Impact of treatment and clinical characteristics on the survival of children with medulloblastoma in Mexico.

Introduction: Data on medulloblastoma outcomes and experiences in low- and middle-income countries, especially in Latin America, is limited. This study examines challenges in Mexico's healthcare system, focusing on assessing outcomes for children with medulloblastoma in a tertiary care setting. Methods: A retrospective analysis was conducted, involving 284 patients treated at 21 pediatric oncology centers in Mexico. Results: High-risk patients exhibited markedly lower event-free survival than standard-risk patients (43.5% vs. 78.3%, p<0.001). Influential factors on survival included anaplastic subtype (HR 2.4, p=0.003), metastatic disease (HR 1.9, p=0.001); residual tumor >1.5cm², and lower radiotherapy doses significantly impacted event-free survival (EFS) and overall survival (OS). Platinum-based chemotherapy showed better results compared to the ICE protocol in terms of OS and EFS, which was associated with higher toxicity. Patients under 3 years old displayed notably lower OS and EFS compared to older children (36.1% vs. 55.9%, p=0.01).

The Effect of COVID-19 on Oncology Care for Adolescents and Young Adults in Latin America.

Children with cancer in low- and middle-income countries were disproportionately impacted by the COVID-19 pandemic, but little is known about how adolescents and young adults (AYAs) with cancer were affected. Sixty-seven physicians and nonphysician providers were interviewed about their experiences caring for AYAs with cancer in Latin America. Quotes related to the COVID-19 pandemic were identified and grouped into themes. Barriers from the COVID-19 pandemic included limited space, restrictions on travel, reduced funding, limited staff, limited services, and changes to treatment. However, improvements to care that arose from the COVID-19 pandemic included better access to distance learning and telemedicine.

A plasma miRNA-based classifier for small cell lung cancer diagnosis.

Introduction: Small cell lung cancer (SCLC) is characterized by poor prognosis and challenging diagnosis. Screening in high-risk smokers results in a reduction in lung cancer mortality, however, screening efforts are primarily focused on non-small cell lung cancer (NSCLC). SCLC diagnosis and surveillance remain significant challenges. The aberrant expression of circulating microRNAs (miRNAs/miRs) is reported in many tumors and can provide insights into the pathogenesis of tumor development and progression. Here, we conducted a comprehensive assessment of circulating miRNAs in SCLC with a goal of developing a miRNA-based classifier to assist in SCLC diagnoses. Methods: We profiled deregulated circulating cell-free miRNAs in the plasma of SCLC patients. We tested selected miRNAs on a training cohort and created a classifier by integrating miRNA expression and patients' clinical data. Finally, we applied the classifier on a validation dataset. Results: We determined that miR-375-3p can discriminate between SCLC and NSCLC patients, and between SCLC and Squamous Cell Carcinoma patients. Moreover, we found that a model comprising miR-375-3p, miR-320b, and miR-144-3p can be integrated with race and age to distinguish metastatic SCLC from a control group. Discussion: This study proposes a miRNA-based biomarker classifier for SCLC that considers clinical demographics with specific cut offs to inform SCLC diagnosis.

Diffuse intrinsic pontine gliomas: First registry effort in Mexico.

INTRODUCTION: Brainstem tumors comprise 10.9% of all brain tumors, and pediatric diffuse intrinsic pontine gliomas (DIPG) have a fatal prognosis. Some countries have developed national and international register databases to characterize their populations to aid clinical and public policy decisions. This study provides information regarding the clinical characteristics of a retrospective cohort of children with DIPG in México from 2001 to 2021, and assesses the proposed prognostic factors previously described for survival outcome. METHODS: Health institutions from Mexico were invited to contribute to a retrospective electronic registry of patients with DIPG based on the International DIPG Registry. Fisher's exact test was used to compare long- and short-term survivors. Overall survival was estimated using the Kaplan-Meier method. Differences between survival curves were evaluated using the log-rank test and Cox proportional hazard regression analysis. RESULTS: Total 110 patients were included. The median age of the patients at diagnosis was 7 years. Sixty patients (54.5%) presented with symptoms in less than 6 months; the most frequent symptom was ataxia (56.4%). Ninety patients received treatment (81.8%), the overall survival at 4 years was 11.4%, and 16 patients (14.5%) were admitted for palliative end-of-life care. We found no significant survival differences for any of the prognostic factors. CONCLUSION: This study highlights the need to develop strategies to standardize healthcare processes and enhance the quality of care to improve clinical diagnosis in Mexico. We also observed a barrier to the acceptance of palliative end-of-life care in the family and medical teams.

Crosstalk between miRNAs and DNA Methylation in Cancer.

miRNAs are some of the most well-characterized regulators of gene expression. Integral to several physiological processes, their aberrant expression often drives the pathogenesis of both benign and malignant diseases. Similarly, DNA methylation represents an epigenetic modification influencing transcription and playing a critical role in silencing numerous genes. The silencing of tumor suppressor genes through DNA methylation has been reported in many types of cancer and is associated with tumor development and progression. A growing body of literature has described the crosstalk between DNA methylation and miRNAs as an additional layer in the regulation of gene expression. Methylation in miRNA promoter regions inhibits its transcription, while miRNAs can target transcripts and subsequently regulate the proteins responsible for DNA methylation. Such relationships between miRNA and DNA methylation serve an important regulatory role in several tumor types and highlight a novel avenue for potential therapeutic targets. In this review, we discuss the crosstalk between DNA methylation and miRNA expression in the pathogenesis of cancer and describe how miRNAs influence DNA methylation and, conversely, how methylation impacts the expression of miRNAs. Finally, we address how these epigenetic modifications may be leveraged as biomarkers in cancer.

Explorando el sistema de protección de la niñez en El Salvador

(analítico) Se exploran las prácticas institucionales que facilitan u obstaculizan la protección de los derechos de niños, niñas y adolescentes en el sistema de protección de la niñez en El Salvador. Partiendo de un diseño de etnografía institucional, se realizaron 61 entrevistas a trabajadores pertenecientes al sistema de protección. Como resultado, se identificó la ausencia de manuales que establezcan prácticas concretas en la aplicación de la Ley de Protección Integral de la Niñez y Adolescencia, obstruyendo su óptimo funcionamiento. A través del uso de la teoría del interaccionismo simbólico, se explora cómo la interpretación discrecional o no entendimiento de la ley forma instituciones aisladas del sistema; también se analiza el grado en que las dinámicas socioeconómicas del país ponen en desventaja a los sectores rurales para acceder a estos servicios.

(analytical) This study explores the institutional practices that support or hinder the rights of children and young people in the child protection system in El Salvador. Using an institutional ethnography approach, 61 individuals who worked directly or indirectly in the child protection system were interviewed. The findings highlight a lack of manuals that establish concrete practices in accordance with the application of the Law of Comprehensive Protection for Children and Youth, which reduces the effectiveness of the country's child protection system. Through an analytical approach based on symbolic interactionism, this study explored how the individual interpretations of the law, or lack thereof, combine with socioeconomic disadvantages to create difficulties for rural child protection institutions in terms of accessing operational resources.

(analítico) O presente estudo explora as práticas institucionais que apoiam ou dificultam os direitos de crianças e jovens no sistema de proteção infantil em El Salvador. Utilizando um desenho de etnografia institucional, foram entrevistados 61 indivíduos que trabalhavam ou trabalham no sistema de proteção à criança. Os achados indicam que faltam manuais que estabeleçam práticas concretas em consonância com a aplicação da Lei de Proteção Integral da Infância e Juventude o que dificulta a efetividade do sistema de proteção. Por meio de um entendimento baseado no interacionismo simbólico, este estudo explorou como as interpretações individuais da lei, ou a falta dela, e a desvantagem socio-econômica das instituições colocam os setores rurais em desvantagem no acesso aos recursos.

A-to-I edited miR-411-5p targets MET and promotes TKI response in NSCLC-resistant cells.

Non-small cell lung cancer (NSCLC) patients carrying an epidermal growth factor receptor (EGFR) mutation have an initial favorable clinical response to the tyrosine kinase inhibitors (TKIs). Unfortunately, rapid resistance occurs mainly because of genetic alterations, including amplification of the hepatocyte growth factor receptor (MET) and its abnormal activity. The RNA post-transcriptional modifications that contribute to aberrant expression of MET in cancer are largely under-investigated and among them is the adenosine-to-inosine (A-to-I) RNA editing of microRNAs. A reduction of A-to-I editing in position 5 of miR-411-5p has been identified in several cancers, including NSCLC. In this study, thanks to cancer-associated gene expression analysis, we assessed the effect of the edited miR-411-5p on NSCLC cell lines. We found that edited miR-411-5p directly targets MET and negatively affects the mitogen-activated protein kinases (MAPKs) pathway. Considering the predominant role of the MAPKs pathway on TKIs resistance, we generated NSCLC EGFR mutated cell lines resistant to TK inhibitors and evaluated the effect of edited miR-411-5p overexpression. We found that the edited miR-411-5p reduces proliferation and induces apoptosis, promoting EGFR TKIs response in NSCLC-resistant cells.

Derivation and validation of the CFracture competing risk fracture prediction tool compared with QFracture in older people and people with comorbidity: a population cohort study.

BACKGROUND: UK guidelines recommend the QFracture tool to predict the risk of major osteoporotic fracture and hip fracture, but QFracture calibration is poor, partly because it does not account for competing mortality risk. The aim of this study was to derive and validate a competing risk model to predict major osteoporotic fracture and hip fracture (CFracture) and compare its performance with that of QFracture in UK primary care. METHODS: We used UK linked primary care data from the Clinical Practice Research Datalink GOLD database to identify people aged 30-99 years, split into derivation and validation cohorts. In the derivation cohort, we derived models (CFracture) using the same covariates as QFracture with Fine-Gray competing risk modelling, and included the Charlson Comorbidity Index score as an additional predictor of non-fracture death. In a separate validation cohort, we examined discrimination (using Harrell's C-statistic) and calibration of CFracture compared with QFracture. Reclassification analysis examined differences in the characteristics of patients reclassified as higher risk by CFracture but not by QFracture. FINDINGS: The derivation cohort included 1 831 606 women and 1 789 820 men, and the validation cohort included 915 803 women and 894 910 men. Overall discrimination of CFracture was excellent (C-statistic=0·813 [95% CI 0·810-0·816] for major osteoporotic fracture and 0·914 [0·908-0·919] for hip fracture in women; 0·734 [0·729-0·740] for major osteoporotic fracture and 0·886 [0·877-0·895] for hip fracture in men) and was similar to QFracture. CFracture calibration overall and in people younger than 75 years was generally excellent. CFracture overpredicted major osteoporotic fracture and hip fracture in older people and people with comorbidity, but was better calibrated than QFracture. Patients classified as high-risk by CFracture but not by QFracture had a higher prevalence of current smoking and previous fracture, but lower prevalence of dementia, cancer, cardiovascular disease, renal disease, and diabetes. INTERPRETATION: CFracture has similar discrimination to QFracture but is better calibrated overall and in younger people. Both models performed poorly in adults aged 85 years and older. Competing risk models should be recommended for fracture risk prediction to guide treatment recommendations. FUNDING: National Institute for Health and Care Research, Wellcome Trust, Health Data Research UK.

The expression of Oct3/4A mRNA and not its isoforms is upregulated by the HPV16 E7 oncoprotein.

PURPOSE: Oct3/4 a transcription factor is involved in maintaining the characteristics of cancer stem cells. Oct3/4 can be expressed differentially with respect to the progression of cervical cancer (CC). In addition, Oct3/4 can give rise to three isoforms by alternative splicing of the mRNA Oct3/4A, Oct3/4B and Oct3/4B1. The aim of this study was to evaluate the mRNA expression from Oct3/4A, Oct3/4B and Oct3/4B1 in low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), CC samples, and measure the effect of the HPV16 E7 oncoprotein on the mRNA expression from Oct3/4 isoforms in the C-33A cell line. METHODS: The expression levels of Oct3/4A, Oct3/4B and Oct3/4B1 mRNA were analyzed by reverse transcription quantitative polymerase chain reaction (RT-qPCR) in patients with LSILs, HSILs and CC. Additionally, C-33A cells that expressed the HPV16 E7 oncoprotein were established to evaluate the effect of E7 on the expression of Oct3/4 mRNA isoforms. RESULTS: Oct3/4A (p = 0.02), Oct3/4B (p = 0. 001) and Oct3/4B1 (p < 0. 0001) expression is significantly higher in patients with LSIL, HSIL and CC than in woman with non-IL. In the C-33A cell line, the expression of Oct3/4A mRNA in the presence of the E7 oncoprotein increased compared to that in nontransfected C-33A cells. CONCLUSION: Oct3/4B and Oct3/4B1 mRNA were expressed at similar levels among the different groups. These data indicate that only the mRNA of Oct3/4A is upregulated by the HPV16 E7 oncoprotein.

Influencia de Factores Psicológicos en el Pronóstico de Individuos con Artroplastia de Cadera por Artrosis: una Revisión de la Literatura / Influence of Psychological Factors on the Prognosis of Individuals with Hip Arthroplasty for Osteoarthritis: A Review of the Literature

Introducción. Los factores psicológicos preoperatorios pueden influir en los resultados de la rehabilitación de la artroplastia de cadera por artrosis. No existe consenso de cuáles serían estos factores, ni sobre en qué medidas de resultados influirían. Objetivo. Sintetizar la evidencia respecto a los factores psicológicos que pronostican los resultados de la artroplastía de cadera en términos de función física y dolor en individuos con artrosis de cadera. Métodos. Se efectuó una búsqueda en PUBMED, EMBASE, SCOPUS y CINAHL. Los términos incluyeron artroplastia de cadera, artrosis, factores psicológicos, función física y dolor. Se incorporaron estudios observacionales prospectivos. Los resultados se agruparon por factor psicológico en periodos menor a un año e igual o mayor a un año. Resultados. La búsqueda arrojó 895 artículos, dos cumplieron los criterios de elegibilidad. Los resultados descritos fueron: 1) un mayor nivel de expectativas preoperatorias genera un efecto positivo en la disminución de la intensidad de dolor y 2) tiene un efecto positivo en la función física, ambas a menos de un año, y 3) la depresión preoperatoria genera un efecto negativo en la disminución de intensidad de dolor a un año o más. Conclusiones. La presencia de depresión preoperatoria se asoció a una menor reducción de dolor, y las altas expectativas preoperatorias se asociaron con una mejor función física y una menor intensidad de dolor. Sin embargo, se hace necesaria la generación de nueva evidencia científica que profundice en la asociación factores psicológicos preoperatorios y dolor crónico en esta población.

Background. Preoperative psychological factors may influence the results of hip arthroplasty rehabilitation for osteoarthritis. There is no consensus on what these factors would be, nor on what outcome measures they would influence. Objetive. To review was to synthesize the evidence regarding psychological factors that predict hip arthroplasty outcomes in terms of physical function and pain in individuals with hip osteoarthritis. Methods. A search was carried out in PUBMED, EMBASE, SCOPUS and CINAHL. Terms included hip arthroplasty, osteoarthritis, psychological factors, physical function, and pain. Prospective observational studies were incorporated. The results were grouped by psychological factor in periods of less than one year and equal to or greater than one year. Results. The search yielded 895 articles, two met the eligibility criteria. The results described were: 1) a higher level of preoperative expectations generates a positive effect in the reduction of pain intensity and 2) has a positive effect on physical function, both at less than one year, and 3) preoperative depression generates a negative effect in the reduction of pain intensity at one year or more. Conclusions. The presence of preoperative depression was associated with less pain reduction, and high preoperative expectations were associated with better physical function and less pain intensity. However, it is necessary to generate new scientific evidence that deepens the association of preoperative psychological factors and chronic pain in this population.

The Epitranscriptome in miRNAs: Crosstalk, Detection, and Function in Cancer.

The epitranscriptome encompasses all post-transcriptional modifications that occur on RNAs. These modifications can alter the function and regulation of their RNA targets, which, if dysregulated, result in various diseases and cancers. As with other RNAs, miRNAs are highly modified by epitranscriptomic modifications such as m6A methylation, 2'-O-methylation, m5C methylation, m7G methylation, polyuridine, and A-to-I editing. miRNAs are a class of small non-coding RNAs that regulates gene expression at the post-transcriptional level. miRNAs have gathered high clinical interest due to their role in disease, development, and cancer progression. Epitranscriptomic modifications alter the targeting, regulation, and biogenesis of miRNAs, increasing the complexity of miRNA regulation. In addition, emerging studies have revealed crosstalk between these modifications. In this review, we will summarize the epitranscriptomic modifications-focusing on those relevant to miRNAs-examine the recent crosstalk between these modifications, and give a perspective on how this crosstalk expands the complexity of miRNA biology.

Patient outcomes following AKI and AKD: a population-based cohort study.

BACKGROUND: Acute kidney injury (AKI) is common and associated with adverse outcomes as well as important healthcare costs. However, evidence examining the epidemiology of acute kidney disease (AKD)-recently defined as AKI persisting between 7 and 90 days-remains limited. The aims of this study were to establish the rates of early AKI recovery, progression to AKD and non-recovery; examine risk factors associated with non-recovery and investigate the association between recovery timing and adverse outcomes, in a population-based cohort. METHODS: All adult residents of Tayside & Fife, Scotland, UK, with at least one episode of community or hospital-managed AKI using KDIGO creatinine-based definition during the period 1 January 2010 to 31 December 2018 were identified. Logistic regression was used to examine factors associated with non-recovery, and Cox modelling was used to establish associations between AKI recovery timing and risks of mortality and development of de novo CKD. RESULTS: Over 9 years, 56,906 patients with at least one AKI episode were identified with 18,773 (33%) of these progressing to AKD. Of those progressing to AKD, 5059 (27%) had still not recovered at day 90 post AKI diagnosis. Risk factors for AKD included: increasing AKI severity, pre-existing cancer or chronic heart failure and recent use of loop diuretics. Compared with early AKI recovery, progression to AKD was associated with increased hazard of 1-year mortality and de novo CKD (HR = 1.20, 95% CI 1.13 to 1.26 and HR = 2.21, 95% CI 1.91 to 2.57 respectively). CONCLUSIONS: These findings highlight the importance of early AKI recognition and management to avoid progression to AKD and long-term adverse outcomes.

Intranasal delivery in glioblastoma treatment: prospective molecular treatment modalities.

Glioblastoma multiforme (GBM) is rare and fatal glioma with limited treatment options. Treatments provide minimal improvement in prognosis and only 6.8% of GBM patients have a life expectancy greater than five years. Surgical resection of this malignant glioma is difficult due to its highly invasive nature and follow-up radiotherapy with concomitant temozolomide, the currently approved standard of care, and will only extend the life of patients by a few months. It has been nearly two decades since the approval of temozolomide and there have been no clinically relevant major breakthroughs since, painting a dismal picture for patients with GBM. Although the future of GBM management seems bleak, there are many new treatment options on the horizon that propose methods of delivery to circumvent current limitations in the standard of care, i.e., the blood brain barrier and treatment resistance mechanisms. The nose is a highly accessible non-invasive route of delivery that has been incorporated into many investigational studies within the past five years and potentially paves the path to a brighter future for the management of GBM. Intranasal administration has its limitations however, as drugs can be degraded and/or fail to reach the site of action. This has prompted many studies for implementation of nanoparticle systems to overcome these limitations and to accurately deliver drugs to the site of action. This review highlights the advances in intranasal therapy delivery and impact of nanotechnology in the management of GBM and discusses potential treatment modalities that show promise for further investigation.

Health conditions in adults with HIV compared with the general population: A population-based cross-sectional analysis.

Background: Life expectancy in adults with human immunodeficiency virus (HIV) has increased and managing other health conditions is increasingly important for patients and healthcare planning. The aim of this study was to examine the prevalence and association between different health conditions and HIV status. Methods: We performed a cross-sectional analysis of adult UK Clinical Practice Research Datalink primary care electronic medical records linked to hospital admissions as of Nov 30, 2015. We examined 47 health condition groups and 304 physical and mental health conditions by HIV status, after adjustment for age, sex, social deprivation status using logistic regression. Findings: There were 964 patients with HIV (61.7% male; 92.8% aged <65 years) and 941,113 non-HIV patients (49.4% male; 75.2% aged <65 years). Condition groups with the greatest prevalence in HIV that were also highly prevalent in adults without HIV included: lipid disorder (41.4% vs 40.2%), and hypertension (19.1% vs 24.6%). Following adjustment, 18 (37.5%) condition groups were more likely in adults with HIV and ten (20.8%) were less likely. Individual conditions that were less likely in adults with HIV included: atrial fibrillation (odds ratio [OR] 0.37 [95% CI 0.20-0.64]) and hypertension (OR_0.78 [0.65-0.94]); rheumatoid arthritis (OR 0.27 [0.05-0.84]); asthma (OR_0.65 (0.53-0.80]); and certain eye diseases such as macular degeneration (OR_0.30 [0.09-0.70]). Meanwhile individual conditions that were more likely included: liver fibrosis, sclerosis, and cirrhosis (OR_3.23 [1.85-5.20]); pulmonary embolism (OR_2.06 [1.15-3.36]); male infertility (OR_2.23 [1.50-3.16]) and female infertility (OR_2.01 [1.34-2.88]); bipolar disorder (OR_2.93 [1.52-5.05]) and depression (OR_1.49 [1.28-1.71]); cervical malignancy (OR_4.64 [1.15-12.15]); and infections. Interpretation: Comorbidity is common in adults with HIV, with physical and mental health conditions spanning a wide spectrum. HIV management should consider multidisciplinary care models to provide optimal patient care. Funding: The project was funded by the Bart's Charity; DRM was funded by a Wellcome Trust Clinical Research Career Development Fellowship; DRM and DMM received funding from the HDR-UK Precision therapeutics programme.

Seek COVER: using a disease proxy to rapidly develop and validate a personalized risk calculator for COVID-19 outcomes in an international network.

BACKGROUND: We investigated whether we could use influenza data to develop prediction models for COVID-19 to increase the speed at which prediction models can reliably be developed and validated early in a pandemic. We developed COVID-19 Estimated Risk (COVER) scores that quantify a patient's risk of hospital admission with pneumonia (COVER-H), hospitalization with pneumonia requiring intensive services or death (COVER-I), or fatality (COVER-F) in the 30-days following COVID-19 diagnosis using historical data from patients with influenza or flu-like symptoms and tested this in COVID-19 patients. METHODS: We analyzed a federated network of electronic medical records and administrative claims data from 14 data sources and 6 countries containing data collected on or before 4/27/2020. We used a 2-step process to develop 3 scores using historical data from patients with influenza or flu-like symptoms any time prior to 2020. The first step was to create a data-driven model using LASSO regularized logistic regression, the covariates of which were used to develop aggregate covariates for the second step where the COVER scores were developed using a smaller set of features. These 3 COVER scores were then externally validated on patients with 1) influenza or flu-like symptoms and 2) confirmed or suspected COVID-19 diagnosis across 5 databases from South Korea, Spain, and the United States. Outcomes included i) hospitalization with pneumonia, ii) hospitalization with pneumonia requiring intensive services or death, and iii) death in the 30 days after index date. RESULTS: Overall, 44,507 COVID-19 patients were included for model validation. We identified 7 predictors (history of cancer, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, hyperlipidemia, kidney disease) which combined with age and sex discriminated which patients would experience any of our three outcomes. The models achieved good performance in influenza and COVID-19 cohorts. For COVID-19 the AUC ranges were, COVER-H: 0.69-0.81, COVER-I: 0.73-0.91, and COVER-F: 0.72-0.90. Calibration varied across the validations with some of the COVID-19 validations being less well calibrated than the influenza validations. CONCLUSIONS: This research demonstrated the utility of using a proxy disease to develop a prediction model. The 3 COVER models with 9-predictors that were developed using influenza data perform well for COVID-19 patients for predicting hospitalization, intensive services, and fatality. The scores showed good discriminatory performance which transferred well to the COVID-19 population. There was some miscalibration in the COVID-19 validations, which is potentially due to the difference in symptom severity between the two diseases. A possible solution for this is to recalibrate the models in each location before use.

Análisis comparativo del ambiente educacional en internos de medicina de hospitales públicos y clínicas del Perú

Objetivos: determinar y comparar la percepción del ambiente educacional de los internos de medicina de hospitales públicos y clínicas privadas del Perú. Métodos: se llevó a cabo un estudio Observacional de corte transversal, mediante el cuestionario PHEEM el cual fue respondido por 101 estudiantes que realizaban su internado en clínicas y hospitales del Perú; el muestreo fue no probabilístico y por conveniencia debido a la facilidad de acceso a dichas sedes. Los datos fueron analizados en el programa SPSS versión 23, se realizó un análisis descriptivo y otro comparativo a través de la prueba de T student tanto en los puntajes globales cómo en cada una de las dimensiones del cuestionario. Resultados: la media global de las puntuaciones del ambiente educacional medico fue de 83,16 (DS 25,4) indicando un ambiente más positivo que negativo. Al comparar las medias entre los internos de los hospitales y los de las clínicas, el ambiente fue mejor percibido por los estudiantes que realizaban su internado en las clínicas privadas tanto en puntaje global, como en todas las dimensiones p valor <0,05 indicando diferencia estadísticamente significativa. La dimensión más preocupante fue la enseñanza donde se observó la mayor diferencia entre estos dos sectores. Conclusiones: existe una percepción negativa en los internos de hospitales comparados a los internos de clínicas. Se deberían realizar estrategias de intervención de mejoría en los internos de hospitales para cada una de las dimensiones del ambiente educacional, en especial en la enseñanza.

Objectives: to determine and compare the perception of the educational environment of medical interns in public hospitals and private clinics in Peru. Methods: a cross-sectional observational study was carried out using the PHEEM questionnaire, which was answered by 101 students who were doing their internship in clinics and hospitals in Peru. The sampling was non-probabilistic and convenient due to the ease of access to these sites. The data were analyzed in the SPSS version 23 program, a descriptive analysis and a comparative one were carried out using the t-student t test both in the overall scores and in each of the dimensions of the questionnaire. Results: the overall mean score of the medical educational environment was 83.16 (SD 25.4), indicating a more positive than negative environment. When comparing the means between interns in hospitals and those in clinics, the environment was better perceived by students doing their internship in private clinics in both the overall score and in all dimensions, p value <0.05 indicating a statistically significant difference. The most concerning dimension was teaching, where the greatest difference between these two sectors was observed. Conclusions: there is a negative perception among interns in hospitals compared to interns in clinics. Intervention strategies to improve the educational environment in interns in hospitals should be implemented in all dimensions, especially in teaching.

Emociones, creencias y actitudes del personal asistencial hacia habitantes de calle que usan drogas en Medellín, Colombia / Emotions, beliefs and attitudes of healthcare workers towards homeless who use drugs in Medellín, Colombia / Emoções, crenças e atitudes do pessoal de assistência social com os moradores de rua que usam drogas em Medellín, Colômbia

Resumen Objetivo: Identificar algunos aspectos relacionados con el estigma de personal asistencial hacia habitantes de calle consumidores de sustancias psicoactivas. Metodología: Para lograr este objetivo, se llevó a cabo un estudio cualitativo, con enfoque hermenéutico y de alcance descriptivo, mediante el análisis categorial de las transcripciones de las grabaciones de los discursos de dos grupos focales con 32 participantes, miembros del Sistema de Atención al Habitante de Calle Adulto de Medellín, Colombia. La sistematización y la codificación del análisis se hicieron en un archivo de Excel®, destacándose la emergencia de las categorías: "emociones", "creencias" y "actitudes". Resultados: En los discursos de los participantes, se reiteran contenidos ambivalentes de los estigmas hacia esta población. Por una parte, la frustración en su trabajo, como principal emoción que coincide con las creencias de desconfianza y actitudes evasivas hacia ellos; y, por otro, los sentimientos de gratificación por la labor realizada, acordes con posturas más protectoras y pacientes durante el acompañamiento, pero que no se alejan de un ideal moralista de cero consumos. Conclusión: Reconocer y discutir abiertamente sobre el estigma podría orientar otras formas más humanizadas en la labor con este tipo de población, en tanto se devela que el rol profesional no nos exime del prejuicio, el estereotipo y la discriminación.

Abstract Objective: To identify some aspects related to the stigma of healthcare workers towards the homeless who consume psychoactive substances. Methodology: To achieve this objective, a qualitative study with a hermeneutic approach and descriptive scope was carried out, through the categorical analysis of transcriptions of recorded speeches from two focus groups comprised of 32 participants, members of the System of Attention to the Homeless Adult in Medellín, Colombia. Systematization and analysis encoding were performed in an Excel ® file, highlighting the presence of categories: "emotions", "beliefs" and "attitudes". Results: Ambivalent contents of the stigma towards this population are frequent in participant's speeches. On the one hand, the frustration about healthcare work, as the main emotion that coincides with the beliefs of distrust and evasive attitudes towards the homeless. On the other hand, the feelings of gratification for the work done and the presence of more protective and forbearing attitudes, but that do not alienate from the moralistic ideal of zero consumption. Conclusion: Recognizing and openly discussing stigma could guide more humanized ways of working with this type of population, as it is showed that the healthcare role does not exempt them from prejudice, stereotype and discrimination.

Resumo Objetivo: Identificar alguns aspectos relacionados ao estigma do pessoal de assistência social com os moradores de rua consumidores de substâncias psicoativas. Metodologia: Para alcançar este objetivo, foi realizado um estudo qualitativo, com abordagem hermenêutica e âmbito descritivo, através da análise categorial das transcrições das gravações dos discursos de dois grupos focais com 32 participantes, membros do Sistema de Atenção ao Morador de Rua Adulto de Medellín, Colômbia. A sistematização e a codificação da análise foram feitas num arquivo Excel®, destacando-se a emergência das categorias: "emoções", "crenças" e "atitudes". Resultados: Os participantes reiteraram em suas falas, conteúdos ambivalentes dos estigmas dessa população. Por um lado, a frustração em seu trabalho, com emoção principal que coincide com as crenças de desconfiança e atitudes evasivas com eles; e por outro, os sentimentos de gratidão pelo trabalho realizado, de acordo com posturas mais protetoras e pacientes durante o acompanhamento, mas que não se distanciam de um ideal moralista de consumo zero. Conclusão: Reconhecer e discutir abertamente o estigma poderia orientar outras formas mais humanizadas no trabalho com este tipo de população, e ao mesmo tempo se revela que o compromisso profissional não os exime do preconceito, o estereótipo e a discriminação.

Characteristics and Outcomes of Over 300,000 Patients with COVID-19 and History of Cancer in the United States and Spain.

BACKGROUND: We described the demographics, cancer subtypes, comorbidities, and outcomes of patients with a history of cancer and coronavirus disease 2019 (COVID-19). Second, we compared patients hospitalized with COVID-19 to patients diagnosed with COVID-19 and patients hospitalized with influenza. METHODS: We conducted a cohort study using eight routinely collected health care databases from Spain and the United States, standardized to the Observational Medical Outcome Partnership common data model. Three cohorts of patients with a history of cancer were included: (i) diagnosed with COVID-19, (ii) hospitalized with COVID-19, and (iii) hospitalized with influenza in 2017 to 2018. Patients were followed from index date to 30 days or death. We reported demographics, cancer subtypes, comorbidities, and 30-day outcomes. RESULTS: We included 366,050 and 119,597 patients diagnosed and hospitalized with COVID-19, respectively. Prostate and breast cancers were the most frequent cancers (range: 5%-18% and 1%-14% in the diagnosed cohort, respectively). Hematologic malignancies were also frequent, with non-Hodgkin's lymphoma being among the five most common cancer subtypes in the diagnosed cohort. Overall, patients were aged above 65 years and had multiple comorbidities. Occurrence of death ranged from 2% to 14% and from 6% to 26% in the diagnosed and hospitalized COVID-19 cohorts, respectively. Patients hospitalized with influenza (n = 67,743) had a similar distribution of cancer subtypes, sex, age, and comorbidities but lower occurrence of adverse events. CONCLUSIONS: Patients with a history of cancer and COVID-19 had multiple comorbidities and a high occurrence of COVID-19-related events. Hematologic malignancies were frequent. IMPACT: This study provides epidemiologic characteristics that can inform clinical care and etiologic studies.

Assessment of the compounds formed by oxidative reaction between p-toluenediamine and p-aminophenol in hair dyeing processes: Detection, mutagenic and toxicological properties.

Previous studies have demonstrated the presence of precursors and coupling agents in wastewater from hair dyeing processes. The complex reaction involved in the oxidation of these compounds can generate extremely hazardous sub-products, leading to an increase in the mutagenicity and toxicity of wastewater. Without proper treatment, this highly toxic wastewater may find its way into the drinking water treatment plant. The present work aimed to investigate the main products generated after the oxidation reaction involving p-toluenediamine (PTD) and p-aminophenol (PAP) - precursors that widely used in the composition of commercial permanent hair dyes, under experimental conditions close to the routine hair dyeing process (in the presence and absence of hydrogen peroxide in ammoniacal medium), using spectroscopic techniques. The study also investigated the mutagenicity and toxicity of the products formed in the hairdressing wash water and conducted detection analysis to determine the presence of the precursors and Bandrowski's Base Derivative (BBD) in samples of wastewater, surface and drinking water using HPLC-DAD and linear voltammetry techniques. Based on this investigation, we identified several PTD and PAP self-oxidation products and eleven sub-products derived from the reaction between PTD and PAP. Assays conducted using Salmonella typhimurium YG1041, with and without activation-induced rat liver metabolism (S9), indicated mutagenicity of the reaction products in concentrations above 10.0 µg µL-1. The concentrations of PTD, PAP, and several reactions and oxidation products of these precursors were detected in wastewater and water samples.

Creencias de los padres acerca de los trastornos mentales de sus hijos en una consulta universitaria en Colombia / Beliefs of parents of children with mental disorders in a university hospital out-patient clinic in Colombia

RESUMEN Objetivo: Describir las creencias de los padres acerca de los trastornos mentales de sus hijos que asistieron a consulta externa infantil en una clínica universitaria. Métodos: Estudio descriptivo transversal realizado en padres de niños con trastornos mentales de una clínica de cuarto nivel de Medellín, Colombia, durante el periodo comprendido entre enero y mayo del 2018. Se estudió a 98 padres de niños y adolescentes que consultaron por primera vez a Psiquiatría Infantil. Se aplicó un instrumento elaborado por los investigadores con variables demográficas y de creencias sobre: el origen del trastorno mental, del tratamiento y sus coadyuvantes. Resultados: El 49,9% de los 98 padres evaluados creyeron que su hijo tenía un trastorno mental; en cuanto al origen de este, el 43,9% creía que era heredado y 41,8% por causas orgánicas. El 95,9% de los padres creía que sus hijos necesitaban tratamiento, de ellos, el 90,4% estimó la psicoterapia y el 58,51%, la medicación. Entre los tratamientos alternativos el más frecuente fue la sanación, con un 27,5%. De los métodos coadyuvantes en el tratamiento, los más frecuentes fueron estimular comportamientos positivos con el 82,7%, y corregir con palabras y dar buen ejemplo con el 72,4%. Conclusiones: En este estudio casi la mitad de los padres pensaba que sus hijos tenían una enfermedad mental. El tratamiento más considerado por los participantes fue la psicoterapia, por encima del uso de psicofármacos. En cuanto a los métodos coadyuvantes, los padres consideraron principalmente el estimular comportamientos positivos, corregir con palabras y dar buen ejemplo.

ABSTRACT Objective: Describe the beliefs of parents about the mental disorders of their children who attended a paediatric outpatient clinic at a university hospital. Methods: This was a descriptive study with parents of children with mental disorders seen from January to May of 2018 at a high complexity hospital in Medellin, Colombia. Ninety-eight (98) parents of children and adolescents attending their first outpatient consultation with Paediatric Psychiatry were studied. An instrument designed by the investigators was applied to obtain demographic variables and beliefs about the origin of their child's mental disorder, treatment and adjuvants. Results: 49.9% of the 98 parents believed that their child had a mental disorder. 43.9% believed the disorder was inherited and 41.8% believed its cause was organic. 95.9% of the parents believed the child needed treatment, including psychotherapy (90.4%) and medication (58.51%). Among the alternative treatments the parents believed the child needed, healing was the most commonly cited by 27.5% of the parents. Of the adjuvant methods, the most commonly cited were reinforcing positive behaviour (82.7%) and correcting with words and setting a good example (72.4%). Conclusions: Nearly half of the parents believed their child had a mental disorder, the treatment that was most commonly considered was psychotherapy above medication, and the best adjuvant methods cited by parents were reinforcing positive behaviour, correcting with words and setting a good example.