Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer.

PURPOSE: The combination of fulvestrant with alpelisib, a PI3K inhibitor, improves progression-free survival in metastatic hormone receptor-positive, PIK3CA-mutant breast cancer. This study describes the incidence, risk factors, and treatment of alpelisib-associated hyperglycemia. METHODS: Patients with metastatic breast cancer who received alpelisib from 2013 to 2021 at Memorial Sloan Kettering Cancer Center were included in this retrospective study. Alpelisib prescription dates and patient/tumor characteristics were abstracted from medical records. Risk factors associated with hyperglycemia and alpelisib dose reduction/discontinuation were evaluated using Pearson's χ2 tests. RESULTS: Among 247 patients, baseline median body mass index was 25.4 kg/m2 and median hemoglobin A1c (HbA1c) was 5.5%. A total of 152 patients (61.5%) developed any-grade hyperglycemia and 72 patients (29.2%) developed grade 3-4 hyperglycemia; median time to onset was 16 days. A total of 100 patients (40.5%) received alpelisib on a clinical trial; rates of hyperglycemia were significantly higher in patients treated as standard care versus on a clinical trial (any-grade hyperglycemia 80.3% vs. 34.0%, grade 3-4 hyperglycemia 40.2% vs. 13.0%, p < .001). Baseline HbA1c was significantly associated with development of hyperglycemia (p < .001) and alpelisib dose reduction/discontinuation (p = .015). Among those who developed hyperglycemia, 101 (40.9%) received treatment, most commonly with metformin. A total of 49 patients (19.8%) were referred to an endocrinologist, which was associated with SGLT2 inhibitor prescription (p = .007). CONCLUSIONS: Rates of hyperglycemia among patients treated with alpelisib as standard care were significantly higher than patients treated on clinical trials. Elevated baseline HbA1c is associated with alpelisib-induced hyperglycemia and requiring dose modification. Optimization of glycemic status before alpelisib initiation should become routine practice.

The Role of Zoos and Aquariums in a Changing World.

Zoos and aquariums have evolved significantly. From their origins as enclosures for the mere entertainment of the public, these institutions have undertaken new functions responding to the biodiversity crisis and social demands. Modern zoos and aquariums have the opportunity to educate people, contribute to species conservation, and produce animal-related research. However, there is increasing criticism toward the outcomes of their actions and the holding of species in their facilities. This review offers an integrated analysis of the state of knowledge about the role that zoos and aquariums play today. It describes their performance regarding their conservation, education, and research functions, highlighting general patterns and offering future perspectives. It identifies some challenges common to all these institutions, concluding that the way they keep up with the ever-growing social and environmental expectations will be decisive hereafter.

Global trends in research output by zoos and aquariums.

Zoos and aquaria, often regarded as preservation-cum-entertainment enterprises, are also actors in the effort to curb the biodiversity crisis: raising awareness, supporting conservation, and conducting research. We assessed trends in zoo and aquaria research topics and study organisms over time worldwide. For the zoos and aquaria registered in the Species360's Zoological Information Management System and the World Association of Zoos and Aquariums, we compiled metadata on their research published in the peer-reviewed literature indexed in Scopus and carried out a keyword frequency analysis. The production of scientific papers by zoos increased at a much faster rate than the average accrual of scientific papers in the literature. Evolution of research themes ran parallel to that of biological sciences (e.g., development of molecular genetics or increased awareness about conservation). The focus of 48.5% of zoo-led research was on vertebrates, of which mammal research was 33.7%. Whether zoos are effectively contributing to conservation may still be debatable, but our results highlight their institutional efforts to increase knowledge about the species in their care.

Tendencias Mundiales en la Producción Investigativa de los Zoológicos y Acuarios Resumen Los zoológicos y los acuarios, con frecuencia considerados empresas de conservación y entretenimiento, también son actores en el esfuerzo por reducir la crisis de la biodiversidad al crear conciencia, apoyar a la conservación y llevar a cabo investigaciones. Evaluamos las tendencias en los temas de investigación y los organismos de estudios en los zoológicos y los acuarios en todo el mundo a través del tiempo. Compilamos los metadatos de las investigaciones realizadas en los zoológicos y acuarios registrados en el Sistema de Manejo de Información Zoológica de Species360 y en la Asociación Mundial de Zoológicos y Acuarios que han sido publicadas en la literatura revisada por pares indexada en Scopus y realizamos un análisis de frecuencias de palabras clave. La producción de artículos científicos por zoológicos se incrementó a una tasa mucho más rápida que la acumulación promedio de artículos científicos en la literatura. La evolución de los temas de investigación fue paralela a la de las ciencias biológicas (p. ej.: desarrollo de la genética molecular o incremento en la conciencia por la conservación). El enfoque del 48.5% de las investigaciones conducidas por los zoológicos estuvo sobre los vertebrados. De este 48.5%, el 33.7% fueron investigaciones sobre mamíferos. Todavía puede debatirse si los zoológicos están contribuyendo efectivamente a la conservación, pero nuestros resultados resaltan sus esfuerzos institucionales por incrementar el conocimiento sobre las especies bajo su cuidado.

Mortalidad precoz en pacientes con enfermedad renal crónica que inician hemodiálisis por urgencia en una población peruana: Incidencia y factores de riesgo / Early mortality in patients with chronic kidney disease who started emergency haemodialysis in a Peruvian population: Incidence and risk factors

OBJETIVOS: Estimar la mortalidad precoz en pacientes con enfermedad renal crónica que iniciaron hemodiálisis por urgencia entre los años 2012-2014 en un hospital de referencia nacional en Lima, Perú, e identificar los factores de riesgo. Diseño, características, participantes y mediciones Se estudió una cohorte retrospectiva mediante la revisión de historias clínicas de todos los pacientes admitidos a la Unidad de Hemodiálisis del hospital en el periodo de tiempo señalado. Se evaluó mortalidad precoz, definida como la muerte dentro de los primeros 90 días luego de iniciar hemodiálisis, así como edad, sexo, etiología de enfermedad renal crónica, comorbilidades, causa de muerte, tasa de filtración glomerular estimada, acceso vascular, entre otras variables, en los pacientes que iniciaron hemodiálisis por urgencia. Se estimó la mortalidad precoz mediante frecuencias y se utilizó regresión de Poisson con varianza robusta para determinar los factores de riesgo. RESULTADOS: Se encontró que el 43,4% fueron mujeres, el 51,5% tenían ≥ 65 años y una mortalidad precoz del 9,3%. Los principales factores de riesgo fueron tasa de filtración glomerular estimada > 10 mL/min/1,73 m2 (RR: 2,72 [IC 95%: 1,60-4,61]); edad ≥ 65 años (RR: 2,51 [IC 95%: 1,41-4,48]); infección de catéter venoso central, RR: 2,25 (IC 95%: 1,08-4,67); sexo femenino, RR: 2,15 (IC 95%: 1,29-3,58); y albúmina < 3,5 g/dL (RR: 1,97 [IC 95%: 1,01-3,82]). CONCLUSIONES: La mortalidad precoz fue del 9,3%. El principal factor de riesgo fue iniciar hemodiálisis con una tasa de filtración glomerular estimada > 10 mL/min/1,73m2

OBJECTIVES: To estimate early mortality in patients with chronic kidney disease who started emergency haemodialysis between 2012 and 2014 in a national referral hospital in Lima, Peru, and to identify risk factors. Design, characteristics, participants and measurements. A retrospective cohort study was conducted by reviewing the medical records of all patients admitted to the hospital's Haemodialysis Unit from 2012 to 2014. Early mortality, defined as death within the first 90 days of starting haemodialysis, as well as age, gender, chronic kidney disease aetiology, comorbidities, cause of death, estimated glomerular filtration rate, vascular access and other variables were evaluated in patients who initiated emergency haemodialysis. Early mortality was estimated using frequencies and risk factors were determined by Poisson regression with robust variance. RESULTS: 43.4% of patients were female, 51.5% were aged ≥ 65 years and the early mortality rate was 9.3%. The main risk factors were estimated glomerular filtration rate > 10 ml/min/1.73 m2 (RR: 2.72 [95% CI: 1.60-4.61]); age ≥ 65 years (RR: 2.51 [95% CI: 1.41-4.48]); central venous catheter infection, RR: 2.25 (95% CI: 1.08-4.67); female gender, RR: 2.15 (95% CI: 1.29-3.58); and albumin < 3.5g/dl (RR: 1.97 [95% CI: 1.01-3.82]). CONCLUSIONS: Early mortality was 9.3%. The main risk factor was starting haemodialysis with an estimated glomerular filtration rate > 10 ml/min/1.73 m2

Early mortality in patients with chronic kidney disease who started emergency haemodialysis in a Peruvian population: Incidence and risk factors. / Mortalidad precoz en pacientes con enfermedad renal crónica que inician hemodiálisis por urgencia en una población peruana: Incidencia y factores de riesgo.

OBJECTIVES: To estimate early mortality in patients with chronic kidney disease who started emergency haemodialysis between 2012 and 2014 in a national referral hospital in Lima, Peru, and to identify risk factors. DESIGN, CHARACTERISTICS, PARTICIPANTS AND MEASUREMENTS: A retrospective cohort study was conducted by reviewing the medical records of all patients admitted to the hospital's Haemodialysis Unit from 2012 to 2014. Early mortality, defined as death within the first 90 days of starting haemodialysis, as well as age, gender, chronic kidney disease aetiology, comorbidities, cause of death, estimated glomerular filtration rate, vascular access and other variables were evaluated in patients who initiated emergency haemodialysis. Early mortality was estimated using frequencies and risk factors were determined by Poisson regression with robust variance. RESULTS: 43.4% of patients were female, 51.5% were aged≥65 years and the early mortality rate was 9.3%. The main risk factors were estimated glomerular filtration rate>10 ml/min/1.73m2 (RR: 2.72 [95% CI: 1.60-4.61]); age≥65 years (RR: 2.51 [95% CI: 1.41-4.48]); central venous catheter infection, RR: 2.25 (95% CI: 1.08-4.67); female gender, RR: 2.15 (95% CI: 1.29-3.58); and albumin<3.5g/dl (RR: 1.97 [95% CI: 1.01-3.82]). CONCLUSIONS: Early mortality was 9.3%. The main risk factor was starting haemodialysis with an estimated glomerular filtration rate>10ml/min/1.73m2.

[Osteomyelitis due to Shewanella putrefaciens: case report and literature review]. / Osteomielitis por Shewanella putrefaciens: reporte de caso y revisión de literatura.

Shewanella putrefaciens is a Gram-negative bacillus and marine pathogen that rarely causes disease in humans. We report a case of osteomyelitis by this organism in a 48-year-old male patient, who presented with pain and erythema of the right foot that was initially diagnosed as cellulitis and did not revert despite treatment. He was transferred to Lima where osteomyelitis was diagnosed and started on empirical treatment with partial regression. A biopsy and culture of the compromised area found S. putrefaciens. The infection was treated according to the antibiotic sensitivity profile of the pathogen. S. putrefaciens infection represents a rare opportunistic infection of devitalized or exposed areas of the body. It is associated with residence in coastal areas and commonly affects the skin and soft tissues. Exceptional cases of osteomyelitis have been reported, but this is the first that involves the metatarsal bones.

Shewanella putrefaciens es un bacilo Gram negativo, patógeno marino que rara vez ocasiona enfermedad en humanos. Se presenta un caso de osteomielitis por este microorganismo en un paciente varón de 48 años, procedente de Chimbote. Presentó dolor y eritema en el pie derecho, inicialmente diagnosticado como celulitis, pero que no revirtió pese al tratamiento. Fue transferido a Lima donde se diagnosticó osteomielitis e inició tratamiento empírico con escasa mejoría. Por ello, se realizó una biopsia y cultivo de la zona comprometida, el metatarso, en el cual se aisló Shewanella putrefaciens. Se trató de acuerdo al perfil de sensibilidad. La infección por Shewanella putrefaciens representa una rara infección oportunista, que se localiza en áreas desvitalizadas o expuestas del cuerpo. Se asocia a vivir en zonas costeras, afectando comúnmente piel y tejidos blandos. Se han reportado casos excepcionales de osteomielitis. Este es el primero que involucra metatarso.

Conocimientos, actitudes y prácticas sobre dengue en estudiantes de educación primaria en Chorrillos, Lima, Perú / Knowledge, attitudes and practices about dengue fever in elementary school students in Chorrillos, Lima, Peru

Objetivos. Evaluar los conocimientos, actitudes y prácticas sobre dengue, medidas de prevención y control, e identificar los factoresasociados a su desconocimiento, en alumnos de una institución educativa estatal. Diseño. Estudio observacional transversal. Lugar. Institución educativa estatal en Chorrillos, Lima, Perú. Participantes. Alumnos de educación primaria. Métodos. En el año 2013, seencuestaron 142 alumnos del quinto y sexto grado de educación primaria y se exploró la percepción en 12 brigadieres en base a latécnica proyectiva. Principales medidas de resultados. Conocimientos, actitudes y prácticas sobre dengue. Resultados. El 53,5 % (76)era varón y el promedio de edad fue 11,2 con ± 1,05 años. El 33,1 % (47; IC95% 25,4 a 41,4) de los estudiantes tenía un conocimientobásico de dengue y 53,5% (76) identificaron la forma de transmisión vectorial del dengue. El 29,6 % (42; IC95% 22,2 a 37,8) de losescolares reconocieron las larvas y 54,2% (77) la forma adulta del vector. El 5,6% (8) y 2,1% (3) de los encuestados identificaronel larvicida y el cambio de arena húmeda de los floreros como medidas de prevención de la infestación domiciliaria. El 75,4% (75;IC95% 67,4 a 82,2) de los niños aceptarían participar en la búsqueda del vector, con diferencias significativas entre los niños y lasniñas (p=0,049238). El no haber recibido información previa se asoció a no tener conocimiento básico de dengue (OR=3,7; IC95%1,7 a 8,3; p= 0,0004676). Conclusiones. Los conocimientos de los estudiantes sobre los signos y síntomas y la forma de transmisióndel dengue, las características del vector y las medidas de prevención del dengue fueron bajos y el no recibir información se asocióal desconocimiento del dengue.

Objectives. To assess the knowledge, attitudes and practices on dengue fever, measures for prevention and control, and to identifyfactors related to unawareness in public elementary school students in the district of Chorrillos, Lima, Peru. Design. Cross sectionalobservational study. Setting. State elementary institution in Chorrillos district, Lima, Peru. Participants. Students of elementary school.Methods. In the year 2013, 142 students from fifth and sixth grade answered a survey questionnaire. We explored the perceptionamong 12 school brigadiers using the projective technique. Main outcome measures. Knowledge, attitudes and practices aboutdengue. Results. In the study, 53.5% students were boys (76), mean age 11.2 ± 1.05 years old; 33.1% (47; CI95% 25.4-41.4) had basicknowledge about dengue; 53.5% (76) were able to identify dengue virus’ mechanism of vertical transmission; 29.6% of students (42;CI95% 22.2-37.8) were able to identify the larvae and 54.2% (77) identified the adult flying mosquito. Only 5.6% (8) and 2.1% (3) knewrespectively of larvicides and using wet sand in flower vases as measures of control at home; 75.4% of the boys (75; CI95% 67.4-82.2)were willing to participate in active control of the mosquito vector, with statistical difference between boys and girls (p = 0.049238). Nothaving previous information led to not having basic knowledge about dengue (OR = 3.7; CI95% 1.7–8.3) (p = 0.0004676) Conclusion. The knowledge among students about clinical features, mode of transmission, vector and measures of prevention and control of thedengue virus were low because they had not received appropriate information.

¿Calcificaciones valvulares en ERC: enfermedad mineral ósea o riesgo cardiovascular previo? / Valvular calcifications in CKD: Mineral and bone disease or previous cardiovascular risk?

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