Sexual dysfunction in patients with cancer, a challenge in oncology practice: results of the CLARIFY project.

BACKGROUND: Sexual dysfunction (SD) associated with oncological treatment is a common and understudied disorder. Our aim was to characterize SD in a cohort of Spanish patients. METHODS: Analytic observational study in patients included in the CLARIFY H2020 project at the Hospital Universitario Puerta de Hierro. Clinical variables and validated measures of sexual function were collected from October 2020 to May 2022. Frequency and quality of sexual activity were assessed. Descriptive, trend associations, and logistic regression analyses were performed. RESULTS: A total of 383 patients were included: breast cancer 68.14% (261), lung cancer 26.37% (101), and lymphoma 5.50% (21). Mean age was 56.5 years (range 33-88). 19.58% (75) were men and 80.42% (308) were women. 69% and 31% of men and women, respectively, reported being sexually active. The absolute frequency of overall sexual dissatisfaction was 76% in women and 24% in men. Women with breast cancer were most likely to have severe sexual dysfunction. Those with early disease had resolved complaints after 5 years. In multinomial logistic regression, significant associations were found in women with metastatic breast cancer and severe disorders of arousal (p 0.000), lubrication (p 0.002), orgasm (p 0.000), as well as dissatisfaction with sexual performance (p 0.000) and global sexual dissatisfaction (p 0.000). Women with lung cancer have severe arousal dysfunction (p 0.016) and global sexual dissatisfaction (p 0.044). CONCLUSIONS: Our population has a high prevalence of SD, which supports the need to increase awareness of this disorder among the medical oncology team and the importance of including sexual health assessment in oncological patient follow-up.

Assessing the risk of cardiovascular events in patients receiving immune checkpoint inhibitors.

Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. However, despite their excellent therapeutic effect, these medications typically result in a broad spectrum of toxicity reactions. Immune-related cardiotoxicity is uncommon but can be potentially fatal, and its true incidence is underestimated in clinical trials. The aim of this study is to assess the incidence and identify risk factors for developing a cardiac event in patients treated with ICIs. Methods: We conducted a single-institution retrospective study, including patients treated with ICIs in our center. The main outcomes were cardiac events (CE) and cardiovascular death. Results: A total of 378 patients were analyzed. The incidence of CE was 16.7%, during a median follow-up of 50.5 months. The multivariable analysis showed that age, a history of arrhythmia or ischemic heart disease, and prior immune-related adverse events were significantly associated with CE. Conclusion: CE during ICI treatment are more common than currently appreciated. A complete initial cardiovascular evaluation is recommended, especially in high-risk patients, being necessary a multidisciplinary approach of a specialized cardio-oncology team.

An Artificial Intelligence-Based Tool for Data Analysis and Prognosis in Cancer Patients: Results from the Clarify Study.

BACKGROUND: Artificial intelligence (AI) has contributed substantially in recent years to the resolution of different biomedical problems, including cancer. However, AI tools with significant and widespread impact in oncology remain scarce. The goal of this study is to present an AI-based solution tool for cancer patients data analysis that assists clinicians in identifying the clinical factors associated with poor prognosis, relapse and survival, and to develop a prognostic model that stratifies patients by risk. MATERIALS AND METHODS: We used clinical data from 5275 patients diagnosed with non-small cell lung cancer, breast cancer, and non-Hodgkin lymphoma at Hospital Universitario Puerta de Hierro-Majadahonda. Accessible clinical parameters measured with a wearable device and quality of life questionnaires data were also collected. RESULTS: Using an AI-tool, data from 5275 cancer patients were analyzed, integrating clinical data, questionnaires data, and data collected from wearable devices. Descriptive analyses were performed in order to explore the patients' characteristics, survival probabilities were calculated, and a prognostic model identified low and high-risk profile patients. CONCLUSION: Overall, the reconstruction of the population's risk profile for the cancer-specific predictive model was achieved and proved useful in clinical practice using artificial intelligence. It has potential application in clinical settings to improve risk stratification, early detection, and surveillance management of cancer patients.

Use of immune checkpoint inhibitors in patients with solid tumors and pre-existing autoimmune or inflammatory disease: real-world data.

AIM: Immune checkpoint inhibitors (ICIs) are a cornerstone in cancer treatment but they can induce immune-related adverse events (irAEs). Furthermore, patients with pre-existing autoimmune and/or inflammatory disease (AID) have been excluded from clinical trials. The objective of this study is to evaluate the efficacy and safety of ICIs in patients with cancer and AID. MATERIALS & METHODS: This is an observational, retrospective study carried out at the Medical Oncology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid between January 2016 and December 2018. RESULTS: A total of 202 cancer patients treated with ICIs were included, 15 (7, 4%) of them had pre-existing autoimmune diseases. The most frequent pre-existing AID were thyroid diseases (33.3%): autoimmune hypothyroidism, Graves-Basedow disease and Hashimoto's thyroiditis. Three patients had psoriasis, two antinuclear antiboides + polyarthritis, one rheumatoid arthritis, another latent autoimmune diabetes in adults, another systemic lupus erythematosus and the last one, a polymyalgia rheumatica. In this series, the majority of patients (73.33%) did not experience any flare up of their autoimmune disease. In patients who had AID flare up, this was treated with corticosteroids. The most frequent cause of immunotherapy discontinuation was tumor progression (40%). A total of 20% of patients had to discontinue immunotherapy due to toxicity. CONCLUSION: In our series, AID flare ups or irAEs in patients with pre-existing AID who receive immunotherapy are not very common and can often be controlled without interrupting treatment. Prospective studies are needed to establish the incidence of irAEs in patients with pre-existing autoimmune conditions, evaluate risk-benefit and elaborate management clinical guidelines in this population.

Cancer and SARS-CoV-2 Infection: A Third-Level Hospital Experience.

INTRODUCTION: Madrid has been the epicenter of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Spain. We analyzed our experience with SARS-CoV-2 infected and cancer patients. PATIENTS AND METHODS: We included patients from March 1 to April 30 2020 at Hospital Universitario Puerta de Hierro, Majadahonda, Madrid (Spain). The inclusion criteria were diagnosis of SARS-CoV-2 infection made by reverse transcription polymerase chain reaction (RT-PCR) of nasopharyngeal specimens in cancer patients who were admitted to the hospital due to the need for respiratory support. The exclusion criteria were suspected cases not confirmed. The primary objective was to analyze the mortality rates of patients with cancer, especially those with lung cancer and COVID-19. RESULTS: Overall in-hospital mortality of cancer patients with coronavirus disease 2019 (COVID-19) was 15.2% similar to 12.7% of the global COVID-19 hospitalized population (p=0.615) and greater than that of patients admitted without SARS-CoV-2 infection during the same period 4.3% (p<0.001). Among 653 patients receiving active cancer therapy during the study period, 24 (3.7%) developed COVID-19 and required admission, 4.2% of those receiving chemotherapy, 9.5% immunotherapy and 2.1% targeted therapies. Lung and breast cancer were the most frequent cancer types (26.1%), followed by colorectal cancer (19.6%). Mortality in patients with lung cancer was 25%. The univariate analysis comparing patients who developed a serious event to those who did not showed that the higher Brescia index, CURB-65 scale, lactate dehydrogenase (LDH) or C-reactive protein (CRP) were the risk factors of developing severe complications. CONCLUSION: Patients with cancer, especially lung cancer, and SARS-CoV-2 infection have a worse overall prognosis than the general population.

Sex is a strong prognostic factor in stage IV non-small-cell lung cancer patients and should be considered in survival rate estimation.

BACKGROUND: Biological differences between the sexes have a major impact on disease and treatment outcome. In this paper, we evaluate the prognostic value of sex in stage IV non-small-cell lung cancer (NSCLC) in the context of routine clinical data, and compare this information with other external datasets. METHODS: Clinical data from stage IV NSCLC patients from Hospital Puerta de Hierro (HPH) were retrieved from electronic health records using big data analytics (N = 397). In addition, data from the Spanish Lung Cancer Group (GECP) Tumor Registry (N = 1382) and from a published study available from the cBioPortal (MSK) (N = 601) were analyzed. Survival curves were estimated using the Kaplan-Meier method. A Cox proportional hazards regression model was used to assess the prognostic value of sex. A meta-analysis to compare the outcome for males and females in terms of overall survival (OS) and progression free survival (PFS) was performed. RESULTS: The median OS time was 12 months for males and 19 months for females (overall HR = 0.77; 95% CI: 0.68-0.87; P < 0.001). Similarly, females with stage IV NSCLC harboring an EGFR-sensitizing mutation lived significantly longer than males (median OS: males, 19 months; females, 32 months) with a lower risk of death compared with males (overall HR = 0.75; 95% CI: 0.67-0.84). In addition, female patients benefited more from EGFR inhibitors in terms of PFS and OS (overall HR = 0.45; 95% CI: 0.32-0.64, and HR = 0.62; 95% CI: 0.48-0.80, respectively). Median PFS was 21 months in females and 12 months in males (P < 0.001). CONCLUSIONS: Using routine clinical data we confirmed the previous finding that among stage IV NSCLC patients, females had a significantly better prognosis than males. The effect size of the sex was notable, highlighting the fact that survival rates are usually estimated and patients are generally managed without considering the sexes separately, which may lead to suboptimal results.

Hábitos alimentarios y estado nutricional en pacientes diabéticos con retinopatía que acuden a una Clínica Oftalmológica Privada de la ciudad de Asunción / Food habits and nutritional status in diabetic patients with retinopathy that attend a private Ophthalmological Clinic of the city of Asunción

La retinopatía diabética (RD) es una complicación microvascular crónica, específica de la diabetes. Es una causa importante de pérdida visual en adultos, con consecuencias médicas, sociales y financieras significativas. El objetivo fue evaluar los hábitos alimentarios y estado nutricional en diabéticos con retinopatía que acuden a la Clínica Vista 10 de la ciudad de Asunción entre setiembre y noviembre del año 2018. Estudio descriptivo, observacional de corte transverso que incluyó 50 pacientes, Siendo la mayor parte de ellos del sexo femenino (65%), la edad media fue de 62,8±11,3 años, el 66% (n=33) estaba casado con nivel educativo primario (n=20;40%) y vivía en Gran Asunción (n= 46; 92%). Respecto a la frecuencia de consumo de alimentos, se encontró que casi la totalidad de la población realizaba el desayuno (96%). El 70% consumía lácteos descremados menos de la cantidad recomendada. Solo un 20% consumía frutas todos los días. Un poco más de la mitad (52%) consumía verduras todos los días. El 70% consumía pescado por debajo de las recomendaciones establecidas, y el 78% consumía legumbres menos de la cantidad recomendada. Más de la mitad (58%) consumía alimentos integrales por debajo de las recomendaciones. El 54% consumía comida casera todos los días y el 56% realizaba la cena todos los días. Más de la mitad de los participantes presentó sobrepeso u obesidad. Los hábitos de la población son deficientes, en relación al consumo de frutas, lácteos según las recomendaciones de las Guías Alimentarias del Paraguay

Diabetic retinopathy (RD) is a chronic microvascular complication specific to diabetes. It is an important cause of visual loss in adults, with significant medical, social and financial consequences. The objective was to evaluate the dietary habits and nutritional status in diabetic atients with retinopathy who attend the Clínica Vista 10 in the city of Asunción between September and November of 2018. This was a descriptive, observational cross-sectional study The majority of the population studied was female (n = 33, 65%), the mean age was 62.8 ± 11.3 years, 66% (n = 33) was married and the highest percentage was presented primary education level(n = 20, 40%). According to the classification of the place of origin, most lived in Gran Asunción (n = 46, 92%). Regarding the frequency of food consumption, it was found that almost the entire population made breakfast(96%), 70% consumed low-fat dairy products less than the recommended amount. Only 20% consumed fruits every day. A little more than half(52%)consumed vegetables every day, 70% consumed fish below the established recommendations and 78% consumed legumes less than the recommended amount. More than half (58%) consumed whole food below the recommendations, 54% consumed home-cooked food every day and 56% made dinner every day. More than half of the population was overweight or obese. The habits of the population are deficient, in relation to the consumption of fruits, dairy products according to the recommendations of the Food Guides of Paraguay

Genetic Variants Associated With Cancer Therapy-Induced Cardiomyopathy.

BACKGROUND: Cancer therapy-induced cardiomyopathy (CCM) is associated with cumulative drug exposures and preexisting cardiovascular disorders. These parameters incompletely account for substantial interindividual susceptibility to CCM. We hypothesized that rare variants in cardiomyopathy genes contribute to CCM. METHODS: We studied 213 patients with CCM from 3 cohorts: retrospectively recruited adults with diverse cancers (n=99), prospectively phenotyped adults with breast cancer (n=73), and prospectively phenotyped children with acute myeloid leukemia (n=41). Cardiomyopathy genes, including 9 prespecified genes, were sequenced. The prevalence of rare variants was compared between CCM cohorts and The Cancer Genome Atlas participants (n=2053), healthy volunteers (n=445), and an ancestry-matched reference population. Clinical characteristics and outcomes were assessed and stratified by genotypes. A prevalent CCM genotype was modeled in anthracycline-treated mice. RESULTS: CCM was diagnosed 0.4 to 9 years after chemotherapy; 90% of these patients received anthracyclines. Adult patients with CCM had cardiovascular risk factors similar to the US population. Among 9 prioritized genes, patients with CCM had more rare protein-altering variants than comparative cohorts ( P≤1.98e-04). Titin-truncating variants (TTNtvs) predominated, occurring in 7.5% of patients with CCM versus 1.1% of The Cancer Genome Atlas participants ( P=7.36e-08), 0.7% of healthy volunteers ( P=3.42e-06), and 0.6% of the reference population ( P=5.87e-14). Adult patients who had CCM with TTNtvs experienced more heart failure and atrial fibrillation ( P=0.003) and impaired myocardial recovery ( P=0.03) than those without. Consistent with human data, anthracycline-treated TTNtv mice and isolated TTNtv cardiomyocytes showed sustained contractile dysfunction unlike wild-type ( P=0.0004 and P<0.002, respectively). CONCLUSIONS: Unrecognized rare variants in cardiomyopathy-associated genes, particularly TTNtvs, increased the risk for CCM in children and adults, and adverse cardiac events in adults. Genotype, along with cumulative chemotherapy dosage and traditional cardiovascular risk factors, improves the identification of patients who have cancer at highest risk for CCM. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01173341; AAML1031; NCT01371981.

Evaluación de la composición nutricional de alimentos procesados y ultraprocesados de acuerdo al perfil de alimentos de la Organización Panamericana de la Salud, con énfasis en nutrientes críticos / Evaluation of the nutritional composition of processed and ultraproced foods according to the food profile of the pan american health organization with emphasis on critical nutrients

La modernización alimentaria ha llevado a una mayor disponibilidad de alimentos industrializados, ricos en azúcares simples, grasas saturadas y altos en sodio; a ese patrón se le ha considerado la "dieta occidental", concomitante al incremento del sobrepeso y obesidad, y al aumento de la morbilidad y mortalidad por enfermedades crónico-degenerativas. El objetivo de este estudio fue determinar la adecuación de la composición nutricional de alimentos procesados y ultraprocesados de acuerdo al Perfil de Alimentos de la Organización Panamericana de la Salud respecto a los nutrientes críticos según lo declarado en el etiquetado nutricional. Estudio transversal, observacional y descriptivo en el que se analizaron 80 productos: 38 procesados y 42 ultraprocesados. Dentro de la categoría de ¨Cereales¨, en comparación con los criterios del Perfil de Nutrientes de la OPS, se ha encontrado que la razón sodio/Kcal supera la proporción 1:1. Además, los azúcares agregados superan el 10% del total de Kcal de los productos en un 24%. En la categoría de ¨Bebidas¨, los azúcares agregados sobrepasan las cantidades sugeridas por la OPS en un 15% del 10% permitido. En conclusión se encontraron que en los alimentos procesados muchos ingredientes sobrepasan lo permitido o recomendado por la OPS, por lo que el mejor consejo dietético es basar las dietas en alimentos frescos y mínimamente procesados, y la preparación de platos y comidas frescos(AU)

Long-term follow up of Hodgkin lymphoma.

BACKGROUND: Hodgkin lymphoma (HL) is the paradigm of curable disease. This study analyzed the overall survival (OS) of patients with HL and compared their survival between decades and with the expected survival of a general population. RESULTS: The median follow-up was 22 years. The median OS was 33 years. The incidence mortality rate for all causes is 2 per every 100 patients per year. The OS of our cohort at 10 years from diagnosis was 76% (95% CI: 72-79) and 52% at 30 years (95% CI: 48-57). Overall SMR (1980-2013) was 2,943 (95% CI: 2,518-3,439). Excluding the primary tumor as the cause of death, the SMR obtained is 2,266 (95% CI: 1,895-2,710). The SMR for those patients diagnosed before the year 2000 was 2,097 (95% CI: 1,732-2,539); and for those diagnosed after 2000 was 5,218 (95% CI: 8,655). The group of patients diagnosed after 2000 had statistically significant more advanced stages, were older and less responsive to treatment. CONCLUSIONS: Despite the advances achieved, the risk of death remains higher than in the general population, mainly for those patients diagnosed after year 2000, even after almost 40 years of follow-up. This data might suggest a shift to more aggressive forms of disease in recent years. PATIENTS AND METHODS: A total of 595 patients diagnosed with HL were included between January 1966 and February 2014. The standardized mortality ratio (SMR) was analyzed using the annual rate of mortality in the general Spanish population, adjusted for age, sex and time period.

Lung cancer as a cardiotoxic state: a review.

As the overall survival of patients with lung cancer continues to increase, more cancer survivors are faced with the risk of developing treatment-related cardiovascular toxicities. The increased knowledge of the molecular biology of non-small cell lung cancer has led to new and more personalized treatments. Nevertheless, the usual chemotherapy schemes and radiation therapy induce cardiac toxicities that are frequently underappreciated or go unnoticed. Up to date, the majority of cardiotoxicity studies have been focused in breast cancer, but new treatments in lung cancer patients, such as immune checkpoint-blocking antibodies or tyrosine kinase inhibitors, may also exert these cardiac toxic effects and therefore demand of the close collaboration of oncologists and cardiologists, in order to be addressed. The aim of this review is to provide more detailed information in regard to drug-induced cardiac toxicity focused in non-small cell lung cancer patients.

Sistematización de la experiencia sobre las implicaciones bioéticas de la investigación en pediatría

ntroducción:La bioética es una rama de la ética que ha ido cobrando fuerza por la relevancia e impacto que ha tenido, no solo en el ámbito de la investigación, sino en otras como la intervención (bioética de la intervención) y lo social (bioética social).Desarrollo: Se muestran los resultados de la actividad de investigación "Implicaciones Bioéticas de la investigación en Pediatría", realizada en el segundo semestre del 2013. En dicha actividad participaron tres expertos, en bioética y enfermería, investigación médica y derecho, mediante una descripción detallada de lo expuesto por los conferencistas para luego reflexionar acerca de lo presentado a la luz de la teoría. Es esencial reflexionar sobre un aspecto vital que se desprende de los resultados del foro y que se concreta en la pregunta ¿para qué se investiga en pediatría? Tal interrogante que pareciera por demás obvia, tiene implicaciones éticas, cuya respuesta sería para mejorar las condiciones de salud de la población infantil, sin embargo hay otros fines explícitos e implícitos que pueden poner en peligro este tan noble propósito. Como el desarrollo de la tecnología (techne) como aspiración humana, aunque por mucho tiempo la tecnología respondía a las necesidades del ser humano, no era una meta era un medio finito para fines bien definidos, lo cual ha cambiado.Conclusión: se encuentra que hay posiciones diversas en lo que respecta a la investigación pediátrica y su abordaje desde la bioética principialista o la casuística; la investigación en enfermería es vista como algo anexo y no substancial de la profesión, motivo por el que debe reflexionarse más respecto de la investigación de enfermería desde la interdisciplinariedad, sin olvidar que para quien investiga es un fin y no un medio.

ntroduction: Bioethics is a branch of ethics that has been gaining strength for the relevance and impact it has had, not only in the field of research, but in other such intervention (intervention bioethics) and social (bioethics social).Developing: The results of the research activity "bioethical implications of research in pediatrics" held in the second half of 2013. Three experts attended this research activity: bioethics and nursing, medical research and law, a detailed description is shown of the comments made by the speakers and the reflect why was presented in the light of the theory. Is essential to reflect on a vital aspect that emerges from the results of the forum, which are specified in the question, why is investigated in pediatrics? Such a question, which seems obvious to others, has ethical implications, the answer is to improve the health of children, however, there are other explicit and implicit purposes may jeopardize this noble purpose, as the development of the (thence) as human aspiration technology, by technology long catered to the needs of human beings, was not a goal, it was a finite medium for defined purposes, which has changed.Conclusions: is that there are different positions with regard to pediatric research and approach from the principialist bioethics casuistry; nursing research is seen as substantial annex and the profession, should generate further reflection on the importance of nursing research from interdisciplinary and the research is an end and not a means.

ntrodução:A bioética é uma ramo da ética que vem ganhando força pela relevância e impacto que tem tido, não apenas no âmbito de pesquisa científica, senão em outros como a intervenção (bioética da intervenção) e no social (bioética social).Desenvolvimento: Mostram-se os resultados da atividade de pesquisa "Implicações Bioéticas da pesquisa científica em Pediatria", realizada no segundo semestre de 2013. Nesta atividade participaram três especialistas, em bioética e enfermagem, pesquisa médica e direito, mediante uma descrição detalhada do exposto pelos conferencistas para logo refletir acerca do apresentado a luz da teoria. É essencial refletir sobre um aspecto vital que se desprende dos resultados do foro e que se concreta na pergunta: para que se pesquisa em pediatria? Tal interrogante que parece tão óbvia, tem implicações éticas, cuja resposta seria para melhorar as condições de saúde da população infantil, no entanto, há outros fins explícitos e implícitos que podem pôr em perigo este tão nobre propósito. Como o desenvolvimento da tecnologia (techne) como aspiração humana, mesmo que, por muito tempo a tecnologia respondia às necessidades do ser humano, não era uma meta, era um meio finito para fins bem definidos, o qual mudou.Conclusão: encontraram-se que existem posições diversas com relação a pesquisa pediátrica e sua abordagem desde a bioética principialista ou a casuística; a pesquisa em enfermagem é vista como algo anexo e não substancial da profissão, motivo por que se deve refletir mais a respeito da pesquisa em enfermagem desde a interdisciplinariedade, sem esquecer que para quem investiga é um fim e não um meio.

Análisis de la integración de la bioética en la investigación de enfermería / Analysis of the integration of bioethics in nursing research

ResumenIntroducción.El objetivo de este artículo es presentar los resultados del análisis de los Trabajos Finales de Graduación (TFG), desarrollados por el estudiantado como requisito para obtener el título de Licenciatura en Enfermería, los cuales son parte del plan de estudios del Programa de Licenciatura en Enfermería de la Universidad de Costa Rica.Método.La indagatoria se ejecutó por medio de una investigación bibliográfica, documental, archivista, de la que se analizó 158 Trabajos Finales de Graduación producidos entre el 2005 y el año 2012. De las memorias e informes finales de investigación se extrajo aspectos que reflejaran implícita o explícitamente los principios de la bioética por medio de una matriz elaborada para ese fin.Resultados.A pesar de que la población objeto de estudio o intervención estuvo representada por grupos vulnerables, en un número importante de los TFG, no se documentó adecuadamente el proceso de consentimiento informado, además de que en el apartado de metodología no se evidencia con claridad la forma en que se aseguró los principios bioéticos.Conclusión.Se debe trabajar con mayor intensidad y claridad en el proceso de aprendizaje del estudiantado acerca de cuán importante son los principios bioéticos, al punto de que debe explicitarse el cómo se respetaron.

AbstractIntroduction.This arricie claims to present the results of an analysis regarding the final graduation projects made by students as a requisite for the Licentiate Degree in Nursing, as a part of the Degree Program in Nursing in the University of Costa Rica.Method.The study was carried out by means of a bibliographical and documental investigation of 158 final graduation projects, produced between the years 2005 and 2012. Characteristics which reflected implicitly or explicitly the principies of bioethics were extracted from the final reports, by means of a base by date created for this purpose.Results.It is noted that although in an important number of the final graduation projects the studied populations were vulnerable groups, the informed consent process is not adequately documented. Similarly, it is not clear the way in which the bioethics principies were ensured.Conclusión.It is concluded that there must be more intense work and clarity throughout the student's learning process, regarding the importance of respecting the principies of bioethics, showing explicitly the way in which they were respected.

Sentinel lymph node biopsy in breast cancer: the role of micrometastasis.

Intraoperative sentinel lymph node biopsy is widely used in patients with early-stage breast cancer for staging the axilla. The conventional analysis of the SLN has classically been performed by frozen section or touch imprint with a rapid H&E (hematoxylin and eosin) staining. Because of the risk of false-negative results, it has been replaced by the one-step acid amplification (OSNA) assay, a molecular diagnostic assay for the detection of cytokeratin 19 mRNA expression. Due to the controversial for the use of OSNA to evaluate the SLN because of its cost-effective and the lack of consensus to perform or avoid a lymphadenectomy when there is micrometastasis, we analyze 410 patients subjected to SLN biopsy in Hospital Puerta de Hierro, Madrid (Spain). Of the total of nodes, 223 (54.4 %) were processed throughout frozen-section examination and imprint cytology and 187 (45.6 %) throughout OSNA. The specificity of the frozen-section histological examination was of 100 %, with a sensitivity of 83.33 % (95 % CI 73.07-93.60). Of the 40 patients with definitive micrometastasis in the SLN, axillary dissection was performed in 90 % of the patients, with subsequent positive affectation in four of them (11.11 %). Based on our result and taking into account that 10 % of the lymphadenectomy performed after micrometastasis are positive, we do not believe that lymphadenectomy should be avoided after N(mi+) is detected in a SLN.

Citomorfología de médula ósea en pacientes con SIDA / Bone marrow cytomorphology in patients with AIDS

El objetivo de éste estudio fue analizar las características citomorfológicas de la médula ósea de pacientes con SIDA y correlacionarlas con las alteraciones hematológicas periféricas. Se incluyeron 29 pacientes en quienes el aspirado de médula ósea se realizó con las técnicas habituales y el hemograma se efectuó en el mismo momento. Los motivos de petición del aspirado medular fueron: citopenias (58 por ciento), fiebre de origen desconocido (38 por ciento) e investigación de patología tumoral (4 por ciento). El 92 por ciento de los pacientes presentó citopenias: anemia (52 por ciento), trombocitopenia (4 por ciento), bicitopenia (16 por ciento) y pancitopenia (28 por ciento). Un caso mostró fibrosis medular y no pudo ser evaluado. En los casos restantes, se constató celularidad medular normal (64 por ciento) o aumentada (36 por ciento). La relación mieloide/eritroide (M/E) fue: disminuida (46 por ciento), normal (36 por ciento) o aumentada (18 por ciento). Las principales anomalías citomorfológicas fueron: diseritropoyesis con rasgos megaloblásticos (63 por ciento), disgranulopoyesis con asincronismo madurativo entre núcleo y citoplasma, hipo/hipergranularidad y desviación a la derecha (48 por ciento) y distrombopoyesis con megacariocitos hipolobulados o núcleos desnudos de megacariocitos (41 por ciento). Además, se constató aumento de células plasmáticas (39 por ciento, algunas con morfología anormal), de eosinófilos (14 por ciento), de linfocitos (11 por ciento) y presencia de células tipo Gaucher. Las citopenias estuvieron asociadas a una médula ósea normo o hipercelular y la anemia a una meyor frecuencia de displasia eritroide. En 6/28 pacientes (21 por ciento), la médula ósea proporcionó diagnóstico morfológico. En conclusión, los hallazgos realizados indican que, si bien algunas anomalías citomorfológicas de la médula ósea no son específicas, determinados rasgos morfológicos podrían sugerir infección por VIH

Efecto del tratamiento con hidroxiurea sobre la actividad oxidativa de neutrófilos de la leucemia mieloide crónica / Effect of hydroxyurea on neutrophic oxidative activity in chronic myeloid leukemia

El efecto del tratamiento con hidroxiurea sobre la actividad oxidativa de neutrófilos fue evaluado en 14 pacientes con Leucemia Mieloide Crónica (LMC) mediante la determinación de la producción de anión superóxido y peróxido de hidrógeno. Seis pacientes fueron estudiados en el momento del diagnóstico y luego de iniciado el tratamiento y ocho pacientes estuvieron tratados previamente. En pacientes con LMC no tratados, la producción de anión superóxido y peróxido de hidrógeno por células no estimuladas fue menor respecto a controles normales. Luego de estimulación celular, hubo menor producción de peróxido de hidrógeno respecto a controles. Luego del tratamiento quimioterápico hubo un incremento en la liberación de anión superóxido -en condiciones basales y estimuladas- que fue mantenido durante un período medio de 9 meses. En pacientes con tratamiento previo, la actividad oxidativa fue mayor y se mantuvo por un período de seguimiento similar, con relación a los pacientes no tratados. Estos resultados indican que los neutrófilos de pacientes con LMC no tratados evidencian una actividad oxidativa disminuida, que luego del tratamiento con hidroxiurea manifiesta una normalización. Este efecto podría ser consecuencia de la aparición de células con una mayor capacidad funcional por efecto de la mediación sobre la maduración de células del clon leucémico o por aumento de las células provenientes de clones normales.

Calidad microbiológica de los quesos producidos a nivel artesanal en Costa Rica / Microbiological quality of home-made cheese produced in Costa Rica

Se analizaron 205 muestras de quesos hechos a partir de leche cruda entera, los cuales se producen en forma artesanal en seis zonas rurales de Costa Rica. La finalidad fue determinar la calidad microbiológica de los mismos y formular recomendaciones tendientes a reducir al mínimo las condiciones sanitarias deficientes de elaboración del producto. La muestras se recolectaron directamente en las fincas productoras, y se sometieron a los análisis microbiológicos seguientes: Staphylococcus aureus, termonucleasa (TNasa) positivo); Determinación del número más probable (MPN) de coliformes fecales; Recuento total de hongos y levaduras; y Recuento de mesófilas aerobias. Según se contató, todas las muestras contenían altos recuentos de los cuatro microorganismos investigados, demostrando, por conseguiente, la calidad microbiológica deficiente de los quesos producidos artesanalmente. Con base en los resultados obtenidos, se emite una serie de recomendaciones prácticas orientadas a mejorar las condiciones sanitarias inadecuadas bajo las cuales se elabora actualmente el producto