Lineage switch in childhood acute leukemia: an unusual event with poor outcome.

Although rarely, switches between lymphoid and myeloid lineages may occur during treatment of acute leukemias (AL). Correct diagnosis relies upon confirmation by immunophenotyping of the lineage conversion and certification that the same cytogenetic/molecular alterations remain despite the phenotypic changes. From a total of 1,482 AL pediatric patients, we report nine cases of lineage conversion (0.6%), seven from lymphoid (four Pro-B, two Pre-B, one Common) to myelo-monocytic, and two from myeloid (bilineal, with myeloid predominance) to Pro-B. Eight patients were infants. Switches were suggested by morphology and confirmed with a median of 15 days (range: 8 days-6 months) from initiation of therapy. Of note, in five cases switches occurred before day 15. Stability of the clonal abnormalities was assessed by cytogenetic, RT-PCR/Ig-TCR rearrangement studies in all patients. Abnormalities in 11q23/MLL gene were detected in seven cases. Treatment schedules were ALL (two pts), Interfant-99 (five pts) and AML (two pts) protocols. Despite changing chemotherapy according to the new lineage, all patients died. Our findings support the association of lineage switches with MLL gene alterations and the involvement of a common lymphoid B-myeloid precursor. New therapies should be designed to address these rare cases. Possible mechanisms implicated are discussed.

Shared decision-making in Argentina in 2022.

Argentina is an upper-middle income country located in South America with an estimated population of 46.2 million inhabitants. There is no unified research agenda or government initiatives encouraging the implementation and research of Shared Decision-Making (SDM). Our working group at the Family and Community Medicine Division of the Hospital Italiano de Buenos Aires is the leading centre for research and implementation of SDM in the country. The implementation strategy is articulated in undergraduate, postgraduate and continuous medical education. However, it is challenged by the professionals' perception that they are already doing it or lack time during consultations. We have advanced research to understand how to adapt tools to measure and implement SDM in our settings. Still, we face additional challenges related to funding, accessing diverse populations beyond the reach of our institution and incorporating patients in the co-production of research. While most of our efforts arise from the voluntary work of our healthcare professionals, we believe this is a strength since SDM research and implementation are then directly linked to patient care.

[Food insecurity in the area of influence of the Center of Family and Community Medicine "San Pantaleón" (Province of Buenos Aires).] / Inseguridad alimentaria en el área de influencia del Centro de Medicina Familiar y Comunitaria "San Pantaleón" (Provincia de Buenos Aires).

Introduction: Last years, food insecurity is a raising problem in Argentina and is a key indicator of population health. The principal aim of this study was to determine food insecurity prevalence in a population of Buenos Aires suburbs, considering as secondary objectives: 1) to evaluate associated variables with food insecurity; 2) to perform provisional statistical validation of the Food Insecurity Experience Scale (FIES). Methods: It was conducted a descriptive, cross-sectional research study was conducted. Check the FIES survey in people over 15 years of age in the Barrio Santa María in Bajo Boulogne, San Isidro district, Buenos Aires. A probabilistic sampling was carried out. The data will be analyzed following the Rasch model proposed by the Food and Agriculture Organization of the United Nations. Results: 222 people were interviewed, finding a prevalence of moderate / severe food insecurity of 47.29% and severe of 6.57%. We found an independent association with a female head of household OR 2.22; (95%CI 1.27 to 3.87) and having more than 4 cohabitants in the home OR 2.24; (95%CI 1.25 to 4.02). The provisional validation of the FIES survey was carried out in our sample through the testing of the Rasch model assumptions. Conclusion: food insecurity is a problem present in our population. It was carried out the validation of an instrument to measure it, easy to apply and that allows valid comparisons between local and international measurements.

Introducción: La inseguridad alimentaria es una problemática en aumento en los últimos años en Argentina y resulta un indicador clave del estado de salud de la población. Este estudio se propuso determinar su prevalencia en una población del conurbano bonaerense planteándose como objetivos secundarios: 1) evaluar variables que se asocien con la inseguridad alimentaria; 2) realizar la validación estadística provisional de la Escala de la Inseguridad Alimentaria basada en la Experiencia (FIES). Materiales y métodos: Se realizó un estudio de investigación descriptivo, de corte transversal. Se utilizó la encuesta FIES en personas mayores de 15 años del Barrio Santa María en el Bajo Boulogne, partido de San Isidro, provincia de Buenos Aires. Se realizó un muestreo probabilístico. Se analizaron los datos siguiendo el modelo Rasch propuesto por la Organización de las Naciones Unidas para la Alimentación y la Agricultura. Resultados: Se entrevistaron 222 personas hallando una prevalencia de inseguridad alimentaria moderada/severa de 47,29% y severa de 6,57%. Se observó una asociación independiente con una jefatura de hogar femenina OR 2,22; (IC95% 1,27 a 3,87) y con tener más de 4 convivientes en el hogar OR 2,24; (IC95% 1,25 a 4,02). Se realizó la validación provisional de la encuesta FIES en nuestra muestra a través del testeo de las asunciones del modelo Rasch. Conclusión: la inseguridad alimentaria es un problema presente en nuestra población. Se realizó la validación de un instrumento para medirla, de sencilla aplicación y que permite realizar comparaciones válidas entre mediciones locales e internacionales.

Shared decision making in Argentina in 2017.

Argentina is a high-middle income country located in Southern South America with an estimated population of 44 million inhabitants. The epidemiological profile of the population is characterised by an increase of non-communicable diseases. The health system is heterogeneous, fragmented and loosely integrated. There are no unified research agenda or government initiatives encouraging the implementation of and research on shared decision making (SDM). Progress has been made lately to respect patient autonomy through the enactment of the 'Patients' Rights Act', which expressly enshrines the right of patients to get information as a key element of decision-making. To our knowledge, the team at the Department of Family and Community Medicine of the Hospital Italiano de Buenos Aires is the only one working on shared decision making in Argentina. This department carries out research, medical undergraduate and graduate training, and clinical practice implementation activities through strategies aimed at professionals and patients alike. We face some challenges regarding SDM, such as: 1) the fragmentation and the heterogeneity of the local health system; 2) we are a small group of people working on this topic who, simultaneously, have care, management, teaching and research responsibilities; 3) we have no government support and project funding is scarce; 4) due to the geographic location of the country, we must make a great effort in order to attend events on the state of the art in SDM. Given the current state of our health system, we believe the government is not likely to encourage, implement or research on SDM in the short term. Our group will continue to work on the local initiative and also to instil it in other interested groups.

Quality of life in type 2 diabetes mellitus patients requiring insulin treatment in Buenos Aires, Argentina: a cross-sectional study.

BACKGROUND: Decision-makers have begun to recognize Health-Related Quality of Life (HRQoL) as an important and measurable outcome of healthcare interventions; and HRQoL data is increasingly being used by policy-makers to prioritize health resources. Our objective was to measure HRQoL in a group of Type 2 Diabetes Mellitus (T2DM) patients receiving insulin treatment in Buenos Aires, Argentina. METHODS: We conducted a cross-sectional study of patients with T2DM over 21 years of age, treated with either Neutral Protamine Hagedorn (NPH) insulin or Insulin Glargine (IG), who had not changed their baseline schedule in the last 6 months. The recruitment was during 2006-7 in nine private diabetes specialists' offices in Buenos Aires, Argentina. A standardized diabetes-specific HRQoL questionnaire, the Audit of Diabetes Dependent Quality of Life (ADDQoL), was used. RESULTS: A total of 183 patients were included (93 receiving NPH and 90 receiving IG). The mean QoL score was: 0.98 (SD: 0.89) and the diabetes specific QoL was: -1.49 (SD: 0.90). T2DM had a negative impact on HRQoL with a mean Average Weighted Impact (AWI) score on QoL of -1.77 (SD: 1.58). The greatest negative impact was observed for domains: 'worries about the future', 'freedom to eat', 'living conditions', 'sex life', and 'family life'. The mean AWI score was -1.71 (SD: 1.48) in patients treated with IG and -1.85 (SD: 1.68) in patients receiving NPH, this difference was not statistically significant. CONCLUSION: The ADDQoL questionnaire is a tool that can be used in Argentina to measure the QoL of patients with diabetes when evaluating diabetes care programs. The scores of QoL in our selected population did not differ from those reported in high-income countries. We expect that the results of this study will increase healthcare providers' awareness of patients' perceived QoL and help to overcome the barriers that delay insulin treatment; mainly clinical inertia and patient resistance.

Programa de Salud Bucodental en escolares de la Comunidad del Bajo Boulogne / Oral Health Program in children from Bajo Boulogne Community

Las afecciones bucodentales constituyen un problema de salud pública por su alta prevalencia y su fuerte impacto individual y colectivo en términos de dolor, malestar y discapacidad social y funcional. El Centro de Medicina Familiar y Comunitaria San Pantaleón, ubicado en la provincia de Buenos Aires, brinda asistencia sanitaria gratuita a la comunidad. Un relevamiento documentó que el 97% de los concurrentes presentaba caries y no se lavaban los dientes por falta de cepillo y pasta dental. Se decidió llevar adelante un programa de promoción de la salud bucodental. El objetivo fue evaluar su implementación; que incluyó: a) rastreo de caries y problemas odontológicos; b) coordinación interinstitucional; c) entrega de cepillos y pasta dental; d) intervención educativa; e) extensión comunitaria. Participaron en forma irregular 120 niñas, niños y adolescentes entre 5 y 18 años del Centro de Apoyo Escolar Fundación Bajo Boulogne. Se realizaron dos encuentros educativos y entrega de cepillos y pasta dental. En la revisión odontológica inicial sobre 60 participantes se detectaron caries en 43 (71,6%), que fueron derivados para tratamiento odontológico, pero concurrieron solo 26 (60,4%). El conocimiento sobre salud bucodental mostró cambios entre los más pequeños luego de las intervenciones educativas. Se logró implementar el programa, cumplimentando las actividades propuestas. Pero surgieron barreras que dificultaron la cobertura. En cuanto a la eficacia de la intervención educativa, no se logró mostrar cambios en el conocimiento. Se consiguió la detección oportuna, la incorporación de hábitos como el cepillado dentro de la institución educativa, la articulación para mejorar el acceso a la atención y la vinculación entre los diferentes actores comunitarios. (AU)

Oral disorders are a public health problem due to their high prevalence and their strong individual and collective impact in terms of pain, discomfort, and social and functional disability. The San Pantaleón Family and Community Medicine Center, located in the province of Buenos Aires, provides free healthcare to the community. A survey documented that 97% of those present had cavities and did not brush their teeth due to a lack of brush and toothpaste. It was decided to carry out an oral health promotion program. The objective was to evaluate its implementation; which included: a) tracking of caries and dental problems; b) inter-institutional coordination; c) delivery of brushes and toothpaste; d) educational intervention; e) community extension. 120 girls and boys and adolescents between 5 and 18 years of age from the Bajo Boulogne Foundation School Support Center irregularly participated. Two educational meetings were held, handing out brushes and toothpaste. In the initial dental review of 60 participants, caries was detected in 43 (71.6%), who were referred for dental treatment, with only 26 (60.4%) concurring. Oral health knowledge showed changes among the youngest after educational interventions. It was possible to implement the program, completing the proposed activities. Barriers arose that made coverage difficult. Regarding the effectiveness of the educational intervention, it was not possible to show changes in knowledge. Timely detection was achieved, the incorporation of habits such as brushing within the educational institution, articulation to improve access to care and the link between the different community actors. (AU)

Factores asociados al autoreporte de rastreo de cáncer de mama y cuello uterino en mujeres atendidas en un Centro de Salud del Bajo Boulogne, San Isidro, Buenos Aires, Argentina: estudio de corte transversal / Associated factors to self-report of cervical and breast cancer screening in women assisted in a Health Center in Bajo Boulogne, San Isidro, Buenos Aires, Argentina: a cross-seccional study

OBJETIVOS: determinar la prevalencia de cobertura de rastreo de cáncer mamario con mamografía y de cuello uterino con Papanicolau en la población accesible de la zona de influencia del Centro de Salud San Pantaleón (San Isidro, Buenos Aires, Argentina) e identificar factores socioeconómicos y culturales asociados a su realización MÉTODOS: estudio de corte transversal con datos recolectados a través de una encuesta autoadministrada a una muestra de conveniencia de mujeres seleccionadas consecutivamente a medida que concurrían al centro entre 06/2009 y 06/2010. RESULTADOS: fueron entrevistadas 474 mujeres. La tasa de autoreporte de haber realizado Papanicolau entre los 19 y los 70 años fue 61,1%(IC95%56,4 a65,6) y la de haber realizado mamografía luego de los 50 años, 51,1% (43,7 a 58,4). En el análisis multivariable, la del primero se asoció independientemente a un mayor nivel educativo (OR 3,4; IC95%1,7 a 6,5), a haber tenido hijos (OR 2,6;1,4 a 4,9), a reconocer un médico de referencia (OR 2,12;1,35 a 3,3) y a ser menor de 50 años (OR 1,7;1,1 a 2,7); y la de la segunda, a un mayor nivel educativo (OR 1,2;0,4 a 3,1), a no estar empleada (OR 1,84;0,94 a 3,6) y a reconocer un médico de referencia (OR 2,63;1,22 a 5,88). CONCLUSIONES: las frecuencias de auto-reporte de rastreo de ambas patologías fueron coincidentes con las reportadas a nivel nacional y menores que las recomendadas como estándares internacionales.

OBJECTIVES: To determine the prevalence of coverage of breast cancer screening with mammography and cervical cancer with Papanicolau in the accessible population of the area of ​​influence of the San Pantaleón Health Center (San Isidro, Buenos Aires, Argentina) and to identify socioeconomic and cultural factors. associated with its performance METHODS: cross-sectional study with data collected through a self-administered survey of a convenience sample of consecutively selected women as they attended the center between 06/2009 and 06/2010. RESULTS: 474 women were interviewed. The rate of self-report of having performed a Pap test between the ages of 19 and 70 was 61.1% (95% CI 56.4 to 65.6) and that of mammography after 50 years, 51.1% (43.7%). to 58.4). In the multivariate analysis, the former was independently associated with a higher educational level (OR 3.4, 95% CI 1.7 to 6.5), having had children (OR 2.6, 1.4 to 4.9). ), to recognize a reference physician (OR 2.12, 1.35 to 3.3) and to be younger than 50 years (OR 1.7, 1.1 to 2.7); and the second, to a higher educational level (OR 1.2, 0.4 to 3.1), not to be employed (OR 1.84, 0.94 to 3.6) and to recognize a reference doctor (OR 2.63, 1.22 to 5.88). CONCLUSIONS: the frequencies of self-reported tracking of both pathologies were coincident with those reported at the national level and lower than those recommended as international standards.