Characteristics of patients with hypersensitivity reactions to chemotherapeutic and biological agents and desensitization behavior / Características de pacientes com reações de hipersensibilidade a agentes quimioterápicos e biológicos e comportamento de dessensibilização

Introduction: Hypersensitivity to chemotherapeutic and biological agents has increased in recent years due to their frequent use. Avoidance has been the first line of defense, leading to decreased treatment efficacy and increased adverse events. Objective: To characterize the sociodemographic and clinical aspects of patients with hypersensitivity reactions to chemotherapeutic agents who underwent desensitization and biological procedures in a Colombian city. Methods: This observational, descriptive, retrospective, multicenter study was conducted in patients with hypersensitivity reactions to chemotherapeutic and biological agents who underwent desensitization. Results: In the 14 included patients with a history of hypersensitivity reactions to chemotherapeutic and biological agents (57.1% women; median age 42.5 years), 45 desensitization procedures were performed. The most commonly prescribed drug was rituximab (57%). The skin was the most frequent reaction site (78.6%), and systemic corticosteroids were the most common treatment (78.6%). Breakthrough reactions occurred in 31.1% of the patients and only premedication with corticosteroids was associated with less severe reactions. All cases of desensitization were successful. Conclusions: Desensitization to chemotherapeutic and biological agents proved to be a useful and safe tool in a Colombian population.

Introdução: A hipersensibilidade aos agentes quimioterápicos e biológicos aumentou nos últimos anos devido ao seu uso frequente. Evitar tem sido a primeira linha de ação, levando à diminuição da eficácia do tratamento e ao aumento de eventos adversos. Objetivos: Caracterizar os aspectos sociodemográficos e clínicos de pacientes com reações de hipersensibilidade a agentes quimioterápicos submetidos a dessensibilização e procedimentos biológicos em uma cidade colombiana. Métodos: Foi realizado um estudo observacional, descritivo, retrospectivo e multicêntrico em pacientes com reações de hipersensibilidade a agentes quimioterápicos e biológicos submetidos à dessensibilização. Resultados: Foram incluídos 45 procedimentos de dessensibilização em 14 pacientes com histórico de reações de hipersensibilidade a agentes quimioterápicos e biológicos (57,1% mulheres, com mediana de idade de 42,5 anos). O medicamento mais relatado foi o rituximabe (57%). O envolvimento cutâneo foi o mais frequente (78,6%) e os corticosteroides sistêmicos foram o tratamento mais utilizado (78,6%). As reações ocorreram em 31,1% e apenas a pré-medicação com corticosteroides foi associada a uma menor gravidade destas. Todos os casos de dessensibilização foram bem-sucedidos. Conclusões: A dessensibilização a agentes quimioterápicos e biológicos provou ser uma ferramenta útil e segura em uma população colombiana.

Descarga de HSV-1, HSV-2, CMV y EBV en la saliva de receptores de trasplante de precursores hematopoyéticos de la Fundación HOMI - Hospital de la Misericordia, Bogotá, DC / Shedding of HSV-1, HSV-2, CMV, and EBV in the saliva of hematopoietic stem cell transplant recipients at Fundación HOMI - Hospital de la Misericordia, Bogotá, DC

Introducción. El trasplante de precursores hematopoyéticos es una alternativa en el tratamiento de diversas condiciones en la población pediátrica. La intensidad del acondicionamiento para el trasplante predispone al desarrollo de complicaciones en los receptores. Las infecciones por el virus herpes simple 1 (HSV-1), el virus herpes simple 2 (HSV-2), el citomegalovirus (CMV) humano y el virus de Epstein-Barr (EBV) son una causa importante de morbimortalidad en estos pacientes. La reactivación de infecciones latentes puede producir descargas virales asintomáticas detectables en la saliva, lo cual ayuda a determinar el comportamiento de dichas infecciones en pacientes con trasplante y a establecer el diagnóstico temprano de la reactivación. Objetivo. Evaluar el comportamiento de la descarga viral de HSV-1, HSV-2, CMV y EBV en la saliva de pacientes hospitalizados en la Unidad de Trasplante de la Fundación HOMI - Hospital de la Misericordia, entre enero y noviembre de 2012. Materiales y métodos. Se evaluaron muestras de saliva de 17 receptores de trasplante. La presencia de ADN de HSV-1, HSV-2, CMV y EBV en las muestras de saliva se detectó mediante reacción en cadena de la polimerasa convencional. Resultados. Se detectó el ADN del HSV-2 en la saliva de cuatro pacientes, del CMV en la de cuatro y del EBV en la de nueve, lo cual se asoció con leucopenia. Cuatro de los 17 pacientes presentaron cargas simultáneas de CMV y EBV. No se detectó el ADN del HSV-1. Conclusiones: Se demostró una descarga asintomática de HSV-2, CMV y EBV asociada a leucopenia en la saliva de los pacientes.

Introduction: Hematopoietic stem cell transplantation in pediatric patients is an alternative treatment for different diseases. The conditioning regimen for transplant predisposes recipients to the development of infections. Viral infections by herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2), human cytomegalovirus (CMV), and Epstein-Barr virus (EBV), are the most common, and the leading cause of morbidity and mortality among these patients. These viruses lie dormant in various cell types and the reactivation of latent infections may lead to asymptomatic viral shedding in saliva. The detection of these viruses in secretions may contribute to understand the behavioral dynamics of these viral infections in transplanted patients, and to the early diagnosis of reactivation. Objective: To assess HSV-1, HSV-2, CMV and EBV viral shedding in the saliva of patients admitted for hematopoietic stem cell transplantation at Fundación HOMI - Hospital de la Misericordia between January and November of 2012. Materials and methods: We evaluated stimulated saliva samples of 17 hematopoietic stem cell transplantation recipients weekly. We performed DNA extraction from saliva, and we evaluated the presence of DNA for HSV-1, HSV-2, CMV, and EBV by PCR. Results: While we detected HSV-2 and CMV DNA in the saliva of four patients, EBV DNA was detected in nine patients with leukopenia. In contrast, we did not detect HSV-1 DNA in saliva. Additionally, four out of the 17 patients showed a simultaneous shedding of CMV and EBV. Conclusions: By conventional PCR, we demonstrated asymptomatic HSV-2, CMV, and EBV viral shedding in saliva, associated with leukopenia.

Characterization of a murine neuron-enriched model of primary trigeminal ganglia cultures to study the interferon-ß antiviral effect against Herpes Simplex Virus type 1 / Caracterización de un modelo murino de cultivos primarios de ganglio trigeminal enriquecido en neuronas para el estudio del efecto antiviral del interferón-ß frente al virus Herpes simple tipo 1

Objective: To characterize a neuron-enriched primary TG culture and evaluate interferon- β expression and activity after HSV-1 infection. Materials and methods: The percentage of neurons present in cultures was assessed by neurofilament immunocytochemistry. Cultures were treated with interferon- β and infected with HSV-1, then viral antigen positive cells were counted and interferon- βexpression was assessed by quantitative PCR. Results: The culture contained 15% neurons and 85% non-neuronal cells. A cytopathic effect was observed, associated with high viral spread (72.9% neurons and 48.3% non-neuronal cells were positive for viral antigen). Interferon- β treatment impaired the cytopathic effect and decreased the infected neurons to 16.7% and infected non-neuronal cells to 7.8%. Viral infection at 6 h postinfection significantly increased the interferon- β transcripts by 18.2 fold, while at 18 h postinfection Interferon pre-treatment in infected cultures increased interferon- β transcription by 3.7 fold. Discussion: This culture model contained 15% neurons, which is 10 times higher compared to other reported cultures, and non-neuronal cells comprised 85% of cells in this culture. All types of cells were found to be infected, which is similar to that reported during acute infections in vivo . Additionally, interferon- βdecreased the infected cells, avoiding the cytopathic effect, which is similar to that reported in swine TG cultures. Conclusions: A neuron-enriched primary TG model was characterized. Interferon- β treatment protected cells from cytopathic effects and viral spread, while viral infection up-regulated interferon- β expression. This result means that interferon- β exerts an important antiviral effect against HSV-1 in these cultures.

Objetivo: Caracterizar un cultivo primario de ganglio trigeminal (GT) enriquecido en neuronas y evaluar la expresión de interferón- y su actividad frente a la infección con Herpes simple tipo 1 (HSV-1). Materiales y métodos: El porcentaje de neuronas fue determinado por inmunocitoquímica para neurofilamento. Los cultivos fueron tratados con interferón- β e infectados con HSV-1, y se cuantificaron las células positivas para antígeno viral por inmunocitoquímica y la expresión de interferón- β por PCR cuantitativa. Resultados: El cultivo presentó un 15% de neuronas y 85% de células no neuronales. Se encontró efecto citopático, asociado a una alta diseminación de la infección (72,9% neuronas y 48,3% de células no neuronales positivas para antígeno viral). El interferón- β evitó la aparición de efecto citopático y disminuyó las células infectadas a 16,7% en neuronas y a 7,8% las células no neuronales. La infección viral incrementó la expresión de transcritos de interferón- β 18,2 veces a las 6 h de infección, mientras que a las 18 h post infección el tratamiento con interferón incrementó esta expresión 3,7 veces. Discusión: Los cultivos presentaron un 15% de neuronas, lo cual es 10 veces más que en otros cultivos reportados. Las células no neuronales representan el 85% de las células del cultivo, y se evidenció que todos los tipos de células se infectaron; similar a lo que ha sido reportado durante infecciones agudas in vivo . Adicionalmente, el interferón- β disminuyó el porcentaje de células infectadas y evitó la aparición de efecto citopático, similar a lo que ha sido reportado en cultivos de GT porcino. Conclusiones: Se caracterizó un modelo de cultivo primario de GT enriquecido en neuronas. Interferón- β protegió las células del efecto citopático y la diseminación viral mientras que la infección viral incrementó la expresión de interferón- β. Por lo tanto, el interferón- β ejerció un papel antiviral importante frente al HSV-1 en estos cultivos.

Perfil cognitivo de la dependencia emocional en estudiantes universitarios en Medellín, Colombia / Cognitive profile of emotional dependence in University Students from Medellín, Colombia

El objetivo de este estudio fue la identificación del perfil cognitivo de los estudiantes universitarios con dependencia emocional. Ésta se plantea como un patrón orientado al otro como fuente de satisfacción y seguridad personal, donde el perfil cognitivo les llevaría a interpretar los hechos de manera diferente, basándose en cubrir sus necesidades emocionales insatisfechas. Se tomó una muestra aleatoria estratificada de 569 estudiantes universitarios. Los resultados arrojaron un modelo que explica el 89.3 % de la variabilidad, con alta capacidad predictiva (sensibilidad 91.4 %, especificidad 97.7 %), conformado por el esquema de desconfianza/abuso, creencias centrales del trastorno de la personalidad paranoide y dependiente, distorsión cognitiva de falacia de cambio y estrategia hipodesarrollada de afrontamiento de autonomía.

The objective of this study was to identify the cognitive profile of university students with emotional dependency. This is considered as a pattern oriented to another person as a source of satisfaction and personal safety, where the cognitive profile will make them to interpret the facts in a different way in order to cover their unsatisfied emotional needs. We use a random sample of 569 university students. The results showed a characteristic profile which explains 89.3% of the variability and a high predictive model capacity (sensitivity 91.4% and specificity 97.7%), formed by the schema of mistrust/abuse, the cores beliefs of paranoid and dependent personality disorders, fallacy of change as cognitive distortion and underdeveloped autonomy as a coping skill.