D-index as a Risk Factor for Invasive Fungal Infections in Patients With Acute Lymphoblastic Leukemia From a Reference Hematology Center in Bogota

Los pacientes con neoplasias hematológicas son huéspedes susceptibles al desarrollo de hongos invasivos. Infección (IFI), una de las principales complicaciones infecciosas potencialmente mortales que enfrentan estos pacientes. Actualmente, Contamos con estrategias de profilaxis antimicótica y esquemas de tratamiento antimicótico y reconocemos que el principal El factor de riesgo implicado es la neutropenia profunda y prolongada. El índice D y el índice D acumulativo son parámetros cuantitativos, que determinan la magnitud de la neutropenia, en función de la duración y profundidad y su valor se correlaciona con la aparición de IFI. material y métodos Se ingresó a un estudio de casos y controles en pacientes mayores de 18 años con leucemia linfoblástica aguda (LLA) entre 2009 y 2019 en el Instituto Nacional del Cáncer para inducción, consolidación y rescate quimioterapia. Resultados Se incluyeron un total de 167 pacientes, quienes recibieron 288 ciclos de quimioterapia, estos últimos fueron considerados la unidad de análisis. Se diseñó un modelo de ecuaciones de estimación generalizadas (GEE) para analizar datos; En este modelo se incluyeron tres variables cuantitativas y continuas de interés: edad (años), Dindex y neutropenia profunda (días). Para el índice D de la población, un odds ratio (OR) = 1,000227 (IC del 95 % 1,0002-1,0004); Se obtuvo p < 0,001. Conclusión El índice D se asocia con el desarrollo de IFI en pacientes con LLA, con un aumento exponencial del OR a medida que aumenta el valor absoluto del índice D.Patients with hematologic malignancies are susceptible hosts for the development of invasive fungal infection (IFI), one of the main life-threatening infectious complications faced by these patients. Currently, we have antifungal prophylaxis strategies and antifungal treatment schemes and we recognize that the main risk factor involved is profound and prolonged neutropenia. D-index and cumulative D-index are quantitative parameters, which determine the magnitude of neutropenia, as a function of duration and depth and their value correlates with the occurrence of IFI. Material and methods A case-control study in patients older than 18 years with acute lymphoblastic leukemia (ALL) was admitted between 2009 and 2019 at the National Cancer Institute for induction, consolidation and salvage chemotherapy. Results A total of 167 patients were included, who received 288 cycles of chemotherapy, the latter were considered the unit of analysis. A generalized estimating equations (GEE) model was designed to analyze correlated data; three quantitative and continuous variables of interest were included in this model: age (years), Dindex and deep neutropenia (days). For the population D-index, an odds ratio (OR) = 1.000227 (95% CI 1.0002-1.0004); p < 0.001 was obtained. Conclusion D-index is associated with the development of IFI in patients with ALL, with an exponential increase in OR as the absolute value of the D-index increases.Revista Internacional - No indexadaS

Fungemia in Hospitalized Adult Patients with Hematological Malignancies: Epidemiology and Risk Factors

Q2Q1Pacientes con Neoplasias malignas hematológicasPacientes con FungemiaFungemia in hematologic malignancies (HM) has high mortality. This is a retrospective cohort of adult patients with HM and fungemia between 2012 and 2019 in institutions of Bogotá, Colombia. The epidemiological, clinical, and microbiological characteristics are described, and risk factors related to mortality are analyzed. One hundred five patients with a mean age of 48 years (SD 19.0) were identified, 45% with acute leukemia and 37% with lymphomas. In 42%, the HM was relapsed/refractory, 82% ECOG > 3, and 35% received antifungal prophylaxis; 57% were in neutropenia, with an average duration of 21.8 days. In 86 (82%) patients, Candida spp. was identified, and other yeasts in 18%. The most frequent of the isolates were non-albicans Candida (61%), C. tropicalis (28%), C. parapsilosis (17%), and C. krusei (12%). The overall 30-day mortality was 50%. The survival probability at day 30 in patients with leukemia vs. lymphoma/multiple myeloma (MM0 group was 59% (95% CI 46–76) and 41% (95% CI 29–58), p = 0.03, respectively. Patients with lymphoma or MM (HR 1.72; 95% CI 0.58–2.03) and ICU admission (HR 3.08; 95% CI 1.12–3.74) were associated with mortality. In conclusion, in patients with HM, non-albicans Candida species are the most frequent, and high mortality was identified; moreover, lymphoma or MM and ICU admission were predictors of mortality.https://orcid.org/0000-0001-6396-3267https://orcid.org/0000-0001-5363-5729Revista Internacional - IndexadaA1N

Effects of Sex, Strain, and Energy Intake on Hallmarks of Aging in Mice

Calorie restriction (CR) is the most robust non-genetic intervention to delay aging. However, there are a number of emerging experimental variables that alter CR responses. We investigated the role of sex, strain, and level of CR on health and survival in mice. CR did not always correlated with lifespan extension, though it consistently improved health across strains and sexes. Transcriptional and metabolomics changes driven by CR in liver indicated anaplerotic filling of the Krebs cycle together with fatty acid fueling of mitochondria. CR prevented age-associated decline in the liver proteostasis network while increasing mitochondrial number, preserving mitochondrial ultrastructure and function with age. Abrogation of mitochondrial function negated life-prolonging effects of CR in yeast and worms. Our data illustrate the complexity of CR in the context of aging, with a clear separation of outcomes related to health and survival, highlighting complexities of translation of CR into human interventions