Satellite and historical data, and statistical modeling to predict potential fishing zones for dolphinfish, Coryphaena hippurus (Perciformes: Coryphaenidae) in Colombian Pacific / Datos satelitales e históricos, y modelado estadístico, para predecir zonas de pesca potencial del pez dorado, Coryphaena hippurus (Perciformes: Coryphaenidae) en el Pacífico colombiano

Introduction: The prediction of potential fishing areas is considered one of the most immediate and practical approaches in fisheries and is an essential technique for decision-making in managing fishery resources. It helps fishermen reduce their fuel costs and the uncertainty of their fish catches; this technique allows to contribute to national and international food security. In this study, we build different combinations of predictive statistical models such as Generalized Linear Models and Generalized Additive Models. Objective: To predict the spatial distribution of PFZs of the dolphinfish (Coryphaena hippurus L.) in the Colombian Pacific Ocean. Methods: We built different combinations of Generalized Linear Models and Generalized Additive Models to predict the Catch Per Unit Effort of C. hippurus captured from 2002 to 2015 as a function of sea surface temperature, chlorophyll-a concentration, sea level anomaly, and bathymetry. Results: A Generalized Additive Model with Gaussian error distribution obtained the best performance for predicting PFZs for C. hipurus. Model validation was performed by calculating the Root Mean Square Error through a cross-validation approach. The R2 of this model was 50 %, which was considered suitable for the type of data used. January and March were the months with the highest Catch per Unit Effort values, while November and December showed the lower values. Conclusion: The predicted PFZs of C. hippurus with Generalized Additive Models satisfactorily with the results of previous research, suggesting that our model can be explored as a tool for the assessment, decision making, and sustainable use of this species in the Colombian Pacific Ocean.

Introducción: La predicción de zonas potenciales de pesca se considera uno de los enfoques más inmediatos y efectivos en las pesquerías, es una técnica importante para la toma de decisiones en el manejo de los recursos pesqueros. Ayuda a los pescadores a reducir su costo de combustible y también a disminuir la incertidumbre de sus capturas, esta técnica permite contribuir a la seguridad alimentaria nacional e internacional. En este estudio, se construyeron diferentes combinaciones de modelos estadísticos predictivos como modelos lineales generalizados y modelos aditivos generalizados. Objetivo: predecir la distribución espacial de las zonas potenciales de pesca del pez dorado (Coryphaena hippurus L.) en el Pacífico colombiano. Métodos: La variable de respuesta se expresó en escala de captura por unidad de esfuerzo, es decir, el número de individuos de C. hippurus capturados por un número total de anzuelos disponibles entre 2002 y 2015. Temperatura de la superficie del mar, concentración de clorofila, anomalía del nivel del mar y batimetría, se utilizaron como variables explicativas para los meses de estacionalidad de C. hippurus (noviembre - marzo). Resultados: El modelo con mejor rendimiento para la predicción de zonas potenciales de pesca fue un modelo aditivo generalizado con distribución de error gaussiana y función de enlace de registro, que se seleccionó en función del criterio de información de Akaike, el R2 y la desviación explicada. La validación del modelo se realizó calculando el error cuadrático medio a través de un enfoque de validación cruzada. El ajuste de este modelo fue del 50 %, lo que puede considerarse adecuado para el tipo de datos utilizados. Enero y marzo fueron los meses con mayor captura por unidad de esfuerzo y noviembre-diciembre los meses con menor. Conclusión: Las zonas potenciales de pesca previstas coincidieron satisfactoriamente con investigaciones anteriores, lo que sugiere que nuestro modelo es una herramienta poderosa para la evaluación, toma de decisiones y uso sostenible de los recursos pesqueros de C. hippurus en el Pacífico colombiano.

Effects of Tree Composition and Soil Depth on Structure and Functionality of Belowground Microbial Communities in Temperate European Forests.

Depending on their tree species composition, forests recruit different soil microbial communities. Likewise, the vertical nutrient gradient along soil profiles impacts these communities and their activities. In forest soils, bacteria and fungi commonly compete, coexist, and interact, which is challenging for understanding the complex mechanisms behind microbial structuring. Using amplicon sequencing, we analyzed bacterial and fungal diversity in relation to forest composition and soil depth. Moreover, employing random forest models, we identified microbial indicator taxa of forest plots composed of either deciduous or evergreen trees, or their mixtures, as well as of three soil depths. We expected that forest composition and soil depth affect bacterial and fungal diversity and community structure differently. Indeed, relative abundances of microbial communities changed more across soil depths than in relation to forest composition. The microbial Shannon diversity was particularly affected by soil depth and by the proportion of evergreen trees. Our results also reflected that bacterial communities are primarily shaped by soil depth, while fungi were influenced by forest tree species composition. An increasing proportion of evergreen trees did not provoke differences in main bacterial metabolic functions, e.g., carbon fixation, degradation, or photosynthesis. However, significant responses related to specialized bacterial metabolisms were detected. Saprotrophic, arbuscular mycorrhizal, and plant pathogenic fungi were related to the proportion of evergreen trees, particularly in topsoil. Prominent microbial indicator taxa in the deciduous forests were characterized to be r-strategists, whereas K-strategists dominated evergreen plots. Considering simultaneously forest composition and soil depth to unravel differences in microbial communities, metabolic pathways and functional guilds have the potential to enlighten mechanisms that maintain forest soil functionality and provide resistance against disturbances.

Enfermedad de Kawasaki en pediatría: caso clínico

la enfermedad de Kawasaki (EK) es una vasculitis multisistémica que se presenta en la infancia. Por lo general es una afección aguda, febril, autolimitada, de etiología desconocida y puede desarrollar alteraciones cardiovasculares; su expresión clínica es variable: presenta inflamación de los vasos de mediano calibre y de múltiples tejidos: pulmonar, meníngeo, cardiaco, urinario, gastrointestinal, musculoesquelético, neurológico o linfático. El diagnóstico y el tratamiento buscan disminuir la duración de los síntomas y prevenir la presencia de aneurismas coronarios.

Kawasaki disease (KD) is a multisystemic vasculitis that presents in childhood. It is usually an acute, febrile, self-limited disease of unknown etiology and may develop cardiovascular alterations; its clinical expression is variable as it presents inflammation of medium caliber vessels and multiple tissues: pulmonary, meningeal, cardiac, urinary, gastrointestinal, musculoskeletal, neurological or lymphatic. Diagnosis is clinical, and treatment aims to reduce the duration of clinical symptoms and prevent the presence of coronary aneurysms. Objective: to describe the clinical case of an infant patient with KD, in which clinical criteria characteristic of this pathology were identified. Case report: a 22-month-old male patient was admitted to the emergency room with a 14-day evolutionary clinical picture consisting of fever, emetic episodes, abdominal pain, unresponsive to acetaminophen, and diarrheal episodes. Two days later, he manifested generalized exanthema in the inguinal region that spread to the right testicle, back, and thorax. Subseguently, he presented bilateral nonpurulent conjunctivitis for three days. He received treatment with topical steroids and oral antihistamines; partial improvement with subseguent evolution in right testicularedema and bilateral desquamation in hands and feet. KD was suspected, a transthoracic echocardiogram was sent without coronary aneurysmal dilatations, and treatment with ASA was started without indication, given the evolution of immunoglobulin. Conclusions: KD is infrequent in childhood and should be suspected in patients with prolonged febrile symptoms unresponsive to conventional treatments and in whom the presence of other pathologies is ruled out.

a doença de Kawasaki (DK) é uma vasculite multissistêmica que ocorre na infância. Geralmente é uma doença aguda, febril, autolimitada, de etiologia desconhecida, podendo desenvolver alterações cardiovasculares; sua expressão clínica é variável, apresentando inflamação de vasos de médio porte e de múltiplos tecidos: pulmonar, meníngeo, cardíaco, urinário, gastrointestinal, musculoesquelético, neurológico ou linfático. O diagnóstico é clínico e o tratamento visa reduzir a duração dos sintomas clínicos e prevenir a presença de aneurismas coronábanos. Objetivo: descrever o caso clínico de um paciente infantil com DK, no qual foram identificados critérios clínicos característicos dessa patologia. Caso clínico: paciente do sexo masculino, 22 meses de idade meses de idade, admitido no departamento de emergência com um curso clínico de 14 dias, consistindo em febre, episódios eméticos e dor abdominal, sem resposta ao acetaminofeno, além de episódios diarreicos. Dois dias depois, ele desenvolveu uma erupção cutánea generalizada na região inguinal que se espalhou para o testículo direito, costas e tórax. Posteriormente, ele apresentou conjuntivite bilateral não purulenta por três dias. Ele foi tratado com esferoides tópicos e anti-histamínicos orais; houve melhora parcial com posterior evolução do edema testicular direito, descamação bilateral nas mãos e nos pés. Suspeitou-se de DK, portanto foi realizado ecocardiograma transtorácico sem dilatações aneurismáticas coronarianas e iniciado tratamento com AAS, sem indicação devido ao tempo de evolução da imunoglobulina. Conclusões: a DK não é frequente na infância e deve ser suspeitada em pacientes com sintomas febris prolongados que não respondem aos tratamentos convencionais e nos quais a presença de outras patologias é descartada.

Platos olvidados o de consumo ocasional en la gastronomía española: Navarra / Forgotten dishes or occasional consumption in Spanish gastronomy: Navarra

La gastronomía navarra goza de una gran personalidad y fuerte raíces históricas, aunque comparte elementos con la cocina de País Vasco, La Rioja, Aragón y Francia en diferentes aspectos. La tierra fértil bañada por el rio Ebro en la mitad sur del territorio y los prados y bosques de las montañas de la mitad norte proporcionan los ingredientes de excelente calidad: frutas, verduras, hortalizas, setas, carne de caza, carne y leche procedente de ganado criado en libertad y excelentes vinos. (AU)

Navarran gastronomy has a great personality and strong historical roots, although it shares elements with the cuisine of the Basque Country, La Rioja, Aragon and France in different aspects. The fertile land by the river Ebro in the southern half of the territory and the meadows and forests of the mountains in the northern half provide excellent quality ingredients: fruits, vegetables, mushrooms, game meat, meat and milk from free-range cattle and excellent wines. (AU)

Preoperative Administration of Hycet Elixir Reduces Hospital Length of Stay After Pediatric Outpatient Adeno/Tonsillectomy.

Background: Postoperative wound pain is commonly observed in the pediatric postanesthesia care unit (PACU) following tonsillectomy, adenoidectomy, and adenotonsillectomy (adeno/tonsillectomy), which contributes to increased medical care costs and delayed facility discharge. The purpose of this study was to review the benefits of preoperative administration of Hycet elixir (2.5 mg hydrocodone and 108 mg acetaminophen per 5 mL) in a pediatric population aged 1 to 9 years following adeno/tonsillectomy. Methods: Patient demographics, comorbidities, surgical and anesthetic times, need for postoperative rescue therapies, and PACU recovery and length of stay times were measured in pediatric patients who received preoperative administration of Hycet elixir (0.2 mg/kg hydrocodone) for adeno/tonsillectomy in an outpatient setting compared to a control group. Results: The Hycet elixir group had significant reductions in PACU and hospital lengths of stay and significant reductions in the need for postoperative rescue analgesics. No significant differences were observed in emergence times or in the incidences of unplanned hospital admission between the control and Hycet elixir groups. Conclusion: These data show that the preoperative administration of Hycet elixir is well tolerated in the pediatric patient population undergoing adeno/tonsillectomy and appears to significantly reduce the need for postoperative rescue analgesics and postoperative care times. These data support the use of preoperative administration of Hycet elixir in this patient population.

Alteración de la salud mental y consumo de alcohol en estudiantes de la Universidad Nacional de Chimborazo / Alteration of mental health and alcohol consumption in students of the National University of Chimborazo

INTRODUCCIÓN. Los trastornos mentales y por consumo de sustancias causan el 19% de todos los años de vida ajustados por discapacidad y el 36% de todos los años vividos con discapacidad. Representan un tercio de la carga total de enfermedades en la población con edades comprendidas entre 10 y 45 años. OBJETIVO. Analizar el trastorno mental y el consumo de alcohol en estudiantes universitarios. MATERIALES Y MÉTODOS. Estudio analítico transversal, de campo. Población y muestra conocida de 125 estudiantes universitarios de primero a quinto semestre de la carrera rediseñada de Pedagogía de la Actividad Física y del Deporte de la Universidad Nacional de Chimborazo, noviembre 2019. La técnica empleada para la recolección de datos fue el Reactivo Psicológico. Se aplicaron: Test de Identificación de los Trastornos Debidos al Consumo de Alcohol - AUDIT y Cuestionario de Salud General GHQ-28. Se calculó frecuencia y porcentaje de niveles de alteración de la salud mental y de consumo de alcohol. Se tabuló datos y analizó la asociación con el estadístico Chi cuadrado χ². RESULTADOS. El 79,2% (99; 125) presentaron un nivel de alteración de la salud mental leve; el 72,8% (91; 125) no reflejaron problemas relacionados con el consumo de alcohol; se encontró asociación significativa entre niveles de alteración de la salud mental y consumo de alcohol. CONCLUSIÓN. Se determinó asociación significativa entre el trastorno mental y el consumo de alcohol, con bajo nivel de alteración de la salud mental y ausencia de problemas relacionados con el alcohol.

INTRODUCTION. Mental and substance use disorders cause 19% of all disability-adjusted life years and 36% of all years lived with disability. They account for one-third of the total burden of disease in the population aged 10-45 years. OBJECTIVE. To analyze mental disorders and alcohol consumption in university students. MATERIALS AND METHODS. Cross-sectional, analytical, field study. Population and known sample of 125 university students from first to fifth semester of the redesigned career of Pedagogy of Physical Activity and Sport of the National University of Chimborazo, November 2019. The technique used for data collection was the Psychological Reactive. The following were applied: Alcohol Use Disorders Identification Test - AUDIT and General Health Questionnaire GHQ-28. Frequency and percentage of mental health and alcohol consumption disorders were calculated. Data were tabulated and the association was analyzed with the Chi-square χ² statistic. RESULTS. 79,2% (99; 125) had a mild level of mental health disturbance; 72,8% (91; 125) did not reflect problems related to alcohol consumption; significant association was found between levels of mental health disturbance and alcohol consumption. CONCLUSION. An significant association was found between mental disorder and alcohol consumption, with low levels of mental health impairment and absence of alcohol-related problems.

Adverse events of radioimmunotherapy for non-Hodgkin lymphoma: A systematic review and meta-analysis.

Non-Hodgkin's lymphoma continues to be a highly prevalent entity in the general population. Currently, there are multiple treatment schemes based on chemotherapeutic agents with a great success rate. However, there is a non-negligible percentage of patients who may relapse or be refractory. In this sense, new therapeutic options have emerged in the search for adequate responses, such as monoclonal antibodies that target the CD20 molecule. Another valid option is radioimmunotherapy (RIT), which combines using monoclonal antibodies for the specific targeting of malignant cells and radiation to destroy these cells. Despite the promising results that favor RIT in several clinical studies in different target populations and types of NHL, one situation to consider is the association of this therapy and second neoplasms (acute myeloid leukemia (AML) or myelodysplastic syndrome (MSD)). In this sense, we have proposed this meta-analysis to analyze the published information and determine the incidence of this association and determine this therapy's safety.

Relative importance of tree species richness, tree functional type, and microenvironment for soil macrofauna communities in European forests.

Soil fauna communities are major drivers of many forest ecosystem processes. Tree species diversity and composition shape soil fauna communities, but their relationships are poorly understood, notably whether or not soil fauna diversity depends on tree species diversity. Here, we characterized soil macrofauna communities from forests composed of either one or three tree species, located in four different climate zones and growing on different soil types. Using multivariate analysis and model averaging we investigated the relative importance of tree species richness, tree functional type (deciduous vs. evergreen), litter quality, microhabitat and microclimatic characteristics as drivers of soil macrofauna community composition and structure. We found that macrofauna communities in mixed forest stands were represented by a higher number of broad taxonomic groups that were more diverse and more evenly represented. We also observed a switch from earthworm-dominated to predator-dominated communities with increasing evergreen proportion in forest stands, which we interpreted as a result of a lower litter quality and a higher forest floor mass. Finally, canopy openness was positively related to detritivore abundance and biomass, leading to higher predator species richness and diversity probably through trophic cascade effects. Interestingly, considering different levels of taxonomic resolution in the analyses highlighted different facets of macrofauna response to tree species richness, likely a result of both different ecological niche range and methodological constraints. Overall, our study supports the positive effects of tree species richness on macrofauna diversity and abundance through multiple changes in resource quality and availability, microhabitat, and microclimate modifications.

Mixing tree species associated with arbuscular or ectotrophic mycorrhizae reveals dual mycorrhization and interactive effects on the fungal partners.

Recent studies found that the majority of shrub and tree species are associated with both arbuscular mycorrhizal (AM) and ectomycorrhizal (EM) fungi. However, our knowledge on how different mycorrhizal types interact with each other is still limited. We asked whether the combination of hosts with a preferred association with either AM or EM fungi increases the host tree roots' mycorrhization rate and affects AM and EM fungal richness and community composition.We established a tree diversity experiment, where five tree species of each of the two mycorrhiza types were planted in monocultures, two-species and four-species mixtures. We applied morphological assessment to estimate mycorrhization rates and next-generation molecular sequencing to quantify mycobiont richness.Both the morphological and molecular assessment revealed dual-mycorrhizal colonization in 79% and 100% of the samples, respectively. OTU community composition strongly differed between AM and EM trees. While host tree species richness did not affect mycorrhization rates, we observed significant effects of mixing AM- and EM-associated hosts in AM mycorrhization rate. Glomeromycota richness was larger in monotypic AM tree combinations than in AM-EM mixtures, pointing to a dilution or suppression effect of AM by EM trees. We found a strong match between morphological quantification of AM mycorrhization rate and Glomeromycota richness. Synthesis. We provide evidence that the combination of hosts differing in their preferred mycorrhiza association affects the host's fungal community composition, thus revealing important biotic interactions among trees and their associated fungi.

Low root functional dispersion enhances functionality of plant growth by influencing bacterial activities in European forest soils.

Current studies show that multispecies forests are beneficial regarding biodiversity and ecosystem functionality. However, there are only little efforts to understand the ecological mechanisms behind these advantages of multispecies forests. Bacteria are among the key plant growth-promoting microorganisms that support tree growth and fitness. Thus, we investigated links between bacterial communities, their functionality and root trait dispersion within four major European forest types comprising multispecies and monospecific plots. Bacterial diversity revealed no major changes across the root functional dispersion gradient. In contrast, predicted gene profiles linked to plant growth activities suggest an increasing bacterial functionality from monospecific to multispecies forest. In multispecies forest plots, the bacterial functionality linked to plant growth activities declined with the increasing functional dispersion of the roots. Our findings indicate that enriched abundant bacterial operational taxonomic units are decoupled from bacterial functionality. We also found direct effects of tree species identity on bacterial community composition but no significant relations with root functional dispersion. Additionally, bacterial network analyses indicated that multispecies forests have a higher complexity in their bacterial communities, which points towards more stable forest systems with greater functionality. We identified a potential of root dispersion to facilitate bacterial interactions and consequently, plant growth activities.

Fungal guilds and soil functionality respond to tree community traits rather than to tree diversity in European forests.

At the global scale, most forest research on biodiversity focuses on aboveground organisms. However, understanding the structural associations between aboveground and belowground communities provides relevant information about important functions linked to biogeochemical cycles. Microorganisms such as soil fungi are known to be closely coupled to the dominant tree vegetation, and we hypothesize that tree traits affect fungal guilds and soil functionality in multiple ways. By analysing fungal diversity of 64 plots from four European forest types using Illumina DNA sequencing, we show that soil fungal communities respond to tree community traits rather than to tree species diversity. To explain changes in fungal community structure and measured soil enzymatic activities, we used a trait-based ecological approach and community-weighted means of tree traits to define 'fast' (acquisitive) versus 'slow' (conservative) tree communities. We found specific tree trait effects on different soil fungal guilds and soil enzymatic activities: tree traits associated with litter and absorptive roots correlated with fungal, especially pathogen diversity, and influenced community composition of soil fungi. Relative abundance of the symbiotrophic and saprotrophic guilds mirrored the litter quality, while the root traits of fast tree communities enhanced symbiotrophic abundance. We found that forest types of higher latitudes, which are dominated by fast tree communities, correlated with high carbon-cycling enzymatic activities. In contrast, Mediterranean forests with slow tree communities showed high enzymatic activities related to nitrogen and phosphorous. Our findings highlight that tree trait effects of either 'fast' or 'slow' tree communities drive different fungal guilds and influence biogeochemical cycles.

Management of adverse effects of new monoclonal antibody treatments in acute lymphoblastic leukemia.

Therapeutic options for relapsed/refractory B-cell acute lymphoblastic leukemia have evolved in the past few years. The FDA has approved three novel therapies for this disease: inotuzumab ozogamicin (an anti-CD22 antibody-drug conjugate), blinatumomab (a bispecific T-cell engager), and chimeric antigen receptor T-cell therapy. Although these novel immunotherapies have revolutionized the therapeutic landscape, it is important to understand the crucial aspects of administration, especially toxicity. In this article, we review the unique toxicities and adverse effects of blinatumomab and inotuzumab ozogamicin and provide recommendations for prevention of adverse effects as well as the management options for each medication.

Use of anti-CD20 therapy in follicular and marginal zone lymphoma: a review of the literature.

The identification of the CD20 antigen in 1979 was the first step in what would become a therapeutic milestone opening the use of immunotherapy in hematological diseases. This protein is expressed on the surface of developing B cells, but not the early progenitors or mature plasma cells. In 1997, rituximab was approved by the Food and Drug Administration, and since then it has revolutionized the treatment of B-cell malignancies. It is used as a monotherapy and in combination, at induction, at relapsed, and also in maintenance. Indolent non-Hodgkin lymphomas are characterized by a long and non-aggressive course. In this group of lymphomas, rituximab represented a great therapeutic improvement, achieving lasting responses with few adverse effects. Nowadays, second-generation molecules are emerging that may have important advantages compared to rituximab, as well as biosimilars that represent an important cost-effective option.

Evaluación de propiedades psicométricas para identificar trastornos por ingesta de alcohol en una universidad de Chimborazo / Evaluation of psychometric properties to identify alcohol intake disorders at a university in Chimborazo

INTRODUCCIÓN. El alcohol es la sustancia psicoactiva con más alto índice de con-sumo a nivel mundial, una de las formas de evaluación de esta problemática es por medio del Alcohol Use Disorders Identification Test. OBJETIVO. Evaluar las pro-piedades psicométricas del cuestionario en una universidad de Chimborazo. MATE-RIALES Y MÉTODOS. Estudio observacional, prospectivo, con una población de 2 064 adultos jóvenes, y muestra de 978 universitarios. El muestreo aplicado fue no probabilístico intencional, en la Universidad Nacional de Chimborazo, periodo abril a diciembre del año 2018. Se realizó análisis de confiabilidad y de validez del Alcohol Use Disorders Identification Test de la Organización Mundial de la Salud por medio del método Delphi. RESULTADOS. La investigación se desarrolló con una muestra no clínica, el 72,8% (712; 978) correspondió a género femenino; las edades com-prendidas entre 18 y 34 años con una X= 21,16. La confiabilidad se aplicó el patrón de referencia del análisis de fiabilidad y validez el α=0,831. Un análisis factorial con-firmatorio de la prueba Kaiser, Meyer y Olkin y prueba de Bartlett= 0,898 y una signifi-cación de p= 0,00. CONCLUSIÓN. Los resultados psicométricos permitieron concluir que el instrumento fue válido y confiable para evaluar consumo perjudicial de alcohol en un contexto propio universitario.

INTRODUCTION. Alcohol is the psychoactive substance with the highest rate of consumption worldwide, one of the forms of evaluation of this problem is through the Alcohol Use Disorders Identification Test. OBJECTIVE. To evaluate the psycho-metric properties of the questionnaire at a University in Chimborazo. MATERIALS AND METHODS. Observational, prospective study, with a population of 2 064 young adults, and a sample of 978 university students. The sampling applied was intentional non-probabilistic, at the National University of Chimborazo, period april to december 2018. Reliability and validity analyses of the World Health Organization's Alcohol Use Disorders Identification Test were performed using the Delphi method. RESULTS. The research was developed with a non-clinical sample, 72,8% (712; 978) corres-ponded to female; ages between 18 and 34 years old with an X= 21,16. Confidence was applied to the reference pattern of the reliability and validity analysis of α=0,831. A confirmatory factorial analysis of the Kaiser, Meyer and Olkin test and Bartlett test= 0,898 and a significance of p=0,00. CONCLUSION. The psychometric results allow us to conclude that the instrument is valid and reliable to evaluate harmful alcohol consumption in its own university context.

Venetoclax: evidence to date and clinical potential.

The emergence of targeted therapy for patients with hematological diseases has permanently altered the therapeutic landscape. Immunochemotherapy regimes are now more and more being replaced by targeted therapies due to superior efficacy and better safety profiles. However, evolution and selection of subclones with continuous treatment leads to disease relapse and resistance toward these novel drugs. Venetoclax, the highly selective BCL-2 inhibitor (ABT-199), has an acceptable safety profile. To date, it has been approved for the treatment of first-line and relapsed/refractory chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML). However, extension of indications can be expected in monotherapy and in combination regimens with promising outcomes in other hematological diseases. In this article, we describe the mechanism of action that stands behind the efficacy of venetoclax and provide a summary of available results from clinical trials.

El abordaje temprano y tratamiento mixto en el manejo de la esquizofrenia: Guía de práctica clínica basada en evidencia de un hospital especializado en salud mental del Ministerio de Salud del Perú / Early approach and mixed treatment in schizophrenia management: Evidence-based clinical practice guideline from a specialized mental health public hospital in the Ministry of Health of Peru

Introducción: La esquizofrenia es un trastorno psicótico caracterizado por alteración sustantiva del funcionamiento mental y efectos sobre la funcionalidad social de la persona afectada. Objetivo: Brindar recomendaciones basadas en la mejor evidencia disponible para abordaje temprano, tratamiento farmacológico y psicosocial. Métodos: Se elaboró una guía de práctica clínica basada en evidencias (GPC-BE), adaptada mediante proceso sistemático, riguroso, transparente, desarrollado por un grupo elaborador integrado por metodólogos y psiquiatras expertos en el manejo de esquizofrenia. La guía comprende cuatro preguntas clínicas y recomendaciones, se realizó búsqueda de guías que respondan al tema priorizado, se preseleccionaron y evaluaron guías mediante el instrumento "Appraisal of Guidelines for Research and Evaluation II" (AGREE-II), la de mejor calidad metodológica fue elegida para adaptación. La búsqueda sistemática de evidencias para cada pregunta clínica fue realizada en múltiples bases de datos: MEDLINE/Ovid, EMBASE/Ovid, EMB reviews/Ovid. La selección y análisis de evidencias se realizó mediante pares clínicos y metodológos, las recomendaciones fueron elaboradas aplicando metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados: Con participación del panel de expertos clínicos de institutos y hospitales del Perú referentes en el manejo de esquizofrenia, se elaboraron cuatro recomendaciones para la intervención temprana, tratamiento farmacológico y mixto de pacientes adultos con esquizofrenia. Conclusiones: Se recomienda el abordaje temprano del primer episodio psicótico a través de centros de salud mental comunitarios (CSMC) y hospitales especializados y tratamiento farmacológico junto a terapia psicosocial estandarizada. El presente artículo resume la guía de práctica clínica basada en evidencias elaborada por un hospital público peruano especializado en salud mental.

Introduction: Schizophrenia is a psychotic disorder characterized by substantive alteration of mental functioning and effects on the social functionality of affected individuals. Objective: Provide recommendations based on the best available evidence for early approach, pharmacological and psychosocial treatment. Methods: An Evidence-based Clinical Practice Guide (GPC-BE) was developed, adapted through a systematic, rigorous, transparent process, by a working group composed of methodologists and psychiatrists who are experts in the management of schizophrenia. The guide includes four clinical questions and recommendations, we searched for guides that respond to the prioritized topic, guides were pre-selected and evaluated using the "Appraisal of Guidelines for Research and Evaluation II" (AGREE-II) instrument, the one with the best methodological quality was chosen for adaptation. The systematic search for evidence for each clinical question was performed in multiple databases: MEDLINE / Ovid, EMBASE / Ovid, EMB reviews / Ovid. The selection and analysis of evidence was carried out using clinical pairs and methodologists, the recommendations were prepared using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Results: With the participation of the panel of clinical experts from institutes and hospitals in Peru in the management of schizophrenia, four recommendations were established for the early intervention, pharmacological and mixed treatment of adult patients with schizophrenia. Conclusions: The early approach of the first psychotic episode through community mental health centers (CSMC) and specialized hospitals and pharmacological treatment together with standardized psychosocial therapy is recommended. This article summarizes the evidence-based clinical practice guideline developed by a Peruvian public hospital specializing in mental health disorders.

Lymphoplasmacytic Lymphoma and Marginal Zone Lymphoma.

Lymphoplasmacytic lymphoma (LPL) and marginal zone lymphoma (MZL) are indolent subtypes of non-Hodgkin lymphoma. Both are typically CD5 and CD10 negative. In recent years, there have been several scientific advances that have helped improve the diagnosis of these conditions. These conditions have been managed similarly in previous years with observation in asymptomatic patients and systemic therapy in advanced stages. However, there are specific differences. Differential responses are also seen with novel agents such as the BTK inhibitor ibrutinib. It is encouraging to see that there several clinical trials specific for patients with LPL and MZL ongoing.