SINUSOIDAL OBSTRUCTION SYNDROME/VENO-OCCLUSIVE DISEASE AFTER UNMANIPULATED HAPLOIDENTICAL HSCT WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE: A STUDY ON BEHALF OF THE SPANISH HEMATOPOIETIC STEM CELL TRANSPLANTATION AND CELLULAR THERAPY GROUP (GETH).

BACKGROUND: Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life threatening complication after both autologous and allogeneic hematopoietic stem cell transplantation (HSCT). However, its characterization after haploidentical HSCT (haplo-HSCT) with post-transplant cyclophosphamide (PT-Cy) is scarce. OBJECTIVES: To describe characteristics and outcomes of patients with SOS/VOD after haplo-HSCT with PT-Cy. STUDY DESIGN: We conducted a retrospective study of 797 patients undergoing a haplo-HSCT with PT-Cy between 2007 and 2019 in 9 centers in Spain. SOS/VOD was defined according to modified Seattle, Baltimore or revised EBMT criteria. Severity was retrospectively graded according to revised EBMT severity criteria into 4 categories: mild, moderate, severe and very severe. RESULTS: From 797 haplo-HSCT performed, 46 patients (5.77%) were diagnosed from SOS/VOD at a median of 19 days (range 4-84) after transplant. Based on revised EBMT severity criteria, there were 4 mild (8.7%), 10 moderate (21.7%), 12 severe (26.1%) and 20 very severe (43.5%) grade SOS/VOD cases. Overall, 30 patients (65%) achieved SOS/VOD complete response, 25 (83%) of whom were treated with defibrotide. Twenty patients (43%) died before day 100 after HSCT. Death was attributed to SOS/VOD in 11 patients, and 5 patients died of other causes without resolution of SOS/VOD. CONCLUSIONS: Incidence of SOS/VOD after haplo-HSCT with PT-Cy was comparable to those reported after HLA-identical HSCT series. Most of the patients developed very severe SOS/VOD according to revised EBMT severity criteria. In spite of a promising SOS/VOD CR rate (65%), 100-day mortality remained high (43%), indicating that further improvement in the management of this potentially fatal complication is needed.

DNA methylation profiling of myelodysplastic syndromes and clinical response to azacitidine: A multicentre retrospective study.

Real-world data have revealed that a substantial portion of patients with myelodysplastic syndromes (MDS) does not respond to epigenetic therapy with hypomethylating agents (HMAs). The cellular and molecular reasons for this resistance to the demethylating agent and biomarkers that would be able to predict the treatment refractoriness are largely unknown. In this study, we shed light on this enigma by characterizing the epigenomic profiles of patients with MDS treated with azacitidine. Our approach provides a comprehensive view of the evolving DNA methylation architecture of the disease and holds great potential for advancing our understanding of MDS treatment responses to HMAs.

Relevance of infections on the outcomes of patients with myelodysplastic syndromes, chronic myelomonocytic leukemia, and acute myeloid leukemia treated with hypomethylating agents: a cohort study from the GESMD.

Background: The consequences of infectious toxicity of hypomethylating agents (HMAs) on overall survival (OS) of patients diagnosed with high-risk myeloid neoplasms have not been thoroughly investigated. Objectives: We aimed to evaluate whether infectious events (IEs) negatively influenced the results of HMA treatment in a real-world setting. Design: Observational study. Methods: We obtained data from 412 non-selected consecutive patients from 23 Spanish hospitals who were diagnosed with high-risk myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia and were treated with HMA. HMAs received after chemotherapy or stem cell transplant were excluded. All IEs were recorded. Outcomes included OS, modifications to the pre-planned treatment, incidence and characteristics of IEs, hospitalization, red blood cell transfusions, and factors associated with infection. Results: The rate of infection was 1.2 per patient/year. Next-cycle delay (p = 0.001) and hospitalizations (p = 0.001) were significantly influenced by IEs. Transfusion requirements during each cycle were significantly higher after infection compared with cycles without infection (coefficient = 1.55 [95% confidence interval (CI) = 1.26-1.84], p < 0.001). The median number of cycles was lower in patients experiencing any infection during the first four cycles (5 [3-8] versu 8 [5-16], p < 0.001). In the multivariable analysis, factors associated with lower OS were having any infection during the first four cycles (hazard ratio (HR) = 1.43 [95% CI = 1.09-1.88], p = 0.01), bone marrow blasts ⩾30% (HR = 2.13 [95% CI = 1.14-3.96], p = 0.01), adverse cytogenetics (HR = 1.70 [95% CI = 1.30-2.24], p < 0.001), and platelet count <50 × 109/l (HR = 1.69 [95% CI = 1.3-2.2], p < 0.001). BM blasts >20% (HR = 1.57 [95% CI = 1.19-2.01], p < 0.001) and adverse cytogenetics (HR = 1.7 [95% CI = 1.35-2.14], p < 0.001) were associated with infection, whereas hemoglobin >9 g/dl (HR = 0.65 [95% CI = 0.51-0.82], p < 0.001) and higher platelet count (HR = 0.997 [95% CI = 0.996-0.998], p = 0.016) protected from it. Conclusion: HMA infectious toxicity worsens OS, hinders the adherence to antineoplastic treatment and results in significant morbidity. Preventive strategies are fundamental in vulnerable patients.

Impact of risk scores in outcome of patients with myeloid neoplasms after allogeneic stem cell transplant / Impacto de las puntaciones del riesgo en los resultados de los pacientes con neoplasias mieloides tras el trasplante alogénico de células madre

Background:The main causes of failure of allogeneic hematopoietic stem cell transplantation (allo-transplant) in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) are relapse and transplant-related mortality. Different scores have been designed to predict the prognosis of these patients. The objective of this study was to assess which score or combination has better outcome predictive capacity.Methods:Retrospective analysis of patients with AML and MDS who received a first peripheral blood allo-transplant in a single center, between December 2001 and October 2019. Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), European Group for Blood and Marrow Transplantation (EBMT) and Disease Risk Index (DRI) scores were calculated. For each score and for the HCT-CI/DRI and HCT-CI/EBMT combinations, overall survival (OS), cumulative incidence of relapse (CIR), non-relapse-related mortality (NRM), and graft versus host disease-free relapse-free survival (GRFS) were analyzed.Results:175 patients were evaluated. With a median (range) follow-up of 3.96 (0.32–17.22) years, the 5-year probabilities (95% CI) of OS, CIR, NRM, and GRFS were 36% (28%–44%), 28% (21%–35%), 38% (30%–46%) and 24% (17%–31%), respectively. For OS, only the DRI score selected two groups with statistically significant differences (DRI 0–1: 41% vs. DRI ≥2: 24%; p=0.011). The combination of DRI 0–1 and HCT-CI 0–2 showed OS probabilities of 45% vs. 26% for those with DRI 0–1 and HCT-CI ≥3; p=0.041.Conclusions:In patients with AML and MDS submitted to allo-transplant, the combination of HCT-CI and DRI scores provided the best stratification for OS. (AU)

Antecedentes:Las principales causas de fallo del trasplante alogénico de células madre hematopoyéticas (alotrasplante) en pacientes con leucemia mieloide aguda (LMA) y síndromes mielodisplásicos (SMD) son las recaídas y la mortalidad debida al trasplante. Se han diseñado diferentes puntuaciones para predecir el pronóstico de dichos pacientes. El objetivo de este estudio fue evaluar qué puntuación o combinación tiene la mejor capacidad predictiva del resultado.Métodos:Análisis retrospectivo de pacientes con LMA y SMD que recibieron un primer alotrasplante de sangre periférica en un único centro, entre diciembre de 2001 y octubre de 2019. Se calcularon las puntuaciones del Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), del European Group for Blood and Marrow Transplantation (EBMT) y del Disease Risk Index (DRI). Para cada puntuación y para las combinaciones HCT-CI/DRI y HCT-CI/EBMT se analizaron la supervivencia global (SG), la incidencia acumulada de recaídas (CIR), la mortalidad no relativa a las recaídas (NRM) y la supervivencia libre de recaídas y libre de enfermedad de injerto versus huésped (GRFS).Resultados:Se evaluaron 175 pacientes. Con un seguimiento medio (rango) de 3,96 (0,32-17,22) años, las probabilidades a 5años (IC95%) de SG, CIR, NRM y GRFS fueron del 36% (28-44), del 28% (21-35), del 38% (30-46) y del 24% (17-31), respectivamente. Para la SG, solo la puntuación DRI seleccionó dos grupos con diferencias estadísticamente significativas (DRI 0-1: 41% vs. DRI≥2: 24%; p=0,011). La combinación de DRI 0-1 y HCT-CI 0-2 reflejó probabilidades de SG del 45% vs. 26% para los pacientes con DRI 0-1 y HCT-CI≥3 (p=0,041).Conclusiones:En los pacientes con LMA y SMD sometidos a alotrasplante la combinación de las puntuaciones HCT-CI y DRI proporcionó la mejor estratificación para la SG. (AU)

Impact of risk scores in outcome of patients with myeloid neoplasms after allogeneic stem cell transplant.

BACKGROUND: The main causes of failure of allogeneic hematopoietic stem cell transplantation (allo-transplant) in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) are relapse and transplant-related mortality. Different scores have been designed to predict the prognosis of these patients. The objective of this study was to assess which score or combination has better outcome predictive capacity. METHODS: Retrospective analysis of patients with AML and MDS who received a first peripheral blood allo-transplant in a single center, between December 2001 and October 2019. Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), European Group for Blood and Marrow Transplantation (EBMT) and Disease Risk Index (DRI) scores were calculated. For each score and for the HCT-CI/DRI and HCT-CI/EBMT combinations, overall survival (OS), cumulative incidence of relapse (CIR), non-relapse-related mortality (NRM), and graft versus host disease-free relapse-free survival (GRFS) were analyzed. RESULTS: 175 patients were evaluated. With a median (range) follow-up of 3.96 (0.32-17.22) years, the 5-year probabilities (95% CI) of OS, CIR, NRM, and GRFS were 36% (28%-44%), 28% (21%-35%), 38% (30%-46%) and 24% (17%-31%), respectively. For OS, only the DRI score selected two groups with statistically significant differences (DRI 0-1: 41% vs. DRI ≥2: 24%; p=0.011). The combination of DRI 0-1 and HCT-CI 0-2 showed OS probabilities of 45% vs. 26% for those with DRI 0-1 and HCT-CI ≥3; p=0.041. CONCLUSIONS: In patients with AML and MDS submitted to allo-transplant, the combination of HCT-CI and DRI scores provided the best stratification for OS.

Estudio prospectivo del seguimiento de pacientes largos supervivientes a un trasplante alogénico de progenitores hematopoyéticos / Prospective follow-up of adult long-term survivors of allogeneic haematopoietic stem cell transplantation

Fundamento y objetivo: Los pacientes que sobreviven más allá de 2 años del trasplante de progenitores hematopoyéticos (TPH), tienen un riesgo aumentado de complicaciones a largo plazo, que tienen impacto en su supervivencia y calidad de vida. El objetivo de este estudio fue diseñar y aplicar un protocolo de seguimiento a largo plazo para detectar necesidades no cubiertas y tratar precozmente dichas complicaciones.Pacientes y métodoA los supervivientes más allá de 2 años del TPH alogénico (aloTPH) se aplicó una sistemática de estudio para detectar y tratar complicaciones y problemas a largo plazo dentro de una unidad funcional interdisciplinar.ResultadosTreinta y seis (36%) de los 99 pacientes incluidos, requirieron de intervención en alguno de los factores de riesgo cardiovascular mediante educación sanitaria o administración de fármacos antihipertensivos e hipolipemiantes. Nueve (25%) de 36 pacientes requirieron aporte de calcio y vitamina D. Se detectó una baja reincorporación de las mujeres a los protocolos de detección de neoplasias ginecológicas, y una baja adherencia al seguimiento odontológico tras el aloTPH.ConclusiónEl seguimiento de los largos supervivientes a un aloTPH en una unidad multidisciplinaria permitió detectar necesidades no cubiertas, que afectaron especialmente al riego cardiovascular, metabolismo óseo, prevención del cáncer y control odontológico. (AU)

Background and objective: Patients who survive beyond two years after haematopoietic stem cell transplantation (HSCT) have an increased risk of long-term complications, which impact on their survival and quality of life. The aim of this study was to design and apply a long-term follow-up protocol to detect unmet needs and treat these complications early.Patients and methodA prospective study to detect and treat complications and long-term problems within an interdisciplinary functional unit was applied to survivors beyond 2 years of allogeneic HSCT (alloHSCT).ResultsThirty-six (36%) of the 99 patients included, required intervention in a cardiovascular risk factor by health education or antihypertensive and lipid-lowering drugs. Nine of 36 (25%) patients required calcium and vitamin D intake. Low inclusion of women in gynaecological neoplasm detection protocols was detected, as well as a low adherence to dental follow-up after alloHSCT.ConclusionThe follow-up of long-term survivors after alloHSCT in a multidisciplinary unit allowed unmet needs to be detected and controlled, especially in cardiovascular risk, bone metabolism, cancer prevention, and dental control. (AU)

How to modulate the formation of negative volatile sulfur compounds during wine fermentation?

Beyond the production of positive aromas during alcoholic fermentation, Saccharomyces cerevisiae metabolism also results in the formation of volatile compounds detrimental to wine quality, including a wide range of volatile sulfur compounds (VSCs). The formation of these VSCs during wine fermentation is strongly variable and depends on biological and environmental factors. First, the comparison of the VSCs profile of 22 S. cerevisiae strains provided a comprehensive overview of the intra-species diversity in VSCs production: according to their genetic background, strains synthetized from 1 to 6 different sulfur molecules, in a 1- to 30-fold concentration range. The impact of fermentation parameters on VSCs production was then investigated. We identified yeast assimilable nitrogen, cysteine, methionine and pantothenic acid contents - but not SO2 content - as the main factors modulating VSCs production. In particular, ethylthioacetate and all the VSCs deriving from methionine catabolism displayed a maximal production at yeast assimilable nitrogen concentrations around 250 mg/L; pantothenic acid had a positive impact on compounds deriving from methionine catabolism through the Ehrlich pathway but a negative one on the production of thioesters. Overall, these results highlight those factors to be taken into account to modulate the formation of negative VSCs and limit their content in wines.

Adolescents with bicuspid aortic valve: Which criteria should we use for aortic dilatation?

BACKGROUND: Criteria to define aortic dilatation in bicuspid aortic valve (BAV) patients are different for children and adults. The objective of this study was to find the best reference tool to define dilation of the aortic root (AR) and the ascending aorta (AA) in BAV adolescents with an adult body surface area (BSA). METHODS: Patients recruited were ≥10-years-old with a BSA ≥1.5 m2. Three measurements of the AR and AA were compared: z-score, the BSA-indexed value (BSA-IV) and the absolute value (AV), with thresholds in +2/+3, 21 mm/m2 and 40 mm, respectively. RESULTS: 231 subjects were collected from the Pediatric REVAB database, with a median age and BSA of 14-year-old and 1.67 m2. Significant differences were reported in the AA: 109 (47%) patients had a z-score ≥2 and 67 (29%) a Z ≥ 3, but only 9 (3%) a BSA-IV ≥21 mm/m2 (p < 0.01 and p < 0.01) and 2 (0.9%) an AV ≥40 mm (p = 0.22 and p = 0.08). CONCLUSION: Our results indicate that in the AA there are a significant number of patients in which it would be recommendable changing to BSA-IV when children are older than 10-year-old and BSA ≥1.5 m2. Regarding the AR, criteria for dilatation seems not to be influenced by the reference chosen.

Outcomes of patients with chronic myelomonocytic leukaemia treated with non-curative therapies: a retrospective cohort study.

BACKGROUND: Approval of hypomethylating agents in patients with chronic myelomonocytic leukaemia is based on trials done in patients with myelodysplastic syndromes. We aimed to investigate whether hypomethylating agents provide a benefit in subgroups of patients with chronic myelomonocytic leukaemia compared with other treatments. METHODS: For this retrospective cohort study, data were retrieved between Nov 30, 2017, and Jan 5, 2019, from 38 centres in the USA and Europe. We included non-selected, consecutive patients diagnosed with chronic myelomonocytic leukaemia, who received chronic myelomonocytic leukaemia-directed therapy. Patients with acute myeloid leukaemia according to 2016 WHO criteria at initial diagnosis (ie, ≥20% blasts in the bone marrow or peripheral blood) or with unavailability of treatment data were excluded. Outcomes assessed included overall survival, time to next treatment, and time to transformation to acute myeloid leukaemia. Analyses were adjusted by age, sex, platelet count, and Chronic myelomonocytic leukaemia-Specific Prognostic Scoring System (CPSS). Patients were grouped by first received treatment with either hydroxyurea, hypomethylating agents, or intensive chemotherapy, and stratified by risk according to blast count, French-American-British subtype, CPSS, WHO 2016 subtype, and the eligibility criteria of the DACOTA trial (NCT02214407). FINDINGS: 949 patients diagnosed with chronic myelomonocytic leukaemia between April 13, 1981, and Oct 26, 2018, were included. Median follow-up was 23·4 months (IQR 11·5-42·3) from diagnosis and 16·2 months (6·6-31·6) from start of first-line treatment. 412 (43%) of 949 patients received hypomethylating agents as first treatment, 391 (41%) hydroxyurea, and 83 (9%) intensive chemotherapy. Adjusted median overall survival for patients treated with hydroxyurea versus hypomethylating agents was 15·6 months (95% CI 13·1-17·3) versus 20·7 months (17·9-23·4); hazard ratio (HR) 1·39 (1·17-1·65; p=0·0002) and 14·0 months (9·8-17·2) versus 20·7 months (17·9-23·4; HR 1·55 [1·16-2·05]; p=0·0027) for those treated with intensive chemotherapy versus hypomethylating agents. In patients with myeloproliferative chronic myelomonocytic leukaemia (myeloproliferative CMML), median overall survival was 12·6 months (10·7-15·0) versus 17·6 months (14·8-21·5; HR 1·38 [1·12-1·70]; p=0·0027) for patients treated with hydroxyurea versus hypomethylating agents, and 12·3 months (8·4-16·6) versus 17·6 months (14·8-21·5; HR 1·44 [1·02-2·03]; p=0·040) for intensive chemotherapy versus hypomethylating agents. Hypomethylating agents did not confer an overall survival advantage for patients classified as having lower-risk disease (ie, myelodysplastic chronic myelomonocytic leukaemia with <10% blasts, CMML-0, or lower-risk CPSS). INTERPRETATION: These data suggest hypomethylating agents as the preferred therapy for patients with higher-risk chronic myelomonocytic leukaemia and those with myeloproliferative CMML. Our findings also suggest that CPSS is a valuable tool to identify patients who are most likely to benefit from hypomethylating agents. Further evidence from prospective cohorts would be desirable. FUNDING: The Austrian Group for Medical Tumor Therapy.

Post-transplant cyclophosphamide for GVHD prophylaxis compared to ATG-based prophylaxis in unrelated donor transplantation.

Post-transplant cyclophosphamide (PTCY) effectively prevents graft-versus-host disease after unmanipulated HLA-haploidentical HSCT. The use of PTCY in the unrelated donor HSCT setting is less explored. We conducted a retrospective study of 132 consecutive patients undergoing a matched or 9/10 mismatched unrelated donor HSCT in 4 centers in Spain, 60 with anti-thymocyte globulin (ATG)-based prophylaxis combined with MTX-CsA, and 72 using a PTCY-based regimen. Peripheral blood stem cells were used as graft in most patients (111 patients, 84%); mMUD donors were balanced between groups. Cumulative incidences of grades II-IV and III-IV acute GVHD at 100 days were lower in the PTCy group (46% vs. 67%, p = 0.008; 3% vs. 34%, p = 0.003), without statistically significant differences in the 2-year cumulative incidence of chronic moderate-severe GVHD. At 2 years, no significant differences were observed in overall survival, event-free survival, cumulative incidence of relapse, and non-relapse mortality. GVHD was the most frequent cause of NRM in the ATG group. No differences were observed between groups in the composite endpoint of GVHD-free and relapse-free survival. In this study, PTCy combined with additional immunosuppression after MUD/mMUD HSCT showed a reduction of aGVHD rate with safety results comparable to those obtained with the ATG-based prophylaxis.

Prospective follow-up of adult long-term survivors of allogeneic haematopoietic stem cell transplantation. / Estudio prospectivo del seguimiento de pacientes largos supervivientes a un trasplante alogénico de progenitores hematopoyéticos.

BACKGROUND AND OBJECTIVE: Patients who survive beyond two years after haematopoietic stem cell transplantation (HSCT) have an increased risk of long-term complications, which impact on their survival and quality of life. The aim of this study was to design and apply a long-term follow-up protocol to detect unmet needs and treat these complications early. PATIENTS AND METHOD: A prospective study to detect and treat complications and long-term problems within an interdisciplinary functional unit was applied to survivors beyond 2 years of allogeneic HSCT (alloHSCT). RESULTS: Thirty-six (36%) of the 99 patients included, required intervention in a cardiovascular risk factor by health education or antihypertensive and lipid-lowering drugs. Nine of 36 (25%) patients required calcium and vitamin D intake. Low inclusion of women in gynaecological neoplasm detection protocols was detected, as well as a low adherence to dental follow-up after alloHSCT. CONCLUSION: The follow-up of long-term survivors after alloHSCT in a multidisciplinary unit allowed unmet needs to be detected and controlled, especially in cardiovascular risk, bone metabolism, cancer prevention, and dental control.

Sequential recruitment of the mRNA decay machinery to the iron-regulated protein Cth2 in Saccharomyces cerevisiae.

Post-transcriptional factors importantly contribute to the rapid and coordinated expression of the multiple genes required for the adaptation of living organisms to environmental stresses. In the model eukaryote Saccharomyces cerevisiae, a conserved mRNA-binding protein, known as Cth2, modulates the metabolic response to iron deficiency. Cth2 is a tandem zinc-finger (TZF)-containing protein that co-transcriptionally binds to adenine/uracil-rich elements (ARE) present in the 3'-untranslated region of iron-related mRNAs to promote their turnover. The nuclear binding of Cth2 to mRNAs via its TZFs is indispensable for its export to the cytoplasm. Although Cth2 nucleocytoplasmic transport is essential for its regulatory function, little is known about the recruitment of the mRNA degradation machinery. Here, we investigate the sequential assembly of mRNA decay factors during Cth2 shuttling. By using an enzymatic in vivo proximity assay called M-track, we show that Cth2 associates to the RNA helicase Dhh1 and the deadenylase Pop2/Caf1 before binding to its target mRNAs. The recruitment of Dhh1 to Cth2 requires the integrity of the Ccr4-Pop2 deadenylase complex, whereas the interaction between Cth2 and Pop2 needs Ccr4 but not Dhh1. M-track assays also show that Cth2-binding to ARE-containing mRNAs is necessary for the interaction between Cth2 and the exonuclease Xrn1. The importance of these interactions is highlighted by the specific growth defect in iron-deficient conditions displayed by cells lacking Dhh1, Pop2, Ccr4 or Xrn1. These results exemplify the stepwise process of assembly of different mRNA decay factors onto an mRNA-binding protein during the mechanism of post-transcriptional regulation.

El cine debate como recurso del aprendizaje en la enseñanza de la Psiquiatría / The film debate as a learning resource in the teaching of Psychiatry

RESUMEN Fundamento: el cine debate constituye una herramienta pedagógica de gran utilidad para el proceso enseñanza aprendizaje en Psiquiatría. Objetivo: corroborar la utilidad del cine debate como recurso del aprendizaje durante la rotación de los estudiantes de Medicina por Psiquiatría. Métodos: se realizó una investigación descriptiva con enfoque cualicuantitativo en el campo de las ciencias médicas, en el Hospital Provincial Psiquiátrico Universitario "Dr. Luis San Juan Pérez" de Villa Clara durante el segundo semestre del curso 2016-2017. Se utilizaron métodos del nivel teórico: analítico-sintético, inductivo-deductivo y sistémico-estructural; y empírico: análisis documental del programa de la asignatura y encuesta en forma de entrevista a los estudiantes, profesores, además se tuvo en cuenta criterios de especialistas. Resultados: la mayoría de los estudiantes manifestó que el cine debate constituye una vía novedosa para identificar síntomas, síndromes y entidades que no pueden ser abordadas en su totalidad durante la rotación, les desarrolló la motivación por la especialidad y se sintieron satisfechos con la profundidad de los debates e interpretaciones realizadas de cada fenómeno, creen haber fortalecido su cultura general y los valores esenciales de la profesión, además fomentaron su pasión por el cine. Los profesores y especialistas calificaron de novedoso, pertinente y oportuno la aplicación de este recurso para trabajar en los contenidos de la especialidad. Conclusiones: se implementó el cine debate como recurso del aprendizaje en la enseñanza de la Psiquiatría con resultados positivos. Los alumnos, profesores y especialistas valoraron la experiencia como adecuada y sugirieron continuar usándola en las rotaciones subsiguientes.

ABSTRACT Background: the film debate is a pedagogical tool of great utility for the teaching-learning process in Psychiatry. Objective: to corroborate the usefulness of the film debate as a learning resource during the rotation of the Medicine students by Psychiatry. Methods: a descriptive investigation was carried out with a qualitative-quantitative approach in the field of medical sciences, in "Ph.D. Luis San Juan Pérez" University Psychiatric Provincial Hospital from Villa Clara during the second semester of the 2016-2017 academic year. Methods of the theoretical level were used: analytic-synthetic, inductive-deductive and systemic-structural; and empirical ones: documentary analysis of the syllabus of the subject and survey in the form of an interview with the students, professors, in addition, criteria of specialists were taken into account. Results: the majority of the students stated that the film debate constitutes a novel way to identify symptoms, syndromes and entities that cannot be addressed in their entirety during the rotation, the motivation for the specialty was developed and they were satisfied with the depth of the debates and interpretations carried out of each phenomenon, they believe to have strengthened their general culture and the essential values of the profession, it also fostered their passion for cinema. The professors and specialists described as novel, pertinent and timely the application of this resource to work on the contents of the specialty. Conclusions: the film debate was implemented as a learning resource in the teaching of Psychiatry with positive results. The students, professors and specialists rated the experience as adequate and suggested continuing to use it in the subsequent rotations.

Dinapenia y función musculo-esquelética en los pacientes mayores de 65 años / Dynapenia and musculoskeletal function in patients over 65 years of age

Objetivo: Describir la frecuencia de dinapenia en pacientes mayores de 65 años y evaluar su relación con la función musculo-esquelética, el nivel de actividad física y variables clínicas y sociodemográficas. Diseño: Estudio observacional descriptivo. Emplazamiento: Consultas de medicina de familia. Participantes: Pacientes mayores de 65 años. Fueron seleccionados 120 pacientes, correspondiendo a una prevalencia esperada de dinapenia del 25 %, un nivel de confianza del 95 % y una precisión de ±7,8 %. Mediciones Principales: Como variable dependiente se consideró la fuerza muscular en mano dominante cuantificada mediante dinamometría hidráulica. Como variables independientes se incluyeron: función musculo-esquelética (timed get up and go), caídas en últimos 3 meses, nivel de actividad física (IPAQ), autopercepción de salud (EQ-5D), medidas antropométricas, porcentaje de masa grasa, problemas de salud y datos sociodemográficos. Resultados: El valor medio de fuerza muscular fue 32,2 kg (DE: 7,6) y 19,5 kg (DE: 5,1) en hombres y mujeres respectivamente. El 41,0 % de hombres (IC95 %: 24,3-57,7) y el 51,9 % de mujeres (IC95 %: 40,2-63,5) cumplieron criterios de dinapenia. Mediante regresión logística, las variables asociadas fueron: edad de 70 o más años (OR=3,9), estados de ansiedad o depresión (OR=2,8), personas sin estudios (OR=2,8) y mayor porcentaje de masa grasa (OR=1,1). Conclusiones: Observamos elevada prevalencia de dinapenia en mayores de 65 años, guardando relación con su situación funcional. Aunque la dinapenia no es más frecuente en sujetos obesos o con pluripatología, podrían jugar un papel los estados de ansiedad o depresión y una pobre autopercepción de salud (AU)

Objective: To describe the frequency of dynapenia in patients over 65 years of age and to evaluate its relationship with musculoskeletal function, physical activity level and clinical and sociodemographic characteristics. Design: Observational, descriptive study. Location: Family Medicine consultations. Participants: Patients over 65 years of age. A total of 120 patients were selected, corresponding to an expected prevalence of dynapenia of 25 %, a confidence level of 95 % and an accuracy of ±7.8 %. Main measurements: As a dependent variable, muscular strength in the dominant hand was quantified by hydraulic dynamometry. As independent variables, we included: musculoskeletal function (timed get up and go), falls in the last 3 months, physical activity level (IPAQ), self-perception of health status (EQ-5D), anthropometric measurements, body fat percentage, health problems, and sociodemographic characteristics. Results: The mean value of muscular strength was 32.2 kg (SD: 7.6) and 19.5 kg (SD: 5.1) in men and women respectively. 41.0% of men (95% CI: 24.3-57.7) and 51.9% of women (95% CI: 40.2-63.5) met criteria for dynapenia. Using logistic regression, the associated variables were: age of 70 years or over (OR=3.9), states of anxiety or depression (OR=2.8), people without studies (OR=2.8) and a higher percentage of fat mass (OR=1.1). Conclusion: We observed a high prevalence of dynapenia in people over 65 years of age, which is related to their functional situation. Although dynapenia is not more frequent in obese subjects or in subjects with multiple pathologies, states of anxiety or depression and poor self-perception of health may play a key role (AU)

Brain Natriuretic Propeptide as an Early Marker of Bronchopulmonary Dysplasia or Death in the Preterm Newborn.

Aim To investigate whether increased brain natriuretic propeptide (NT-proBNP) levels at 48 to 72 h of life are associated with the development of bronchopulmonary dysplasia (BPD) or death in premature neonates. Methods A retrospective study was performed in neonates born before 32 weeks' gestation or with birth weight below 1500 grams, in whom NT-proBNP determination and echocardiography were performed at 48 to 72 h of life. Associations between NT-proBNP levels and the combined outcome BPD or death were analyzed using multivariate logistic regression analysis. Results 117 neonates with mean gestational age 27.8±2.1 weeks and birth weight 949.7±267.5 grams were included. Forty (34.2%) had an outcome of BPD or death. The risk of this combined outcome was found to be 3.95-fold higher (OR 3.95; 95% CI 1.1-14.6) in neonates with NT-proBNP levels above 17800 pg/mL. Conclusion Increased NT-proBNP levels may be associated with a significant decrease in BPD-free survival in very immature newborns.

Lack of impact of human immunodeficiency virus infection on the outcome of lymphoma patients transferred to the intensive care unit.

The impact of human immunodeficiency virus (HIV) infection on the outcome of patients with acquired immunodeficiency syndrome (AIDS)-related lymphoma with life-threatening complications requiring intensive care unit (ICU) admission is not well known. The objective of this study was to compare the outcome of patients with lymphoma transferred to the ICU according to HIV infection status. The clinical characteristics, reason for ICU admission, and outcome of 48 consecutive critically ill patients with lymphoma admitted to the ICU from January 2000 to March 2010 was retrospectively analyzed, focusing on their HIV serology status. Thirty-six patients were HIV-negative and 12 patients HIV-positive. Burkitt lymphoma was more frequent in HIV-infected patients, whereas diffuse large B-cell lymphoma was more frequent in HIV-negative patients. The main acute life-threatening diseases precipitating ICU transfer were similar in both groups. Severe neutropenia was more frequent in HIV-positive than in HIV-negative patients. With a median follow-up of 53 months after ICU admission, the overall survival probabilities were 15% (95% confidence interval [CI]: 3-27%) and 17% (95% CI: 0-38%) for HIV-negative and HIV-positive patients, respectively. The 2-year survival probabilities were 34% (95% CI: 10-58%) and 40% (95% CI: 0-43%) for HIV-negative and HIV-positive patients discharged from the ICU, respectively. In this study, HIV infection did not have a negative impact on the outcome of patients with lymphoma admitted to the ICU.