Invasive fungal infection in immunosuppressed patients treated in a tertiary hospital

Antecedentes: las infecciones fúngicas invasivas son una causa importante de morbimortalidad mundial. El aumento en la incidencia de estas micosis se relaciona con el incremento de las condiciones de inmunosupresión. Objetivo: Describir las características demográficas y clínicas de pacientes inmunosuprimidos tratados con antifúngicos por sospecha de infecciones fúngicas invasivas en una institución de tercer nivel. Materiales y métodos: estudio descriptivo de corte transversal, en el que se incluyeron pacientes que recibieron tratamiento antifúngico durante 2012 y 2013, por sospecha de infecciones fúngicas invasivas (aspergilosis, criptococosis, histoplasmosis y mucormicosis) y condición de inmunosupresión. Resultados: se analizaron 81 pacientes, con predominio masculino (66,5%) y una media de edad de 44 años. El diagnóstico de base más frecuente fue neoplasia hematolinfoide seguido de infección por el virus de la inmunodeficiencia humana (VIH). La aspergilosis angioinvasiva (52%) y la criptococosis (28%) fueron las sospechas clínicas más frecuentes. El 43 y 85% de los pacientes tuvieron hallazgos anormales en radiografía y tomografía axial computarizada de tórax respectivamente. De aquellos con sospecha de aspergilosis, el 23% tuvo prueba de galactomanano positiva, en tanto que en aquellos con sospecha de criptococosis pulmonar, el 75% fue positivo para el antígeno capsular. El 22% de los pacientes fallecieron y el 17% requirieron estancia en UCI y soporte hemodinámico. Conclusión: es importante sospechar de forma temprana la infecciones fúngicas invasivas, así como establecer un algoritmo diagnóstico e instaurar el tratamiento antifúngico de manera anticipada para disminuir los desenlaces fatales. La dificultad en la confirmación microbiológica de las infecciones fúngicas invasivas continúa siendo una problemática local, similar a lo reportado en la literatura mundial.Artículo original10-17Background: invasive fungal infections (IFI) are a major cause of mortality and morbidity worldwide. The increased incidence of these fungal infections are associated with an increase in immunosuppressive conditions. Objective: to describe demographic and clinical characteristics of immunosuppressed patients treated with antifungals for suspected invasive fungal infection (IFI) in a tertiary hospital. Materials and methods: in this descriptive cross-sectional study, immunosuppressed patients receiving antifungal treatment during 2012 and 2013, with suspected IFI (aspergillosis, cryptococcosis, mucormicosis and histoplasmosis) were included. Results: 81 patients, predominantly men (66.5%), with a mean age of 43.8 years were analyzed. The most common underlying conditions were lymphoproliferative disorders followed by HIV infection. Angioinvasive aspergillosis (52%) and cryptococcosis (28%) were most frequently suspected. 43% and 85% of patients had abnormal findings on chest radiograph and CT, respectively. 22% of the patients died and 17% required monitoring in the ICU and hemodynamic support. Conclusion: This highlights the importance of a high index of suspicion and early diagnosis of IFI, following an algorithm that enables the timely initiation of antifungal treatment to reduce fatal outcomes. It also identifies the obstacles of getting microbiological confirmation of these pathogens; the difficulties being similar in our institution to those reported elsewhere

Annual Conference on Formative Research on EFL. Practices thar inspire change.

The conference papers of the Annual Conference on Formative Research on EFL. Practices thar inspire change collect pedagogical experiences, research reports, and reflections about social issues, language teaching, teaching training, interculturality under the panorama of the Covid-19 pandemic. Each paper invites the reader to implement changes in their teaching practice through disruptive pedagogies, reflect on the social and emotional consequences of the lockdown, new paths for teacher training and different approaches for teaching interculturality. We expect to inspire new ways to train pre-service teachers and teach languages in this changing times

Síndrome linfoproliferativo postrasplante renal con lesión única en sistema nervioso central tratada con radioterapia: reporte de un caso y revisión de la literatura

El síndrome linfoproliferativo postrasplante (SLPT) confinado al sistema nervioso central (SNC) es una entidad extremadamente rara y de mal pronóstico. El tratamiento tiene un impacto significativo en la supervivencia, pues no está claramente estandarizado, dada la poca incidencia de esta entidad y la poca literatura al respecto. La radioterapia es una alternativa de tratamiento en estos pacientes con afectación en el SNC. Se revisaron las principales características de esta patología y se reporta un caso de una adolescente de 13 años de edad con SLPT confinado a SNC como único sitio de compromiso, tratada con radioterapia, en quien se obtuvo una buena respuesta y adecuada tolerancia al tratamiento

Post-Renal Transplant Lymphoproliferative Syndrome with Unique Lesion in Central Nervous System Treated with Radiotherapy: A Case Report and Literature Review

El síndrome linfoproliferativo postrasplante (SLPT) confinado al sistema nervioso central (SNC) es una entidad extremadamente rara y de mal pronóstico. El tratamiento tiene un impacto significativo en la supervivencia, pues no está claramente estandarizado, dada la poca incidencia de esta entidad y la poca literatura al respecto. La radioterapia es una alternativa de tratamiento en estos pacientes con afectación en el SNC. Se revisaron las principales características de esta patología y se reporta un caso de una adolescente de 13 años de edad con SLPT confinado a SNC como único sitio de compromiso, tratada con radioterapia, en quien se obtuvo una buena respuesta y adecuada tolerancia al tratamiento.Post-transplant lymphoproliferative syndrome (PFS) confined to the central nervous system (CNS) is an extremely rare and poor prognosis. The treatment has a significant impact on survival. This standard is not clearly given the low incidence of this condition and therefore there is little literature. Radiotherapy is an alternative treatment in these patients with involvement in the CNS. A review of the main characteristics of this pathology was conducted and a case of a patient of 13 years old with CNC SLPT confined to the only site of involvement, treated with radiotherapy getting a good response, adequate tolerance to treatment

Latin American Consensus for the Evaluation and Treatment of Patients With Metastatic/Locally Advanced Urothelial Carcinoma

PURPOSEUrothelial cancer accounts for approximately 3% of new cancer cases worldwide, with a high burden of disease in countries with medium and low human development indexes where its incidence and mortality are increasing. The purpose of this consensus is to develop statements on the evaluation and treatment of locally advanced and metastatic urothelial carcinoma that would further guide the clinical practice in Latin America.METHODSA systematic review of the literature was conducted by an independent team of methodologists. Then, a modified Delphi method was developed with clinical specialists from different Latin American countries.RESULTSForty-two consensus statements, based on evidence, were developed to address the staging, the evaluation (suitability for chemotherapy, risk assessment, and biomarkers), and systemic treatment (first-line and subsequent therapies) of locally advanced or metastatic urothelial carcinoma. The statements made in this consensus are suggested practice recommendations in the Latin American context; however, the importance of a complete and individualized patient evaluation as a guide for therapeutic selection is highlighted. The availability and affordability of support tools for the evaluation of the disease, as well as specific therapies, may limit the application of the best practices suggested.RecommendationsTherapeutic decisions need to be tailored to the context-specific clinical setting and availability of resources. Local research is promoted to improve outcomes for patients with this challenging cancer in Latin America