Radiochemotheraphy-induced oral mucositis: Ectoin solution as a new treatment.

Background: The current treatment for head and neck cancer involves radiotherapy, systemic therapy and surgery in a multidisciplinary approach. Unfortunately, cancer therapies can lead to local and systemic complications or side effects such as mucositis, which is the most common dose-dependent complication in the oral cavity and gastrointestinal tract. Mucositis can cause a considerably reduced quality of life in cancer patients already suffering from physical and psychological exhaustion. Moreover, radiotherapy interruptions due to toxicity can impact negatively in local control and survival. The main purpose of this study was to analyze patient satisfaction of Ectoin solution use in radiotherapy or radiochemotherapy-induced oral mucositis. Material and Methods: This is an institutional prospective analysis including 15 patients, conducted by two Spanish centers, between October 2019 and May 2020. Patients were treated with Ectoin solution during Radiotherapy and one month after the end of the treatment, three times per day. A seven-ítem Likert scale was used. We present our descriptive statistic regarding doctors and patients´s satisfaction. Results: Our results suggest that Ectoin solution relieves mucositis and is well tolerated by patients. Conclusions: We observed a favorable repercussion in the oral mucositis management and suggest a potential benefit of treating it. Key words:Radiotherapy, oral mucositis, head and neck cancer, ectoine, oral care.

Evaluación de los riesgos del proceso de gestión de medicamentos y productos médicos / Risk assessment in the management process of medical drugs and devices

OBJETIVOS: Establecer los riesgos del proceso de gestión de medicamentos y productos médicos para priorizar la implementación de acciones de mejora y medidas preventivas. MATERIALES Y MÉTODOS: Se utilizó la primera fase de la metodología de Análisis Modal de Fallos y Efecto (AMFE) hasta la valoración del riesgo. La conducción del servicio de farmacia identificó para cada uno de los subprocesos del proceso mencionado, los posibles modos de fallo, las causas y sus efectos y analizó, para cada uno de ellos, su frecuencia, gravedad y detectabilidad. Se confeccionó la matriz de riesgo y se calculó el puntaje de riesgo y el índice de prioridad de riesgo. RESULTADOS: Se establecieron 47 modos de fallo. Los subprocesos que presentan todos sus modos de fallo con mayor gravedad fueron la planificación de la compra (PC) y el reenvasado de comprimidos (RC). Los Modos de Fallo de mayor puntaje de riesgo fueron la incorrecta reposición del insumo en el equipo automatizado sin considerar las fechas de vencimiento ya existentes en el mismo y recibir productos de diferentes marcas y/o medidas. El de mayor índice de prioridad de riesgo fue recibir productos de diferentes marcas y/o medidas. Conclusión: La aplicación del AMFE a nuestro proceso de gestión de medicamentos y productos médicos nos permitió priorizar a los subprocesos de PC y RC para realizar las acciones correctivas y medidas preventivas, por ser estos los de mayor riesgo.

OBJECTIVE: To establish the risks in the management process of medical drugs and devices in order to prioritize the implementation of actions for improvement and preventive steps. MATERIALS AND METHODS: The first step of the Failure Modes and Effects Analysis (FMEA) was used until the risk assessment. The pharmacy service management identified the potential failure modes, and the causes and effects for each of the subprocesses of this process, and analyzed the occurrence, severity and detection for each of them. A risk matrix was developed and the risk score and risk priority number (RPN) were calculated. RESULTS: 47 failure modes were established. The subprocesses that show all their failure modes on the highest severity were purchase planning (PP) and tablet repackaging (TR). The failure modes with the highest risk score were the incorrect replacement of supplies in the automated equipment without considering the existing expiration date and receiving products of different trademarks and/or measures. The failure mode with the highest RPN was receiving products of different trademarks and/or measures. CONCLUSION: The application of the FMEA to our medical drugs and devices management process has allowed us to prioritize the PP and TR subprocesses in order to take corrective actions and preventive steps, since these subprocesses have the highest risk.

De novo recipient-specific Glutathione S-transferase T1 antibody development after HLA-identical hematopoietic cell transplantation.

Donor-specific antibodies against Glutathione S-transferase T1 (GSTT1) have been associated with de novo immune hepatitis after liver transplantation. These antibodies have also been found very early in allo-HCT associated with acute hepatic GvHD but in all the cases the donor cells had experienced previous priming through pregnancies. It remained to be explored whether or not primary recognition of the antigen occurs after HCT and what could be the consequences in the long term outcome. We genotyped a cohort of 68 HCT patients and found 11 with the GSTT1 null donor/positive recipient mismatch. After testing 114 serum samples, we found a unique case of a 33-year-old patient transplanted from his HLA-identical sibling donor in which IgG GSTT1 antibodies were detected for the first time on day +178. After stimulation of peripheral blood mononuclear cells with GSTT1 peptides we could demonstrate that this patient also had GSTT1-specific T lymphocytes that became activated upon exposure to the GSTT1 antigen. In this report, we describe the first case in which simultaneous T and B cell response against GSTT1 is developed in HCT although the clinical consequences in GvHD are still unclear.

El pensamiento pre-consciente en los estudios clínicos del trabajo / Pre-conscious thinking in clinical studies of work

Este texto se propone dar cuenta del análisis realizado acerca del tipo de pensamiento que se manifiesta en los relatos solicitados a los sujetos de una investigación en curso. La misma explora la manera en que los integrantes de un colectivo profesional docente han ido elaborando, a lo largo de su trayectoria vital, su actual posición de autoridad pedagógica. Dicho estudio se apoya en la epistemología de la complejidad, lo que autoriza la elaboración de un marco teórico también complejo, integrado por corrientes psicosociológicas clínicas que encuentran en el Psicoanálisis un referente común. Es desde ese marco teórico-epistemológico, y en función de nuestro material empírico, que abordaremos inicialmente las postulaciones freudianas acerca de cómo se expresa el pensamiento en la evocación de los recuerdos. Luego nos referiremos, siguiendo los planteos de las Clínicas del Trabajo, a la relación pensamiento/afecto; para finalmente analizar el pensamiento comprometido en el acto humano, tal como ha sido investigado por el Sociopsicoanálisis. (AU)

This text aims to account for the analysis made about the type of thinking that manifests itself in the stories requested from the subjects of an ongoing investigation. It explores the way in which the members of a professional teaching group have been developing, throughout their life trajectory, their current position of pedagogical authority. This study is based on the epistemology of complexity, which authorizes the elaboration of a complex theoretical framework, integrated by clinical psychosociological currents that find in Psychoanalysis a common reference. It is from this theoretical-epistemological framework, and based on our empirical material, that we will initially address the Freudian postulations about how thought is expressed in the evocation of memories. Then we will refer, following the approaches of the Clinics of Work, to the relationship thought / affection; to finally analyze the thought committed in the human act, as it has been investigated by Sociopsychoanalysis. (AU)

Biomarcadores del metabolismo y nutrición de hierro / Biomarkers of metabolism and iron nutrition

La anemia por deficiencia de hierro continúa siendo la deficiencia nutricional más abundante en el mundo, y son los lactantes, preescolares, mujeres en edad fértil y embarazadas los grupos de mayor susceptibilidad. Debido a esto es que se hace necesario el conocer los mecanismos de regulación de captación, transporte y absorción del metal a nivel celular, principalmente a nivel del enterocito y, una vez que el hierro entra a la circulación, conocer cuáles son los biomarcadores que permiten realizar un seguimiento del estatus del hierro corporal. En esta revisión mostramos, en primer lugar, cómo se regula la entrada de hierro a nivel de la célula del epitelio intestinal, mostrando las principales proteínas involucradas (transportadores de entrada y salida de hierro, oxido-reductasas, proteína de almacenamiento) y, para finalizar, hacemos un recuento de los principales biomarcadores del metabolismo de hierro una vez que este ha entrado y circula por el organismo.

Iron deficiency anemia is the most common nutritional deficiency worldwide, and the most susceptible groups are infants, preschoolers, women of childbearing age, and pregnant women. It is therefore essential to understand the mechanisms of regulation of iron uptake, transport, and absorption at the cellular level, particularly in enterocytes, and to identify blood biomarkers that allow the evaluation of iron status. This review describes how iron absorption is regulated by intestinal epithelial cells, the main proteins involved (iron transporters, oxidoreductases, storage proteins), and the main blood biomarkers of iron metabolism.

T-cell allorecognition of donor glutathione S-transferase T1 in plasma cell-rich rejection.

AIM: To investigate the role of glutathione S-transferase T1 donor-specific T lymphocytes in plasma cell-rich rejection of liver allografts. METHODS: The study group included 22 liver transplant patients. Among them, 18 patients were mismatched for the glutathione S-transferase T1 (GSTT1) alleles (don+/rec-), and 4 were matched (don+/rec+). Seven of the mismatched patients produced anti-GSTT1 antibodies and developed plasma cell-rich rejection (former de novo immune hepatitis). For the detection of specific T lymphocytes, peripheral blood mononuclear cells were collected and stored in liquid nitrogen. The memory T cell response was studied by adding to the cell cultures to a mix of 39 custom-made, 15-mer overlapping peptides, which covered the entire GSTT1 amino acid sequence. The specific cellular response to peptides was analyzed by flow cytometry using the markers CD8, CD4, IL-4 and IFNγ. RESULTS: Activation of CD8+ T cells with different peptides was observed exclusively in the group of patients with plasma-cell rich rejection (3 out of 7), with production of IL-4 and/or IFNγ at a rate of 1%-4.92% depending on the peptides. The CD4+ response was most common and not exclusive for patients with the disease, where 5 out of 7 showed percentages of activated cells from 1.24% to 31.34%. Additionally, two patients without the disease but with the mismatch had cells that became stimulated with some peptides (1.45%-5.18%). Highly unexpected was the finding of a double positive CD4+CD8low T cell population that showed the highest degree of activation with some of the peptides in 7 patients with the mismatch, in 4 patients with plasma cell-rich rejection and in 3 patients without the disease. Unfortunately, CD4+CD8low cells represent 1% of the total number of lymphocytes, and stimulation could not be analyzed in 9 patients due to the low number of gated cells. Cells from the 4 patients included as controls did not show activation with any of the peptides. CONCLUSION: Patients with GSTT1 mismatch can develop a specific T-cell response, but the potential role of this response in the pathogenesis of plasma cell-rich rejection is unknown.

[Biomarkers of Metabolism and Iron Nutrition]. / Biomarcadores del metabolismo y nutrición de hierro.

Iron deficiency anemia is the most common nutritional deficiency worldwide, and the most susceptible groups are infants, preschoolers, women of childbearing age, and pregnant women. It is therefore essential to understand the mechanisms of regulation of iron uptake, transport, and absorption at the cellular level, particularly in enterocytes, and to identify blood biomarkers that allow the evaluation of iron status. This review describes how iron absorption is regulated by intestinal epithelial cells, the main proteins involved (iron transporters, oxidoreductases, storage proteins), and the main blood biomarkers of iron metabolism.

La anemia por deficiencia de hierro continúa siendo la deficiencia nutricional más abundante en el mundo, y son los lactantes, preescolares, mujeres en edad fértil y embarazadas los grupos de mayor susceptibilidad. Debido a esto es que se hace necesario el conocer los mecanismos de regulación de captación, transporte y absorción del metal a nivel celular, principalmente a nivel del enterocito y, una vez que el hierro entra a la circulación, conocer cuáles son los biomarcadores que permiten realizar un seguimiento del estatus del hierro corporal. En esta revisión mostramos, en primer lugar, cómo se regula la entrada de hierro a nivel de la célula del epitelio intestinal, mostrando las principales proteínas involucradas (transportadores de entrada y salida de hierro, oxido-reductasas, proteína de almacenamiento) y, para finalizar, hacemos un recuento de los principales biomarcadores del metabolismo de hierro una vez que este ha entrado y circula por el organismo.

Reclaiming the streets for people: Insights from Ciclovías Recreativas in Latin America.

The Ciclovías comprise worldwide programs in which streets are closed to motor-vehicles and open to individuals for leisure activities. Currently, 93% of the regular programs are in Latin American countries (LAC). The aims of this study were to describe the characteristics of regular Ciclovías in 7 LAC and to analyze the factors that influence the sustainability and scaling-up of five case studies. We conducted a survey of 67 Ciclovías in 2014-2015. In addition, we conducted semi-structured interviews with current and former program coordinators and reviewed policy documents from Ciclovías in 5 LAC. The greatest expansion of Ciclovías has occurred since 2000. The number of participants per event ranged from 40 to 1,500,000 (mean 41,399±193,330; median 1600), and the length ranged from 1 to 113.6km (mean 9.1±16.4; median 3). Ciclovía routes connect low-middle and high income neighborhoods (89.3%), and include the participation of minority populations (61.2%). The main complementary activity offered was physical activity (PA) classes (94.0%), and 80.0% of the programs included strategies to promote biking. All five case studies met definitions for sustainability and scaling-up. All programs shared some level of government support, alliances, community appropriation, champions, compatibility with the mission of the host organization, organizational capacity, flexibility, perceived benefits, and funding stability. However, they differed in operational conditions, political favorability, sources of funding, and number of alliances. The Ciclovías of LAC showed heterogeneity within their design and sustainability factors. Both their heterogeneity and flexibility to adjust to changes make them promising examples of socially inclusive programs to promote PA.

El cambio clínico desde la perspectiva de la psicosociología / Clinical change from the perspective of psychosociology

El presente trabajo está destinado a dar cuenta de los fundamentos teóricos que nos permiten afirmar que la noción de “clínica” no designa con exclusividad un campo de intervención–investigación referido a salud física y mental de un sujeto. Cuando de hechos sociales se trata, situaciones o fenómenos complejos que tienen lugar en distintas áreas de la vida social (trabajo, educación, colectivos sociales...) cuya conflictividad es productora de sufrimiento individual o colectivo, las instituciones o equipos de trabajo recurren a profesionales en búsqueda de ayuda para enfrentar esas problemáticas. En el caso que la demanda sea dirigida a analistas/investigadores inscriptos en alguna de las corrientes de la psicosociología de raigambre francesa, la experiencia tiene carácter clínico porque responde a criterios de abordaje muy precisos y a un particular posicionamiento del analista, a los cuales nos referiremos en este texto...

This article aims to consider the theoretical foundations that allow to sustain that the notion of “clinical” does not designate exclusively a research–intervention field referring to the physical and mental health of an individual. Within the realm of social facts, conflictive situations or complex phenomena taking place in different áreas (work, education, social collectives) trigger individual or collective suffering. When this is the case, institutions or work teams appeal to professionals in search of help to deal with these problems. When the demand targets analysts/researchers aligned with the psychosociological French perspective, the experience acquires clinical traits because it responds to precise approach criteria and a particular positioning of the analyst, which we reflect on in this text...

Una psicología institucional de perspectiva clínica / Institutional psychology within a clinical perspective

Este texto intentará realizar una aproximación al pensamiento de quienes, desde hace ya varias décadas, se consagran a la práctica de la intervención/investigación en el ámbito de las organizaciones: práctica clínica por la búsqueda de explicitación y comprensión de los conflictos latentes; práctica clínica en la medida en que, mediante dispositivos probados en el terreno, esos profesionales acompañan a los colectivos institucionales en su proceso de elucidación de los sentidos atribuibles a los fenómenos productores de sufrimiento psíquico; práctica clínica, asimismo, por su propósito explícito de contribuir a la salud mental y al desarrollo de los sujetos que consultan. La psicología institucional, ubicada en el punto de confluencia de lo subjetivo y lo social, está integrada por investigadores que coinciden en su interés por el estudio de ciertos fenómenos de orden colectivo, a los que nos referiremos aquí, y lo hacen sin rehuir la confrontación de sus respectivas experiencias de terreno, ni los debates teóricos a los que ellas dan lugar.

This text aims at addressing the thoughts of those who, for several decades, have been devoting themselves to the practice of intervention / research in the field of organizations. This practice is a clinical one insofar as it aims to clarify and understand latent conflicts; it´s clinical practice insofar as, by means of field–tested strategies, professionals involved assist institutional groups in the process of elucidating meanings concerning occurrences producing mental suffering; in addition it is clinical practice insofar as its explicit purpose is to contribute to the mental health and development of individuals who consult. Institutional psychology, positioned at the convergence of the subjective and the social, is a field for researchers who share, as the article states, an interest in the study of certain phenomena of a collective sort whilst acknowledging confrontation due to particular experiences in the field, which result in theoretical debates.

Lo enigmático en los íconos publicitarios / The enigmatic feature of advertisement icons

El estudio que presentaremos se propuso indagar de qué manera el proceso técnico de creación de un ícono publicitario busca movilizar, en un cierto grupo social, mecanismos psicológicos que lo conducirían a adherir a un determinado producto de valor material o cultural. Asimismo, nos interesó analizar, a la luz de los desarrollos freudianos y de autores inscriptos en la psicosociología clínica, las diversas connotaciones de carácter inconsciente que pueden ser atribuidas a dichos íconos. Con este fin tomamos como ejemplo un ícono particular utilizado frecuentemente en imágenes publicitarias dirigidas al campo de la educación...

Las defensas funcionales en la constitución del sujeto social / Adaptive defenses in the constitution of the social individual

El presente estudio, de carácter psicosociológico, está basado en el análisis del relato de una joven docente, a partir de la aplicación del Algoritmo David Liberman. En el curso del mismo intentaremos mostrar la complementariedad de conceptos provenientes del psicoanálisis y el sociopsicoanálisis para dar cuenta del complejo proceso a lo largo del cual la narradora se desprende de la autoridad parental, y se asume como un sujeto social consciente de su proyecto de vida.

Las defensas funcionales en la constitución del sujeto social / Adaptative defenses in the constitution of the social individual

El presente estudio, de carácter psicosociológico, está basado en el análisis del relato de una joven docente, a partir de la aplicación del Algoritmo David Liberman. En el curso del mismo intentaremos mostrar la complementariedad de conceptos provenientes del psicoanálisis y el sociopsicoanálisis para dar cuenta del complejo proceso a lo largo del cual la narradora se desprende de la autoridad parental, y se asume como un sujeto social consciente de su proyecto de vida.(AU)

The present study, of psycho-sociological characteristics, is based on the narration of a young teacher, analysed by application of the David Liberman algorithm. In the course of the analysis, the complementarity of concepts derived from Psychoanalysis and from Socio-psychoanalysis will try to be demonstrated, in order to account for the complex process throughout which the narrator frees herself form parental authority and takes on a social identity aware of her life project.(AU)

Las defensas funcionales en la constitución del sujeto social / Adaptive defenses in the constitution of the social individual

El presente estudio, de carácter psicosociológico, está basado en el análisis del relato de una joven docente, a partir de la aplicación del Algoritmo David Liberman. En el curso del mismo intentaremos mostrar la complementariedad de conceptos provenientes del psicoanálisis y el sociopsicoanálisis para dar cuenta del complejo proceso a lo largo del cual la narradora se desprende de la autoridad parental, y se asume como un sujeto social consciente de su proyecto de vida.(AU)

Clinical relevance of anti-HLA donor-specific antibodies detected by Luminex assay in the development of rejection after renal transplantation.

BACKGROUND: The role of anti-human leukocyte antigen (HLA) donor-specific antibodies (DSA) detected by Luminex in the development of rejection is not fully understood. METHODS: A study including 369 patients who received transplants from deceased donors with a negative complement-dependent cytotoxicity crossmatch (XM) was performed. From the total of patients, 151 underwent a renal biopsy because of renal dysfunction, whereas the 218 remaining showed a stable renal function, and no rejection was assumed. Diagnosis and type of rejection was based in biopsy data. RESULTS: Patients with a positive virtual XMs showed more rejection episodes of any types when comparing with patients with negative virtual XMs (P<0.0001). Nevertheless, there were no significant differences between patients without anti-HLA antibodies and patients with anti-HLA no DSA. Allograft impairment was caused by a rejection episode in 84% (32/38) of patients with anti-HLA-DSA but only in 30% (34/113) of patients without anti-HLA-DSA. Regarding the type of rejection detected in the biopsy, all the patients with de novo (after transplantation) anti-HLA-DSA were diagnosed as antibody-mediated rejection (AMR) or AMR+T-cell-mediated rejection, whereas most of the patients without anti-HLA-DSA (68%) were diagnosed with T-cell-mediated rejection, and patients with preexistent anti-HLA-DSA showed a more homogeneous distribution of the different types of rejection. CONCLUSIONS: According to our results, patients with preformed or de novo anti-HLA-DSA showed the highest likelihood to suffer rejection episodes. Transplantation with preformed anti-HLA-DSA should be avoided, and an early detection of de novo HLA antibodies is important to treat patients before damage occurs in the graft.

Unidad centralizada de reconstitución de citostáticos del servicio de farmacia del Hospital El Cruce / Centralized unit for the reconstitution of cytostatic drugs in the El Cruce Hospital pharmacy service

Desde agosto del año 2008 el Servicio de Farmacia del Hospital El Cruce cuenta con una Unidad Centralizada de Reconstitución de Citostáticos (UCRC). Los objetivos del presente son, describir las tareas realizadas por la Unidad de Reconstitución de Citostáticos, y analizar su producción. Estudio descriptivo retrospectivo. Se incluyeron todas las tareas realizadas y la producción global de la UCRC desde agosto de 2008 a agosto de 2010. Se utilizaron para la recolección de la información, la base de datos de intervenciones farmacéuticas, los registros informáticos de órdenes de elaboración y las prescripciones médicas.Con el presente trabajo se pudo demostrar la responsabilidad asumida por el servicio de Farmacia frente a, la farmacoterapia del paciente oncológico. Compromiso que se refleja en la intervención farmacéutica y su registro, y que da como resultado una mejora en la calidad de atención y seguridad del paciente. El manejo de medicamentos citostáticos. Por medio de la centralización de los procesos relacionados con este tipo de medicamentos se disminuye la exposición del personal a los posibles riesgos en la salud, y se trabaja en un área específica, con el equipamiento adecuado y personal protegido y entrenado. La creciente demanda de estos medicamentos en nuestro hospital demostrado por la respuesta que brinda el Servicio de Farmacia.

Regulator of G-protein signaling 14 protein modulates Ca²+ influx through Cav1 channels.

Calcium flux through L-type voltage-activated calcium (Cav1) channels is crucial for regulating brain functions including memory formation and behavior. Alterations in Ca²+ homeostasis have been linked to many cognitive disorders, and understanding the regulation of this process is crucial for their remedy. Therefore, here, we have evaluated the effect of a multifunctional protein known to be involved in memory functions called regulator of G-protein signaling 14 (RGS-14) on Cav1 channel activity in neuronal cell lines NG108-15 and SH-SY5Y. RGS-14 protein produced significant reduction in Ca²+ influx in both cell lines and this effect was dependent on nifedipine-sensitive Cav1 channels. Thus, our results provide evidence supporting the idea that RGS-14 may facilitate the cognitive processing by modulating Cav1 channel-mediated intracellular Ca²+ transients.

Importancia de la validación farmacéutica de las prescripciones médicas en el Hospital El Cruce / Importance of pharmaceutical validation of medical prescriptions at El Cruce Hospital

En el Hospital El Cruce el farmacéutico trabaja en un modelo de atención con un nuevo concepto de actuación, en el cual trabaja diariamente con el perfil farmacoterapéutico del paciente, validando las prescripciones médicas. El propósito de este proceso es identificar problemas relacionados con el medicamento y recomendar una acción correctora que se traduzca en el beneficio del paciente.