Caracterización del polo anterior en pacientes tratados mediante trasplante alogénico de precursores hematopoiéticos

El objetivo de esta tesis Doctoral es conocer los cambios provocados en la superficie ocular en pacientes sometidos a trasplante alogénico de precursores hematopoiéticos tras presentar una enfermedad hematológica, dado el incremento de estas enfermedades y el aumento de uso de trasplante alogénico para el tratamiento de las mismas. La complicación fundamental de trasplante alogénico es la enfermedad de injerto contra huésped, que puede afectar a a las estructurad oculares. Los Grupos estudiados son 3: - Grupo 1: pacientes vistos antes y 100 después del trasplante. - Grupo 2: pacientes con enfermedad injerto contra huésped ocular. - Grupo 3: Grupo control. En todos ellos se analizan las características morfológicasy funcionales de la superficie ocular. Se hacen las siguientes exploraciones: - Agudeza visual. - Test de Schirmer. - Topografía corneal. - Exámen biomicroscópico. -Tinciones corneales y tiempo de ruptura de película lagrimal (BUT test). - Test de OSDI. -Toma de muestras por citología de impresión conjuntival. Se analizan los resultados de dichas variables y se comparan entre grupos de la siguiente forma utilizando programación en R: - Rama 1: comparación de sujetos de Grupo 1 antes y después del trasplante. - Rama 2: comparación de sujetos con enfermedad injerto contra huésped (Grupo 2) y sujetos sanos (Grupo 3). - Rama 3: comparación entre sujetos trasplantados de precursores hematopoiéticos sin enfermedad injerto contra huésped (Grupo1) y sujetos con enfermedad injerto contra huésped (Grupo3). Según los resultados podemos concluir que las variables alteradas tras trasplante alogénico de precursores hematopoiéticos sin enfermedad injerto contra huésped son el test de OSDI, las tinciones corneales, el BUT test y cambios inmunohistoquímicos en muestras citológicas de conjuntiva. Además todas estas variables junto a test de Schirmer están alteradas en pacientes sometidos a trasplante de precursores hematopoiéticos que ya presentan enfermedad injerto contra huésped

Propuesta de plataforma tecnológica digital para una ciudad turística inteligente para el análisis de información de la cadena productiva del sector turismo de Cartagena de Indias

Cartagena de Indias D. T. y C., es una de las ciudades con mayor cantidad de visitantes en Colombia, por ello, requiere contar con información y datos estadísticos en tiempo real, que le permita una mejor toma de decisiones en las políticas locales para un mayor aprovechamiento económico del sector turístico y mejorar la experiencia de los visitantes. En este trabajo abordamos el contexto y soluciones para el mejoramiento de las capacidades de análisis de información de la cadena productiva del sector turismo del Distrito a través de una propuesta de plataforma tecnológica digital para una ciudad turística inteligenteThe city of Cartagena de Indias DT and C., is one of the cities with the largest number of visitors in Colombia, for this reason, it is important to have smart tourism that allows generating more economic use from the tourism sector and improving the experience of the visitors. The objective of this document is to present the main characteristics of smart tourism, with an emphasis on the context of the city, propose reflections and present as a product thereof, a proposal for a digital technological platform for a smart tourist city

Anatomic Response to Intravitreal Dexamethasone Implant and Baseline Aqueous Humor Cytokine Levels in Diabetic Macular Edema

Dexamethasone; Cytokine; Macular EdemaDexametasona; Citocina; Edema macularDexametasona; Citosina; Edema macularPURPOSE: To determine whether baseline cytokine aqueous humor (AH) levels are associated with diabetic macular edema (DME) anatomic response to dexamethasone intravitreal implant (DEX) injection. METHODS: This was a prospective cohort study of DME cases receiving DEX treatment. Seventy patients were recruited with center-involving DME with spectral-domain (SD) optical coherence tomography (OCT) detection of central macular thickness (CMT) ≥300 μm on macular cube 518 × 128-μm scan protocol (Cirrus SD-OCT). DEX injection and anterior chamber tap to obtain an AH sample were performed at the same time. Multiplex immunoassay was carried out for interleukin (IL)-1β, IL-3, IL-6, IL-8, IL-10; monocyte chemoattractant protein (MCP)-1; interferon gamma-induced protein (IP)-10; tumor necrosis factor (TNF)-α; and vascular endothelial growth factor (VEGF). A follow-up visit and OCT exam were undertaken 6 to 8 weeks afterward. The association between AH cytokine baseline levels and change in CMT and macular volume (MV) was defined as main outcome measure. RESULTS: Multivariate linear regression analysis showed a higher decrease in MV to be associated (Rs of 0.512) with four baseline items: higher MCP-1 (β = -0.4; P = 0.028), higher CMT (β = -0.003; P = 0.024), decreased visual acuity (β = -0.7; P = 0.040), and a diffuse retinal thickening (DRT) OCT pattern (β = -1.3; P < 0.001). Logistic regression found DRT also to be associated with higher odds of a good MV response (odds ratio, 31.96; 95% confidence interval [CI] 7.11-143.72; P < 0.001). CONCLUSIONS: Even though visual acuity response and anatomic effect are not always correlated in DME, we found that baseline elevated MCP-1 AH levels and DRT pattern were biomarkers that predicted a future favorable anatomic response to DEX

Allergen exposure boosts peripheral Th9 responses in patients with local allergic rhinitis

Key points ∙ Intranasal allergen exposure increases peripheral total Th2 and Th9 cells in patients with local allergic rhinitis (LAR). ∙ Peripheral T-cell response seems dominated by Th9 cells in patients with LAR, whereas Th2 responses prevail in patients with allergic rhinitis. ∙ Our results identify Th9 cells as potential therapeutic targets for patients with LAR.Instituto de Salud Carlos III (ISCIII) of the Spanish Ministry of Science and Competitiveness, Grant/Award Number: PI20/01715; Regional Ministry of Health of Andalucia through research projects, Grant/Award Numbers: PI-0346-2016, PI-0176-2018; Regional Ministry of Education of Andalucia through a research project, Grant/Award Number: P20-00405; Francisca Palomares holds a Senior Postdoctoral Program contract, Grant/Award Number: RH-0028-2021; Almudena Testera-Montes a “Rio Hortega” contract, Grant/Award Number: CM20/00160; Carlos Jose Aranda a “Sara Borrell” contract, Grant/Award Number: CD21/00034; Carmen Alba-Linero a “Río Hortega” contract, Grant/Award Number: CM21/00262; Ibon Eguiluz-Gracia a “Juan Rodes” contract, Grant/Award Number: JR19/00029; Cristobalina Mayorga holds a “Nicolas Monardes” contract, Grant/Award Number: RC-0004-2021; Asma, ReaccionesAdversas y Alérgicas-ARADyAL, Grant/ Award Number: RD16/0006/0001; Redes de InvestigacionCooperativaOrientadas al Resultado en Salud: Enfermedades Inflamatorias, Grant/Award Number: RD21/0002/0008 Funding for open access charge: Universidad de Málaga/CBU

Organ-specific allergen challenges in airway allergy: Current utilities and future directions

Atopy has been long used as the screening method for airway allergy. Nevertheless, aeroallergens can trigger respiratory symptoms not only in atopic patients (atopic res piratory allergy, ARA), but also in non-atopic subjects (local respiratory allergy, LRA). Moreover, ARA and LRA can coexist in the same patient, and this clinical scenario has been called dual respiratory allergy (DRA). When the clinical history cannot determine the relevance of sensitizations in ARA patients, nasal, conjunctival or bronchial aller gen challenges (NAC, CAC, and BAC, respectively) should be conducted. Moreover, these tests are required to identify patients with LRA and DRA. The clarification of the allergic triggers of airway diseases has a profound impact on the management strategies the patients can be offered. Importantly, allergen immunotherapy (AIT) remains as the only disease-modifying intervention for ARA. Recent data indicate that AIT might have a similar effect on LRA patients. Nevertheless, AIT success relies largely on the correct phenotyping of allergic individuals, and NAC, CAC, and BAC are very helpful tools in this regard. In this review, we will summarize the main indications and methodology of CAC, NAC, and BAC. Importantly, the clinical implementation of these tests might translate into precision medicine approaches and better health outcomes for patients with airway allergy.Consejería de Salud, Junta de Andalucía, Grant/Award Number: P20_00405; Instituto de Salud Carlos III, Grant/Award Number: PI20/01715, RD21/0002/0008, CM21/00262, CM20/00160, JR22/00048 and JR19/00029. Funding for open access charge: Universidad de Málaga / CBUA

Autologous versus allogeneic versus umbilical cord sera for the treatment of severe dry eye disease : a double-blind randomized clinical trial

Funding Information: The research work presented here has been funded through a grant awarded by the Ministry of Health within the framework of the Aid for Independent Clinical Research of 2011 (EC11‐506), whose promoter is the Andalusian Public Foundation for Research on Malaga in Biomedicine and Health (FIMABIS). Publisher Copyright: © 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons LtdPurpose: To measure the effects of Autologous serum (AS), Allogeneic Serum (HS) and Umbilical Cord serum (CS) eye drops in severe dry eye disease (DES), as well as to characterize and quantify several molecules in the three sera (albumin, fibronectin; Vitamin A and E; IgG, IgA and IgM; Transforming growth factor β; Epithelial growth factor). Methods: Randomized, double-blind, single-centre, three-arm (AS, HS and CS) clinical trial. Sixty-three subjects were included with severe DES, 21 in each arm of the study. Visual acuity, Schirmer test, Breakup time (BUT), lissamine green, fluorescein staining measurements and a questionnaire were performed prior to treatment, and after one-month and three-month follow-up. Results: There was a significant main effect of time on visual acuities, Schirmer and BUT tests and fluorescein and lissamine green staining measurements and questionnaire scores (p = 0.015, p = 0.002, p < 0.001, p < 0.001, p = 0.031 and p < 0.001, respectively), although there was no significant interaction between time and serum type, nor between serum type and the test performed. Regarding the concentration of molecules, in our study AS contained significantly higher concentrations of IgA, IgG and fibronectin whereas HS contained significantly higher concentration of IgM, vitamins A and E, TGF and albumin. Contrary to previous reports, CS did not show higher concentration of any of the molecules analysed. Conclusions and relevance: The three sera were effective in the treatment of severe DES. CS did not contain a higher proportion of molecules compared to AS/HS. More research is needed to assess the effect of AS in patients with DES and autoimmune diseases.Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Ocular surface toxicity of depatuxizumab mafoditin (ABT-414): case reports

The purpose of this study is to report the clinical features and outcomes of ocular surface toxicity following depatuxizumab mafoditin (ABT-414) therapy for unresectable glioblastoma. Ocular signs and symptoms of three patients treated with ABT-414 during a phase III trial for glioblastoma multiforme were evaluated. Both eyes of all patients were damaged during the week after the first infusion of the ABT-414 molecule. In all patients, mild-to-moderate keratitis could be ascertained, along with decreased visual acuity and blurred vision, as well as foreign-body sensation and redness. Symptoms and visual acuity improved 4 weeks. In conclusion, ABT-414 therapy may cause transient ocular surface toxicity. The initiation of artificial tears and lubricant ointment was enough to control the ocular surface signs and symptoms. A multidisciplinary approach, complete ophthalmologic monitorization, and elaboration of protocols are required to adequately manage these patients