Basophil activation test is a complementary tool in the diagnosis of immediate reactions to platinum salts and taxanes

Background Delabelling pathways offer confirmatory diagnosis and can prevent unnecessary second-line therapies or drug desensitization procedures after chemotherapeutic hypersensitivity reactions (CHT-HSRs). However, these pathways rely on risky in vivo tests. Data on whether in vitro tests could be helpful are scarce. We assessed the role of basophil activation test (BAT) in the diagnosis of HSRs to platin salts (PSs) and taxanes (TXs) in a well-defined population featuring varied endophenotypes and severities of HSRs. Methods We conducted a 3-year-long multicentric, prospective study with 121 suspected-immediate CHT-HSR patients. The allergy workup included clinical history (initial reaction based on Type I, cytokine release syndrome, and mixed phenotype's symptoms and if unable to fit in any of these, as “indeterminate”), skin testing (ST), and drug provocation testing (DPT), provided risk assessment was favorable. Final diagnosis classified patients as “hypersensitive,” “non-hypersensitive,” or “inconclusive.” We performed BAT using CD63 and CD203c as activation markers in patients and controls. Patients underwent DPT regardless of BAT results to prevent bias. Results ST positivity significantly correlated with skin involvement, Type I phenotype, cancer recurrence, and lifetime exposures before reactions. DPTs were negative in all indeterminate phenotype patients (p = .02) and those considered low-risk, whereas they were negative in 62% moderate-risk patients. 55% were confirmed as hypersensitive (mainly Type I reactions, p < .0001), 24% as non-hypersensitive (mainly TXs and indeterminate phenotypes), and 21% as inconclusive. BAT showed 79% sensitivity in Type I IgE-mediated reactions to PSs with a high correlation to ST.Funding for open access charge: Universidad de Málaga / CBUA. This work was supported by the Instituto de Salud Carlos III (ISCIII) of the Ministry of Economy and Competitiveness (MINECO), grants co-founded by Fondo Europeo de Desarrollo Regional—FEDER for the Thematic Networks and Co-operative Research Centres: PI22/01119; PI18/00095; RETICS ARADYAL RD16/0006/0001, RICORS REI (RD21/0002/0008); Biobank network RD09/0076/00112; Biobank platform PT13/0010/0006; Andalusian Regional Ministry of Economy and Knowledge (grants PI-0076-2019). G.B. is a clinical investigator (B-0007-2022), research contract by Andalusian Regional Ministry Health. A.A. thanks Senior Postdoctoral Contract (RH-0099-2020) from Andalusian Regional Ministry of Health (co-funded by European Social Fund [ESF]: “Andalucía se mueve con Europa”) and “Nicolas Monardes” research contract by Andalusian Regional Ministry Health (C1-0007-2023). CLM holds a P-FIS contract (FI23/00027) by ISCIII. SCS holds a predoctoral contract by Andalusian Regional Goverment (PREDOC_01545). CM holds a “Nicolas Monardes” research contract by Andalusian Regional Ministry Health (RC-0004-2021)

Valoración del estado nutricional del paciente geriátrico institucionalizado: Mini Nutritional Assessment

Es fundamental la identificación temprana del estado nutricional de adultos mayores para prevenir el desarrollo de desnutrición. OBJETIVOS: Evaluar la prevalencia de desnutrición, los tipos y grados, en una muestra de ancianos institucionalizados. Como objetivo secundario, se evaluó el soporte nutricional que recibían estos pacientes, su efecto beneficioso y la tolerancia. MATERIAL Y MÉTODOS: Estudio transversal descriptivo, en el que se incluyeron todos los pacientes que aceptaron participar en el estudio y se excluyeron aquellos pacientes con deterioro cognitivo, con imposibilidad de colaborar, negativa del paciente en participar o la falta de consentimiento para la participación. Se procedió a la recogida de variables: test MNA, variables antropométricas y analíticas. RESULTADOS: Muestra de 115 pacientes: 60% mujeres y 40% hombres; con una edad media de 82,1 ± 7,64. Mediante el test MNA se identificó a un 8,7% de residentes desnutridos y un 34,8% en riesgo de malnutrición. A partir de la valoración antropométrica se observó un ascenso de sobrepeso y obesidad. Aplicando el método de Chang (combina variables antropométricas y bioquímicas) se obtuvo un 10,4% de pacientes desnutridos. CONCLUSIONES: La utilización de cuestionarios estructurados ayuda a realizar una valoración nutricional rápida y sencilla. En este trabajo, si comparamos los datos de prevalencia de desnutrición a través del MNA y la clasificación de Chang, se obtuvieron datos muy próximos (8,7% versus 10,4%), lo que permite asegurar que el MNA funciona como un instrumento que permite identificar desnutrición con un alto grado de sensibilidad y especificidad.It is worth mentioning the importance of identifying early of the nutritional status of older adults to prevent the development of malnutrition. OBJECTIVES: To assess the prevalence of malnutrition, the types and degrees, in an example of institutionalized elderly. As a secondary objective, we evaluated the nutritional support given to these patients, its beneficial effect and tolerance. MATERIAL AND METHODS: Descriptive cross-sectional study, in which all patients who agreed to participate in the study were included and we excluded those patients with cognitive impairment, inability to work, refusal of the patient to participate or lack of consent for participation. We proceeded to the collection of variables: test MNA, anthropometric and analytical variables. RESULTS: Sample of 115 patients: 60% women and 40% men; with an average age of 82.1 ± 7.64. Using the test MNA identified 8.7% of residents malnourished and 34.8% at risk of malnutrition. A rise of overweight and obesity was observed from the anthropometric assessment. Applying the method of Chang (variable combines anthropometric and biochemical) a 10.4% of malnourished patients was obtained. CONCLUSIONS: The use of structured questionnaires helps to carry out a fast and easy nutritional assessment. In this work, if we compare the data of prevalence of malnutrition through the MNA and the classification of Chang, data were obtained very close (8.7% versus 10.4%), helping to ensure that the MNA works as an instrument that allows to identify malnutrition with a high degree of sensitivity and specificity

Valoración del estado nutricional del paciente geriátrico institucionalizado: Mini Nutritional Assessment

Es fundamental la identificación temprana del estado nutricional de adultos mayores para prevenir el desarrollo de desnutrición. OBJETIVOS: Evaluar la prevalencia de desnutrición, los tipos y grados, en una muestra de ancianos institucionalizados. Como objetivo secundario, se evaluó el soporte nutricional que recibían estos pacientes, su efecto beneficioso y la tolerancia. MATERIAL Y MÉTODOS: Estudio transversal descriptivo, en el que se incluyeron todos los pacientes que aceptaron participar en el estudio y se excluyeron aquellos pacientes con deterioro cognitivo, con imposibilidad de colaborar, negativa del paciente en participar o la falta de consentimiento para la participación. Se procedió a la recogida de variables: test MNA, variables antropométricas y analíticas. RESULTADOS: Muestra de 115 pacientes: 60% mujeres y 40% hombres; con una edad media de 82,1 ± 7,64. Mediante el test MNA se identificó a un 8,7% de residentes desnutridos y un 34,8% en riesgo de malnutrición. A partir de la valoración antropométrica se observó un ascenso de sobrepeso y obesidad. Aplicando el método de Chang (combina variables antropométricas y bioquímicas) se obtuvo un 10,4% de pacientes desnutridos. CONCLUSIONES: La utilización de cuestionarios estructurados ayuda a realizar una valoración nutricional rápida y sencilla. En este trabajo, si comparamos los datos de prevalencia de desnutrición a través del MNA y la clasificación de Chang, se obtuvieron datos muy próximos (8,7% versus 10,4%), lo que permite asegurar que el MNA funciona como un instrumento que permite identificar desnutrición con un alto grado de sensibilidad y especificidad.It is worth mentioning the importance of identifying early of the nutritional status of older adults to prevent the development of malnutrition. OBJECTIVES: To assess the prevalence of malnutrition, the types and degrees, in an example of institutionalized elderly. As a secondary objective, we evaluated the nutritional support given to these patients, its beneficial effect and tolerance. MATERIAL AND METHODS: Descriptive cross-sectional study, in which all patients who agreed to participate in the study were included and we excluded those patients with cognitive impairment, inability to work, refusal of the patient to participate or lack of consent for participation. We proceeded to the collection of variables: test MNA, anthropometric and analytical variables. RESULTS: Sample of 115 patients: 60% women and 40% men; with an average age of 82.1 ± 7.64. Using the test MNA identified 8.7% of residents malnourished and 34.8% at risk of malnutrition. A rise of overweight and obesity was observed from the anthropometric assessment. Applying the method of Chang (variable combines anthropometric and biochemical) a 10.4% of malnourished patients was obtained. CONCLUSIONS: The use of structured questionnaires helps to carry out a fast and easy nutritional assessment. In this work, if we compare the data of prevalence of malnutrition through the MNA and the classification of Chang, data were obtained very close (8.7% versus 10.4%), helping to ensure that the MNA works as an instrument that allows to identify malnutrition with a high degree of sensitivity and specificity

Monkeypox outbreak in Spain: clinical and epidemiological findings in a prospective cross-sectional study of 185 cases.

Since May 2022, a new outbreak of monkeypox has been reported in several countries, including Spain. The clinical and epidemiological characteristics of the cases in this outbreak may differ from those in earlier reports. To document the clinical and epidemiological characteristics of cases of monkeypox in the current outbreak. We conducted a prospective cross-sectional study in multiple medical facilities in Spain to describe the cases of monkeypox in the 2022 outbreak. In total, 185 patients were included. Most cases started with primarily localized homogeneous papules, not pustules, in the probable area of inoculation, which could be cutaneous or mucous, including single lesions. Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms. Less common lesions included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Four patients were hospitalized, none died. Smallpox vaccination and well-controlled HIV disease were not associated with markers of severity. Contact during sex is the most likely mechanism of transmission. In this outbreak, cases have been described in men who have sex with men and are strongly associated with high-risk sexual behaviours. Seventy-six per cent of the patients had other sexually transmitted diseases upon screening. The clinical findings in this outbreak differ from previous findings and highly suggest contact transmission and initiation at the entry site. The characterization of the epidemiology of this outbreak has implications for control. What is already known about this topic? Monkeypox eruption is described as consisting of pustules. The roles of HIV and previous smallpox vaccination in the prognosis are unknown. The transmission route was initially described as respiratory droplets and was later suggested to be via sexual contact. What does this study add? Initial lesions at the probable inoculation area were homogeneous and papular (pseudopustules). Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms. Less common signs included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Well-controlled HIV and previous smallpox vaccination were not associated with severity. No patient died. The data support the hypothesis of transmission via contact during sex. Although this might change, the outbreak is currently limited mostly to men who have sex with men, with high-risk factors for sexually transmitted diseases