Real-World Evidence of Epidemiology and Clinical Outcomes in Multiple Myeloma, Findings from the Registry of Hemato-Oncologic Malignancies in Colombia, Observational Study.

INTRODUCTION/BACKGROUND: Multiple Myeloma (MM) is a plasma cell derived clonal disorder that represents around 1% of all newly diagnosed neoplasms. Limited data regarding MM treatment in Latin America is available, and access to novel agents for a substantial portion of the population is limited by their high costs. MATERIALS (OR PATIENTS) AND METHODS: RENEHOC is a bidirectional (retrospective and prospective) multicenter observational registry of hematological malignancies in Colombia. MM patients included up to July 2020 were analyzed on this report. RESULTS: 890 are reported with a median follow-up of 18 months (IQR: 7-42 months). Patients were classified by age group (≤ or > 65 years). Median age at diagnosis was 67 years (IQR: 59-75 years) and 47.1% of patients were women. 709 patients (79.6%) received Bortezomib-based schemes as part of the first line. Two hundred and fifty-two patients (28.3%) were consolidated with Autologous Stem Cell Transplantation (ASCT) in first-line. ASCT consolidation and age were the main independent factors influencing outcomes; in the non-ASCT cohort, 5-year overall survival was 48.7% (CI 41.8-55.2) compared to 80.7% (CI 73-86.4) in ASCT patients. CONCLUSION: This data depicts the reality of MM in Colombia, which likely reflects other Latin American countries, where access barriers to diagnosis and treatment are echoed in advanced stage diagnosis and a low rate of transplants. These seem to negatively impact survival despite the availability of most novel drugs approved for this disease. Thus, emphasizing the paradox that prevails in most of the region: availability without equitable access.

Impacto clínico de la profilaxis con levofloxacino en pacientes neutropénicos con neoplasias hematológicas Estudio antes y después, en un hospital de cuarto nivel de Colombia / Clinical impact of levofloxacin prophylaxis in neutropenic patients with hematological malignancies Before and after study in a fourth-level Colombian hospital

Resumen Introducción: el uso de la profilaxis con fluoroquinolonas en pacientes con neutropenia y enfermedades hematológicas malignas es controvertido. Se ha reportado un impacto positivo en la reducción de la morbilidad y mortalidad, pero el consiguiente desarrollo de resistencia bacteriana es una preocupación. Objetivo: comparar la incidencia de neutropenia febril, infección documentada y muerte por infección, en una cohorte de pacientes adultos con neoplasias hematolinfoides en quimioterapia de alto riesgo, que reciben profilaxis con levofloxacino, versus quienes no recibieron profilaxis. Material y métodos: s e realizó un estudio de antes y después. Los desenlaces fueron neutropenia febril, infección clínica y microbiológicamente documentada, duración de la hospitalización, estancia en la unidad de cuidados intensivos, y mortalidad asociada a infección. Resultados: ciento sesenta y ocho (168) admisiones hospitalarias, 98 en el grupo con levofloxacino y 70 en grupo sin profilaxis. El grupo de levofloxacino tuvo reducción de eventos de neutropenia febril (39 vs 70%, p=<0,001), menor tasa de infecciones microbiológicamente documentadas (45.6 vs 61,2%, p= 0.049), menor estancia hospitalaria (24 vs 28.1 días, p=0.008), y menor estancia en la unidad de cuidados intensivos (17 vs 6.1%, p=0.023), comparado con el grupo sin profilaxis. Se encontró asociación en la administración de levofloxacino y reducción de eventos de neutropenia febril OR= 0.21 (IC 95% 0.10-0.43), NNT= 3 (IC 95% 2-6). No se documentó diferencia en la mortalidad (3 vs 8.6%, p=0.118). Conclusiones: la profilaxis mostró beneficio en reducción de eventos febriles, infección micro-biológicamente documentada, menor estancia hospitalaria y en la unidad de cuidados intensivos, sin impacto en la mortalidad. (Acta Med Colomb 2016; 40: 235-242).

Abstract Introduction: the use of fluoroquinolone prophylaxis in patients with neutropenia and hematological malignancies is controversial. A positive impact on reducing morbidity and mortality has been reported, but the subsequent development of bacterial resistance is a concern. Objective: to compare the incidence of febrile neutropenia, documented infection and death from infection in a cohort of adult patients with hematolymphoid neoplasms on high-risk chemotherapy that receive prophylaxis with levofloxacin versus those who did not receive prophylaxis. Material and methods: a before and after study was performed. Outcomes were febrile neutropenia, clinically and microbiologically documented infection, duration of hospitalization, intensive care unit stay, and mortality associated with infection. Results: one hundred sixty-eight (168) hospital admissions, 98 in the levofloxacin group and 70 in the non-prophylaxis group. The levofloxacin group had a reduction in febrile neutropenia events (39 vs 70%, p = <0.001), a lower rate of microbiologically documented infections (45.6 vs 61.2%, p = 0.049), shorter hospital stay (24 vs. 28.1 days , P = 0.008), and shorter stay in the intensive care unit (17 vs 6.1%, p = 0.023) compared to the group without prophylaxis. Association in the administration of levofloxacin and reduction of febrile neutropenia events OR = 0.21 (95% CI 0.10-0.43), NNT = 3 (95% CI 2-6) was found. There was no documented difference in mortality (3 vs 8.6%, p = 0.118). Conclusions: prophylaxis showed benefit in reducing febrile events, microbiologically documented infection, less hospital and intensive care unit stay, with no impact on mortality. (Acta Med Colomb 2016; 40: 235-242).

Caracterización de la diabetes mellitus tipo 2 y el control metabólico en el paciente hospitalizado / Characterization of type 2 diabetes mellitus and metabolic control in the hospitalized patient

Introducción: la prevalencia de la diabetes mellitus tipo 2 se ha incrementado, siendo una de las primeras causas de hospitalización y de muerte en la población mayor de 45 años. Objetivo: describir las características demográficas y clínicas de los pacientes con diabetes tipo dos hospitalizados en el servicio de medicina interna durante el periodo comprendido entre octubre de 2010 y agosto de 2012 en el hospital de San José, Bogotá, Colombia. Material y métodos: se reporta una serie de casos de pacientes adultos diabéticos tipo 2 hospitalizados, independiente del motivo de ingreso. Se determinaron características demográficas, variables asociadas con la diabetes (tiempo de evolución, tratamiento, control por médico especialista y complicaciones crónicas), estancia hospitalaria, complicaciones intrahospitalarias y mortalidad. Resultados: 318 pacientes, 283 diabéticos conocidos y 35 con diabetes de novo, edad promedio 65 años (DE 13.7). La principal causa de admisión fue enfermedad infecciosa (43%), seguido de descompensación metabólica (21%). El 81% se encontraba fuera de las metas de control metabólico. La neuropatía (68%) y la nefropatía diabética (66%) son las complicaciones crónicas más frecuentes. El 71% presentaban hipertensión arterial. Los pacientes con un mal control metabólico tuvieron una estancia hospitalaria mayor a 10 días de 17.5% respecto a 12% de aquellos con buen control metabólico. Se presentaron 17 defunciones (5.3%) principalmente por complicaciones infecciosas. Conclusiones: un importante número de pacientes diabéticos a su ingreso se encuentran fuera de metas de control metabólico, con una alta prevalencia de complicaciones crónicas y una mayor estancia hospitalaria. Contrario a reportes de la literatura, los pacientes diabéticos de novo no presentaron complicaciones intrahospitalarias.

Introduction: the prevalence of type 2 diabetes has increased, being one of the leading causes of hospitalization and death in the population over 45 years. Objective: to describe the demographic and clinical characteristics of patients with type 2 diabetes hospitalized in the internal medicine service during the period between October 2010 and August 2012 in the Hospital San José, Bogotá, Colombia. Material and methods: a series of cases of adult patients with type 2 diabetes independent from the reason for its hospitalization, is reported. Demographic characteristics, variables associated with diabetes (time of evolution, treatment, control by specialist and chronic complications), hospital stay, hospital complications and mortality were determined. Results: 318 patients, 283 known diabetics and 35 with de novo diabetes, mean age 65 years (SD 13.7). The leading cause of hospitalization was infectious disease (43%), followed by metabolic decompensation (21%). 81% was outside the goal of metabolic control. Neuropathy (68%) and diabetic nephropathy (66%) are the most common chronic complications. 71% had arterial hypertension. 17.5% of patients with poor metabolic control had a hospital stay longer to 10 days compared to 12% of those with good metabolic control. 17 deaths (5.3%) occurred mainly due to infectious complications. Conclusions: A significant number of diabetic patients on admission are outside metabolic control goals, with a high prevalence of chronic complications and longer hospital stay. Contrary to literature reviews, de novo diabetic patients showed no hospital complications.

Methods to detect antifibrillarin antibodies in patients with systemic sclerosis (SSc): a comparison.

Autoantibodies against nucleolar antigens are common in systemic sclerosis (SSc). They include autoantibodies against fibrillarin (Fb), which are serological markers for SSc. Fb is associated with the evolutionally-conserved box C/D of small nucleolar RNAs (snoRNAs). We compared indirect immunofluorescence (IIF), Western blot (WB), and immunoprecipitation (IPP) of total small RNAs assays to determine which of these techniques is most specific for the detection of snoRNPs. We also examined the frequency and specificity of autoantibodies from SSc patients to snoRNAs, snRNAs, and scRNAs, and concluded that 1) IIF can not determine autoantibody specificity against Fb, 2) 36% of SSc sera were false-negative by WB, and 3) by IPP, anti-Fb autoantibodies from SSc patients can bind U3, U8, U13, U15, and U22 snoRNAs.

Sensibilidad in vitro de Pseudomonas aeruginosa / Sensibility in vitro of Pseudomonas aeruginosa

Al someter 148 cepas de Pseudomonas aeruginosa a agentes antimicrobianos de uso común, se determinó la concentración mínima inhibitoria. La mayor actividad sobre las cepas sometidas fue la de polimixina, sulfato de amikacina y tobramicina. El índice más alto de resistencia a tratamiento con ampicilina, cloramfenicol, nitrofurazona y estreptomicina correspondió a cepas aisladas de pacientes quemados