Actionable mutations in non-small cell lung cancer in patients at hospital de Especialidades Eugenio Espejo, Ecuador 2017-2020.

OBJECTIVES: Determine the frequency of actionable mutations in non-small cell lung cancer (NSCLC) and their correlation with overall survival (OS) and the site of metastases. METHODS: We performed a descriptive cross-sectional study at the Hospital de Especialidades Eugenio Espejo, Ecuador, between 2017 and 2020. Demographic, pathological, and molecular alterations in epidermal growth factor (EGFR), Anaplastic lymphoma kinase (ALK), ROS proto-oncogene 1 (ROS1), Programmed death-ligand 1 (PD-L1) expression, and clinical data detailed in patients' medical records with metastatic NSCLC were collected and analyzed. Seventy-nine stage IV patients had NSCLC; adenocarcinoma histology represents 56 (70.9%). The predominant mutation was in EGFR (22.8%); the most common variant was the deletion of exon 19 (72.2%). The most common metastatic site was in the contralateral lung (22.3%); however, this variable showed no significant correlation to the molecular markers (p=0.057). The overall survival (OS) and the status of molecular markers are not statistically significant (p=0.27). OS was better for non-mutated EGFR than for mutated EGFR (p=0.012). However, the frequency values are unrelated to contralateral lung metastasis or survival. CONCLUSIONS: Our frequency mutations are concordant with those found in other studies in Latin America. EGFR was the most common biomarker mutation, and there was a better OS in EGFR non-mutated patient.

Pediatric Approach to Trauma Treatment and Resilience-A Novel Relationship-Based Curriculum and Approach to Train Pediatric Professionals to Provide Trauma-Informed Care.

Information and techniques from evidence-based, trauma-informed mental health treatments, resilience and parenting literature and supporting evidence from neuroscience were adapted to provide pediatricians a practical approach and tools to promote resilience and respond to trauma symptoms.

Criterios de inelegibilidad al uso de platinos en cáncer otorrinolaringológico, Guías 2021 / Criteria for ineligibility for the use of platinums in otorhino-laryngological cancer, Guidelines 2021

Introducción: el uso de sales de platinos en patologías oncológicas es ampliamente usado, una de las preocupaciones de los profesionales de la salud es la presencia de eventos adversos en este grupo de pacientes que suelen ser vulnerables, por lo que es necesario la generación de consensos para realizar una selección óptima de pacientes candidatos a terapias basadas en platinos Objetivo: Realizar un consenso de expertos para la inelegibilidad al uso de platinos de acuerdo a varios criterios para realizar un tratamiento óptimo de acuerdo a la selección y categorización de pacientes Pregunta de salud cubierta por la Guía: ¿Qué pacientes portadores de cáncer de origen otorrinolaringológico no son elegibles para tratamiento con platinos? Población: La población objetivos son pacientes adultos con cáncer otorrinolaringológico. Resultados: Se establecieron consensos para la inelegibilidad al uso de platinos sobre los siguientes criterios: Edad >70 años, ECOG >1, Pérdida involuntaria de peso >20%, función auditiva "borderline": alteraciones Grado I, Alteraciones neurológicas Grado I, Trastornos de la función renal: CrCL <60 ml/min, Alteración hepática ≥ grado II Child-Pugh B, Comorbilidades: diabetes, HTA, alteraciones pulmonares, anemia e Insuficiencia cardiaca

Introduction: the use of platinum salts in oncological pathologies is widely used, one of the concerns of health professionals is the presence of adverse events in this group of patients who are usually vulnerable, so it is necessary to generate of consensus to make an optimal selection of candidate patients for platinum-based therapies Objective: To carry out a consensus of experts for the ineligibility for the use of points according to several criteria to carry out an optimal treatment according to the selection and categorization of patients Health question covered by the Guide: Which patients with otorhinolringological origin cancer are not eligible for treatment with platinums? Population: The target population is adult patients with ENT cancer. Results: consensus was established for the ineligibility for the use of lenses on the following crite-ria: Age> 70 years, ECOG> 1, Involuntary weight loss> 20%, "borderline" hearing function: Grade I al-terations, Neurological alterations Grade I, Renal function disorders: CrCL <60 ml / min, Hepatic im-pairment ≥ grade II Child-Pugh B, Comorbidities: diabetes, hypertension, pulmonary disorders, anemia and heart failure.

Concordance and correlation of activity indices in patients with rheumatoid arthritis in northwestern Colombia: A cross-sectional study.

AIM: To determine the correlation and concordance between different clinimetric scores in patients with rheumatoid arthritis in two high-complexity reference centers in northwestern Colombia. METHOD: A cross-sectional study in adults diagnosed with rheumatoid arthritis was conducted according to the 2010 American College of Rheumatology and European League Against Rheumatism Classification Criteria, between January and June, 2013. The correlation was evaluated using Spearman's correlation coefficient, and concordance with quadratic weighted kappa with the respective confidence intervals, for which patients were classified into different categories of disease activity. RESULTS: One hundred patients were included, of whom 83% were women; 58 and 75% received methotrexate and glucocorticoids, respectively. Most individuals were in remission or low activity. High correlations between Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR) values with DAS28 C-reactive protein and Simple Disease Activity Index (SDAI) with Clinical Disease Activity Index (P < 0.0001; r = 0.82 and r = 0.86, respectively) were observed; likewise, the scores obtained with different indices correlated well with gold standard values for remission (SDAI), where the correlation with DAS28-ESR was slightly lower. Excellent concordance among all clinimetric scores was observed, although it was lower among DAS28-ESR and SDAI. CONCLUSION: Clinimetric indices had high concordance and correlation, especially for rheumatoid arthritis patients in remission or low disease activity, without being interchangeable among them.

Cáncer mamario en hombres / Mammary cancer in men

El cáncer mamario en hombres es una enfermedad infrecuente, ya que representa el 1 % de todos los cánceres de mama y es responsable del 0,1 % de las muertes por cáncer en hombres. La incidencia se ha incrementado en los últimos 25 años. En la patogenia se han involucrado factores de riesgo genéticos, hormonales y ambientales. La presentación clínica es la de una masa indolora, retroareolar, con inversión del pezón o sin ella. La enfermedad en estadios avanzados (III-IV) ocurre en más del 40 % de los pacientes. En la mayoría de los casos el diagnóstico se basa en la evaluación clínica, la mamografía, la ecografía y la biopsia. Cerca de 90 % de todos los tumores son carcinomas ductales invasores, que expresan altos niveles de receptores hormonales. El tratamiento local y regional incluye cirugía y radioterapia, dependiendo de la presentación clínica, y el tratamiento sistémico, hormonal o quimioterapia, acorde con los hallazgos clínicos y biológicos. En este artículo se presenta el caso de un paciente con la enfermedad y la última información sobre el tema.

Male breast cancer is an infrequent disease representing only about 1% of all breast cancers responsible for 0.1 % cancer deaths in men. The incidence has increased over the past 25 years. Genetic, hormonal, and environmental risk factors have been implicated in its pathogenesis. Clinical presentation is a painless retroareolar lump, or nipple inversion with more than 40% of individuals having stage III or IV disease. In most cases diagnosis is established by clinical assessment, mammography, ultrasonography and core biopsy. About 90% of all tumors are invasive ductal carcinomas, expressing high levels of hormone receptors. Locoregional treatment includes surgery and radiotherapy, according to the clinical presentation, and systemic treatment (hormonal and/or chemotherapy) according to clinical and biological features. In this article we present the case of a patient with the disease and review the latest information on this subject.

Improved efficacy of a tolerizing DNA vaccine for reversal of hyperglycemia through enhancement of gene expression and localization to intracellular sites.

Insulin is a major target for the autoimmune-mediated destruction of pancreatic beta cells during the pathogenesis of type I diabetes. A plasmid DNA vaccine encoding mouse proinsulin II reduced the incidence of diabetes in a mouse model of type I diabetes when administered to hyperglycemic (therapeutic mode) or normoglycemic (prophylactic mode) NOD mice. Therapeutic administration of proinsulin DNA was accompanied by a rapid decrease in the number of insulin-specific IFN-gamma-producing T cells, whereas prophylactic treatment was accompanied by enhanced IFN-gamma-secreting cells and a decrease in insulin autoantibodies. Adoptive transfer experiments demonstrated that the protection was not mediated by induction of CD25(+)/CD4(+) T regulatory cells. The efficacy of the DNA vaccine was enhanced by increasing the level of expression of the encoded Ag, more frequent dosing, increasing dose level, and localization of the protein product to the intracellular compartment. The efficacy data presented in this study demonstrate that Ag-specific plasmid DNA therapy is a viable strategy for preventing progression of type I diabetes and defines critical parameters of the dosing regime that influences tolerance induction.