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Viral infections represent a major health problem worldwide. Due to the wide variety of etiological agents and their increasing resistance to anti-virals and antibiotics treatments, new strategies for effective therapies need to be developed. Scientific evidence suggests that probiotics may have prophylactic and therapeutic effects in viral diseases. Indeed, these microorganisms interact harmoniously with the intestinal microbiota and protect the integrity of the intestinal barrier as well as modulate the host immune system. Currently, clinical trials with probiotics have been documented in respiratory tract infections, infections caused by human immunodeficiency viruses, herpes, human papillomavirus and hepatic encephalopathy. However, the benefits documented so far are difficult to extrapolate, due to the strain-dependent effect. In addition, the dose of the microorganism used as well as host characteristics are other parameters that should be consider when advocating the use of probiotics to treat viral infections. This review addresses the scientific evidence of the efficacy of probiotics in clinical strains perspective in viral infectious diseases in the last 10 years.

Education researchers have been impacted by COVID-19 as school closures interrupted ongoing education research, including clinical trials, case study and ethnographic inquiry in schools, and longitudinal studies using federal, state, or district administrative data. The recommendations we present here focus on immediate and future actions education researchers can take to support public health and educational institutions dealing with a pandemic. Clearly not exhaustive, our recommendations are intended to prompt the education research community to collectively consider how the field’s efforts can both inform the knowledge base and support frontline educators and health care researchers dealing with COVID-19.

Introduction The effect of surgical vs nonsurgical management on hip fracture mortality of Hispanic-American male veterans has not been rigorously studied. Hence, we examined the mortality and life expectancy effect of nonsurgical vs surgical management after hip fracture in a geriatric Hispanic-American male veterans’ population. Material and Methods This was a retrospective cohort study of Hispanic-American male veterans who were 65 years of age or older and suffered a femoral neck or intertrochanteric fracture from January 2008 to December 2015. Analysis between a surgical cohort (cannulated screw fixation, hemiarthroplasty, total hip arthroplasty, or cephalomedullary nail) and a non-surgical cohort was performed. In-hospital, 30-day, one-year, and two-year mortality were compared between both groups. Results Out of 268 patients with hip fracture, 159 (59.2%) were treated surgically and 109 (40.8%) non-surgically. The overall in-hospital (9.2% vs 1.9%, P = .009), 30-day (17.4% vs 5.0%, P = .002), one-year (48.6% vs 23.3%, P < .001), and two-year (63.3% vs 36.5%, P < .001) mortality rate was found to be higher for the nonoperative group. The average life expectancy of the nonoperative cohort was significantly shorter than those who were managed surgically (216 days vs 260 days, P < .001). Discussion and Conclusion This study shows a higher mortality rate and lower life expectancy in geriatric male patients who were treated nonsurgically in a Veterans Health Affair hospital facility that mostly serves Hispanic-American veterans. Our results provide an expansion to the findings of other geriatric studies on hip fracture with focus in a Hispanic-American veteran male population.

The objective of this study was to know the relationship between dietary intake (DI) and body composition (BC) with the metabolic syndrome (MS) among university students. A total of 50 students (56% female) among 19 and 25 years of age ( M = 20.58, SD = 1.86), completed a questionnaire aimed at assessing DI, in addition biochemical and BC parameters were collected. According to the percentage of body fat (BF), a high prevalence of overweight (22%) and obesity (38%) was identified. In addition, visceral fat increased as the BF increased. In both sexes, there was a low consumption of carbohydrates and high in lipids, mostly of animal fat as well as high consumption of saturated fats, but low omegas 3 y 6. The MS was identified in 20% of the sample, mainly in women. The most frequently risk criteria were low levels of HDL cholesterol, followed by abdominal obesity; whereas the most frequent dyslipidemia was hypertriglyceridemia. In this study, although no direct relationship was found between DI and MS, it was found between MS and BC indicators. It is imminent the need to implement strategies that allow university students to acquire healthy eating and physical activity habits. Resumen El objetivo de este estudio fue conocer la relacion de la ingesta alimentaria (IA) y la composicion corporal (CMC) con el sindrome metabolico (SM) entre estudiantes universitarios. Participaron 50 alumnos (56% mujeres) de entre 19 y 25 anos de edad ( M = 20.58, DE = 1.86), quienes completaron un cuestionario dirigido a evaluar IA, ademas se recabaron parametros bioquimicos y de CMC. De acuerdo con el porcentaje de grasa corporal (PG), se identifico una alta ocurrencia de sobrepeso (22%) y obesidad (38%). Ademas, la grasa visceral incremento conforme aumento el PG. En ambos sexos existio un consumo bajo de hidratos de carbono y alto en lipidos, mayormente de origen animal, asi como alto consumo de grasas saturadas, pero bajo de omegas 3 y 6. El SM fue identificado en 20% de la muestra, principalmente mujeres. El criterio de riesgo mas frecuente fueron bajos niveles sericos de colesterol HDL, seguido de la obesidad abdominal; en tanto que la dislipidemia mas frecuente fue la hipertrigliceridemia. En este estudio, aunque no se encontro relacion directa entre IA y SM, si de este con indicadores de CMC. Resulta inminente la necesidad de implementar estrategias que permitan a los estudiantes universitarios adquirir habitos alimentarios y de actividad fisica saludables.

espanolLa insuficiencia venosa pelvica es un tema de mucho debate en congresos de nuestro ambito profesional. Sin embargo, cuanto mas se reconoce y se trata esta patologia en nuestro medio, mas casos encontramos en los que, aplicando un tratamiento estandar de embolizacion venosa o stenting, se obtiene un resultado desfavorable. Para evitar este patron de resultados, debemos estudiar con detenimiento la circulacion venosa abdominopelvica estableciendo paralelismos con la circulacion venosa infrainguinal y, ademas, aplicar tecnologia IVUS en los casos de duda. Con estas dos medidas, podemos afrontar esta patologia en su conjunto con unos resultados muy positivos para nuestros pacientes EnglishPelvic Venous Insufficiency is a topic of much debate in Congresses of our professional field. However, the more this pathology is recognized and treated in our setting, the more cases we find in which applying a standard venous embolization or stenting, treatment results in an unfavorable result. To avoid this type of results, we must carefully study the abdomino-pelvic venous circulation, establishing parallels with the infrainguinal venous circulation, and also apply IVUS technology in cases of doubt. With these two measures, we can face this pathology as a whole with very positive results for our patients.

Objetivos: conocer la prevalencia de lactancia materna (exclusiva, predominante y con alimentación complementaria) en bebés

The aim of this study was to obtain data on the biodistribution of (64)CuCl2 in rats and to obtain estimates of the radiation doses to humans by extrapolating the animal data. MicroPET imaging and biodistribution studies were carried out with Wistar rats, and the doses were estimated with OLINDA/EXM. The lower large intestine wall was found to be the critical organ with an absorbed dose of 139±34 and 125±32µGy/MBq for females and males, respectively. The corresponding effective doses were estimated as 47±4 and 39±4µSv/MBq.

espanolIntroduccion: la obesidad es la acumulacion excesiva de tejido adiposo relacionada con la ingesta de alimentos y otros factores. El objetivo de este estudio fue evaluar la ingesta de nutrientes, parametros antropometricos, indicadores de salud, adipocinas y niveles de insulina en una poblacion de jovenes universitarios con una dieta habitual. Metodo: en este estudio se invito a participar a 378 jovenes universitarios. Debido a los criterios de inclusion y su propia decision de participar, 90 asistieron a los estudios antropometricos y de indicadores de salud: circunferencia de cintura (WC), indice de cadera cintura (WHR), indice de cintura-talla (WHtR) y modelo homeostatico de evaluacion-indice de resistencia a la insulina (HOMA-IR) y completaron el cuestionario de frecuencia de ingesta de alimentos. Treinta y cuatro participantes fueron seleccionados para realizar la determinacion de los parametros bioquimicos, niveles de insulina y adipocinas (leptina, IL-6, IL-8, factor de necrosis tumoral alfa [TNF- α], proteina quimioatractante de monocitos-1 [MCP-1] y factor de crecimiento hepatico [HGF]). Resultados: de acuerdo con WC, WHR y WHtR (mujeres: 104 ± 20, 0,87 ± 0,08, 0,6 ± 0,13; hombres: 112 ± 10, 0,95 ± 0,09, 0,64 ± 0,06, respectivamente), la poblacion obesa mostro riesgo cardiovascular, metabolico y para la salud. La poblacion con sobrepeso mostro riesgo cardiometabolico. En general, la ingesta de lipidos fue superior al 30% y la grasa animal fue la mas consumida. Los niveles de leptina (mujeres: 17,2 ± 9,2, 28 ± 11,3, 36,8 ± 17,8; hombres: 4,3 ± 3,6, 9,5 ± 3,1, 24,6 ± 16,4 para delgados, sobrepeso y obesos, respectivamente) e insulina (mujeres: 408 ± 182, 438 ± 187, 768 ± 167; hombres: 244 ± 88, 520 ± 256, 853 ± 590) aumentaron junto con el indice de masa corporal (BMI), porcentaje de grasa corporal (BFP), area de grasa visceral (VFA), WC, WHR y WHtR. Las mujeres delgadas (2,4 ± 1,3), con sobrepeso (2,2 ± 0,9) y obesas (4,3 ± 1,1) y los hombres con sobrepeso (2,8 ± 1,2) y obesos (5,0 ± 3,1) mostraron resistencia a la insulina de acuerdo con HOMA-IR. Se encontro una correlacion significativa entre leptina y HOMA-IR (p = 0,41). BMI, BFP, VFA, WC y WHtR correlacionaron positivamente con leptina (p = 0,67, 0,75, 0,66, 0,60 y 0,67, respectivamente) e insulina (p = 0,37, 0,40, 0,48, 0,49 y 0,42, respectivamente), mientras que el WHR solo con insulina (p = 0,43). No se encontraron diferencias signifi cativas en las otras adipocinas. Conclusion: el uso de indicadores de salud como VFA, WC, WHR, WHtR y HOMA-IR es una herramienta util en la determinacion del riesgo metabolico, cardiovascular y de salud, y dichos indicadores correlacionaron con los niveles de leptina e insulina en la poblacion estudiada. EnglishBackground: obesity is the excessive accumulation of adipose tissue related to food intake and other factors. The aim of this study was to evaluate the intake of nutrients, anthropometric parameters, health indicators, adipokines and insulin levels in a population of young undergraduates. Method: in this study, 378 young undergraduates were invited to participate. Due to the inclusion criteria and their own decision of participating, 90 attended the anthropometric, health indicators: waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), and homeostatic model assessment-insulin resistance index (HOMA-IR) studies and completed the questionnaire of frequency of food intake; and 34 participants were selected to perform the determination of biochemical parameters, insulin and adipokines levels: leptin, IL-6, IL-8, tumor necrosis factor alpha (TNF- α), monocyte chemoattractant protein-1 (MCP-1) and hepatocyte growth factor (HGF). Results: according to WC, WHR and WHtR (women: 104 ± 20, 0.87 ± 0.08, 0.6 ± 0.13; men: 112 ± 10, 0.95 ± 0.09, 0.64 ± 0.06, respectively), obese population showed health, cardiovascular and metabolic risk. Overweight population showed cardiometabolic risk. In general, lipid intake was higher than 30%, being animal fat the most consumed. The levels of leptin (women: 17.2 ± 9.2, 28 ± 11.3, 36.8 ± 17.8; men: 4.3 ± 3.6, 9.5 ± 3.1, 24.6 ± 16.4 to lean overweight and obese, respectively) and insulin (women: 408 ± 182, 438 ± 187, 768 ± 167; men: 244 ± 88, 520 ± 256, 853 ± 590) increased along with body mass index (BMI), body fat percentage (BFP), visceral fat area (VFA), WC, WHR and WHtR. Lean (2.4 ± 1.3), overweight (2.2 ± 0.9) and obese (4.3 ± 1.1) women and overweight (2.8 ± 1.2) and obese (5.0 ± 3.1) men showed insulin resistance according to HOMA-IR. Signifi cant correlation between leptin and HOMA-IR was found (p = 0.41). BMI, BFP, VFA, WC, and WHtR positively correlated with leptin (p = 0.67, 0.75, 0.66, 0.60, 0.67, respectively) and insulin (p = 0.37, 0.40, 0.48, 0.49, 0.42, respectively), while WHR only with insulin (p = 0.43). No significant differences were found in the other adipokines. Conclusion: the use of health indicators such VFA, WC, WHR, WHtR and HOMA-IR are useful tools in the determination of health, cardio vascular and metabolic risk and are correlated with levels of leptin and insulin in the studied population.

Introduction The use of unmanipulated peripheral blood from haploidentical donors (UPB Haplo) with post transplantation cyclophosphamide (PT-Cy) is often associated with a higher incidence and severity of cytokine release syndrome (CRS) and aGVHD when it is compared with bone marrow source (BM haplo). Recently it has been published (1) a modification of PT-Cy protocol moving the day of administration of cyclosporine (CsA) and mycophenolate (MMF) from day +5 to zero and + 1 and using BM haplo with encouraging results. With the aim to reduce the incidence of CRS and aGVHD we did the same but keeping UPB haplo as a cellular source. Methods and patients The conditioning used was fludarabine 150 mg/m2, melphalan 100-120 mg/m2, and TBI 200-400 cGy or the same but with busulfan 4 mg/kg instead of melphalan, the CsA began on day zero and continuous until d+180, MMF was administered from d+ 1 to d+ 60 and PT-Cy 50 mg/kg on days +3 and +4 (fig 1). After a signed informed consent, 22 patients were transplanted; median age was 31 y (range 18-64), the diagnoseswere: acute lymphoid leukemia 11, acute myeloid leukemia 7, two had lymphoma, 1 myelodysplasia, and another, chronic myeloid leukemia. 50 % were in first remission, 36% in second, and 14% in third or with active disease. Results All of the donors shared 4 out of 8 alleles with the recipient; their median age was 27 y (range 10-52) in 77% of the cases was a sibling, in 18% a child and in 5% a parent, 4 males received cells from female donors. A median of 7.2 × 10(6)/kg (range 3.9-12) of CD34 and 3 × 10(8)/kg of CD3 were infused. The engraftment rate of 21 patients alive at day +30 was 100%, the median time to achieve 500 neutrophil and self-sustained platelets was 15 and 16 days respectively (range 13-22 and 15-29), one patient with mix chimerism had secondary graft failure. The only manifestation of CRS was fever in 8 out of 22 (36%), range of temperature 38.2 to 39 ¼ C, median duration of 2.5 days. With a median follow-up for surviving patients of 9.5 months (range 3- 18) the incidence of aGVHD (GII-IV) was 5 %. Regarding cGVHD, the follow-up is still short, but only 2 out of 17 evaluable cases had extensive disease. Event was defined as death for any cause or relapse; 3 patients died due to an infection and 2 relapsed, the event-free survival at day 100 was 90% and at one year (Kaplan-Meier) 71.8% (fig 2). Conclusion In this series of 22 patients, the administration of CsA on day zero and MMF on day + 1 in the UPB haplo transplant with PT-Cy was feasible and it decreased the severity and incidence of CRS and of aGVHD, even achieving a rate similar to that which has been reported using BMT haplo. The follow-up is still short to draw conclusions regarding the incidence of cGVHD and relapses, but they also seem encouraging. This strategy deserves further assessment with a bigger number of patients and longer follow-up.

We studied the saproxylic beetle community inhabiting deadwood in remnants of riparian cloud forests in “La Antigua” basin, in central Veracruz (Mexico). We assessed the influence of deadwood features (tree species, trunk position, trunk diameter, trunk volume and decomposition stages) on saproxylic beetle diversity. In order to assess the stability of beetle species-deadwood interactions, we also analyzed the ecological networks structure. A total of 63 deadwood trunks, belonging to four tree species, were sampled by standardized hand-collection throughout well-preserved remnants of riparian cloud forest. We found that tree species and deadwood decay stage are the main drivers that determine the diversity and stability of saproxylic beetle species interactions. Our results indicate that Quercus corrugata is the main tree species in terms of maintaining the significantly highest saproxylic beetle diversity, but with no stable interactions (saproxylic beetle-deadwood). A nested network structure was detected for Clethra mexicana and Liquidambar styraciflua, with a pool of core (generalist) saproxylic beetle species. We observed that beetle diversity from the early and late deadwood stages comprises distinct assemblages and the four stages of decomposition showed a nested network structure. During deadwood succession, community composition and guilds changed among networks; the early successional stage had more specialized xylophagous beetles, while other guilds (mycophagous, saprophagous and zoophagous) arrive later and become the core species in the advanced stages of decomposition networks. Heliscus tropicus (Passalidae) is a key species constituting the core of all of the networks and could be considered an ecosystem engineer in cloud forests. By exploring links between saproxylic beetles and deadwood characteristics, we can further our understanding of species interaction in order to develop management strategies oriented towards the protection of species and their habitats in this threatened ecosystem. Project No. 101542 was granted to FE and funded by Consejo Nacional de Ciencia y Tecnología de México. ARH was granted with a posdoctoral fellowship (2015-2016) funded by Consejo Nacional de Ciencia y Tecnología de México.

Diverse studies mention the consequences generated by providing special care to patients, particularly when associated with mental illness. The objective of this research was to analyze scientific studies published between 2003 and 2010 on the burden suffered by caregivers of patients with mental illnesses. A systematic review was made of literature found in open access databases (Scielo, Pubmed, Lilacs). The results suggest that, regardless of gender and marital status, when using strategies such as coping mechanisms and social support, younger patients have a greater impact on the burden felt by their caregivers than their older counterparts. This burden varies over time and is influenced by the type of symptomatology experienced by the patient and it is improbable that there will be improvement without some type of intervention.

Background: The incidence of coronary arteries lesion in Takayasu's arteritis varies from 9% to 10% and is usually discovered at autopsy. Recent studies have demonstrated the value of echocardiography in noninvasive detection of significant coronary stenosis. Aim: The aim of our study was to evaluate coronary reserve in 15 patients with Takayasu's arteritis using contrast transesophageal echocardiography (Optison). Methods: Transesophageal echocardiogram under basal conditions and in the hyperemic phase with dipyridamole challenge, myocardial perfusion studies and coronary angiography were performed on all patients. Seventy-three percent of them had histories of systemic hypertension, and the most frequent cardiovascular symptoms were shortness of breath (80%), headache (46%), angina (40%), and dizziness (33%). Results: The transthoracic echocardiogram showed left ventricular systolic dysfunction in 6% and diastolic dysfunction in 53%. Aortic regurgitation was found in 67% of the patients, and 60% had mitral and/or tricuspid regurgitation. Coronary reserve was diminished in 3 patients with significant coronary lesions and in 2 patients with coronary dilation (33%). In the 3 patients with obstructive lesions and diminished coronary reserve, reversible perfusion defects were found with thallium-201 single-photon emission computed tomography. One patient with coronary dilation had normal perfusion, while the other demonstrated reversible and irreversible perfusion defects. One patient without coronary lesions and with normal coronary reserve had an irreversible fibrotic changes and the other reversible defects due to abnormal microcirculation. Conclusions: Transesophageal echocardiography is a feasible and promising technique for assessing coronary reserve in patients with Takayasu's arteritis.

Background Neoadjuvant chemotherapy (NAC) is the standard treatment for patients with locally advanced breast cancer, showing improvement in disease-free survival (DFS) and overall survival (OS) rates in patients achieving pathological complete response (pCR). The relationship between immunohistochemistry-based molecular subtyping (IMS), chemo sensitivity and survival is currently a matter of interest. We explore this relationship in a Hispanic cohort of breast cancer patients treated with NAC. Methods A retrospective survival analysis was performed on Colombian females with breast cancer treated at Instituto de Cancerología-Clinica Las Américas between January 2009 and December 2011. Patients were classified according to immunohistochemistry-based subtyping into the following five groups: Luminal A, Luminal B, Luminal B/HER 2+, HER2-enriched, and triple-negative breast cancer. Demographic characteristics, recurrence pattern, and survival rate were reviewed by bivariate and multivariate analysis. Results A total of 328 patients fulfilled the study’s inclusion parameters and the distribution of subtypes were as follows: Luminal A: 73 (22.3%), Luminal B/HER2−: 110 (33.5%), Luminal B/HER2+: 75 (22.9%), HER2-enriched: 30 (9.1%), and triple-negative: 40 (12.2%). The median follow-up was 41 months (interquartile range: 31–52). Pathological response to NAC was as follows: complete pathological response (pCR) in 28 (8.5%) patients, partial 247 (75.3%); stable disease 47 (14.3%), and progression 6 (1.8%) patients. The presence of pCR had a significant DFS and OS in the entire group (p = 0.01) but subtypes had different DFS in Luminal B (p = 0.01) and triple negative (p = 0.02) and also OS in Luminal B (p = 0.01) and triple negative (p = 0.01). Conclusions pCR is associated with an improved overall survival and disease-free survival rates in this group of Hispanics patients. Advanced stages, Luminal B subtypes, triple-negative tumours and non-pCR showed lower DFS.

A 35-year-old patient was brought to the emergency department referring dysarthria, left ear tinnitus for 5 min, and short-lasting blindness, with headache in the 45 min before the clinical presentation. In the magnetic resonance imaging, an acute-subacute lesion in the cerebellum right-anterior lobe (in the territory of the cerebellum anterior artery) and a dilatation near the ostium of the right vertebral artery were seen. For a better assessment, an Angio-CT was done, showing a 9-mm saccular pseudoaneurysm of the right vertebral artery close to the origin of the vessel, without being able to determine if it had been caused because of a dissection. The rest of the study (cerebral vessels and supra-aortic vessels) showed no disorders. He was operated under local anesthesia and sedation a week after the onset of the symptoms. Through a 0.014 wire, a Biotronik PK Papyrus balloon-expandable covered cobalt-chromium stent was deployed covering the hole in the artery. Antiplatelet drugs were prescribed, and the patient was discharged 24 hr after surgery. He has remained symptom free since then.

Introduction The use of Haploidentical Transplantation (haploSCT) with pos-transplantation cyclophosphamide (PTCy) has become in a very good alternative for patients with acute leukemia who need a transplant but without a well matched donor, however, it is not clear what is the "best" conditioning regimen in this setting; on the other hand, fludarabine + melphalan (flu-mel) is a well-known preparative protocol, it has a good balance between toxicity and anti-leukemic activity. We explored the use of it plus the addition of 200-400cGy of total body irradiation (TBI) in a group of 34 patients with acute leukemia who were allografted with haplo peripheral blood stem cells (PBSC) and PTCy. Methods and Patients Donors were mobilized with filgrastim 5 mg/kg/BID for five days, the PBSC were collected with one or two large volume apheresis procedure. The conditioning consisted of melphalan 100-120 mgs/m2 administered on day -6, fludarabine 150 mgs/m2 split in 5 days, and 200-400 cGy of TBI added on day - 1 (Flu Mel TBI). All patients were given PTCy 50 mg/kg/day on D+3 and D+4, followed by ciclosporin and mycophenolate starting on day + 5. In all cases filgrastim was administered after transplant beginning on d + 6. After a signed informed consent, 34 patients underwent to transplant; median age was 22 years (range 5-53), the diagnosis were: acute myeloid leukemia 11 patients, acute lymphoid leukemia 22 and 1 had myelodysplasia. 26.5% were in first remission (CR1), 47 % in second (CR2), and 26.5% in third or with more than 5% of blast in bone marrow (CR3). 5 out of 30 cases in remission had MRD positivity Results 50% of patients received flu-mel +TBI 400 cGy, while the other half were given flu-mel + TBI 300 or 200 cGy. A mean of 12 million of PBSC/kg was infused. The neutrophil engraftment rate was 97%, median time to achieve 500 or more was 15 days (range 11-20), 3 patient died before d+ 100 without platelet recovery, the remaining had a self- sustained platelet count of 20.000 or more at an average of 15 days (range 12-48). Chimerism was available in all cases that survived beyond day + 100; all of them had full donor hematopoiesis. The main toxicities were gastro intestinal; mucositis G II-III 35%, and two cases of hemorrhage, and bacteremia (30%). With a median follow-up for surviving patients of 11 months, the incidence of GVHD acute (GII-IV) and chronic extensive was 29.4 and 25% respectively. The transplantation related mortality was 17.4% while the rate of relapse was 14%. Causes of death were relapse: 4, sepsis: 4 fusariosis: 1, intestinal GVHD: 1. Event was defined as death for any cause or relapse, the event free survival (Kaplan Meier) at 12 and 24 months was; 63% for the whole group, 73% for CR1+CR2 and 31% for patients in CR3 or with active disease (figure 1) Conclusion The use of fludarabine - melphalan plus 200-400 cGy of TBI as a preparative regimen previous to transplant of haplo PBSC with PTCy was associated to a fast and almost universal engraftment, acceptable toxicity and encouraging disease free survival showing a very good balance between tolerance and anti leukemic activity. It deserve more studies Figure 1 Event free survival according remission Figure 1. Event free survival according remission Disclosures No relevant conflicts of interest to declare.

PCR is a highly accurate technique for confirming the presence of Mycobacterium avium subsp. paratuberculosis (Map) in broth culture. In this study, a simple, efficient, and low-cost method of harvesting DNA from Map cultured in liquid medium was developed. The proposed protocol (Universidad Austral de Chile [UACH]) was evaluated by comparing its performance to that of two traditional techniques (a QIAamp DNA Stool Mini Kit and cethyltrimethylammonium bromide [CTAB] method). The results were statistically assessed by agreement analysis for which differences in the number of cycles to positive (CP) were compared by Student's t-test for paired samples and regression analysis. Twelve out of 104 fecal pools cultured were positive. The final PCR results for 11 samples analyzed with the QIAamp and UACH methods or ones examined with the QIAamp and CTAB methods were in agreement. Complete (100%) agreement was observed between data from the CTAB and UACH methods. CP values for the UACH and CTAB techniques were not significantly different, while the UACH method yielded significantly lower CP values compared to the QIAamp kit. The proposed extraction method combines reliability and efficiency with simplicity and lower cost.

Introduction: Autologous stem cell transplantation (ASCT) is the standard of care for treating patients with advanced lymphomas. The most commonly employed preparative regimens are BCNU (Carmustine), etoposide, cytosine arabinoside, melphalan (BEAM), and BCNU, etoposide, cyclophosphamide (CVP). Both regimens use BCNU, but this medication is associated with pulmonary toxicity, besides, in some underdeveloped countries there is a serious shortage of it. Carboplatin is an agent with good activity in Hodgkin and non-Hodgkin´s lymphomas and has a tolerable toxicity profile. Here we present our experience in a bone marrow transplant service in Colombia (South America) a country with shortage of BCNU. We evaluated the effects of a high-dose chemotherapy regimen with carboplatin replacing BCNU in the CVP regimen. Methods: After peripheral blood progenitor cells were mobilized with filgrastim 10 µg/kg for five days, twenty four patients with advanced lymphomas were conditioned prior to ASCT. The conditioning regimen consisted of carboplatin (450 mg/m2/ days -5,-4), etoposide (330 mgs mg/m2/days -4,-3,-2) and cyclophosphamide (2.000 mg/m2/days -3,-2,-1). After the autograft all patients received filgrastim or pegfilgrastim from day +5. Results: 24 consecutive patients were transplanted, median age 39.2 years (range 5-70), eleven were female. 11 patients (46%) had Hodgkin lymphoma; 7 in CR2 and four in partial remission or with refractory disease. 13 (54%) had non-Hodgkin´s lymphoma classified as: 6 diffuse large B cell, 5 mantle cell, 2 transformed follicular. Patients with mantle cell lymphoma were in CR1 while the rest were in CR2. The median CD 34+ cells infused was 4.09 x 106 cells/kg. The median time to achieve 500/µL absolute granulocyte count and 20.000/µL platelets was 11.7 days (range 8-17), and 16.5 days (range 7-23) respectively. 20 out of 24 had febrile neutropenia, the other toxicities were mild; grade II mucositis in three patients, neutropenic colitis in two and hemorrhagic cystitis in one. There were no pulmonary or renal toxicities and the transplant related mortality was 0%. The four patients with active disease achieved complete remission after transplant but two of them have relapsed. The one year overall survival is 100%, with a median follow-up of 12 months (range 5-18), and the disease-free survival, estimated by Kaplan-Meier is 90%. Conclusions: The use of carboplatin replacing BCNU in the CVP regimen seems to be a safe and effective conditioning protocol followed by ASCT in patients with various types of lymphomas. This treatment option seems an adequate alternative for underdeveloped countries with shortage of BCNU. The regimen shows good anti-tumor activity, with a tolerable toxicity profile. These promising results must be confirmed with the inclusion of more patients and a longer follow-up. Citation Format: Miguel Gonzalez Velez, Amado Jose Karduss-Urueta, Rosendo Perez, Luis Rodolfo Gomez, Juan Alejo Jimenez, Pedro Alejandro Reyes, Ana Cardona, Liliana Hurtado, Hilda Deossa, Clara Fernandez. Carboplatin replacing BCNU in the BCNU, etoposide, cyclophosphamide (CVP) regimen for autologous stem cell transplant in patients with advanced lymphoma. Very low toxicity and encouraging results. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C82.

Fludarabine 120-160 mgs/m2 plus melphalan 140 mgs/m2 (Flu- Mel) is a well known reduced intensity conditioning protocol used in allogeneic transplantation, however it can be no enough intense to treat high risk acute leukemia, specially in the relapse setting. On the other hand, 400 cGy of total-body irradiation (TBI 400) has been successfully added to myeloablative dose of fludarabine busulfan without excessive toxicity. We designed a regimen adding TBI 400 to usual dose of Flu-Mel with the idea to increase its anti-leukemic activity. Below we present our experience Methods and patients Peripheral blood stem cells were mobilized with figrastim for 5 days, later, 1 or 2 apheresis were done to achieve a minimum of 3 million of CD34 + cells/kg. The conditioning consisted of fludarabine 30-40 mgs/m2 for four days, melphalan 140 mgs/m2 one dose, on day - 1, TBI 400 was administered split in 2 fractions. The prophylaxis against graft versus host disease (GVHD) was done with cyclosporine and methotrexate, all patients were given pegfilgrastim 22 patients were transplanted, median age 26.5 years (range 8-49), the diagnosis were; acute lymphoblastic leukemia (13), acute myeloid leukemia (6), chronic myeloid leukemia (1), high risk myelodisplasia(1), mixed acute leukemia(1). 32% were in first remission, 41% in second, 27% were in third or they had active disease. The discrimination according CIBMTR disease risk index (CIBMTR-DRI) was: 54% high risk, 41% intermediate and 5% low Results All donors were matched siblings, a median of 10 millions/kg of CD34+ cells were infused; all patients engrafted, the neutrophil and platelet recovery occurred on days +11 and + 14 respectively. The grade III toxicity was; mucositis, 45% and one case of encephalopathy, there were not any case of sinusoidal obstruction syndrome. The incidence of GVHD acute (GII-IV) and chronic extensive was 10 and 25%. With a median follow up of 11 months (range 6-30) the overall survival (OS)(Kaplan-Meier) at 24 and 36 months is 69 and 55% . Six patients have died, one due to sepsis and five secondary to relapse. The OS according to CIBMTR-DRI at 36 month was 75 and 46% for intermediate and high risk groups Conclusion: The addition of TBI 400 to Flu- Mel regimen is feasibly, the main toxicity is mucositis, the non- relapse mortality is very low and the incidence of GVHD, acute a chronic, is not higher than expected This combination shows an encouraging anti leukemic effect, as it is demonstrated by an OS of 75 and 46% in patients classified in intermediate and high risk CIBMTR DRI groups. This preparative protocol can be a low toxicity alternative to more conventional myeloablative regimen. It warrants further studies Disclosures No relevant conflicts of interest to declare.

Introduction: T cell replete haploidentical stem cell transplantation with post-transplantation cyclophosphamide (PTCy) has shown encouraging results for the treatment of hematologic malignancies, its main advantage is that almost every patient will have a donor in a timely manner. However this technique has been explored mainly in adults and using bone marrow as a cellular source. Here we present our experience using T cell replete haploidentical peripheral blood stem cell transplantation (TCR-Haplo-PBSCT) with PTCy in 21 pediatric patients whit high-risk acute leukemia Methods and Patients: Donors were mobilized with filgrastim 5 mg/kg/BID for five days, the PBSC were collected with one large volume apheresis procedure. The conditioning consisted of fludarabine 30 mg/m2/day for 5 days, oral busulfan 4-8 mg/kg/split in 1-2 days and, one day before transplant, total body irradiation 400 cGy divided in two fractions (Flu Bu TBI) or fludarabine 150 mgs/m2 split in 5 days, melphalan 100-140 mgs/m2, one day and TBI 200-400 cGy on day - 1 (Flu Mel TBI). All patients were given PTCy 50 mg/kg/day on D+3 and D+4, followed by ciclosporin and mycophenolate starting on day + 5. In all cases filgrastim was administered after transplant beginning on d + 6. After a signed informed consent, 21 patients who needed an urgent transplant, were allografted; median age was 11 years (range 1-16), 10 were girls, the diagnosis were: acute lymphoblastic leukemia 11 patients, acute myeloid leukemia 9, and blastic phase of chronic myeloid leukemia one. 19% were in first remission (CR1), 43% in second (CR2), and 39% in third or with refractory disease(CR3). Results: 17 patients were given Flu Bu TBI conditioning while 4 received Flu Mel TBI combination All the donors shared 4 out of 8 alleles with the recipient; in 62% of the cases the donor was the Mother in 19% the Father and in other 19% one sibling. A median of 16 million of CD34+ cells/kg was infused. The engraftment rate was 100%, median time to achieve 500 neutrophil or more was 15 days (range 14-20), 1 patient out of 21 died without platelet recovery, the remaining had a self- sustained platelet count of 20.000 or more at a median of 14 days (range 10-21). Chimerism at day + 100 was available in 19 cases; all of them had full donor hematopoiesis. The median follow-up is 11 months (range 3-28), the cumulative incidence of graft versus host disease (GVHD) acute grade II-IV and chronic extensive was 23.8% and 25% respectively. Six patients have died, the causes were; pneumonia (n:1) and relapse of leukemia(n:5). In table 1 is presented the overall survival (OS) and event free survival (EFS) for the whole group and discriminated according remission Table 1.Whole groupCR1CR2CR3OS month 1277.4% ± 10100%100%47.3% ± 18.8EFS month 1271.5% ± 10.9100%100%43.8% ± 18.8OS month 2469.6% ± 11.6100%80% ± 17.947.3% ± 18.8EFS month 2463.6% ± 12.3100%83% *22 months21.9% ±18.1 Conclusion: The use of TCR-Haplo-PBSCT with PTCy and a medium intensity conditioning for treating pediatric high risk acute leukemia is promising; it is associated with very good engraftment rate, low transplantation related mortality and an acceptable incidence of GVHD despite the use of peripheral blood. This protocol produces a remarkable leukemia free survival rate, especially in patients in CR1 and CR2. This approach could be a good alternative for children with high-risk leukemia and without suitable matched donors. It deserve further studies Disclosures No relevant conflicts of interest to declare.

OBJECTIVE Proinflammatory cytokines play a major role in the pathomechanisms of heart failure. Besides this, the influence of mental stress on heart failure is poorly documented despite its effects on sympathetic stimulation of interleukin-1β (IL-1β) secretion. We examined whether the polymorphisms of proinflammatory cytokines are predictors of left ventricular systolic dysfunction (LVSD) and if so, whether such associations are related to the secretion of these cytokines, in 572 consecutive patients under mental stress produced by coronary angiography. METHODS We examined IL-1RN (VNTR), IL1A-889 C>T, IL1B-511 C>T, IL6-174 G>C and TNFA-308 G>A, according to LVSD (left ventricular ejection fraction

In this article, the authors contend that school reform proposals in the 1980s and 1990s have ignored the changing racial and ethnic complexion of our nation. An analysis is provided of the government's school reform responses to the rapidly growing Latino student sector. The authorsfirst provide a discussion and critique offive major assumptions of 'first wave" reform. For example, one of the assumptions is that students are homogeneous. In this article, it is argued that this assumption is not only false, but it creates barriers in comprehending and appreciating Latino student diversity. Second, a discussion is presented of school reform and its negative consequences for Latino students (i.e., schoolfailure and retention, stratification, inequity). Third, the authors offersome specific implicationsforpolicymakers and administrators (e.g., policymakers need to embrace school policies that are embedded in multiculturalism; and administrator preparation programs should provide new and different perspectives that are in tune with current thinking, such asfeminist and multicultural views). The article closes with a brief overview of several concrete policy actions that can be taken to improve education for the fast growing Latino student population.

e17553 Background: Breast cancer mortality rates in Colombia remain high in part due to unequal access to quality programs within the country´s health care system. Patient navigation Program (PNP) ...

Storage of peripheral blood stem cells (PBSC) at 4oC is a simple and inexpensive alternative to cryopreservation for preserving the clonogenic capacity of progenitors cells in the autologous transplant setting, however it has been perceived as unsafe and has deserved little attention. We present the experience of two Latin-American centers using refrigerated, non-cryopreserved stem cells after conditioning with high dose melphalan, CBV or BEAM in a large group of lymphoma and myeloma patients Materials and Methods PBSC were mobilized with filgrastim 5 mg/kg/BID for three to six days.One to three apheresis procedure were employed; the cells were stored at 4oC for 5 to 6 days in patients who received BEAM or CBV and for 3 days in those given melphalan. All of the conditioning regimens were administered preserving the full intensity of dose (Table 1). After the autograft all patients received filgrastim or pegfilgrastim | BEAM | D-5 | D-4 | D-3 | D-2 | D-1 | || | BiCNU 300 mgs/m2 | X | | | | | | Etoposide 200-400 mgs/m2 | X | X | X | X | | | Citarabine 300-400 mgs/m2 | | X | X | X | | | Melphalan 140 mgs/m2 | | | | X | | | CBV | | | | | | | BiCNU 300 mgs/m2 13 patients received carboplatin 900 mgs/m2 instead BiCNU | X | | | | | | Etoposide 300 mgs/m2 | | X | X | X | | | Ciclophosphamide 2.000 mgs/m2 | | | X | X | X | | Melphalan | | | | | | | Melphalan 200 mgs/m2 | | | | X | | | Melphalan 100 mgs/m2 | | | X | X | | Table 1 Results 102 lymphoma patients: 48 Hodgkin`s lymphoma (HL) and 54 non-Hodgkin´s lymphoma (NHL) received BEAM (71) or CBV (31). A median of 3.3 millions/kg of CD34 was infused; the median viability of the cells after 5-6 days of refrigeration (trypan blue exclusion) was 82%. 101 out of 102 patients engrafted, median time to achieve 500/ul neutrophil or more was 12 days, 100 were evaluable for thrombopoiesis, 99 of them had a self- sustained platelet count of 20.000 or more at a median of 17 days. The OS at 5 years was 59% and 42% for patients with Hodgkin and lymphoma respectively 151 patients with multiple myeloma received melphalan 200 mgs/m2. After 72 hours of refrigeration, a median of 2.6 millions/kg of CD34 cells were infused, the viability in all cases being > 90%. Three patients were not evaluable because early death. Median time to achieve 500 neutrophil or more and 20.000 platelets was 12 (9-50) and 15 (7-50) days. The OS at 5 years was 50% 21 patients with NHL and HL received as conditioning regimen melphalan 200 mgs/m2. After 72 hours of storage, a median of 1.75 millions/kg of CD34 cells were transplanted, 100% of them engrafted, median time to 500 neutrophils and 20.000 platelets was 11.9 and 15 days respectively There were no cases of secondary engraftment failure in any of the three groups Conclusion In this series of 268 patients, we have shown that autologous PBSC can be kept at 4oC in a conventional blood bank refrigerator for up to six days and use them to rescue high-dose chemotherapy in both multiple myeloma and lymphoma patients. Avoiding freezing procedures results in substantial cost savings. The availability of freezing devices for hematopoietic stem cells is not anymore an obstacle to start a an autologous transplantation program This observation is critical in areas of underprivileged economic circumstances, where more than 50% of the inhabitants of the world live. Disclosures No relevant conflicts of interest to declare.

exact and Cochran-Mantel-Haenszel tests were used to compare responses and toxicities. Results: The median age of the patients was 58 yrs (range: 39-72) in Group A and 58 yrs (range: 49-68) in Group B. Group A had more female pts (56% vs 25%) and a decreased baseline renal function (median creatinine clearance 76 vs 108 ml/min) compared to Group B. There was no significant difference in disease status pre-2nd ASCT between the 2 groups. Salvage therapywas given to 12 pts in group A and 16 pts in group B. The median time between 2 ASCTs were 29 (range: 3-67) months in group A vs 35.5 (range: 18-58) months in group B. All patients received stem cells which were collected and cryopreserved prior to the 1stASCT. At day +100, seven patients from Group B had CR compared to 2 from group A (p1⁄4.11) (Table 1). Patients who received BEAM had higher incidence of febrile neutropenia (16 vs 10 pts) and longer hospitalization (23 vs 15 days, p

We have designed a double-lumen inflatable needle for the atraumatic dissection of brain substance. This balloon needle has been successfully used for the ventricular approach in brain grafting procedures to obtain a rounded corticotomy with a diameter of 1.5-2 cm in the treatment of Parkinson's disease.

There are several reports published in the medical literature addressing the roll of non-cryopreserved stem cells for supporting autologous transplant in lymphoma patients. However, in most of them, the conditioning used was a modification of BEAM or CBV with important differences in dose intensity or, in fact with different drugs. We present our experience using non cryopreseved stem cells and BEAM, but without decreasing the dose intensity of it. From Jun 2004 to May 2007, after a signed inform consent, 20 patients were transplanted; 16 men, 4 women, the median age was 37 years (range 15–57), 9 with Hodgkin lymphoma, 10 with large cell lymphoma and 1 with Burkitt. 13 of them were in second complete remission and 7 in third or partial remission. The mobilization was done with filgrastin 5 mg/kg/BID without chemotherapy and in the 5th and 6th day a leukopheresis of 3 or 4 blood volume was performed, the cells obtained were stored at 4oC for 6 days, in the case of the first leukopheresis, and for 5 days in the case of the second leukopheresis The administration of BEAM began in the evening of the last leukopheresis day and it was completed in 5 days as follow: BiCNU 300 mgs/m2 on day −5, etoposide 150–200 mgs/m2 BID for 6 doses on days −5 to −2, citarabine 300–400 mgs/m2 /day from days −4 to −2 and melphalam 140/mg/m2 on day −2. The stem cells were re-infused on day zero after 6 days of refrigeration for the first leokopheresis, and 5 days for the second. All patients received filgrastin from day + 5 until neutrophil recovery or pegfilgrastin one dose The mobilization and recollection were successful in 19 out of 20 patients with a median CD34 of 2.3 x 10(6)/kg (range 1–6) but in one was necessary obtain also bone marrow stem cell. The median viability of the cells after 6 days of refrigeration, measured by trypan blue, was 82% (range 66–90). The median time to achieve an absolute neutrophil count greater than 500 /ml in all patients was 12 days (range 9–20); 18 out of 20 were evaluable for thrombopoesis, they obtained a self sustained platelets count of 20.000 or more at a median of 15 days (range 9–30). The tolerance of the 5 days BEAM was good, one patient died from weak capillary syndrome on day + 18 and another from pneumonia on day + 16 there were no other grade III or IV non hematologic toxicity. With a follow of 3 to 36 months 13 out of 20 patients are alive. We conclude that the use of non-cryopreserved stem cell for supporting autologous transplant after a 5 days BEAM conditioning is feasible, safe, and produce a rapid, complete and sustained hematopoiesis. This simple procedure is a good alternative for saving costs.

For the prevention of TA-GHVH in patients who received a allogeneic stem cell transplant is mandatory the gamma irradiation of the all cellular blood components. This irradiation is usually done with Cesium 137 and with a special blood bank irradiators. However these devices are expensive; because that, in developing countries, is frequent the utilization of Cobalt 60 and the same device that is used in the radiotherapy department, instead of blood bank irradiators. We present our experience with this technique. From Dec 2002 to Dec 2005 thirty patients received a allogeneic stem cell transplant and 28 were analysed. The stem cells source was: peripheral blood 25, unrelated cord blood 2, and bone marrow 1. The irradiation of the blood was performed with Cobalt 60–1.24 Mev- (theratron 780 C); the irradiation field was calculated for covering all of the bag surface and a dose of 3.5 Gy was administered to the mild plane of the bag. 158 blood concentrates were transfused, 68 red cell (X:2.5 per patient), and 90 platelets (3.2 per patient). The pre transfusion median hemoglobin and platelet levels were 7.63 g/dl and 12.000/ul; after transfusion was a median increase of 2.3 gm/dl (0.6–4.7) in hemoglobin and 18.000/ul (0–140.000) in platelets. There was no any case of TA-GVHD. Four patients developed pos transplant aGVHD, in all of the cases the disease began 50 days or more after the last transfusion, there were no pancytopenia and the aGVHD was resolved completely with the treatment. Conclusion In receptors of allogeneic stem cell transplant the gamma irradiation of blood components with Cobalt 60 and with the same device which is used for patients radiotherapy is 100% effective and safe in the prevention of TA-GVHD. This is a good alternative in centers without blood bank irradiator

Gerodermia osteodysplastica hereditaria was diagnosed in three Mexican brothers 6, 7, and 8 years old, respectively, who had the distinct facial appearance with sagging cheeks, premature wrinkling of the skin of face, abdomen, and dorsum of hands and feet; malocclusion, span greater than height; hyperextensibility; winging of the scapulae; stooped posture with kyphoscoliosis; protuberant abdomen; and pes planus. Radiologically they had generalized osteoplorosis, platyspondily due to multiple compression fractures, pseudoepiphyses of second metacarpals, and dislocated hips. Three other families with a total of 14 affected individuals have been reported. Inter- and intrafamilial variability can be recognized, particularly regarding the tendency to fractures, upper:lower segment ratio abnormalities, and results of skin biopsies, which have shown fragmentation of the elastic fibers in some cases (including the present family) and not in others. Although inheritance was considered to be X-linked recessive in the first reported family, an analysis of that pedigree together with those of the other reported families, including the present one, suggests that gerodermia osteodrysplastica is inherited in an autosomal recessive manner.