Chronic lymphocytic leukemia in the elderly: clinico-biological features, outcomes, and proposal of a prognostic model.

We investigated the clinico-biological features, outcomes, and prognosis of 949 patients with chronic lymphocytic leukemia according to age. No biological differences (cytogenetics by fluorescent in situ hybridization, IGHV, ZAP-70, CD38, NOTCH1, SF3B1) were found across age groups. Elderly patients (>70 years; n=367) presented more frequently with advanced disease (Binet C/Rai III-IV: 10/12% versus 5/5%; P4; hazard ratio 2.2, P<0.001) and response (treatment failure versus response: hazard ratio 1.60, P<0.04) were the most important prognostic factors for overall survival. In conclusion, in our series, elderly patients with chronic lymphocytic leukemia did not present with any biological features distinct from those of younger patients, but did have a poorer clinical outcome. This study highlights the importance of comprehensive medical care, achieving response to therapy, and specific management strategies for elderly patients with chronic lymphocytic leukemia

Factors associated with mortality in patients with decompensated heart failure

Introducción: la falla cardiaca (FC) es una de las principales causas de morbimortalidad a nivel mundial, la cual ha experimentado aumento gradual de su incidencia sin variación importante en su desenlace en las dos últimas décadas. En Colombia muy pocos estudios evalúan factores asociados a mortalidad por falla cardiaca. Métodos: estudio de cohorte prospectivo en el que se incluyeron pacientes con diagnóstico de falla cardiaca descompensada al momento del ingreso a urgencias, entre febrero de 2010 y marzo de 2013. Se calculó el tamaño de muestra y se realizó un análisis multivariado para la evaluación de los factores de riesgo asociados a mortalidad intrahospitalaria y a 30 días. Resultados: se incluyeron 462 pacientes. La mortalidad hospitalaria fue de 8.9% y a 30 días de 13.8%, en el modelo multivariado para el desenlace mortalidad intrahospitalaria se observó que la única variable con significancia estadística fue el BUN ≥43 mg/dL (OR, 3.45 [IC 95% 1.54-7.74], p= 0.003). Para la mortalidad a 30 días, la estancia hospitalaria >5 días (OR, 2.23 [IC 95% 1.20-4.12], p= 0.011), el BUN ≥43 mg/dL (OR, 2.55 [IC 95% 1.31-4.94], p= 0.005) y el NT-proBNP ≥ 4630 pg/dL (OR, 2.47 [IC 95% 1.30-4.70], p= 0.006). Conclusiones: la mortalidad intrahospitalaria de los pacientes con falla cardiaca descompensada en la población evaluada fue alta. En los análisis multivariados, se encontró que el BUN ≥ 43 mg/dL fue el único factor de riesgo independiente asociado a mortalidad intrahospitalaria; mientras que la mortalidad a 30 días se relacionó además con el NT-proBNP y la estancia hospitalaria superior a cinco días.Introduction: heart failure is one of the main causes of morbidity and mortality worldwide; it has experienced a gradual increase in incidence with no significant variation in outcome in the last two decades. In Colombia there are no studies to evaluate risk factors for mortality, which is the subject of this study. Methods: prospective cohort study in which patients with diagnosis of decompensated heart failure on admission to the emergency department between February 2010 and March 2013 were included. The sample size was calculated and a multivariate analysis was performed to evaluate the risk factors associated with in-hospital and 30-day mortality. Results: 462 patients were included. Hospital mortality was 8.9% and 30-day mortality 13.8%; in the multivariate model for hospital mortality outcome was observed that the only variable with statistic significance was BUN ≥ 43 mg/dL (OR, 3.45 [95% CI 1.54- 7.74], p = 0.003). For 30 day mortality, hospital stay > 5 days (OR, 2.23 [95% CI 1.20-4.12], p = 0.011), BUN ≥43 mg/dL (OR, 2.55 [95% CI 1.31-4.94] , p = 0.005) and NT-proBNP ≥ 4630 pg/dL (OR, 2.47 [95% CI 1.30-4.70], p = 0.006). Conclusions: in-hospital mortality in patients with decompensated heart failure in the study population was high. In multivariate analysis, it was found that BUN ≥ 43 mg/dL was the only independent risk factor associated with hospital mortality, while the 30-day mortality was also associated with NT-proBNP and hospital stay greater than five days.https://orcid.org/0000-0002-7021-6769N/

Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post–Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial

Las intervenciones de salud mental en contextos escolares tienen un gran potencial en la prevención e identificación temprana de trastornos de salud mental en adolescentes. Explorar el papel activo de los profesores y consejeros escolares en la salud mental de sus estudiantes es imperativo, especialmente después de los desafíos impuestos por la pandemia de COVID-19. Objetivo: Nuestra investigación tuvo como objetivo adaptar una intervención digital existente centrada en el paciente llamada DIALOG+ desde un entorno clínico para adultos a un entorno educativo para adolescentes. Nuestro objetivo era evaluar la viabilidad, aceptabilidad y efecto estimado de implementar esta intervención como una herramienta para mitigar el impacto de las dificultades sociales y promover la calidad de vida, el bienestar mental y la resiliencia. Métodos: Realizamos un estudio exploratorio de métodos mixtos en escuelas públicas en áreas de posconflicto en Tolima, Colombia. El estudio se llevó a cabo en 3 fases. La fase de adaptación identificó los cambios que la intervención requería para ser utilizada en el ámbito escolar. La fase de exploración consistió en un ensayo aleatorio grupal exploratorio con maestros y consejeros escolares donde se recopilaron datos sobre los síntomas de salud mental y el bienestar de los adolescentes antes y después del uso de DIALOG+S. Por último, una fase de consolidación exploró las experiencias y la aceptabilidad de los profesores y estudiantes de DIALOG+S a través de discusiones de grupos focales. Resultados: Los cambios sugeridos por los participantes en la fase de adaptación resaltaron la importancia central del entorno escolar en la salud mental de los adolescentes. En la fase exploratoria se incluyeron un total de 70 participantes con una edad media de 14,6 años. Los cambios observados en el grupo de intervención sugieren que la intervención tiene el potencial de mejorar aspectos de su salud mental, especialmente en lo que respecta a su calidad de vida y resiliencia. La fase de consolidación mostró que los actores sintieron que el uso de esta intervención en el ámbito escolar era factible y aceptable y pensaron que su uso era una experiencia enriquecedora que generaba cambios en la salud mental percibida y el comportamiento de los participantes. Conclusiones: Nuestros resultados son alentadores y muestran que la intervención DIALOG+S es factible y aceptable como una oportunidad prometedora para promover el bienestar y prevenir e identificar problemas de salud mental en el contexto escolar de una zona de posconflicto en Colombia. Se justifican estudios más amplios y con todo el poder estadístico para evaluar adecuadamente la eficacia y el impacto potencial de la intervención y perfeccionar los planes de implementación. Ensayo clínico: Registro ISRCTN ISRCTN14396374.Q3Q3Mental health interventions in school contexts have great potential in the prevention and early identification of mental health disorders in adolescents. Exploring the active role of the teachers and school counsellors in the mental health of their students is imperative especially after the challenges imposed by the COVID-19 pandemic. Objective: Our research aimed to adapt an existing patient-centered digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting. We aimed to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool to mitigate the impact of social difficulties and to promote quality of life, mental well-being and resilience. Methods: We conducted an exploratory mixed methods study in public schools in post-conflict areas in Tolima, Colombia. The study was carried out in 3 phases. The adaptation phase identified changes that the intervention required to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized trial with teachers and school counsellors where data about adolescent's mental health symptoms and well-being were collected before and after the use of DIALOG+S. Lastly, a consolidation phase explored the experiences of and acceptability to teachers and students of DIALOG+S through focus group discussions. Results: The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase a total of 70 participants with a mean age of 14.6 years were included. Changes seen in the intervention group suggest that the intervention has the potential to improve aspects of their mental health, especially regarding their quality of life and resilience. The consolidation phase showed that stakeholders felt that the use of this intervention in the school setting was feasible and acceptable and thought that using it was an enriching experience that generated changes in the perceived mental health and the behavior of participants. Conclusions: Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and to prevent and identify mental health problems in the school context of a post-conflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Clinical Trial: ISRCTN Registry ISRCTN14396374.Revista Internacional - IndexadaS

Chronic lymphocytic leukemia in the elderly: clinico-biological features, outcomes, and proposal of a prognostic model.

We investigated the clinico-biological features, outcomes, and prognosis of 949 patients with chronic lymphocytic leukemia according to age. No biological differences (cytogenetics by fluorescent in situ hybridization, IGHV, ZAP-70, CD38, NOTCH1, SF3B1) were found across age groups. Elderly patients (>70 years; n=367) presented more frequently with advanced disease (Binet C/Rai III-IV: 10/12% versus 5/5%; P4; hazard ratio 2.2, P<0.001) and response (treatment failure versus response: hazard ratio 1.60, P<0.04) were the most important prognostic factors for overall survival. In conclusion, in our series, elderly patients with chronic lymphocytic leukemia did not present with any biological features distinct from those of younger patients, but did have a poorer clinical outcome. This study highlights the importance of comprehensive medical care, achieving response to therapy, and specific management strategies for elderly patients with chronic lymphocytic leukemia