[Determinants of the choice of the first level of care in medicine as a field of training and work: A qualitative study]. / Determinantes de la elección del primer nivel de atención en medicina como ámbito de formación y laboral: un estudio cualitativo.

OBJECTIVE: To explore the determinants of eligibility and the choice of the first level of care as a workplace and training environment for health professionals. DESIGN: Qualitative study. SETTING: Four universities in the Metropolitan Area of Buenos Aires, Argentina. PARTICIPANTS: Recently graduated doctors and medical students. METHOD: Based on the grounded constructivist theory, semi-structured interviews and focus groups were conducted for data collection and subsequent analysis. RESULTS: 31 interviews and three focus groups were conducted during 2019-2020. Emerging concepts were organized in main axes for analysis. Positive and negative experiences were identified in relation to primary health care (PHC) in curricular spaces and practical rotations, and a significant lack of knowledge of its scope. For the choice of medical specialties, personal interests, future projections, social prestige, economic income and knowledge of a specific area of medicine are important. There is a devaluation in terms of the role and resolution capacity of PHC, and it is also associated with the assistance of populations with low socioeconomic resources. CONCLUSIONS: Little knowledge of PHC, its lack of prestige, and insufficient remuneration for first-level care professionals were identified as the main barriers to choosing PHC as a place of work and training. In contrast, social commitment, the possibility of having a better lifestyle, and the type of doctor-patient relationship appear as the main facilitators.

Effects of freeze-dried pulp of Eugenia uniflora L. and Opuntia ficus-indica fruits on quality attributes of beef patties enriched with n-3 fatty acids.

The objective of this work was to evaluate the effect of freeze-dried pulps of Eugenia uniflora L. and Opuntia ficus-indica fruits on oxidative stability of n-3-enriched beef patties. Besides, the effect of freeze-dried pulps on cooking yield, color, texture parameters and sensory acceptance of patties was also evaluated. Eugenia uniflora L. (orange-skinned variety) and Opuntia ficus-indica (orange-skinned and red-skinned varieties) fruits were collected, their pulp was lyophilized and incorporated, as a natural source of antioxidant, in beef patties enriched with canola oil as a source of polyunsaturated fatty acids. Oxidation stability of samples was monitored by measuring thiobarbituric acid-reactive substances during refrigerated storage. Results show that all freeze-dried pulps limited lipid oxidation to an acceptable level during 15 days refrigerated storage, having Opuntia ficus-indica (red-skinned variety) the highest inhibitory activity. Besides, the addition of freeze-dried pulps increased the cooking yield and decreased the hardness of beef patties. Respect to sensorial parameters, patties elaborated with no added freeze-dried fruit pulp and patties elaborated with freeze-dried pulp of Opuntia ficus-indica (red-skinned variety) presented the highest overall acceptance of consumers, remaining as a future task to improve the color and taste of patties elaborated with freeze-dried pulps of Eugenia uniflora L. and Opuntia ficus-indica (orange-skinned variety). This research reveals the effectiveness of studied fruits to reduce lipid oxidation in beef patties. In addition, preliminary information about which sensorial parameters of these products should be improved in futures incorporation of pulps in the manufacture of healthy meat products.

Using quantification of the PML-RARalpha transcript to stratify the risk of relapse in patients with acute promyelocytic leukemia.

BACKGROUND AND OBJECTIVES: The detection of PML-RARalpha by real-time polymerase chain reaction (RQ-PCR) is becoming an important tool for monitoring minimal residual disease (MRD) in patients with acute promyelocytic leukemia (APL). However, its clinical value remains to be determined. Our aim was to analyze any associations between the risk of relapse and RQ-PCR results in different phases of treatment, comparing these data with those yielded by conventional qualitative reverse transcriptase-PCR. DESIGN AND METHODS: Follow-up samples from 145 APL patients treated with the PETHEMA protocols were evaluated by the RQ-PCR protocol (Europe Against Cancer program) and by the RT-PCR method (BIOMED-1 Concerted Action). Hematologic and molecular relapses and relapse-free survival were recorded. We then looked for associations between relapse risk and RQ-PCR results. RESULTS: After induction therapy, no association was found between positive RQ-PCR results and relapse. The PCR result here did not imply any change in the scheduled therapy. After the third consolidation course, two out of three cases with positive RQ-PCR relapsed in contrast to 16 out of 119 (13%) patients with negative RQ-PCR. During maintenance therapy and out-of treatment, all patients with >10 PML-RARalpha normalized copy number (NCN) (n=19) relapsed while all patients with <1 NCN at the end of the study remained in hematologic remission (p<0.0001). In the intermediate group (NCN 1-10) (n=18), the relapse-free survival at 5 years was 60%. Hematologic relapses were predicted if a positive RQ-PCR result had been obtained in a follow-up sample within the previous 4 months. INTERPRETATION AND CONCLUSIONS: Based on the information provided by RQ-PCR in samples obtained after the end of consolidation and subsequently, a relapse risk stratification could be established for APL patients. This stratification divides patients into three groups: those at high risk of relapse, those with an intermediate risk and those with a low risk of relapse.

FLT3-activating mutations are associated with poor prognostic features in AML at diagnosis but they are not an independent prognostic factor.

FLT3: gene alterations (internal tandem duplications - ITDs - and D835 mutations) are thought to be associated with poor-risk acute myeloid leukemia (AML). However, not all studies confirm this association, so it is still a matter of debate. Moreover, their association with other molecular abnormalities is less studied. We have investigated the presence of FLT3-ITD and D835 mutations in AML patients and their correlation with clinical and biological disease characteristics. The presence of ITD was analyzed in diagnostic samples of 176 AML patients and the D835 mutation in 135 of these patients. In all these patients, the presence of four well-known molecular abnormalities were also simultaneously characterized: PML/RARalpha, AML1/ETO, CBFbeta/MYH11 and MLL rearrangements. In all, 41 (23%) patients harbored FLT3 mutations, with 34 (19.3%) of them positive for the ITD, and seven (5%) positive for the D835 mutation. Of the acute promyelocytic leukemia (APL) patients, 16 (27%) showed FLT3 mutations, more frequently in M3 hypogranular cases (62% versus 17%, P=0.001) and cases with the short (bcr3) PML-RARalpha isoform (69%, P=0.002). In contrast, FLT3 was never altered in patients with inv(16), t(8;21) or 11q23 abnormalities. FLT3 mutations were significantly associated with some negative prognostic features at diagnosis (leukocytosis, high blast-cell percentage, and elevated LDH values), but they were not associated with different disease-free or overall survival. Therefore, we confirm a high frequency of FLT3 mutations in APL and in adult AML without recurrent cytogenetic translocations. In addition, they were not found as independent prognostic factors although associated with several adverse features at diagnosis.