CD74 is expressed in a subset of pediatric acute myeloid leukemia patients and is a promising target for therapy: a report from the Children's Oncology Group.

As curative therapies for pediatric AML remain elusive, identifying potential new treatment targets is vital. We assessed the cell surface expression of CD74, also known as the MHC-II invariant chain, by multidimensional flow cytometry in 973 patients enrolled in the Children's Oncology Group AAML1031 clinical trial. 38% of pediatric AML patients expressed CD74 at any level and a comparison to normal hematopoietic cells revealed a subset with increased expression relative to normal myeloid progenitor cells. Pediatric AML patients expressing high intensity CD74 typically had an immature immunophenotype and an increased frequency of lymphoid antigen expression. Increased CD74 expression was associated with older patients with lower WBC and peripheral blood blast counts, and was enriched for t(8;21), trisomy 8, and CEBPA mutations. Overall, high CD74 expression was associated with low-risk status, however 26% of patients were allocated to high-risk protocol status and 5-year event free survival was 53%, indicating that a significant number of high expressing patients had poor outcomes. In vitro pre-clinical studies indicate that anti-CD74 therapy demonstrates efficacy against AML cells but has little impact on normal CD34+ cells. Together, we demonstrate that CD74 is expressed on a subset of pediatric AMLs at increased levels compared to normal hematopoietic cells and is a promising target for therapy in expressing patients. Given that nearly half of patients expressing CD74 at high levels experience an adverse event within 5 years, and the availability of CD74 targeting drugs, this represents a promising line of therapy worthy of additional investigation.

Negative mood is associated with sociobehavioral factors contributing to cardiovascular risk in an immigrant population.

BACKGROUND: After settling in the United States (US), immigrants often accumulate obesity and cardiovascular risk factors. As mood is often associated with health behaviors in the US population, mood may be an important mediating factor in immigrant populations. METHODS: The Healthy Immigrant Community (HIC) study, set in southeast Minnesota, enrolled 475 adult participants in a weight loss intervention designed to reduce cardiovascular risk. Baseline questionnaires assessed mood, nutrition, physical activity, self-efficacy for healthy eating and physical activity, social support, and cohesion. A single-item mood rating of poor or fair was considered "negative", while ratings of good, very good, or excellent were considered "positive". RESULTS: Hispanic/Latino (n = 268) and Somali (n = 181) adults enrolled in HIC completed baseline measures and were included in this analysis. Participants endorsing negative mood compared to positive mood had lower healthy eating scores (p = 0.02), lower physical activity levels (p = 0.03), lower confidence in eating a healthy diet (p = 0.001), and felt less of a sense of belonging to their community (p = 0.01). Those endorsing negative mood reported receiving less social support to eat healthy (p = < 0.001) and be physically active (p = 0.01). They also accessed community resources for healthy eating (p = 0.001) and physical activity (p = < 0.01) less frequently than participants endorsing positive mood. CONCLUSIONS: On self-report, negative mood was associated with less healthy nutrition, lower confidence in eating healthy, sedentary lifestyle, and perceived lack of belonging to the community. Integrating mood management and self-efficacy strategies may enhance the effectiveness of lifestyle interventions to reduce obesity and cardiovascular risk among immigrants who report negative mood. TRIAL REGISTRATION: ClinicalTrials.gov registration: NCT05136339; April 23, 2022.

Microwave-assisted acid treatment for the mineral transformation of chrysotile as an alternative for asbestos waste management.

In this work, the effect of microwave-assisted acid treatments on the morphological and crystallochemical characteristics of chrysotile fibers is investigated. A low concentration of nitric acid (0.2 N) is used to remove Mg2+-species located in the octahedral sheet of its structure, thereby causing a crystallo-chemical change forming a skeleton of non-crystalline amorphous silica. This skeleton maintains an elongated morphology but characterized by rounded -not sharp-edges and porous surfaces whose physical resistance under stress is reduced when compared with the initial fibers of chrysotile, favoring a lower pathogenicity of the fibers. Thus, microwave-assisted acid treatment rise as a low-cost, fast and effective option in avoiding the dangerousness associated with asbestos waste management.

Daratumumab and Nelarabine Treatment as Salvage Therapy for T-Lymphoblastic Lymphoma: A Case Report.

T-cell lymphoblastic lymphoma is an uncommon lymphoid neoplasm in adults, although more frequent in children and teenagers, that often affects the mediastinum and bone marrow, requiring intensive chemotherapy protocols. Its prognosis is poor if a cure is not achieved with first-line treatments. We present a case report of a 19-year-old man diagnosed with this type of lymphoma due to significant respiratory distress and a mediastinal mass. He received treatment according to the hyper-CVAD regimen, with a complete metabolic response. However, seven months later a new mediastinal growth was observed, leading to salvage treatment with a combination of nelarabine and daratumumab. We observed not only refractoriness, but also leukemization, which prompted consideration of hematopoietic stem cell transplantation. Based on this case, we conducted a review of pharmacological treatment options for refractory or relapsed lymphoblastic lymphoma, as well as the role of radiotherapy in managing mediastinal disease. This case report highlights the limited evidence available regarding later-line treatments, with unusual reports regarding employing our combination of daratumumab and nelarabine, and emphasizes the importance of achieving cures in the first line of treatment.

Clinical characteristics of complete responders versus non-complete responders to omalizumab, benralizumab and mepolizumab in patients with severe asthma: a long-term retrospective analysis.

BACKGROUND: Some patients with severe asthma may benefit from treatment with biologics, but evidence has been mostly collected from randomized controlled trials (RCTs), in which patients' characteristics are different from those encountered in asthma patients in the real-world setting. The aim of this study was to describe the clinical features of complete responders versus non-complete responders to long-term treatment with biologics in patients with severe asthma attended in routine daily practice. METHODS: Data of a cohort of 90 patients with severe asthma who were treated with biologics (omalizumab, benralizumab, and mepolizumab) for at least 12 months and were followed up to March 2022. Data recorded included clinical characteristics and effectiveness of treatment (exacerbation, Asthma Control Test [ACT] score, lung function, use of maintenance oral corticosteroids [mOCS]), FeNO, and blood eosinophils at baseline, at 12 months, and at the end of follow-up. Complete response is considered if, in addition to not presenting exacerbations or the use of mOCS, the ACT score was >20 and, the FEV1 >80% predicted. RESULTS: An improvement in all asthma control parameters was observed after 12 months of treatment and a mean follow-up of 55 months. After 12 months of treatment 27.2% of patients met the criteria of complete response and this percentage even increased to 35.3% at the end of follow-up. Long-term complete response was associated to better lung function with mepolizumab and omalizumab treatment and to less previous exacerbations in the benralizumab group. The main cause of not achieving a complete response was the persistence of an airflow obstructive pattern. CONCLUSIONS: This study shows that omalizumab, benralizumab, and mepolizumab improved the clinical outcomes of patients with severe asthma in a clinic environment with similar effect sizes to RCTs in the long term follow-up. Airflow obstruction, however, was a predictor of a non-complete response to biologics.

Treatment with anti-IgE and anti-IL-5 biologics significantly improved clinical outcomes in severe asthma patients.The rate of complete responders of 27.2% at 12 months even increased to 35.3% at the end of a mean follow-up of 55 months.The persistence of an airflow obstructive pattern was the main cause of the failure to achieve complete response.

Negative Mood is Associated with Sociobehavioral Factors Contributing to Cardiovascular Risk in an Immigrant Population.

Background: Immigrants to the United States, on average, accumulate cardiovascular risk after resettlement, including obesity. There is a need to co-create interventions to address these disparities, and mood may be an important mediating factor. Methods: The Healthy Immigrant Community (HIC) study, set in southeast Minnesota, enrolled 475 adult participants in a weight loss intervention to reduce cardiovascular risk. Baseline questionnaires assessed mood, nutrition, physical activity, self-efficacy for healthy eating and physical activity, social support, and cohesion. A single-item mood rating of poor or fair was considered "negative", while ratings of good, very good, or excellent were considered "positive". Results: A total of 449 HIC participants (268 Hispanic/Latino and 181 Somali) with complete baseline measures and were included in this analysis. Participants endorsing negative mood compared to those endorsing positive mood had lower scores for healthy eating (p = 0.02) and physical activity levels (p = 0.03), lower confidence in eating a healthy diet (p = 0.001), and felt less of a sense of belonging to their community (p = 0.01). Those endorsing negative mood also reported receiving less social support from their family and friends to eat healthy (p = < 0.001) and be physically active (p = 0.01), and less often accessed community resources for healthy eating (p = 0.001) and physical activity (p = < 0.01) compared to participants reporting positive mood. Conclusions: Negative mood was associated with less healthy nutrition, lower confidence in eating healthy, sedentary lifestyle, and perceived lack of belonging to the community. Integrating mood management and self-efficacy strategies may enhance the effectiveness of lifestyle interventions among immigrants who report negative mood. ClinicalTrialsgov registration: NCT05136339; April 23, 2022.

Exploring the Associations of Inflammatory and Oxidative Stress Biomarkers with Pancreatic Diseases: An Observational and Mendelian Randomisation Study.

Identifying biomarkers linked to pancreatic ductal adenocarcinoma (PDAC) and chronic pancreatitis (CP) is crucial for early detection, treatment, and prevention. Methods: Association analyses of 10 serological biomarkers involved in cell signalling (IFN-γ, IL-6, IL-8, IL-10), oxidative stress (superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzyme activities, total glutathione (GSH), malondialdehyde (MDA) levels), and intestinal permeability proteins (zonulin, I-FABP2) were conducted across PDAC (n = 12), CP (n = 21) and control subjects (n = 23). A Mendelian randomisation (MR) approach was used to assess causality of the identified significant associations in two large genetic cohorts (FinnGen and UK Biobank). Results: Observational results showed a downregulation of SOD and GPx antioxidant enzyme activities in PDAC and CP patients, respectively, and higher MDA levels in CP patients. Logistic regression models revealed significant associations between CP and SOD activity (OR = 0.21, 95% CI [0.05, 0.89], per SD), GPx activity (OR = 0.28, 95% CI [0.10, 0.79], per SD), and MDA levels (OR = 2.05, 95% CI [1.36, 3.08], per SD). MR analyses, however, did not support causality. Conclusions: These findings would not support oxidative stress-related biomarkers as potential targets for pancreatic diseases prevention. Yet, further research is encouraged to assess their viability as non-invasive tools for early diagnosis, particularly in pre-diagnostic CP populations.

Intention to use physical restraint in paediatric intensive care units and correlated variables: A multicentre and cross-sectional study.

OBJECTIVES: To determine the intention to use physical restraint (PR) and the relationship with sociodemographic and professional variables of the Paediatric Intensive Care Unit (PICU) nurses. RESEARCH METHODOLOGY/DESIGN AND SETTING: A multicentre and correlational study was carried out from October 2021 to December 2023 in five paediatric intensive care units from five maternal and child hospitals in Spain. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire was provided. Moreover, sociodemographic and employment variables were registered. RESULTS: A total of 230 paediatric nurses participated in the study. A total of 87.7 % were females with an average age of 35.5 ± 9.7 years and working experience of 10.5 ± 8.4 years. The mean scores obtained were 21.1 ± 3.8 for attitude, 13.1 ± 5.0 for subjective norms, 14.4 ± 4.3 for perceived behavioural control and 28.0 ± 6.0 for intention. The nurses apply more physical restraint to anxious patients, with scarce analgesics and sedation, those affected with pharmacological withdrawal symptoms and those with a high risk of accidental removal of vital support devices or fall from bed. The sex (p = 0.007) and type of employment contract (p = 0.01) are the variables that are significantly correlated with the intention to use of PR. CONCLUSION: The paediatric nurses analysed had a moderate attitude, social pressure and perceived behavioural control towards the use of PR. IMPLICATIONS FOR CLINICAL PRACTICE: It is important to know the factors that influence the intention to use physical restraint in order to standardise safe practice for critically ill paediatric and to ensure that patients' rights are respected by obtaining informed consent and assessing the prescription, continuation and removal of physical restraint.

Prevalence of use of physical restraints in pediatric intensive care units and correlated variables: A Spanish multicenter study.

OBJECTIVE: To calculate the prevalence of physical restraint (PR) use in Spanish PICUs and (2) to analyze the correlation between the prevalence of PR use and the sociodemographic, clinical variables of the patients and the PICU structural and organizational variables. METHODS: We conducted a multicenter prevalence study from January 2022 to January 2023 in Spanish PICUs. The method of data collection was by direct observation, review of the patient's medical history, and asking the professionals involved in the patient's care. Three weekly 24-hour prevalence observations (morning, afternoon, and night) were conducted for 6 months. RESULTS: A total of 336 patients were included in the study, obtaining an overall crude prevalence of PR use of 16 % (95 %CI: 15 %-17.7 %). Pediatric patients with respiratory pathology received the highest number of hours of PR, with significant differences observed when comparing respiratory cases with post-surgical cases. Statistical significance was also observed when comparing the mean scores of hours of PR according to admission diagnosis (p = 0.01), with respiratory patients being the ones who were restrained the longest (24 h [20-24]) and infectious patients the least (15 h [14-20]). Patients who receive PR upon admission remain in this situation for more hours (24 h [15-24] and in the PICUs that specifically recorded PR application, fewer hours of PR occurred (20 h [4-24]). CONCLUSIONS: The use of PR is still present in the PICUs analyzed, with a crude prevalence of 16%. Factors such as the reason for admission, the use of respiratory support, and the reason for application of PR were linked to the hours of use of PR. IMPLICATIONS FOR CLINICAL PRACTICE: Knowing the prevalence of PR use will make professionals aware that it is still necessary to implement policies that avoid its use to prevent the side effects they have in pediatric patients.

Diabetes Mellitus tipo 1 y salud bucal en niños uruguayos / Diabetes Mellitus tipo 1 e saúde bucal em crianças uruguaias / Type 1 diabetes mellitus and oral health in Uruguayan children

Resumen La Diabetes Mellitus es una enfermedad crónica con repercusiones bucales; no existen datos en Uruguay. Objetivo: Determinar si el estado de salud bucal de los niños con Diabetes Mellitus tipo 1 es significativamente diferente a los niños sin diabetes. Método: Estudio caso-control, observacional y analítico. Se evaluaron 86 niños en dos grupos: DM1) diabéticos tipo 1, asisten al Centro Hospitalario Pereira Rossell, sin otra enfermedad sistémica asociada ni tratamiento ortodóncico; Control) no diabéticos, concurren a escuela pública, no toman medicación, no cuentan con ortodoncia y se asisten en servicios públicos. Variables: biofilm; caries dental; inflamación gingival; sexo; edad. Resultados : Biofilm: presente en 100% de DM1 y Control. Caries: DM1) 100% presenta alguna lesión cariosa y 92,9% en control (diferencia no significativa). Inflamación gingival: DM1) 76,7% sangrado al sondaje y 60.7% en Control (diferencia significativa). Conclusiones : Confirma datos internacionales sobre la relación significativa entre Diabetes Mellitus tipo 1 y enfermedad periodontal.

Resumo Diabetes Mellitus é uma doença crônica com repercussões bucais; não há dados no Uruguai. Objetivo: Determinar se o estado de saúde bucal de crianças com Diabetes Mellitus tipo 1 é significativamente diferente de crianças sem diabetes. Método: Caso-controle, estudo observacional e analítico. 86 crianças foram avaliadas em dois grupos: DM1) diabeticos tipo 1, de 8 a 12 años, frequentam o Centro Hospitalar Pereira Rossell, sem outra doença sistêmica associada ou tratamento ortodôntico. Control): não diabéticos de 8 a 12 anos, frequentam escola pública, não tomam medicamentos, não têm ortodontia e frequentam os serviços publicos. Variáveis: biofilme; cárie dentária; inflamação gengival; sexo; Idade. Resultados: 100% de grupos DN1 y Control apresentam biofilme. Caries: 100% Grupo DM1 e 92,9% no Grupo Control (deferencia não significativa). Inflamação gengival: Grupo DM1) 76,7% sangramento sondajem e 60,7% Control (diferencia significativa). Conclusões: Dados internacionais da relação Diabetes Mellitus tipo 1 e doença periodontal são confirmados.

Abstract Diabetes mellitus is a chronic disorder that affects oral health; there are no data in Uruguay. Objective: To determine if the oral health of children with type 1 diabetes mellitus is significantly different from that of children without diabetes. Method: Case-control, observational and analytical study. Eighty-six children were evaluated in two groups: 1) type 1 diabetic patients treated at Centro Hospitalario Pereira Rossell (CHPR) with no associated systemic disease or orthodontic treatment; 2) control group including non-diabetic children attending public school who do not take any medication, are not undergoing orthodontic treatment, and have public health coverage. Variables: biofilm, tooth decay, gingival inflammation, sex, age. Results : Biofilm present in 100% of cases in groups 1 and 2. Caries: 100% of Group 1 (DM1) participants and 92.9% of Group 2 (control group) participants have a carious lesion (not a significant difference). Gingival inflammation: 76.7% of DM1 participants and 60.7% of control participants present bleeding on probing (significant difference). Conclusions : This study confirms international data highlighting the connection between type 1 diabetes mellitus and periodontal disease.

Resultados inmediatos e impacto funcional y pronóstico tras la recanalización de oclusiones coronarias crónicas. Resultados del Registro Ibérico / Procedural, functional and prognostic outcomes following recanalization of coronary chronic total occlusions. Results of the Iberian Registry

Introducción y objetivos: El impacto de la intervención coronaria percutánea (ICP) sobre oclusiones coronarias crónicas totales (OCT) presenta controversias. Se analizan los resultados agudos y al seguimiento en nuestro entorno. Métodos: Registro prospectivo de ICP sobre OCT en 24 centros durante 2 años. Resultados: Se realizaron 1.000 ICP sobre OCT en 952 pacientes. La mayoría tenía síntomas (81,5%) y cardiopatía isquémica previa (59,2%), y hubo intentos de desobstrucción previos en un 15%. El SYNTAX anatómico fue 19,5 +/- 10,6 y tenía J-score > 2 el 17,3%. El procedimiento fue retrógrado en 92 pacientes (9,2%). La tasa de éxito fue del 74,9%, mayor en aquellos sin ICP previa (el 82,2 frente al 75,2%; p = 0,001), con J-score ≤ 2 (el 80,5 frente al 69,5%; p = 0,002) y con el uso de ecografía intravascular (el 89,9 frente al 76,2%; p = 0,001), que fue predictor independiente del éxito. Por el contrario, lesiones calcificadas, > 20 mm o con muñón proximal romo lo fueron de fracaso. El 7,1% tuvo complicaciones, como perforación (3%), infarto (1,3%) o muerte (0,5%). Al año de seguimiento, el 88,2% mejoró clínicamente en caso de ICP exitosa (frente al 34,8%; p < 0,001). Dicha mejoría se asoció con menor mortalidad. La tasa de mortalidad al año fue del 1,5%. Conclusiones: Los pacientes del Registro Ibérico con OCT tratados con ICP presentan complejidad clínico-anatómica, tasas de éxito y complicaciones similares a los de otros registros nacionales e importante impacto de la recanalización exitosa en la mejoría funcional, que a su vez se asoció con menor mortalidad

Introduction and objectives: There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting. Methods: Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers. Results: A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 +/- 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score ≤ 2 (80.5% vs 69.5%; P = .002), and in intravascular ultrasound-guided PCI (89.9% vs 76.2%, P = .001), which was an independent predictor of success. In contrast, severe calcification, length > 20mm, and blunt proximal cap were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including perforation (3%), myocardial infarction (1.3%), and death (0.5%). At 1-year of follow-up, 88.2% of successfully revascularized patients showed clinical improvement (vs 34.8%, P < .001), which was associated with lower mortality. At 1-year of follow-up, the mortality rate was 1.5%. Conclusions: Compared with other national registries, patients in the Iberian registry undergoing PCI of a CTO showed similar complexity, success rate, and complications. Successful recanalization was strongly associated with functional improvement, which was related to lower mortality

Comparación de la situación de salud bucal en niños uruguayos de 8 a 12 años diabéticos y no diabéticos / Comparison of the oral health status of diabetic and non-diabetic Uruguayan children aged 8-12

La Diabetes Mellitus es una enfermedad crónica con repercusiones bucales; no existen datos en Uruguay. Objetivo: Comparar la situación de salud bucal de niños diabéticos y no diabéticos. Método: Estudio caso-control, observacional, analítico. Se evaluaron 86 niños divididos en dos grupos: Grupo DM1: diabéticos de 8 a 12 años, que asisten al Centro Hospitalario Pereira Rossell, sin otra enfermedad sistémica ni tratamiento ortodóncico; Grupo control: no diabéticos de 8 a 12 años con asistencia en servicio médico público, no toman medicación y no cuenten con ortodoncia. Variables: biofilm, caries dental, sangrado gingival. Resultados: Todos los sujetos presentan biofilm. Media del índice de O'Leary: DM1=71,48 y Control=89,81. Sangrado al sondaje: DM1=76,7% y Control =60,7% (medias ISG: 5,57 y 2,36 respectivamente; mediana del ISG: DM1=3.65 y Control=1.04. Caries: DM1=40,0% y Control=28,6% (media CPOD: DM1=1,233 y Control=1,0357). Conclusiones: Existen diferencias estadísticamente significativas en el índice de sangrado entre diabéticos y no diabéticos (test de Mann y Whitney) pero no en las variables relativas a caries. Estos resultados posibilitan la comparación con estudios internacionales

Diabetes mellitus is a chronic disorder that affects oral health; there are no data in Uruguay. Objective: To compare the oral health status of diabetic and non-diabetic children. Method: Observational, analytical case-control study where 86 children were evaluated and divided into two groups: DM1 Group, diabetic children aged 8-12 who go to Pereira Rossell Hospital Center without other systemic diseases and with no orthodontic treatment; Control group (CG): non-diabetic children in the same age group with public health care coverage, non-medicated and without orthodontic treatment. Variables: biofilm, dental caries, gingival bleeding. Results: Biofilm was present in all subjects. O'Leary Index: DM1=71.48 and CG=89.81. Bleeding on probing: DM1=76.7% and CG=60.7% (GBI averages are 5.57 and 2.36 respectively and GBI mean: DM1=3.65 and CG=1.04. Caries: DM1=40.0% and CG=28.6% (DMFT average: DM1=1.223 and CG=1.0357). Conclusions: We found significant statistical differences in bleeding index between diabetic and non-diabetic subjects (Mann & Whitney test) but not in the caries variables. These results allow for a comparison with international studies.

Caracterización de la población y evaluación de la calidad asistencial de los niños controlados en la Unidad de Diabetes del Centro Hospitalario Pereira Rossell / Population characterization and evaluation of healthcare quality of children controlled by the Diabetes Unit of CHPR

Introducción: la diabetes mellitus es una enfermedad crónica frecuente en pediatría. El análisis de indicadores de calidad asistencial contribuye a mejorar el proceso de asistencia. Objetivo: describir las principales características clínico epidemiológicas de los pacientes diabéticos asistidos en la Unidad de Diabetes (UD) de la Policlínica Pediátrica General de Referencia. Evaluar la calidad asistencial en base a indicadores. Método: estudio descriptivo, retrospectivo, utilizando los registros clínicos de los pacientes controlados en la UD entre el 1º de julio de 2012 y el 1º de julio de 2013. Se definieron indicadores de proceso asistencial e indicadores de resultados. Los resultados se clasificaron en: bueno ? 80%, aceptable 60% - 80% y malo < 80%. Se calcularon medianas y promedios como medida de tendencia central. Los resultados se expresaron en frecuencias absolutas y porcentajes con su respectivo intervalo de confianza de 95%. Resultados: se incluyeron 83 pacientes. La mediana de edad fue de 12 años. El 56% era de sexo masculino. Provenían del interior del país, 66%. La mediana de edad al diagnóstico fue de 6 años. La mediana de evolución de enfermedad fue de 5 años. Tres de los nueve indicadores de calidad tuvieron un resultado bueno, cinco aceptable y uno malo. La principal falla fue el valor promedio de HbA1c. Conclusiones: se encontraron indicadores de calidad aceptables. Se debe mejorar el cumplimiento de la pesquisa microvascular y en particular el control metabólico de la enfermedad. La evaluación periódica de indicadores de calidad permitirá mejorar la calidad de asistencia.

Abstract Introduction: diabetes mellitus is a chronic disease that is most common children. Analysing quality health care indicators contributes to improving the healthcare services. Objective: to describe the main epidemiological and clinical characteristics of diabetic patients seen at the Diabetes Unit of the General Pediatrics Policlinic of Reference. To evaluate healthcare quality based on indicators. Method: descriptive, retrospective study based on clinical records of patients seen at the Diabetes Unit between July 1, 2012 and July 1, 2013. Indicators were defined for healthcare services and results. Results were classified into good ?80%, acceptable 60% - 80% and bad < 80%. Median and averages were calculated to serve as a measure of the central trend. Results were expressed in absolute frequencies and percentages, with their corresponding confidence interval of 95%. Results: 83 patients were included. Median age was 12 years old, 56% of them were male and 66% of them lived in the provinces. Median age upon diagnosis was 6 years old. Median disease evolution was five years. Three out of nine of the quality indicators were evaluated as good, five as acceptable and one as bad. The main flaw was average measurements of HbA1c. Conclusions: quality indicators were acceptable. Microvascular screening needs to be improved, and in particular, the metabolic follow up of the disease. Regular evaluation of quality indicators will enable improving healthcare quality.

Resumo Introdução: a diabetes mellitus é uma doença crônica frequente em Pediatria. A análise de indicadores de qualidade do atendimento contribui a melhoria do processo de atendimento. Objetivo: descrever as principais características clínico epidemiológicas dos pacientes diabéticos atendidos na Unidade de Diabetes (UD) do Ambulatório Pediátrico Geral de Referência. Avaliar a qualidade do atendimento usando indicadores. Material e método: estudo descritivo, retrospectivo, utilizando os prontuários médicos dos pacientes controlados na UD no período 1° de julho de 2012 - 1°de julho de 2013. Foram definidos indicadores de processo de atendimento e de resultados. Os resultados foram classificados como: bom ? 80%, aceitável 60% - 80% e ruim < 60%. Como medidas de tendência central foram calculadas medianas e médias. Os resultados foram expressos em frequências absolutas e porcentagem com intervalo de confiança de 95%. Resultados: foram incluídos 83 pacientes. A mediana de idade foi de 12 anos. 56% eram de sexo masculino. 66% eram do interior do país. A mediana da idade no momento do diagnóstico foi de seis anos. A mediana de evolução da doença foi de cinco anos. Três dos nove indicadores de qualidade obtiveram resultado bom, cinco aceitável e 1 ruim. A principal falha foi o valor médio da HbA1c. Conclusões: foram encontrados indicadores de qualidade aceitáveis. É necessário melhorar o cumprimento da pesquisa microvascular especialmente o controle metabólico da doença. A avaliação periódica de indicadores de qualidade permitirá melhorar a qualidade do atendimento.

Alta prevalencia de infección por SARS-CoV-2 en pacientes programados para endoscopia digestiva después del pico de la primera onda pandémica / High prevalence of SARS-CoV-2 infection in patients scheduled for digestive endoscopy after the peak of the first wave of the pandemic

Objetivo: Describir la detección del SARS-CoV-2, en una serie de pacientes, programados para endoscopia digestiva en el Hospital Santa Caterina. Salt. (Girona). Métodos: Estudio descriptivo de una serie de casos de pacientes programados para endoscopia durante el mes de mayo de 2020, en el reinicio de la actividad endoscópica después del pico pandémico, siguiendo las recomendaciones de SCD, SEED, AEG y ESGE. Examinamos muestras nasofaríngeas 48-72 horas antes de la cita, mediante RT-PCR a todos los pacientes. La extracción del ARN se hizo mediante kits: Qiagen®-adaptado, BiosSprint®96-DNA-Blood-Kit (384). Para amplificación-detección del SARS-CoV-2 se siguieron métodos recomendados por la OMS y el CDC. Resultados: Se programaron 110 pacientes asintomáticos sin contacto estrecho con positivo los 14 días previos; 105 (96,4%) fueron negativos y 5 (4,5%) positivos. Dos pacientes desarrollaron clínica respiratoria después del diagnóstico (presintomáticos) y 3 continuaron asintomáticos. Los 5 pacientes eran casos autóctonos y sin antecedentes de viaje o residencia en otra ciudad o país asociado a alta prevalencia de infección. Cuatro casos fueron mujeres entre 60-81 años. El gen N fue detectado en todos los casos. Conclusiones: Se detectó una alta prevalencia de infección por SARS-CoV-2 en pacientes programados por endoscopia digestiva. Dado el riesgo de transmisión a los profesionales, consideramos recomendable realizar RT-PCR del SARS-CoV-2 48-72 horas antes de la exploración en situaciones de alta incidencia poblacional.(AU)

Objective: To describe the detection of SARS-CoV-2 in a series of patients scheduled for digestive endoscopy at the Hospital Santa Caterina. Salt. (Girona). Methods: Descriptive study of a series of cases of patients scheduled for endoscopy during the month of May 2020, when endoscopic activity was resumed after the peak of the pandemic, following SCD, SEED, AEG and ESGE recommendations. We examined nasopharyngeal samples 48-72 hours before the appointment, by RT-PCR, in all patients. RNA extraction was performed using the kits: Qiagen®-adapted, BiosSprint®96-DNA-Blood-Kit (384). For amplification-detection of SARS-CoV-2, methods recommended by the WHO and the CDC were followed. Results: 110 asymptomatic patients without close contact with a positive case in the previous 14 days were scheduled; 105 (96.4%) were negative and five (4.5%) were positive. Two patients developed respiratory symptoms after diagnosis (presymptomatic) and three remained asymptomatic. Allfive5 patients were autochthonous cases with no history of travel or residence in another city or country associated with high prevalence of infection. Four cases were women aged 60-81 years. The N gene was detected in all cases. Conclusions: A high prevalence of SARS-CoV-2 infection was detected in patients scheduled for digestive endoscopy. Given the risk of transmission to professionals, we consider it advisable to perform SARS-CoV-2 RT-PCR 48-72 hours before the examination in situations of high incidence in the population.(AU)

Impacto del remodelado del anillo mitral tras el procedimiento MitraClip en la reducción de la insuficiencia mitral funcional / Effects of mitral annulus remodeling following MitraClip procedure on reduction of functional mitral regurgitation

Introducción y objetivos: El procedimiento de reparación mitral percutánea (MitraClip) parece reducir los diámetros del anillo mitral de pacientes con etiología funcional, pero no se ha demostrado la relación con la intensidad de la regurgitación. El objetivo es evaluar si el remodelado del anillo mitral tiene algún impacto en la reducción de la regurgitación mitral en pacientes con insuficiencia mitral funcional. Métodos: Se incluyó a todos los pacientes con etiología funcional tratados con MitraClip en el centro hasta enero de 2015. Se les realizó ecocardiograma inmediatamente después de la colocación del dispositivo (equipo iE33, Philips). Los cambios en el anillo mitral se correlacionaron con la intensidad de la regurgitación mitral evaluada por el orificio regurgitante efectivo. Resultados: Se incluyó a 23 pacientes (edad, 65 ± 14 años; el 74% varones; fracción de eyección del ventrículo izquierdo, 31 ± 13%; presión sistólica de la arteria pulmonar, 47 ± 10 mmHg). Tras el procedimiento, el orificio regurgitante disminuyó en 0,30 ± 0,04 cm2 (p < 0,0005), desde un valor basal de 0,49 ± 0,9 cm2. Se observó una reducción del diámetro anteroposterior de 3,14 ± 1,01 mm (p < 0,0005) desde un valor basal de 28,27 ± 4,9 mm, sin cambios en el diámetro intercomisural (0,50 ± 0,91 frente a 40,68 ± 4,7 mm; p = 0,26). Se observó una relación significativa entre la reducción del diámetro anteroposterior y la reducción del orificio regurgitante (r = 0,49; p = 0,020). Conclusiones: El dispositivo MitraClip produce una inmediata reducción del diámetro anteroposterior en pacientes con insuficiencia mitral funcional. Este remodelado podría relacionarse con la reducción de la regurgitación mitral (AU)

Introduction and objectives: The percutaneous mitral valve repair procedure (MitraClip) appears to reduce mitral annulus diameter in patients with functional mitral regurgitation, but the relationship between this and regurgitation severity has not been demonstrated. The aim of this study was to determine the effect of mitral annulus remodeling on the reduction of mitral regurgitation in patients with functional etiology. Methods: The study included all patients with functional mitral regurgitation treated with MitraClip at our hospital until January 2015. Echocardiogram (iE33 model, Philips) was performed in all patients immediately after device positioning. Changes in the mitral annulus correlated with mitral regurgitation severity, as assessed using the effective regurgitant orifice area. Results: The study included 23 patients (age, 65 ± 14 years; 74% men; left ventricular ejection fraction, 31% ± 13%; systolic pulmonary artery pressure, 47 ± 10 mmHg). After the procedure, the regurgitant orifice area decreased by 0.30 cm2 ± 0.04 cm2 (P < .0005), from a baseline of 0.49 cm2 ± 0.09 cm2. Anteroposterior diameter decreased by 3.14 mm ± 1.01 mm (P < .0005) from a baseline of 28.27 mm ± 4.9 mm, with no changes in the intercommissural diameter (0.50 mm ± 0.91 mm vs 40.68 mm ± 4.7 mm; P = .26). A significant association was seen between anteroposterior diameter reduction and regurgitant orifice area reduction (r = .49; P = .020). Conclusions: In patients with functional mitral regurgitation, the MitraClip device produces an immediate reduction in the anteroposterior diameter. This remodeling may be related to the reduction in mitral regurgitation (AU)

Significado pronóstico de los niveles de albúmina previos al tratamiento en los pacientes con carcinoma escamoso de cabeza y cuello / Prognostic significance of albumin levels prior to treatment in patients with head and neck squamous cell carcinoma

INTRODUCCIÓN Y OBJETIVOS: Los niveles de albúmina pretratamiento han demostrado tener valor pronóstico en pacientes oncológicos. El objetivo del presente estudio es analizar la relación entre las cifras de albúmina pretratamiento y el pronóstico en pacientes con un carcinoma escamoso de cabeza y cuello (CECC). MÉTODOS: Estudio retrospectivo de una cohorte de 741 pacientes con CECC con una determinación de albúmina plasmática dentro de las 4 semanas previas al inicio del tratamiento. Se analizó la relación entre la supervivencia específica y los niveles de albúmina mediante un análisis de partición recursiva. RESULTADOS: Los niveles de albúmina tuvieron una relación directamente proporcional y estadísticamente significativa con la supervivencia específica. De acuerdo con los resultados del análisis de partición recursiva, los puntos de corte con una mayor capacidad pronóstica fueron 37,5 y 46,1 g/l. En relación con los pacientes con albúmina > 46,1 g/l, los pacientes con albúmina entre 37,5 y 46,1 g/l contaron con un riesgo 1,44 veces superior de morir como consecuencia del tumor (IC 95%: 0,95-2,19, p = 0,081), y los pacientes con cifras de albúmina < 37,5 g/l, con un riesgo 3,19 veces superior (IC 95%: 2,01-5,04, p = 0,0001). Las diferencias en supervivencia en función del valor de albúmina se observaron de forma exclusiva en los pacientes con tumores avanzados (estadios III-IV). CONCLUSIÓN: Las concentraciones de albúmina plasmática previas al tratamiento son un factor pronóstico independiente de supervivencia en los pacientes con CECC en estadios avanzados (III-IV), siendo el punto de corte de 37,5 g/l el de mayor capacidad pronóstica

INTRODUCTION AND OBJECTIVES: Pre-treatment albumin levels have been shown to have prognostic capacity in oncological patients. The aim of this study is to analyse the relationship between albumin levels and prognosis in patients with head and neck squamous cell carcinoma (HNSCC). METHODS: We performed a retrospective study in a cohort of 741 patients with HNSCC and a plasmatic albumin testing within the 4 weeks prior to the start of treatment. The relationship between disease-specific survival and plasma albumin levels was analysed by a recursive partitioning analysis. RESULTS: Albumin levels showed a directly proportional and statistically significant association with disease-specific survival. According to the results of the recursive partitioning analysis, the cut-off points with a higher prognostic capacity were 37.5 g/L and 46.1 g/L. Taking patients with albumin levels > 46.1 g/L as the benchmark, patients with albumin levels between 37.5-46.1 g/L had a 1.44 times higher risk of disease-specific death (95% CI: .95-2.19, P = .081), and patients with levels < 37.5 g/L had a 3.19 times higher risk (95% CI: 2.01-5.04, P = .0001). The differences in survival based on albumin levels were only seen in patients with advanced stage tumours (stages III-IV). CONCLUSION: Pre-treatment plasmatic albumin is an independent prognostic factor for patients with advanced stage HNSCC (III-IV), 37.5g/L being the cut-off point with the highest prognostic capacity

Sistema de referencia-contrarreferencia en pediatría: análisis de la situación en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell / Reference and contrareference in pediatrics

Introducción: en nuestro país, como en el resto del mundo, los sistemas de salud están sometidos a procesos de modernización y reforma con el objetivo de adecuar sus capacidades a las necesidades de la población. En este contexto la estructura y gestión del sistema de salud son vehículos importantes para cumplir el objetivo. A fin de hacer buen uso de esta red,resulta crucial asegurar una buena coordinación entre los diferentes niveles de atención. Un sistema de referencia-contrarreferencia (SRC) constituye una herramienta que pone, a disposición de los médicos, criterios y procedimientos homogéneos que permiten canalizar lademanda para servicios de salud y hacer uso eficiente del sistema de atención.Objetivos: analizar las derivaciones de pacientes al Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR) a través del Departamento de Emergencia (DEP) y de la Policlínica Pediátrica General de Referencia (PPGR). Conclusiones: los resultados hallados muestran una ineficiente utilización de los recursos. Sedeben establecer medidas para racionalizar el sistema de atención y promover su eficacia. Se proponen medidas para mejorar el funcionamiento del SRC y la derivación oportuna y adecuada a especialista en el HP-CHPR.

Introduction: following a global trend, the health system in our country is undergoing modernization and reformprocesses with the purpose of making their capabilities suitable for the needs of the population. Under this framework,the structure and management of the health system are important tools to achieve this goal. To this end, thedifferent levels of health care providers need to be well coordinated. A reference-contrareference system is a tool that provides physicians with criteria and homogeneousprocedures that enable their channeling the demand for health care services and to use the system efficiently.Objectives: the study aims to analyze how patients consulting at the Emergency Department and the GeneralPediatrics Reference Policlinic are referred to the Pereira Rossell Hospital.good in 30 of the cases. Conclusions: results show resources are inefficientlyused. We need to set specific measures to rationalize thehealth care system and promote its efficacy. Measures toimprove functioning of the reference-contrareference systemand the timely and appropriate referral to a specialistat the Perreira Rossell Hospital are suggested.

Introdução: no nosso país, como no resto do mundo, os sistemas de saúde estão submetidos a processos demodernização e reforma buscando adequar sua capacidade às necessidades da população. Dessa forma, a estrutura e a gestão do sistema de saúde são veículos importantespara atingir o objetivo. Para fazer um bom uso dessa rede, é fundamental garantir uma boa coordenação entre os diferentes níveis de atenção. Um sistema de referência e contra-referência (SRC) é uma ferramenta que coloca a disposição dos médicos, critérios e procedimentos homogêneosque permitem canalizar a demanda de serviços de saúde e utilizar o sistema de atenção de forma eficiente.Objetivos: analisar a derivação de pacientes ao Hospital Pediátrico do Centro Hospitalar Pereira Rossell (HPCHPR) através do Departamento de Emergência (DEP) e da Policlínica Pediátrica Geral de Referência (PPGR). Conclusões: os resultados encontrados mostram uma utilização ineficiente dos recursos. É necessário estabelecermedidas para racionalizar o sistema de atenção e promover sua eficácia. Propõem-se medidas para melhorar o funcionamento do SRC e o encaminhamento oportuno e adequado a especialistas no HP-CHPR.

Primer estudio multicéntrico realizado por el Grupo Rioplatense de Citometría de Flujo: control de calidad en las mediciones de subpoblaciones de linfocitos T / First multicentric study by Grupo Rioplatense de Citometría de Flujo : quality control of lymphocyte subsets

El control de calidad se efectuó sobre los valores obtenidos, relativos y absolutos, de linfocitos T y de sus subpoblaciones CD4+ y CD8+ en muestras de sangre de pacientes infectados con el virus de la inmunodeficiencia humana (HIV). El estudio incluyó dieciocho centros: diez utilizaron citómetros de flujo de Becton Dickinson, tres de Coulter y 5 de Ortho que representan a 17 laboratorios de Argentina y a uno de Uruguay. Los siguientes programas se utilizaron para analizar los datos : SimulSET, Paint a Gate (Becton Dickinson), Profile II, XL System (Coulter), ImmunoCount Trio y Combo Cytoron (Ortho). Se obtuvieron muestras de sangre periférica en horas de la mañana (8 a 10 hs) de 10 voluntarios normales (por serología y hemograma) y de 10 pacientes HIV positivos con valores previos de CD4 que variaron entre 200-350 células por microlito y fueron procesadas dentro de las 12 horas. Cada centro obtuvo los valores relativos con el procedimiento técnico habitual y el de los valores absolutos utilizando el hemograma propio. Además, en un contador hematológico Cell-Dyn 3500 se obtuvo para cada muestra el hemograma correspondiente considerado de referencia. Los valores absolutos medios, obtenidos en cada centro con el hemograma propio, para los linfocitos T y los de sus subpoblaciones fueron significativamente diferentes. No hubo diferencias significativas para los valores porcentuales entre los diferentes centros ni para los valores absolutos obtenidos con el hemograma de referencia. Concluimos que las diferencias en los valores absolutos de los linfocitos T y sus subpoblaciones dependen del recuento hematológico empleado.