Advertising and Eco-Labels as Influencers of Eco-Consumer Attitudes and Awareness-Case Study of Ecuador.

This study examined the impact of green advertising and eco-labels on the attitudes and environmental awareness of millennials purchasing eco-friendly products in shopping centers across Ecuador. The research utilized a quantitative, correlational, cross-sectional methodology with 430 millennials participating. A 20-item survey was administered face-to-face at shopping centers in Quito and Guayaquil, Ecuador. The validity of the research model was established through Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM), employing SPSS 20 and AMOS 24 for statistical evaluations. Findings reveal that green advertising significantly shapes environmental attitudes (ß: 0.245) and awareness (ß: 0.110), as well as directly influences the purchasing behavior (ß: 0.154) towards green products. While eco-labels do not exert a direct effect on purchasing behavior (ß: 0.128), they significantly inform attitudes (ß: 0.406) and ecological awareness (ß: 0.277) of millennials who purchase organic products. This paper is among the pioneering research to delineate the correlation between green advertising elements and the purchasing patterns of green products among millennials in a developing nation. It concludes that marketing strategies centered on green advertising and eco-labels do affect millennials' attitudes and environmental consciousness, but only advertising has a direct impact on purchasing behaviors, contrary to eco-labels. The research bears social significance as it affirms that millennials are attentive to environmental issues and are actively engaged in promoting sustainability.

Situs Inversus Totalis in the Critical Care Unit: A Case Report and Literature Review.

Situs inversus is a rare congenital disorder where the reversal of some of the major thoracic or abdominal organs is present. In this disorder, alterations in the fetus's organ lateralization lead to a complete reversal in the arrangement of the internal organs. Most of the time, they are found incidentally when having a procedure or imaging modality. Little has been written regarding the challenges encountered while providing critical care to these patients. Here we present the case of a 68-year-old male patient admitted to the intensive care unit (ICU) with hypoxemic respiratory failure secondary to pneumonia who underwent diagnostic bronchoscopy for organism identification and was confirmed to have situs inversus totalis. Situs inversus totalis represents a challenge at different levels of care to these patients, including in the ICU. Limitations in critical care can be seen upon imaging identification, and during routine procedures performed at the ICU. Confusion might appear while performing bedside point of care ultrasound, obtaining vascular access, performing electrocardiogram, and sample identification, among others. The case brings the relevance of being able to recognize this rare disorder, which can be diagnosed even in advanced age since it might present the clinician with challenges at the time of providing care to patients.

Alteraciones hematológicas en sangre periférica de pacientes con COVID-19 / Molecular study of leukemias: essential tool for the hematologist

Introducción: Los primeros casos con neumonía atípica de etiología desconocida fueron reportados en Wuhan, China en diciembre de 2019. En enero 2020 se describió como agente causal un nuevo tipo de virus de la familia Coronaviridae, denominado SARS-CoV-2. Objetivo: Evaluar la significación clínica de los cambios hematológicos y morfológicos en la sangre periférica de pacientes con COVID-19. Métodos: Se realizó un estudio descriptivo, observacional, transversal que incluyó a los pacientes con COVID-19 que ingresaron en el Hospital Clínico Quirúrgico Docente Freyre de Andrade desde el 1ro de junio hasta 31 de septiembre de 2021. Los pacientes fueron asignados a dos grupos según fueron admitidos, en las unidades de vigilancia intensiva o en la unidad de cuidados intensivos. Se les realizó hemograma completo y lámina periférica el día del ingreso para evaluar la significación clínica de estas variables en la evolución de estos pacientes. Resultados: El sexo femenino predominó en los pacientes ingresados en unidades de vigilancia intensiva (67,36 %) y el masculino en los ingresados en unidades de cuidados intensivos (63,26 %). La media de edad fue mayor en el grupo de pacientes en cuidados intensivos (65,83 años). La leucocitosis y el menor recuento de plaquetas predominaron en los pacientes ingresados en cuidados intensivos, seguido de linfopenia. Las macroplaquetas, las vacuolas citoplasmáticas y las granulaciones tóxicas fueron más frecuentes en el grupo de cuidados intensivos. Conclusiones: El hemograma y el frotis de sangre periférica son útiles para diagnosticar y predecir la evolución de los pacientes y permiten un mejor manejo de la infección.

Introduction: The first cases of atypical pneumonia of unknown etiology were reported in Wuhan, China in December 2019. In January 2020 a new virus from Coronaviridae family was described as causal agent and was named SARS-COV-2. Objectives: To evaluate the clinical significance of numerical values of complete blood count (CBC) and morphologic changes on peripheral blood on patients with COVID-19. Methods: A descriptive, observational, transversal study included patients with diagnosis of COVID-19 admitted in Freyre de Andrade Hospital in Havana, between June 1st and September 31st of 2022 was carried out. Patients were assigned to two groups according to their admission in intensive vigilance ward or intensive care unit. CBC test and peripheral blood smear were performed on admission day to evaluate the significance on clinical evolution. Results: Female sex predominated on intensive vigilance group (67,36 %) and male in intensive care group (63,26 %). Media of age was superior in intensive care group (67,83 years). Leukocytosis and low level of platelets count were significantly more common in more severe group followed by lymphopenia. The presence of big platelets, cytoplasmic vacuoles and toxic granules were more common in intensive care unit group. Conclusions: The CBC and peripheral blood smear are useful tools to diagnose and predict clinical evolution and allow a better management of infection.

Resultados del trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple / Outcome of autologous stem cell transplantation in patients with multiple myeloma

Introducción: El mieloma múltiple es una neoplasia caracterizada por la proliferación de un clon de células plasmáticas monoclonales. Representa el 1 por ciento de todos los cánceres y el 10 por ciento de las neoplasias hematológicas. Las altas dosis de quimioterapia seguidas de trasplante autólogo de progenitores hematopoyéticos constituyen una opción terapéutica segura para un grupo seleccionado de pacientes. Objetivo: Analizar los resultados del trasplante autólogo de progenitores hematopoyéticos en pacientes con mieloma múltiple. Métodos: Estudio descriptivo, longitudinal, ambispectivo. El universo estuvo conformado por 14 pacientes (de los cuales se incluyeron 13) con diagnóstico de mieloma múltiple tratados con trasplante autólogo de progenitores hematopoyéticos de sangre periférica como tratamiento de consolidación, en el Instituto de Hematología e Inmunología de La Habana, desde enero de 2014 hasta diciembre de 2019. Resultados: La edad media fue de 53,9±5,6 años, predominó el sexo femenino. Las complicaciones más frecuentes fueron las infecciosas y la mucositis. La supervivencia global al año fue del 100 por ciento y del 80 por ciento a los cinco años. La supervivencia libre de progresión al año fue de 83 por ciento y 73 por ciento a los cinco años. Conclusiones: El trasplante hematopoyético autólogo de sangre periférica en pacientes con mieloma múltiple es un tratamiento que eleva las tasas de respuestas, la supervivencia global y libre de progresión y generalmente presenta pocas complicaciones(AU)

Introduction: Multiple myeloma is a neoplasm characterized by the presence of a plasmatic cells clone; accounts for 1 percent of cancers, and approximately 10 percent of hematologic malignancies. High dose chemotherapy followed by autologous stem cell transplantation remains a safe option in selected patients. Objective: To analyze the results of autologous stem cell transplantation from peripheral blood in patients with multiple myeloma. Methods: A descriptive, longitudinal, ambispective study. The universe was by 14 patients (13 of them were finally included), with diagnosis of multiple myeloma treated with autologous stem cell transplantation from peripheral blood at Institute of Hematology and Immunology of Havana from January 2014 to December 2019. Results: The median age of the patient was 53.9±5.6 years, with predominance of female sex. More frequents complications were infections and mucositis. A year overall survival was 100 percent and 80 percent at five years. Progression free survival at one and five years was 83 percent and 73 percent, respectively. Conclusions: The autologous stem cell transplantation in multiple myeloma patients increase complete responses, overall survival and progression free survival and is well accepted without severe complications(AU)

Reactivación de brucelosis en paciente receptor de trasplante hematopoyético autólogo: reporte de caso / Reactivation of brucellosis in an autologous hematopoietic transplant recipient: a case report

Introducción: La brucelosis es la zoonosis más frecuente, producida por el género brucella, que afecta a varias especies de mamíferos y dentro de ellos a los humanos. Se transmite al hombre por contacto directo con los animales infectados, por sus excretas o por la ingestión de productos no pasteurizados. En los últimos años se ha descrito un incremento de la enfermedad en los pacientes inmunocomprometidos. Objetivo: Describir la reactivación de la brucelosis en paciente receptor de un trasplante hematopoyético, su curso y manejo. Presentación de caso: Se presenta una paciente con linfoma de Hodgkin y antecedentes de brucelosis que recibió un trasplante hematopoyético autólogo mieloablativo. Después de la recuperación hematológica, inició con cuadro de fiebre, diaforesis, dolores articulares y hepato-esplenomegalia. Se le diagnosticó brucelosis, por lo que se inició tratamiento con doxiciclina y rifampicina, con lo que se logró la eliminación de los síntomas y la negativización de las pruebas evolutivas. Conclusiones: La brucelosis puede mantenerse meses o años asintomática y reactivarse después de la inmunosupresión en los pacientes trasplantados. Su sospecha y rápido tratamiento puede lograr la curación y evitar complicaciones(AU)

Introduction: Brucellosis is the most frequent zoonosis, produced by the genus brucella, which affects several species of mammals, including human beings. It is transmitted to persons by direct contact with infected animals, by their excreta or by ingestion of unpasteurized products. In recent years, an increase has been described in immunocompromised patients. Objectives: To describe the reactivation of brucellosis in a hematopoietic transplant recipient patient, its course and management. Case presentation: A patient with Hodgkin's lymphoma and a history of brucellosis is presented; that she received a myeloablative autologous hematopoietic transplant. After haematological recovery, she started with symptoms of fever, diaphoresis, joint pain and hepato-splenomegaly. She was diagnosed with brucellosis, so treatment with doxycycline and rifampin was started, which eliminated the symptoms and made the evolutionary tests negative. Conclusions: Brucellosis can be asymptomatic for months or years and after immunosuppression it can be reactivated in transplanted patients. Suspicion and prompt treatment can bring about a cure and avoid complications(AU)

Células tumorales circulantes en una paciente con sospecha clínica de mieloma múltiple / Circulating tumor cells in a patient with clinical suspicious of multiple myeloma

Introducción: La circulación de células tumorales en la sangre periférica, conocido como carcinocitemia, es un fenómeno raro y muy poco comunicado en la literatura científica y su diagnóstico diferencial puede constituir un desafío en la práctica clínica. Objetivos: Describir las causas más frecuentes de carcinocitemia, los retos diagnósticos que representa y contribuir a elevar el índice de sospecha de esta entidad. Presentación del caso: Paciente femenina de 71 años de edad que acude por dolores óseos y palidez cutánea. En el examen de sangre periférica se observa células de gran tamaño que recordaron células plasmáticas. El inmunofenotipo por citometría de flujo fue sugestivo de mieloma múltiple isotipo IgM. El ultrasonido de mamas y la tomografía de tórax mostraron lesión tumoral en la mama izquierda. El estudio inmunohistoquímico de la biopsia de médula ósea fue compatible con adenocarcinoma de mamas. La paciente falleció sin haber comenzado tratamiento específico. Conclusiones: Se presenta paciente con células circulantes tumorales secundaria a adenocarcinoma de la mama donde la inmunohistoquímica de la biopsia de médula ósea descartó el diagnóstico de mieloma múltiple sospechado clínica, radiológicamente, por la morfología celular y el inmunofenotipo(AU)

Introduction: The circulating tumor cells in peripheral blood, known as carcinocythemia is a rare and poorly documented phenomenon, that can be a challenge diagnosis. Objectives: To describe the most frequents causes of carcinocythemia, the diagnosis challenges that it represents and to contribute raising awareness of this entity. Case presentation: Female patient, 71-year-old who complained bone pain and skin pale. The peripheral blood smear showed big size cells mimicking plasma cells. The immunophenotype by flow cytometry suggested IgM isotype multiple myeloma. Breast ultrasound and thorax tomography showed a tumor in the left breast. The bone marrow biopsy immunohistochemical was compatible with adenocarcinoma of breast. The patient died short after before receive specific treatment. Conclusions: We present a patient with circulating tumor cells secondary to breast adenocarcinoma where the bone marrow biopsy immunohistochemical ruled out multiple myeloma diagnosis suspected by clinical, image studies, cell morphology and immunophenotype(AU)

Leukemia Cutis As the Initial Manifestation of Chronic Lymphocytic Leukemia Progression.

Chronic lymphocytic leukemia (CLL) is a malignant proliferation of monoclonal mature B-cells in peripheral blood. Leukemia cells can commonly spread from the blood to other sites such as the lymph nodes, liver, and spleen. However, contrary to T-cell lymphomas that can involve the skin, CLL metastasis to the skin is unusual and is rarely the first manifestation of systemic disease. When leukemia cells invade the skin, it is termed leukemia cutis. Furthermore, multiple skin morphologies can be present in leukemia cutis making diagnosis challenging. Likewise, it can be mistaken for other common etiologies such as drug or substance allergy, infection, and scabies, among others. We herein present a case of CLL with leukemia cutis as the initial manifestation of systemic disease. The initial punch biopsy results were non-specific for inflammatory changes, but a subsequent biopsy revealed findings confirming leukemia cutis. This case not only demonstrates that identifying malignant skin manifestations in a timely manner and treating them is essential, as it improves the quality of life and survival, but also demonstrates that leukemia cutis can be a dynamic disease where multiple biopsies may be needed to confirm the diagnosis, as histopathology can change over time.

Immunoblot Validation of Phospho-Specific Antibodies Using Lung Cancer Cell Lines.

The cancer phenotype is usually characterized by deregulated activity of a variety of cellular kinases, with consequent abnormal hyper-phosphorylation of their target proteins. Therefore, antibodies that allow the detection of phosphorylated versions of proteins have become important tools both preclinically in molecular cancer research, and at the clinical level by serving as tools in pathological analyses of tumors. In order to ensure reliable results, validation of the phospho-specificity of these antibodies is extremely important, since this ensures that they are indeed able to discriminate between the phosphorylated and unphosphorylated versions of the protein of interest, specifically recognizing the phosphorylated variant. A recommended validation approach consists in dephosphorylating the target protein and assessing if such dephosphorylation abrogates antigen immunoreactivity when using the phospho-specific antibody. In this chapter, we describe a protocol to validate the specificity of a phospho-specific antibody that recognizes a phosphorylated variant of the Retinoblastoma (Rb) protein in lung cancer cell lines. The protocol consists in the dephosphorylation of the Rb-containing protein lysates by treating them with bovine intestinal phosphatase, followed by assessment of the dephosphorylation by immunoblot.

Hemorrhagic cystitis and giant condyloma acuminatum of anus in a receptor of haploidentical hematopoietic transplant / Cistitis hemorrágica y condiloma acuminado gigante del ano en un receptor de trasplante hematopoyético haploidéntico

ABSTRACT Introduction: The reactivations of latent virus after bone marrow transplants affect the outcome of these patients. Hemorrhagic cystitis caused by BK virus, constitute a frequently lethal complication characterized by abdominal pain, hematuria and renal damage. The incidence is between 13-70 % in hematopoietic transplant receptors. The management includes antibiotics, antivirals, hyperhydration and forced diuresis, platelets and hyperbaric oxygen. Condyloma acuminatum of the anus associated to human papillomavirus is rare among transplanted patients (0.3-1.3 %). It is characterized by an invading mass in the region of the anus producing pain and bleeding. The treatment of choice is the surgical resection of the tumor. Objectives: To describe the clinical characteristics and evolution of hemorrhagic cystitis and anal condyloma acuminatum in a receptor of haploidentical hematopoietic transplant. Discussion: A 20-year-old man with diagnosis of acute myeloid leukemia, on day +21 post-transplant presented macroscopic hematuria associated to BK virus reactivation and resolved with hyperbaric oxygen. On day + 59 post-transplant, anal pain started and a perianal, cauliflower-like mass over 5 cm, was observed. He was diagnosed with condyloma acuminatum of the anus and surgical resection was successfully performed. Conclusions: We reported a unique case of concurrence of both, hemorrhagic cystitis and condyloma acuminatum of the anus after haploidentical hematopoietic transplant. The proper management of these two pathologies allowed a satisfactory evolution of the patient.

RESUMEN Introducción: La reactivación de virus latentes en el organismo después del trasplante de progenitores hematopoyéticos (TPH) afecta la evolución de estos pacientes. La cistitis hemorrágica por virus BK constituye una complicación frecuentemente mortal caracterizada por dolor suprapúbico, hematuria y daño renal. La incidencia varía entre 13 y 70 % de los receptores de trasplante hematopoyético. El tratamiento comprende el uso de antibióticos, antivirales, hidratación y diuresis forzada, plaquetas y oxígeno hiperbárico. El condiloma acuminado del ano asociado al virus del papiloma humano es extremadamente raro en pacientes trasplantados (0,3-1,3 %). Se caracteriza por una masa que invade la región del ano produciendo dolor y sangramiento. El tratamiento de elección consiste en la resección quirúrgica del tumor. Objetivos: Describir las características clínicas, el manejo y la evolución de cistitis hemorrágica y condiloma acuminado anal en un receptor de trasplante hematopoyético haploidéntico. Presentación del caso: Paciente de 20 años de edad con diagnóstico de leucemia mieloide aguda que en el día + 21 del trasplante comenzó con hematuria macroscópica asociada a virus BK que resolvió con oxígeno hiperbárico. En el día +59 comenzó con dolor anal y se observó una masa perianal en forma de coliflor de aproximadamente 5 cm. Se diagnosticó condiloma acuminado del ano y se realizó resección quirúrgica del tumor con todo éxito. Conclusiones: Se presenta un caso único donde concurren cistitis hemorrágica y condiloma acuminado del ano después del trasplante hematopoyético haploidéntico. El manejo apropiado de estas dos patologías condujo a la evolución satisfactoria del paciente.

El citomegalovirus en los receptores de trasplante hematopoyético / Cytomegalovirus in hematopoietic stem cell transplant recipients

Introducción: La infección por citomegalovirus es muy frecuente en pacientes sometidos a trasplante de progenitores hematopoyéticos, debido a tratamientos mieloablativos de acondicionamiento, disparidad genética y al tratamiento inmunosupresor, y ocurre fundamentalmente después de la toma del implante. Objetivos: Actualizar el diagnóstico, manejo y seguimiento de la infección por citomegalovirus en pacientes trasplantados. Métodos: Se realizó revisión bibliográfica en los idiomas español e inglés, utilizando los motores de búsqueda de Pubmed, Google Académico y Scielo sobre el diagnóstico y manejo del citomegalovirus en pacientes receptores de trasplante hematopoyético. Análisis y síntesis de la información: Se recolectó y organizó la información obtenida siguiendo cronológicamente el surgimiento de técnicas para diagnóstico y la aparición de nuevos medicamentos en los últimos años. Se seleccionaron artículos recientes de expertos en el tema en revistas prestigiosas, donde se evidencia la importancia del diagnóstico adelantado y el inicio del tratamiento. Conclusiones: En la actualidad se cuenta con nuevas formas de diagnóstico y medicamentos novedosos para el citomegalovirus, pero la mortalidad puede llegar a ser alta, si el paciente no es tratado antes de que aparezcan los síntomas de la enfermedad e incluso a pesar del tratamiento. En ocasiones, no es posible erradicar el virus, lo que lleva a complicaciones importantes y a la muerte. La enfermedad citomegálica continúa siendo una complicación frecuente en estos pacientes a pesar de las medidas para evitar su reactivación(AU)

Introduction: Cytomegalovirus infection is very common in patients undergoing hematopoietic progenitor transplantation, due to myeloablative conditioning treatments, genetic disparity, and immunosuppressive treatment, and occurs mainly after the engrafment. Objective: A review and update of the diagnosis and management of cytomegalovirus is made in hematopoietic transplant recipients. Method: A bibliographic review was carried out in Spanish and English, using the search engines of Pubmed, Scholar Google and Scielo about the diagnosis and management of cytomegalovirus in hematopoietic transplant recipients. Development: The information obtained was collected and organized chronologically about the emergence of techniques for diagnosis and the appearance of new drugs in recent years. Recent articles by experts in prestigious journals were reviewed and the importance of early diagnosis and initiation of treatment is evidenced. Conclusions: There are currently new forms of diagnosis and novel medications, but mortality can be high, if the patient is not treated before the symptoms of the disease appear and even despite treatment, sometimes it is not possible to eradicate the virus, leading to major complications and death. Cytomegalic disease continues to be a frequent complication in these patients despite measures to prevent virus reactivation(AU)

Cistitis hemorrágica por infección viral en receptores de trasplante hematopoyético haploidéntico: reporte de dos casos / Hemorrhagic cystitis due to viral infection in patients who received hematopoietic haploidentical transplantation: two case reports

Introducción: Las infecciones por virus o la reactivación de virus en estado latente son frecuentes durante el estado de inmunosupresión que sigue al trasplante de progenitores hematopoyéticos, y constituyen una causa importante de complicaciones, como la cistitis hemorrágica, que se caracteriza por disuria, polaquiuria, dolor abdominal y hematuria. La aparición precoz se asocia a la administración de citostáticos como la ciclofosfamida, y el comienzo tardío a la primoinfección o reactivación de virus como citomegalovirus, los adenovirus o los poliomavirus como el BK y el JC. Objetivo: Describir las características clínicas, la evolución y el manejo de la cistitis hemorrágica postrasplante. Casos clínicos: Se presentan dos pacientes con leucemia mieloide aguda que desarrollaron cistitis hemorrágica asociada a infección viral por virus BK y citomegalovirus después del trasplante haploidéntico con ciclofosfamida postrasplante. La cistitis hemorrágica de causa viral después del trasplante hematopoyético en estos pacientes estuvo asociada a una severa inmunosupresión, por lo que constituyó una complicación potencialmente letal. Los dos pacientes presentaron cistitis hemorrágica grado IV y fallecieron a pesar del tratamiento. Conclusiones: El trasplante haploidéntico con la administración de ciclofosfamida postrasplante incrementa la posibilidad de donantes de progenitores hematopoyéticos para los pacientes sin un hermano HLA idéntico pero el mayor nivel de inmunosupresión podría aumentar la incidencia de cistitis hemorrágica de causa viral(AU)

Introduction: Viral infections or latent-virus reactivation are frequent during the immunosuppressed cincition that follows hematopoietic stem-cell transplantation, and an important cause of complications, such as hemorrhagic cystitis, characterized by dysuria, urinary frequency, abdominal pain, and hematuria. The early appearance is associated with the administration of cytostatic drugs such as cyclophosphamide, and the late onset is associated with primary infection or reactivation of viruses such as cytomegalovirus, adenoviruses, or polyomaviruses such as BK and JC. Objective: To describe the clinical characteristics, evolution and management of post-transplant hemorrhagic cystitis. Clinical cases: The cases are presented of two patients with acute myeloid leukemia who developed hemorrhagic cystitis associated with viral infection by BK virus and cytomegalovirus after haploidentical transplantation with post-transplant cyclophosphamide. Viral hemorrhagic cystitis after hematopoietic transplantation in these patients was associated with severe immunosuppression, making it a potentially lethal complication. Both patients presented grade IV hemorrhagic cystitis and died despite treatment. Conclusions: Haploidentical transplantation with the of post-transplant cyclophosphamide administration increases the possibility for donors of hematopoietic progenitor cells to patients without an identical HLA match, but the higher level of immunosuppression could increase the incidence of viral hemorrhagic cystitis(AU)

Hyper-phosphorylation of Rb S249 together with CDK5R2/p39 overexpression are associated with impaired cell adhesion and epithelial-to-mesenchymal transition: Implications as a potential lung cancer grading and staging biomarker.

Prediction of lung cancer metastasis relies on post-resection assessment of tumor histology, which is a severe limitation since only a minority of lung cancer patients are diagnosed with resectable disease. Therefore, characterization of metastasis-predicting biomarkers in pre-resection small biopsy specimens is urgently needed. Here we report a biomarker consisting of the phosphorylation of the retinoblastoma protein (Rb) on serine 249 combined with elevated p39 expression. This biomarker correlates with epithelial-to-mesenchymal transition traits in non-small cell lung carcinoma (NSCLC) cells. Immunohistochemistry staining of NSCLC tumor microarrays showed that strong phospho-Rb S249 staining positively correlated with tumor grade specifically in the squamous cell carcinoma (SCC) subtype. Strong immunoreactivity for p39 positively correlated with tumor stage, lymph node invasion, and distant metastases, also in SCC. Linear regression analyses showed that the combined scoring for phospho-Rb S249, p39 and E-cadherin in SCC is even more accurate at predicting tumor staging, relative to each score individually. We propose that combined immunohistochemistry staining of NSCLC samples for Rb phosphorylation on S249, p39, and E-cadherin protein expression could aid in the assessment of tumor staging and metastatic potential when tested in small primary tumor biopsies. The intense staining for phospho-Rb S249 that we observed in high grade SCC could also aid in the precise sub-classification of poorly differentiated SCCs.

Síndromes de hemopatías mieloides malignas hereditarias / Inherited myeloid malignancy syndromes

La predisposición de algunas familias a padecer hemopatías mieloides malignas ha sido descrita desde hace varias décadas; sin embargo, solo recientemente ha sido posible conocer las bases moleculares de estos síndromes. La importancia de reconocer y diagnosticar la presencia de mutaciones predisponentes de la línea germinal en pacientes con hemopatías malignas y en sus familiares determinó que la Organización Mundial de la Salud (OMS) introdujera esta nueva categoría en su última revisión de la clasificación de las neoplasias malignas y leucemias agudas. Mediante el uso de las modernas técnicas de biología molecular se ha logrado el descubrimiento de mutaciones en diferentes genes que aportan nuevos elementos en el proceso de leucemogénesis, permiten ofrecer consejo genético, una mejor selección del donante de médula ósea y se erigen en la fuente de futuras dianas terapéuticas. En este trabajo se revisan algunos de los síndromes de hemopatías mieloides malignas hereditarias (HMMH) y se enfatiza en la necesidad de realizar una exhaustiva historia clínica personal y familiar que permita un elevado índice de sospecha para el diagnóstico de estas entidades(AU)

The familial predisposition to inherited myeloid malignancies has been described since several decades ago; however, only recently have been possible to known the molecular basis of these syndromes. The importance to recognize and diagnosed predisposing germ line mutations in patients and relatives contributed to the introduction of this new category in the latest update of myeloid neoplasm and acute leukemia by World Health Organization (WHO). The use of modern molecular biology techniques has achieved the discovery of genetic mutations that shed light inside leukemogenesis process, allow offering a genetic counseling, a better donor selection and are the basis of future therapeutics targets. The main hereditary myeloid malignancy syndromes (IMMS) are reviewed, emphasizing the need of exhaustive personal and family clinical history and to have a high suspicion index to diagnose these entities(AU)

Síndromes de hemopatías mieloides malignas hereditarias / Inherited myeloid malignancy syndromes

La predisposición de algunas familias a padecer hemopatías mieloides malignas ha sido descrita desde hace varias décadas; sin embargo, solo recientemente ha sido posible conocer las bases moleculares de estos síndromes. La importancia de reconocer y diagnosticar la presencia de mutaciones predisponentes de la línea germinal en pacientes con hemopatías malignas y en sus familiares determinó que la Organización Mundial de la Salud (OMS) introdujera esta nueva categoría en su última revisión de la clasificación de las neoplasias malignas y leucemias agudas. Mediante el uso de las modernas técnicas de biología molecular se ha logrado el descubrimiento de mutaciones en diferentes genes que aportan nuevos elementos en el proceso de leucemogénesis, permiten ofrecer consejo genético, una mejor selección del donante de médula ósea y se erigen en la fuente de futuras dianas terapéuticas. En este trabajo se revisan algunos de los síndromes de hemopatías mieloides malignas hereditarias (HMMH) y se enfatiza en la necesidad de realizar una exhaustiva historia clínica personal y familiar que permita un elevado índice de sospecha para el diagnóstico de estas entidades(AU)

The familial predisposition to inherited myeloid malignancies has been described since several decades ago; however, only recently have been possible to known the molecular basis of these syndromes. The importance to recognize and diagnosed predisposing germ line mutations in patients and relatives contributed to the introduction of this new category in the latest update of myeloid neoplasm and acute leukemia by World Health Organization (WHO). The use of modern molecular biology techniques has achieved the discovery of genetic mutations that shed light inside leukemogenesis process, allow offering a genetic counseling, a better donor selection and are the basis of future therapeutics targets. The main hereditary myeloid malignancy syndromes (IMMS) are reviewed, emphasizing the need of exhaustive personal and family clinical history and to have a high suspicion index to diagnose these entities(AU)

Molecular and Phenotypic Characterization of Diarrheagenic Escherichia coli Strains Isolated from Bacteremic Children.

Escherichia coli is an important cause of Gram-negative bacteremia. The aim of this study was to characterize at the molecular and phenotypic levels E. coli strains belonging to different diarrheagenic pathotypes [diarrheagenic E. coli (DEC)] isolated from bacteremia in children younger than 5 years of age. Seventy bacteremia E. coli strains were collected in a prospective study in 12 hospitals in Lima, Peru. The presence of virulence genes associated with DEC [enterotoxigenic (lt and st), enteropathogenic (eaeA), shiga toxin-producing (stx1and stx2), enteroinvasive (ipaH), enteroaggregative (aggR), and diffusely adherent (daaD)] was determined by multiplex real-time polymerase chain reaction (PCR). Those positive E. coli strains were further analyzed for 18 additional virulence factors encoding genes and others phenotypic features. Virulence genes associated with DEC were identified in seven bacteremic children (10%), including: one aggR-positive [enteroaggregative E. coli (EAEC)], one eaeA-positive [enteropathogenic E. coli (EPEC)], one st-positive [enterotoxigenic E. coli (ETEC)], one daaD-positive [diffusely adherent E. coli (DAEC)], and three strain positive for aggR and daaD (EAEC/DAEC) at the same time. All strains, except EPEC, had the Ag43 adhesin, and all, except ETEC had the siderophore gene fyuA. The phylogenetic profile of these strains was variable, two (B2), two (D), two (A), and one (B1) strain. These isolates were susceptible to all tested antibacterial agents except to ampicillin and gentamicin. The three EAEC/DAEC strains showed biofilm formation and aggregative adhesion and had the same repetitive extragenic palindromic-PCR patterns. These findings suggest that some DEC strains, especially agg-R and daa-D positive, might cause bacteremia in children.

Priapismo en la drepanocitosis. Diagnóstico y opciones terapéuticas / Priapism in sickle cell disease. Diagnosis and therapeutics options

El priapismo es una complicación de la anemia drepanocítica y se define como una erección prolongada, dolorosa y persistente del pene de más de 4 horas de duración sin estimulación sexual asociada. El 95 por ciento de las crisis de priapismo en estos pacientes es de tipo isquémico o de bajo flujo y constituyen una emergencia médica que, de no diagnosticarse y tratarse adecuadamente, provoca necrosis del tejido y disfunción eréctil. En este trabajo se revisan el diagnóstico y las opciones terapéuticas actuales y futuras de esta grave complicación(AU)

Priapism is a common complication of sickle cell disease and it is characterized by a prolonged, painful and persistent erection of the penis lasting more than 4 hours without associated sexual stimulation. The 95 percent of priapism crisis in these patients is ischemic type and represents a medical emergency that can provoke erectile tissue necrosis and erectile dysfunction if not treated properly. In this paper we reviewed the diagnosisand the current and perspectives therapeutic options of this severe complication(AU)

Resistance to quinolones, cephalosporins and macrolides in Escherichia coli causing bacteraemia in Peruvian children.

OBJECTIVES: To characterise the ß-lactam, quinolone and macrolide resistance levels and mechanisms in 62 Escherichia coli isolates causing bacteraemia in Peruvian children. METHODS: Minimum inhibitory concentrations (MICs) of ciprofloxacin, nalidixic acid (NAL) and azithromycin were determined in the presence and absence of Phe-Arg-ß-naphthylamide. Susceptibility to other 14 antimicrobial agents was also established. Extended-spectrum ß-lactamases (ESBLs) were identified, and mutations in gyrA and parC as well as the presence of transferable mechanisms of quinolone resistance (TMQR) and macrolide resistance (TMMR) were determined. RESULTS: Fifty isolates (80.6%) were multidrug-resistant. High proportions of resistance to ampicillin (93.5%), NAL (66.1%) and trimethoprim/sulfamethoxazole (66.1%) were observed. No isolate showed resistance to carbapenems and only two isolates were resistant to nitrofurantoin. Twenty-seven isolates carried ESBL-encoding genes: 2 blaSHV-12; 13 blaCTX-M-15; 4 blaCTX-M-2; 6 blaCTX-M-65; and 2 non-identified ESBLs. Additionally, 27 blaTEM-1 and 9 blaOXA-1-like genes were detected. All quinolone-resistant isolates showed target mutations, whilst TMQR were present in four isolates. Efflux pumps played a role in constitutive NAL resistance. The association between quinolone resistance and ESBL production was significant (P=0.0011). The mph(A) gene was the most frequent TMMR (16 isolates); msr(A) and erm(B) genes were also detected. Only one TMMR-carrying isolate [presenting mph(A) and erm(B) concomitantly] remained resistant to azithromycin when efflux pumps were inhibited. CONCLUSIONS: A variety of ESBL-encoding genes and widespread of blaCTX-M-15 in Lima has been shown. The role of efflux pumps in azithromycin resistance needs to be further evaluated, as well as effective control of the use of antimicrobial agents.