Epidemiología de las quemaduras pediátricas: seis años de experiencia en una unidad especializada de alta complejidad

Introducción: Las lesiones por quemaduras son una patología grave, que pueden conducir a una gran morbilidad y una mortalidad significativa, pero también tienen un impacto sanitario-económico considerable. El objetivo de este estudio fue describir epidemiológicamente la población hospitalizada en la Unidad de Quemados del Hospital de Pediatría “Prof. Dr. Juan P. Garrahan” entre los años 2015 y 2020. Material y métodos: Estudio observacional, descriptivo- analítico, transversal, con evaluación y análisis de datos registrados en base de datos de historias clínicas digitalizadas. Resultados: La serie incluyó 214 pacientes, 60,3% sexo masculino, mediana de edad 4.6 años (0-16,6), 63% provenientes de la provincia de Buenos Aires, 78% de traslados se hicieron por vía terrestre con tiempo promedio de 55,6 minutos (DS 81,9), 52,8% ingresaron en los meses de otoño-invierno, 80% carecían de cobertura social. La etiología lesional fue fuego y variantes (69,2%) y escaldaduras (25,7%). El 49% reunieron criterios de lesión inhalatoria. La mediana de superficie corporal quemada (SCQ) fue 30% (0-100%), lesiones tipo B (profundas) 16,2% (0-100%) y gravedad crítica (37,4%) y grave (19,2%), requiriendo una mediana de 5 actos quirúrgicos (0-55). El 87,3% de los ingresos fue en Cuidados Intensivos, con mediana de estancia hospitalaria de 33 días (1-243) y relación promedio %SCQ/días internación 1,9 (DS 2,1). El uso de Asistencia Respiratoria Mecánica (ARM) fue 68,7% con una mediana de 7.5 días (1-100). La mortalidad de la serie fue 9,8% y estuvo asociada estadísticamente a lesión inhalatoria (p=0,0001), profundidad lesional B (p=0,00001) y uso de ARM (p=0,0011). Conclusion: Los resultados de este estudio concluyen que el sexo masculino, la franja etaria < 5 años, los ingresos en otoño-invierno, las lesiones por fuego, el grupo de gravedad crítico y la utilización de ARM son datos epidemiológicos predominantes correspondientes a una Unidad de Quemados de Alta Complejidad y deben ser tenidos en cuenta para la planificación y adecuación de los recursos asistenciales.Burn injuries are a serious pathology, which can lead to high morbidity and significant mortality, but also have a considerable health-economic impact. The objective of this study was to epidemiologically describe the population hospitalized in the Burn Unit of the Pediatric Hospital “Prof. Dr. Juan P. Garrahan” between 2015 and 2020. Material and method: Observational, descriptive-analytical, cross-sectional study, with evaluation and analysis of data recorded in a database of digitized medical records. Results: The series included 214 patients, 60,3% male, median age 4,6 years (0-16,6), 63% from the province of Buenos Aires, 78% of transfers were made by land with an average time of 55,6 minutes (DS 81,9), 52,8% entered in the fall-winter months, 80% lacked social coverage. The lesional etiology was fire and variants (69,2%) and scalds (25,7%). 49% met criteria for inhalation injury. The median body surface area burned (SCQ) was 30% (0-100%), type B (deep) injuries 16,2% (0-100%) and critical (37,4%) and severe (19,2%) severity, requiring a median of 5 surgical acts (0-55). 87,3% of the admissions were in Intensive Care, with a median hospital stay of 33 days (1-243) and average ratio %SCQ/days hospitalization 1,9 (DS 2,1). The use of Mechanical Respiratory Assistance (MRA) was 68,7% with a median of 7,5 days (1-100). Mortality in the series was 9,8% and was statistically associated with inhalation injury (p=0,0001), injury depth B (p=0,00001) and use of MRA (p=0,0011). Conclusion: The results of this study conclude that male sex, the age group <5 years, admissions in autumn-winter, fire injuries, the critical severity group and the use of MRA are predominant epidemiological data corresponding to a Unit of High Complexity Burns and must be taken into account for the planning and adaptation of care resources

Miltefosine in the Treatment of Cutaneous Leishmaniasis Caused by Leishmania braziliensis in Brazil: A Randomized and Controlled Trial

Cutaneous leishmaniasis (CL) is characterized by skin ulcerations and occurs in rural poor areas of developing countries. It is treated with daily injections of antimony for 20 days, which is associated with irregular use and increasingly lower cure rates. Miltefosine is an oral medication with activity against the agent of CL (Leishmania). We have studied the efficacy and safety of miltefosine compared with antimony in patients with CL caused by Leishmania braziliensis in Bahia, Brazil. A total of 90 patients participated; 60 received miltefosine and 30 were treated with antimony. Six months after treatment, 75% of patients treated with miltefosine were cured, compared with 53% of the patients in the antimony group, a difference considered significant (p = 0.04). We also found that miltefosine was more effective than antimony in adults than in children. The incidence of side effects was similar with both drugs (76.7% vs. 78.3%), but all patients were able to finish the treatments. Our study shows that miltefosine is more effective than antimony for the treatment of CL in Bahia, Brazil and can contribute to the control of this disease due to its activity and easier administration

Recent advances in the management of Hodgkin lymphoma [version 1; referees: 3 approved]

Hodgkin lymphoma (HL) is a rare cancer of the immune system that typically affects lymph nodes and sometimes other organs. Although the majority of patients can be potentially cured with the use of multi-agent chemotherapy and radiotherapy, a proportion of them will relapse or develop resistant disease for which treatment options are limited. In recent years, new agents have been developed and tested in HL with encouraging results. Two classes of drugs stand out as highly active in advanced HL based on recent study results: antibody-drug conjugates and programmed death 1 inhibitors. Clinical trials in HL with these agents have been completed in the past several years and the results have recently become available. In this review, we discuss the recent advances in the management of HL with a focus on strategies to decrease toxicity and a review of the two drug classes that have the potential to change the landscape of treatment of this disease

Long‐term outcome of immunologic autograft engineering

Abstract Our phase III trial reported that autograft‐absolute lymphocyte count (A‐ALC) improved survival post‐autologous peripheral blood hematopoietic stem cell transplantation (APBHSCT) for a short‐term follow‐up of 2 years. We evaluated retrospectively in our phase III trial patients that the A‐ALC still confers survival benefit with a longer follow‐up. With a median follow‐up of 127.6 months, patients infused with an A‐ALC ≥ 0.5 × 109 cells/kg experienced better overall survival (HR = 0.392, 95% confidence of interval [CI]: 0.224–0.687, p < 0.001) and progression‐free survival (HR = 0.413, 95% CI: 0.253–0.677), p < 0.0004). This study supports that A‐ALC provides long‐term survival benefit post APBHSCT