Consensus in acute myeloid leukemia in Mexico.

Acute myeloid leukemia (AML) comprises a heterogeneous group of hematopoietic cell neoplasms of myeloid lineage that arise from the clonal expansion of their precursors in the bone marrow, interfering with cell differentiation, leading to a syndrome of bone marrow failure. AML is a consequence of genetic and epigenetic changes (point mutations, gene rearrangements, deletions, amplifications, and arrangements in epigenetic changes that influence gene expression) in hematopoietic precursor cells, which create a clone of abnormal cells that are capable of proliferating but cannot differentiate into mature hematopoietic cells or undergo programmed cell death. The diagnosis requires more than 20% myeloid blasts in the bone marrow and certain cytogenic abnormalities. Treatment will depend on age, comorbidities, and cytogenetic risk among the most frequent.

La leucemia mieloide aguda (LMA) comprende un grupo heterogéneo de neoplasias de células hematopoyéticas de linaje mieloide que surgen de la expansión clonal de sus precursores en la médula ósea, interfiriendo con la diferenciación celular, lo que conlleva a un síndrome de falla medular. La LMA es una consecuencia de cambios genéticos y epigenéticos (mutaciones puntuales, rearreglos de genes, deleciones, amplificaciones y arreglos en cambios epigenéticos que influyen en la expression del gen) en las células hematopoyéticas precursoras, la cual crea una clona de células anormales que son capaces de proliferar, pero no se pueden diferenciar en células hematopoyéticas maduras ni sufrir una muerte celular programada. El diagnostic requiere más del 20% de blastos mieloides en médula ósea y ciertas anormalidades citogénicas. El tratamiento dependerá de la edad, comorbilidades, riesgo citogenético entre las más frecuentes.

Consenso de leucemia mieloide aguda en México / Mexican consensus in acute myeloid leukemia in Mexico

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Abstract Acute myeloid leukemia (AML) comprises a heterogeneous group of hematopoietic cell neoplasms of myeloid lineage that arise from the clonal expansion of their precursors in the bone marrow, interfering with cell differentiation, leading to a syndrome of bone marrow failure. AML is a consequence of genetic and epigenetic changes (point mutations, gene rearrangements, deletions, amplifications, and arrangements in epigenetic changes that influence gene expression) in hematopoietic precursor cells, which create a clone of abnormal cells that are capable of proliferating but cannot differentiate into mature hematopoietic cells or undergo programmed cell death. The diagnosis requires more than 20% myeloid blasts in the bone marrow and certain cytogenic abnormalities. Treatment will depend on age, comorbidities, and cytogenetic risk among the most frequent.

'I think there is nothing . . . that is really comprehensive': healthcare professionals' views on recommending online resources for pain self-management.

OBJECTIVES: To explore healthcare professionals' views on, and attitudes, towards recommending online resources for persistent pain self-management. METHODS: This study was the qualitative phase of a two-phase mixed method study. Thirty-one New Zealand health professionals involved in the management of persistent pain were interviewed via focus groups and individual interviews. Data were analysed using the general inductive approach. RESULTS: The major themes were as follows: (1) risks and limits of online information outweigh benefits, (2) a blended model, of online resources with healthcare professional support, could work, (3) only trustworthy resources can be recommended, (4) need for personalisation and (5) perceived barriers to adoption. CONCLUSION: Online resources were perceived as a useful adjunct to support pain self-management; however, due to potential risks of misinterpretation and misinformation, healthcare professionals proposed a 'blended model' where curated online resources introduced during face-to-face consultations could be used to support self-management. Participants needed 'trustworthy online resources' that provide evidence-based, updated information that is personalised to clients' health literacy and cultural beliefs. PRACTICE IMPLICATIONS: Training for healthcare professionals on critical appraisal of online resources or curation of evidence-based online resources could increase recommendation of online resources to support pain self-management as an adjunct to in-person care.

Mexican Concensus of Multiple Myeloma.

To identify this increasingly common pathology, known as multiple myeloma (MM), it is necessary to refer to the specific factors that characterize it; to this end, the classic criteria known as CRAB (hyperkalemia, renal failure, anemia, and lytic lesions) are available, in which renal failure is one of the most frequent complications. Recently, three indisputable biomarkers have been described for the diagnostic support for MM, which are: more than 10% of clonal plasma cells in bone marrow or, a biopsy that corroborates the presence of a plasmacytoma, light chain ratio ≥ 100 mg/dL and more than one focal lesion on magnetic resonance imaging. A differential diagnosis for plasma cell leukemia, solitary bone plasmacytoma, and extramedullary plasmacytoma should always be considered. Being this an incurable disease, a lot of research has been done regarding its therapeutic management, whose main objective is the disappearance of plasma cells and the patient clinical improvement. Melphalan was the first drug that showed a benefit in 1958 and afterward, with the addition of a steroid as a second drug, it was possible to improve response rates. Subsequently, different molecules were studied, forming multiple combinations, and achieving better rates of overall survival and progression-free survival. Years later, with the arrival of proteasome inhibitors such as bortezomib, and immunomodulators such as thalidomide and lenalidomide, an important turnaround in the disease has been seen, as deeper responses, more prolonged remissions, and improvement in the quality of life of patients have been achieved. This consensus has the purpose of integrating a group of Mexican specialists and promoting the updating of this pathology.

Para identificar una patología cada vez más común, conocida como mieloma múltiple, es necesario hacer alusión de los factores específicos que la caracterizan. Para ello existen los clásicos criterios conocidos como CRAB (hipercalcemia, insuficiencia renal, anemia y lesiones líticas), siendo la insuficiencia renal una de sus complicaciones más frecuentes. Recientemente se han descrito tres biomarcadores indiscutibles para el apoyo diagnóstico del mieloma múltiple, que son: más del 10% de células plasmáticas clonales en medula ósea o biopsia que corrobora la presencia de un plasmocitoma, relación de cadenas ligeras ≥ 100 mg/dl y más de una lesión focal en resonancia magnética. Se debe tomar siempre en cuenta el diagnóstico diferencial con leucemia de células plasmáticas, plasmocitoma óseo solitario y plasmocitoma extramedular. Al ser una enfermedad incurable, se ha investigado mucho en cuanto al manejo terapéutico, el cual tiene como objetivo principal la desaparición de las células plasmáticas y la mejoría clínica del paciente. El primer fármaco que demostró algún beneficio fue el melfalán en el año 1958 y posteriormente al adicionar un esteroide como segundo fármaco se logró mejorar las tasas de respuesta. Después se fueron estudiando diferentes moléculas, con las que se han realizado múltiples combinaciones, alcanzando mejores tasas de supervivencia global y supervivencia libre de progresión. Años más tarde, con la llegada de los inhibidores de proteosoma como el bortezomib, así como de los agentes inmunomoduladores como la talidomida y la lenalidomida, se presenta un giro importante en la enfermedad, ya que se logran respuestas más profundas, periodo de remisiones más prolongadas y mejoría en la calidad de vida de los pacientes. Este consenso tiene la finalidad de integrar a un grupo de especialistas mexicanos y promover la actualización de esta patología.

Evaluación de la capacidad antioxidante, características fisicoquímicas y perfil sensorial de Opuntia robusta y O. ficus-indica / Evaluation of antioxidant capacity, physicochemical characteristics and sensory profile of Opuntia robusta and O. ficus-indica

Las Opuntia spp. son un recurso fitogenético Mexicano de gran valor nutritivo y alto contenido de betalaínas, compuestos conocidos por sus propiedades antioxidantes. Este estudio evaluó las características fisicoquímicas, el contenido de betalaínas y su capacidad antioxidante (CA), así como el perfil sensorial de frutos de O. robusta y O. ficusindica. Esta última presentó mayor acidez y contenido de sólidos solubles (F= 769,2; P= 0,0001), (F= 360,4; P ≤0,0001), que O. robusta. En humedad y contenido de cenizas no hubo diferencias significativas entre ambas especies. La concentración de betalaínas fue superior en Opuntia robusta (F=529,1; P= ≤0,0001) betacianinas (0,114 mg/mL pulpa) y betaxantinas (0,073 mg/ mL de pulpa), en O. ficus-indica (0,023 mg/ mL de pulpa y 0,0198 mg/ mL de pulpa). Se encontraron diferencias significativas en la CA (F=545,9; P ≤0,0001), en O. ficus-indica hasta 195,38 µmol equivalente Trolox/ mL por el método Ácido2, 2´-azino-bis-(3-etilbenzotiazolina)6-sulfónico (ABTS) y 22% de inhibición de radicales libres por el método 2,2 difenil-1-pricrilhidrazilo (DPPH), para O. robusta 165,6 µmol equivalente Trolox/ mL y más del 36% de inhibición de radicales libres. Los resultados mostraron que la CA está directamente relacionada con la concentración de betacianinas y betaxantinas. Ambas variedades de Opuntia exhiben una tendencia a lo dulce y ácido, con aromas, sabores y resabios con notas frutales y vegetales. Estos resultados sugieren que estas especies pueden ser empleadas para la extracción de betalaínas debido a su gran potencial para utilizarse en la industria como fuente de pigmentos naturales con propiedades antioxidantes y agradables características sensoriales(AU)

Opuntia spp. are a Mexican phytogenetic resource with great nutritive value and high betalains (compounds known for their antioxidant properties) content. Our main goal was to evaluate the physicochemical characteristics, betalains concentration and antioxidant capacity (AC), as well as sensory profiles of Opuntia robusta and O. ficus-indica, where the later one showed higher acidity and soluble solids content (F= 769.2; P= 0.0001 and F= 360.4; P ≤0.0001 respectively) than O. robusta. There was no significant difference between the species in terms of humidity and ash content. Betalains concentrations were higher in Opuntia robusta (F=529.1; P= ≤0.0001), while betacyanins (0.114 mg/ mL pulp) and betaxantins (0.073 mg/ mL de pulp) were higher in O. ficus-indica (0.023 mg/ mL pulp and 0.0198 mg/ mL de pulp). Significant differences for AC were found (F=545.9, P ≤0.0001), with O. ficus-indica showing up to 195.38 µmol Trolox equivalent / mL by the method 2,2'-Azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) and 22% of free radicals inhibition by the method 2, 2 diphenyl-1-pricrylhydrazyl (DPPH), while 165.6 µmol Trolox equivalent / mL and more than 36% free radicals inhibition were found for O. robusta. Results showed that the antioxidant capacity is directly related with betacyanins and betaxantines concentration. Both Opuntia varieties exhibit a tendency to sweetness and acidity, with aromas, flavors and scents within fruity and vegetable notes. These results suggest that both species could be used in the extraction of betalains due to their great industrial potential as a source of natural pigments with antioxidant properties and pleasant sensorial characteristics(AU)