 28 participants respectively using the Jaccard Index (which was the indicator used as a basis for ranking) and the 1st in the 2017 Challenge using the Sensitivity. CONCLUSION: The method has been proven to be robust and reliable. It's main contribution is the very design of the algorithm, highly innovative, which could also be used to deal with other segmentation problems of a similar nature.

Home transfusion: three decades of practice at a tertiary care hospital.

BACKGROUND: Hospital at Home (HH) provides specialized care at the patients' homes. Keeping patients in familial surroundings can result in better outcomes reducing readmission to hospital, mortality, and costs of care. Home transfusion (HT) can be a key element in HH management but is scarcely deployed due to concerns about safety and cost. We have reviewed our HT practice to assess its feasibility and safety. STUDY DESIGN AND METHODS: We prospectively reviewed data collected from 1985 to 2015, focusing specially on feasibility and procedural safety, looking for adverse events of transfusion. We also assessed the situation in similar hospitals in Spain with a survey about their practice. RESULTS: A total of 613 patients received 2260 blood components in 2126 transfusion episodes. A total of 93% patients received fewer than 10 transfusions. Most patients were treated for blood diseases (32%) or cancers (20%). The rate of adverse effects was 2.68% and decreased significantly with time. Fever was the most common adverse reaction. Patients who received transfusion of more than one blood product in a day were at higher risk of adverse events. No errors or near-miss events were detected, and no patient had to be readmitted to hospital for this cause. The survey on HT practices in similar hospitals showed great variation in practice. CONCLUSION: HT is feasible, sustainable, and safe, when performed on selected patients by dedicated HH units with well-trained staff, under specific protocols.

[Molecular response with triple therapy in patients with chronic myeloid leukemia]. / Respuesta molecular con terapia triple en pacientes con leucemia mieloide crónica.

BACKGROUND: Chronic myeloid leukemia is a myeloproliferative disorder which results from the translocation t(9;22)(q34;q11). Imatinib mesylate is an inhibitor of kinase tyrosine that has proved to be useful in patients with chronic myeloid leukemia. Our aim was to evaluate the major molecular response to 12 months with triple therapy, analyze the evolution of these patients, and the hematological and non-hematological toxicity. METHODS: It was performed a longitudinal study in patients with diagnosis of chronic myeloid leukemia who were treated with sequential triple therapy: Pegylated interferon alpha 2a (90 µg/week for four weeks) + imatinib (800 mg a day for 30 days) + cytarabine (20 mg/m2 from day 1 to 10). Molecular and hematologic responses at 12 months of treatment were analyzed. RESULTS: Thirty eight patients with chronic myeloid leukemia were eligible; the mean age was 43.4 years and the medians of hemoglobin levels, leukocyte and platelet counts at diagnosis were 10 g/dL (5.1 to 16.0 g/dL), 208 000/µL3 (10 600 to 529 000/µL3) and 573 500/µL3 (130 000 to 4 272 000/µL3), respectively. According to the Sokal score, 68.4 % had low risk, 26.3 % intermediate and 5.3 % high risk. CONCLUSIONS: The hematologic response was similar to that reported in the IRIS study, but the molecular response was greater in more cases. The adverse hematological effects grades 3-4 and non-hematological were significative: 45 % and 87 %, which forces to continous monitoring. The combination of interferon alpha 2a, cytarabine and a high-dose of imatinib induced the major molecular response, of 68.4 %, at 12 months.

INTRODUCCIÓN: la leucemia mieloide crónica es un trastorno mieloproliferativo provocado por la translocación t (9;22)(q34;q11). El mesilato de imatinib es un inhibidor de la tirosina cinasa útil en el tratamiento de la leucemia mieloide crónica. El objetivo de este estudio fue evaluar la respuesta molecular mayor a los 12 meses con esquema terapéutico triple, analizar la evolución de los pacientes, así como la toxicidad general y la hematológica. MÉTODOS: estudio observacional longitudinal en pacientes con leucemia mieloide crónica, tratados con interferón pegilado alfa 2a subcutáneo (90 µg/semana por cuatro semanas) + imatinib oral (800 mg/día por 30 días) + citarabina subcutánea (20 mg/m2 de superficie corporal del día 1 al 10). Se analizaron las respuestas hematológica y molecular a los 12 meses. RESULTADOS: se trataron 38 pacientes con leucemia mieloide crónica con edad media de 43.4 años. Los niveles de hemoglobina, leucocitos y plaquetas al diagnóstico fueron de 10 g/dL (5.1 a 16 g/dL), 208 000/µL3 (10 600 a 529 000/µL3) y 573 500/µL3 (130 000 a 4 272 000/µL3), respectivamente. Según la escala Sokal, 68.4 % tuvo bajo riesgo, 26.3 % intermedio y 5.3 % riesgo alto. CONCLUSIONES: la respuesta hematológica fue semejante a la del estudio IRIS. Se obtuvo una respuesta molecular mayor en mayor proporción de casos. Los efectos secundarios hematológicos grados 3 y 4 y no hematológicos fueron significativos: 45 y 87 %, lo que obliga al monitoreo continuo. La combinación de interferón alfa 2a, citarabina e imatinib a dosis altas indujo la remisión molecular mayor a los 12 meses en 68.4 % de los casos.

Detection of pigment network in dermoscopy images using supervised machine learning and structural analysis.

By means of this study, a detection algorithm for the "pigment network" in dermoscopic images is presented, one of the most relevant indicators in the diagnosis of melanoma. The design of the algorithm consists of two blocks. In the first one, a machine learning process is carried out, allowing the generation of a set of rules which, when applied over the image, permit the construction of a mask with the pixels candidates to be part of the pigment network. In the second block, an analysis of the structures over this mask is carried out, searching for those corresponding to the pigment network and making the diagnosis, whether it has pigment network or not, and also generating the mask corresponding to this pattern, if any. The method was tested against a database of 220 images, obtaining 86% sensitivity and 81.67% specificity, which proves the reliability of the algorithm.

[Polypharmacy prevalence and potentially inappropriate drug prescription in the elderly hospitalized for cardiovascular disease]. / Prevalencia de la polifarmacia y la prescripción de medicamentos inapropiados en el adulto mayor hospitalizado por enfermedades cardiovasculares.

INTRODUCTION: Many older adults have multiple medical conditions that require medical attention, exposing them to polypharmacy and to a higher increase in prescribing potentially inappropriate medications. These situations may cause adverse drug reactions, longer hospital stays, and death. The prevalence of polypharmacy in our country is estimated at 55% and inappropriate prescribing of medications of 30%. OBJECTIVE: To determine the prevalence of polypharmacy and potentially inappropriate drug prescription in older patients hospitalized for cardiovascular diseases. MATERIAL AND METHODS: Patients older than 70 years from a tertiary level hospital admitted to cardiology and angiology were included, from the period 2013-2014. Fragility status, polypharmacy, and drug prescription based on the Beer's criteria were established. The results were analyzed using descriptive statistics. For inferential analysis, cross tabulations with Pearson χ2 were used. RESULTS: 446 patients where included, with female predominance of 56% (mean age 76.6 ± 5.9 years). The prevalence of fragility was 35.7%, polypharmacy 84.5%, and inappropriate prescription of drugs 48.9%. Coefficient correlation between inappropriate prescription of drugs and polypharmacy was p = 0.001. CONCLUSIONS: The prevalence of polypharmacy and inappropriate prescription of drugs was higher than reported previously, which shows the situational diagnosis in this tertiary level hospital, considering a population with high cardiovascular risk.

Analysis of hematopoietic progenitor cells in patients with myelodysplastic syndromes according to their cytogenetic abnormalities.

The present work analyzes the hematopoietic progenitor cells (HPC) in myelodysplastic syndrome (MDS) patients using both an immunophenotypical and a functional approaches in order to know whether they are similar in patients with or without cytogenetic abnormalities. Among CD34+ HPC, the proportion of myeloid committed progenitors was higher in patients with an abnormal karyotype. Ninety MDS patients were studied. Patients with abnormal karyotype showed a similar platting efficiency than patients with normal cytogenetics. Trisomy 8 and 5q- showed a significant higher P.E. than patients with normal karyotype or monosomy 7. We observed that when the most immature HPC were studied, the total number of granulo-monocytic colonies produced by LTBMC was higher in the normal karyotype group. In summary, the present study shows that in MDS the HPC are impaired; this impairment is deeper in patients with abnormal karyotype.

Impact of immunophenotype on prognosis of patients with myelodysplastic syndromes. Its value in patients without karyotypic abnormalities.

The aim of this study was simultaneously to evaluate the potential influence of cytogenetic, immunophenotypic and cell culture studies in the evolution of the myelodysplastic syndromes (MDS) with particular attention to the value of the two latter features in predicting the outcome of those patients in which karyotypic information is normal or not available. A series of 77 newly diagnosed patients with primary MDS were analyzed. Immunophenotypic studies were carried out by flow cytometry in triple color combinations: CD34/CD33/CD38, CD15/CD34/HLADR and HLADR/CD13/CD45. In all, 63% of patients showed a normal karyotype and 37% showed clonal abnormalities. In immunophenotypic analysis, overall 90% of patients displayed phenotypic aberrations and 60% showed two or more aberrations. In univariate analysis, 10 variables had a significant influence on survival: >10% bone marrow (BM) blast cells, >or=peripheral blood (PB) cytopenias, >2% of BM CD34+ cells, >85% of BM myeloid cells, >7% monocytic cells, <49% of neutrophils, a neutrophil/monocytic cell ratio <7, more than three phenotypic aberrations and >80 colony-forming units for granulocytes and macrophages (CFU-GM)/10(5) plated cells. Only the presence of >or=5% of BM blast cells (P=0.001) and cytogenetic subgroups (P=0.008) showed independent prognostic significance by multivariate analysis. In patients lacking cytogenetic information or in which the karyotype was normal additional markers had an independent prognostic value in multivariate analysis: >or=2 phenotypic aberrations (P=0.001) and >or=2 PB cytopenias (P=0.004). In summary, our results show that in patients in whom the karyotype is normal or where an insufficient amount of mitoses is obtained, immunophenotype could help to establish a prognosis.