Prognostic assessment for chronic myelomonocytic leukemia in the context of the World Health Organization 2016 proposal: a multicenter study of 280 patients.

Knowledge on chronic myelomonocytic leukemia (CMML) patients from Argentina and Brazil is limited. Our series of 280 patients depicted an older age at diagnosis (median 72 years old), 26% of aberrant karyotypes, and a prevalence of myelodysplastic (60%) and CMML-0 subtypes (56%). The median overall survival (OS) was 48.2 months for patients in CMML-0 (Ref.), 24.7 months for those in CMML-1 (HR = 2.0, p = 0.001), and 8.8 months for patients in CMML-2 (HR = 4.6, p < 0.001). In the CMML-0 category, median OS were different between myelodysplastic and myeloproliferative subtypes (63.7 vs 21.2 months, p < 0.001); however, no differences were observed within CMML-1 and CMML-2 subtypes (24.7 vs 23.7 months, p = 0.540, and 9.1 vs 8.2 months, p = 0.160). The prognostic impact of 24 variables and 7 prognostic systems was adjusted to the WHO 2016 after validating their usefulness. Multivariate analysis were performed, and the final model revealed Hb ≥ 8 -< 10g/dL (HR 1.7), Hb < 8g/dL (HR 2.8), poor karyotypes (HR 2.1), WHO 2016-CMML-1 (HR 2.1), and CMML-2 (HR 3.5) as independent adverse clinical parameters in our cohort with a borderline influence of platelets count < 50 × 109/L (HR 1.4). We could validate several scoring systems, the WHO 2016 proposal and its prognostic capability, along with accessible covariates, on predicting the outcome in our series of CMML patients from Latin America.

Myelodysplastic syndromes in South America: a multinational study of 1080 patients.

There are previously reported data describing differences between Asian and European patients with Myelodysplastic Syndromes (MDS), few direct comparisons based on cancer registration characteristics or using cohorts to validate scoring systems. This is the first study from South-America, which attempts to describe demographic, clinical features, and outcome of MDS patients. We retrospectively analyzed 1,080 patients with de novo MDS from Argentina (635), Brazil (345), and Chile (100). Chilean patients were younger (P = 0.001) with female preponderance (P = 0.071). Brazilian series showed a higher predominance of RARS subtype regarding FAB and WHO classifications (P < 0.001). Hemoglobin levels were significantly lower in Brazilian and Chilean series (P < 0.001), and Chilean series also showed a lower platelet count (P = 0.028), with no differences concerning the neutrophil count, % BM blast, and the distribution of cytogenetic risk groups (P > 0.05). Chilean series depicted a lower overall survival (OS; 35 months vs. 56 months-Argentine; 55 months-Brazil, P = 0.030), which was consistent with a higher predominance of the high-risk group according both to the IPSS and IPSS-R (P = 0.046 and P < 0.001). The IPSS-R system and its variables showed a good reproducibility to predict clinical outcome for the whole South-American population. Epidemiological and clinical characteristics, distribution among prognostic subgroups, the OS, and the access to disease modifying therapies were more similar between Argentinean and Brazilian compared with Chilean MDS series. This will need further analysis in a larger group of patients. Descriptive and comparative studies are necessary to establish epidemiological features useful for public health attitudes to generate suitable therapeutic schemes.

[IgE myeloma. Laboratory typing difficulties]. / Mieloma IgE. Dificultades de laboratorio para su tipificación.

The IgE multiple myeloma is a rare neoplasm of plasma cell accounting for 0.01% of all plasma cell dyscrasias. They are generally of more aggressive development and to date there are no more than 50 cases published in current literature. Laboratory studies are, in these cases, essential for the classification of the monoclonal component in serum and urine. The aim of this presentation is to report a patient diagnosed with IgE myeloma and to point out that the laboratory difficulties noted in these rare cases can lead to an erroneous report.

New species of Tetradiplosis (Diptera: Cecidomyiidae) inducing galls on Prosopis caldenia (Fabaceae) in Argentina.

Two new species of Tetradiplosis inducing galls on Prosopis caldenia are described from Argentina: Tetradiplosis panghitruz Martínez n. sp. and Tetradiplosis rayen Martínez n. sp. Tetradiplosispanghitruz induces multilocular galls on vegetative stems, whereas T. rayen induces unilocular galls containing multiple larvae on the rachis of the developing inflorescences. The adult male, female, pupa and larva are described and illustrated for both species. A key to the known species of the genus is provided.

A prospective study to assess the predictive value for hereditary spherocytosis using five laboratory tests (cryohemolysis test, eosin-5'-maleimide flow cytometry, osmotic fragility test, autohemolysis test, and SDS-PAGE) on 50 hereditary spherocytosis families in Argentina.

This prospective study was carried out to assess the usefulness of five laboratory tests in the diagnosis of hereditary spherocytosis (HS), based on the correlation of erythrocyte membrane protein defects with clinical and laboratory features, and also to determine the membrane protein deficiencies detected in Argentina. Of 116 patients and their family members tested, 62 of them were diagnosed to have HS. The specificity of cryohemolysis (CH) test was 95.2%, and its cut-off value to distinguish HS from normal was 2.8%. For flow cytometry, cut-off points of 17% for mean channel fluorescence (MCF) decrease and 14% coefficient of variation (CV) increase showed 95.9% and 92.2% specificity, respectively. Both tests showed the highest percentages of positive results for diagnosis. Either CH or flow cytometry was positive in 93.5% of patients. In eight patients, flow cytometry was positive only through CV increase. Protein defects were detected in 72.3% of patients; ankyrin and spectrin were the most frequently found deficiencies. The CV of the fluorescence showed significantly higher increases in moderate and severe anemia than in mild anemia (p = 0.003). Severity of anemia showed no other correlation with tests results, type of deficient protein, inheritance pattern, or neonatal jaundice. CH and flow cytometry are easy methods with the highest diagnostic accuracy. Simultaneous reading of mean channel fluorescence (MCF) decrease and CV increase improve diagnostic usefulness of flow cytometry. This test seems to be a reliable predictor of severity. The type of detected protein deficiency has no predictive value for outcome. Predominant ankyrin and spectrin deficiencies agree with reports from other Latin American countries.

Improving risk stratification of patients with childhood acute lymphoblastic leukemia: Glutathione-S-Transferases polymorphisms are associated with increased risk of relapse.

The inclusion of genotype at Acute Lymphoblastic Leukemia (ALL) diagnosis as a genetic predictor of disease outcome is under constant study. However, results are inconclusive and seem to be population specific. We analyzed the predictive value of germline polymorphisms for childhood ALL relapse and survival. We retrospectively recruited 140 Argentine patients with de novo ALL. Genotypes were analyzed using PCR-RFLP (GSTP1 c.313A > G, MDR1 c.3435T > C, and MTHFR c.665C > T) and multiplex PCR (GSTT1 null, GSTM1 null). Patients with the GSTP1 c.313GG genotype had an increased risk for relapse in univariate (OR = 2.65, 95% CI = 1.03-6.82, p = 0.04) and multivariate (OR = 3.22, 95% CI = 1.17-8.83, p = 0.02) models. The combined genotype slightly increased risk for relapse in the univariate (OR = 2.82, 95% CI = 1.09-7.32, p = 0.03) and multivariate (OR = 2.98, 95% CI = 1.14-7.79, p = 0.03) models for patients with 2/3-risk-genotypes (GSTT1 null, GSTM1 null, GSTP1 c.313GG). The Recurrence-Free Survival (RFS) was shorter for GSTP1 c.313GG (p = 0.025) and 2/3-risk-genotypes (p = 0.021). GST polymorphisms increased the risk of relapse and RFS of patients with childhood ALL. The inclusion of these genetic markers in ALL treatment protocols might improve risk stratification and reduce the number of relapses and deaths.

Estudio de patrones de prescripción y dispensación de medicamentos a pacientes ambulatorios de cuatro IPS del municipio de Villavicencio / Study patterns of prescribing and dispensing of drugs to outpatients four IPS the municipality of Villavicencio

RESUMEN Justificación: el cumplimiento de las características y el contenido de la prescripción de medicamentos contribuyen a disminución de errores de medicación. Objetivo: identificar algunos patrones de la prescripción y dispensación ambulatoria de medicamentos en 4 IPS del municipio de Villavicencio. Método: estudio descriptivo observacional, de corte transversal durante un mes, utilizando indicadores de prescripción OMS, y verificando el cumplimiento de la normatividad colombiana vigente. Resultados: 1493 prescripciones analizadas (28,8% elaboradas por profesionales no autorizados; 2,9% con enmendaduras; 6% sin diagnóstico; 9,2% ilegibles; 6,7% contenían al menos 1 antibiótico sistémico; 3,4% contenían al menos un inyectable). Del total de medicamentos prescritos: 99,79% con denominación común internacional; 99,22% incluidos en el Plan Obligatorio de Salud, 99,18% dispensados. El 96,6% de las prescripciones presentaban al menos 1 incumplimiento ; el 31,4% contenía la unidad de dosis; el 32,8% la vía de administración y el 35,3% la duración del tratamiento. Las prescripciones de medicamentos con señales de uso inapropiado fueron menores del 0,4%. Conclusiones: se identificó el no cumplimiento de las 4 IPS de algunos requisitos exigidos en la normatividad colombiana para la prescripción médica, lo que puede contribuir a la generación de errores de medicación en los procesos de prescripción y dispensación de medicamentos.

SUMMARY Justification: compliance of characteristics and content of prescriptions drugs help to decrease medication errors. Objective: to identify some patterns of prescription and dispensing of drugs for outpatient in 4 IPS the municipality of Villavicencio. Method: observational descriptive study, cross-sectional for a month, using WHO prescribing indicators, and verifying compliance with current Colombian law. Results: 1493 analyzed prescriptions (28.8% developed by professionals unauthorized, 2.9% with erasures; 6% without diagnosis 9.2%, 6.7% contained at least one systemic antibiotic, 3.4% contained at least one injection). Of all prescription drugs: 99.79% generic name; 99.22% included in the list of essential medicines, 99.18% dispensed. 96.6 % had at least 1 prescription failure: only 31.4% contained unit dose; 32.8% of route of administration and 35.3% the duration of treatment. Prescriptions drugs misuse signals did not exceed 0.4%. Conclusions: the non-compliance with the 4 IPS of some requirements demanded in the Colombian regulations for medical prescription was identified, which may contribute to the generation of medication errors in the prescription and dispensing processes of medications.

Climate and soil attributes determine plant species turnover in global drylands.

AIM: Geographic, climatic, and soil factors are major drivers of plant beta diversity, but their importance for dryland plant communities is poorly known. This study aims to: i) characterize patterns of beta diversity in global drylands, ii) detect common environmental drivers of beta diversity, and iii) test for thresholds in environmental conditions driving potential shifts in plant species composition. LOCATION: 224 sites in diverse dryland plant communities from 22 geographical regions in six continents. METHODS: Beta diversity was quantified with four complementary measures: the percentage of singletons (species occurring at only one site), Whittake's beta diversity (ß(W)), a directional beta diversity metric based on the correlation in species occurrences among spatially contiguous sites (ß(R2)), and a multivariate abundance-based metric (ß(MV)). We used linear modelling to quantify the relationships between these metrics of beta diversity and geographic, climatic, and soil variables. RESULTS: Soil fertility and variability in temperature and rainfall, and to a lesser extent latitude, were the most important environmental predictors of beta diversity. Metrics related to species identity (percentage of singletons and ß(W)) were most sensitive to soil fertility, whereas those metrics related to environmental gradients and abundance ((ß(R2)) and ß(MV)) were more associated with climate variability. Interactions among soil variables, climatic factors, and plant cover were not important determinants of beta diversity. Sites receiving less than 178 mm of annual rainfall differed sharply in species composition from more mesic sites (> 200 mm). MAIN CONCLUSIONS: Soil fertility and variability in temperature and rainfall are the most important environmental predictors of variation in plant beta diversity in global drylands. Our results suggest that those sites annually receiving ~ 178 mm of rainfall will be especially sensitive to future climate changes. These findings may help to define appropriate conservation strategies for mitigating effects of climate change on dryland vegetation.

Mieloma IgE: Dificultades de laboratorio para su tipificación

El mieloma múltiple de tipo IgE es una neoplasia de células plasmáticas muy poco frecuente pues representa el 0.01% de todas las discracias de células plasmáticas. Son generalmente de curso más agresivo y hasta el presente existen publicados no más de 50 casos en la literatura. Los estudios de laboratorio son, en estos casos, esenciales para la tipificación del componente monoclonal tanto en suero como en orina. El objetivo de esta presentación es informar sobre un paciente con diagnóstico de mieloma IgE señalando las dificultades de laboratorio que, en estos casos tan poco frecuentes, pueden conducir a un informe erróneo.

The IgE multiple myeloma is a rare neoplasm of plasma cell accounting for 0.01% of all plasma cell dyscrasias. They are generally of more aggressive development and to date there are no more than 50 cases published in current literature. Laboratory studies are, in these cases, essential for the classification of the monoclonal component in serum and urine. The aim of this presentation is to report a patient diagnosed with IgE myeloma and to point out that the laboratory difficulties noted in these rare cases can lead to an erroneous report.

Donación voluntaria de sangre: significados construidos por estudiantes universitarios pampeanos / Voluntary blood donation: meanings constructed by students from University of La Pampa

La transfusión de sangre o de sus derivados se ha convertido en una demanda imprescindible en la actual asistencia sanitaria, requiriendo la provincia de La Pampa de donantes voluntarios. El presente trabajo analiza las opiniones referidas a la donación voluntaria de sangre, en estudiantes universitarios que concurrieron a una actividad educativa interinstitucional organizada por el Servicio de Hemoterapia del Establecimiento Asistencial Dr. Lucio Molas y la Universidad Nacional de La Pampa. Al finalizar la jornada se solicitó a los estudiantes participantes que respondieran de manera anónima y voluntaria, un dispositivo de evaluación con frases incompletas, cuyas respuestas tenían como objetivo la evaluación cualitativa de dos ejes: 1) el significado de gesto solidario y requisito médico; y 2) los miedos en la donación voluntaria de sangre. Los resultados del primer eje, arrojaron que el 20% de los estudiantes pueden donar como gesto solidario, el 69% puede hacerlo porque cumple con los requisitos médicos, y el 11% por ambos motivos. Respecto del segundo eje, manifestaron temor a donar sangre el 30% de los estudiantes, por miedo al contagio de enfermedades o a tener una reacción orgánica, y ningún miedo de donar sangre el 60%. Conclusión: los estudiantes universitarios constituyen un grupo mayoritariamente apto y sin temor a donar. Deben mantenerse acciones educativas para abordar las causas de temor. La continuidad en esta tarea y su impacto en los jóvenes podría favorecer el cumplimiento de la propuesta de OPS referida a evolucionar desde la donación de sangre por solicitud (reposición) a la donación voluntaria de sangre.

Blood and its derivates transfusion has turned into an indispensable demand into the current sanitary assistance, needing the province of La Pampa of voluntary donors. The present work analyzes the opinions referred to the voluntary blood donation in university students who met to an educational interinstitutional activity organized by the Hemotherapy Service of Lucio Molas Establishment and the National University of La Pampa. On having finished the day the students were requested to answer in an anonymous and voluntary way, a device of evaluation with incomplete phrases, which answers had as aim an aim the qualitative evaluation of two axes: 1) the meaning of solidary gesture and medical requirement; and 2) the fears in the voluntary donation of blood. The results of the first axis showed that 20% of the students can donate as solidary action, 69% can do so beca use they meet the medical requirements, and 11% for both reasons. On the second axis, 30% of the students expressed fear to donate, to contract diseases or to have an organic reaction, and no fear of donating blood 60%. Conclusion: the university students constitute a group mostly fit and safe to donate. Future educational actions could approach the reasons of fear. The continuity in this task and its impact on young persons could encourage compliance with OPS reffered to evolve from the blood donation for request to voluntary blood donation.

Factores asociados con la abstinencia y eficacia de un programa de cesación de tabaquismo / Risk factors associated with abstinence. Efficacy of a smoking cessation program

El tabaquismo es la primera causa de morbimortalidad evitable en el mundo occidental. Objetivo: evaluar la eficacia de un programa de cesación de tabaquismo y factores asociados con la cesación. Material y método: 517 individuos ingresaron al programa, 357 completaron al menos dos sesiones. Se consignó: sexo, edad, estado civil, nivel de educación, enfermedades asociadas, entorno familiar de fumadores, intentos previos para dejar de fumar, historia de tabaquismo y grado de dependencia por escala de Fagerstrõm. Se aplicó un programa de ocho semanas multicomponente: cognitivo-conductual, farmacológico (bupropión o terapia de reemplazo nicotínico) y terapia grupal. La abstinencia fue confirmada por medida del CO exhalado. Resultados: los individuos tuvieron una edad entre 20 y 77 años (media de 50,58 ± 11,24), fueron 61,1 por ciento mujeres, 82,9 por ciento con intentos previos para dejar de fumar, fumadores de 44,22 ± 26,30 paquetes/año, edad de inicio media de 17,93 ± 3,65 años, consumo de 28,38 ± 13,45 cigarrillos/día, dependencia por Fagerstrõm de 5,99 ± 2,12, 89,4 por ciento recibieron medicación; 113 participantes (31,6 por ciento) se mantuvieron sin fumar al año. Un menor índice de cesación se asoció significativamente con: sexo femenino, mayor dependencia por escala de Fagerstrõm, y seguir fumando en las primeras semanas y a los tres meses de inicio del programa. Conclusiones: se comprobó la eficacia del programa con una tasa de cesación al año de 31,6 por ciento, comparable con los datos publicados por otros centros y asociada al género, la dependencia a la nicotina y el cese precoz, al inicio del programa.

Utilización de recursos sanitarios para tratar la Leucemia Mieloide Crónica en Argentina. Los resultados de una reunión de consenso de especialistas en hematología / Use of healthcare resources to treat chronic myelogenous leukemia in Argentina. The results of a consensus meeting of specialists in hematology

Un grupo de 7 hematólogos argentinos con reconocida experiencia en el tratamiento de la leucemia mieloide crónica, participó de una reunión de consenso realizada en julio de 2007, con el fin de precisar la utilización de recursos sanitarios en el manejo de dicha enfermedad, en el país. Mediante la aplicación de la técnica Delphi modificada se obtuvo elevado grado de acuerdo entre los especialistas, quienes expresaron la situación real de la práctica clínica en las diferentes regiones y ámbitos de atención, en los cuales se desempeñan. Resultaron evidentes la importante adhesión a los lineamientos terapéuticos recomendados a nivel internacional, así como la optimización de los recursos de atención de la salud disponibles. Esta información, complementada con estudios farmacoeconómicos adicionales, puede resultar de utilidad para definir planes futuros de asistencia sanitaria integrales, que permitan a los enfermos con LMC acceder a las opciones más ventajosas desde el punto de vista clínico y de la relación costo-efectividad, de modo de mejorar no sólo la tasa de supervivencia sino también su calidad de vida.