Evaluation of factors leading to poor outcomes for pediatric acute lymphoblastic leukemia in Mexico: a multi-institutional report of 2,116 patients

Background and aimsPediatric acute lymphoblastic leukemia (ALL) survival rates in low- and middle-income countries are lower due to deficiencies in multilevel factors, including access to timely diagnosis, risk-stratified therapy, and comprehensive supportive care. This retrospective study aimed to analyze outcomes for pediatric ALL at 16 centers in Mexico.MethodsPatients <18 years of age with newly diagnosed B- and T-cell ALL treated between January 2011 and December 2019 were included. Clinical and biological characteristics and their association with outcomes were examined.ResultsOverall, 2,116 patients with a median age of 6.3 years were included. B-cell immunophenotype was identified in 1,889 (89.3%) patients. The median white blood cells at diagnosis were 11.2.5 × 103/mm3. CNS-1 status was reported in 1,810 (85.5%), CNS-2 in 67 (3.2%), and CNS-3 in 61 (2.9%). A total of 1,488 patients (70.4%) were classified as high-risk at diagnosis. However, in 52.5% (991/1,889) of patients with B-cell ALL, the reported risk group did not match the calculated risk group allocation based on National Cancer Institute (NCI) criteria. Fluorescence in situ hybridization (FISH) and PCR tests were performed for 407 (19.2%) and 736 (34.8%) patients, respectively. Minimal residual disease (MRD) during induction was performed in 1,158 patients (54.7%). The median follow-up was 3.7 years. During induction, 191 patients died (9.1%), and 45 patients (2.1%) experienced induction failure. A total of 365 deaths (17.3%) occurred, including 174 deaths after remission. Six percent (176) of patients abandoned treatment. The 5-year event-free survival (EFS) was 58.9% ± 1.7% for B-cell ALL and 47.4% ± 5.9% for T-cell ALL, while the 5-year overall survival (OS) was 67.5% ± 1.6% for B-cell ALL and 54.3% ± 0.6% for T-cell ALL. The 5-year cumulative incidence of central nervous system (CNS) relapse was 5.5% ± 0.6%. For the whole cohort, significantly higher outcomes were seen for patients aged 1–10 years, with DNA index >0.9, with hyperdiploid ALL, and without substantial treatment modifications. In multivariable analyses, age and Day 15 MRD continued to have a significant effect on EFS.ConclusionOutcomes in this multi-institutional cohort describe poor outcomes, influenced by incomplete and inconsistent risk stratification, early toxic death, high on-treatment mortality, and high CNS relapse rate. Adopting comprehensive risk-stratification strategies, evidence-informed de-intensification for favorable-risk patients and optimized supportive care could improve outcomes

Factores asociados a la permanencia escolar Universitaria: habilidades sociales y motivación

El presente reporte corresponde a los resultados parciales de una línea de investigacióndel proyecto. “Análisis de trayectorias académicas y los factores que inciden en el desempeñoescolar de la carrera de psicología, generación 2017”. Se realizó un estudio cualitativo bajo elsupuesto de que la permanencia universitaria es un fenómeno multifactorial y multidireccional, endonde las habilidades sociales y motivación de los estudiantes son factores determinantes de lapermanencia escolar. Por tanto el objetivo del estudio fue analizar la trayectoria escolar de dosestudiantes de pregrado con desempeño escolar adecuado con relación al nivel de habilidadessociales que poseen, así como la motivación hacia los estudios de licenciatura, en el contexto de lamodificación del plan de estudios de la licenciatura en psicología. Participaron dos alumnos, unamujer y un varón de 21 y 22 años de edad, con adecuado desempeño escolar inscritos en 7º semestrede la licenciatura en psicología. La recopilación de datos fue a través de una entrevista aprofundidad presencial individual, con enfoque fenomenológico, indagando sobre los factoresrelacionados con la permanencia escolar, el entorno de los alumnos, las experiencias, conocimientosy contextos en los cuales se han desempeñado. Los resultados demostraron a partir de los relatos delos participantes, que las habilidades sociales y la motivación son factores determinantes de lapermanencia estudiantil, y se confirmó el carácter multifactorial de los procesos de la permanenciauniversitaria, en virtud que se identificaron otros elementos de gran magnitud necesarios paraconsiderar en el análisis, tales como el perfil de ingreso, las características de la familia y losapoyos que ofrece la universidad. Estos hallazgos permiten desarrollar líneas de trabajo para laplaneación de acciones tales como talleres, tutorías institucionales, talleres en línea dirigidos a losalumnos que se encuentren en riesgo de abandonar los estudios, para que sigan desarrollandohabilidades sociales e incrementen la motivación para culminar su ciclo de formación profesional

Factores asociados a la permanencia escolar Universitaria: habilidades sociales y motivación

El presente reporte corresponde a los resultados parciales de una línea de investigacióndel proyecto. “Análisis de trayectorias académicas y los factores que inciden en el desempeñoescolar de la carrera de psicología, generación 2017”. Se realizó un estudio cualitativo bajo elsupuesto de que la permanencia universitaria es un fenómeno multifactorial y multidireccional, endonde las habilidades sociales y motivación de los estudiantes son factores determinantes de lapermanencia escolar. Por tanto el objetivo del estudio fue analizar la trayectoria escolar de dosestudiantes de pregrado con desempeño escolar adecuado con relación al nivel de habilidadessociales que poseen, así como la motivación hacia los estudios de licenciatura, en el contexto de lamodificación del plan de estudios de la licenciatura en psicología. Participaron dos alumnos, unamujer y un varón de 21 y 22 años de edad, con adecuado desempeño escolar inscritos en 7º semestrede la licenciatura en psicología. La recopilación de datos fue a través de una entrevista aprofundidad presencial individual, con enfoque fenomenológico, indagando sobre los factoresrelacionados con la permanencia escolar, el entorno de los alumnos, las experiencias, conocimientosy contextos en los cuales se han desempeñado. Los resultados demostraron a partir de los relatos delos participantes, que las habilidades sociales y la motivación son factores determinantes de lapermanencia estudiantil, y se confirmó el carácter multifactorial de los procesos de la permanenciauniversitaria, en virtud que se identificaron otros elementos de gran magnitud necesarios paraconsiderar en el análisis, tales como el perfil de ingreso, las características de la familia y losapoyos que ofrece la universidad. Estos hallazgos permiten desarrollar líneas de trabajo para laplaneación de acciones tales como talleres, tutorías institucionales, talleres en línea dirigidos a losalumnos que se encuentren en riesgo de abandonar los estudios, para que sigan desarrollandohabilidades sociales e incrementen la motivación para culminar su ciclo de formación profesional

Fundamentos teórico - prácticos para el cálculo de nóminas, dirigidos a empresas del sector restaurantero

Tesis (Licenciatura en Turismo), Instituto Politécnico Nacional, EST, 2016, 1 archivo PDF, (144 páginas). tesis.ipn.m

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health