Resiliencia y consumo de alcohol o tabaco en adolescentes de la zona este de Tijuana / Resilience and use of alcohol or tobacco among adolescents from the eastern area of Tijuana

Objetivo: describir las características de la resiliencia y su asociación con el consumo de alcohol y tabaco en adolescentes residentes en la zona este de Tijuana, frontera norte de México. Método: estudio descriptivo transversal cuya población fueron 7.611 adolescentes de 11 a 16 años escolarizados de la ciudad de Tijuana, Baja California. Se estimó una muestra de 663 participantes seleccionados mediante muestreo por conglomerados. Se recogieron variables sociodemográficas, de historia de consumo de tabaco y alcohol y la resiliencia (ER-14) (mín. 14 a máx. 98 p; muy baja, baja, normal, alta o muy alta). Se realizó estadística descriptiva, bivariante y modelos de regresión logística ajustados por sexo para la variable “consumo de alcohol o tabaco”. Resultados: participaron 710 adolescentes (50,7% mujeres). El 46% había consumido alcohol o tabaco en algún momento de su vida y el 27,1% en el último año (mujeres 31,5%; hombres 23,3%; p= 0,005). El 29% mostró alta resiliencia y el 25,5% muy alta resiliencia. Se obtuvo con más frecuencia alta puntuación en las afirmaciones: soy alguien en quien se puede confiar en emergencias (42,5%), siento orgullo de mis logros (41,3%), la vida tiene sentido (33,1%). Se encontró un efecto negativo de la resiliencia sobre el consumo de alcohol o tabaco alguna vez en la vida (ORa= 0,984; IC95% [0,978-0,990]) y en el último año (ORa= 0,987; IC95% [0,981-0,994]). Conclusión: a mayor resiliencia menor fue la probabilidad de consumo de alcohol o tabaco alguna vez en la vida y en el último año. Intervenciones futuras deben considerar estos resultados.(AU)

Objective: to describe the characteristics of resilience and its association with the use of alcohol and tobacco among adolescents living in Eastern Tijuana, in the Northern border of Mexico. Method: a descriptive cross-sectional study on a population of 7,611 adolescents from 11 to 16 years old, attending school in the city of Tijuana, Baja California. The sample was estimated in 633 participants, selected through cluster sampling. Sociodemographic variables were collected, their history of use of tobacco and alcohol, as well as resilience (RS-14) (minimum 14 to maximum 98 scores; very low, low, normal, high or very high). Descriptive bivariate statistics were used, as well as logistical regression models adjusted by gender for the “use of alcohol of tobacco” variable. Results: the study included 710 adolescents (50.7% were female); 46% of them had used alcohol or tobacco at some point in their lives, and 27.1% during the past year (31.5% female; 23.3% male; p= 0.005); 29% showed high resilience and 25.5% showed very high resilience. The most frequently obtained high scores were for the statements: I am someone who can be trusted in emergencies (42.5%), I feel proud of my achievements (41.3%), and Life makes sense (33.1%). A negative effect of resilience was found on alcohol and tobacco use at some point in life (ORa= 0.984; CI95% [0.978-0.990]) and during the past year (ORa= 0.987; CI95% [0.981-0.994]). Conclusion: the higher the resilience, the lower the likelihood of using alcohol or tobacco at some point in life and during the last year. Future interventions should consider these results.(AU)

A Multicenter Prospective Evaluation of the Benefits of Two Advanced Hybrid Closed-Loop Systems in Glucose Control and Patient-Reported Outcomes in a Real-world Setting.

OBJECTIVE: Advanced hybrid closed-loop systems (AHCL) have been shown to improve glycemic control and patient-reported outcomes in type 1 diabetes. The aim was to analyze the outcomes of two commercially available AHCL in real life. RESEARCH DESIGN AND METHODS: A prospective study was performed, including adolescents and adults with type 1 diabetes, AHCL naïve, from 14 centers, who initiated the use of MM780G with SmartGuard or Tandem t:slimX2 with Control-IQ. Baseline and 3-month evaluations were performed, assessing HbA1c, time in different glycemic ranges, and patient-reported outcomes. The primary outcome was the between-group time in range 70-180 mg/dL difference from beginning to end of follow-up. RESULTS: One hundred fifty participants were included, with 75 initiating each system (age: 39.9 ± 11.4 years [16-72]; 64% female; diabetes duration: 21.6 ± 11.9 years). Time in range increased from 61.53 ± 14.01% to 76.17 ± 9.48% (P < 0.001), with no between-group differences (P = 0.591). HbA1c decreased by 0.56% (95% CI 0.44%, 0.68%) (6 mmol/mol, 95% CI 5, 7) (P < 0.001), from 7.43 ± 1.07% to 6.88 ± 0.60% (58 ± 12 to 52 ± 7 mmol/mol) in the MM780G group, and from 7.14 ± 0.70% to 6.56 ± 0.53% (55 ± 8 to 48 ± 6 mmol/mol) in the Control-IQ group (both P < 0.001 to baseline, P = 0.819 between groups). No superiority of one AHCL over the other regarding fear of hypoglycemia or quality of life was found. Improvement in diabetes-related distress was higher in Control-IQ users (P = 0.012). Sleep quality was improved (PSQI: from 6.94 ± 4.06 to 6.06 ± 4.05, P = 0.004), without differences between systems. Experience with AHCL, evaluated by the INSPIRE measures, exceeded the expectations. CONCLUSIONS: The two AHCL provide significant improvement in glucose control and satisfaction, with no superiority of one AHCL over the other.

Condom use and drug consumption in migrants: a systematic review.

OBJECTIVE: To identify condom use and drug consumption in migrants, as well as the association between these variables. METHOD: A systematic search was carried out for articles published in Spanish and English (2017-2022), in PubMed, EBSCO, WEB of SCIENCE, Elsevier, Scielo, Redalyc, with eligible studies reporting on condom use and drug consumption, and their association. RESULTS: The search strategy found 147 articles with the combination of terms and other sources. After excluding articles by title, abstract, and finding that they had the study variables, eight articles were included for qualitative analysis and only three met the criteria for quantitative analysis. CONCLUSION: Drug consumption favors inconsistent condom use, increasing the risk of acquiring an STI, and can lead to other mental health issues derived from the use of these substances.

Responsabilidades de autocuidado acordes a la edad en población pediátrica con diabetes tratada con ISCI / Age-appropriate self-care responsibilities in the pediatric population with diabetes treated with CSII

Objetivo: Determinar en población infantil con Diabetes tipo 1 (DT1) en tratamiento con infusión subcutánea continua de insulina (ISCI), si asumir responsabilidades de autocuidado tras recibir un programa estructurado de educación terapéutica (PEET) se relaciona con el control metabólico y la calidad de vida (CV). Métodos: Estudio observacional, transversal. Se realizó un sub-análisis retrospectivo. Se incluyeron sujetos con DT1 (edad 9-17 años) en terapia ISCI (>1año) que habían recibido el mismo PEET al inicio de ISCI. Se registraron: grado en que asumían responsabilidades de autocuidado acordes a su edad, control metabólico, CV, nivel de conocimientos sobre diabetes y uso de funciones específicas del dispositivo. Resultados: Se incluyeron 44 pacientes. Los niños que asumieron responsabilidades de autocuidado acordes a su edad presentaron valores de hemoglobina glicada (HbA1c) significativamente menores que los niños que no las asumieron (8,0±0,7% vs. 9,2±1,1%, respectivamente, p<0,001), así como una mayor puntuación en los cuestionarios de CV y de conocimientos (CV 84,3±9,3 vs. 79,4±10,6, p<0,01; conocimientos 27,9±4,2 vs. 26,5±4,3, respectivamente, n.s). El uso de las funciones específicas de la bomba se observó principalmente en aquellos que asumieron esas responsabilidades de autocuidado presentando valores más bajos de HbA1c que aquellos niños que no las utilizaron (7,9±1,0% vs. 8,4±0,8%, p<0,05). Conclusiones: Los pacientes con DT1 en tratamiento con ISCI que asumieron responsabilidades de autocuidado de su diabetes acorde a su edad, mostraron mejor control de HbA1c y mejor CV que aquellos que no lo hicieron. Se necesitan más estudios para profundizar en el conocimiento de estos aspectos. (AU)

Objective: The aim of this study was to determine if children and adolescents with type 1 diabetes (DT1) managed with continuous subcutaneous insulin infusion (ISCI) who assume self-care responsibilities tailored to the age after a specific structured education program (PEET), present better metabolic control and quality of life (CV). Methods: A observational, cross-sectional study was conducted. A retrospective sub-analysis was performed. Subjects with DT1 (aged 9-17 years) who have been using ISCI (>1year) were included. All patients received the same structured PEET when initiating ISCI treatment. The degree of self-care age-appropriate responsibilities assumed by children was registered. Data related to metabolic control, diabetes knowledge, use of different pump features, and quality of life were also collected. Results: Forty-four patients were included. Children assuming age-appropriate self-care responsibilities had a significantly lower glycated hemoglobin (HbA1c) value compared to those children who did not take on these responsibilities (8,0±0,7% vs. 9,2±1,1%, p<0,001). as well as higher scores in the CV and knowledge questionnaires (84,3±9,3 vs. 79,4±10,6 respectively, p<0,01; knowledge 27,9±4,2 vs. 26,5±4,3, respectively, n.s). The use of specific pump features was mainly observed in those who assumed age-appropriate self-care responsibilities and showed lower HbA1c values than those children who did not take on these responsibilities (7,9±1,0% vs. 8,4±0,8%, p<0,05). Conclusion: Patients with DT1 managed with ISCI, who assumed age-appropriate responsibilities on disease self- management, showed better HbAc1 and better CV than those who did not. More studies are needed to deepen the knowledge of these topics. (AU)

Psychometric analysis of the cross-cultural Spanish version of the diabetes management questionnaire.

Evaluation of the degree of adherence to self-care among Spanish type 1 diabetes (T1DM) pediatric population lacks of a validated tool. PURPOSE: To cross-culturally adapt and determine the psychometric properties of the Spanish version of the Diabetes Management Questionnaire to assess the degree of adherence to self-care among children with T1DM. METHODS: Translation, back-translation, and patient suggestions, were considered to obtain the Spanish version (DMQ-Sp). A cross-sectional study was conducted with 323 children (aged 8-18 years) with T1DM and their parents to determine internal reliability, structural validity, and external validity. Responsiveness to change was analyzed through a prospective longitudinal study involving 102 newly diagnosed T1DM patients. Psychometrics were evaluated for the entire sample and stratified by age (8-12 and 13-18 years). RESULTS: A total of 323 children with T1DM [49.8% female; age 13.3 ± 2.8 years; 155 aged 8-12; glycated hemoglobin (HbA1c) value 7.7 ± 1.0%] answered the Spanish final version. The internal consistency Cronbach's alpha was 0.76 and intraclass correlation coefficient 0.84. Test-retest reliability was r = 0.84 (p < 0.001). Fit index of structural validity was >0.7. External validity correlated inversely with HbA1c (r = -0.39; p < 0.001). The DMQ-Sp score increased significantly after 6 months of receiving the full therapeutic education program (TEP) (baseline 57.07 ± 10.81 vs. 6 months 78.80 ± 10.31; p < 0.001). CONCLUSION: The DMQ-Sp is reliable, valid, and sensitive to change in a large sample of children (aged 8-18 years) with T1DM and their parents. PRACTICE IMPLICATIONS: DMQ-Sp can be a useful tool for diabetes teams to identify adherence to different tasks and to evaluate TEPs.

Condom use and drug consumption in migrants: a systematic review / Uso de preservativo e consumo de drogas em migrantes: revisão sistemática / Uso de condón y consumo de drogas en migrantes: revisión sistemática

ABSTRACT Objective: To identify condom use and drug consumption in migrants, as well as the association between these variables. Method: A systematic search was carried out for articles published in Spanish and English (2017-2022), in PubMed, EBSCO, WEB of SCIENCE, Elsevier, Scielo, Redalyc, with eligible studies reporting on condom use and drug consumption, and their association. Results: The search strategy found 147 articles with the combination of terms and other sources. After excluding articles by title, abstract, and finding that they had the study variables, eight articles were included for qualitative analysis and only three met the criteria for quantitative analysis. Conclusion: Drug consumption favors inconsistent condom use, increasing the risk of acquiring an STI, and can lead to other mental health issues derived from the use of these substances.

RESUMO Objetivo: Identificar o uso de preservativo e o consumo de drogas em migrantes, bem como a associação entre essas variáveis. Método: Foi realizada uma busca sistemática de artigos publicados em espanhol e inglês (2017-2022), em PubMed, EBSCO, WEB of SCIENCE, Elsevier, Scielo, Redalyc, com estudos elegíveis relatando o uso de preservativos e consumo de drogas, e sua associação. Resultados: Com a estratégia de busca foram identificados 147 artigos com a combinação de termos e outras fontes. Após eliminar os artigos por título, resumo e identificar que continham as variáveis do estudo, oito artigos foram incluídos para análise qualitativa e apenas três atenderam aos critérios para análise quantitativa. Conclusão: O consumo de drogas estimula o uso inconsistente do preservativo, o que aumenta o risco de aquisição de uma IST, além de outros problemas de saúde mental decorrentes do consumo dessas substâncias.

RESUMEN Objetivo: Identificar el uso del condón y el consumo de drogas en migrantes, así como la asociación entre estas variables. Método: Se realizó una búsqueda sistemática de artículos publicados en español e inglés (2017-2022), en PubMed, EBSCO, WEB of SCIENCE, Elsevier, Scielo, Redalyc, siendo que los estudios elegibles informaron sobre el uso del condón y el consumo de drogas, y su asociación Resultados: Con la estrategia de búsqueda se identificaron 147 artículos con la combinación de términos y de otras fuentes. Después de la eliminación de artículos por título, resumen, identificar que cuenten con las variables de estudio, se incluyeron ocho artículos para el análisis cualitativo y únicamente tres cumplieron con los criterios para el análisis cuantitativo. Conclusión: El consumo de drogas favorece el uso inconstante del condón, y esto incrementa el riesgo de adquirir alguna ITS, además de otras cuestiones de salud mental derivadas del consumo de estas sustancias.

Type 1 Diabetes Patient Experiences Before and After Transfer from a Paediatric to an Adult Hospital.

Introduction: The management of type 1 diabetes (T1D) is especially complex during adolescence when youths are transferred to adult care centres. The objectives of this qualitative study were to: a) determine the expectations of young T1D patients prior to transfer, b) evaluate the transfer process between the 2 centres, and c) evaluate the therapeutic education and care programme (TECP) in the adult centre from their point of view. Material and Methods: Opinion sampling of adolescents from 2018-2019 was performed: Phase 1: adolescents with T1D prior to transfer to the adult hospital; Phase 2: adolescents with T1D one or two years after transfer and having undergone TECP. A focus group (1.5h) and semi-structured interviews (45 min) were performed and taped, transcribed, and sent to the participants for confirmation. Date analysis was performed of the transcriptions of the focus group and interviews. Fragments were selected and meta-categories created. Results: Eleven youths accepted to participate: 7 in Phase 1, 4 repeated in Phase 2 and 4 more transferred 2 years previously were added. The meta-categories obtained were: 1) perception of the quality of care and therapeutic education in the paediatric hospital. 2) transfer to the adult hospital. 3) experience of the youths 1-2 years after transfer and having undergone TECP. The data are presented in narrative form and are supported with text fragments of the participants' discussions. Discussion and conclusions: Analysis of patients' experience complemented by clinical-educational evaluation of TECP provides understanding of the perspectives of youths on the complexity of living with a chronic disease since childhood. It also provides information regarding the factors favouring quality care and therapeutic education, the complexity of transfer from paediatric to adult care, determination of the strong and weak points and the establishment of strategies to improve the programme.

p53 knock-down and hypoxia affects glutathione peroxidase 4 antioxidant response in hepatopancreas of the white shrimp Litopenaeus vannamei.

Hypoxia (<2 mg O2/L) is one of the main environmental stressors that affects aquatic organisms, including the white shrimp (Litopenaeus vannamei). During hypoxia, reactive oxygen species (ROS) accumulation induces oxidative stress and damage to biomolecules. Redox state and ROS overproduction are modulated by the antioxidant system that is composed of several antioxidant enzymes, proteins, and other small compounds. Glutathione peroxidase 4 (GPx4) has emerged as an important antioxidant enzyme with cytoprotective roles. In vertebrates, antioxidant and pro-oxidant stress responses are regulated by several factors, including the p53 protein. However, little is known about GPx4 responses in crustaceans and the regulation by p53. Herein we analyzed and characterized the L. vannamei GPx4 and evaluated the responses to hypoxia and p53 knock-down. We found a unique GPx4 gene that produces five transcript variants (TVs) and only two protein isoforms with distinct cellular localization. GPx4 expression in hepatopancreas during hypoxia and p53 knock-down changed during short and long-term hypoxia, suggesting that GPx4 may be a sensitive indicator of antioxidant imbalance during stress. Knock-down of p53 induced a reduction in GPx4 expression, indicating that p53 modulates GPx4 responses during stress. This agrees with our findings of putative consensus sequences for p53 in the GPx4 gene promoter by in silico analysis. Also, the antioxidant response was effective in preventing major protein damage during hypoxia since no changes were detected in carbonylated proteins content in hepatopancreas during hypoxia. Conversely, p53 knock-down produced significant changes in carbonylated proteins.

The anaplerotic pyruvate carboxylase from white shrimp Litopenaeus vannamei: Gene structure, molecular characterization, protein modelling and expression during hypoxia.

Hypoxic zones are spreading worldwide in marine environments affecting many organisms. Shrimp and other marine crustaceans can withstand environmental hypoxia using several strategies, including the regulation of energy producing metabolic pathways. Pyruvate carboxylase (PC) catalyzes the first reaction of gluconeogenesis to produce oxaloacetate from pyruvate. In mammals, PC also participates in lipogenesis, insulin secretion and other processes, but this enzyme has been scarcely studied in marine invertebrates. In this work, we characterized the gene encoding PC in the white shrimp Litopenaeus vannamei, modelled the protein structure and evaluated its gene expression in hepatopancreas during hypoxia, as well as glucose and lactate concentrations. The PC gene codes for a mitochondrial protein and has 21 coding exons and 4 non-coding exons that generate three transcript variants with differences only in the 5'-UTR. Total PC expression is more abundant in hepatopancreas compared to gills or muscle, indicating tissue-specific expression. Under hypoxic conditions of 1.53 mg/L dissolved oxygen, PC expression is maintained in hepatopancreas, indicating its key role even in energy-limited conditions. Finally, both glucose and lactate concentrations were maintained under hypoxia for 24-48 h in hepatopancreas.

SUCCESSFUL USE OF COVID-19 CONVALESCENT PLASMA IN A PATIENT WITH MULTIPLE MYELOMA CHEMOTHERAPY / USO SATISFACTORIO DE PLASMA CONVALECIENTE DE COVID-19 EN UN PACIENTE CON MIELOMA MÚLTIPLE EN QUIMIOTERAPIA

Multiple myeloma (MM) is a clonal disease derived from plasma cells, whose biology and treatment can produce immunosuppression, which could explain the high mortality rate of patients with MM and COVID-19. The following describes the clinical course of a 63-year-old patient with arterial hypertension, type 2 diabetes mellitus, relapsed MM receiving chemotherapy and SARS-CoV-2 infection who presented a rapid deterioration of respiratory function, requiring orotracheal intubation and admission to the Intensive Care Unit of the HRLBO. Due to the progressive worsening of ventilatory parameters, and considering the different risk factors, it was decided to administer 200 cc of convalescent plasma, showing clinical improvement 24 hours after infusion; finally, the patient was extubated and transferred to the Intermediate Care Unit where she was subsequently discharged.

El mieloma múltiple (MM) es una enfermedad clonal que deriva de las células plasmáticas, cuya biología y tratamiento puede producir inmunosupresión, lo cual pudiera explicar la elevada tasa de mortalidad de los pacientes con MM y COVID-19. A continuación, se describe el curso clínico de un paciente de 63 años, con hipertensión arterial, diabetes mellitus tipo 2, MM en recaída recibiendo quimioterapia e infección por SARS-CoV-2 que cursó con un rápido deterioro de la función respiratorio, requiriendo intubación orotraqueal e ingreso a la Unidad de Cuidados Intensivos del HRLBO. Debido al empeoramiento progresivo de los parámetros ventilatorios, y considerando los diferentes factores de riesgo, se decidió administrar 200 cc de plasma convaleciente, objetivándose mejoría clínica 24 horas después de su infusión; finalmente, la paciente fue extubada y trasladada a la Unidad de Cuidados Intermedios donde posteriormente fue egresada.

Results of a specific and structured program in the transition of young patients with type 1 diabetes from the paediatric center to an adult hospital. The experience of a decade. / Resultados de un programa específico y estructurado en la transición de pacientes jóvenes con diabetes tipo 1 desde pediatría a un hospital de adultos. La experiencia de una década.

OBJECTIVE: Evaluate the results of a healthcare and therapeutic education programme (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a paediatric centre. METHODOLOGY: This was a prospective, pre-postest in young T1D patients transferred from 2005-2015. The programme has four phases: coordinated transfer, evaluation and objective pacting, knowledge (DKQ2) adherence (SCI-R.es) and quality of life (DQoL and SF12). Results were compared according to Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusión (CSII) and adherence (SCI-R.es < 65 vs. > 65%). RESULTS: A total of 330 patients were transferred (age 18.19 ± 0.82 years, 49% females, glycated haemoglobin [HbA1c] 8.6 ± 1.4%). The programme was completed by 68%, and 61% did a group course. While no changes in HbA1c were observed at one year (8.3 ± 1.4 vs. 8.2 ± 1.4%), there were changes in severe hypoglycaemias/patient/year (0.23 ± 0.64 to 0.05 ± 0.34 p < 0.001) and mild > 5 hypoglycaemias/patient/week (6.9% vs. 3.9% p = 0.09). DQK2 knowledge increased (25.7 ± 3.6 vs. 27.8 ± 3.8 p < 0.001), with no changes in quality of life or grade of adherence. Patients with CSII (n = 21) performed more blood glucose controls and showed greater programme adherence with no changes in metabolic control. Patients with the best initial adherence presented the best control (p < 0.0001). A lower initial HbA1c and receiving the group course were associated with better clinical HbA1c results ≥ 0.5% (p < 0.05) CONCLUSIONS: The TEP improved some parameters of metabolic control without modifying the quality of life in young T1D patients. When comparing patients on MDI vs. CSII, there were no differences in metabolic control but there were when differences were evaluated considering treatment adherence.

The Use of Virtual Reality Technologies in the Treatment of Duchenne Muscular Dystrophy: Systematic Review.

BACKGROUND: Duchenne muscular dystrophy is a serious and progressive disease affecting one in 3500-6000 live male births. The use of new virtual reality technologies has revolutionized the world of youth rehabilitation. OBJECTIVE: We performed a systematic review to study the effectiveness of the use of virtual reality systems applied in the rehabilitation of the upper limbs of individuals with Duchenne muscular dystrophy. METHODS: Between June 2018 and September 2019, we carried out a series of searches in 5 scientific databases: (1) PubMed, (2) Web of Science, (3) Scopus, (4) The Cochrane Library, and (5) MEDLINE via EBSCO. Two evaluators independently conducted the searches following the PRISMA recommendations for systematic reviews for articles. Two independent evaluators collated the results. Article quality was determined using the PEDro scale. RESULTS: A total of 7 clinical trials were included in the final review. These studies used new technologies as tools for physiotherapeutic rehabilitation of the upper limbs of patients with Duchenne muscular dystrophy. Collectively, the studies showed improvement in functionality, quality of life, and motivation with the use of virtual reality technologies in the rehabilitation of upper limbs of individuals with Duchenne muscular dystrophy. CONCLUSIONS: The treatment of neuromuscular diseases has changed in recent years, from palliative symptom management to preventive methods for capacity building. The use of virtual reality is beginning to be necessary in the treatment of progressive diseases involving movement difficulties, as it provides freedom and facilitates the improvement of results in capacity training. Given that new technologies are increasingly accessible, rehabilitation and physiotherapy programs can use these technologies more frequently, and virtual reality environments can be used to improve task performance, which is essential for people with disabilities. Ultimately, virtual reality can be a great tool for physiotherapy and can be used for Duchenne muscular dystrophy rehabilitation programs to improve patient performance during training. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42018102548; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=102548.

Different outcomes for transplant-eligible newly diagnosed multiple myeloma patients in Latin America according to the public versus private management: a GELAMM study.

The aim of this study was to describe clinical and survival characteristics of transplant-eligible multiple myeloma (MM) patients in Latin America (LA), with a special focus on differences between public and private healthcare facilities. We included 1293 patients diagnosed between 2010 and 2018. A great disparity in outcomes and survival between both groups was observed. Late diagnosis and low access to adequate frontline therapy and ASCT in public institutions probably explain these differences. Patients treated with novel drug induction protocols, followed by autologous stem cell transplantation (ASCT) and maintenance, have similar overall survival compared to that published internationally.

Molecular characterization and expression analysis of the chicken-type and goose-type lysozymes from totoaba (Totoaba macdonaldi).

Lysozymes play a key role in innate immune response to bacterial pathogens, catalyzing the hydrolysis of the peptidoglycan layer of bacterial cell walls. In this study, the genes encoding the c-type (TmLyzc) and g-type (TmLyzg) lysozymes from Totoaba macdonaldi were cloned and characterized. The cDNA sequences of TmLyzg and TmLyzc were 582 and 432 bp, encoding polypeptides of 193 and 143 amino acids, respectively. Amino acid sequences of these lysozymes shared high identity (60-90%) with their counterparts of other teleosts and showed conserved functional-structural signatures of the lysozyme superfamily. Phylogenetic analysis indicated a close relationship with their vertebrate homologues but distinct evolutionary paths for each lysozyme. Expression analysis by qRT-PCR revealed that TmLyzc was expressed in stomach and pyloric caeca, while TmLyzg was highly expressed in stomach and heart. These results suggest that both lysozymes play important roles in defense of totoaba against bacterial infections or as digestive enzyme.

Mieloma múltiple en Chile: Respuesta a tratamiento en pacientes con mieloma múltiple elegibles para trasplante autólogo de progenitores hematopoyéticos / Response rates to first-line treatment in eligible patients to autologous stem transplantation in Chile

Background The treatment of choice of newly diagnosed multiple myeloma (NDMM) is an induction with proteasome inhibitors followed autologous stem cell transplantation (HSCT). Since 2013, the treatment of these patients in the public system is based on CTD (cyclophosphamide, thalidomide, and dexamethasone). Aim To evaluate the response rates achieved with CTD, and the results of HSCT in patients with NDMM in the public setting. Material and Methods Data from patients considered as candidates for HSCT from different centers of the National Adult Antineoplastic Drug Program (PANDA, for its acronym in Spanish), diagnosed between 2013 and 2017, was analyzed. The response to treatment of first and second lines of treatment was evaluated, in addition to the results of HSCT. An optimal Response was defined as the sum of strict complete remission, complete remission and very good partial response (sCR, CR and VGPR). Results One hundred and seventy-seven patients were analyzed, 54% women, and 53% with IgG multiple myeloma. Information about the international staging system was retrieved in 127 patients (71%). Seventeen percent were ISS I, 22% in ISS II and 32% ISS III. CTD was used as first treatment in 106 patients (60%), and cyclophosphamide, bortezomib and dexamethasone (CyBorD) in 13 (7%). As first line, CTD had an overall response of 50.9%, and CyBorD of 76.9%. Thirty patients were treated with bortezomib as second line treatment. Forty patients (22%) underwent HSCT. The 5-year Overall Survival (OS) in transplanted patients and non-transplanted patients was 100 and 62% respectively (p < 0.01). Conclusions The response rate achieved by CTD in these patients is suboptimal. The response to CyBorD was better.

AL amyloidosis in the Chilean public health system: a pending debt: multicenter study of the Chilean Monoclonal Gammopathies Cooperative Group / Amiloidosis AL en el sistema público de Chile: una deuda pendiente: estudio multicéntrico

ABSTRACT Background: Immunoglobulin light chain (AL) amyloidosis is a rare and underdiagnosed entity. Aim: To characterize patients with AL amyloidosis in Chilean public health centers. Material and Methods: We conducted a retrospective, multicenter study. Public centers of the Chilean Monoclonal Gammopathies Cooperative Group were asked to search for patients with AL amyloidosis in their databases. Epidemiological, clinical and laboratory characteristics were evaluated. Results: Forty-two patients aged 22 to 84 years were found. Twenty four percent had localized AL amyloidosis; 64% had a lambda light chain clone; 47% were associated with multiple myeloma and 9% with non-Hodgkin lymphoma. The most commonly involved organ was the kidney (76%). Serum free light chains were measured in 31% and an echocardiogram was performed in 74% of patients. Seventeen percent of patients received only palliative care, 17% were treated with bortezomib, 21% with thalidomide, and 40% with melphalan. No patient was transplanted. The mean overall survival (OS) of the group was 19 months. The 5-year OS was 28%. Conclusions: It is important to obtain these realistic, national data to initiate strategies to improve early diagnosis and proper management of this disease.

La amiloidosis AL es una entidad poco frecuente y subdiagnosticada. Mientras todo el mundo discute sobre las nuevas herramientas diagnósticas y terapéuticas, en Chile y en América Latina en general, estamos lejos de esa realidad. El objetivo del presente estudio fue caracterizar a los pacientes con amiloidosis AL en centros del sistema público de nuestro país. Se realizó un estudio retrospectivo, multicéntrico, descriptivo. Los centros públicos del grupo cooperativo hematológico chileno buscaron en sus bases de datos pacientes diagnosticados con amiloidosis AL. Se evaluaron las características epidemiológicas, clínicas y de laboratorio. La edad media fue de 65 años. A 24% de los pacientes se les diagnosticó amiloidosis AL localizada; 64% tuvo paraproteína con cadena ligera lambda; 47% se asoció con mieloma múltiple y 9% con linfoma no Hodgkin. El órgano afectado con mayor frecuencia fue el riñón (76%). Las cadenas ligeras libres de suero se realizaron en 31% y ecocardiograma en 74%. El 17% recibió solo cuidados paliativos, 17% recibió tratamiento con bortezomib, 21% con talidomida y 40% con melfalán. Ningún paciente fue trasplantado. La media de sobrevida global (SG) del grupo fue de 19 meses. La SG a 5 años fue de 28%. Es importante reportar estos resultados nacionales para iniciar estrategias que mejoren tanto el diagnóstico temprano como el tratamiento de esta patología. Por lo tanto, mejorar la sospecha diagnóstica es crucial.

El cuidado en la Enfermería de Práctica Avanzada / Care in Advanced Practice Nursing

El proceso de cuidar es un entendimiento propio de cada situación, la práctica en Enfermería es contextualizar un sinfín de tareas que el profesional debe llevar a cabo, lo cual se denomina como Práctica Avanzada. El cuidado humano se ha definido desde varias perspectivas filosóficas, para Heidegger el cuidado es la conciencia del desvelo por sí mismo, significando inquietud, preocupación y alarma por otros, implicando el quehacer expresado en la praxis mediante una clara manifestación del cuidado existencial. Las enfermeras de Práctica Avanzada son capaces de realizar cuidados a un elevado nivel de pericia, con un alto grado de complejidad basada en evidencia científica. Es claro que la filosofía del cuidado no es un mundo alejado de las competencias de la Enfermería, ya que descifrar esta, es comprender la esencia de la profesión y de la humanidad, llevarla a la Práctica Avanzada es fundamental para mantener la calidad integral del cuidado.

The process of caring is an understanding of each situation, the practice in nursing is to contextualize a myriad of tasks that the professional must carry out, which is called Advanced Practice. Human care has been defined from various philosophical perspectives, for Heidegger the care is the conscience of sleeplessness by itself, meaning restlessness, concern and alarm for others, implying the task expressed in praxis through a clear manifestation of existential care. The Advanced Practice Nurses are capable of performing care at an expert level, with a high degree of complexity based on scientific evidence. It is clear that the philosophy of care is not a world away from the competencies of nursing, because to decipher this, is to understand the essence of the profession and humanity, take it to Advanced Practice is essential to maintain comprehensive quality of care.

Genome-Wide Identification of Mango (Mangifera indica L.) Polygalacturonases: Expression Analysis of Family Members and Total Enzyme Activity During Fruit Ripening.

Mango (Mangifera indica L.) is an important commercial fruit that shows a noticeable loss of firmness during ripening. Polygalacturonase (PG, E.C. 3.2.1.15) is a crucial enzyme for cell wall loosening during fruit ripening since it solubilizes pectin and its activity correlates with fruit softening. Mango PGs were mapped to a genome draft using seventeen PGs found in mango transcriptomes and 48 bonafide PGs were identified. The phylogenetic analysis suggests that they are related to Citrus sinensis, which may indicate a recent evolutive divergence and related functions with orthologs in the tree. Gene expression analysis for nine PGs showed differential expression for them during post-harvest fruit ripening, MiPG21-1, MiPG14, MiPG69-1, MiPG17, MiPG49, MiPG23-3, MiPG22-7, and MiPG16 were highly up-regulated. PG enzymatic activity also increased during maturation and these results correlate with the loss of firmness observed in mango during post-harvest ripening, between the ethylene production burst and the climacteric peak. The analysis of PGs promoter regions identified regulatory sequences associated to ripening such as MADS-box, ethylene regulation like ethylene insensitive 3 (EIN3) factors, APETALA2-like and ethylene response element factors. During mango fruit ripening the action of at least these nine PGs contribute to softening, and their expression is regulated at the transcriptional level. The prediction of the tridimensional structure of some PGs showed a conserved parallel beta-helical fold related to polysaccharide hydrolysis and a modular architecture, where exons correspond to structural elements. Further biotechnological approaches could target specific softening-related PGs to extend mango post-harvest shelf life.

Programa de Atención y Educación Terapéutica dirigido a jóvenes con diabetes tipo 1 trasladados desde el centro pediátrico al hospital de adultos. Percepción de las enfermeras / Therapeutic education program addressed to young people with type 1 diabetes transferred from the pediatric center to the adult hospital

El traslado de los jóvenes con diabetes tipo 1 desde los centros pediátricos a las unidades de adultos se realiza durante la adolescencia, periodo caracterizado por cambios fisiológicos y psicológicos que los hace especialmente vulnerables. En este periodo se aconseja que las familias y/o cuidadores trasladen, en parte, la responsabilidad del manejo de la diabetes a los jóvenes de forma progresiva. El cambio de rol en el autocuidado, de centro y de profesionales añadido a la gran vulnerabilidad se relaciona con el empeoramiento del control metabólico y pérdida de seguimiento asistencial. Se requieren programas educativos específicos, estructurados y coordinados con los centros pediátricos para minimizar los posibles efectos adversos del traslado y mantener y/o mejorar el control metabólico y la calidad de vida de estos jóvenes. Siguiendo las recomendaciones de la Sociedad Española de Diabetes y la Sociedad Española de Endocrinología Pediátrica, presentamos la estructura, el proceso y los resultados del programa de acogida a los jóvenes con diabetes tipo 1 trasladados desde el centro pediátrico de Sant Joan de Déu al Hospital Clínic de Barcelona, durante el primer año después del traslado

The transfer of young people with type 1 diabetes from pediatric centers to adult units takes place during adolescence, a period characterized by physiological and psychological changes that make them especially vulnerable. In this period it is recommended that families and /or caregivers progressively leave the responsibility of managing diabetes to the young people themselves. The change of role in self-care, center and professionals in addition to the inherent vulnerability is related to the worsening of metabolic control and loss of these patients to follow-up care. Specific educational programs are required, which are structured and coordinated with the pediatric centers to minimize the possible adverse effects of the transfer and maintain and / or improve the metabolic control and the quality of life of these young people. Following the recommendations of the Spanish Society of Diabetes and the Spanish Society of Pediatric Endocrinology, we present the structure, process and results of the reception program for young people with type 1 diabetes transferred from the pediatric center of Sant Joan de Déu to the Hospital Clínic of Barcelona during the first year after the transfer