Analysis of apheresis outcomes in a cohort of Chilean patients treated with autologous stem cell transplantation: A single center real-world experience.

Adequate stem cell harvesting is required for autologous hematopoietic transplantation. In deficient mobilizer patients, the collection of stem cells can be challenging because of the impossibility of achieving satisfactory CD34 cell counts with GCSF + - chemotherapy. Plerixafor is a potent and expensive drug that promotes the release of stem cells from the medullary niche to the peripheral blood and allows satisfactory harvests. We performed a retrospective analysis of 370 patients with myeloma and lymphoma harvested at our institution. 99 % of patients achieved satisfactory apheresis using Plerixafor in 45 %. Satisfactory harvests were obtained in patients mobilized with GCSF or plerixafor. In patients who used plerixafor, it was necessary to perform fewer apheresis procedures (P = 0.05). In multivariate analysis, the only factor that predicted the need for plerixafor was the presence of less than 30,000 CD34 / ul on the day of apheresis (OR 0.3. p < 0.001). Since we adopted the plerixafor protocol guided by CD34 counts, the number of patients with harvest failure has decreased. In conclusion, the rational and standardized use of plerixafor favors satisfactory harvest in patients who require autologous transplantation in South-American patients.

Risk management of radioiodine treatment in differentiated thyroid cancer.

INTRODUCTION: Patient safety is paramount in providing quality healthcare and constitutes a global concern for healthcare systems. Radioiodine treatment to patients with well-differentiated thyroid cancer is not without risks. The aim of this study is to identify, evaluate and mitigate the risks associated with this procedure. MATERIALS AND METHODS: A single-centre descriptive study was conducted in which risk management was carried out by establishing a risk map using FMEA methodology. RESULTS: Based on the process map 6 sub-processes and 23 failure modes in the three phases of the treatment process were analysed. According to risk priority number (RPN), the sub-process with the highest risk was administrative management (RPN 82), followed by treatment per se and post-treatment imaging (both with RPN 70). An overall process RPN of 300 (156 pre-treatment, 74 treatment and 70 post-treatment) was obtained. Failures directly related to the patient pose a high risk. The implementation of verification systems, performing tasks earlier and providing quality medical information are the most relevant preventive measures to be implemented. CONCLUSIONS: The application of the FMEA methodology in the risk management for radioiodine treatment is a valuable tool for improving the quality and safety of this process. The risk map has been able to identify failures at different stages, assess their causes and effects, prioritise the risks identified and implement preventive and corrective measures that can be monitored, ensuring the effectiveness of the actions taken.

Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: primary results from the phase III MARIPOSA-2 study.

BACKGROUND: Amivantamab plus carboplatin-pemetrexed (chemotherapy) with and without lazertinib demonstrated antitumor activity in patients with refractory epidermal growth factor receptor (EGFR)-mutated advanced non-small-cell lung cancer (NSCLC) in phase I studies. These combinations were evaluated in a global phase III trial. PATIENTS AND METHODS: A total of 657 patients with EGFR-mutated (exon 19 deletions or L858R) locally advanced or metastatic NSCLC after disease progression on osimertinib were randomized 2 : 2 : 1 to receive amivantamab-lazertinib-chemotherapy, chemotherapy, or amivantamab-chemotherapy. The dual primary endpoints were progression-free survival (PFS) of amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy. During the study, hematologic toxicities observed in the amivantamab-lazertinib-chemotherapy arm necessitated a regimen change to start lazertinib after carboplatin completion. RESULTS: All baseline characteristics were well balanced across the three arms, including by history of brain metastases and prior brain radiation. PFS was significantly longer for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy [hazard ratio (HR) for disease progression or death 0.48 and 0.44, respectively; P < 0.001 for both; median of 6.3 and 8.3 versus 4.2 months, respectively]. Consistent PFS results were seen by investigator assessment (HR for disease progression or death 0.41 and 0.38 for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy, respectively; P < 0.001 for both; median of 8.2 and 8.3 versus 4.2 months, respectively). Objective response rate was significantly higher for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (64% and 63% versus 36%, respectively; P < 0.001 for both). Median intracranial PFS was 12.5 and 12.8 versus 8.3 months for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (HR for intracranial disease progression or death 0.55 and 0.58, respectively). Predominant adverse events (AEs) in the amivantamab-containing regimens were hematologic, EGFR-, and MET-related toxicities. Amivantamab-chemotherapy had lower rates of hematologic AEs than amivantamab-lazertinib-chemotherapy. CONCLUSIONS: Amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy improved PFS and intracranial PFS versus chemotherapy in a population with limited options after disease progression on osimertinib. Longer follow-up is needed for the modified amivantamab-lazertinib-chemotherapy regimen.

Dyskeratosis congenita: natural history of the disease through the study of a cohort of patients diagnosed in childhood.

Background: Dyskeratosis congenita (DC) is a multisystem and ultra-rare hereditary disease characterized by somatic involvement, bone marrow failure, and predisposition to cancer. The main objective of this study is to describe the natural history of DC through a cohort of patients diagnosed in childhood and followed up for a long period of time. Material and methods: Multicenter, retrospective, longitudinal study conducted in patients followed up to 24 years since being diagnosed in childhood (between 1998 and 2020). Results: Fourteen patients were diagnosed with DC between the ages of 3 and 17 years (median, 8.5 years). They all had hematologic manifestations at diagnosis, and nine developed mucocutaneous manifestations during the first decade of life. Seven presented severe DC variants. All developed non-hematologic manifestations during follow-up. Mutations were identified in 12 patients. Thirteen progressed to bone marrow failure at a median age of 8 years [range, 3-18 years], and eight received a hematopoietic stem cell transplant. Median follow-up time was 9 years [range, 2-24 years]. Six patients died, the median age was 13 years [range, 6-24 years]. As of November 2022, eight patients were still alive, with a median age of 18 years [range, 6-32 years]. None of them have developed myeloblastic syndrome or cancer. Conclusions: DC was associated with high morbidity and mortality in our series. Hematologic manifestations appeared early and consistently. Non-hematologic manifestations developed progressively. No patient developed cancer possibly due to their young age. Due to the complexity of the disease multidisciplinary follow-up and adequate transition to adult care are essential.

Conversion to Roux-en-Y gastric bypass surgery through a robotic-assisted hybrid technique after failed sleeve gastrectomy: Short-term results. / Conversión por técnica híbrida robótica a bypass gástrico en Y de Roux posterior a falla de manga gástrica: resultados a corto plazo.

INTRODUCTION AND AIMS: Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric surgery worldwide but complications and failed procedures are on the rise. AIMS: To determine the reasons for failed LSGs and report the results of conversion to gastric bypass surgery, comparing the outcomes with those of primary gastric bypass surgery. MATERIALS AND METHODS: Patients with failed LSG that underwent conversion to gastric bypass surgery through a robotic-assisted and laparoscopic (hybrid) technique were evaluated. Outcomes and follow-up related to weight loss failure (WLF) were compared with those in patients that underwent primary laparoscopic gastric bypass (pLGB) surgery. RESULTS: Revisional surgery was performed on 13 patients due to WLF, on 3 patients because of refractory gastroesophageal reflux disease (GERD), and on 2 patients due to gastric stricture. There were no differences between the preoperative characteristics of the patients with WLF before undergoing conversion to gastric bypass and the patients that underwent pLGB surgery. At postoperative month 36, the percentage of excess weight loss was greater in the patients that underwent pLGB surgery, than in those with WLF that underwent conversion to gastric bypass (69.17±23.73 vs. 54.17±12.48, respectively; P<0.05). Refractory GERD, symptoms due to gastric stricture, and comorbidities all improved after the revisional surgery. CONCLUSION: Revisional surgery resulted in acceptable weight loss at 36 months of follow-up and favored comorbidity remission. In addition, it resolved symptoms of refractory GERD and gastric stricture.

Effect of female sex hormones on the developmental cycle of Chlamydia abortus compared to a penicillin-induced model of persistent infection.

BACKGROUND: Chlamydia abortus, an obligate intracellular pathogen with an affinity for placenta, causes reproductive failure. In non-pregnant animals, an initial latent infection is established until the next gestation, when the microorganism is reactivated, causing abortion. The precise mechanisms that trigger the awakening of C. abortus are still unknown. Sexual hormones such as estradiol and progesterone have been shown to affect the outcome of infection in other species of the family Chlamydiaceae, while estrogens increase chlamydial infection, progesterone has the opposite effect. To try to establish whether there is a relationship between these events and the latency/ reactivation of C. abortus in the reproductive tract of small ruminants, ovine endometrial (LE) and trophoblastic (AH-1) cells were treated with estradiol or progesterone prior to their infection with C. abortus. The results are compared with those obtained for treatment with penicillin prior to infection, which is a well-established model for studying persistent infection in other chlamydial species. Cells were examined by transmission electron microscopy, and an mRNA expression analysis of 16 genes related to the chlamydial developmental cycle was made. RESULTS: The changes observed in this study by the action of sex hormones seem to depend on the type of cell where the infection develops. In addition, while the changes are morphologically similar to those induced by treatment with penicillin, the patterns of gene expression are different. Gene expression patterns therefore, seem to depend on the persistence induced models of C. abortus used. Hormone treatments induced aberrant forms in infected endometrial cells but did not affect the chlamydial morphology in trophoblast cells. At the genetic level, hormones did not induce significant changes in the expression of the studied genes. CONCLUSIONS: The results suggest that penicillin induces a state of persistence in in vitro cultured C. abortus with characteristic morphological features and gene transcriptional patterns. However, the influence of hormones on the C. abortus developmental cycle is mediated by changes in the host cell environment. Furthermore, a persistent state in C. abortus cannot be characterised by a single profile of gene expression pattern, but may change depending on the model used to induce persistence.

Effect of progesterone on the vaccination and immune response against Chlamydia abortus in sheep.

Chlamydia abortus produces ovine enzootic abortion (OEA). Symptoms are not observed until the organism colonises the placenta, eventually causing abortion. Infected animals become carriers and will shed the organism in the following oestruses. This process suggests that sex hormones might play an important role in the physiopathology of OEA, affecting the success of chlamydial clearance and also jeopardising the effectiveness of vaccination. However, the mechanisms through which sex hormones are involved in chlamydial pathogenicity remain unclear. The aim of this study, therefore, was to determine the effect of progesterone on the immune response against C. abortus and on the protection conferred by an experimental inactivated vaccine in sheep. Eighteen sheep were ovariectomised and divided into four groups: vaccinated and progesterone-treated (V-PG), vaccinated and non-treated (V-NT), non-vaccinated and non-treated (NV-NT) and non-vaccinated and progesterone-treated sheep (NV-PG). Animals from both PG groups were treated with commercial medroxyprogesterone acetate impregnated intravaginal sponges before and during the vaccination (V-PG) or just before challenge (NV-PG). The animals from both V groups were subcutaneously immunised with an experimental inactivated vaccine, which was seen to confer high protection in previous studies. All sheep were challenged intratracheally with C. abortus strain AB7 and were sacrificed on day 8 post-infection. Morbidity was measured as the variation in rectal temperature and samples of sera were collected for antibody and cytokine (IFN-γ and IL-10) analysis by commercial ELISA. In addition, lung and lymph node samples were collected for chlamydial detection by qPCR and for histopathological and immunohistochemical analyses. Sheep from the V-PG group showed less severe or no lesions and lower morbidity than the other groups. They also had the highest abundance of regulatory T-cells. The sheep from V-NT also manifested high antibody levels against C. abortus and less severe lesions than those observed in non-vaccinated sheep, which showed high morbidity, low antibody levels and severe lesions, especially in NV-NT. These results confirm the effectiveness of the experimental vaccine employed and suggest that progesterone could enhance the effect.

Radiotherapy volume delineation using 18F-FDG-PET/CT modifies gross node volume in patients with oesophageal cancer.

PURPOSE: Evidence supporting the use of 18F-FDG-PET/CT in the segmentation process of oesophageal cancer for radiotherapy planning is limited. Our aim was to compare the volumes and tumour lengths defined by fused PET/CT vs. CT simulation. MATERIALS AND METHODS: Twenty-nine patients were analyzed. All patients underwent a single PET/CT simulation scan. Two separate GTVs were defined: one based on CT data alone and another based on fused PET/CT data. Volume sizes for both data sets were compared and the spatial overlap was assessed by the Dice similarity coefficient (DSC). RESULTS: The gross tumour volume (GTVtumour) and maximum tumour diameter were greater by PET/CT, and length of primary tumour was greater by CT, but differences were not statistically significant. However, the gross node volume (GTVnode) was significantly greater by PET/CT. The DSC analysis showed excellent agreement for GTVtumour, 0.72, but was very low for GTVnode, 0.25. CONCLUSIONS: Our study shows that the volume definition by PET/CT and CT data differs. CT simulation, without taking into account PET/CT information, might leave cancer-involved nodes out of the radiotherapy-delineated volumes.

Diarrea por Clostridium difficile en pacientes hospitalizados / Diarrhea due to Clostridium difficile in hospitalized patients

Resumen ANTECEDENTES: La infección por Clostridium difficile es la causa más importante de enfermedad gastrointestinal relacionada con el sistema hospitalario que conlleva alta morbilidad y mortalidad y costos estimados en 3.2 mil millones de dólares anualmente. OBJETIVO: Conocer el comportamiento de la diarrea intrahospitalaria por C. difficile, así como las características de la enfermedad y de los pacientes. MATERIAL Y MÉTODO: Estudio longitudinal, efectuado del 1 de julio de 2015 al 30 de abril de 2016, en el que se incluyeron los casos de diarrea intrahospitalaria atendidos en todos los servicios del Hospital Regional Lic. Adolfo López Mateos, Ciudad de México. Con el apoyo del Laboratorio de Vigilancia Epidemiológica del ISSSTE, ubicado en el Centro Médico Nacional 20 de Noviembre, a todos los casos se les realizó prueba de inmunoensayo para la identificación de toxinas A, B o ambas. RESULTADOS: Se identificaron 220 casos de diarrea intrahospitalaria en el periodo de estudio, de los que 106 (48.2%) resultaron positivos a la prueba de inmunoensayo para toxinas A, B (o ambas) de C. difficile y correspondieron a los servicios de Medicina Interna, Cirugía General y Unidad de Cuidados Intensivos. Se realizó seguimiento a 100 pacientes de los que 75 fueron dados de alta y 25 fallecieron (tasa de mortalidad de 25%). El servicio en el que se identificaron más casos fue Medicina Interna con 58 (54.7%), seguido de Cirugía General con 14 (13.2%) y de Ortopedia con 10 (10.6%). Los 106 pacientes incluidos que resultaron positivos habían recibido durante su estancia hospitalaria y antes de manifestar el cuadro diarreico al menos un antimicrobiano, 41.4% monoterapia y 58.6% dos o más antibióticos. El antibiótico más frecuente en los casos de monoterapia fue ceftriaxona (50%), seguido de meropenem (20.6%) y en los casos de combinaciones se observó una variedad de ellas. La mediana de días de estancia hospitalaria en los pacientes que fallecieron fue de 24 días (intervalo: 5-112) y en los que fueron dados de alta la mediana fue de 20 días (intervalo: 2-85). CONCLUSIONES: Este estudio aporta información muy similar a la reportada en las escasas publicaciones mexicanas referidas en este trabajo en cuanto a los factores de riesgo, variabilidad de las manifestaciones clínicas, oportunidad del tratamiento, evidencia, consecuencias de la administración indiscriminada de antibióticos con fines profilácticos, terapéuticos o ambos y necesidad del tratamiento multidisciplinario de los pacientes con enfermedad grave o severa. Destaca también la participación de los bloqueadores H2 como un importante factor de riesgo encontrado en más de 70% de los casos y la administración de mesalazina y probióticos como coadyuvantes en el tratamiento.

Abstract BACKGROUND: Infection due to Clostridium difficile is the most important cause of gastrointestinal disease related to the hospitality system leading to high morbidity and mortality and costs estimated in 3.2 billion dollars each year. OBJECTIVE: To know the behavior of intrahospitalary diarrhea due to C. difficile, as well as the characteristics of the disease and patients. MATERIAL AND METHOD: A longitudinal study done from July 1st 2015 to April 30 2016, in which cases of intrahospitalary diarrhea attended in all services of the Reginal Hospital Lic. Adolfo López Mateos, Mexico City, were included. With the support of the Laboratory of Epidemiological Surveillance of ISSSTE, at Centro Médico Nacional 20 de Noviembre, Mexico City, all cases were submitted to immunoassay test to the identification of toxins A, B or both. RESULTS: There were identified 220 cases of intrahospitalary diarrhea in the study period, from which 106 (48.2%) were positive to immunoassay test for toxins A, B (or both) of C. difficile and corresponded to services of Internal Medicine, General Surgery and Intensive Care Unit. One hundred patients were followed, from which 75 were discharged and 25 died (mortality rate of 25%). Service in which most cases were identified was Internal Medicine with 58 (54.7%), followed by General Surgery with 14 (13.2%) and Orthopedics with 10 (10.6%). The 106 patients included that resulted positive had received during their hospitalization and before presenting diarrhea at least one antimicrobial, 41.4% monotherapy and 58.6% two or more antimicrobials. The most frequently prescribed antibiotic in cases of monotherapy was ceftriaxone (50%), followed by meropenem (20.6%) and in all cases of combinations it was observed a variety of them. The mean days of hospitalization of patients who died was of 24 days (range: 5-112) and of discharged patients was of 20 days (range: 2-85). CONCLUSIONS: This study gives information very similar to that reported in the little Mexican publications referred in this paper about risk factors, variability of clinical manifestations, opportunity of treatment, evidence, consequences of the indiscriminate administration of antibiotics with prophylactic and/or therapeutic objectives and the need of multidisciplinary treatment of patients with severe disease. It is also highlighted the participation of H2 blockers as an important risk factor found in more than 70% of cases and the administration of mesalazine and probiotics as adjuvant in the treatment.

National registry of hemoglobinopathies in Spain (REPHem).

BACKGROUND: Although highly prevalent throughout the world, the accurate prevalence of hemoglobinopathies in Spain is unknown. PROCEDURE: This study presents data on the national registry of hemoglobinopathies of patients with thalassemia major (TM), thalassemia intermedia (TI), and sickle cell disease (SCD) in Spain created in 2014. Fifty centers reported cases retrospectively. Data were registered from neonatal screening or from the first contact at diagnosis until last follow-up or death. RESULTS: Data of the 715 eligible patients were collected: 615 SCD (497 SS, 64 SC, 54 SBeta phenotypes), 73 thalassemia, 9 CC phenotype, and 18 other variants. Most of the SCD patients were born in Spain (65%), and 51% of these were diagnosed at newborn screening. Median age at the first diagnosis was 0.4 years for thalassemia and 1.0 years for SCD. The estimated incidence was 0.002 thalassemia cases and 0.03 SCD cases/1,000 live births. Median age was 8.9 years (0.2-33.7) for thalassemia and 8.1 years (0.2-32.8) for SCD patients. Stroke was registered in 16 SCD cases. Transplantation was performed in 43 TM and 23 SCD patients at a median age of 5.2 and 7.8 years, respectively. Twenty-one patients died (3 TM, 17 SCD, 1 CC) and 200 were lost to follow-up. Causes of death were related to transplantation in three patients with TM and three patients with SCD. Death did not seem to be associated with SCD in six patients, but nine patients died secondary to disease complications. Overall survival was 95% at 15 years of age. CONCLUSIONS: The registry provides data about the prevalence of hemoglobinopathies in Spain and will permit future cohort studies and the possibility of comparison with other registries.

Percepción del paciente quirúrgico acerca de la seguridad en el ámbito hospitalario / Surgical patient’s perception about safety in the hospital context

Introducción: La construcción de lazos entre los pacientes y los profesionales de la salud después de la presentación de un evento tiene importancia crítica. El Foro Nacional para la Calidad recientemente publicó en su reporte (2010), “Prácticas Seguras para una Mejor Atención en Salud”, recomendando, que el paciente debe recibir información oportuna, transparente y clara en relación con lo que se refiere al evento adverso. Objetivos: Determinar la percepción de seguridad que tienen los pacientes con la atención de la salud, identificar el número de pacientes que refieran haber sufrido un error y las respuestas a las preguntas de cómo se resolvió el error durante su hospitalización el servicio de cirugía de un hospital de seguridad social. Materiales y Métodos: Diseño descriptivo, población 127 pacientes hospitalizados en el servicio de cirugía, que cumplieron con los criterios de inclusión. Resultados y Discusión: La media de percepción fue de 40.77 con una (DE=8.37). Los errores que refirieron los pacientes fueron: Infección 7.1 %, 4.75 % reacción alérgica, 10.2 % intervenido por segunda ocasión y 100% de los pacientes contestaron no haberse caído. El 1.6% (2) estuvo completamente de acuerdo al preguntarles si se resolvió satisfactoriamente el error, el 3.1% mencionó que el error se resolvió rápido, 1.6% (2) mencionó estar completamente de acuerdo referente a la información recibida acerca del error. El 2.4% (3) de los pacientes contestaron en desacuerdo respecto a la información de si se tomarían medidas para evitar que el error se volviera a presentar. Conclusiones: La mayoría de los pacientes refirieron percibirse seguros durante su hospitalización, un porcentaje menor mencionó haber tenido incidentes y al preguntarles sobre si se habían sentido seguros durante su estancia hospitalaria la mayoría dijo haberse sentido bastantes seguros.

Introduction: Building bridges between patients and health professionals after the presentation of an event is critical. The National Forum for Quality recently released its report (2010), "Safe Practices for Better Health Care", recommending that the patient should get timely, transparent and clear information regarding what concerns the adverse event. Objectives: To determine the patient perception of safety within health care, to identify the number of patients reporting to have suffered an error and the answers to questions about how the surgery service resolved the failure during hospitalization in a social security hospital. Materials and Methods: A descriptive design, population of 127 patients hospitalized in the surgery department, who met the inclusion criteria. Results and Discussion: The mean perception was 40.77 (SD = 8.37). The errors reported by patients were: infection 7.1%, 4.75% allergic reaction, 10.2% being operated on for the second time and, 100% of the patients reported not having fallen. The 1.6% (2) fully agreed when asked whether the error was resolved successfully, the 3.1% mentioned that the error was resolved quickly, 1.6% (2) mentioned to agree completely regarding information received about the error. Only 2.4% (3) of the patients disagreed about the information whether they would take measures to prevent the error to occur again. Conclusions: Most patients perceived themselves as safe during their hospitalization, a lower percentage reported having had incidents and when asked whether they felt safe during their hospital stay, the most said they felt pretty safe.

Can an Immediate 2-stage Breast Reconstruction Be Performed After Previous Conservative Surgery and Radiotherapy?

BACKGROUND: Prosthetic breast reconstruction is generally considered contraindicated after previous breast irradiation. As a result, patients undergoing a salvage mastectomy for recurrent breast cancer or "risk-reducing" mastectomies after previous conservative surgery and radiotherapy (CS + RT) are usually offered autologous breast reconstruction. However, not all such patients are suitable candidates for a major flap reconstruction. The purpose of this study is to review our results of immediate 2-stage prosthetic breast reconstruction after CS + RT. METHODS: A retrospective review was undertaken for 671 consecutive patients with prosthetic-only breast reconstruction performed by a single surgeon over a 12.5-year period. Twenty-two patients who qualified for the criteria were audited. Outcomes examined include complications, loss of tissue expander or implant, revisional surgery, and aesthetic result. RESULTS: Twenty-two patients underwent 33 mastectomies and immediate 2-stage breast reconstructions after previous CS + RT (15 for recurrent cancer and seven "risk-reduction") and 11 contralateral risk-reducing mastectomies. One patient died due to extensive metastatic disease. There was no reconstruction failure. The average breast implant size was 491.7 g (range 220 -685g). Seroma was the most common complication and occurred in 3 of 22 patients (13.6%) after stage 1 and 3 of 21 patients (14.3%) after stage 2 reconstruction. The revisional surgery rate was 28.6%. Aesthetic result was rated as excellent in 9.5%, good in 76.2%, and fair in 14.3%. CONCLUSIONS: For selected patients, immediate 2-stage prosthetic breast reconstruction can be performed successfully after a salvage mastectomy subsequent to a recurrence after CS + RT.

Recommendations for the Diagnosis and Management of Bladder Pain Syndrome. Spanish Urological Association Consensus Document.

INTRODUCTION: Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) and other bladder pathologies share common manifestations, such as the presence of mictional symptoms and a negative impact on the patient's quality of life. To be properly diagnosed and clinically managed, it is important to distinguish between its clinical modalities and diagnostic criteria for adequate exclusion. OBJECTIVE: The purpose of this study was to standardize criteria for making decisions in BPS management, for its diagnosis, initial treatment and follow-up. MATERIAL AND METHOD: A nominal group methodology was employed, using scientific evidence on BPS taken from a systematic (non-exhaustive) literature review for developing recommendations along with specialist expert opinions. RESULTS: The diagnosis of BPS should be made based on the patient's clinical history, with emphasis on pain and mictional symptoms as well as excluding other pathologies with similar symptomatology. BPS treatment should be directed towards restoring normal bladder function, preventing symptom relapse and improving patients' quality of life. It is therefore advisable to start with conservative treatment and to adopt less conservative treatments as the level of clinical severity increases. It is also recommended to abandon ineffective treatments and reconsider other therapeutic options. CONCLUSIONS: Quickly identifying the pathology is important when trying to positively influence morbidity and care quality for these patients.

Percepción del personal de enfermería hacia la cultura de seguridad en un hospital pediátrico en México / Nursing staff perception towards a culture of safety in a pediatric hospital in Mexico

Introducción: La seguridad del paciente es un tema que en los últimos años ha mostrado pleno desarrollo. Ya que en, 2004 la Organización Mundial de la Salud (OMS) creó la Alianza Mundial para la Seguridad del paciente. La alianza promueve la sensibilización y el compromiso político para mejorar la seguridad de la atención y apoya a los estados miembros en la formulación de políticas y prácticas para la seguridad de los pacientes en todo el mundo. Objetivo: Determinar las Fortalezas y oportunidades de mejora hacia la cultura de la seguridad con que cuenta el personal de enfermería que labora en los diferentes servicios y turnos del Hospital de Pediatría de México y el grado global de seguridad percibido. Materiales y Métodos: Diseño descriptivo y transversal en una muestra de 247 enfermeras del hospital de pediatría. Resultados: La media de edad de los encuestados fue de 49 años el 91 % fueron mujeres y el 70 son enfermeras generales, las dimensiones que calificaron como fortalezas fueron cuatro y ocho de las doce calificaron como oportunidad de mejora, el grado global de seguridad lo calificaron en el rango de 7-8 que significa muy buena. Discusión: Los resultados del estudio difieren de lo reportado por: diversos autores ya que ellos en sus investigaciones reportaron como fortaleza las dimensiones que en este estudio calificaron como oportunidad de mejora y son similares con lo reportado por otros autores en lo que se refiere a la notificación de eventos adversos y dotación de personal, que en este estudio también calificaron como fortalezas. Conclusiones: El personal de enfermeria considera que las fortalezas con que se cuenta en el hospital son pocas y que faltan muchas cosas por mejorar para garantizar la seguridad del paciente.

Introduction: Patient safety is an issue that in recent years has shown full development. Since 2004, the World Health Organization (WHO) created the World Alliance for Patient Safety. The alliance promotes awareness and political commitment to improve the safety of care and support to member states in the formulation of policies and practices for patient safety worldwide. Objective: To determine the strengths and opportunities for improvement to the safety culture available to the nursing staff working in the various departments and shifts of the Mexico Hospital of Pediatrics and the overall degree of perceived safety. Materials and Methods: A descriptive cross-sectional design in a sample of 247 nurses from the pediatric hospital. Results: The mean age of respondents was 49 years, 91% were women and 70 were general nurses, the dimensions rated as strengths were four, and eight of the twelve were rated as opportunities for improvement, they scored the overall level of safety as 7-8, which means ‘very good’. Discussion: The results of the study differ from those reported by several authors as they reported in their research as strength dimensions those which in this study were rated as an opportunity for improvement and are similar to those reported by other authors in regard to the adverse event reporting and staffing, which in this study also were rated as strengths. Conclusions: The nursing staff considers the strengths available in the hospital as few and missing many things to improve to ensure patient safety.

Panhipopituitarismo congénito secundario a interrupción del tallo hipofisario: informe de caso / Congenital panhypopituitarism secondary to pituitary stalk interruption: case report / Pan-hipopituitarismo congênito secundário na interrupção da haste hipofisária: relato de caso

La disrupción del tallo hipofisario es una patología infrecuente que causa hipogenesia de la pituitaria anterior y agenesia o ectopia \r\nde la hipófisis posterior. El diagnóstico se realiza tardíamente cuando aparecen mayores alteraciones antropométricas o disminu\r\n-\r\nciones en la velocidad de crecimiento. Se estima que solo el 23% de los casos se diagnostica en el periodo neonatal, con lo cual \r\nse logra disminuir la mortalidad y morbilidades secundarias. Este estudio describe el caso de un recién nacido con hipoglicemia \r\npersistente desde el nacimiento, micropene e incisivo único central. Se solicitó resonancia magnética cerebral y determinación \r\nsérica hormonal para confirmar el diagnóstico de panhipopituitarismo congénito secundario a la disrupción del tallo hipofisario. \r\nSe inició el reemplazo hormonal de forma temprana.

The disruption of the pituitary stalk is a rare disease that causes \r\nhypogenesis of the anterior pituitary and agenesis or ectopic \r\nposterior hypophysis. The diagnostic is carried out late, when \r\ngreater anthropometric alterations or decreases in the growth \r\nspeed materialize. Only 23% of the cases are diagnosed during \r\nthe neonatal period, therefore decreased in mortality and \r\nsecondary morbidities is achieved. This study describes the \r\ncase of a newborn that had persistent hypoglycemia from \r\nbirth, micropenis, and a single central incisor. A brain magnetic \r\nresonance and determination of serum hormones were \r\nrequested to confirm the diagnostic of congenital panhypo\r\n-\r\npituitarism secondary to the disruption of the pituitary stalk. \r\nHormone replacement was initiated early.

A interrupção da haste hipofisária é uma patologia pouco \r\nfrequente que causa hipogenesia da pituitária anterior e \r\nagenesia, ou ectopia, da hipófise posterior. O diagnóstico é \r\nrealizado tardiamente quando aparecem maiores alterações \r\nantropométricas ou diminuições na velocidade do crescimento. \r\nEstima-se que apenas 23% dos casos são diagnosticados no \r\nperíodo neonatal, com o que se atinge redução da morta\r\n-\r\nlidade e morbidades secundárias. Este estudo descreve o \r\ncaso de um recém-nascido com hipoglicemia persistente \r\ndesde o nascimento, micro pênis e incisivo central único. Foi \r\nsolicitada ressonância magnética cerebral e determinação \r\nsérica hormonal para confirmar o diagnóstico de pan-hipo\r\n-\r\npituitarismo congênito secundário na interrupção da haste \r\nhipofisária. A reposição hormonal foi iniciada precocemente.

[Clinical and urodynamic results of alpha-blocker drug treatment in patients with lower urinary tract symptoms and benign prostatic hyperplasia]. / Resultados clínicos y urodinámicos del tratamiento con fármacos alfabloqueantes en los pacientes con síntomas del tracto uninario inferior e hyperplasia benigna de prostata.

OBJECTIVES: To analyse the improvement in both symptoms (IPSS questionnaire) and uroflowmetry parameters (Qmax) after treatment with different alpha-blockers in patients with LUTS and BPH. The efficacy of alpha-blocker treatment on urodynamic parameters was also analysed in some patients. METHODS: An epidemiological, retrospective, multi-centre, and observational study. Twenty-five (24) Spanish healthcare centres recruited 443 patients with LUTS and BPH, and no other concurrent urological disease, they were on treatment with alpha-blockers. The study variables (demographic, physical examination, IPSS, and urodynamic) were collected retrospectively at start of the study (at least 12 weeks after the start of treatment). Two-tailed statistical tests were performed with a 5% significance level using a SAS statistical software package version 9.0. RESULTS: The IPSS score improved after 12 weeks of treatment (p<0.0001). The quality of life perception significantly improved (p<0.0001). The voiding volume and Qmax increased (p<0.0001) and the post-void residual urine decreased (p<0.0001) after treatment both in patients with moderate and severe symptoms. Other than filling pressure and involuntary contraction amplitude (p>0.05), all cystomanometry parameters improved (p<0.05). There were statistically significant differences (p<0.05) in the pressure flow study values, except for the detrusor contractility rate. CONCLUSION: Alpha-blocker drug treatment of LUTS in patients with BPH leads to a significant improvement in symptoms and bladder voiding urodynamic parameters.

Single fraction volumetric modulated arc radiosurgery of brain metastases.

PURPOSE: To show the clinical results of the treatment of brain metastases via radiosurgery using Volumetric Modulated Arc Therapy (VMAT). MATERIALS AND METHODS: 52 patients having lung (62 %), breast (17 %), colorectal (8 %) and other cancers (13 %) with one to three brain metastases were treated with 5 non-coplanar VMAT arcs. The treatment dose varied from 12 to 20 Gy, administered in one single session. The volume of metastases ranged from 0.04 to 24.92 cc. Radiosurgery alone was used for 54 % of cases, while 19 % received whole brain radiotherapy due to relapse. Patients were classified according to the Disease-specific graded prognostic assessment (DS-GPA) index and survival was assessed via the Kaplan-Meier model. RESULTS: The median survival time was 7.2 months from the date of radiosurgery. The Karnofsky and DS-GPA indices were the most significant with regard to survival. Patients with a Karnofsky performance status (KPS) over 70 had a longer survival time of 9.2 months, as opposed to those with a KPS below 70 of 3.5 months. No significant differences were found with regard to the type of cancer or the number of lesions. Local tumour control was achieved for 42 metastases (82 %), of which a complete response was achieved for 7 lesions, a partial response for 21; 15 lesions were stabilized. Local progression was observed in 8 lesions (15 %). The median treatment time per patient was 29 min. CONCLUSIONS: The VMAT technique proves to be safe and effective for treating brain metastases via radiosurgery.

Consensus document of the Spanish Urological Association on the management of uncomplicated recurrent urinary tract infections.

INTRODUCTION: The clinical manifestations of urinary infections, commonly mild and uncomplicated, have resulted in a generally empirical therapeutic decision-making process, which does not help fight resistances to antibacterial agents, thus causing a high rate of recurrence. OBJECTIVE: This study seeks to reduce the clinical variability in the diagnosis and treatment of uncomplicated recurrent urinary tract infections (RUTIs). MATERIAL AND METHOD: The consensus document was developed using a nominal group methodology, using scientific evidence on RUTIs extracted from a systematic (noncomprehensive) literature review, along with the expert judgment of specialists and their experience in clinical practice. RESULTS: RUTIs are considered the manifestation of at least 3 episodes of uncomplicated infection, with a positive culture in the past 12 months, in addition to (for men) the absence of structural or functional abnormalities. We maintain that the treatment should be empiric when suspecting RUTIs (prior to obtaining a urine sample for culture) in those patients who have a high probability of recurrence, associated risk factors and/or urinary or general symptoms, such as fever and chills. Homogeneous criteria are recommended for the diagnosis and treatment in order to fight the increased rates of resistance that the microorganisms develop against antimicrobial agents. CONCLUSION: Imprecision in the identification of the infection requires a search for agreements on homogenized criteria and decision algorithms that guide the management of these patients.

Characterization of pressurized hot water extracts of grape pomace: chemical and biological antioxidant activity.

Pressurized hot water extracts obtained at different temperatures possess different compositions and antioxidant activities and, consequently, different bioactivities. We characterized two pressurized hot water extracts from grape pomace obtained at 100°C (GPE100) and 200°C (GPE200) in terms of antioxidant activity and composition, as well as protective effect on cell growth and mitochondrial membrane potential (Δψm) in a HL-60 cell culture under oxidative conditions. GPE100 extracts were richer in polyphenols and poorer in Maillard reaction products (MRPs) than were GPE200 extracts. Moreover, hydroxymethylfurfural was detected only in GPE200. Both extracts exhibited similar protective effects on cell growth (comparable to the effect of trolox). In addition, GPE100 strongly decreased the Δψm loss, reaching values even lower than those of the control culture. This protective effect may be related to its high polyphenols content. At the highest concentration assessed, both extracts showed strong cytotoxicity, especially GPE200. This cytotoxicity could be related to their MRPs content.

Prognostic factors of endoscopic treatment of vesicoureteral reflux in spinal cord injured patients.

INTRODUCTION: Vesicoureteral reflux (VUR) is an important complication in patients with spinal cord injury due to its frequency and morbidity. One of the most extended therapeutic options is endoscopic injection of obliteration substances in the urethral meatus. OBJECTIVE: To analyze the prognostic factors of VUR treatment using obliterative substances in patients with spinal cord injury. MATERIAL AND METHODS: A prospective study was performed in a cohort of 76 patients (age 48.9±14.4 years), of both genders, with spinal cord injuries, who underwent endoscopic treatment of the VUR during the years 2008 to 2011. In all the patients, a clinical history was obtained and a pre-operative videourodynamic study was performed. Another study was carried out at 7.32 months (standard deviation: 6.28 months) of the intervention. Treatment consisted in endoscopic injection of dextranomer/hyaluronic acid copolymer (62 cases) and polydimethylsiloxane (14). The statistical tests applied were the Fisher's exact test and the Student's T test comparing the means. Bilateral significance level was established at 95%. RESULTS: Resolution of VUR was achieved in 46 cases (61%). The statistically significant prognostic factors were age (younger aging cured patients), bilaterality and reflects great (greater grade in bilaterality in the cases with persistence of reflux) and presence of neurogenic detrusor overactivity (greater percentage in the cases of reflux persistence). Stress urinary incontinence (greater percentage in cured patients), contractile potency (lower percentage in cured patients) and urethral resistance (greater percentage in cured patients) were also statistically significant prognostic factors. CONCLUSIONS: Among the prognostic factors that affected the endoscopic treatment results of the VUR in patients with neurogenic lower urinary tract dysfunction (NLUTD), anatomical as well as functional factors were found.