Cisplatin as a Viable and Secure Alternative to Carmustine in BEAM-Based Conditioning for Autologous Hematopoietic Stem Cell Transplantation in Patients with Lymphoma.

BACKGROUND: High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is a standard treatment for relapsed/refractory lymphoma patients. Yet, the widespread use of BEAM is hindered by carmustine accessibility. This study evaluates the efficacy and safety of PEAM (Cisplatin, Etoposide, Cytarabine, and Melphalan) versus BEAM in auto-HSCT for Hodgkin (HL) and non-Hodgkin lymphoma (NHL) patients. METHODS: We conducted a retrospective single-center study of adult lymphoma patients who received PEAM or BEAM pretransplant conditioning between January 2004 to December 2022, comparing efficacy and safety outcomes. RESULTS: Among 143 patients (median age of 33 years, 58% males), 55 had HL, and 88 had NHL. The overall response rate (ORR) was 86.7% for PEAM and 72.3% for BEAM, and the relapse rate (RR) was lower for PEAM than BEAM (22.9% vs 45.6%). Median time to relapse (TTR) and overall survival (OS) were not reached for either group. PEAM exhibited a shorter time to both neutrophil (NE) and platelet (PE) engraftment compared to BEAM (10 vs 12 days), with a more tolerable gastrointestinal (GI) toxicity profile. CONCLUSIONS: Both BEAM and PEAM showed similar outcomes, demonstrating comparable efficacy in terms of ORR, TTR, and OS for both HL and NHL patients. However, PEAM-conditioning was associated with a shorter time to engraftment and fewer GI adverse events.

Urban birds: An important source of antimicrobial resistant Salmonella strains in Central Spain.

Antimicrobial resistance (AMR) is one of the most important threats of the 21 st century. Wild birds have been described as reservoirs of AMR in different bacterial species, such as Salmonella spp. Privation of food, climate change and overpopulation have forced many wild species to modify their feeding habits, attending urban areas. In this context, the aim of this study was to study Salmonella presence, as well as related AMR in urban birds that inhabit the city and its surroundings. A total of 300 urban birds were sampled for Salmonella detection according to the ISO 6579-1:2017 (Annex D) recommendations, and serotyping was carried out according to the White-Kauffman-Le Minor scheme. Antimicrobial susceptibility was tested following 2013/652/EU Decision guides. Wild birds analysed were positive for Salmonella in 12.3 % of cases, with white storks fed in landfills as the most Salmonella prevalent species (p < 0.05). The most common serovars isolated were zoonotic (S. Enteritidis, S. Typhimurium and S. Typhimurium monophasic variant). From Salmonella isolated strains, 40.5 % were resistant to the most prevalent AMRs found in urban birds were ciprofloxacin (36.4 %), nalidixic acid (36.4 %) and colistin (27.3 %). The scientific community, public administration and population in general should work together to control antimicrobial administration and drug waste management in order to decrease the development and spread of AMR.

Intervenciones psicológicas en cuidadores primarios de pacientes con trasplante de células hematopoyéticas: Revisión descriptiva / Psychological interventions on primary care healthcare providers of patients with hematopoietic cells transplantation: Descriptive revision / Intervenções psicológicas em cuidadores primários de pacientes com transplante de células hematopoiéticas: Revisão descritiva

Resumen Introducción: El ser cuidador primario informal de un paciente con indicación médica de trasplante de células progenitoras hematopoyéticas puede tener consecuencias negativas en su salud mental y calidad de vida. Objetivo: Describir las intervenciones psicológicas disponibles para el cuidador primario de pacientes sometidos a trasplante de células hematopoyéticas. Metodología: Se realizó una búsqueda sistematizada de los últimos 10 años con los términos MeSH: psychotherapy AND caregive AND stem cell transplantation en las principales bases de datos médicas y de psicología, para su análisis se empleó la estrategia: Problema, Intervención, Comparación y Outcomes (PICO). Resultados: Se identificaron 122 artículos, de ellos diez cumplieron los criterios de inclusión. Las intervenciones provenían de profesionales de enfermería o trabajo social; el 50% incluyó diadas (paciente y cuidador primario), mostraron una tendencia de duración corta, enfocada al periodo posterior al trasplante. Se basan en el entrenamiento en solución de problemas, manejo de estrés, atención plena y expresión emocional. Las intervenciones lograron la disminución de la depresión, ansiedad y estrés en el cuidador; pero no alcanzaron permanencia en la significancia estadística de dichos restablecimientos. Discusión: De acuerdo con lo observado en las publicaciones y por su impacto positivo en la salud mental, se recomienda la implementación de intervenciones psicológicas en cuidadores de pacientes con trasplante de células progenitoras hematopoyéticas. Conclusión: El apoyo psicológico brindado al cuidador generalmente es de profesionales de la salud que no pertenecen al área de la psicología, con resultados clínicos favorables en las etapas más críticas de su estado mental.

Abstract Introduction: Being an informal primary healthcare provider of a patient who undergoes hematopoietic progeny cells transplantation can have adverse consequences on mental health and the quality of life. Objective: To describe the available psychological interventions for the primary healthcare provider of patients undergoing hematopoietic cells transplantations. Methodology: A systematized search of the last 10 years using the MeSH terms psychotherapy AND caregiver AND stem cell transplantation was conducted on the main medical and psychological databases. The analysis strategy followed the PICO scheme (Problem, Intervention, Comparison, Outcomes). Results: 122 articles were identified, and 10 of them fulfilled the inclusion criteria. The interventions were related to nursing or social work professionals. 50% described patient-healthcare provider dyads with short interventions focused on the post-transplantation period. Discussion: According to what has been observed in the publications and due to its positive impact on mental health, the implementation of psychological interventions is recommended in caregivers of patients who underwent hematopoietic stem cell transplantation. Conclusion: The psychological support provided to the caregiver comes mainly from health professionals who do not belong to the area of psychology, with favorable clinical results in the most critical periods for their mental state.

Resumo Introdução: Ser cuidador primário informal de um paciente sometido a transplante de células progenitoras hematopoiéticas pode ter consequências negativas na saúde mental e na qualidade de vida. Objetivo: Descrever as intervenções psicológicas disponíveis para o cuidador primário de pacientes sometidos a transplante de células hematopoiéticas. Metodologia: Realizou-se uma busca sistematizada dos últimos 10 anos com os termos MeSH: psychotherapy AND caregive AND stem cell transplantation nas principais bases de dados médicas e de psicologia, para sua análise realizou-se a estratégia: Problema, Intervenção, Comparação e Outcomes (PICO). Resultados: Identificaram-se 122 artigos, dos quais, dez cumpriram os critérios de inclusão. As intervenções provinham de profissionais em enfermagem ou trabalho social; o 50% incluiu díades (paciente e cuidador primário), mostraram uma tendência de duração curta, focalizada no período posterior ao transplante. Baseiam-se no treinamento em solução de problemas, manejo de estresse, atenção plena e expressão emocional. As intervenções conseguiram melhoras clínicas na diminuição da depressão, ansiedade e estresse no cuidador; mas não alcançaram permanência na significância estatística destes restabelecimentos. Discussão: Conforme o observado nas publicações e por seu impacto positivo na saúde mental, recomenda-se a implementação de intervenções psicológicas em cuidadores de pacientes para quem se indicou transplante de células progenitoras hematopoiéticas. Conclusão: O apoio psicológico oferecido ao cuidador vem de principalmente profissionais da saúde que não pertencem à área da psicologia, com resultados clínicos favoráveis nos períodos mais críticos para seu estado mental.

A systematic review of tools used to screen and assess for externalising behaviour symptoms in low and middle income settings.

BACKGROUND: Mental health issues, often manifested as behavioural difficulties, in children are estimated to be high in low and middle-income countries (LMIC) settings. There is a paucity of definitive data due to a lack of well-validated tools to use across settings. This review aims to provide evidence on what tools are used and which have been adapted and validated in LMIC settings. METHODS: We performed a systematic review to identify tools used to assess or screen externalising behaviour problems in children and adolescents in LMIC and assess their cultural adaptations. We searched for studies measuring externalising behaviour in children from 0 to 19 years published up to September 2018. Articles were assessed to identify tools used and analysed using the Ecological Validity Framework. RESULTS: We identified 82 articles from over 50 LMICs who had studied externalising behaviour in children. Twenty-seven tools were identified, with a predominance of studies using tools from the USA and Europe. Most studies did not describe an adaptation and evaluation process, with only one study following recommended criteria. New tools were identified which both screen and assess externalising behaviour which have not yet been utilised across settings. CONCLUSIONS: Although tools from the USA and Europe are often utilised to screen and assess for externalising behaviour problems in children in LMICs, the conceptual frameworks behind the use of these tools in other cultural contexts are not always carefully examined. In order to have valid data across cultures, we should aim to adapt and validate tools before use. Provision of processes to validate tools across LMIC settings would be beneficial.

Infectious Complications and Multidrug-Resistant Bacteria in Patients With Hematopoietic Stem Cell Transplantation in the First 12 Months After Transplant.

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) has been used as treatment in different hematologic and solid malignancies. The aim of this study was to describe the frequency of infectious complications, microbiology, and outcome in patients undergoing HSCT in Mexico during the pre-engraftment period and the impact on mortality rates at 12 months. METHODS: We conducted a retrospective study of all hematologic malignancies that received HSCT from January 2009 and December 2014, at an oncology reference center. RESULTS: We included 210 patients: 144 autologous (69%) and 66 allogeneic HSCT (31%). There were 184 infections documented in 109 patients; incidence rate was 47.2 per 1000 neutropenia/days and 22.4 per 1000 hospitalization/days. The main infections reported were pneumonia (n = 40, 19%), bloodstream infections (n = 36, 17.1%), and central line-associated bloodstream infections (n = 28, 13.3%). There were 110 bacteria isolated, 31 were multidrug-resistant (26 were extended-spectrum beta-lactamase; Escherichia coli). There were 25 disseminated or complicated viral infections and 20 invasive fungal diseases. Fourteen patients died in the first 30 days (all related to the infectious process). In multivariate analysis leukemia, more than 2 chemotherapy regimens before transplant and pneumonia were related to 12-month mortality rates. CONCLUSIONS: Even though infectious processes are frequent in patients with HSCT, multidrug-resistant bacteria were not as frequent as supposed; however, when these microorganisms are involved, mortality rate is increased. It is important to be alert that patients with pneumonia have a significantly increased mortality risk in the first year.

Hoxa-10 and Cyclin D3 Overexpression in the Decidual Reaction in a Superovulation Protocol in Young Adult C57BL/6J Mice.

Following the performance of a superovulation protocol, multiple nodules were observed bilaterally in the uterine horns of 31 of 276 (11.2%) C57BL/6 J female mice aged 8.5 ± 0.6 (mean and standard error of mean) weeks. These lesions prevented embryo collection, and the uterine decidual reaction was suspected. Samples of pathological uteri (n = 20) and the normal genital tracts of donors treated with a similar superovulation protocol (control group, n = 10) were collected. Immunohistochemistry was performed to evaluate pancytokeratin, desmin, vimentin, progesterone receptor (PR), estrogen receptor α (ERα), Ki-67, cyclin D3 and c-Myc expression, as well as quantitative polymerase chain reaction to assess cyclin D3, Hoxa-10 and heparin-binding epidermal growth factor-like growth factor (HB-EGF) mRNA expression. The uterine decidual reaction presented a high degree of structural organization and specifically affected the antimesometrial region of the endometrium. The abnormal decidual cells were large polygonal cells that were frequently polyploid or binucleated and strongly positive for desmin. Immunohistochemistry showed higher Ki-67 proliferation index and higher expression of PR and cyclin D3 in decidual cells in the antimesometrial aspect of the endometrium, compared to nondecidualized endometrial stromal cells in the mesometrial aspect of affected uteri, and compared to endometrial stromal cells in healthy uteri. High expression of cyclin D3 and Hoxa-10 mRNA was also observed in uteri affected by the decidual reaction. These results suggest that PR overexpression in endometrial stromal cells, likely due to high progesterone levels, triggers cyclin D3 and Hoxa-10 overexpression, which may be involved in the pathological mechanisms of the mouse uterine decidual reaction.

Disfunción sexual en la mujer diabética pre y postmenopáusica / Sexual dysfunction in women with diabetes in pre and postmenopausic state

Objective: female sexual dysfunction (FSD) in diabetic women, is a topic poorly studied. The aim of this study is to determine the prevalence of FSD in typ1 1 and typ2 diabetic patients (T1D and T2D) compared with non diabetic controls. Patients and Method: interview under written consent 24 diabetic patients attended at Diabetes Unit of the San Juan de Dios Hospital and 24 healthy controls. Inclusion criteria: diagnosis of diabetes mellitus over one year, age 18-75 years old and stable partner for over a year. Exclusion criteria: antidepressants treatment. The validated survey by Rosen et al. was applied. Female Sexual Function Index (FSFI), of 19 questions that assess 6 areas of sexual function: desire, lubrication, excitement, orgasm, satisfaction and pain. A total score of 26.55 or less diagnosed DSF. In diabetic patients the metabolic control, lipid profile, creatinine and glycated hemoglobin A1c (HbA1c) was recorded. Statistical analysis was performed using median, range and Mann Whitney test. Percentages of sexual dysfunction was analysed by chi². It was considered significant at p < 0.05. Results: the results of the FSFI survey were divided and related to menopause. In premenopausal diabetic group (n = 11), the average score was 31.1 versus 32.5 in controls (NS) and in postmenopausal diabetic group (n = 13) the average score was 23,1 versus 28,5 (p = 0.05). The overall frequency of DSF in premenopausal diabetic women was 27.3 percent and 6.3 percent in controls (NS), in postmenopausal reached 69.2 percent and25.0 percent in controls (p = 0.01 ). Conclusion: in diabetic patients sexual dysfunction was more frequent than in controls; in premenopausal women the most affected area is the excitement and in postmenopausal women was lubrication.

Iberian pig early pregnancy: vascular endothelial growth factor receptor system expression in the maternofetal interface in healthy and arresting conceptuses.

In Iberian pigs, a high conceptus loss occurs during the first 30 days of gestation. Although the exact causes for these losses have not been determined to date, the importance of blood vessel development during early pregnancy has been noted. The aim of this study was to analyze the messenger RNA (mRNA) and protein expression of VEGF-rs (vascular endothelial growth factor, the VEGFR1, and the VEGFR2 receptor system) and elucidate a possible relationship with the conceptus status (healthy or arrested) on gestational Days (gd) 22 and 32. Both mRNA and protein expression for VEGF-rs molecules were consistently expressed in conceptuses and endometrium during the pregnancy period analyzed. In endometrium, a significant increase in VEGF mRNA and VEGFR2 mRNA expression in healthy sites was observed as pregnancy advances (P < 0.001 and P < 0.05, respectively), whereas VEGFR1 mRNA expression was maintained at a constant level. Interestingly, a significantly elevated VEGFR2 mRNA expression (P < 0.05) was observed on gd 22 in endometrium from arrested conceptuses. Furthermore, VEGF mRNA and VEGFR1 mRNA expression in trophoblasts from healthy conceptuses decreased as pregnancy proceeded (P < 0.001). Arrested trophoblasts on gd 32 showed higher VEGFR2 mRNA expression than healthy conceptuses (P < 0.05). Although, in endometrium attachment sites, the pattern of VEGF-rs immunostaning was not affected by conceptus status, the immunoexpression of VEGF-rs in healthy attachment sites increased slightly but consistently as gestation proceeded. In arresting trophoblasts, VEGF and VEGFR2 staining decreased from gd 22 to 32. Moreover, the number of VEGF and VEGFR1-positive capillaries in the subepithelial vascular plexus of endometrium was related to the conceptus status, showing a moderate increase in healthy sites as pregnancy advances. In conclusion, it appears that VEGF-rs is expressed and related to vascular development in Iberian pigs between gd 22 and 32. The upregulated expression of VEGF mRNA and VEGFR2 mRNA in healthy uterine sites suggests a significant role for these angiogenic factors in early pregnancy.

[Outbreaks of acute gastroenteritis in Antofagasta Region, Chile 2010]. / Brote de gastroenteritis aguda en la Región de Antofagasta,Chile: 2010.

Outbreaks of acute gastroenteritis are a public health problem. Norovirus is known as the most common cause (50%). In Chile, immediate notification allows surveillance of these events. We describe an acute gastroenteritis outbreak that occurred in Antofagasta region, between March and April 2010. An observational study was conducted to perform the outbreak investigation. Local residents who met case definition were included. Stool samples, epidemiological surveys and environmental samples were requested. The outbreak began approximately on March 8, 2010 and lasted until April 28 with 31,036 reported cases (rate 54 per 1000 inhabitants). The most affected age group was between 25 and 44 years, and diarrhea was the main symptom (97% of cases). We determined the presence of norovirus genogroup II in clinical and environmental samples. This outbreak was caused by consumption of raw vegetables from La Chimba, which were watered and contaminated with treated sewage containing low concentration of free residual chlorine. Subsequently, the outbreak spread from person to person in a poor sanitary environment.

[The etiology and management of gout]. / Ätiologie und Management der Gicht.

Gout is an inflammatory arthritis caused by monosodium urate (MSU) crystal deposits in and around the joint. The formation of urinary calculi can also occur in gout, but are less common than arthritis. Gout usually presents with recurrent episodes of joint inflammation, which over time lead to tophus formation and joint destruction. In the last decade, significant advances have been made regarding not only the epidemiology and genetics of gout and hyperuricemia but also the mechanisms of inflammation and treatment of gout. In addition, knowledge concerning the key role of interleukin 1 (IL-1) has provided new therapeutic perspectives. However, the current management of gout is often suboptimal, with many Patienten either not receiving adequate treatment or being unable to tolerate existing treatments. New therapeutic agents provide interesting new options for Patienten with difficult-to-treat gouty arthritis.The English full-text version of this is available at SpringerLink (under "Supplemental").

Brote de gastroenteritis aguda en la Región de Antofagasta,Chile: 2010 / Outbreaks of acute gastroenteritis in Antofagasta Region: Chile 2010

Outbreaks of acute gastroenteritis are a public health problem. Norovirus is known as the most common cause (50%). In Chile, immediate notification allows surveillance of these events. We describe an acute gastroenteritis outbreak that occurred in Antofagasta region, between March and April 2010. An observational study was conducted to perform the outbreak investigation. Local residents who met case definition were included. Stool samples, epidemiological surveys and environmental samples were requested. The outbreak began approximately on March 8, 2010 and lasted until April 28 with 31,036 reported cases (rate 54 per 1000 inhabitants). The most affected age group was between 25 and 44 years, and diarrhea was the main symptom (97% of cases). We determined the presence of norovirus genogroup II in clinical and environmental samples. This outbreak was caused by consumption of raw vegetables from La Chimba, which were watered and contaminated with treated sewage containing low concentration of free residual chlorine. Subsequently, the outbreak spread from person to person in a poor sanitary environment.

Antecedentes: Los brotes por gastroenteritis aguda constituyen un problema de salud pública. Se conoce al norovirus como la causa más común (50%). En Chile, la vigilancia de estos eventos, se establece mediante la notificación inmediata. Objetivo: Investigar y caracterizar el brote de gastroenteritis aguda ocurrido en la Región de Antofagasta, durante los meses de marzo y abril de 2010. Método: Se efectuó un estudio observacional descriptivo para realizar la investigación de brote. Se incluyó a residentes de la región que cumplían con la definición de caso. Se solicitó muestras de deposición, encuesta epidemiológica y muestras ambientales. Resultados: Se estimó que el brote comenzó el 8 de marzo de 2010 y duró hasta el 28 de abril del mismo año; se notificaron 31. 036 casos (tasa 54 por 1.000 habitantes). El grupo de 25 y 44 años de edad fue el más afectado y la diarrea fue el síntoma predominante (97% de los casos). Se determinó la presencia de norovirus genogrupo II en muestras clínicas y ambientales. Conclusiones: El brote se originó por el consumo crudo de hortalizas que provenían del sector La Chimba, las que fueron regadas y contaminadas con agua servida tratada que contenía baja concentración de cloro libre residual y posteriormente se propagó por transmisión persona-persona, en un ambiente sanitario deficiente.

[Antimicrobial susceptibility, capsular serotypes and clonal relationship of invasive streptococcus pneumoniae isolates in adult population of the Bio-Bio region, Chile. 2005-2006]. / Susceptibilidad antimicrobiana, serotipos capsulares y relación clonal entre cepas invasoras de streptococcus pneumoniae aisladas de pacientes adultos de la Región del Bío-Bío, Chile. Periodo 2005-2006.

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, serotypes and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4%), trimethoprim/ sulfamethoxazole (18%), erythromycin (18%), chloramphenicol (7%) and 1 penicillin resistant isolate from a meningeal focus (2%) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80% of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Susceptibilidad antimicrobiana, serotipos capsulares y relación clonal entre cepas invasoras de Streptococcus pneumoniae aisladas de pacientes adultos de la Región del Bío-Bío, Chile: Período 2005-2006 / Antimicrobial susceptibility, capsular serotypes and clonal relationship of invasive Streptococcus pneumoniae isolates in adult population of the Bio-Bio Region, Chile: 2005-2006

Las infecciones ocasionadas por Streptococcus pneumoniae constituyen un problema de salud pública. En nuestro país existe escasa información sobre aislados de procesos bacteriémicos en población adulta. Se estudió la susceptibilidad, serotipos y relación clonal de 56 aislados de S. pneumoniae desde hemocultivos, entre enero 2005 y agosto 2006, de pacientes adultos de la intercomuna Concepción-Talcahuano, Región del Bío-Bío, Chile. Se encontró resistencia a tetraciclina (21,4 por ciento), cotrimoxazol (18 por ciento), eritromicina (18 por ciento), cloranfenicol (7 por ciento) y a penicilina en un solo aislado procedente de un foco meníngeo (2 por ciento). La totalidad mostró susceptibilidad a cefotaxima, levofloxacina, moxifloxacina y vancomicina. Se demostró una amplia variedad de serotipos capsulares, con predominio de los serotipos 1, 5, 23F, 7F y 3. El análisis de macrorestricción y electroforesis en campo pulsado reveló 31 patrones electroforéticos con 12 grupos clona-les, descartando un clon predominante. De acuerdo a los resultados, al menos 80 por ciento de los serotipos de aislados de S. pneumoniae de procesos bacteriémicos están incluidos en la vacuna comercial disponible.

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, sero-types and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4 percent), trimethoprim/ sulfamethoxazole (18 percent), erythromycin (18 percent), chloramphenicol (7 percent) and 1 penicillin resistant isolate from a meningeal focus (2 percent) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80 percent of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Administration of autologous bone marrow stem cells into spinal cord injury patients via multiple routes is safe and improves their quality of life: comprehensive case studies.

Presently, there is no cure or effective treatment for spinal cord injury (SCI). Studies in SCI patients have shown that for a treatment to be effective it must primarily improve their quality of life. Numerous studies have shown that stem cells represent an alternative treatment for various disorders and have shown promise in several disease/trauma states. For instance, the use of autologous CD34+ stem cells has been shown to ameliorate symptoms of several disorders such as leukemia, cardiomyopathy, diabetes, and several autoimmune diseases, including multiple sclerosis. For the first time, we report eight case studies of SCI (four acute, four chronic) with approximately 2 years of follow-up that were administered bone marrow stem cells (BMSCs) via multiple routes: directly into the spinal cord, directly into the spinal canal, and intravenous. Magnetic resonance imaging illustrated morphological changes in the spinal cord of some of the patients following BMSCs administration. Comprehensive evaluations demonstrate improvements in ASIA, Barthel (quality of life), Frankel, and Ashworth scoring. Moreover, in order to assess bladder function, we designed a simple numerical clinical scoring system that demonstrates significant changes in bladder function following BMSCs administration. To date, we have administration BMSCs into 52 patients with SCI and have had no tumor formations, no cases of infection or increased pain, and few instances of minor adverse events. These studies demonstrate that BMSCs administration via multiple routes is feasible, safe, and may improve the quality of life for patients living with SCI.

Evaluación retrospectiva de la vigilancia de Streptococcus pneumoniae causante de enfermedades invasoras en adultos de la Región Metropolitana-Chile: 2000-2006 / Retrospective assessment of laboratory surveillance for invasive Streptococcus pneumoniae isolates from adults of the Metropolitan Region (Chile): 2000-2006

Este estudio evaluó el funcionamiento de la norma nacional de vigilancia de Streptococcus pneumoniae recuperado desde procesos invasores en adultos de la Región Metropolitana-Chile. Material y Métodos: Se revisaron las notificaciones correspondientes a pacientes de 15 años o más, recibidas por el ISP en el período 2000-2006, emitidas por establecimientos asistenciales de la región. Paralelamente, se revisaron los resultados de cultivos de fluidos estériles practicados en 14 hospitales estatales que atienden adultos. Resultados: Se encontró documentación de 1.429 aislados de S. pneumoniae provenientes de procesos invasores en pacientes de 15 años o más, incluyendo 1.095 notificados y 334 no notificados. La tasa de sub-notificación estimada para los 14 establecimientos visitados alcanzó a 33 por ciento. La edad y el diagnóstico fueron omitidos en 23 y 78 por ciento de las notificaciones, respectivamente. En 235 de 303 (78 por ciento) cepas aisladas de pacientes de 65 años o más, investigadas mediante reacción de Quellung, se identificaron serotipos capsulares representados en la vacuna polisácarida 23-valente. Conclusiones: El Ministerio de Salud anunció un programa de inmunización con vacuna neumocóccica 23-valente dirigido a los adultos mayores. Con miras a la futura evaluación del impacto de esta medida, los resultados de esta revisión señalan la necesidad de reforzar el cumplimento y la calidad de las notificaciones de S. pneumoniae causante de enfermedades in-vasoras.

This study assessed the performance of the national norm for laboratory surveillance of invasive Streptococcus pneumoniae in adults of the Metropolitan Region (Chile). Material and Methods. We reviewed all notifications of isolates from patients > 15 years of age received by the Institute of Public Health of Chile during the period 2000-2006, submitted by health care facilities of the study region. We also reviewed the original records of sterile fluid cultures, in 14 public adult hospitals. Results. We found documentation of 1429 invasive S. pneumoniae isolates recovered from adult patients, including 1095 reported and 334 not-reported isolates. A 33 percent under-reporting rate was estimated for the 14 hospitals where local laboratory records were inspected. Age and clinical diagnosis were omitted in 23 percent and 78 percent of the notifications, respectively. Among 303 isolates from patients > 65 years of age that were investigated with Quellung reaction, 235 (78 percent) had capsular serotypes represented in the 23-valent polysacharide vaccine. Conclusions. The Ministry of Health of Chile announced implementation of 23-valent vaccine immunization program for the elderly. In the perspective of future evaluations of the impact of this intervention, the results of this study indicate the need of reinforcing adherence and improving the quality of notifications of invasive S. pneumoniae.

Prevalencia de factores de riesgo de enfermedad cardiovascular en una población de empleados chilenos / Prevalence of cardiovascular risk factor among chilean employees

Cardiovascular diseases are the main causes of death in Chile and there is a high prevalence of cardiovascular risk factors in the population. Aim: To assess the prevalence of those risk factors in a group of employees. Subjects and methods: We studied 2,219 individuals, 1,378 males with a mean age of 46.2ñ10.4 years and 841 females with a median age of 41.9ñ10.3 years. Results: High blood pressure was observed in 39.7 percent of men and in 21.8 percent of women. A serum cholesterol between 200 and 239 mg/dl was observed in 38 percent of men and 31.3 percent of women. A cholesterol over this value was seen in 23.7 percent of men and 18.8 percent of women. A low proportion of those with high blood pressure, or elevated cholesterol, were under treatment. Prevalence of smoking was high in men and women: 43.5 and 48.9.2 percent, respectively. Eighty four percent of men and 61.3 percent of women over 54 years were overweight or obese. The prevalence of diabetes mellitus was 4.5 percent. Twenty percent of men and 13 percent of women exercised regularly, at least 3 times a week. Conclusions: There is a high prevalence of untreated cardiovascular risk factors in this population

Micosis profundas sistemáticas: casuística del Departamento de Micología del Instituto Nacional de Higiene Rafael Rangel durante 5 años (1997-2001) / Deep systemic mycoses: casuistry of the mycology departamet of the National Hygiene Institute Rafael Rangel

La vigilancia epidemiológica es esencial para fomentar nuestros conocimientos sobre las micosis profundas sistémicas en Venezuela. Como un aporte al conocimiento de estas patologías, presentamos la casuística del Departamento de Micología del Instituto Nacional de Higiene "Rafael Rangel" durante los últimos 5 años (1997-2001). Se revisaron retrospectivamente informes diagnósticos de 4.171 pacientes. Para detectar histoplasmosis, para coccidioidomicosis, conccidiodomicosis, aspergilosis y criptococosis fueron utilizadas pruebas serológicas, aglutinación de látex y aislamiento del agente etiológico según el caso: 240 muestras (5,7 por ciento) resultaron positivas. La distribución por patología fue la siguiente: histoplasmosis 112 (46,7 por ciento), paracoccidioidomicosis 65 (27 por ciento), criptococosis 55 (23 por ciento), aspergilosis 6 (2,5 por ciento) y coccidioidomicosis 2 (8 por ciento). La positividad general de estas micosis en los pacientes con VIH/SIDA fue del 11 por ciento y del 4 por ciento en los pacientes con otras patologías distintas al VIH/SIDA. Nuestro departamento se desempeña como el centro de referencia nacional del diagnóstico micológico, y su casuística representa la mitad de las publicaciones nacionales en este período de tiempo. La revisión de la casuística de las enfermedades nicóticas sistémicas es de gran relevancia, ya que su conocimiento permite incrementar el diagnóstico y orientar adecuadamente el tratamiento.

Diagnóstico inmunológico de las micosis sistémicas en pacientes con SIDA (1997-2001) / Immunological diagnosis to the systemic mycoses in patients with AIDS (1997-2001)

Las micosis profundas sistémicas y oportunistas son patologías que han incrementado su frecuencia en pacientes inmunosuprimidos en los últimos años, especialmente por la aparición del VIH, agente causal del SIDA. El propósito de esta revisión fue determinar la incidencia de las micosis sistémicas en pacientes con SIDA por inmunodiagnóstico en el Instituto Nacional de Higiene "Rafael Rangel", desde 1997 hasta 2001. Se procesaron 1.044 muestras, entre suero y LCR. El diagnóstico de histoplasmosis, paracoccidioidomicosis, coccidioidomicosis y aspergilosis, se realizó por la técnica de inmunodifusión doble en gel de agarosa. Para el diagnóstico de criptococosis se utilizó la aglutinación de látex. De 583 muestras procedentes de pacientes con SIDA, 113 (19,4 por ciento), resultaron positivas para el diagnóstico de estas micosis. La distribución por patología fue la siguiente: histoplasmosis 57 (50,4 por ciento), criptococosis 48 (42,5 por ciento), paracoccidioidomicosis 5 (4,4 por ciento), aspergilosis 2 (1,8 por ciento) y coccidioidomicosis 1 (0,9 por ciento). No se detectó ninguna de las patologías investigadas en 461 muestras procedentes de pacientes con infección por VIH asintómaticos. Nuestros resultados muestran que la histoplasmosis y la criptococosis son las micosis sistémicas más frecuentes en pacientes con SIDA, lo que coincide con los reportes a nivel internacional. Recomendamos el uso de las pruebas de inmunodifusión doble en gel de agarosa y la aglutinación de látex para el diagnóstico y seguimiento de las micosis sistémicas en estos pacientes, por su alta sensibilidad, especificidad y fácil realización