Online description of services provided in adult survivorship programs across U.S. accredited cancer centers.

PURPOSE: The American College of Surgeons Standard 4.8 requires an institution to implement a survivorship program to become a Commission on Cancer (CoC)-accredited cancer center. The online information offered by these cancer centers can help educate patients and their caregivers about available services. We assessed the content of survivorship program websites of CoC-accredited cancer centers in the United States. METHODS: Of the 1245 CoC-accredited centers for adults, we sampled 325 institutions (26%) based proportionately on the 2019 new cancer cases by state. Website pages of the institutions' survivorship programs were assessed for information and services offered using the COC Standard 4.8. We included programs for adult survivors of adult- and childhood-onset cancers. RESULTS: 54.5% of the cancer centers did not have a survivorship program website. Of the 189 included programs, most were aimed at adult survivors in general, rather than those with specific cancer types. On average, five essential CoC-recommended services were described, most commonly nutrition, care plans, and psychology services. The least mentioned services were genetic counseling, fertility, and smoking cessation. Most programs described services offered to patients who had completed treatment, while 7.4% of described services for those with metastatic disease. CONCLUSION: More than half of CoC-accredited programs did have information about cancer survivorship programs on their websites and when included, had variable and limited description of services. IMPLICATIONS FOR CANCER SURVIVORS: Our study provides an overview of online cancer survivorship services and offers a methodology that may be used by cancer centers to review, expand, and improve the information described on their websites.

Integrative analysis of clinicopathological features defines novel prognostic models for mantle cell lymphoma in the immunochemotherapy era: a report from The North American Mantle Cell Lymphoma Consortium.

BACKGROUND: Patients with mantle cell lymphoma (MCL) exhibit a wide variation in clinical presentation and outcome. However, the commonly used prognostic models are outdated and inadequate to address the needs of the current multidisciplinary management of this disease. This study aims to investigate the clinical and pathological features of MCL in the immunochemotherapy era and improve the prognostic models for a more accurate prediction of patient outcomes. METHODS: The North American Mantle Cell Lymphoma Project is a multi-institutional collaboration of 23 institutions across North America to evaluate and refine prognosticators for front-line therapy. A total of 586 MCL cases diagnosed between 2000 and 2012 are included in this study. A comprehensive retrospective analysis was performed on the clinicopathological features, treatment approaches, and outcomes of these cases. The establishment of novel prognostic models was based on in-depth examination of baseline parameters, and subsequent validation in an independent cohort of MCL cases. RESULTS: In front-line strategies, the use of hematopoietic stem cell transplantation was the most significant parameter affecting outcomes, for both overall survival (OS, p < 0.0001) and progression-free survival (PFS, p < 0.0001). P53 positive expression was the most significant pathological parameter correlating with inferior outcomes (p < 0.0001 for OS and p = 0.0021 for PFS). Based on the baseline risk factor profile, we developed a set of prognostic models incorporating clinical, laboratory, and pathological parameters that are specifically tailored for various applications. These models, when tested in the validation cohort, exhibited strong predictive power for survival and showed a stratification resembling the training cohort. CONCLUSIONS: The outcome of patients with MCL has markedly improved over the past two decades, and further enhancement is anticipated with the evolution of clinical management. The innovative prognostic models developed in this study would serve as a valuable tool to guide the selection of more suitable treatment strategies for patients with MCL.

Neumonía de organización como causa de hipoxemia persistente a la tercera semana de infección por SARS-CoV-2. Reporte de caso / Organization pneumonia as a cause of persistent hypoxemia in the third week of SARS CoV-2 infection, case report

El Coronavirus 2 es un betacoronavirus de ARN responsable de la enfermedad por coronavirus 2019 (COVID-19). Fue detectado por primera vez en Wuhan, China y se propagó rápidamente a nivel mundial, llevando a la OMS a declarar una pandemia en marzo de 2020. Para julio de 2021, se habían registrado casi 196 millones de casos confirmados de COVID-19, siendo responsable de más de cuatro millones de muertes en todo el mundo. En la mayoría de los casos, los pacientes presentan síntomas respiratorios que van desde leves hasta graves, pudiendo desencadenar lesiones pulmonares agudas y disfunción multiorgánica; incluso se han reportado casos de hipoxemia refractaria, lo que implica una elevada morbimortalidad. Las posibles causas incluyen infecciones secundarias, enfermedad tromboembólica pulmonar, fibrosis pulmonar y reinfección por SARS-CoV-2. En pacientes con COVID-19 se ha observado la neumonía de organización como una complicación en la fase subaguda y tardía de la enfermedad, desencadenando un deterioro clínico y radiológico significativo. El tratamiento con glucocorticoides ha mostrado una respuesta favorable en estos casos. Presentamos un caso de neumonía de organización relacionado con la infección por SARS-CoV-2 que, aunque no contó con confirmación histológica, la integración de la presentación clínica, la evolución y los hallazgos radiológicos permitieron realizar la aproximación diagnóstica, destacando la importancia del manejo adecuado con glucocorticoides en estos casos. Sin embargo, se necesitan más estudios para evaluar el desarrollo de esta complicación en una población más amplia.

Coronavirus 2 is an RNA beta coronavirus responsible for coronavirus disease 2019 (COVID-19). It was first detected in Wuhan, China, and spread rapidly globally, leading the WHO to declare a pandemic in March 2020. By July 2021, there had been nearly 196 million confirmed cases, being responsible for more than four million deaths worldwide. In most cases, patients present with respiratory symptoms ranging from mild to severe, which can lead to acute lung lesions and multi-organ dysfunction; cases of refractory hypoxemia have even been reported, which implies high morbidity and mortality. Possible causes include secondary infections, pulmonary thromboembolic disease, pulmonary fibrosis, and SARS-CoV-2 reinfection. Most COVID-19 patients exhibit respiratory symptoms, ranging from mild to severe, with the potential for acute lung injuries and multiorgan dysfunction leading to high mortality. Cases of refractory hypoxemia in COVID-19 patients have been reported, indicating significant morbidity and mortality. Possible causes include secondary infections, pulmonary thromboembolism, pulmonary fibrosis, and reinfection by SARS-CoV-2. In patients with COVID-19, organization pneumonia has been observed as a complication in the subacute and late phase of the disease, triggering significant clinical and radiological deterioration. Treatment with glucocorticoids has shown a favorable response in these cases. We present a case of organizing pneumonia in relation SARS-CoV-2 infection that, although it did not have histological confirmation, the clinical presentation, evolution and radiological findings allowed a diagnostic approach, highlighting the importance of proper management with glucocorticoids in these cases. However, more studies are needed to evaluate the development of this complication in a larger population.

Gastrointestinal Foreign Bodies: 14 Years of Experience in a University Clinic

Introduction: Ingesting foreign bodies is a common medical problem, especially in the emergency department. Some small studies describe experiences in this regard. Materials and methods: A descriptive retrospective study included patients with suspected ingestion of foreign bodies admitted to the gastroenterology and GI endoscopy service of the Clínica Universitaria Colombia between January 2007 and August 2020. Results: The age of occurrence of the event was 18 to 95 years, and the average age was 45 years. The foreign bodies ingested and found were variable. The most frequent was fish bones, representing 64.11% of the cases, followed by chicken bones and dietary impaction. Thirty-eight percent of patients required foreign body removal; the most frequently used tool was the foreign body forceps. The primary location was the esophagus in 12.53% of cases, followed by the cricopharynx in 11.18% and the hypopharynx in 10%. Conclusions: The Clínica Universitaria Colombia is a referral site for many gastroenterology emergencies due to its high technological level and extensive human resources. This paper probably describes the largest number of patients with this reason for consultation, which is why this retrospective descriptive study was designed. It shows the demographic characteristics, foreign body types, radiological and endoscopic findings, and associated complications, which help to provide a more accurate knowledge of this pathology.

Introducción: La ingesta de cuerpos extraños es un problema médico frecuente, especialmente en el servicio de urgencias. Existen algunos estudios pequeños que describen las experiencias al respecto. Materiales y métodos: Estudio descriptivo, retrospectivo, en el cual se incluyó a pacientes con sospecha de ingesta de cuerpos extraños, ingresados al servicio de gastroenterología y endoscopia digestiva de La Clínica Universitaria Colombia, entre enero de 2007 y agosto de 2020. Resultados: La edad de ocurrencia del evento se presentó en pacientes desde los 18 hasta los 95 años, y la edad promedio fue de 45 años. Los cuerpos extraños ingeridos y encontrados fueron variables; los más frecuentes fueron la ingesta de espinas de pescado, que representó el 64,11% de los casos, seguido por la ingesta de huesos de pollo y la impactación alimentaria. Un 38% de los pacientes requirieron la extracción de cuerpo extraño y la herramienta usada con mayor frecuencia fue la pinza de cuerpo extraño. La localización principal fue el esófago, en el 12,53% de los casos, seguido por la cricofaringe, en el 11,18%, y la hipofaringe, en el 10%. Conclusiones: La Clínica Universitaria Colombia es un sitio de referencia de una gran cantidad de urgencias en gastroenterología debido a su alto nivel tecnológico y al gran recurso humano que requieren. Este trabajo representa probablemente la cantidad más grande de pacientes con este motivo de consulta, razón por la que se diseñó este estudio descriptivo retrospectivo, que muestra las características demográficas, los tipos de cuerpo extraño, los hallazgos radiológicos y endoscópicos y las complicaciones asociadas, que son de utilidad para tener un conocimiento más real de esta patología.

[E-VAC therapy as treatment of complications in gastrointestinal surgery in a gastroenterology reference center in Colombia: Case series]. / Terapia E-VAC como tratamiento de complicaciones en cirugía gastrointestinal en centro de referencia de gastroenterología en Colombia: Serie de casos.

Gastrointestinal postoperative anastomotic leaks and fistulas occur frequently and many are managed surgically; however, endoscopic interventions have shown to improve healing outcomes and length of hospital stay. The experience of vacuum-assisted closure therapy (E-VAC) is described, in complications such as fistulas and postoperative anastomotic leaks, in a gastrointestinal reference center in Colombia. A case series study was carried out in patients with anastomotic leaks and fistulas at different levels of the digestive tract, treated by E-VAC, by the Gastroenterology Service in Colombia, during a period from February 2019 to November 2021. Sociodemographic, clinical and surgical variables were described. 6 cases are described, 4 from lower digestive tract and 2 from upper digestive tract. 83% were men; the mean age was 51.8 years (+/-17.5). The indication for E-VAC was colorectal anastomotic fistula in 66%; the most frequent anatomical location was near the anal region (66%), less frequently at the level of the cardia (16%) and esophagus (16%). The size of the defect was described between 20 and 80% in patients undergoing E-VAC therapy, with an average hospitalization length of stay of 22.5 days, with an average number of exchanges of seven per patient. Anastomotic leaks and fistulas are potentially fatal complications in gastrointestinal surgery. E-VAC therapy has shown to be effective and safe, promoting defect closure and drainage of collections present, also decreasing the length of hospital stay.

Impact of detectable monoclonal protein at diagnosis on outcomes in marginal zone lymphoma: a multicenter cohort study.

Given the paucity of data surrounding the prognostic relevance of monoclonal paraprotein (M-protein) in marginal zone lymphoma (MZL), we sought to evaluate the impact of detecting M-protein at diagnosis on outcomes in patients with MZL in a large retrospective cohort. The study included 547 patients receiving first-line therapy for MZL. M-protein was detectable at diagnosis in 173 (32%) patients. There was no significant difference in the time from diagnosis to initiation of any therapy (systemic and local) between the M-protein and no M-protein groups. Patients with M-protein at diagnosis had significantly inferior progression-free survival (PFS) compared with those without M-protein at diagnosis. After adjusting for factors associated with inferior PFS in univariate models, presence of M-protein remained significantly associated with inferior PFS (hazard ratio, 1.74; 95% confidence interval, 1.20-2.54; P = .004). We observed no significant difference in the PFS based on the type or quantity of M-protein at diagnosis. There were differential outcomes in PFS based on the first-line therapy in patients with M-protein at diagnosis, in that, those receiving immunochemotherapy had better outcomes compared with those receiving rituximab monotherapy. The cumulative incidence of relapse in stage 1 disease among the recipients of local therapy was higher in the presence of M-protein; however, this did not reach statistical significance. We found that M-protein at diagnosis was associated with a higher risk of histologic transformation. Because the PFS difference related to presence of M-protein was not observed in patients receiving bendamustine and rituximab, immunochemotherapy may be a preferred approach over rituximab monotherapy in this group and needs to be explored further.

The Democratization of Hematology-Oncology Medical Education during the COVID-19 Pandemic.

Like many other aspects of hematology-oncology training, medical education experienced rapid changes throughout the COVID-19 pandemic that continue until today. We discuss some of the most transformative areas within medical education, including, but not limited to, educational philosophy; use of virtual resources; inter-institutional connections, shifts in clinical training; changes in recruitment practice; and attention to equity and diversity. Moreover, we add our own experiences to complement the limited literature addressing these topics. We conclude by highlighting some of the benefits of this unprecedented transformation in democratizing medical education that we hope endure beyond the pandemic.

Multimodal Endoscopic Management of Esophageal Perforations as a Complication of Peroral Endoscopic Myotomy for a Zenker's Diverticulum.

Zenker's diverticulum develops because of a weakness in Killian's triangle, leading to a mucosal and submucosal herniation. Its treatment has evolved from morbid surgical interventions to safer endoscopic techniques such as peroral endoscopic myotomy (Z-POEM). Despite being a safe technique, Z-POEM is not free of complications such as perforations, bleeding, pneumoperitoneum, and pneumothorax, for which new endoscopic techniques have been developed. We present the case of a 53-year-old man taken to a Z-POEM who postoperatively presented dehiscence of the mucosotomy and a mediastinal collection, managed with a vacuum-assisted endoscopic closure device.

Impact of early relapse within 24 months after first-line systemic therapy (POD24) on outcomes in patients with marginal zone lymphoma: A US multisite study.

Progression of disease within 24 months (POD24) from diagnosis in marginal zone lymphoma (MZL) was shown to portend poor outcomes in prior studies. However, many patients with MZL do not require immediate therapy, and the time from diagnosis-to-treatment interval can be highly variable with no universal criteria to initiate systemic therapy. Hence, we sought to evaluate the prognostic relevance of early relapse or progression within 24 months from systemic therapy initiation in a large US cohort. The primary objective was to evaluate the overall survival (OS) in the two groups. The secondary objective included the evaluation of factors predictive of POD24 and the assessment of cumulative incidence of histologic transformation (HT) in POD24 versus non-POD24 groups. The study included 524 patients with 143 (27%) in POD24 and 381 (73%) in non-POD24 groups. Patients with POD24 had inferior OS compared to those without POD24, regardless of the type of systemic therapy received (rituximab monotherapy or immunochemotherapy) at diagnosis. After adjusting for factors associated with inferior OS in the univariate Cox model, POD24 remained associated with significantly inferior OS (HR = 2.50, 95% CI = 1.53-4.09, p = 0.0003) in multivariable analysis. The presence of monoclonal protein at diagnosis and those who received first-line rituximab monotherapy had higher odds of POD24 on logistic regression analysis. Patients with POD24 had a significantly higher risk for HT compared to those without POD24. POD24 in MZL might be associated with adverse biology and could be used as an additional information point in clinical trials and investigated as a marker for worse prognosis.

Terapia E-VAC como tratamiento de complicaciones en cirugía gastrointestinal en centro de referencia de gastroenterología en Colombia: Serie de casos

Las fístulas y dehiscencias anastomóticas postoperatorias gastrointestinales se presentan de forma frecuente y muchas son manejadas quirúrgicamente, sin embargo, las intervenciones endoscópicas han mostrado mejorar desenlaces de curación y tiempo de estancia hospitalaria. Se describe la experiencia de la terapia de cierre asistida por vacío (E-VAC), en el manejo de fístulas y dehiscencias anastomóticas postoperatorias, en un centro de referencia gastrointestinal en Colombia. Se realizó un estudio serie de casos en pacientes con dehiscencia de anastomosis y fístula a diferentes niveles del tracto digestivo, tratados mediante E-VAC, por el servicio de gastroenterología de la clínica universitaria Colombia, en Bogotá, durante un periodo comprendido de febrero 2019 y noviembre 2021. Se describieron variables sociodemográficas, clínicas y quirúrgicas. Se describen 6 casos, 4 de tracto digestivo inferior y 2 de tracto digestivo superior. El 83% fueron hombres, la edad media fue de 51,8 años (+/-17,5). La indicación de E-VAC fue fístula anastomótica colorrectal en el 66%, siendo la ubicación anatómica más frecuente la anastomosis colorrectal (66%), con menor frecuencia a nivel de los cardias (16%) y esófago (16%). El tamaño del defecto se describió entre el 20 y el 80% en pacientes sometidos a terapia E-VAC, siendo el tiempo promedio de hospitalización 22.5 días con un número de recambios promedio de siete por paciente. Las fugas y fístulas anastomóticas son complicaciones potencialmente mortales en pacientes llevados a intervenciones quirúrgicas gastrointestinales, en las que la terapia E-VAC ha mostrado ser eficaz y segura, promoviendo el cierre del defecto y el drenaje de colecciones presentes, igualmente disminuyendo el tiempo de estancia hospitalaria.

Gastrointestinal postoperative anastomotic leaks and fistulas occur frequently and many are managed surgically; however, endoscopic interventions have shown to improve healing outcomes and length of hospital stay. The experience of vacuum-assisted closure therapy (E-VAC) is described, in complications such as fistulasand postoperative anastomotic leaks, in a gastrointestinal reference center in Colombia. A case series study was carried out in patients with anastomotic leaks and fistulasat different levels of the digestive tract, treated by E-VAC, by the Gastroenterology Service in Colombia, during a period from February 2019 to November 2021. Sociodemographic, clinical and surgical variables were described. 6 cases are described, 4 from lower digestive tract and 2 from upper digestive tract. 83% were men; the mean age was 51.8 years (+/-17.5). The indication for E-VAC was colorectal anastomotic fistula in 66%; the most frequent anatomical location was near the anal region (66%), less frequently at the level of the cardia (16%) and esophagus (16%). The size of the defect was described between 20 and 80% in patients undergoing E-VAC therapy, with an average hospitalization length of stay of 22.5 days, with an average number of exchanges of seven per patient. Anastomotic leaks and fistulasare potentially fatal complications in gastrointestinal surgery. E-VAC therapy has shown to be effective and safe, promoting defect closure and drainage of collections present, also decreasing the length of hospital stay.

Protein-metabolite interactomics of carbohydrate metabolism reveal regulation of lactate dehydrogenase.

Metabolic networks are interconnected and influence diverse cellular processes. The protein-metabolite interactions that mediate these networks are frequently low affinity and challenging to systematically discover. We developed mass spectrometry integrated with equilibrium dialysis for the discovery of allostery systematically (MIDAS) to identify such interactions. Analysis of 33 enzymes from human carbohydrate metabolism identified 830 protein-metabolite interactions, including known regulators, substrates, and products as well as previously unreported interactions. We functionally validated a subset of interactions, including the isoform-specific inhibition of lactate dehydrogenase by long-chain acyl-coenzyme A. Cell treatment with fatty acids caused a loss of pyruvate-lactate interconversion dependent on lactate dehydrogenase isoform expression. These protein-metabolite interactions may contribute to the dynamic, tissue-specific metabolic flexibility that enables growth and survival in an ever-changing nutrient environment.

Digital marketing of commercial breastmilk substitutes and baby foods: strategies, and recommendations for its regulation in Mexico.

BACKGROUND: Parents are exposed to breastmilk substitutes and baby foods marketing on the internet and social media, which hinders adequate breastfeeding and complementary feeding. This study identifies digital marketing strategies for breastmilk substitutes, specifically commercial milk formula and baby foods used by the industry to influence infant and young children's feeding practices in Mexico and proposes regulatory recommendations that can be useful for similar countries. METHODS: Qualitative study based on the CLICK monitoring framework developed by the World Health Organization, adapted for digital marketing of commercial milk formula and baby foods. Semi-structured interviews (n = 53) with key actors were conducted between November 2020 and March 2021, and used grounded theory for the analysis and interpretation with the MAXQDA 20 software. RESULTS: Commercial milk formula and baby food companies use digital media to contact and persuade parents to use their products by sending electronic newsletters with advertising. Companies hire influencers to market their products because there is no regulation prohibiting the advertisement of breastmilk substitutes on social media, and promote formula among health professionals inviting them to participate in sponsored webinars on infant nutrition, ignoring conflict of interest and the International Code of Marketing of Breastmilk Substitutes. Parents trust formula and baby food advertisements, which use emotional messages and health and nutrition claims to encourage their consumption. Health professionals consider that claims contribute to the indiscriminate use of formula, and some actors propose the use of plain packaging for these products. CONCLUSIONS: Breastmilk substitutes companies promote their products in digital media using unethical strategies that fail to comply with the International Code of Marketing of Breastmilk Substitutes. They generate strong conflicts of interest with health professionals, taking advantage of legal framework gaps and the lack of monitoring and effective sanctions for non-compliers. Updating the legal framework and monitoring compliance, including digital media, is urgently needed to protect children's right to breastfeeding, healthy nutrition and life, and the rights of women to health and informed decision-making.

Carfilzomib combined with rituximab, ifosfamide, carboplatin, and etoposide for relapsed or refractory DLBCL.

The CORAL study highlighted the need to develop novel salvage regimens in relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) previously treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. Carfilzomib (CFZ) can overcome rituximab chemotherapy resistance in lymphoma preclinical models by targeting the ubiquitin-proteasome system. We conducted an investigator initiated, single-center, open-label, prospective phase 1 study evaluating the safety and efficacy of CFZ in combination with rituximab, ifosfamide, carboplatin, and etoposide (C-R-ICE) in high-dose chemotherapy with autologous stem cell transplant (HDC-ASCT) eligible patients with R/R DLBCL (NCT01959698). In the dose-escalation phase, 18 patients were enrolled at 6 dose levels with no dose-limiting toxicities noted. CFZ 45 mg/m2 was selected as the recommended dose for expansion. Eleven additional patients were enrolled in the dose-expansion phase. Overall response rate (ORR) was 66% (48% CR; 17% PR); 52% patients underwent HDC-ASCT. An ORR of 85% was observed in patients with nongerminal center B-cell-like (non-GCB) DLBCL compared with only 13% in those with GCB DLBCL. Median progression-free survival (PFS) was 15.2 months (5.1 months, not reached [NR]), and median overall survival (OS) was 22.6 months (6.8 months, NR). Patients with non-GCB subtype had a significantly longer PFS (NR vs 6.6 months; P = .0001) and OS (NR vs 6.6 months; P = .001) than those with GCB subtype. C-R-ICE is well tolerated in patients with R/R DLBCL with toxicities comparable to rituximab, ifosfamide, carboplatin, and etoposide therapy. Our data show that patients with non-GCB DLBCL benefit significantly from incorporating CFZ into second-line therapy and HDC-ASCT.

Health Disparities Experienced by Hispanic Americans with Multiple Myeloma: A Systematic Review.

Health disparities in multiple myeloma (MM) disproportionately affect minorities. Characterization of health disparities encountered by Hispanic Americans with MM is necessary to identify gaps and inform future strategies to eliminate them. We performed a systematic review of publications that described health disparities relevant to Hispanic Americans with MM through December 2021. We included all original studies which compared incidence, treatment, and/or outcomes of Hispanic Americans with other ethnic groups. Eight hundred and sixty-eight articles were identified of which 22 original study articles were included in our systematic review. The number of publications varied over time with the highest number of studies (32%) published in 2021. Most of the published studies (59%) reported worse outcomes for Hispanic Americans with MM compared to other ethnic groups. There is growing evidence that Hispanic Americans with MM are facing a multitude of disparities that require immediate attention and solutions.

Digital marketing of formula and baby food negatively influences breast feeding and complementary feeding: a cross-sectional study and video recording of parental exposure in Mexico.

BACKGROUND: There is little evidence of the association between digital marketing of formula and baby food and infant and young child feeding (IYCF) practices. OBJECTIVE: Assess parents' exposure to digital marketing of formula and baby food for children <2 years and its association with the purchase and IYCF practices in Mexico. METHODS: Parents ≥18 years recruited from a market research panel completed an online survey (n=1074) and capture-on-screen (n=95) between December 2020 and January 2021. Logistic regressions were used to estimate the association between exposure to digital marketing of formula and baby foods with its purchase, motivation, consumption and IYCF practices. RESULTS: Digital marketing of formula and baby food was self-reported by 93.9% of parents in the online survey and observed by 93.7% in the capture-on-screen. Recorded ads did not comply with the International Code of Marketing of Breast-milk Substitutes. Parents who self-reported seeing a higher versus lower number of ads were less likely to exclusive breast feed (OR=0.38; 95% CI: 0.19 to 0.78), and more likely to give mixed feeding (OR=2.59; 95% CI: 1.28 to 5.21), formula (OR=1.84; 95% CI: 1.34 to 2.53), processed foods (OR=2.31; 95% CI: 1.59 to 3.32) and sugary drinks (OR=1.66; 95% CI: 1.09 to 2.54). Higher exposure to ads was associated with a higher chance of purchasing products motivated by nutritional (OR=2.1; 95% CI: 1.32 to 3.28) and organic claims (OR=2.1; 95% CI: 1.21 to 3.72). CONCLUSIONS: Digital marketing of formula and baby food may negatively influence IYCF and should be regulated to ensure children's nutrition and health.

Factores de riesgo para complicaciones en pacientes con tuberculosis en una institución de tercer nivel de la ciudad de Bogotá / Risk factors for complications in tuberculosis patients in a third-level institution in Bogotá city

Introducción: la tuberculosis es considerada como un problema de salud pública a nivel mundial, siendo la decimotercera causa de muerte y la enfermedad infecciosa más mortífera detrás del COVID-19 y por encima de la infección por VIH, llegando a un total de 1.5 millones de muertes en el 2020. Colombia es el quinto país de la región con mayor carga de casos de tuberculosis, reportándose en el Programa Nacional de Tuberculosis un total de 13.037 casos preliminares en el 2020, representando una importante carga para el Sistema General de Seguridad Social en Salud. Material y métodos: se realizó un estudio observacional de corte retrospectivo con una población de 130 pacientes con diagnóstico de tuberculosis en una institución de tercer nivel en la ciudad de Bogotá, con el fin de identificar posibles factores de riesgo asociados al desarrollo de complicaciones en estos pacientes. Resultados y discusión: en el grupo total encontramos que la presencia de desnutrición es un factor de riesgo independiente para presentar complicaciones asociadas a la infección por tuberculosis; mediante análisis de regresión condicionada por método exacto se identifica un HR de 2.53 [1.008;6.378] (p 0.002) y HR ajustado de 1.47 [0.400-2.556] (p 0.007). El resto de condiciones no presentaron asociación estadísticamente significativa con el desarrollo de complicaciones en pacientes con diagnóstico de tuberculosis. Conclusiones: en los pacientes con diagnóstico de tuberculosis que asistieron al hospital Santa Clara entre 2017 y 2018, encontramos que un estado nutricional inadecuado tuvo una asociación significativa a la presencia de complicaciones relacionadas con infección por tuberculosis. Otros factores como el nivel de educación, estrato socioeconómico o la presencia de comorbilidades no demostraron una influencia significativa en el objetivo del estudio.

Introduction: Tuberculosis is considered a public health problem worldwide, being the thirteenth cause of death and the deadliest infectious disease behind COVID-19 and above HIV infection, reaching a total of 1, 5 million deaths in 2020. Colombia is the fifth country in the region with the highest burden of tuberculosis cases, reporting a total of 13,037 preliminary cases in 2020 in the National Tuberculosis Program, representing a significant burden for the General System of Social Security in Health. Materials and methods: A retrospective observational study was carried out with a population of 130 patients diagnosed with tuberculosis in a third level institution at Bogotá city, to identify factors associated with the development of complications in tuberculosis patients. Results and discussion: In the total group, the presence of malnutrition is found to be an independent risk factor for tuberculosis complications by means of a conditioned regression analysis using the exact method we found an OR of 2.53 [1.008;6.378] (p 0.00202) and adjusted OR of 1.47 [0.400-2.556] (p 0.007), neither of the other conditions can't be associated with the presence of complications in patients diagnosed with tuberculosis. Conclusions: In patients diagnosed with tuberculosis who attended the Santa Clara hospital between 2017 and 2018, we found that an inadequate nutritional status is associated with the presence of major complications. Other factors such as level of education, socioeconomic status or the presence of comorbidities do not show a significant influence on the objective of the study.

Impairment of glutamate homeostasis in the nucleus accumbens core underpins cross-sensitization to cocaine following chronic restraint stress.

Though the facilitating influence of stress on drug abuse is well documented, the mechanisms underlying this interaction have yet to be fully elucidated. The present study explores the neurobiological mechanisms underpinning the sensitized response to the psychomotor-stimulating effects of cocaine following chronic restraint stress (CRS), emphasizing the differential contribution of both subcompartments of the nucleus accumbens (NA), the core (NAcore) and shell (NAshell), to this phenomenon. Adult male Wistar rats were restrained for 2 h/day for 7 days and, 2 weeks after the last stress exposure (day 21), all animals were randomly assigned to behavioral, biochemical or neurochemical tests. Our results demonstrated that the enduring CRS-induced increase in psychostimulant response to cocaine was paralleled by an increase of extracellular dopamine levels in the NAcore, but not the NAshell, greater than that observed in the non-stress group. Furthermore, we found that CRS induced an impairment of glutamate homeostasis in the NAcore, but not the NAshell. Its hallmarks were increased basal extracellular glutamate concentrations driven by a CRS-induced downregulation of GLT-1, blunted glutamate levels in response to cocaine and postsynaptic structural remodeling in pre-stressed animals. In addition, ceftriaxone, a known GLT-1 enhancer, prevented the CRS-induced GLT-1 downregulation, increased basal extracellular glutamate concentrations and changes in structural plasticity in the NAcore as well as behavioral cross-sensitization to cocaine, emphasizing the biological importance of GLT-1 in the comorbidity between chronic stress exposure and drug abuse. A future perspective concerning the paramount relevance of the stress-induced disruption of glutamate homeostasis as a vulnerability factor to the development of stress and substance use disorders during early life or adulthood of descendants is provided.

The mediating role of work-family conflict in the relationship between organizational justice and work-related stress / Rol mediador del conflicto trabajo-familia en la relación entre justicia organizacional y estrés laboral

Abstract Although the effects of overall organizational justice on perceptions of work-related stress have been demonstrated in previous studies, the mechanisms underlying this relationship are not explicit. Current research suggests that supervisors who are perceived as fair enhance employees' ability to balance their work and family roles, positively impacting their stress levels. The aim of this research is to examine the mediating role of work-family conflict in the relationship between perceptions of overall organizational justice and work-related stress in a Latin-American work context; also analyze gender differences in work-family/work-family conflict. 129 workers belonging to a Chilean public institution participated and answered a self-report questionnaire. Analyses were done using bivariate correlations of Pearson, Tau-b of Kendall, Student t-test and structural equation modeling. The results showed the existence of a significant negative correlation between perceptions of overall organizational justice and work-related stress. Furthermore, this relationship was partially mediated by work-family conflict, which means, perceptions of organizational justice were directly and indirectly associated with work-related stress, through work-family conflict. With respect to the gender variable and the work-family, no significant differences were found. This study contributes empirical evidence regarding the importance of perceptions of overall organizational justice and the work-family conflict on work-related stress, and the results obtained guide the diagnosis and the design of more specific models of prevention and intervention from the perspective of occupational health psychology.

Resumen Si bien los efectos de las percepciones de justicia organizacional global sobre las percepciones de estrés laboral han sido demostrados en estudios previos, los mecanismos que subyacen a esta relación no resultan explícitos. La investigación actual plantea que las jefaturas percibidas como más justas potencian la capacidad del trabajador para conciliar sus roles laborales y familiares, impactando positivamente sus niveles de estrés. El objetivo de este estudio es analizar, en un contexto laboral latinoamericano, el rol mediador del conflicto trabajo-familia en la relación entre las percepciones de justicia organizacional global y estrés laboral; y analizar diferencias entre hombres y mujeres respecto al conflicto trabajo-familia. Participaron 129 trabajadores pertenecientes a una institución pública chilena, quienes contestaron un cuestionario de autoreporte. Se efectuaron correlaciones bivariadas de Pearson, Tau-b de Kendall, prueba t de Student y modelamiento de ecuaciones estructurales. Los resultados mostraron la existencia de una correlación negativa y significativa entre las percepciones de justicia organizacional global y el estrés laboral. Además, esta relación estuvo mediada parcialmente por el conflicto trabajo-familia, es decir, las percepciones de justicia organizacional se asociaron de manera directa e indirecta al estrés laboral, a través del conflicto trabajo-familia. Respecto de la variable género y el conflict trabajo-familia, no se encontraron diferencias significativas. Este estudio aporta evidencia empírica sobre la importancia de las percepciones de justicia organizacional global, y sus resultados orientan el diagnóstico y la elaboración de modelos de prevención e intervención más específicos desde el campo de la psicología de la salud ocupacional.