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Background: Cisplatin is employed in hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS) for peritoneal surface malignancies (PSMs). The main concern regarding intraperitoneal cisplatin administration is nephrotoxicity. Numerous reports in this context are available. Our objective was to conduct a systematic review and meta-analysis to assess cisplatin-based HIPEC-related nephrotoxicity (CHRN). Methods: A systematic literature review on CHRN after CRS for the treatment of PSMs was performed. The literature search was carried out using Medline, Cochrane, and Embase. The last day of the search was 23 October 2023. PRISMA guidelines were used. A meta-analysis was then conducted. The main endpoint was the incidence of acute and chronic renal impairment after CHRN. Secondary endpoints included the potential impact of several clinical variables on the primary endpoint and a critical appraisal of the different renal impairment scales employed. Results: Our study included 26 articles with a total sample of 1473 patients. The incidence of acute kidney injury (AKI) was 18.6% (95% CI: 13.6-25%, range of true effects 3-59%). For chronic kidney disease, it was 7% (95% CI: 3-15.3%, range of true effects 1-53%). The variables that statistically influenced these results were the scale used to measure renal insufficiency, the use of nephroprotective agents, and the presence of pre-existing renal disease. Conclusions: The reported incidence of renal impairment following cisplatin-based HIPEC is highly variable. The incidence of renal failure obtained in this meta-analysis should be used as a reference for subsequent reports on this topic. Further prospective studies are warranted to establish optimal and standardized management.
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Long-term analyses of the immune response following SARS-CoV-2 mRNA vaccines are essential to determining its characteristics and providing the basis for vaccination strategies. We conducted a prospective study in a cohort of 268 healthy adults followed for >2 years after two doses of BNT162b2. Antibodies targeting the receptor-binding domain of the S1 subunit of the spike of SARS-CoV-2 (anti-RBD) were measured at eight time points; T cell response was analyzed using an interferon-γ release assay. A total of 248 (93%) subjects received mRNA-1273 on month 9; 93 (35%) received the bivalent Omicron-adapted BNT162b2 vaccine between months 19 and 26. Breakthrough infections occurred in 215 (80%) participants, with frequencies unaffected by the additional vaccines. Anti-RBD declined over the initial 9 months, increased after mRNA-1273, and declined gradually thereafter. In 50 (17%) previously infected subjects, anti-RBD levels were significantly higher up to month 9 (p < 0.05) but subsequently declined below those of uninfected individuals. Anti-RBD titers protective against SARS-CoV-2 could not be defined. Most subjects developed a positive T cell response that remained after 26 months. Waning of protection against SARS-CoV-2 infection occurred over time, resulting in non-severe breakthrough infections in most participants. The evolution of anti-RBD suggests modulation of the immune response through immune imprinting.
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Purpose: Adherence to disease-modifying therapies (DMTs) in multiple sclerosis (MS) is a complex and multidimensional phenomenon. Identifying the predictors of therapeutic adherence in MS will guide the design of interventions to improve health outcomes. Our aim was to assess the degree of adherence to pharmacological treatments, assess the relationship between patient-related factors and pharmacological adherence and to identify predictors of adherence to pharmacological treatments in patients with MS in Spain. Patients and Methods: A cross-sectional nationwide study was carried out in Spain between December 2020 and September 2021. The web-based evaluation protocol consisted of a self-questionnaire survey designed ad hoc and the application of validated questionnaires to assess adherence, as well as beliefs about medication and quality of life. Predictor variables of adherence to MS treatment were assessed using multivariate analysis. Results: A total of 152 patients with MS participated (mean age: 44 years; 64% were female; and 78% had relapsing-remitting MS). Seventy-three percent of the patients reported being adherent to their pharmacological treatment for MS. Forgetfulness was the most common cause of non-adherence. Necessity beliefs and concerns beliefs were not statistically associated with adherence. The adherent group shows statistically significant better levels of quality of life in the cognitive function subscale than the non-adherent participants (p=0.040). Role limitations-emotional, emotional well-being and overall quality of life were not significantly associated with adherence. Predictors with a statistical association with adherence to treatment were years of education (OR=0.79; 95% CI: 0.65-0.96; p=0.020) and intravenous treatment (OR=3.17; 95% CI: 1.07-9.45; p=0.038). Conclusion: We found an adequate adherence to pharmacological treatment. Low education and intravenous treatment were significant predictors of adherence to DMTs.
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This study provides a framework to implement the theory of multiple intelligences (MI) in the identification of high-ability students in secondary education. The internal structure of three scales to assess students MI (students, parents and teachers ratings) was analyzed in a sample of 566 students nominated as gifted by their teachers. Participants aged 11 to 16 years (M = 14.85, SD = 1.08). The results indicated differentiated intellectual profiles depending on the informant estimating students MI. This study provided evidence for two components that allow us to analyze the cognitive competence of high-ability students beyond the areas commonly assessed at school: an academic component composed by the linguistic, logical-mathematical, naturalistic, and visual-spatial intelligences; and a non-academic component statistically loaded by the bodily-kinesthetic, musical and social intelligences. Convergence of the two components in the three scales was evidenced; and correlations between these components and students objective performance on a psychometric intelligence test were found to be low. Finally, the utility of the MI scales to identify high-ability students in secondary education is discussed
Este trabajo ofrece una propuesta para implementar la teoría de las inteligencias múltiples (IM) en la identificación de alumnos de altas habilidades en Educación Secundaria. Para ello se analizó la estructura interna de tres escalas para la evaluación de las IM destinadas a alumnos, padres y profesores en una muestra de 566 alumnos nominados con altas habilidades de edades comprendidas entre los 11 y los 18 años (M = 14.85, DT = 1.08). Los resultados indicaron perfiles intelectuales diferenciados dependiendo del informante estimando las IM de los alumnos. Este estudio proporcionó evidencia de la existencia de dos componentes que permiten analizar la competencia cognitiva de los alumnos más allá de las dimensiones generalmente valoradas en la escuela: un componente académico que engloba las inteligencias lingüística, lógico-matemática, naturalista y viso-espacial; y un componente no académico que comprende las inteligencias corporal, musical y social. Finalmente, se discute la utilidad de las escalas de IM para identificar alumnos de altas habilidades en educación secundaria