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Resumen Objetivo Medir el conocimiento de los estudiantes de enfermeria de la Universidad de Jaen hacia las pautas basadas en la evidencia para la prevencion de las lesiones por presion. Metodo Estudio observacional transversal de validacion de un cuestionario utilizando un formulario online con estudiantes de enfermeria de la Universidad de Jaen. Se invito a participar a todos los matriculados en los 4 cursos. Se evaluaron las propiedades psicometricas del cuestionario «Conocimientos sobre prevencion de lesiones por presion» (PIPK) mediante un analisis de Rasch. Se calcularon porcentajes de respuestas correctas y errores para cada item, puntuacion total y su asociacion con variables formativas. Resultados El cuestionario PIPK mostro adecuadas caracteristicas psicometricas (alfa = 0,89) y buen ajuste del modelo de Rasch. La puntuacion media de conocimientos fue de 21,0 (67,7% del maximo). Obtuvieron mayores puntuaciones aquellos estudiantes que habian realizado practicas clinicas, mas periodos de practicas, habian asistido a jornadas especificas sobre lesiones por presion o estaban matriculados en cursos superiores. Conclusiones El cuestionario PIPK es un instrumento valido y fiable para medir los conocimientos de los estudiantes de enfermeria hacia la prevencion de lesiones por presion. Los estudiantes de enfermeria de la Universidad de Jaen obtuvieron una puntuacion de conocimientos hacia la prevencion de las lesiones por presion superior al 50%.

Choroid plexus papilloma is an uncommon tumour of the central nervous system, accounting for less than 1% of all intracranial neoplasm. The usual locations are the lateral ventricle in infants and children and the fourth ventricle in adults. The third ventricle is a rare location, with few cases reported in the literature. We describe the case of a 3-month-old boy who was admitted to our centre with signs of raised intracranial pressure. Neuroimaging studies showed a third ventricular mass with associated hydrocephalus. The patient underwent complete tumour removal through a transfrontal approach and ventriculo-peritoneal shunt surgery. Postoperative course of the child was uneventful and follow-up magnetic resonance imaging revealed no residual tumour. Histopathology of the resected lesion confirmed the diagnosis of choroid plexus papilloma. We discuss the clinical, radiological and histological features of this infrequent type of tumours.

Infectious complications are a major cause of morbidity and mortality in B-cell hematological malignancies (HM). Prophylaxis for recurrent infections in HM patients with antibody deficiency consists of first-line antibiotics and when unsuccessful, gammaglobulin replacement therapy (IgRT). Recent knowledge of trained immunity-based vaccines (TIbV), such as the sublingual polybacterial formulation MV130, has shown a promising strategy in the management of patients with recurrent infections. We sought to determine the clinical benefit of MV130 in a cohort of HM patients with recurrent respiratory tract infections (RRTIs) who underwent immunization with MV130 for 3 months. Clinical information included the frequency of infections, antibiotic use, number of visits to the GP and hospitalizations previous and after MV130 immunotherapy. Improvement on infection rate was classified as: clear (>60% reduction of infection), partial (26%–60%) and low (≤25%) improvement. Fifteen HM patients (aged 42 to 80 years; nine females) were included in the study. All patients reduced their infection rate. Analysis of paired data revealed that the median (range, min - max) of respiratory infectious rate significantly decreased from 4.0 (8.0–3.0) to 2.0 (4.0–0.0) (pp = 0.002) during 12 months after initiation of treatment with MV130. The number of infectious-related GP or emergency room visits declined from 4.0 (8.0–2.0) to 2.0 (3.0–0.0) (pp = 0.032). Regarding safety, no adverse events were observed. On the other hand, immunological assessment of serum IgA and IgG levels demonstrated an increase in specific antibodies to MV130-contained bacteria following MV130 immunotherapy. In conclusion, MV130 may add clinical benefit reducing the rate of infections and enhancing humoral immune responses in these vulnerable patients.

espanolRESUMEN Objetivos: Conocer la actitud hacia la prevencion de las lesiones por presion que tienen los estudiantes y las estudiantes del Grado en Enfermeria. Objetivos secundarios: a) realizar la valoracion psicometrica de la version espanola del cuestionario Attitudes towards Pressure ulcer Prevention (APuP) (Actitudes hacia la prevencion de las UPP) en poblacion de estudiantes y b) identificar los factores formativos asociados con la actitud. Metodos: Estudio observacional transversal, llevado a cabo en la Universidad de Jaen mediante un cuestionario online en estudiantes de los 4 cursos del Grado en Enfermeria. Se utilizo el analisis de Rasch para establecer las propiedades psicometricas del cuestionario. Se calculo la puntuacion de actitud y su asociacion con variables formativas. Para estimar el tamano del efecto se uso la diferencia estandarizada de medias (d de Cohen). Resultados: Se analizaron un total de 188 cuestionarios validos. La puntuacion media obtenida en el cuestionario APuP fue 22,60 (44,23% del maximo). El cuestionario presenta una buena consistencia global (α = 0,74) y los indices de ajuste de los items fueron buenos. Se encontro una actitud menos positiva en estudiantes que habian realizado practicas clinicas (p EnglishABSTRACT Objectives: To explore the attitude towards pressure injury prevention of nursing students. Secondary objectives: a) To establish the psychometric properties of the questionnaire of Attitudes towards the prevention of pressure ulcer (APuP) -Spanish version- in student population, and b) To identify the educational factors associated with the attitude. Methods: A cross-sectional observational and validation study was carried out with students of the four years of the Bachelor in Nursing in the University of Jaen (Spain) using an online survey. Rasch analysis was used to establish the psychometric properties of the questionnaire. Also, the score of attitude and its association with educational variables were analysed. The standardised median difference (Cohen's d) was used to estimate the effect size. Results: A total of 188 valid questionnaires were analysed. The average score obtained in the APuP questionnaire was 22.60 (44.23% of the maximum). The questionnaire has a good overall internal consistency (α=0.74) and the item fit indices were good. It was found a less positive attitude in students who had done clinical placements (p

Summary Rituximab is a standard treatment for non‐Hodgkin diffuse large B‐cell (DLBCL) and follicular (FL) lymphomas. A subcutaneous formulation was developed to improve the resource use of intravenous rituximab, with comparable efficacy and safety profiles except for increased administration‐related reactions (ARRs). MabRella was a phase IIIb trial to assess the safety of switching from intravenous to subcutaneous administration of rituximab during first‐line induction/maintenance for DLBCL or FL, focusing on ARRs. Efficacy, satisfaction and quality of life were also assessed. Patients received subcutaneous rituximab plus standard induction chemotherapy for DLBCL or FL for 4–7 cycles, and/or every 2 months maintenance monotherapy for FL for 6–12 cycles. The study included 140 patients: DLBCL, n = 29; FL, n = 111. Ninety‐five percent of patients experienced adverse events, reaching grade ≥3 in 38·6% and were serious in 30·0%. AARs occurred in 48·6%, mostly (84·9%) at the injection site, with only 2·1% of patients reaching grade 3. The end‐of‐induction complete/unconfirmed complete response rate was 69·6%. After a median follow‐up of 33·5 months, median disease‐/event‐/progression‐free and overall survivals were not attained. The Rituximab Administration Satisfaction Questionnaire showed improvements in overall satisfaction and the EuroQoL‐5D a good quality‐of‐life perception at induction/maintenance end. Therefore, switching to subcutaneous rituximab showed no new safety issues and maintained efficacy with improved satisfaction and quality of life.

Hemato-oncologic patients with chemotherapy-induced thrombocytopenia are one of the populations receiving platelet transfusions. The general practice with these patients is to give prophylactic platelet transfusions when platelet counts fall below 10×109PLT/L. However, in more than 40% of these patients, platelet transfusion does not prevent bleeding. The reason of the low efficacy of platelet transfusion in the context of chemotherapy patients is not entirely understood. We therefore aimed at immunophenotyping the expression of platelet surface and activation markers and thrombopoietin levels from hemato-oncologic patients before and after transfusion. A more detailed follow-up was performed in three patients that underwent autologous bone marrow transplantation. As previously reported, basal platelet activation was observed in hemato-oncologic patients. Based on flow cytometry parameters, i.e. the percentage of positivity and mean fluorescence intensity (MFI) distribution, our data provide an additional interpretation of platelet acquired qualitative changes in the hemato-oncologic patient. From our results we propose: first, the underlying activation of platelets in the hemato-oncologic patient is accompanied by loss of expression of the platelet receptors that are susceptible to protease-mediated shedding; second, soon after transfusion, the newly circulating donor platelets show additional activation, which may result in subsequent platelet receptor recycling and potential accelerated clearance of these activated platelets. In conclusion, the immunophenotype of circulating platelets changes after prophylactic platelet transfusion. Next to platelet count increment, exploration of this immunophenotype might help to explain transfusion refractory bleeding in hemato-oncologic patients. Eventually this may lead to personalization and improvement of the present platelet transfusion support regime.

Acute promyelocytic leukemia (APL) has become a highly curable malignant disease after the introduction of all transretinoic acid (ATRA) to chemotherapy treatment. However, the risk to develop therapy-related myeloid neoplasms (t-MN) has become a matter of concern, as APL patients are otherwise expected to have a good prognosis. We report a patient with APL who achieved complete remission after chemotherapy induction with anthracycline and ATRA, followed by consolidation and maintenance chemotherapy. Two years later, the patient developed t-AML, with MLL rearrangements, without any evidence of relapse of the APL original clone. The increasing incidence of t-MN in oncohematological patients is partly due to the development of safer, more efficient or targeted therapies, which allow better outcomes and lengthened survival amongst treated patients. The identification of genetic factors, mechanisms or prognostic biomarkers in t-MN might open new windows for the development of personalized targeted therapy regimes in this underserved patient population.

An increasing healthcare challenge in the management of hematological malignancy (HM) is secondary immunodeficiency (SID), either caused by the underlying malignancy or by treatments, including B-cell-targeting therapies. From January 2019, the EMA (European Medicines Agency) included the evaluation of specific antibody (Ab) responses to better select patients for immunoglobulin replacement therapy (IgRT). Antibody response to polysaccharide immunizations is primordial in the immunological evaluation of the patients and it is thought to be the first Ab response to be lost in the rising of an immunodeficiency. Clinically, an impaired polysaccharide response means that the patient may not be protected to new encounters with encapsulated bacteria, having therefore higher risk of severe or recurrent infections. We evaluated Ab responses to pneumococcal (PPV) and Salmonella typhi (TV) pure polysaccharide immunization in a cohort of 42 HM patients and 24 healthy controls. Pre-post specific Ab serum concentrations were measured by ELISA (Binding Site, UK), before immunizations and at 4 weeks. Globally, the prevalence of TV titers pre-immunization was lower (9%) compared to PPV pre-immunization titers (76%) (p3-fold increase in TV titers) than PPV non-responders (62%) (p Disclosures No relevant conflicts of interest to declare.

OBJETIVO: El momento para indicar un trasplante pulmonar esta definido por criterios clinicos y funcionales diferentes para cada enfermedad. El objetivo de este estudio es presentar cuales fueron los criterios por los que en nuestro hospital se incluyo a los pacientes en lista de espera de trasplante pulmonar. PACIENTES Y METODOS: Se ha realizado un analisis retrospectivo de las caracteristicas clinicas, la funcion respiratoria, la prueba de la marcha de 6 minutos y el estudio cardiologico de los pacientes que recibieron un trasplante pulmonar entre enero de 2002 y septiembre de 2005. RESULTADOS: En el periodo estudiado se realizaron 100 trasplantes pulmonares. La edad media de los pacientes era de 45 anos (rango: 15-67) y el 57% eran varones. Las enfermedades que con mayor frecuencia motivaron el trasplante pulmonar fueron la enfermedad pulmonar obstructiva cronica (EPOC, 35%), la fibrosis pulmonar (29%) y las bronquiectasias (BQ) (21%). La media ± desviacion estandar de la funcion pulmonar oscilo entre el 20 ± 11% del volumen espiratorio forzado en el primer segundo (FEV1) y el 37 ± 15% de la capacidad vital forzada (FVC) en la EPOC; del 41 ± 15% del FEV1 y el 40 ± 17% de la FVC en la fibrosis pulmonar, y del 23 ± 7% del FEV1 y el 37 ± 10% de la FVC en las BQ. CONCLUSIONES: Los pacientes que recibieron un trasplante pulmonar en nuestro centro se encontraban en fases muy evolucionadas de su enfermedad y cumplian los criterios de inclusion admitidos por las diferentes sociedades medicas cuando se les incluyo en lista de espera.

OBJECTIVE: The time at which lung transplantation is indicated is determined by clinical and functional criteria that vary according to the particular disease. The aim of our study was to present the criteria according to which patients were placed on waiting lists for lung transplantation in our hospital. PATIENTS AND METHODS: We analyzed retrospectively the clinical characteristics, lung function, heart function, and 6-minute walk test results of patients who had received a lung transplant in our hospital from January 2002 through September 2005. RESULTS: During the study period 100 lung transplants were performed. The mean age of the patients was 45 years (range, 15-67 years) and 57% were men. The diseases that most often led to a lung transplant were chronic obstructive pulmonary disease (COPD) (35%), pulmonary fibrosis (29%), and bronchiectasis (21%). Lung function values differed by disease: mean (SD) forced expiratory volume in 1 second (FEV1) was 20% (11%) and forced vital capacity (FVC) was 37% (15%) in patients with COPD; FEV1 was 41% (15%) and FVC, 40% (17%) in patients with pulmonary fibrosis; and FEV1 was 23% (7%) and FVC, 37% (10%) in patients with bronchiectasis. CONCLUSIONS: The patients who received lung transplants in our hospital were in advanced phases of their disease and met the inclusion criteria accepted by the various medical associations when they were placed on the waiting list.

Objetivo Conocer los costes directos del proceso de diagnostico del cancer de pulmon (CP) en el ano 2003. Como objetivo secundario se evaluo el coste asociado a los ingresos definidos como inadecuados. Material y metodos Se ha llevado a cabo un estudio de una cohorte prospectiva de casos de CP diagnosticado durante el ano 2003 mediante citohistologia o por criterios clinicorradiologicos. Se determino el coste total, segun Decreto 222/2003 de Tarifas de los Servicios Sanitarios de Galicia, diferenciando entre pacientes ingresados y ambulatorios, y entre carcinoma microcitico y no microcitico. Asimismo, se analizaron los ingresos inapropiados, segun criterios establecidos por nuestro grupo, y se estimo el ahorro que supondria haberlos manejado de forma ambulatoria. Para el analisis estadistico se utilizo el programa estadistico SPSS 10.0. Resultados Se diagnostico de CP a 160 pacientes, 76 (47,5%) de forma ambulatoria y 84 (52,5%) mediante ingreso. Este se considero inapropiado en 27. El diagnostico fue de carcinoma no microcitico en 108 pacientes y microcitico en 38, y en 14 se establecio por criterios clinicorradiologicos. El coste total fue de 742.847 € (media: 4.643 €; intervalo de confianza del 95%, 4.049-5.236), de 552.614 € (media: 6.579 €) en los ingresados y de 190.233 € (media: 2.503 €) en los ambulatorios. El coste medio en los carcinomas microciticos fue de 3.692 € y en los no microciticos de 5.070 €. En los primeros, el coste medio en la enfermedad limitada fue significativamente menor que en la enfermedad extendida (1.894 frente a 4.098 €), y en los segundos el coste medio en los estadios iniciales tambien fue significativamente menor que en los avanzados (3.660 frente a 5.494 €). El ahorro estimado por ingresos inapropiados seria de 120.258 €. Conclusiones El coste medio del paciente con manejo ambulatorio es un 62% inferior al que ocasiona el ingresado. El coste medio en el carcinoma no microcitico es mayor que en el microcitico, y el de los estadios avanzados, mayor que el de los iniciales. En nuestra serie, el ahorro estimado por ingresos inapropiados seria de 120.258 € por ano.

Objective To establish the direct, costs of the process of diagnosing lung cancer in 2003. As a secondary objective, the cost of admissions defined as inappropriate was evaluated. Material and Methods A prospective cohort study of lung cancer, cases diagnosed in 2003 was performed. Diagnosis was based on cytohistology or clinical and radiological criteria. the total cost was determined according to Decree 222/2003, governing Galician health service rates. A distinction was drawn between hospitalized patients and outpatients, and between small cell and non-small cell carcinomas. Inappropriate admissions were analyzed in accordance with the criteria established by our study team, and the savings that would have been made had these patients been treated as outpatients were calculated. the statistical analyses were performed using SPSS version 10.0. Results A total of 160 patients were diagnosed with lung cancer; 76 (47.5%) of these were outpatients, and the remaining 84 (52.5%) were hospitalized patients. Admissions were considered inappropriate in 27 cases. of the total of 160 patients, 108 were diagnosed as having non-small cell carcinomas, and 38 as having small cell carcinomas; the remaining 14 patients were diagnosed on the basis of clinical-radiological criteria. Total cost was €742847 (mean. €4643; 95% confidence interval, €4049€5236), composed of €552614 (mean, €6579) for admitted patients, and €190 233 (mean, €2503) for outpatients. Mean cost was €3692 for the small cell carcinomas, and €5070 for the non-small cell carcinomas. Comparing limited and extensive small cell carcinomas, the mean cost for the former was significantly lower than for the latter (€1894 compared to €4098); there was also a lower mean cost for early compared to advanced stages of non-small cell carcinomas (€3660 compared to €5494). the savings to be made from unnecessary admissions were calculated at €120258. Conclusions The mean cost for outpatient lung cancer treatment was 62% lower than for hospitalization. Non-small cell carcinomas were more costly on average than small cell carcinomas, and advanced stages of the small cell carcinomas involved a higher average cost than the initial stages of the disease. For our series, the savings to be made from unnecessary admissions were calculated at €120258.

Varon de 25 anos, sin antecedentes de interes, que consulta por tumefaccion testicular bilateral y esterilidad. En la ecografia se visualizaron testes de tamano, ubicacion y morfologia normal, asi como multiples microcalcificaciones bilaterales y difusas en el parenquima testicular (figs. 1, 2 y 3), sin observarse lesion/masa asociada. El epididimo, los cordones espermaticos y las bolsas escrotales no mostraban alteraciones significativas. Figuras 1 y 2. Corte ecografico axial de ambos testes y sagital del testiculo derecho; se observan multiples pequenas calcificaciones difusas parenquimatosas, sin sombra sonica posterior. No se evidenciaba imagen que sugiriera patologia tumoral sobreanadida. Figura 3. La vascularizacion testicular no mostraba alteraciones ecograficas en los registros Duplex Doppler arteriales. Los marcadores tumorales gonadotropina corionica y alfa­fetoproteina estaban en el rango de la normalidad. Se realizo biopsia testicular bilateral, siendo el resultado positivo para malignidad en el testiculo derecho (carcinoma embrionario). Se practico orquiectomia derecha. Comentario La microlitiasis testicular es una entidad poco frecuente, mas prevalente en varones jovenes, descrita por primera vez con ecografia por Doherty et al en 1987. Su etiologia es desconocida y es el resultado de la formacion de calcificaciones en los tubulos testiculares1. Hasta hace no mucho tiempo era considerada un hallazgo ecografico benigno que podia estar relacionado con criptorquidia, torsion testicular o de hidatide, traumatismos gonadales previos... Pero su asociacion con multiples patologias displasicas como el sindrome Klinefelter (47 XXY), el pseudohermafroditismo o la infertilidad ha...

Elderly patients with acute myeloid leukemia (AML) have a less favorable outcome, which has been related, among other factors, to multidrug resistance (MDR) phenotypes.Freshly obtained erythrocyte-lysed bone marrow samples from 150 elderly patients (65 years) with de novo AML and 30 younger AML patients were analyzed using a 4-color immunofluorescence technique for quantitative expression of proteins associated with apoptosis (bcl-2, bax, APO2.7) and MDR (P-gp, MRP, LRP) in 3 blast cell subpopulations, defined according to their maturation stage.Although a homogeneous CD34+ blast cell population was more frequent in the elderly patients, (25% vs 7%, p=0.02), no statistically significant differences were detected between the two age groups in the expression of either apoptosis- or MDR-associated proteins, except for slightly higher quantities of LRP protein in the more immature CD34+ blast cell subset in the elderly AML cases (p=0.04). Interestingly, when different blast cell populations were compared, immature (CD34+) blast cells were characterized by higher levels of bcl-2 in both age groups and lower levels of APO2.7 in the elderly group. In addition, higher P-gp levels were found in CD34+ blast cells than in CD34-- ones in elderly AML patients. Reactivity for LRP was low in both elderly and younger patients.In summary, our results suggest that the higher resistance to chemotherapy observed in elderly AML patients could be related to a higher incidence of cases with a CD34+ homogeneous blast cell population, since these blast cells frequently display a more pronounced anti-apoptotic and MDR1 phenotype.

Mujer de 58 anos, hipertensa, acude a urgencias por dolor abdominal de inicio subito. En la exploracion fisica destacaba hipotension, palidez cutanea y ligera disminucion del nivel de consciencia. Con la sospecha de abdomen agudo por sindrome aortico agudo se solicito una tomografia computarizada toracoabdominopelvica realizada con contraste endovenoso en fase arterial que objetivaba la rotura de aneurisma disecante de aorta abdominal infrarrenal (figs. 1 y 2), demostrandose la presencia de flap intimal con realce de ambas luces (verdadera y falsa) y trombo mural. Figuras 1 y 2. Tomografia computarizada abdominopelvica (proyeccion axial y sagital) con rotura de aneurisma disecante de la aorta. Flap intimal (flechas) delimitando la luz verdadera y falsa. Se procedio a estabilizar a la enferma y a tratamiento quirurgico endovascular. Comentario El sindrome aortico agudo engloba un grupo de enfermedades que afectan a la pared de la aorta, que fundamentalmente son: la diseccion aortica, el hematoma intramural y la ulcera ateroesclerotica penetrante1. En un importante porcentaje de pacientes estas tres entidades estan muy relacionadas, teniendo como causa comun la ateroesclerosis con ulceracion2. Los pacientes suelen acudir a urgencias con un cuadro clinico de dolor toracico y/o abdominal y variable grado de inestabilidad hemodinamica que pueden llevar a equivoco con otros sindromes dolorosos mas comunes. A pesar de los importantes avances en el diagnostico y tratamiento quirurgico, la mortalidad continua siendo elevada. En la diseccion aortica se produce una rotura de..

Varon de 38 anos, con sobrepeso, que acude a urgencias por dolor intenso y defensa en la fosa iliaca izquierda de dos dias de evolucion, sin fiebre ni otra clinica acompanante. Analiticamente destacaba una ligera leucocitosis con neutrofilia, siendo el resto de los parametros normales. En la ecografia abdominal, coincidiendo con el punto de maximo dolor, se observaba una lesion nodular ecogenica no compresible proxima a la pared abdominal. A continuacion, se realizo una tomografia computarizada (TC) abdominopelvica sin contraste (figs. 1 y 2), en la que se identificaba una imagen oval de 1,5 centimetros de densidad grasa, adyacente al borde antimesenterico de la union colon descendente-sigma y rodeada de cambios inflamatorios (reticulacion de la grasa perilesional), sin observarse diverticulos ni engrosamientos parietales colonicos. Figuras 1 y 2. TC multidetector abdominopelvico (proyecciones axial y oblicuo-sagital). Se identifica una imagen oval densidad grasa adyacente al borde anterior de la union colon descendente-sigma, con cambios inflamatorios perilesionales (flechas). Los hallazgos radiologicos eran altamente sugestivos de apendicitis epiploica. El paciente fue tratado de forma conservadora, con analgesia y cobertura antibiotica. La evolucion fue favorable. Comentario La apendicitis epiploica, termino introducido por Dockerty et al en 19561, tambien conocida como epiploitis aguda, epiplopericolitis o infarto graso focal intraabdominal2, es una causa poco frecuente de abdomen agudo. Se produce un infarto de los apendices grasos adheridos al colon. El sigma y el colon descendente suponen la localizacion mas frecuente. La incidencia es mayor...

Resumen:Una de las ramas en la que la enfermera puededesarrollarse profesionalmente es la EnfermeríaIndustrial, esta se encarga de la prevención y controlde la salud de los trabajadores en las empresas, eidentifica factores de riesgos que puedan ocasionaraccidentes fatales dentro de la misma.Dentro de la empresa Kromalabs S.A. de C.V. serealizaron practicas de enfermería industrial en laque se identificaron ciertas deficiencias y problemasque nos parecieron importantes para la realización ydesarrollo de los programas preventivos, tales comola elevada incidencia de trabajadores que asistíanal consultorio por lumbalgias, se observaron malasposturas y la rutina de trabajo implica movimientosrepetitivos; así como las deficiencias con respectoa señalizaciones de evacuación, alarmas contraincendios, ausencia de puntos de reunión, etc. Por esasrazones creamos los programas: “Espalda saludable,tranquilidad invaluable” y “Que no te hagan temblarlos sismos”.Para el desarrollo de los programas, se planearondiferentes actividades, como charlas para lostrabajadores en las que se informaban ejerciciospara la espalda, posturas correctas, etc. En caso delprograma de sismo se organizo un simulacro paraevaluar los conocimientos de los trabajadores acercade las acciones durante y después de un sismo.Los resultados fueron favorables para ambosprogramas, pues el personal se mostro interesado ycooperativo en las actividades que se desarrollaron alo largo de la práctica.Palabras clave:Enfermería Industrial, Lumbalgia, Higiene deColumna, Sismo, Simulacro.Abstract:One of the branches in which the nurse can developprofessionally is the Industrial, this is responsible forthe prevention and control of the health of workers inan enterprise, in addition to notice and identify risksthat can cause fatal accidents within the same.Within the company Kromalabs S.A. de C.V. wereperformed industrial nursing practices whichidentified certain deficiencies and problems thatseemed important for the creation and developmentof preventive programs, such as the high incidenceof workers attending the clinic for back pain, poorposture were observed and routine moves workinvolves repetitive and gaps regarding evacuationsigns, fire alarms, lack of meeting points, etc. forthese reasons we believe the programs: “Healthy back,invaluable peace of mind” and “Do not let earthquakes make you tremble".For program development will be planned activities,including lectures for workers which reported backexercises, correct posture, etc. If the program wasorganized a mock earthquake to assess the skills andknowledge gaps about the workers about the actionsduring and after an earthquake.The results were favorable for both programs, as thestaff was interested and cooperative activities to bedeveloped over the practice.Key words:Industrial Nursing, Backache, Column Hygiene,Earthquakes, Mock.

Abstract 1113 Poster Board I-135 Currently, imatinib (IM) 400 mg daily is the frontline therapy for patients with CP-CML. In an attempt to improve the therapeutic response to IM, the Spanish collaborative PETHEMA group undertook a study of early optimization of therapy, in which 210 adult patients newly diagnosed with CP-CML (< 3 months from diagnosis) were included. Median age was 44 (range: 18-71) years and distribution by Sokal groups: low risk 56%, intermediate risk 28%, and high risk 16%. Hydroxyurea was permitted before IM. Patients initially received IM 400 mg daily for 3 months and then those failing to achieve a complete hematologic response (CHR) had the dose increased (to 600 and then 800 mg daily), while the remainder were maintained on 400 mg daily for three more months. At 6 months, depending on cytogenetic response, patients were kept on IM 400, if they had achieved a complete cytogenetic response (CCyR), or randomized to receive higher IM doses (600 and then 800 mg) or IM 400 plus low dose interferon (IFN, 3 million units 3 times a week) in case that a CCyR had not been attained by that time. In patients already in CCyR at 6 months, the IM dose was increased if a major molecular response (MMolR) according to the international scale had not been achieved at 18 months, whereas in patients not in CCyR and randomized at 6 months, a switch to a second generation TKI (dasatinib or nilotinib) was permitted if a CCyR was not achieved at one year of randomization. At standard intervals, cytogenetic response was assessed in bone marrow by chromosome banding analysis and molecular response determined in peripheral blood by RT-Q-PCR performed in three reference laboratories. At the time of the analysis, median follow-up was 48.3 (range: 1.2-73) months. Median time from diagnosis to IM start was 0.5 (range: 0-2.8) months; 72% of patients started IM within one month from diagnosis. At 3 months of treatment, 4 patients had not achieved a CHR; two of them failed to achieve a favorable response following the increase in the IM dose. At 6 months, a CCyR was obtained in 79% of patients; of the 41 patients not in CCyR, 9 could not be randomized because of toxicity (n= 3) or withdrawal of consent (n=6), 17 were assigned to higher IM dose, and 15 to IM 400 + IFN, but only 9 of the latter actually started IFN. Due to the scarce number of patients randomized, no comparison could be established between the two arms. Overall, cumulative incidence of response at 3 years was: CHR 98.6%, CCyR 90%, and MMolR 82%. Based on an intention-to-treat analysis, CCyR was 70% at 18 months. With current follow-up, only 5 patients have died and 9 have progressed to the accelerated or blastic phases (AP/BP). At 5 years, overall survival rate is 97.5%, survival free from AP/BP 95.5%, survival free from failure (including death, progression to AP/BP and the lack of achievement or the loss of a previously obtained CHR and CCyR) 82%, and event-free survival (including the above plus the permanent IM discontinuation for any reason) 80%. Twenty-seven patients (12.8% of the overall group) had grade 3-4 hematological toxicity and 26 (12.4%) grade 3-4 nonhematological side effects, in most cases during the first year of treatment. The presentresults show the benefit of prompt institution and early optimization of IM therapy in patients with newly diagnosed CP-CML. Disclosures Cervantes: Novartis: Consultancy, Speakers Bureau; Bristol-Myers Squibb: Consultancy, Speakers Bureau.