Diferencias territoriales en el reconocimiento de la discapacidad de niños y adolescentes con cáncer en España

El impacto del diagnóstico de cáncer en niños y adolescentes afecta a todas las áreas individuales y familiares desde el momento del diagnóstico colocándolos en situación de discapacidad. Existe un conocimiento empírico, no cuantificado, de que el reconocimiento de la discapacidad no es igual en todas las comunidades autónomas. Nos planteamos conocer el estado actual de concesión de la discapacidad de niños y adolescentes con cáncer y su variabilidad entre comunidades autónomas. Se utilizó una muestra de 1288 casos nuevos de niños y adolescentes diagnosticados de cáncer entre 0 y 18 años en el periodo 2014-2016. El 26,9 % solicitó valoración de discapacidad y se concedió en el 92,8 % con amplia variabilidad entre comunidades autónomas. El tiempo medio entre solicitud y diagnóstico es 6 meses, variando entre 1 y 11 meses entre comunidades autónomas. El tiempo medio entre solicitud y concesión es 3,4 meses, variando según comunidades autónomas entre 1 y 5 meses

COVID-19 vaccine failure

COVID-19 affects the population unequally with a higher impact on aged and immunosuppressed people. Hence, we assessed the effect of SARS-CoV-2 vaccination in immune compromised patients (older adults and oncohematologic patients), compared with healthy counterparts. While the acquired humoral and cellular memory did not predict subsequent infection 18 months after full immunization, spectral and computational cytometry revealed several subsets within the CD8+ T-cells, B-cells, NK cells, monocytes and CD45RA+ CCR7- Tγδ cells differentially expressed in further infected and non-infected individuals not just following immunization, but also prior to that. Of note, up to 7 subsets were found within the CD45RA+ CCR7- Tγδ population with some of them being expanded and other decreased in subsequently infected individuals. Moreover, some of these subsets also predicted COVID-induced hospitalization in oncohematologic patients. Therefore, we hereby have identified several cellular subsets that, even before vaccination, strongly related to COVID-19 vulnerability as opposed to the acquisition of cellular and/or humoral memory following vaccination with SARS-CoV2 mRNA vaccines.This study has been funded through Programa Estratégico Instituto de Biología y Genética Molecular (IBGM Junta de Castilla y León. Ref. CCVC8485), Junta de Castilla y León (Proyectos COVID 07.04.467B04.74011.0) and the European Commission – NextGenerationEU (Regulation EU 2020/2094), through CSIC's Global Health Platform (PTI Salud Global; SGL21-03-026 and SGL2021-03-038)N

Diferencias territoriales en el reconocimiento de la discapacidad de niños y adolescentes con cáncer en España

El impacto del diagnóstico de cáncer en niños y adolescentes afecta a todas las áreas individuales y familiares desde el momento del diagnóstico colocándolos en situación de discapacidad. Existe un conocimiento empírico, no cuantificado, de que el reconocimiento de la discapacidad no es igual en todas las comunidades autónomas. Nos planteamos conocer el estado actual de concesión de la discapacidad de niños y adolescentes con cáncer y su variabilidad entre comunidades autónomas. Se utilizó una muestra de 1288 casos nuevos de niños y adolescentes diagnosticados de cáncer entre 0 y 18 años en el periodo 2014-2016. El 26,9 % solicitó valoración de discapacidad y se concedió en el 92,8 % con amplia variabilidad entre comunidades autónomas. El tiempo medio entre solicitud y diagnóstico es 6 meses, variando entre 1 y 11 meses entre comunidades autónomas. El tiempo medio entre solicitud y concesión es 3,4 meses, variando según comunidades autónomas entre 1 y 5 meses

Selective Digestive Decontamination Attenuates Organ Dysfunction in Critically Ill Burn Patients

Objective: To evaluate whether selective decontamination of the digestive tract (SDD) attenuates organ dysfunction in critically ill burn patients. Background: The effect of SDD on the development and progression of organ dysfunction, as an important determinant of mortality in burned patients, is still unknown. We asked whether organ dysfunction is mitigated by treatment with SDD. Methods: Patients with burns >20% of total body surface or suspected inhalation injury from a randomized placebo-controlled trial were analyzed to determine the relationship between treatment received (placebo or SDD) and the severity of organ dysfunction as measured by the area under the curve of the Sequential Organ Failure Assessment (SOFA) score (and its individual components) from day 1 to day 7 of admission. Results: One hundred seven patients (53 in the SDD group and 54 in the placebo group) were included. Survival was significantly higher in SDD-treated patients (48 of 53, 90.6%) than in placebo-treated patients (39 of 54, 72.2%, P = 0.013). Total (P < 0.01) and respiratory (P < 0.01), cardiovascular (P = 0.04) and hematological (not reaching statistical significance, P = 0.07) organ dysfunction was associated with mortality after adjusting for predicted mortality. In multivariate logistic regression, SDD treatment was independently associated with total (P < 0.01), respiratory (P = 0.02), and hematological (P < 0.01) dysfunction over the first week postinjury. Conclusions: The beneficial effect of SDD on mortality in critically ill burned patients is accompanied by a reduction in the degree of organ dysfunction. SDD seems to be a valuable therapeutic strategy to prevent organ dysfunction and, more specifically, respiratory and hematological dysfunction in severely ill burn patients.Sin financiación1.331 SJR (2016) Q1, 13/95 Critical Care and Intensive Care Medicine, 5/86 Emergency MedicineUE

Identification and validation of a mirna as a diagnostic biomarker of diffuse alveolar damage in an animal model of acute lung injury and adult respiratory distress syndrome in mechanically ventilated patients

The objective is to discover a miRNA with diagnostic characteristics for diffuse alveolar damage (DAD) in an animal of acute lung injury (ALI) and in patients with the ARDS. Male rats (325-372 gr) underwent mechanical ventilation for 2.5 h with VT=9 ml/kg + PEEP=5 cm H2O (low VT, LV, n=10); or VT=25 ml/kg + PEEP=0 cm H2O (high VT, HV, n=19) (11 of 19 developed DAD at histological examination). Whole miRNA expression (RNA-seq-Single Read, 72 cycles, Illumina GaIIx) was analyzed in lung parenchyma. miRNA expression in LV vs. HV and in HV-DAD vs. HV-no-DAD was compared. We used a data mining strategy to prioritize the most relevant miRNA within the miRNAs differentially expressed. Prioritized miRNAs were validated in (1) serum from the same group of rats (RT-PCR); (2) human lung tissue (preserved at -80º after sampling) from autopsies of patients with ARDS (RT-PCR and in situ hybridization) (n=20); (3) human serum from mechanically ventilated patients obtained during the first 24 hours of ICU admission (n=66, 14 nonsurvivors). A p value < 0.05 was considered statistically significant. Results are median (IQR), and odds ratio (OR [95% confidence interval]). RT-PCR results were expressed x10-4. Categorical and continuous variables were compared with χ2 and Mann-Whitney, respectively. Predictive multivariate logistic analysis was used to identify independent risk factors. The area under ROC curve (AUROC, mean±SEM) was used to assess the discriminatory capacity. Multiple-comparison was adjusted by FDR. The local Ethics Committee approved this study.7.214 JCR (2014) Q1, 3/27 Critical care medicineUE