Patients with secondary acute myeloid leukemia undergoing allogeneic stem-cell transplant have inferior outcomes than de novo acute myeloid leukemia regardless minimal residual disease level by flow cytometry.

Secondary acute myeloid leukemia (s-AML) patients have a poor prognosis and currently the only curative therapy is allogeneic stem-cell transplant (HSCT). However, we do not yet know whether transplantation is sufficient to reverse the poor prognosis compared to de novo AML patients. We analyzed survival after HSCT comparing a cohort of 58 patients with s-AML versus 52 de novo patients who were transplanted between 2012 and 2020. Patients with s-AML had worse event-free survival (EFS) (p = 0.001) and overall survival (OS) (p < 0.001) compared to de novo AML due to an increased risk of relapse (p = 0.06) and non-relapse mortality (p = 0.03). The main difference in survival was observed in patients who achieved complete remission (CR) before HSCT (EFS p = 0.002 OS and <0.001), regardless minimal residual disease (MRD) by |multiparametric flow cytometry cohorts. In patients transplanted with active disease (AD), the prognosis was adverse in both s-AML and de novo AML groups (EFS p = 0.869 and OS p = 0.930). After excluding patients with AD, we stratified the cohort according to conditioning intensity, noticing that s-AML who received MAC had comparable outcomes to de novo AML, but the survival differences remained among reduce intensity conditioning group. In conclusion, transplanted s-AML patients have worse survival among patients in CR before HSCT, regardless of MRD level by flow cytometry compared to de novo AML. MAC patients had similar outcomes irrespective of leukemia ontogeny.

Severe Acute Respiratory Syndrome Coronavirus 2 Spreads to Lymph Nodes and Strongly Expands CD4+ Effector Memory RA Cells in a Patient With Mild Coronavirus Disease 2019.

A woman with mild coronavirus disease 2019 developed cervical adenopathy, being diagnosed of Epstein-Barr virus infectious mononucleosis. We performed fine needle aspiration, and demonstrate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found in lymph nodes even in mild disease along with a strong expansion of terminally differentiated effector memory CD4+ T cells, a cell population that is practically absent in lymph nodes.

Survival after allogeneic transplantation according to pretransplant minimal residual disease and conditioning intensity in patients with acute myeloid leukemia.

Background: The measurement of minimal residual disease (MRD) by multiparametric flow cytometry (MFC) before hematopoietic stem cell transplantation (HSCT) in patients with acute myeloid leukemia (AML) is a powerful prognostic factor. The interaction of pretransplant MRD and the conditioning intensity has not yet been clarified. Objective: The aim of this study is to analyze the transplant outcomes of patients with AML who underwent HSCT in complete remission (CR), comparing patients with positive MRD (MRD+) and negative MRD (MRD-) before HSCT, and the interaction between conditioning intensity and pre-HSCT MRD. Study design: We retrospectively analyzed the transplant outcomes of 118 patients with AML who underwent HSCT in CR in a single institution, comparing patients with MRD+ and MRD- before HSCT using a cutoff of 0.1% on MFC, and the interaction between conditioning intensity and pre-HSCT MRD. Results: Patients with MRD+ before HSCT had a significantly worse 2-year (2y) event-free survival (EFS) (56.5% vs. 32.0%, p = 0.018) than MRD- patients, due to a higher cumulative incidence of relapse (CIR) at 2 years (49.0% vs. 18.0%, p = 0.002), with no differences in transplant-related mortality (TRM) (2y-TRM, 19.0% and 25.0%, respectively, p = 0.588). In the analysis stratified by conditioning intensity, in patients who received MAC, those with MRD- before HSCT had better EFS (p = 0.009) and overall survival (OS) (p = 0.070) due to lower CIR (p = 0.004) than MRD+ patients. On the other hand, the survival was similar in reduced intensity conditioning (RIC) patients regardless of the MRD status. Conclusions: Patients with MRD+ before HSCT have worse outcomes than MRD- patients. In patients who received MAC, MRD- patients have better EFS and OS due to lower CIR than MRD+ patients, probably because they represent a more chemo-sensitive group. However, among RIC patients, results were similar regardless of the MRD status.

Analysis of the polymorphisms EGFR-r521K and ERBB2-I655V in Mexican patients with gastric cancer and premalignant gastric lesions.

The proto-oncogenes epidermal growth factor receptor (EGFR) and erythroblastic leukemia viral oncogene homolog 2 (ERBB2), are involved in the development of diverse malignant tumors, including gastric cancer. We analyzed the association of SNPs EGFR-R521K and ERBB2-I655V with gastric cancer and premalignant gastric lesions in Mexican patients. Through restriction fragment length polymorphisms, we analyze both SNPs in the DNA from 155 patients with gastric cancer and premalignant gastric lesions, 121 controls, and 103 people from the Mexican general population. The frequencies of both SNPs did not differ significantly between any of the groups (chi2 p = NS); Odds ratio analysis showed that the alleles EGFR-521K and ERBB2-655V were not related to gastric cancer or premalignant gastric lesions in the Mexican population. Our data suggest that the EGFR-R521K and ERBB2-I655V polymorphisms are not suitable as markers for identifying individuals with a higher risk for developing gastric cancer in our population.

Enfermedad de Crohn fistulizante en una adolescente / Fistulizing Crohn's disease in an adolescent girl: a case report

RESUMEN Introducción: la enfermedad de Crohn es una enfermedad inflamatoria intestinal de causa desconocida con una génesis multifactorial que afectan todo el tracto digestivo, desde la boca hasta el ano. Presentación de caso: se describe un caso de una adolescente de 18 años de edad con historia de múltiples ingresos hospitalarios por cuadros de fiebre, diarreas, cólicos abdominales y desnutrición proteico energética que a los nueve años se le hace diagnóstico de una colitis ulcerosa, con una respuesta no favorable al tratamiento con salazosufalpiridina, mesalazina, esteroides orales e inmunosupresores. A los 16 años de edad presenta fisuras y fistulas perianales. Por la histología se concluye que es enfermedad de Crohn; fue necesario la realización de ileostomía y tratamiento con anticuerpos monoclonales (infliximab), primera experiencia de su uso en Pinar del Río. Conclusiones: presentó una respuesta muy favorable con cicatrización total de las fisuras y las fístulas perianales, desarrollo de caracteres sexuales secundarios, así como su menarquia y recuperación nutricional.

ABSTRACT Introduction: Crohn's disease is an inflammatory bowel disease of unknown cause with a multifactorial genesis affecting the entire digestive tract, from the mouth to the anus. Case report: an 18-year-old adolescent girl with a history of multiple hospital admissions for fever, diarrhea, abdominal colic and protein-energy malnutrition. At the age of 9 she was diagnosed with ulcerative colitis, with an unfavorable response to treatment with salicylazosulfapyridine, mesalazine, oral steroids and immunosuppressant. At 16 years old she presented fissures and perianal fistulas, histologically concluded as Crohn's disease, and it was necessary to perform an ileostomy and treatment with monoclonal antibodies (infliximab), the first experience of its use in the province. Conclusions: she presented a very favorable response with total healing of the fissures and perianal fistulas, development of secondary sexual characteristics as well as her menarche and nutritional recovery.

Quiste de la glándula de Skene en una recién nacida / Skene's gland cyst on a newborn

RESUMEN Introducción: el hallazgo de una masa interlabial en una niña crea dudas en cuanto a su etiología. Las glándulas de Skene son unas glándulas de pequeño tamaño que se localizan en la cúpula de la vagina. El quiste del conducto de Skene, es una anomalía congénita con una incidencia de 1 en 7000 nacimientos vivos femeninos. Presentación de caso: paciente femenina, nacida a término, de buen peso, que al examen físico de los genitales presenta una tumoración amarillenta, redondeada, en relación con el meato uretral. Conclusión: los quistes de la glándula de Skene son entidades raras, con múltiples diagnósticos diferenciales, mayormente clínicos, con varias opciones de tratamiento.

ABSTRACT Introduction: the discovery of an interlabial mass in a girl creates doubts concerning its etiology. Skene's glands are small glands located in the dome of the vagina. Skene's duct cyst is a congenital anomaly with an incidence of 1 in 7000 live female births. Case presentation: female patient, born at full term, normal weight, at physical examination of the genitals she presented a yellowish, rounded tumor in relation to the urethral meatus. Conclusion: Skene's gland cysts are rare entities, having multiple differential diagnoses, mostly clinical, with many options of treatment.

Caracterización de pacientes con fractura de cadera, intervenidos con artroplastia / Characterizing Patients with Hip Fracture, Operated with Arthroplasty

Introducción: Las lesiones traumáticas de la cadera ocupan uno de los propósitos más importantes de la cirugía traumatológica. El uso de la artroplastia como regla de oro en el tratamiento quirúrgico de las mismas, es el fundamento del trabajo. Objetivo: Caracterizar los pacientes con diagnóstico de fractura de cadera, intervenidos con artroplastia total y parcial y estudiar la mortalidad, según el tipo de prótesis utilizada. Métodos: Se realizó un estudio descriptivo de corte transversal retrospectivo en 1506 pacientes del Hospital Ortopédico Docente Fructuoso Rodríguez entre 2015 y 2019, portadores de fractura de cadera, y tratados con artroplastia. Se analizaron variables tales como edad, sexo y comorbilidades presentes. Resultados: Se colocaron prótesis totales a 427 pacientes y en 1079 se utilizó la modalidad de prótesis parcial. Predominaron las personas entre 61 y 80 años de edad. El sexo femenino prevaleció en el estudio, con una relación 3:1. Predominó el grupo de pacientes con 1 o 2 enfermedades asociadas. La mortalidad < 30 días resultó el 1,1 por ciento y ≥ 30 días el 9,2 por ciento. Conclusiones: La utilización de prótesis totales dista mucho de la media interpuesta actualmente en el mundo, donde la prótesis total se maneja como herramienta de elección. Las prótesis parciales quedan reservadas para pacientes que tienen una corta expectativa de vida y muy poco validismo(AU)

Introduction: Traumatic hip injuries occupy one of the most important purposes of trauma surgery. The use of arthroplasty as a golden rule in their surgical treatment is the foundation of the work. Objectives: To characterize patients with a diagnosis of hip fracture, who underwent total and partial arthroplasty and to study mortality, according to the type of prosthesis used. Methods: A descriptive retrospective cross-sectional study was carried out in 1506 patients from Fructuoso Rodríguez Orthopedic Teaching Hospital from 2015 to 2019, with hip fracture, and treated with arthroplasty. Variables such as age, sex, and present comorbidities were analyzed. Results: Total prostheses were placed in 427 patients and in 1079 the partial prosthesis modality was used. Persons between 61 and 80 years of age predominated. The female sex prevailed in this study, with a 3: 1 ratio. The group of patients with 1 or 2 associated diseases predominated. Mortality <30 days was 1.1 percent and ≥30 days was 9.2 percent. Conclusions: The use of total prostheses is far from the current average in the world, where the total prosthesis is used as the tool of choice. Partial prostheses are reserved for patients who have short life expectancy and very little validity(AU)

Quistes del mesenterio en niños como causa de abdomen agudo / Mesenteric cysts in children as a cause of acute abdomen

RESUMEN Introducción: las masas abdominales en pediatría, pueden ser de diverso origen que incluyen patologías benignas y malignas. Los quistes mesentéricos son tumores intraabdominales raros. Se originan por el fracaso de los nódulos linfáticos intestinales en comunicar con los sistemas linfáticos o venosos. Presentación de casos: dos pacientes masculinos en edad pediátrica, de tres y 14 años de edad, que acudieron a urgencias son síntomas y signos de abdomen agudo, en el acto operatorio se encontraron quistes del mesenterio de diferente origen, los cuales fueron resecados. Ambos evolucionaron satisfactoriamente. Conclusión: los quistes del mesenterio son entidades que cuando se complican pueden ser causas de abdomen agudo en pediatría, su diagnóstico es difícil y mayormente ocurre durante el acto operatorio. La excéresis total brinda el menor índice de recurrencia.

ABSTRACT Introduction: abdominal tumors in pediatric ages can be of diverse origin including benign and malignant pathologies. Mesenteric cysts are rare tumors. They originate from the failure of the intestinal lymphatic nodules in communicating with the lymphatic or venous systems. Two-case report: three and 14 year-old male patients in pediatric ages, who came to emergency room with symptoms and signs of acute abdomen, at surgery mesenteric cysts of different origins were found, which were resected. Their evolution was satisfactory. Conclusion: mesenteric cysts are entities that when complicate can be causes of acute abdomen in pediatric ages, their diagnosis are difficult and mostly happens during the surgical procedure. The total resection of these cysts presents the least recurrence index.

Use of tigecycline in critically ill patients with serious nosocomial intra-abdominal infections.

Intra-abdominal infection (IAI) is a frequent complication found in surgical intensive care unit (SICU) and continues to be associated with considerable mortality. Tigecycline, the first-in-class glycylcycline has demonstrated a broad spectrum of activity against a wide range of bacteria commonly found in IAI. This observational retrospective study aimed to describe the experience with tigecycline for serious nosocomial IAI in the SICU. Data were collected from 23 consecutive patients admitted to SICU with serious nococomial IAI who had received empirical treatment with tigecycline. In all cases, IAI was diagnosed via emergency surgery. Severe sepsis was found in 56.5% and 43.5% developed septic shock. Oncological disease was the most common comorbidity (60%). The mean Simplified Acute Physiology Score (SAPS) III within 24 hours from IAI diagnosis was 57.5±14.7, and 87% showed a McCabe score >1 (2 or 3). Escherichia coli was the most common pathogen (43.5%), followed by Bacteroides spp. and Streptococcus spp. (30.4%, respectively). All but one patient received tigecycline in combination (95.7%), particularly with fluconazole (52.2%), followed by piperacillin-tazobactam (43.5%). Empirical antibiotic therapy was considered adequate in 95%. The mean duration of treatment was 8.5±4.5 days. A favorable response was achieved in 78%. Failure of the antibiotic therapy was not observed in any patient. None of the patients discontinued tigecycline due to adverse reactions. SICU mortality was 13%, with no deaths attributable to tigecycline. These findings suggest that tigecycline combination therapy is an effective and well tolerated empirical treatment of serious nosocomial IAI in the SICU.

Factores de riesgo asociados a amputación de miembros inferiores en personas con pie diabético infectado, Hospital Alemán Nicaragüense, Managua, Agosto de 2017 a Enero de 2018 / Risk factors associated with lower limb amputation in people with infected diabetic foot, German Nicaraguan Hospital, Managua, August 2017 to January 2018

Estudio Transversal, con alcance analítico. Se incluyeron a personas con úlceras de pie diabético en la clasificación B-D de la Universidad de Texas. Se recopiló información clínico-epidemiológica de los pacientes y se tomaron muestras biológicas de las lesiones para ser transportadas y analizadas (perfil bacteriológico y pruebas de susceptibilidad antimicrobiana) en el laboratorio de microbiología de la UNAN-Managua. Se aplicaron pruebas descriptivas, correlacionales y analíticas según el objetivo de estudio, a través del paquete estadístico IBM SPSS Versión 21. La edad media detectada fue de 61.15±9.8 años y el principal rango de edad de las personas fue de 50-59 años. Se encontró significancia estadística que comprueba la relación entre haber sido amputado anteriormente con volver a ser intervenido quirúrgicamente en el futuro. Se encontró correlación entre las variables "riesgo de amputación" y "cambio de coloración" según la prueba de Phi. Los individuos que presentaron fiebre y cambio de coloración del tejido afectado tuvieron el doble de riesgo de ser amputados a corto plazo. La razón de bacterias Gram positivas en relación con las bacterias Gram negativas fue de 1:9.6. Se encontró un predominio de resistencia en contra de las cefalosporinas, penicilinas, cloramfenicol, quinolonas, sulfamidas y monobactámicos. Se encontró correlación entre las variables "riesgo de amputación" y "cambio de coloración" según la prueba de Phi. El análisis de varianza de un factor demostró que las variables "duración de la úlcera" y "clasificación clínica de la úlcera" muestran asociación entre si