Post-CART-T Cell Infection: Etiology, pathogenesis, and therapeutic approaches.

Chimeric antigen receptor (CAR) T cell therapy targeting CD-19 has revolutionized the treatment of refractory B-cell malignancies. However, patients undergoing this therapy face an increased risk of infections due to compromised immune function, lymphodepleting chemotherapy, hospitalization, and therapy-related complications such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome. Patients with systemic corticosteroid use, low immunoglobulin levels, and severe CRS, are at higher risk of infection. This review article highlights the spectrum of infections encountered in CAR T cell therapy, including bacterial, viral, and fungal infections. Following consensus guidelines for vaccination and immunoglobulin replacement is recommended. Clear criteria for antibiotic usage and vaccinating household members against respiratory viruses are crucial. Understanding the risk factors, spectrum of infections, and implementing appropriate prophylactic measures are essential to optimize outcomes in patients undergoing CAR T cell therapy. By prioritizing infection prevention strategies, healthcare professionals can effectively improve patient care.

[SUNCT-type headache secondary to herpes zoster virus infection. A case report]. / Cefalea de tipo SUNCT secundaria a infección por el virus herpes zóster. A propósito de un caso.

INTRODUCTION: Headache is one of the most frequent reasons for medical consultation. The SUNCT type is classified as a primary trigeminal-autonomic headache and should be considered in cases of short-lasting, hemifacial pain associated with autonomic dysfunction. Additionally, in the approach to this disease, secondary causes that facilitate its onset must be ruled out. CASE REPORT: We describe a case of a new-onset SUNCT-type headache in which involvement of the first branch of the trigeminal nerve due to herpes zoster virus infection was documented six days after the onset of pain. CONCLUSION: Trigeminal autonomic headaches are usually primary; yet, multiple conditions have been described that are associated with SUNCT-type headaches and have a secondary etiology. Among these, herpes zoster virus infection should be considered at the onset of episodes consistent with SUNCT-type headache unresponsive to medical treatment.

TITLE: Cefalea de tipo SUNCT secundaria a infección por el virus herpes zóster. A propósito de un caso.Introducción. La cefalea es uno de los motivos más frecuentes de consulta médica. La de tipo SUNCT forma parte de las cefaleas primarias de tipo trigeminoautonómico y debe considerarse en casos de dolor hemifacial de corta duración asociado a signos disautonómicos. Adicionalmente, dentro del enfoque de esta enfermedad se deben descartar causas secundarias que faciliten su aparición. Caso clínico. Se describe un caso de cefalea de novo de tipo SUNCT en el cual se documentó afectación de la primera rama del nervio trigémino por infección del virus herpes zóster tras seis días de aparición del dolor. Conclusión. Habitualmente, las cefaleas trigeminoautonómicas son primarias; sin embargo, existen múltiples entidades descritas asociadas a cefalea de tipo SUNCT de etiología secundaria. Dentro de éstas debe considerarse la infección por el virus herpes zóster en el inicio de episodios compatibles con cefalea de tipo SUNCT que no respondan al tratamiento médico.

Implementación del Servicio SIFAC durante el episodio de calima prolongado en la Pandemia del COVID 19 / Implementation of the SIFAC Service during the prolonged haze episode in COVID Pandemic 19

JUSTIFICACIÓN: los problemas asociados a la calima y el impacto del polvo sahariano son un potencial peligro para la salud, y se manifiestan la mayoría en síntomas menores respiratorios y oftalmológicos tales como congestión nasal, tos, ojo rojo y ojo seco. Aunque la duración habitual es de 3 a 5 días, en las Islas Canarias ocurrió un episodio del 27 de enero de al 12 de febrero de 2022. Valor en la práctica habitual del Servicio definido y protocolizado por Foro de Atención Farmacéutica en farmacia comunitaria, siendo necesario: reducir la inseguridad del paciente en el autocuidado y la automedicación, en el caso de los síntomas menores realizar actuación o intervención: dispensación del medicamento solicitado que no precise prescripción, asegurando que es utilizado correctamente. Indicación de tratamiento farmacológico que no precise prescripción, para ese síntoma menor. Indicación de medidas higiénico-dietéticas, educación sanitaria y/o recomendaciones sanitarias. La derivación al centro de salud de manera adecuada y consensuada, potenciando la comunicación con otros profesionales sanitarios implicados en la atención a ese paciente.MATERIAL Y MÉTODOS: reunión de los tres farmacéuticos comunitarios en plataforma ZOOM para coordinar la recopilación de datos en el SIF de los siguientes síntomas menores: congestión nasal, tos, ojo rojo y ojo seco. Creación de documento compartido en la plataforma Google Drive donde poder registrar la información. Entrevista con el paciente: PASITAMAE. Registro del servicio en Programa Digital de SEFAC, que permite la evaluación simultanea del paciente con ayuda de los protocolos consensuados. Entrega del Informe para el paciente de la actuación farmacéutica y/o entrega del informe de derivación al médico. Cuantificar los datos de las tres farmacias comunitarias en función de resolución del síntoma menor y/o derivación al médico de Atención primaria o al Servicio de Urgencias. (AU)

[Sepsis Code: dodging mortality in a tertiary hospital]. / Código Sepsis: esquivando la mortalidad en un hospital terciario.

OBJECTIVE: In the hospital of La Princesa, the "Sepsis Code" (CSP) began in 2015, as a multidisciplinary group that provides health personnel with clinical, analytical and organizational tools, with the aim of the detection and early treatment of patients with sepsis. The objective of this study is to evaluate the impact of CSP implantation on mortality and to determine the variables associated with an increase in it. METHODS: A retrospective analytical study of patients with CSP alert activation from 2015 to 2018 was conducted. Clinical-epidemiological variables, analytical parameters, and severity factors such as admission to critical care units (UCC) and the need for amines were collected. Statistical significance was established at p < 0.05. RESULTS: We included 1,121 patients. The length of stay was 16 days and 32% required admission to UCC. Mortality showed a statistically significant linear downward trend from 24% in 2015 to 15% in 2018. The predictive mortality variables with statistically significant association were lactate > 2 mmol/L, creatinine > 1.6 mg/dL and the need for amines.>5.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. CONCLUSIONS: The implementation of Sepsis Code decreases the mortality of patients with sepsis and septic shock. The presence of a lactate > 2 mmol/L, creatinine > 1.6 mg/dL and/or the need to administer amines in the first 24 hours, are associated with an increase in mortality in the patient with sepsis.

Rootstock effects on scion gene expression in maritime pine.

Pines are the dominant conifers in Mediterranean forests. As long-lived sessile organisms that seasonally have to cope with drought periods, they have developed a variety of adaptive responses. However, during last decades, highly intense and long-lasting drought events could have contributed to decay and mortality of the most susceptible trees. Among conifer species, Pinus pinaster Ait. shows remarkable ability to adapt to different environments. Previous molecular analysis of a full-sib family designed to study drought response led us to find active transcriptional activity of stress-responding genes even without water deprivation in tolerant genotypes. To improve our knowledge about communication between above- and below-ground organs of maritime pine, we have analyzed four graft-type constructions using two siblings as rootstocks and their progenitors, Gal 1056 and Oria 6, as scions. Transcriptomic profiles of needles from both scions were modified by the rootstock they were grafted on. However, the most significant differential gene expression was observed in drought-sensitive Gal 1056, while in drought-tolerant Oria 6, differential gene expression was very much lower. Furthermore, both scions grafted onto drought-tolerant rootstocks showed activation of genes involved in tolerance to abiotic stress, and is most remarkable in Oria 6 grafts where higher accumulation of transcripts involved in phytohormone action, transcriptional regulation, photosynthesis and signaling has been found. Additionally, processes, such as those related to secondary metabolism, were mainly associated with the scion genotype. This study provides pioneering information about rootstock effects on scion gene expression in conifers.

La biopsia selectiva del ganglio centinela en melanoma sí tiene utilidad terapéutica / Sentinel Lymph Node Biopsy in Melanoma Does Have Therapeutic Utility

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Initial clinical outcomes and prognostic variables in the implementation of a Code Sepsis in a high complexity University Hospital.

OBJECTIVE: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient´s epidemiological and clinical characteristics and prognostic factors. METHODS: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. RESULTS: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p <0.05), lactic acid (6.10 vs 2.62 mmol/L, p <0.05) and procalcitonin (23.27 vs 12.73 mg/dL, p<0.05). A statistically significant linear trend was found between SOFA scale rating and mortality (p<0.05). In the multivariate analysis additional independent risk factors associated with death were identified: age > 65 years (OR 5.33, p <0.05), lactic acid > 3 mmol/L (OR 5,85, p <0,05), creatinine > 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). CONCLUSIONS: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programs.

Distance from home to the nearest park and the use of the parks for physical activity: the mediator role of road safety perception in adolescents.

OBJECTIVE: The objective of the study is to examine whether adolescents' road safety perception (RSP) acts as a mediator on the association between the distance from home to the nearest park and the use of the parks for physical activity (PA). STUDY DESIGN: This is a cross-sectional study. METHODS: The evaluation was through a random sample of 1130 adolescents (534 male), corresponding to 47.3%, 14-20 years old, from Porto Alegre, Brazil. RSP was assessed through some questions of the Neighborhood Environment Walkability Scale for Youth. Park use, socioeconomic status, age, and sex were measured using a questionnaire. Distance from home to the nearest park was evaluated through geographic information system. Data analysis was performed using Pearson correlation, and linear regression models were fitted as per the Baron and Kenny procedures for mediation analyses. All analyses were adjusted for sex and socioeconomic status. RESULTS: Road safety perception is independently associated with less distance from home to the nearest park (P = 0.04) and use of the parks for PA (P = 0.02). Road safety perception is a mediator and explains 16% of the association between park use and distance from home to the park (indirect Effect = -40.9966; 95% confidence interval [CI]: 119.3733-2.2455). CONCLUSION: Our findings indicated that RSP is a mediator on the association between the distance from home to the nearest park and the use of the parks for PA. Future studies should take this into consideration frequency and intensity of PA and other environmental characteristics, such as crime, aesthetics, and neighborhood facilities.

Exploring the optimal experimental setup for surface flow velocity measurements using PTV.

Advances in flow monitoring are crucial to increase our knowledge on basin hydrology and to understand the interactions between flow dynamics and infrastructures. In this context, image processing offers great potential for hydraulic monitoring, allowing acquisition of a wide range of measurements with high spatial resolution at relatively low costs. In particular, the particle tracking velocimetry (PTV) algorithm can be used to describe the dynamics of surface flow velocity in both space and time using fixed cameras or unmanned aerial systems (UASs). In this study, analyses allowed exploration of the optimal particle seeding density and frame rate in different configurations. Numerical results provided useful indications for two field experiments that have been carried out with a low-cost quadrocopter equipped with an optical camera to record RGB videos of floating tracers manually distributed over the water surface. Field measurements have been carried out using different natural tracers under diverse hydraulic and morphological conditions; PTV's processed velocities have been subsequently benchmarked with current meter measurements. The numerical results allowed rapid identification of the experimental configuration (e.g., required particle seeding density, image resolution, particle size, and frame frequency) producing flow velocity fields with high resolution in time and space with good agreement with the benchmark velocity values measured with conventional instruments.

Linfadenectomía tras una biopsia positiva del ganglio centinela en el melanoma: un cambio de paradigma / Lymphadenectomy After a Positive Sentinel Lymph Node Biopsy in Melanoma: A Paradigm Shift

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Dermoscopy of inverted follicular keratosis: study of 12 cases.

BACKGROUND: Inverted follicular keratosis (IFK) is an uncommon benign tumour of the follicular infundibulum, which is often misdiagnosed clinically as other keratinizing tumours, and commonly diagnosed correctly by histopathology. There are few reports about the dermoscopic findings of this lesion. AIM: To evaluate the dermoscopic features of IFK. METHODS: The dermoscopic structures and patterns in digital dermoscopic images of 12 histopathologically confirmed cases of IFK collected from 5 hospitals in Spain were evaluated. RESULTS: A keratoacanthoma (KA)-like pattern composed of central keratin surrounded by hairpin vessels in a radial arrangement was the most common pattern in IFK (58.3%). The second most common pattern was composed of a yellowish-white amorphous central area surrounded by vascular structures in a radial arrangement (33.3%). The remaining case showed a pattern composed of a yellowish-white amorphous central area with milky red globules. Vascular structures were present in all cases, with a monomorphic pattern in seven cases and a polymorphic pattern in five, mainly with radial arrangement. Arborizing vessels, linear irregular vessels, corkscrew vessels and milky red globules were present in some cases. CONCLUSIONS: We describe the two main patterns of IFK. Lesions with a KA-like pattern are clinically and dermoscopically undistinguishable from KA and squamous cell carcinoma. Cases with a polymorphic vascular pattern could be confused with malignant tumours, including basal cell carcinoma and amelanotic melanoma.

Resultados oncológicos y funcionales en prostatectomía radical laparoscópica en grupo de bajo riesgo vs riesgo intermedio y alto / Oncological and functional results OF radical laparoscopic prostatectomy in low-risk group vs intermediate and high risk

INTRODUCCIÓN: La prostatectomía radical (PR) es el tratamiento de elección en pacientes con cáncer de próstata organoconfinado y esperanza de vida mayor a 10 años. Dentro de este grupo se pueden distinguir pacientes de riesgo bajo, intermedio y alto según D'Amico. Parámetros oncológicos y funcionales, como la continencia inmediata o precoz y potencia sexual sirven para evaluar el resultado de este procedimiento. OBJETIVO: Evaluar parámetros oncológicos y funcionales entre el grupo de riesgo bajo Vs Intermedio alto. PACIENTES Y MÉTODOS: Estudio prospectivo de carácter descriptivo. 132 Pacientes sometidos aprostatectomía radical laparoscópica entre 2003-2013 por un único cirujano. Datos recopilados en el momento de la cirugía y controles postoperatorios. Se agruparon según edad, Score de Gleason, PSA y estadio clínico en pacientes de riesgo bajo e intermedio-alto. En controles se realizó encuesta de continencia, potencia sexual y evaluación de biopsia. Los datos se analizaron considerando p<0,05 estadísticamente significativo según prueba Xi Square. RESULTADOS: Se incluyeron en total 132 pacientes, edad promedio 64,2(±7)años (48-75). PSA promedio 8,4(±6)ng/dl (1,5-37). El grupo de riesgo bajo(G1) corresponde a 92 pacientes (70 %), Promedio 64 años, PSA 6, 83 por ciento T1c. El grupo de riesgo intermedio-alto (G2) 40 pacientes (30 %), Promedio 64,9 años, PSA 13,7; 86 por ciento T1c. Márgenes positivos en G1 13(14 por ciento )pacientes Vs 11(26 por ciento) pacientes en G2. En G1 41 (45 por ciento ) están continentes al mes, 73 por ciento al tercer mes y 92 por ciento al año Vs 35 (41 por ciento ) están continentes al mes, 65 por ciento al tercer mes y 825 al año en G2. De los pacientes con seguimiento mayor a un año y erección satisfactoria previa, en G1 un 53 por ciento logró erección de igual calidad al octavo mes Vs G2 un (53 por ciento ) lo logró al mes 11. No hubo diferencia significativa en márgenes (+), continencia y potencia postoperatoria entre ambos grupos con (P>0.05). CONCLUSIONES: Los resultados oncológicos y funcionales no difieren en pacientes de bajo riesgo VS riesgo mayor. No hubo diferencias significativas en los parámetros estudiados, aunque se necesitan estudios de mayor cantidad de pacientes y revisiones sistemáticas para comparar series de distintos centros.(AU)

INTRODUCTION: Radical prostatectomy is the treatment of choice for patients with localized prostate cancer and life expectancy over 10 years. Within this group we can distinguish patients with low, intermediate and high risk according to D'Amico. Oncological and functional parameters, such as immediate or early continence and sexual potency are useful to evaluate the outcome of this procedure. OBJECTIVE: To evaluate oncological and functional parameters among low-risk group vs. intermediate. PATIENTS AND METHODS: Prospective descriptive clinical study. 132 patients underwent laparoscopic radical prostatectomy between the years 2003-2013 performed by a single surgeon. Data collected that at the time of surgery and postoperative controls. They were grouped according to age, Gleason Score, PSA and clinical stage in patients with risk low- and intermediate-high. During controls, a survey was performed in relation to continence, sexual potency and evaluation of biopsy. Data were analyzed considering p <0.05 statistically significant according Xi Square test. RESULTS: 132 patients participated, with an average age of 64.2 (± 7) years (48-75). PSA average 8.4 (± 6) ng / dl (1.5 to 37). The low risk group (G1) corresponds to 92 patients (70 pertrcent), average 64 years, PSA 6.83 pertcent T1c. The intermediate-high risk group G2) consisted of 40 patients (30 pertcent), average 64.9 years, PSA 13.7; 86 pertcent T1c. G1 positive margins in 13 (14 percent) patients vs 11 (26 pertcent) patients in G2. In G1 41 (45 pertcent) are continent in a month, 73 pertcent in the third month and 92 pertcent in one year vs 35 (41 pertcent)are continent in a month, 65 pertcent in the third month and 825 in a year in G2. Of patients with follow-up longer than a year and satisfactory prior erection in G1, a 53 pertcent achieved erection of equal quality in eighth month vs. G2 one (53 pertcent) did it achieved it in month 11. There was no significant difference in margins (+), postoperative continence or potency between the two groups (P> 0.05). CONCLUSIONS: oncological and functional results do not differ in low-risk patients vs. higher risk. There were no significant differences in the parameters studied, althoug. (AU)

Prevalencia de anemia y estado nutricional de escolares del área periurbana de Sucre, Bolivia / Anemia prevalence and nutritional status in children of a suburban area of Sucre, Bolivia

Background: There is limited data on the nutritional status and the prevalence of anemia among school children of Bolivia. This study aimed to determine the prevalence of anemia, iron deficiency and nutritional status by anthropometry in children of a suburban area in the Municipality of Sucre, Bolivia. Subjects and methods: A cross-sectional observational study was conducted involving all school children aged 6 to 10years (n=195) of a suburban school of Sucre-Bolivia (2750 m over sea level). We measured weight and height and calculated Z score for weight/age, height/age, and BMI/age indices using WHO standards. Blood samples were drawn to determine hemoglobin (Hb) and mean corpuscular volume (MCV). Anemia was defined using cut-offs points adjusted for age and corrected for altitude (Hb < 13.4 d/dl). Results: The prevalence of malnutrition observed by Z scores of height/age and weight/age were 20% and 8, 7%, respectively, and mean BMIz score was -0,07. Of these children, 17.9% showed anemia (17.4% iron deficiency anemia), 22.6% iron deficiency without anemia and 19.5% depleted iron stores. Conclusions: The school age children from the suburban area of Sucre-Bolivia presented a mild prevalence of anemia and medium prevalence of stunting.

Introducción: Existen escasos datos sobre el estado nutricional y la prevalencia de la anemia entre los escolares de Bolivia. Este estudio tuvo como objetivo determinar la prevalencia de anemia, deficiencia de hierro y el estado nutricional por antropometría en niños de una zona suburbana de la Municipalidad de Sucre, Bolivia. Sujetos y métodos: Se realizó un estudio observacional transversal en que participaron todos los escolares de 6 a 10 años (n=195) de una escuela suburbana de Sucre-Bolivia (2750 msnm). Se midió el peso y la talla y se calculó puntaje Z peso/edad, talla/edad, e IMC utilizando tablas de la OMS. Se extrajo una muestra de sangre para determinar hemoglobina, volumen corpuscular medio y ferritina sérica. La anemia se definió utilizando un punto de corte por edad y corregidos por la altitud (Hb <13.4 d/dl). Resultados: La prevalencia de malnutrición observado por las puntuaciones Z de talla/edad y peso/edad fueron de 20% y 9%, respectivamente, y la media del z de IMC fue -0,07. De estos niños, 17, 9% presentó anemia (17,4 anemia por deficiencia de hierro), 22,6% deficiencia de hierro sin anemia y 19,5% depósitos de hierro depletados. Conclusiones: Los niños en edad escolar de la zona suburbana de Sucre-Bolivia presentaron una prevalencia leve de anemia, y una moderada prevalencia de retraso del crecimiento.