COVID-19 Severity and Survival over Time in Patients with Hematologic Malignancies: A Population-Based Registry Study.

Mortality rates for COVID-19 have declined over time in the general population, but data in patients with hematologic malignancies are contradictory. We identified independent prognostic factors for COVID-19 severity and survival in unvaccinated patients with hematologic malignancies, compared mortality rates over time and versus non-cancer inpatients, and investigated post COVID-19 condition. Data were analyzed from 1166 consecutive, eligible patients with hematologic malignancies from the population-based HEMATO-MADRID registry, Spain, with COVID-19 prior to vaccination roll-out, stratified into early (February-June 2020; n = 769 (66%)) and later (July 2020-February 2021; n = 397 (34%)) cohorts. Propensity-score matched non-cancer patients were identified from the SEMI-COVID registry. A lower proportion of patients were hospitalized in the later waves (54.2%) compared to the earlier (88.6%), OR 0.15, 95%CI 0.11-0.20. The proportion of hospitalized patients admitted to the ICU was higher in the later cohort (103/215, 47.9%) compared with the early cohort (170/681, 25.0%, 2.77; 2.01-3.82). The reduced 30-day mortality between early and later cohorts of non-cancer inpatients (29.6% vs. 12.6%, OR 0.34; 0.22-0.53) was not paralleled in inpatients with hematologic malignancies (32.3% vs. 34.8%, OR 1.12; 0.81-1.5). Among evaluable patients, 27.3% had post COVID-19 condition. These findings will help inform evidence-based preventive and therapeutic strategies for patients with hematologic malignancies and COVID-19 diagnosis.

Impact of hematologic malignancy and type of cancer therapy on COVID-19 severity and mortality: lessons from a large population-based registry study.

BACKGROUND: Patients with cancer have been shown to have a higher risk of clinical severity and mortality compared to non-cancer patients with COVID-19. Patients with hematologic malignancies typically are known to have higher levels of immunosuppression and may develop more severe respiratory viral infections than patients with solid tumors. Data on COVID-19 in patients with hematologic malignancies are limited. Here we characterize disease severity and mortality and evaluate potential prognostic factors for mortality. METHODS: In this population-based registry study, we collected de-identified data on clinical characteristics, treatment and outcomes in adult patients with hematologic malignancies and confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection within the Madrid region of Spain. Our case series included all patients admitted to 22 regional health service hospitals and 5 private healthcare centers between February 28 and May 25, 2020. The primary study outcome was all-cause mortality. We assessed the association between mortality and potential prognostic factors using Cox regression analyses adjusted for age, sex, comorbidities, hematologic malignancy and recent active cancer therapy. RESULTS: Of 833 patients reported, 697 were included in the analyses. Median age was 72 years (IQR 60-79), 413 (60%) patients were male and 479 (69%) and 218 (31%) had lymphoid and myeloid malignancies, respectively. Clinical severity of COVID-19 was severe/critical in 429 (62%) patients. At data cutoff, 230 (33%) patients had died. Age ≥ 60 years (hazard ratios 3.17-10.1 vs < 50 years), > 2 comorbidities (1.41 vs ≤ 2), acute myeloid leukemia (2.22 vs non-Hodgkin lymphoma) and active antineoplastic treatment with monoclonal antibodies (2·02) were associated with increased mortality; conventional chemotherapy showed borderline significance (1.50 vs no active therapy). Conversely, Ph-negative myeloproliferative neoplasms (0.33) and active treatment with hypomethylating agents (0.47) were associated with lower mortality. Overall, 574 (82%) patients received antiviral therapy. Mortality with severe/critical COVID-19 was higher with no therapy vs any antiviral combination therapy (2.20). CONCLUSIONS: In this series of patients with hematologic malignancies and COVID-19, mortality was associated with higher age, more comorbidities, type of hematological malignancy and type of antineoplastic therapy. Further studies and long-term follow-up are required to validate these criteria for risk stratification.

Ortodoncia mínimamente invasiva / Minimally invasive orthodontics

Se presentan casos clínicos tratados con aparatología, definida en forma genérica como alineadores, demostrando que se producen cambios en todos los sentidos del espacio y permiten llevar a cabo tratamientos completos sin recurrir a otros recursos que las placas termoformadas secuenciadas. Estas mismas se realizan siguiendo set ups progresivos desarrollados en el flujo digital. Se analizan los pros y contras en el manejo de la nueva mecánica de tratamiento haciendo hincapié en el cumplimiento del siguiente protocolo: diagnóstico, pronóstico, lista de problemas, enunciación de objetivos, elaboración del plan de tratamiento, diagramación de las etapas, visualización de los renders para asegurarse de los movimientos necesarios, su secuencia según un nuevo paradigma de movimiento individual y tridimensionalmente controlado, comunicación y logro de la máxima colaboración del paciente, seguimiento correcto de las acciones previstas, colocación de aditamentos, desgastes programados, control de cambios clínicos según el número de alineador/número de render, obtención de los objetivos planteados, realización de controles oclusales, cumplimiento de una estrategia de contención y rehabilitación posterior si fuese necesario(AU)

Clinical cases treated with appliances commonly known as aligners are presented, proving that changes take place in all spatial directions and make it possible to carry out complete treatment without resorting to other resources than sequenced thermoformed plates. These ones are made following progressive setups developed in the digital flow. Pros and cons of the management of the new treatment mechanics are analyzed, emphasizing the adherence to the following protocol: diagnosis, prognosis, list of issues, objectives stating, treatment plan making, stages diagramming, renders visualization to make sure of the necessary movements, their sequence according to a new paradigm of individual and controlled threedimensionally movement, communication with and achievement of patient's maximum cooperation, accurate follow-up of expected actions, application of attachments, programmed wear, clinical change control according to the number of aligner/render number, achievement of the stated objectives, occlusal controls performance, fulfilment of a retention strategy and subsequent rehabilitation if necessary(AU)

Indicación de extracciones en ortodoncia, para pacientes en preparación para cirugía ortognática. ¿Cuándo, cuáles, por qué? / Indication of extractions in orthodontics, for patients in preparation for orthognathic surgery. When, which, why?

La indicación de extracciones en aquellos casos en preparación para cirugía ortognática representa un compromiso, ya que la mayoría de las veces dichas extracciones sirven para exponer las desarmonías del contenido dental en relación con el continente óseo, lo que causa un empeoramiento estético que solo se reparará en ocasión de la cirugía. Es por eso que las opciones de "cirugía primero" se solicitan con mayor frecuencia en los últimos años.(AU)

Prescription of extractions in those cases in preparation for orthognathic surgery represents a compromise, since most times those extractions serve to show disharmonies of dental content in relation to the bone continent, which causes an aesthetical worsening that will only be repaired on occasion of surgery. That is why the 'surgery first' options are most frequently requested in recent years.(AU)

Treatment of invasive fungal infections in high risk hematological patients. The outcome with liposomal amphotericin B is not negatively affected by prior administration of mold-active azoles.

There are concerns of a reduced effect of liposomal amphotericin B (L-AmB) given sequentially after mold-active azoles due to a possible antagonism in their antifungal mechanism. To investigate this possible effect in the clinic, we retrospectively studied 182 high risk hematologic patients with invasive fungal infections (IFI) who were treated with L-AmB. Overall, 96 patients (52.7%) had possible, 52 (28.6%) probable and 34 (18.7%) proven IFI according to EORTC classification. Most had suspected or proven invasive aspergillosis. We compared patients with prior exposure to mold-active azoles (n=100) to those having not (n=82). The group with prior mold-active azoles included more patients with poor risk features for IFI as acute myeloid leukemia (p<0.05) and prolonged neutropenia (p<0.05). A favorable response in the IFI, defined as a complete or partial response, was achieved in 75% and 74.4% of patients in the whole cohort, and in 66% and 74.4% of patients with probable or proven IFI in the two groups. None of these differences were significant. Multivariate analysis showed that refractory baseline disease and renal dysfunction were adverse factors for response in the IFI (p<0.05). Survival was poorer for patients with prior broad spectrum azoles (p<0.05), and for those who did not recover from neutropenia (p<0.05). In conclusion, the effectiveness of treatment of breakthrough fungal infection with L-AmB is not likely to be affected by prior exposure to mold-active azoles prophylaxis, but survival largely depends on host and disease factors.

Treatment of invasive fungal infections in high risk hematological patients. The outcome with liposomal amphotericin B is not negatively affected by prior administration of mold-active azoles

Existe cierta inquietud sobre una reducción del efecto de la anfotericina B liposomal (L-AmB) administrada secuencialmente después de la administración de azoles activos frente a mohos debido a un posible antagonismo en su mecanismo antifúngico. Para investigar este posible efecto en la práctica clínica, hemos estudiado retrospectivamente 182 pacientes hematológicos con infecciones fúngicas invasivas (IFI) de alto riesgo que fueron tratados con L- AmB. En total, 96 pacientes (52,7%) tenían IFI posible, 52 (28,6%) probable y 34 (18,7%) probada de acuerdo con la clasificación de la EORTC. La mayoría presentaban aspergilosis invasiva. Comparamos los pacientes con exposición previa a azoles activos frente a mohos (n=100) con aquellos no expuestos (n=82). El grupo con exposición previa a azoles activos frente a mohos incluía más pacientes con características de alto riesgo de IFI, como leucemia mieloide aguda (p<0,05) y neutropenia prolongada (p<0,05). Se alcanzó una respuesta favorable en la IFI, definida como una respuesta completa o parcial, en 75,0% y 74,4% de los pacientes de la cohorte completa y en 66,0% y 74,4% de los pacientes con IFI probable o probada en los dos grupos. Ninguna de estas diferencias fue significativa. El análisis multivariante mostró que la enfermedad basal y la disfunción renal eran factores adversos para la respuesta en la IFI (p<0,05). La supervivencia fue peor en los pacientes tratados con azoles de amplio espectro (p<0,05) y en aquellos en los que no se resolvió la neutropenia (p<0,05). En conclusión, la eficacia del tratamiento con LAmB de una infección fúngica de brecha probablemente no se vea afectada por la exposición previa a un tratamiento profiláctico con azoles activos frente a mohos, dependiendo la supervivencia más bien de los factores del huésped y de la enfermedad de base(AU)

There are concerns of a reduced effect of liposomal amphotericin B (L-AmB) given sequentially after mold-active azoles due to a possible antagonism in their antifungal mechanism. To investigate this possible effect in the clinic, we retrospectively studied 182 high risk hematologic patients with invasive fungal infections (IFI) who were treated with L-AmB. Overall, 96 patients (52.7%) had possible, 52 (28.6%) probable and 34 (18.7%) proven IFI according to EORTC classification. Most had suspected or proven invasive aspergillosis. We compared patients with prior exposure to mold-active azoles (n=100) to those having not (n=82). The group with prior mold-active azoles included more patients with poor risk features for IFI as acute myeloid leukemia (p<0.05) and prolonged neutropenia (p<0.05). A favorable response in the IFI, defined as a complete or partial response, was achieved in 75% and 74.4% of patients in the whole cohort, and in 66% and 74.4% of patients with probable or proven IFI in the two groups. None of these differences were significant. Multivariate analysis showed that refractory baseline disease and renal dysfunction were adverse factors for response in the IFI (p<0.05). Survival was poorer for patients with prior broad spectrum azoles (p<0.05), and for those who did not recover from neutropenia (p<0.05). In conclusion, the effectiveness of treatment of breakthrough fungal infection with L-AmB is not likely to be affected by prior exposure to mold-active azoles prophylaxis, but survival largely depends on host and disease factors(AU)

Desarrollo, salud humana y amenazas ambientales: la crisis de la sustentabilidad / Development, human health and enviromental threatenings: sustainability crisis

Contenido: Ecología, ambiente y salud. Urbanización, ambiente y calidad de vida. Contaminación y riesgo ambiental. El medio ambiente y la salud de las comunidades. Factores microambientales que producen accidentes. Provisión de agua. Efluentes domiciliarios e industriales. Contaminación de cursos de agua dulce. Los residuos sólidos urbanos y su relación con la salud. Tratamiento de residuos sólidos y peligrosos. Residuos patogénicos. Temperatura ambiente y salud. Radiaciones ionizantes. Ondas electomagnéticas. Fuegos e incendios. Ruidos y vibraciones. Vectores de enfermedad. Roedores. Sociedad, animales de compañía y zoonosis. Animales venenosos. Pesticidas y salud. Infecciones e intoxicaciones alimentarias. Accidentes de tránsito. Atención sanitaria en catástrofes.

Ensanche mandibular por medio de distracción osteogénica: presentación de un caso / Mandibular widthening by means of osteogenic distraction: report of a case

La falta de desarrollo transversal severa de la mandíbula obligaba hasta hace unos años a la realización de exodoncias múltiples. Desde la sistematización de los protocolos de distracción osteogénica intraoral dichos tratamientos pueden ser llevados a cabo en una forma más conservadora

Ensanche mandibular por medio de distracción osteogénica; presentación de un caso / Mandibular widening thourgh of distraction osteogenesis

La falta de desarrollo transversal severa de la mandíbula obligaba hasta hace unos años a la realización de exodoncias múltiples. Desde la sistematización de los protocolos de distracción osteogénica intraoral, dichos tratamientos pueden ser llevados a cabo en una forma más conservadora

Ensanche mandibular por medio de distracción osteogénica; presentación de un caso / Mandibular widening thourgh of distraction osteogenesis

La falta de desarrollo transversal severa de la mandíbula obligaba hasta hace unos años a la realización de exodoncias múltiples. Desde la sistematización de los protocolos de distracción osteogénica intraoral, dichos tratamientos pueden ser llevados a cabo en una forma más conservadora(AU)