Criteria for melanocytic lesions in LC-OCT.

BACKGROUND: Line-field confocal optical coherence tomography (LC-OCT) is an emerging diagnostic tool with imaging depth reaching ~400 µm and a novel three-dimensional (3D) cube providing cellular resolution. As far as we are aware, there are only a limited number of papers that have reported diagnostic criteria for melanocytic lesions using this technique, and none of them have been multicentric. OBJECTIVES: Our aim was to establish the diagnostic criteria for melanocytic lesions using LC-OCT and identify the most significant architectural and cytologic features associated with malignancy. METHODS: A retrospective evaluation of 80 consecutive melanocytic lesions from a prospective multicentric data set spanning three European centres was conducted. We excluded facial, acral and mucosal lesions from the study. Dermoscopic and LC-OCT images were evaluated by a consensus of four observers. Multivariate logistic regression with backward elimination was employed. RESULTS: The main melanoma diagnostic criteria include detecting >10 pagetoid cells in 3D acquisition, irregular 3D epidermal architecture, disrupted dermoepidermal junction (DEJ) and clefting. Significant risk factors were irregular 3D epidermal architecture, >10 pagetoid cells, dendritic cells at DEJ without underlying inflammation. Novel malignancy criteria in vertical view were DEJ disruption and clefting around atypical melanocyte nests. Exclusive melanoma features were epidermal nests, epidermal consumption, dense dermal nests with atypia. Protective features in the absence of any malignancy indicators were DEJ ring pattern, cobblestone, elongated rete ridges (vertical), well-defined DEJ and wave pattern (vertical). CONCLUSIONS: A series of diagnostic criteria for the identification of melanocytic lesions with LC-OCT have been established. Validation of these criteria in clinical practice through future studies is essential to further establish their utility.

Country-report pattern corrections of new cases allow accurate 2-week predictions of COVID-19 evolution with the Gompertz model.

Accurate short-term predictions of COVID-19 cases with empirical models allow Health Officials to prepare for hospital contingencies in a two-three week window given the delay between case reporting and the admission of patients in a hospital. We investigate the ability of Gompertz-type empiric models to provide accurate prediction up to two and three weeks to give a large window of preparation in case of a surge in virus transmission. We investigate the stability of the prediction and its accuracy using bi-weekly predictions during the last trimester of 2020 and 2021. Using data from 2020, we show that understanding and correcting for the daily reporting structure of cases in the different countries is key to accomplish accurate predictions. Furthermore, we found that filtering out predictions that are highly unstable to changes in the parameters of the model, which are roughly 20%, reduces strongly the number of predictions that are way-off. The method is then tested for robustness with data from 2021. We found that, for this data, only 1-2% of the one-week predictions were off by more than 50%. This increased to 3% for two-week predictions, and only for three-week predictions it reached 10%.

[Executive functions in patients with obstructive sleep apnea: exploring the prefrontal model]. / Funciones ejecutivas en pacientes con apnea obstructiva del sueño: explorando el modelo prefrontal.

INTRODUCTION: According to the prefrontal model, individuals with obstructive sleep apnea (OSA) manifest behaviours mimicking dysexecutive syndrome as a result of blood gas abnormalities and sleep fragmentation. OBJECTIVE: To compare executive functions in OSA patients with normative values and explore their relationship with blood gas abnormalities and sleep fragmentation. PATIENTS AND METHODS: Patients were recruited from the wider community and from a tertiary care hospital. The score obtained in the neuropsychological assessment was compared with Student's t-test for a sample. A multiple linear regression analysis was subsequently estimated, using polysomnographic parameters of hypercapnia, hypoxemia and sleep fragmentation as the predictor variables, and the executive function score as the variable to be predicted. RESULTS: Although the neuropsychological assessment performance of 26% of this sample was classified as executive impairment, indicators of sleep fragmentation and gas abnormalities failed to predict the performance of executive functions. CONCLUSION: A proportion of the patients with OSA presented performance similar to a dysexecutive syndrome; however, the factors underlying and fostering this type of cognitive manifestation remain unclear. Early treatment for this public health problem could be the best tool available for improving quality of life and preventing health risks.

TITLE: Funciones ejecutivas en pacientes con apnea obstructiva del sueño: explorando el modelo prefrontal.Introducción. El modelo prefrontal propone que los individuos con apnea obstructiva del sueño (AOS) manifiestan conductas similares a un síndrome disejecutivo como resultado de las alteraciones de gases en la sangre y la fragmentación del sueño. Objetivo. Comparar las funciones ejecutivas en pacientes con AOS con valores normativos y explorar su relación con las alteraciones de gases en la sangre y la fragmentación del sueño. Pacientes y métodos. Se reclutó a pacientes de la comunidad general y de un hospital de tercer nivel. La puntuación obtenida en la evaluación neuropsicológica se contrastó con la t de Student para una muestra. Posteriormente, se estimó un análisis de regresión lineal múltiple mediante parámetros polisomnográficos de hipercapnia, hipoxemia y fragmentación del sueño como variables predictoras, y la puntuación de funciones ejecutivas como variable que se debe predecir. Resultados. Pese a que el desempeño en la evaluación neuropsicológica del 26% de esta muestra se clasificó como alteración ejecutiva, los indicadores de fragmentación del sueño y alteraciones de gases no predijeron el desempeño ejecutivo. Conclusión. Una fracción de los pacientes con AOS mostró un desempeño similar a un síndrome disejecutivo; no obstante, permanecen indefinidos los factores que subyacen y favorecen este tipo de manifestaciones cognitivas. La atención temprana de este problema de salud pública podría ser la mejor herramienta disponible en aras de mejorar la calidad de vida y prevenir riesgos a la salud.

Clinicopathological features, MCPyV status and outcomes of Merkel cell carcinoma in solid-organ transplant recipients: a retrospective, multicentre cohort study.

BACKGROUND: The proportion of Merkel cell carcinomas (MCCs) in solid-organ transplant recipients (SOTR) harbouring Merkel cell polyomavirus (MCPyV) is unknown, as are factors affecting their outcomes. OBJECTIVE: To describe clinicopathological features of MCC in SOTR, investigate the tumoral MCPyV-status and identify factors associated with tumour outcomes. METHODS: Retrospective, international, cohort-study. MCPyV-status was investigated by immunohistochemistry and polymerase chain reaction. RESULTS: A total of 30 SOTR and 44 consecutive immunocompetent patients with MCC were enrolled. SOTR were younger at diagnosis (69 vs. 78 years, P < 0.001). Thirty-three percent of SOTR MCCs were MCPyV-positive vs. 91% of immunocompetent MCCs (P = 0.001). Solid-organ transplantation was associated with an increased cumulative incidence of progression (SHR: 3.35 [1.57-7.14], P = 0.002), MCC-specific mortality (SHR: 2.55 [1.07-6.06], P = 0.034) and overall mortality (HR: 3.26 [1.54-6.9], P = 0.002). MCPyV-positivity and switching to an mTOR inhibitor (mTORi) after MCC diagnosis were associated with an increased incidence of progression (SHR: 4.3 [1.5-13], P = 0.008 and SHR: 3.6 [1.1-12], P = 0.032 respectively) in SOTR. LIMITATIONS: Retrospective design and heterogeneity of SOTR cohort. CONCLUSIONS: MCPyV appears to play a less prominent role in the aetiopathogenesis of MCC in SOTR. SOTR have a worse prognosis than their immunocompetent counterparts and switching to an mTORi after the diagnosis of MCC does not improve progression.

Advanced cutaneous squamous cell carcinoma of the head in two renal transplanted patients treated with cemiplimab.

It is well known that organ transplant recipients are prone to develop non-melanoma skin cancers, particularly cutaneous squamous cell carcinoma (cSCC). This is explained by the long-term use of immunosuppressants and thus the decrease of the immunosurveillance that protects from developing malignant tumours. Solid organ transplant recipients (SOTRs) are 65-250 times more likely to develop cSCC compared to the general population (Am J Transplant 2017; 17: 2509). Moreover, in these patients cSCCs follow a more aggressive course. Close follow-up and regular skin check-ups by a dermatologist are, therefore, crucial in the management of these patients. When detected early, cSCC can be easily and effectively treated by a simple excision. However, when advanced, outcomes are poor. Immune checkpoints inhibitors (ICIs) have been recently added to our arsenal and represent a breakthrough, having proved to be effective in achieving long-term responses. We, hereby, present two cases of difficult-to-treat cSCCs in renal transplanted patients.

Cemiplimab for advanced cutaneous squamous cell carcinoma in kidney transplant recipients.

Background: Kidney transplant recipients (KTR) are at increased risk of cancer due to chronic immunosuppression. Non-melanoma skin cancer has an excess risk of approximately 250 times higher than the general population. Moreover, in solid organ transplant recipients (SOTR) these cancers have a more aggressive behavior, with an increased risk of metastasis and death. Cemiplimab, a human monoclonal IgG4 antibody against programmed cell death (PD-1) has shown considerable clinical activity in metastatic and locally advanced cutaneous squamous cell carcinoma (cSCC) in patients for whom no widely accepted standard of care exists. Cemiplimab has therefore been approved since 2018 for the treatment of advanced cSCC. However, data regarding the use of cemiplimab in SOTR and particularly in KTR are scarce and based on published case reports and small case series. In this study, we report on the real-life outcome of cemiplimab use in a Belgian cohort of seven KTR suffering from advanced cSCC. Objective: To report on the overall response rate (ORR) and safety of cemiplimab in KTR in Belgium. Results: Seven patients suffering from advanced cSCC, treated with cemiplimab, between 2018 and 2022, in Belgium were identified. Three patients were on corticosteroid monotherapy, one patient on tacrolimus monotherapy and three patients were on at least 2 immunosuppressants at start of cemiplimab. The ORR was 42.8%, stable disease was seen in 14.3% and progressive disease was found in 42.8% of the patients, respectively. The median administered number of cycles was 12, interquartile range (IQR) 25-75 [3.5 - 13.5]. All patients were treated with surgery before administration of cemiplimab, 71.4% received additional radiotherapy and only 1 patient was treated with chemotherapy prior to receiving cemiplimab. Biopsy-proven acute renal allograft rejection was observed in one patient, who eventually lost his graft function but showed a complete tumor response to treatment. Low grade skin toxicity was seen in one patient of the cohort. Conclusion: The present case series shows that the use of cemiplimab in KTR with advanced cSCC who failed to respond to previous surgery, chemo - and/or radiotherapy treatment is associated with an ORR of 42.8% with minimal risk of graft rejection (14.3%) and good tolerance.

Line-field confocal optical coherence tomography for actinic keratosis and squamous cell carcinoma: a descriptive study.

BACKGROUND: Early and accurate diagnosis of cutaneous squamous cell carcinomas (SCCs) and actinic keratoses (AK) is fundamental to reduce their associated morbidity and to select the correct treatment. Line-field confocal optical coherence tomography (LC-OCT) is a new imaging device that can characterize healthy skin and basal cell carcinoma, but no large studies on keratinocyte cell tumours have yet been published. AIM: To identify and describe LC-OCT criteria associated with SCC and AK, and to compare LC-OCT findings in these tumours. METHODS: A retrospective observational multicentre study was conducted. Lesions were imaged with the LC-OCT device before surgery and examined histologically. LC-OCT criteria for AK/SCC were identified and their presence was evaluated in all study lesions. Univariate and multivariate analyses were performed to compare AK and SCCs, and to investigate differences between in situ and invasive tumours. RESULTS: In total, 158 patients with 50 AK and 108 SCCs (62 in situ and 46 invasive) were included. Cytological and architectural alterations were found in most lesions, and differences were found between AK and SCCs. Although the visualization of the dermoepidermal junction (DEJ) was often hampered by hyperkeratosis and acanthosis, an outlined DEJ without broad strands was observed in almost all AK and almost all in situ SCCs, but in only three invasive SCCs (P < 0.001) when the DEJ was detectable. CONCLUSION: Our results suggest that LC-OCT can help clinicians in the identification of AK and SCC and their differentiation, providing a real-time and noninvasive examination. Further studies are needed to confirm our data.

Line-field confocal optical coherence tomography of basal cell carcinoma: a descriptive study.

BACKGROUND: Early diagnosis and subtype classification of basal cell carcinoma (BCC) are crucial to reduce morbidity and optimize treatment. Good accuracy in differentiating BCC from clinical imitators has been achieved with existing diagnostic strategies but lower performance in discriminating BCC subtypes. Line-field confocal optical coherence tomography (LC-OCT) is a new technology able to combine the technical advantages of reflectance confocal microscopy and OCT. OBJECTIVES: To identify and describe LC-OCT criteria associated with BCC and explore their association with BCC subtypes. METHODS: Basal cell carcinoma were imaged with a handheld LC-OCT device before surgical excision. LC-OCT images were retrospectively evaluated by three observers for presence/absence of criteria for BCC. Multivariate logistic regression models were used to find independent predictors of BCC subtypes. RESULTS: Eighty-nine histopathologically proven BCCs were included, of which 66 (74.2%) were pure subtypes [superficial BCC (sBCC): 19/66 (28.8%); nodular BCC (nBCC): 31/66 (47.0%); infiltrative BCC (iBCC): 16/66 (24.2%)]. Lobules, blood vessels and small bright cells within epidermis/lobules were the most frequent criteria for BCC. LC-OCT criteria independently associated with sBCC were presence of hemispheric lobules, absence of lobule separation from the epidermis, absence of stretching of the stroma; with nBCC were presence of macrolobules, absence of lobule connection to the epidermis; and with iBCC were presence of branched lobules. CONCLUSIONS: This was the first study describing the characteristics of BCC under LC-OCT examination. We proposed morphologic criteria, which could be potentially useful for diagnosis and subtype classification of BCC, as well as for its therapeutic management. Future studies are needed to assess these hypotheses.

Motiva.DM2 project. A pilot behavioral intervention on diet and exercise for individuals with type 2 diabetes mellitus.

AIM: The purpose of this study was to assess the efficacy of an educational intervention based on the Behavior Change Wheel (BCW) framework for individuals with type 2 diabetes mellitus (DM2) on dietary and exercise behavior in a Spanish region. METHODS: A two-arm pilot research was developed. The intervention consisted of a 6-month period with guidelines and 4 in-person interventions. The outcome was changes in behaviors, motivation, competence, autonomy, social support to implement the recommendations, HbA1c, and body composition. RESULTS: n = 111 patients were recruited. Individuals in the intervention experienced a significative improvement on adherence to dietary recommendations (+1.23; p = 0.026), exercise (+0.86; p = 0.001), and a decrease in HbA1c levels (-0.6%; p = 0.002) and BMI (-0.73; p < 0.001). CONCLUSION: The intervention for DM2 individuals, based on the BCW framework, developed, and implemented by primary care nurses has been effective in improving the adherence to healthy eating, exercise, HbA1c levels, and body composition.

In vivo characterization of healthy human skin with a novel, non-invasive imaging technique: line-field confocal optical coherence tomography.

BACKGROUND: Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive optical technique recently developed for skin examination in vivo. It provides real-time, high-resolution vertical images with an isotropic resolution of ~1 µm and a penetration depth of ~500 µm. OBJECTIVES: Study goals were to qualitatively/quantitatively characterize healthy skin at different body sites using LC-OCT. METHODS: The skin of young healthy volunteers was imaged with a handheld LC-OCT imaging device. Seven body sites (back of the hand, forehead, cheek, nose, chest, forearm and back) were investigated. An independent qualitative [cutaneous structures' description; visibility of keratinocytes' nuclei and dermal-epidermal junction (DEJ)] and quantitative [stratum corneum (SC)/epidermal thicknesses; height of dermal papillae] assessment of the LC-OCT images was performed. RESULTS: A total of 88 LC-OCT images were collected from 29 participants (20 females; nine males; mean age 25.9 years). Keratinocytes' nuclei and DEJ were visible in the totality of images. The different layers of the epidermis and the remaining cutaneous structures/findings were visualized. Body sites-related variability was detected for SC/epidermal thicknesses and height of dermal papillae. Inter-observer agreement was excellent (SC thickness), good-to-excellent (epidermal thickness) and moderate-to-good (papillae). CONCLUSIONS: Line-field confocal-OCT provides non-invasive, real-time imaging of the skin in vivo with deep penetration and high resolution, enabling the visualization of single cells. The histology-like vertical view provides an easy way to recognize/measure different cutaneous structures/findings. LC-OCT appears as a promising technique for the examination of physiological/pathological skin.

[Association between major depression and arterial hypertension in a Colombian population]. / Asociación entre depresión mayor e hipertensión arterial en una población colombiana.

INTRODUCTION: A third of hypertensive patients have major depression, a relationship that is associated with a worse prognosis. The objective of the study was to estimate the association between depression and high blood pressure, as well as to establish the possible bidirectionality of the conditions. MATERIALS AND METHODS: Retrospective cohort study. People between 18 and 65 years old with high blood pressure, depression or use of medications for their management were included. To analyze the antecedent, a comorbidity model was performed. A bivariate analysis was performed and then a multivariate logistic regression. The association was estimated using the Chi-square test and the odds ratios that were crude and adjusted to the other variables included in the analysis. The Hosmer-Lemeshow test was used to assess the goodness of fit. SPSS® v.21 was used as the statistical package. RESULTS: A total of 1,721 people were included in the study. The prevalence of depression in patients with and without hypertension was 17.4 and 12.6%, respectively, with a 43% risk of hypertension in people with depression. In patients with depression, it preceded the diagnosis of hypertension in 64.8% of cases and in hypertensive patients, 22.2% were later diagnosed with depression. The association between high blood pressure and major depression remained significant after adjusting for the other risk factors. CONCLUSIONS: Depression was found as a risk factor for high blood pressure, with a 2-way risk relationship between depression and high blood pressure.

Synthetic cannabinoid receptor agonists: classification and nomenclature.

Introduction: The emergence of novel psychoactive substances has changed the epidemiology of drugs used recreationally throughout Europe and have posed significant challenges for clinicians, researchers and regulators. Synthetic cannabinoid receptor agonists have made up a large proportion of these novel psychoactive substances. Developed for legitimate scientific research, synthetic cannabinoid receptor agonists are potent agonists at CB1 and CB2 receptors and there have been many case reports of severe or fatal toxicity following their recreational use. At least 180 analytically confirmed compounds belonging to this group of drugs have been reported in Europe as of January 2019. Synthetic cannabinoid receptor agonists have a complex molecular structure, consisting of four pharmacophore components termed the 'core', 'tail', 'linker' and 'linked' groups. This structural complexity offers multiple opportunities for chemical modification to evade drug control legislation based on chemical structure, and this explains the large numbers of individual products that have been detected.Objectives: To discuss the chemical structure of synthetic cannabinoid receptor agonists and to describe the different nomenclature used to identify individual compounds thereby increasing understanding of their chemical heterogenicity and the potential relevance of their molecular structure to the risk of toxicity.Methods: The European Database on New Drugs (EDND) and EMCDDA-Europol annual implementation reports (2010-2017) was searched for compounds with known agonist activity at CB1 and/or CB2 receptors. Information on the different names and chemical structures of each compound was extracted and analysed for patterns. PUBMED, Google Scholar and MEDLINE databases were searched, in addition to non-peer reviewed sources, for data on structure, structure-activity relationships and nomenclatures for each compound.Nomenclature of synthetic cannabinoid receptor agonists: The structural complexity of synthetic cannabinoid receptor agonists presents challenges for nomenclature. There are several nomenclature systems in use.Colloquial and clandestine names: Non-scientific names (e.g. AKB-48, 2NEI, XLR-11) have been used to refer to specific compounds and most have probably been invented by vendors, presumably for the purpose of successful marketing of recreational products, however such names do not convey useful information about structure.Systematic chemical names: Each compound has a systematic chemical name that describes its exact structure; however, it is complex, unwieldy, inaccessible to non-chemists and not suitable for routine communication or clinical use.Serial names: Represent iterative designations assigned to compounds produced as a series in a laboratory (e.g. 'WIN-', 'HU-', 'CP-', 'JWH-' and 'AM-'). This nomenclature does not provide structural information or reflect structural similarities between compounds.Systematic abbreviated names: Succinctly describe each compound utilising structural pharmacophores. The chemical motif in each pharmacophore group is assigned a unique code-letter and assembled into a name with the format of 'Linked Group - TailCoreLinker'. Frequently encountered groups include indole and indazole cores, amino-acid-like like groups, most notably methyl-3,3-dimethylbutanoate (MDMB), methanone linker groups and pentyl, 5-fluoropentyl and 4-fluorobenzyl tails. There has been inconsistent usage of this nomenclature, likely due to a lack of consensus and identification of code-letters for several chemical motifs.Emerging compounds and practices: Tricyclic carbazole and γ-carbolinone core analogues have been identified and may represent the next significant structural analogues to emerge onto the recreational market. There is a need to establish basic pharmacological and toxicological data for these analogues.Conclusions: There is a need for international consensus on the nomenclature used to name synthetic cannabinoid receptor agonists to ensure precise and effective communication between professional groups in the clinic and for the purposes of research and regulation, especially with the emergence of analogues of existing compounds and novel structural motifs. A well-defined nomenclature system also supports quick and accurate communication of the structure-activity of these compounds, potentially highlighting compounds that carry a significant risk of toxicity.

Development of liquid chromatography tandem mass spectrometry method to quantify cyclobutane pyrimidine dimer photolyase activity by detection of 15mer oligonucleotide as reaction product.

Ultraviolet radiation from sunlight causes DNA damage in skin cells by formation of photoproducts, mainly cyclobutane pyrimidine dimers (CPD), which are reverted by exogenous CPD-photolyase, preventing photoaging and skin cancer. High performance liquid chromatography tandem mass spectrometry method for quantification of CPD-photolyase activity was developed to search new enzymes sources for dermatology or clinical studies. The method was based in the enzymatic conversion of a 15mer oligonucleotide, containing a center cyclobutane thymidine dimer, to the restored 15mer oligonucleotide. Three ion pair reagent were evaluated by response surface methodology to increase mass intensities. Additionally, chromatographic separation of oligonucleotides was performed. The selected mobile phase was 15 mM diisopropylethylamine/20 mM hexafluoroisopropanol in methanol. The method allowed total separation between the oligonucleotides studied (resolution of 2.3) by using the core shell technology, which reduce the diffusion time of the analyte into the column, increasing the efficiency and minimizing the analysis time at 7 min. The mass spectrometry detection allowed a high selectivity and sensitivity. This is the first time where MRM modality has been employed with this specific purpose. Oligonucleotides recovery from reaction mixture was ∼ 94% and the limit of quantification was 13.4 nM for 15mer. The method was evaluated with a recombinant CPD-photolyase from Synechococcus leopoliensis using purified and crude protein extract. CPD-photolyase could be measured in terms of activity for enzymatic kinetics studies, for evaluation of UV-R effects in (micro)organisms and to identify new enzymes.

Obesity in Patients with Endometrial Cancer: May It Affect the Surgical Outcomes of Laparoscopic Approach?

OBJECTIVE: To evaluate the impact of obesity on surgical outcomes for women with endometrial cancer (EC) managed by laparoscopic surgery. Minimal invasive surgery has been incorporated in the surgical management of EC, improving perioperative outcomes. However, this approach may become more challenging in case of obesity. So it is important to accurately evaluate and establish the most appropriate surgical approach for these patients. MATERIALS AND METHODS: From January 2008 through April 2016, we conducted a prospective observational study, including all consecutive patients with a histological diagnosis of EC undergoing surgical staging by laparoscopy at our institution. Patients were classified in two groups (obese vs non-obese) according to their body mass index. Information about short- and long-term outcomes were recorded and analyzed during an outpatient follow-up. RESULTS: Between January 2008 and April 2016, 83 women underwent laparoscopic surgery for EC at our institution. Forty-six (56.6%) of them were classified as obese. Surgical outcomes were similar in both groups. No significant difference was reported in surgical time, number of lymph nodes removed, blood loss, length of hospital stay, and incidence of intra- or postoperative complications. Also, long-term outcomes did not show any statistical significant difference: recurrence rate was 6.4% (3/47) among obese patients and 13.9% (5/36) among non-obese (p = 0.251). No difference was reported even in time to recurrence (log-rank p = 0.280) and in survival time (log-tank p = 0.132) between the two groups. CONCLUSIONS: Our results show that obesity did not impair the outcomes of laparoscopic surgery for EC. This surgical approach may be offered to obese patients with the same level of safety, radicality, and efficiency as for the normal-weight population.

HIV infection and care pathway: From guidelines to clinical practice.

OBJECTIVES: To quantify within a cohort of HIV-infected individuals the number of medical visits and procedures to be carried out according to comorbidities and risk factors to implement a personalized care pathway. PATIENTS AND METHODS: Retrospective study of 915 patients consulting from January 1 to December 31, 2016 at an outpatient unit of multidisciplinary consultations, using an electronic patient record. We built an algorithm using parameters required for the application of the national guidelines for the management of HIV-infected individuals. The frequency of comorbidities was measured according to gender, transmission risk group, and nadir CD4 (200/mm3). RESULTS: Patients were mostly men (median age: 52 years), of whom 16% were aged≥60 years. Viral load was<40 copies/mL in 93.5% of treated patients and CD4 cell count≥500/mm3 for 73%. Overall, 74.5% of patients had at least one comorbidity. The number of comorbidities was similar in men and women but was significantly higher in patients with a nadir CD4 <200/mm3 and increased with age (irrespective of gender). The minimum number of consultations to be scheduled per year was 8123: 70% for the management of comorbidities with an average of six consultations/year/patient. Overall, 53% of patients should attend a proctology consultation. The minimum number of paramedical procedures to be performed was 5115. CONCLUSION: The implementation of a personalized multidisciplinary management within a single facility seems to be a suitable care model to address the needs of HIV-infected individuals.

The impact of the extension of the post-natal in the adherence to breastfeeding Cohort study. / Impacto de la extensión del postnatal en la adherencia a la lactancia materna. Estudio de Cohorte.

INTRODUCTION: In Chile, Law 20,545 came into force in 2011, extending the maternity leave from 12 to 21 weeks. The National Breastfeeding Survey (ENALMA, in Spanish), applied after the exten ded maternity leave, reported a 12% increase in adherence to exclusive breastfeeding (EBF) at the sixth month. However, 63% of the women surveyed were unemployed, therefore, the main causes of cessation of breastfeeding (BF) were not related to maternal rest time. OBJECTIVES: To calculate the impact of changes in the EBF adherence in patients who attend to well-child visits in the period before and after the entry into force of the extended maternity leave. MATERIALS AND METHODS: Data were collected from electronic medical records of the San Joaquin Health Center between 2009 and 2013, which were recruited according to specified inclusion and exclusion criteria (n = 938 patients). Subsequently, they were divided into two groups according to the presence or absence of the ex tended maternity leave and with follow-up at three, six and 12 months. Using frequency tables, the characterization of the groups was carried out at the beginning of the observation period. To evaluate group homogeneity, study variables were compared between groups using Chi-square and Wicolxon Mann-Whitney tests. The prevalence of EBF maintenance was compared by pr-test between the groups with follow-up at three, six and 12 months. Using survival analysis and Cox regression, the impact of the extended maternity leave effect between both groups in the first 12 months was cal culated. RESULTS: At the beginning of the observation periods, no differences were observed between the groups in the studied variables. When comparing groups, without and with extended maternity leave, there were no significant differences in EBF adherence at three months: 327 (66%) versus 302 (68%), p = 0.492, respectively. However, in the groups in follow-up at six and 12 months, there was an increase in EBF adherence from 164 (33%) to 187 (42%), p = 0.004 and from 51 (10%) to 72 (16), p = 0.007, respectively. Analyzing the impact of the maternity leave extension on the adherence to breastfeeding, determined by risk ratio, this extension may positively influence on the adherence to EBF over time, with a HR < 1 (HR: 0.852, p=0.04 CI 95%: 0.728-0.996). CONCLUSION: Increased ma ternal resting time may influence as a protective factor for adherence to EBF.

Impacto de la extensión del postnatal en la adherencia a la lactancia materna: estudio de cohorte / The impact of the extension of the post-natal in the adherence to breastfeeding: cohort study

INTRODUCCIÓN: En Chile, el año 2011 entró en vigencia la ley 20.545, correspondiente a la extensión del postnatal de 12 a 21 semanas. La Encuesta Nacional de Lactancia Materna (ENALMA), aplicada posterior al postnatal extendido, reportó un aumento del 12% en la adherencia a la lactancia materna exclusiva (LME) al sexto mes. Sin embargo, un 63% de las mujeres encuestadas eran laboralmente inactivas, por lo que las principales causas de cese de LM (lactancia materna) no estaban relacionadas con el tiempo de descanso materno. OBJETIVOS: Calcular el impacto de los cambios en la adherencia a la LME en pacientes atendidos en control sano, en el período previo y posterior a la entrada en vigencia del post natal extendido. MATERIALES Y MÉTODOS: Se realizó la extracción de datos de las fichas electrónicas del Centro Médico San Joaquín entre los años 2009 a 2013, los cuales fueron reclutados según criterios de inclusión y exclusión especificados (n = 938 pacientes). Posteriormente, fueron divididos en 2 grupos, según la presencia o ausencia de postnatal extendido, con seguimiento a los 3, 6 y 12 meses. Mediante tablas de frecuencia se realizó la caracterización de los grupos al comienzo del periodo de observación. Para evaluar homogeneidad de grupos, las variables del estudio se compararon entre los grupos mediante los test de chi cuadrado y Wilcolxon Mann-Whitney. Se comparó la prevalencia de mantención de LME mediante pr-test entre los grupos a los 3, 6 y 12 meses. Mediante análisis de sobrevida y regresión de Cox, se calculó el impacto del efecto del postnatal extendido entre ambos grupos en los primeros 12 meses. RESULTADOS: Al comienzo de los periodos de observación, no se observaron diferencias entre los grupos en las variables estudiadas. Al comparar ambos grupos, sin y con postnatal extendido, no se encontraron diferencias significativas en la adherencia a la LME a los 3 meses: 327(66%) vs 302(68%), p = 0,492, respectivamente. En contraste, en el seguimiento a 6 y 12 meses se evidenció un aumento en la adherencia a la LME: 164 (33%) a 187 (42%), p = 0,004 y a los 12 meses; de 51 (10%) a 72 (16%), p = 0,007. Al analizar el impacto de la extensión del postnatal en la adherencia a la lactancia materna, determinado por la razón de riesgo, el postnatal extendido podría influir positivamente en la adherencia a la LME en el tiempo, con un HR < 1 (HR: 0,852, p = 0,04 IC 95%: 0,728-0,996). CONCLUSIÓN: el aumento del tiempo de descanso materno, podría influir como factor protector de la adherencia a la LME.

INTRODUCTION: In Chile, Law 20,545 came into force in 2011, extending the maternity leave from 12 to 21 weeks. The National Breastfeeding Survey (ENALMA, in Spanish), applied after the exten ded maternity leave, reported a 12% increase in adherence to exclusive breastfeeding (EBF) at the sixth month. However, 63% of the women surveyed were unemployed, therefore, the main causes of cessation of breastfeeding (BF) were not related to maternal rest time. OBJECTIVES: To calculate the impact of changes in the EBF adherence in patients who attend to well-child visits in the period before and after the entry into force of the extended maternity leave. MATERIALS AND METHODS: Data were collected from electronic medical records of the San Joaquin Health Center between 2009 and 2013, which were recruited according to specified inclusion and exclusion criteria (n = 938 patients). Subsequently, they were divided into two groups according to the presence or absence of the ex tended maternity leave and with follow-up at three, six and 12 months. Using frequency tables, the characterization of the groups was carried out at the beginning of the observation period. To evaluate group homogeneity, study variables were compared between groups using Chi-square and Wico- lxon Mann-Whitney tests. The prevalence of EBF maintenance was compared by pr-test between the groups with follow-up at three, six and 12 months. Using survival analysis and Cox regression, the impact of the extended maternity leave effect between both groups in the first 12 months was cal culated. RESULTS: At the beginning of the observation periods, no differences were observed between the groups in the studied variables. When comparing groups, without and with extended maternity leave, there were no significant differences in EBF adherence at three months: 327 (66%) versus 302 (68%), p = 0.492, respectively. However, in the groups in follow-up at six and 12 months, there was an increase in EBF adherence from 164 (33%) to 187 (42%), p = 0.004 and from 51 (10%) to 72 (16), p = 0.007, respectively. Analyzing the impact of the maternity leave extension on the adherence to breastfeeding, determined by risk ratio, this extension may positively influence on the adherence to EBF over time, with a HR < 1 (HR: 0.852, p=0.04 CI 95%: 0.728-0.996). CONCLUSION: Increased ma ternal resting time may influence as a protective factor for adherence to EBF.