Principales modificaciones asociadas a la esplenectomía

El bazo es un órgano linfoide implicado en el reconocimiento antigénico, la depuración de patógenos y la remoción de eritrocitos envejecidos o con inclusiones citoplasmáticas. La esplenectomía es una técnica utilizada tanto para el diagnóstico (linfomas), tratamiento (trombocitopenia inmune, anemia hemolítica adquirida) y la curación (microesferocitosis hereditaria) de diversas enfermedades.  Los cambios posteriores a la esplenectomía pueden considerarse como inmediatos: aparición de cuerpos de Howell-Jolly, trombocitosis y la presencia de leucocitosis durante las primeras dos semanas. Otras complicaciones incluyen la presencia de trombosis, en especial en pacientes con factores de riesgo o un estado hipercoagulable, siendo tanto el flujo de la vena porta como el volumen esplénico los principales factores de riesgo para su aparición.  Las complicaciones tardías incluyen la alteración en la respuesta inmune, aumentando el riesgo de infecciones por bacterias encapsuladas en conjunto con una reducción en los niveles de IgM secundario a la ausencia de linfocitos B a nivel de bazo, debido al riesgo de infecciones principalmente por Streptococcus pneumoniae, la esplenectomía parcial se ha considerado una opción.  Una adecuada valoración de la indicación de esplenectomía y la identificación precoz de complicaciones son fundamentales para reducir la mortalidad asociada a la esplenectomía

Edad y recuento leucocitario como factores pronósticos en leucemia linfoblástica aguda: cohorte hgmla07

In order to establish the cutoff with prognostic implications for white blood cell count and age at diagnosis in adults with acute lymphoblastic leukemia (ALL), we conducted an observational, descriptive and analytical study nested in a retrospective cohort of patients with ALL treated by institutional protocol HGMLAL07 during 2007-2014. We study 255 patients, the 52.9% (n=135) were female and 47.1% (n=120) were male. The mean age was 31 (16-80) years-old. The disease-free survival (DFS) decreases in both genders after 20 years-old (p = 0.001). Leukocyte count average was 56.1 x 109/L (0.1-850 x 109/L). DFS decreases significantly from an equal or greater leukocyte count of 20 x 109/L (p<0.05). With this results, we can conclude that use foreign cutoff for age and leukocyte count could determine a bad prognosis stratification and a consequent suboptimal treatment.Con el objetivo de establecer la cifra de corte de leucocitos y edad con implicación pronostica en adultos con leucemia linfoblástica aguda (LLA), se efectuó un estudio observacional, descriptivo y analítico anidado en la cohorte retrospectiva de pacientes con LLA tratados mediante el protocolo institucional HGMLAL07 durante 2007-2014. Se estudiaron 255 pacientes, el 52.9% (n=135) correspondieron al género femenino y 47.1% (n=120) al género masculino. La media de edad fue de 31 (16-80) años. La supervivencia libre de la enfermedad (SLE) disminuyó en ambos géneros a partir de los 20 años (p=0.001). La media de leucocitos fue 56.1 x 109/L (0.1-850 x 109/L). La SLE disminuyó significativamente a partir de una cifra igual o mayor de 20 x 109/L (p<0.05). Con esto se puede concluir que emplear puntos de corte para leucocitos y edad obtenidos en poblaciones distintas pudiera condicionar una mala clasificación pronostica y un consiguiente tratamiento subóptimo

Effect of Metformin to a pretreatment with steroids in adult patients with acute lymphoblastic leukemia and in the viability of the MOLT-4 cell line

Introducción: metformina es un medicamento antidiabético evaluado en varios modelos in vitro e in vivo de cáncer ya que es capaz de incrementar la proteincinasa activada por adenosin monofosfato y bloquear las vías de señalización tumoral. Objetivo: evaluar los efectos antitumorales de metformina en línea celular MOLT-4 en pacientes bajo tratamiento de inducción a la remisión. Materiales y métodos: fase in vitro: ensayo en línea celular MOLT-4 adicionando metformina 40 mM evaluando la viabilidad y ciclo celular mediante citometría de flujo. Fase clínica: Estudio de casos y controles en pacientes portadores de leucemia linfoblástica aguda de novo, adicionando metformina 850 mg cada ocho horas en etapa de pretratamiento e inducción a la remisión, contra el registro histórico del protocolo institucional HGMLAL07. Para el análisis estadístico se utilizó el test de chi-cuadrado, estudio multivariado para factores de riesgo y evaluación del efecto sobre la remisión mediante Odds Ratio. Resultados: ensayo celular: meformina inhibió la viabilidad celular a las 120 horas, reduciendo el porcentaje de células en fase S. Estudio clínico: en un total de 151 pacientes, el 29,1% correspondieron al brazo de metformina. La mayor tasa de respuesta favorable a esteroides como de remisiones completas se encontraron en los pacientes que recibieron metformina (59,1% versus 26,2% y 81,8% versus 57,9%) con significancia estadística (p= 0.000* y 0,006 95% IC). Conclusiones: la adición de metformina a la quimioterapia incremento la respuesta favorable a esteroides y las tasas de remisiones completas. In vitro, y semejante a otros modelos, metformina arresta a las células en G0/G1, induciendo una disminución en la viabilidad celular. MÉD.UIS. 2015;28(2):221-8.Introduction: metformin, antidiabetic drug evaluated in several in vitro and in vivo cancer models, is able of increasing the adenosine monophosphate activated protein kinase and block tumor signaling pathways. Objetive: to evaluate the antitumor effects of metformin in MOLT-4 cell line and in patients under treatment for remission induction. Materials and methods: in vitro phase: essay in MOLT-4 cell line adding metformin 40 mM evaluating the viability and cell cycle by flow cytometry. Clinic phase: Case-control study in patients with de novo acute lymphoblastic leukemia, adding metformin three time a day on pretreatment stage and remission induction, against the historical record of the institutional protocol HGMLAL07. Statistical analysis: chi-square analysis, multivariate analysis for risk factors and evaluation of the effect over the remission by Odds ratio. Results: celular assay: metformina inhibited cell viability at 120 hours reducing the percentage of cells in phase S. Clinical assay: 151 patients were studied, 29.1% on metformina arm. The highest rate of good steroid response and complete remissions were found in patients who received metformin (59,1% versus 26,2% and 81,8% vs 57,9%) statistically significant (p= 0.000* and 0.006, 95% IC). Conclusions: the addition of metformin to chemotherapy increased the good steroids response to steroids and rates of complete remissions. In vitro, and similar to other models, metformin arrest cells in G0/G1, inducing a decrease in cell viability. MÉD.UIS. 2015;28(5):221-8

Geomorphological and sedimentary processes of the glacially influenced northwestern Iberian continental margin and abyssal plains

The offshore region of northwestern Iberia offers an opportunity to study the impacts of along-slope processes on the morphology of a glacially influenced continental margin, which has traditionally been conceptually characterised by predominant down-slope sedimentary processes. High-resolution multibeam bathymetry, acoustic backscatter and ultrahigh-resolution seismic reflection profile data are integrated and analysed to describe the present-day and recent geomorphological features and to interpret their associated sedimentary processes. Seventeen large-scale seafloor morphologies and sixteen individual echo types, interpreted as structural features (escarpments, marginal platforms and related fluid escape structures) and depositional and erosional bedforms developed either by the influence of bottom currents (moats, abraded surfaces, sediment waves, contourite drifts and ridges) or by gravitational features (gullies, canyons, slides, channel-levee complexes and submarine fans), are identified for the first time in the study area (spanning ~90,000 km2 and water depths of 300m to 5 km). Different types of slope failures and turbidity currents are mainly observed on the upper and lower slopes and along submarine canyons and deep-sea channels. The middle slope morphologies are mostly determined by the actions of bottom currents (North Atlantic Central Water, Mediterranean Outflow Water, Labrador Sea Water and North Atlantic Deep Water), which thereby define the margin morphologies and favour the reworking and deposition of sediments. The abyssal plains (Biscay and Iberian) are characterised by pelagic deposits and channel-lobe systems (the Cantabrian and Charcot), although several contourite features are also observed at the foot of the slope due to the influence of the deepest water masses (i.e., the North Atlantic Deep Water and Lower Deep Water). Thiswork shows that the study area is the result of Mesozoic to present-day tectonics (e.g. themarginal platforms and structural highs). Therefore, tectonism constitutes a long-term controlling factor, whereas the climate, sediment supply and bottom currents play key roles in the recent short-term architecture and dynamics. Moreover, the recent predominant along-slope sedimentary processes observed in the studied northwestern Iberian Margin represent snapshots of the progressive stages and mixed deep-water system developments of the marginal platforms on passive margins and may provide information for a predictive model of the evolution of other similar margins.Departamento de Investigación y Prospectiva Geocientífica, Unidad de Tres Cantos, Instituto Geológico y Minero de España, EspañaDepartamento de Geología y Geoquímica, Universidad Autónoma de Madrid, EspañaDepartment of Earth Sciences, Royal Holloway University of London, Reino Unid

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 8

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, volumen 8, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

The Inflammatory Biomarkers Behavior Profile of Patients Following Elective Degenerative Spine Surgery and Differences Compared to Those Coursing With a Postoperative Spinal Infection: Protocol for a Systematic Review

BackgroundThe incidence of postoperative spinal infection (PSI) ranges from 0% to 10%, with devastating effects on the patient prognosis because of higher morbidity while increasing costs to the health care system. PSIs are elusive and difficult to diagnose, especially in the early postoperative state, because of confusing clinical symptoms, rise in serum biomarkers, or imaging studies. Current research on diagnosis has focused on serum biomarkers; nevertheless, most series rely on retrospective cohorts where biomarkers are studied individually and at different time points. ObjectiveThis paper presents the protocol for a systematic review that aims to determine the inflammatory biomarker behavior profile of patients following elective degenerative spine surgery and their differences compared to those coursing with PSIs. MethodsThe proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. This protocol was registered at PROSPERO on January 19, 2022. We will include studies related to biomarkers in adult patients operated on for degenerative spinal diseases and those developing PSIs. The following information will be extracted from the papers: (1) study title; (2) study author; (3) year; (4) evidence level; (5) research type; (6) diagnosis group (elective postoperative degenerative disease or PSI); (7a) region (cervical, thoracic, lumbosacral, and coccygeal); (7b) type of infection by anatomical or radiological site; (8) surgery type (including instrumentation or not); (9) number of cases; (10) mean age or individual age; (11) individual serum biomarker values from the preoperative state up to 90 days postoperative for both groups, including (10a) interleukin-6, (10b) presepsin, (10c) erythrocyte sedimentation rate, (10d) leukocyte count, (10e) neutrophil count, (10f) C-reactive protein, (10g) serum amyloid, (10h) white cell count, (10i) albumin, (10j) prealbumin, (10k) procalcitonin, (10l) retinol-associated protein, and (10m) Dickkopf-1; (11) postoperative days at symptoms or diagnosis; (12) type of organism; (13) day of starting antibiotics; (14) duration of treatment; and (15) any biases (including comorbidities, especially those affecting immunological status). All data on biomarkers will be presented graphically over time. ResultsNo ethical approval will be required, as this review is based on published data and does not involve interaction with human participants. The search for this systematic review commenced in February 2021, and we expect to publish the findings in mid-2023. ConclusionsThis study will provide the behavior profile of biomarkers for PSI and patients following elective surgery for degenerative spinal diseases from the preoperative period up to 90 days postoperative, providing cutoff values on the day of diagnosis. This research will provide clinicians with highly trustable cutoff reference values for PSI diagnosis. Finally, we expect to provide a basis for future research on biomarkers that help diagnose more accurately and in a timely manner in the early stages of illness, ultimately impacting the patient’s physical and mental health, and reducing the disease burden. Trial RegistrationPROSPERO CRD42022304645; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304645 International Registered Report Identifier (IRRID)DERR1-10.2196/4155

Blood type does not modify prognosis in patients with COVID-19: experience in a COVID-19 hospital in Mexico

Introduction: According to reports from China and Europe, there are various clinical and laboratory risk factors that associate with both death and the use of a ventilator in coronavirus disease 2019 (COVID-19). In Wuhan, blood type A was related to these complications, but this factor is unknown for Latin America. Objective was to describe the association of blood type with complications related to COVID-19 infection. Material and methods: A retrospective comparative study from the clinical files of patients cared for in the emergency department between April and May 2020. Results: Data was analyzed from 120 patients hospitalized with COVID-19 infection. There were no differences in age and gender by blood type. Type O was the most frequent (80.8%) followed by type A (11.7%) and type B (7.5%). In univariate analysis, there was no impact of blood type on survival, individually (groups A, B, O) (log rank 0.154). In multivariate analysis, only age influenced prognosis (p =0.004). Above the risk, type O showed no impact on mortality (OR 1.0119, 95% CI: 0.3898–2.6272, p =0.980) or ventilator use (1.5616, 95% CI: 0.4834–5.0453, p =0.456), likewise for types A and B (OR 0.9882, 95% CI, 0.3806–2.5657). Conclusion: Blood type does not impact prognosis in Mexican patients with COVID-19

Age and leukocyte count as prognostic factors on acute lymphoblastic leukemia: hgmlal07 cohort

In order to establish the cutoff with prognostic implications for white blood cell count and age at diagnosis in adults with acute lymphoblastic leukemia (ALL), we conducted an observational, descriptive and analytical study nested in a retrospective cohort of patients with ALL treated by institutional protocol HGMLAL07 during 2007-2014. We study 255 patients, the 52.9% (n=135) were female and 47.1% (n=120) were male. The mean age was 31 (16-80) years-old. The disease-free survival (DFS) decreases in both genders after 20 years-old (p = 0.001). Leukocyte count average was 56.1 x 109/L (0.1-850 x 109/L). DFS decreases significantly from an equal or greater leukocyte count of 20 x 109/L (p<0.05). With this results, we can conclude that use foreign cutoff for age and leukocyte count could determine a bad prognosis stratification and a consequent suboptimal treatment

Effect of metformin on the survival of patients with ALL who express high levels of the ABCB1 drug resistance gene

Abstract Background In acute lymphoblastic leukemia (ALL), high ABCB1 gene expression has been associated with treatment resistance, which affects patient prognosis. Many preclinical reports and retrospective population studies have shown an anti-cancer effect of metformin. Therefore, the objective of this study was to assess the effect of metformin on the treatment regimen in patients with ALL who exhibited high levels of ABCB1 gene expression and to determine its impact on overall survival. Methods A total of 102 patients with ALL were recruited; one group (n = 26) received metformin, and the other received chemotherapy (n = 76). Measurement of ABCB1 transcript expression was performed using qRT-PCR prior to treatment initiation. Survival analysis was performed using Kaplan–Meier curves. The impact of both the type of treatment and the level of expression on the response (remission or relapse) was analyzed by calculating the odds ratio. Results The survival of patients with high ABCB1 expression was lower than those with low or absent ABCB1 gene expression (p = 0.030). In the individual analysis, we identified a benefit to adding metformin in the group of patients with high ABCB1 gene expression (p = 0.025). In the metformin user group, the drug acted as a protective factor against both therapeutic failure (odds ratio [OR] 0.07, 95% confidence interval [CI] 0.0037–1.53) and early relapse (OR 0.05, 95% CI 0.0028–1.153). Conclusion The combined use of metformin with chemotherapy is effective in patients with elevated levels of ABCB1 gene expression. Trial registration NCT 03118128: NC