Multi-parametric MRI in the diagnosis and scoring of gastrointestinal acute graft-versus-host disease.

OBJECTIVES: Acute gastrointestinal graft-versus-host disease (GI-aGVHD) is a severe complication of allogeneic hematopoietic stem cell transplantation (HSCT). Diagnosis relies on clinical, endoscopic, and pathological investigations. Our purpose is to assess the value of magnetic resonance imaging (MRI) in the diagnosis, staging, and prediction of GI-aGVHD-related mortality. METHODS: Twenty-one hematological patients who underwent MRI for clinical suspicion of acute GI-GVHD were retrospectively selected. Three independent radiologists, blinded to the clinical findings, reanalyzed MRI images. The GI tract was evaluated from stomach to rectum by analyzing fifteen MRI signs suggestive of intestinal and peritoneal inflammation. All selected patients underwent colonoscopy with biopsies. Disease severity was determined on the basis of clinical criteria, identifying 4 stages of increasing severity. Disease-related mortality was also assessed. RESULTS: The diagnosis of GI-aGVHD was histologically confirmed with biopsy in 13 patients (61.9%). Using 6 major signs (diagnostic score), MRI showed 84.6% sensitivity and 100% specificity in identifying GI-aGVHD (AUC = 0.962; 95% confidence interval 0.891-1). The proximal, middle, and distal ileum were the segments most frequently affected by the disease (84.6%). Using all 15 signs of inflammation (severity score), MRI showed 100% sensitivity and 90% specificity for 1-month related mortality. No correlation with the clinical score was found. CONCLUSION: MRI has proved to be an effective tool for diagnosing and scoring GI-aGVHD, with a high prognostic value. If larger studies will confirm these results, MRI could partly replace endoscopy, thus becoming the primary diagnostic tool for GI-aGVHD, being more complete, less invasive, and more easily repeatable. KEY POINTS: • We have developed a new promising MRI diagnostic score for GI-aGVHD with a sensitivity of 84.6% and specificity of 100%; results are to be confirmed by larger multicentric studies. • This MRI diagnostic score is based on the six MRI signs most frequently associated with GI-aGVHD: small-bowel inflammatory involvement, bowel wall stratification on T2-w images, wall stratification on post-contrast T1-w images, ascites, and edema of retroperitoneal fat and declivous soft tissues. • A broader MRI severity score based on 15 MRI signs showed no correlation with clinical staging but high prognostic value (100% sensitivity, 90% specificity for 1-month related mortality); these results also need to be confirmed by larger studies.

Influence of Interferon beta treatment on quality of life in multiple sclerosis patients.

BACKGROUND: Interferon-beta (IFN-beta) shows beneficial effect on the course of multiple sclerosis (MS), nevertheless its route and frequency of administration and side effects might impact negatively the quality of life (QoL) of MS patients. The objective of this study was to evaluate the influence of IFN-beta on QoL in MS patients. METHODS: Seventy-seven disease modifying treatment (DMT) free and 41 IFN-beta treated MS patients were evaluated. QoL, assessed by MSQoL-54, was related to IFN-beta treatment and to clinical and demographic parameters at baseline and after two years. Multivariate hierarchical linear model for repeated measurements was used. RESULTS: Treated patients showed a younger age, a lower disease duration and a higher relapse rate in the two years preceding study entry. At inclusion time treated and untreated patients did not differ in relapse rate, expanded disability status scale (EDSS), fatigue, depression, physical and mental QoL. IFN-beta did not influence QoL at inclusion time, but when QoL was evaluated after two years, treatment negatively affected mental QoL. Depression and fatigue negatively influenced physical and mental QoL both at baseline and after two years. EDSS correlated with a poor physical QoL only at baseline. CONCLUSION: IFN-beta had a negative impact on QoL over the time in MS patients, influencing mainly mental QoL. The impairment of QoL in MS was strongly associated with increasing fatigue and depression, whereas clinical disability had a minor unfavourable role.

Morbimortalidad por síndrome de broncoaspiración meconial en recién nacidos de un hospital público del estado Cojedes: Venezuela / Morbidity and mortality by meconium aspiration syndrome in newborns of Cojedes state public hospital: Venezuela

Normalmente el meconio es la primera excreción intestinal del recién nacido, está compuesto por células epiteliales, pelo fetal, moco y bilis. El estrés intrauterino puede causar evacuación in útero de meconio hacia el líquido amniótico el cual puede ser aspirado por el feto in útero o por el recién nacido durante el trabajo de parto. La aspiración del meconio puede causar obstrucción de la vía aérea y reacción inflamatoria intensa, lo que determinará dificultad respiratoria severa. La presencia de meconio en el líquido amniótico es un signo que advierte sufrimiento fetal y exige una supervisión cuidadosa del trabajo de parto con adecuada evaluación de la salud fetal. En atención a ello se planteo como objetivo del estudio, conocer la frecuencia del síndrome de broncoaspiración meconial en un hospital público, y establecer factores de riesgo asociados a su aparición. Se realizo una investigación de tipo descriptivo, transversal y de campo, en el servicio de neonatología de un hospital público del Estado Cojedes. Fue seleccionada una muestra no probabilística intencional, siendo evaluados 71 recién nacidos vivos que presentaron Síndrome de Dificultad Respiratoria. Los resultados reportaron que 13% de los sujetos presentaron el síndrome. La mortalidad fue de 44,4% causada por dificultad respiratoria. Los factores de riesgo predominantes fueron: expulsivo prolongado 44,4%, ruptura prematura de membrana 22,2% y traumatismo durante el parto 22,2%. Se concluye que la frecuencia y mortalidad elevada por esta condición, se encuentra asociado a factores de riesgo altamente prevenibles.

The violence constitutes one of the high-priority problems in America currently and together with the insecurity, they occupy the first place in the civic concern in most of the countries, Venezuela has been investing in security`s public politics, while the mortality for violent facts has had a tendency to increase in the last ten years. Exploring some answers was carried out a correlacional study with the purpose of looking for associations among the mortality for homicides, with socio-political variables that could be influencing in the behavior of the violent facts in the Aragua State. The results indicates the education investment influences the behavior of this mortality with 72,4%. Paradoxically, it was observed a coefficient of positive Pearson and a direct moderate (p = 0,05) correlation. 59,8% of the behavior of the mortality for the violent facts. This can be explained by the inefficacy of the developed security strategies and the current penal legislation. It concludes the behavior of the mortality for the violent facts of Aragua state. have been associated with the quality of the educational strategies and the police and repressive focus of the security politics carried out in region.