Biological relapse in multiple myeloma: Outcome and treatment strategies in a Spanish real-world setting.

Recommendations regarding the best time to start treatment in patients with relapsed/refractory multiple myeloma (RRMM) after biological relapse/progression (BR) are unclear. This observational, prospective, multicenter registry aimed to evaluate the impact on time to progression (TTP) of treatment initiation at BR versus at symptomatic clinical relapse (ClinR) based on the Spanish routine practice in adult patients with RRMM. Patients had two or less previous treatment lines and at least one previous partial response. Baseline characteristics and treatment outcomes were recorded, and survival was analyzed. Of 225 patients, 110 were treated at BR (TxBR group) and 115 at ClinR (TxClinR group) according to the investigators' criteria. The proportion of patients with higher ECOG, previous noncomplete remission (CR), and second relapse were significantly higher in the TxBR group compared to the TxClinR group. TheTxClinR group showed improved outcomes, including TTP, compared to the TxBR group. Progression-free survival increased in the TxClinR group (56.2 months) compared to the TxBR group (32.5 months) (p = 0.0137), and median overall survival also increased (p = 0.0897). Median TTP was significantly longer in patients relapsing from a CR (50.4 months) and in their first relapse (38.7 months) compared to those relapsing from a non-CR response (32.9 months) and in their second relapse (25.2 months). Physicians seemed to start treatment earlier in RRMM patients with poor prognosis features. Previous responses to anti-MM treatment and the number of prior treatment lines were identified as prognosis factors, whereby relapse from CR and first relapse were associated with a longer time to progression.

Evaluación de cursos en línea, masivos y abiertos de educación en salud y nutrición para prevenir la obesidad / Assessment of massive open online courses for teaching nutrition and preventing obesity

Background: A massive open online course (MOOC) is an online course aimed at unlimited participation and open access via the Web. Aim: To assess the MOOC experience for teaching nutrition, healthy food consumption, physical activity and health promotion to prevent obesity. Material and Methods: Two MOOC courses, (one with two versions), are described with the registration and evaluation instruments such as surveys carried out at the beginning and at the end of the courses. Effective participants in the three versions were 17.456, 11.121 in MOOC1, 2.351 in MOOC1 second version and 3.984 in MOOC2. Their median age was 31 years, 82% were women, 60% were professionals and 12% were foreigners. Results: In the final evaluation of the three courses, 85% to 99% qualified as "very good" or "good" all the surveyed topics. Thirty five percent of participants reported having lack of time, 11% reported problems with internet connectivity and 3.9%, personal or work problems. Conclusions: This is the first experience with MOOC in health and nutrition to prevent obesity in Chile. Considering the good results and positive evaluation of these courses, we estimate that they are an important tool to prevent obesity and chronic diseases in Chile, Latin America and other regions of the world.

Virtual Navigation Endoscopically Integrated Into Orbital Trauma.

ABSTRACT: Orbital reconstruction has traditionally been accomplished utilizing different techniques developed for this purpose and has been modified and improved throughout the years. However, there is a high rate of complications associated with eye globe positioning and/or migration of implants, which has created the need to continue to improve these techniques to decrease the frequency of complications. On the other hand, techniques that involve an endoscopic approach and technologies that use virtual surgical planning and three-dimensional model impressions are being used more often to decrease complication rates and seek better surgical outcomes. Combining these 2 methods results in endoscopically integrated virtual surgical navigation. When used for orbital reconstruction, it can be a great alternative and can be useful to decrease the risk of complications associated with this procedure. Therefore, this technical note aims to describe the integration of these 2 techniques into the same instrument to demonstrate the synergy of their benefits when used together.

Meningoencefalitis por Listeria monocytogenes / Meningoencephalitis due to Listeria monocytogenes

RESUMEN La neurolisteriosis se presenta principalmente como meningitis o meningoencefalitis, en menor frecuencia romboencefalitis o absceso cerebral. Es la principal causa de muerte entre todas las meningitis bacterianas y se asocia con una alta tasa de discapacidad neurológica. Para su diagnóstico se deben tener en cuenta la edad y los factores de riesgo, principalmente individuos mayores de 50 años y con condiciones de inmunosupresión. Las ayudas diagnósticas son clave para lograr el aislamiento de Lm, donde el cultivo de LCR tiene la mejor sensibilidad. Aunque faltan estudios que demuestren la superioridad de los estudios moleculares, el FilmArray-MEP parece ser prometedor en el aislamiento rápido y preciso de los principales microorganismos involucrados en la meningitis piógena, entre estos Lm. La IRM cerebral es el estudio de elección para el diagnóstico de romboencefalitis. La piedra angular del tratamiento sigue siendo ampicilina, cuya asociación con aminoglucósido podría disminuir la mortalidad.

SUMMARY Neurolisteriosis presents mainly as meningitis or meningoencephalitis, to a lesser extent rhombencephalitis or brain abscess frequency. It is the leading cause of death among all Bacterial meningitis and is associated with a high rate of neurological disability. For your diagnosis must take into account age and risk factors, mainly over 50 years and with immunosuppression conditions. Diagnostic aids are key to achieving the isolation of Lm, where CSF culture has the best sensitivity. Although studies are lacking demonstrating the superiority of molecular studies, the Film Array-MEP appears to be promising in fast and accurate isolation of the main microorganisms involved in pyogenic meningitis, among these Lm. Brain MRI is the study of choice for the diagnosis of rhombencephalitis. The cornerstone of treatment remains ampicillin, and its association with aminoglycoside could decrease mortality.

Restraint of Human Skin Fibroblast Motility, Migration, and Cell Surface Actin Dynamics, by Pannexin 1 and P2X7 Receptor Signaling.

Wound healing is a dynamic process required to maintain skin integrity and which relies on the precise migration of different cell types. A key molecule that regulates this process is ATP. However, the mechanisms involved in extracellular ATP management are poorly understood, particularly in the human dermis. Here, we explore the role, in human fibroblast migration during wound healing, of Pannexin 1 channels and their relationship with purinergic signals and in vivo cell surface filamentous actin dynamics. Using siRNA against Panx isoforms and different Panx1 channel inhibitors, we demonstrate in cultured human dermal fibroblasts that the absence or inhibition of Panx1 channels accelerates cell migration, increases single-cell motility, and promotes actin redistribution. These changes occur through a mechanism that involves the release of ATP to the extracellular space through a Panx1-dependent mechanism and the activation of the purinergic receptor P2X7. Together, these findings point to a pivotal role of Panx1 channels in skin fibroblast migration and suggest that these channels could be a useful pharmacological target to promote damaged skin healing.

The interplay between α7 nicotinic acetylcholine receptors, pannexin-1 channels and P2X7 receptors elicit exocytosis in chromaffin cells.

Pannexin-1 (Panx1) forms plasma membrane channels that allow the exchange of small molecules between the intracellular and extracellular compartments, and are involved in diverse physiological and pathological responses in the nervous system. However, the signaling mechanisms that induce their opening still remain elusive. Here, we propose a new mechanism for Panx1 channel activation through a functional crosstalk with the highly Ca2+ permeable α7 nicotinic acetylcholine receptor (nAChR). Consistent with this hypothesis, we found that activation of α7 nAChRs induces Panx1-mediated dye uptake and ATP release in the neuroblastoma cell line SH-SY5Y-α7. Using membrane permeant Ca2+ chelators, total internal reflection fluorescence microscopy in SH-SY5Y-α7 cells expressing a membrane-tethered GCAMP3, and Src kinase inhibitors, we further demonstrated that Panx1 channel opening depends on Ca2+ signals localized in submembrane areas, as well as on Src kinases. In turn, Panx1 channels amplify cytosolic Ca2+ signals induced by the activation of α7 nAChRs, by a mechanism that seems to involve ATP release and P2X7 receptor activation, as hydrolysis of extracellular ATP with apyrase or blockage of P2X7 receptors with oxidized ATP significantly reduces the α7 nAChR-Ca2+ signal. The physiological relevance of this crosstalk was also demonstrated in neuroendocrine chromaffin cells, wherein Panx1 channels and P2X7 receptors contribute to the exocytotic release of catecholamines triggered by α7 nAChRs, as measured by amperometry. Together these findings point to a functional coupling between α7 nAChRs, Panx1 channels and P2X7 receptors with physiological relevance in neurosecretion.

[Assessment of massive open online courses for teaching nutrition and preventing obesity]. / Evaluación de cursos en línea, masivos y abiertos de educación en salud y nutrición para prevenir la obesidad.

BACKGROUND: A massive open online course (MOOC) is an online course aimed at unlimited participation and open access via the Web. AIM: To assess the MOOC experience for teaching nutrition, healthy food consumption, physical activity and health promotion to prevent obesity. MATERIAL AND METHODS: Two MOOC courses, (one with two versions), are described with the registration and evaluation instruments such as surveys carried out at the beginning and at the end of the courses. Effective participants in the three versions were 17.456, 11.121 in MOOC1, 2.351 in MOOC1 second version and 3.984 in MOOC2. Their median age was 31 years, 82% were women, 60% were professionals and 12% were foreigners. RESULTS: In the final evaluation of the three courses, 85% to 99% qualified as "very good" or "good" all the surveyed topics. Thirty five percent of participants reported having lack of time, 11% reported problems with internet connectivity and 3.9%, personal or work problems. CONCLUSIONS: This is the first experience with MOOC in health and nutrition to prevent obesity in Chile. Considering the good results and positive evaluation of these courses, we estimate that they are an important tool to prevent obesity and chronic diseases in Chile, Latin America and other regions of the world.

Knowledge and attitudes are important factors in farmers' choice of lamb tail docking length.

BACKGROUND: Tail docking is common practice in the sheep industry to prevent soiling of the breech and flystrike. To ensure optimal healing after tail docking and reduce the risk of arthritis, perineal cancers and prolapses, it is recommended to dock tails equivalent to the length of the vulva. However, recent studies have found that some tails are docked too short (24-86 per cent). METHODS: To address this issue, this study aimed to identify key drivers behind tail docking length decisions. Two focus groups, phone (n=30) and online surveys (n=21) were conducted in regional Victoria, Australia to examine farmer knowledge of and attitudes towards appropriate lamb tail length and barriers to best practice. The focus group data were analysed qualitatively, and the surveys were analysed qualitatively and quantitatively. RESULTS: In total, 57 per cent of farmers were classed as docking tails short. Short tail docking appeared to be influenced by unawareness of the recommended length and docking at a length that shearers approve of. Other potential factors included lack of knowledge of negative health consequences associated with short tails, importance placed on dag and flystrike prevention, and impracticality of measuring where to dock. CONCLUSION: Addressing these factors in future education and intervention programmes may improve tail docking practice and sheep welfare.

In vitro immunomodulatory activities of peptides derived from Salmo salar NK-lysin and cathelicidin in fish cells.

Antimicrobial peptides (AMPs) are amphipathic peptides, which play an important role in innate defence. These peptides are gene-encoded and either constitutively expressed and/or upregulated during an infection. NK-lysins are AMPs with a three-dimensional globular structure. They are larger molecules, which comprise 74-78 amino acid residues and six conserved cysteine residues forming three disulphide bonds. Cathelicidins are a family of antimicrobial peptides that act as important components of the innate immune system with a broad spectrum of antimicrobial activity and immunomodulatory properties. Although they are widely studied in mammals, little is known about their immunomodulatory function. In the present study, we identified and characterized for the first time four NK-lysin-like transcripts from Atlantic salmon (Salmo salar) based on EST reported sequences. In vitro, NK-lysin derived peptides were able to induce the expression of IL-1ß and IL-8 in Salmo salar head kidney leukocytes. We also tested Salmo salar cathelicidin 1 derived peptide in a similar assay, showing its ability to induce the expression of IFN-γ. These results indicate that NK-lysin and cathelicidin 1 derived peptides are able to modulated immune response, suggesting their potential use to enhance immune response in fish.

Characterizing patients with multiple chromosomal aberrations detected by FISH in chronic lymphocytic leukemia.

We analyzed the features of chronic lymphocytic leukemia (CLL) with multiple abnormalities (MA) detected by FISH. A local database including 2095 CLL cases was used and 323 with MA (15.4%) were selected. MA was defined by the presence of two or more alterations (deletions of 13q14 (13q-), 11q22 (11q-), 17p13 (17p-) or trisomy 12 (+12)). The combination of 13q- with 11q- and 13q- with 17p-, accounted for 58.2% of the series, in contrast to 11q- with 17p- (3.7%). Patients carrying MA since diagnosis presented a short time to first therapy(TTFT) (27 months) and overall survival (OS) (76 months). The combinations including 17p- had a shorter OS (58 months) than the ones without 17p- (not reached, p = .002). Patients with a complex-FISH were the ones with worse OS (34 months). MA imply poor prognosis when they emerge at diagnosis, probably due to the high incidence of bad prognosis markers, which may be a reflection of a more complex karyotype.

Clinical characteristics of hepatocellular carcinoma in Spain. Comparison with the 2008-2009 period and analysis of the causes of diagnosis out of screening programs. Analysis of 686 cases in 73 centers. / Características clínicas del carcinoma hepatocelular en España. Comparación con el período 2008-2009 y análisis de las causas del diagnóstico fuera de cribado. Estudio de 686 casos en 73 centros.

BACKGROUND AND OBJECTIVE: In 2010 we published that 53% of cases of hepatocellular carcinoma (HCC) detected in Spain were diagnosed outside the context of standard screening programs, which consequently leads to lower survival rates. The aim of this study was to analyze the current situation and the causes of diagnosis out of screening programs. MATERIAL AND METHODS: Prospective registry of 73 second- and third-level Spanish healthcare centers carried out between October 1, 2014 and January 31, 2015. The baseline characteristics of the disease and the first treatment administered for the incidental primary liver tumors during such period were recorded. RESULTS: A total of 720 patients were included in the study: HCC (n=686), intrahepatic cholangiocarcinoma (n=29), hepatic cholangiocarcinoma (n=2), other (n=3). HCC characteristics: male 82%; mean age 67 years; cirrhosis 87%; main etiologies: alcohol 35%, HCV 30%, alcohol and HCV 15%, non-alcoholic fatty liver disease 6%; tumor stage: BCLC-0 11%, A 43%, B 19%, C 16% and D 11%; first treatment: transarterial chemoembolization (23%), percutaneous ablation (22%), symptomatic treatment (20%), resection (11%), sorafenib (11%). Three hundred and fifty-six patients (53%) were diagnosed outside of screening programs, mainly owing to the fact that they suffered from an undiagnosed liver disease (76%) and to the poor adherence to the screening program (18%). These patients were mainly male (P<.001), with an alcoholic etiology (P<.001) and active alcohol consumption (P<.001). Moreover, the disease was predominantly diagnosed at more advanced stages (P<.001) and was addressed with less radical treatments (P<.001). CONCLUSIONS: In Spain, the main cause of diagnosis of a HCC outside the context of a screening program is the absence of a prior diagnosis of a liver disease, particularly in alcohol-consuming men. Detecting a liver disease in asymptomatic populations and improving adherence to screening programs are the main areas that must be subject to improvement in order to improve the early detection of HCC.

Liver and Spleen Stiffness Measurements by Point Shear Wave Elastography via Acoustic Radiation Force Impulse: Intraobserver and Interobserver Variability and Predictors of Variability in a US Population.

OBJECTIVES: Measurements of liver stiffness and spleen stiffness are useful noninvasive ways to assess fibrosis and portal hypertension in patients with chronic liver disease. One method for assessing stiffness is by point shear wave elastography via acoustic radiation force impulse imaging (ARFI). Its advantage is that sites where stiffness is measured are visualized sonographically. However, its reliability has not been well established, and all studies done to date evaluating the use of ARFI in chronic liver disease have been performed outside the United States. We aimed to characterize the intraobserver and interobserver variability of ARFI-measured liver and spleen stiffness. METHODS: Two hepatologists evaluated unselected hepatology outpatients with ARFI. Exclusions were hepatocellular carcinoma, ascites, a surgical shunt or transjugular intrahepatic portosystemic shunt, portal thrombosis, and cholestatic disease. Each operator obtained 20 measurements from the right liver lobe and spleen. Intraclass correlation coefficients (ICC) were calculated. RESULTS: A total of 177 patients were included: median age, 61 years; 85% male; and 43% obese. Intraobserver ICCs were the same for both observers for liver stiffness (0.89; 95% confidence interval [CI], 0.85-0.92) and spleen stiffness (0.72; 95% CI, 0.61-0.80). Interobserver agreement was excellent for liver stiffness (ICC, 0.85; 95% CI, 0.76-0.90) but not as good for spleen stiffness (ICC, 0.73; 95% CI, 0.60-0.83). A body mass index of 30 kg/m2 or greater, waist circumference of greater than 105 cm, and skin-to-capsule distance of 2 cm or greater negatively affected the ICC for liver stiffness; small spleen size negatively affected the ICC for spleen stiffness. CONCLUSIONS: To our knowledge, this article is the first report of ARFI findings in a US population with chronic liver disease. Liver stiffness reproducibility was excellent, particularly in nonobese patients. Spleen stiffness reproducibility was excellent in those with larger spleens and therefore may be most useful in patients with cirrhosis and portal hypertension.

Connexinopathies: a structural and functional glimpse.

Mutations in human connexin (Cx) genes have been related to diseases, which we termed connexinopathies. Such hereditary disorders include nonsyndromic or syndromic deafness (Cx26, Cx30), Charcot Marie Tooth disease (Cx32), occulodentodigital dysplasia and cardiopathies (Cx43), and cataracts (Cx46, Cx50). Despite the clinical phenotypes of connexinopathies have been well documented, their pathogenic molecular determinants remain elusive. The purpose of this work is to identify common/uncommon patterns in channels function among Cx mutations linked to human diseases. To this end, we compiled and discussed the effect of mutations associated to Cx26, Cx32, Cx43, and Cx50 over gap junction channels and hemichannels, highlighting the function of the structural channel domains in which mutations are located and their possible role affecting oligomerization, gating and perm/selectivity processes.

Factores físicos y mentales asociados con la capacidad funcional del adulto mayor, Antioquia, Colombia, 2012 / Demographic, social, physical and mental factors associated with functional capacity in the elderly, Antioquia, Colombia, 2012

Objetivo Describir los factores demográficos, sociales, de la salud física y mental asociados a la capacidad funcional de los adultos mayores del Departamento de Antioquia en el año 2012. Materiales y Métodos Estudio descriptivo, tomando como población los registros de 4 248 adultos de 60 años o más, encuestados en el Departamento de Antioquia, en el año 2012, a los cuales se les indagó por la capacidad funcional a través de la encuesta de Katz que consta de 6 ítems. Con las variables independientes se calcularon medidas de frecuencia, la razón de prevalencias (Rp) crudas y ajustadas con sus respectivos IC del 95 %. Resultados El estar soltero, viudo o separado, presentar bajo o nulo nivel educativo (66,4 %), padecer de hipertensión arterial (56,7 %), diabetes (16,8 %) y problemas óseos (22,0 %), el consumo de cigarrillo (64,6 %), el riesgo nutricional, sufrir de depresión (20,1 %), ansiedad y deterioro cognitivo leve (49,6 %), influyen de manera negativa en la capacidad funcional de los adultos mayores del Departamento. Las edades jóvenes, la vida social activa y la utilización adecuada del tiempo libre fortalecen la buena capacidad funcional en el mismo grupo poblacional. Conclusiones Hay factores demográficos, de la salud física y mental que inciden negativamente sobre la capacidad funcional de los adultos mayores. Por lo tanto, se hace necesario la capacitación de los mismos respecto al tema, con el fin, de que reconozcan dichos factores y su influencia en el debilitamiento de la capacidad funcional.

Objective To describe the demographic, social, physical and mental health factors associated with the functional capacity of older adults in the Department of Antioquia in 2012. Materials and Methods A descriptive study with the records of 4 248 adults aged 60 years or more as the population, surveyed in the Department of Antioquia, in 2012. They were asked about their functional capacity through a Katz survey consisting of 6 items. With the independent variables, frequency measurements were calculated, along with crude and adjusted prevalence ratios (PR) with their respective 95 % CI. Results Being single, widowed or separated, presenting little or no educational level (66.4 %), suffering from hypertension (56.7 %), diabetes (16.8 %) and bone problems (22.0 %), cigarette smoking (64.6 %), nutritional risk, suffering from depression (20.1 %), or anxiety and cognitive impairment (49.6 %), impact negatively on functional capacity of older adults in Antioquia. However, younger ages, active social lives, and proper use of leisure strengthen good functional capacity in the same population group. Conclusions The results of this study indicate that there are demographic factors of physical and mental health that negatively affect the functional capacity of older adults. Therefore, training them on the issue, in order to recognize these factors and their influence on the weakening of functional capacity, is required.

The Rare and Challenging Presentation of Gastric Cancer during Pregnancy: A Report of Three Cases.

Pregnancy-associated gastric cancer is extremely rare. In many cases, it is diagnosed at an advanced stage because the symptoms during pregnancy are generally overlooked. We report three cases of gastric cancer during pregnancy with various outcomes. The first case included a patient with stage IV gastric cancer who received palliative chemotherapy. This patient had a preterm birth and died 7 months after diagnosis. The second case received neoadjuvant chemotherapy during pregnancy and a total gastrectomy was performed after delivery. She then received adjuvant chemoradiotherapy. This patient developed pulmonary metastasis and died of recurrence 41 months after surgery. In the third case, a distal subtotal gastrectomy was performed at week 14 of pregnancy, with no complications. The patient received adjuvant chemoradiotherapy. She is currently without recurrence 14 months after surgery. In patients with pregnancy-associated gastric cancer, treatment decisions are predominantly influenced by clinical stage and gestational age at diagnosis.

A high proportion of cells carrying trisomy 12 is associated with a worse outcome in patients with chronic lymphocytic leukemia.

The prognosis of chronic lymphocytic leukemia (CLL) patients displaying trisomy 12 (+12) remains unclear. In this study, we analyzed the influence of the proportion of cells with +12, and other clinical and biologic factors, in time to first therapy (TTFT) and overall survival (OS), in 289 patients diagnosed with CLL carrying +12. Median OS was 129 months. One hundred seventy-four patients (60.2%) presented +12 in <60% of cells. TTFT and OS for this subgroup were longer than for the subgroup with +12 in ≥60% of cells, with a median TTFT of 49 months (CI95%, 39-58) vs 30 months (CI95%, 22-38) (P = 0.001); and a median OS of 159 months (CI95%, 119-182), vs 96 months (CI95%, 58-134) (P = 0.015). Other factors associated with a shorter TTFT were: Binet stage, B symptoms, lymphadenopathy, splenomegaly, high lymphocyte count, 11q-, high ß2 microglobulin, and high LDH. In the multivariate analysis, clinical stage, +12 in ≥60% of cells, high lymphocyte count, B symptoms, and 11q- in addition, resulted of significance in predicting shorter TTFT. Significant variables for OS were: Binet stage, lymphadenopathy, splenomegaly, high LDH, high ß2 microglobulin, 11q-, and CD38. In the multivariate analysis, only Binet stage, 11q-, and high ß2microglobulin significantly predicted shorter OS. CLL with +12 entails a heterogeneous group with intermediate prognosis. However, a high proportion of cells carrying +12 separates a subgroup of patients with poor outcome. Copyright © 2015 John Wiley & Sons, Ltd.

[Demographic, social, physical and mental factors associated with functional capacity in the elderly, Antioquia, Colombia, 2012]. / Factores físicos y mentales asociados con la capacidad funcional del adulto mayor, Antioquia, Colombia, 2012.

Objective To describe the demographic, social, physical and mental health factors associated with the functional capacity of older adults in the Department of Antioquia in 2012. Materials and Methods A descriptive study with the records of 4 248 adults aged 60 years or more as the population, surveyed in the Department of Antioquia, in 2012. They were asked about their functional capacity through a Katz survey consisting of 6 items. With the independent variables, frequency measurements were calculated, along with crude and adjusted prevalence ratios (PR) with their respective 95 % CI. Results Being single, widowed or separated, presenting little or no educational level (66.4 %), suffering from hypertension (56.7 %), diabetes (16.8 %) and bone problems (22.0 %), cigarette smoking (64.6 %), nutritional risk, suffering from depression (20.1 %), or anxiety and cognitive impairment (49.6 %), impact negatively on functional capacity of older adults in Antioquia. However, younger ages, active social lives, and proper use of leisure strengthen good functional capacity in the same population group. Conclusions The results of this study indicate that there are demographic factors of physical and mental health that negatively affect the functional capacity of older adults. Therefore, training them on the issue, in order to recognize these factors and their influence on the weakening of functional capacity, is required.

Response to therapy in patients with cryptococcosis and AIDS: Association with in vitro susceptibility to fluconazole.

BACKGROUND: The implications of the Cryptococcus neoformans resistance to fluconazole on patient therapy have not been fully elucidated due to the discordant results found in published studies. AIMS: To establish the influence of C. neoformans resistance to fluconazole in the therapy of individuals with cryptococcosis and AIDS. METHODS: This study retrospectively compared the clinical course of patients with cryptococcosis according to the level of fluconazole resistance of their C. neoformans isolates. RESULTS: This study included 71 episodes of cryptococcosis, defined as those isolates of C. neoformans obtained from patients with mycosis, of which 36 isolates were sensitive to fluconazole, 20 susceptible dose-dependent (SDD), and 15 were resistant. There were 5 treatment failures in the consolidation phase; two occurred in patients who had a susceptible strain, 2 in patients who had SDD strains, and one in a patient who had a resistant strain. During the maintenance treatment, relapses occurred in 4 of 33 patients (12%), seen during the follow-up period, none of which occurred in the group with resistant isolates. There were no significant differences in survival time free of treatment failure (p=0.65) or survival time free of failure or relapse (p=0.38). These results were not affected when tested in a Cox model that included age, CD4T lymphocyte counts, and use of antiretroviral therapy. CONCLUSIONS: In HIV patients with cryptococcosis, the resistance of C. neoformans appeared not to increase the risk of failure or relapse during treatment.

Efectos cognitivos de la estimulación audiovisual en niños con limitaciones severa de la movilidad: la utilidad de las tecnologías de apoyo de bajo costo / The cognitive effects of audiovisual stimulation in children with severe mobility limitations: the utility of low-cost assistive technology

El desarrollo cognitivo del niño requiere de la exploración del entorno. En niños con enfermedades neuromusculares, esta exploración está limitada, dificultando su desarrollo. El objetivo de este estudio es evaluar un modelo de estimulación audiovisual de bajo costo. Se desarrollaron dos vehículos de estimulación audiovisual portátiles (VEP), usados para presentar la intervención, y que eran apropiados para la población participante. En la intervención se incluyó a 9 niños(mediana edad=42,6 meses; rango = 16-99 meses) con enfermedades neuromusculares. El programa de estimulación duró 20 días. Para evaluar la intervención, se usó un lector de movimientos oculares que registró la actividad en una tarea de rastreo visual. Además, se evaluó la frecuencia de respuesta en una tarea de causa-efecto. En la tarea de rastreo visual, tres pacientes (42,8 por ciento) disminuyeron el tiempo de ejecución, en magnitud del 61,9 por ciento (mediana: 13s; rango: 9-54,5 s). Con respecto al número de errores: 5 de 7 participantes (71,4 por ciento) disminuyeron los errores, en magnitud del 56 por ciento (mediana: 5 errores; rango: 2,3-5,8 errores). Respecto a la tarea de causa-efecto, dos de cuatro pacientes mostraron un mejor rendimiento, siendo mas responsivos a la estimulación ambiental. Los resultados muestran que los niños se beneficiaron de la intervención, incluso, los más pequeños. Estas intervenciones deben ser parte de la atención de niños con limitaciones del movimiento...

The cognitive development of children requires the exploration of the environment. In children with neuromuscular diseases this exploration is limited, compromising their development.The aim of this study is to assess a model of low-cost audiovisual stimulation. Two audiovisual stimulation portable vehicle (VEP, in Spanish), were used to apply the intervention, as they were appropriate for the patients. In the intervention, 9 children (age median=42.6 months; range= 16.99) with muscular disease were included. The program of stimulation lasted 20 days. In order to assess the intervention, an eye-tracker device was used to register the performance in a visual pursuit task. In addition, responsiveness was assessed. In the visual pursuit task, three patients (42,8 per cent) diminished the latency in 61,9 per cent (median: 13s; range: 9-54,5 s). Regarding the amount of errors: 5 out 7 participants (71,4 per cent) diminished the amount of errors in 56 per cent (median: 5 errors; range: 2,3-5,8 errors). In regards of the cause-effect task, two out of four subjects showed a better performance, being more responsive to the environmental stimulation. The results show that children are benefited from the intervention, even the younger ones. This intervention should be part of the attention of children with mobility limitations...