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Stroke is the second leading cause of death worldwide and fifth in the United States, and it represents the major cause of disability in older adults.We aimed to determine the risk of acute ischemic stroke (AIS) in individuals with obesity with a history of transient ischemic attack (TIA) compared with patients with a history of bariatric surgery.Academic hospital, United States.Using the Nationwide Inpatient Sample (NIS) database from 2010 to 2015, we retrospectively identified patients with obesity and past medical history of TIA and divided them into 2 groups: a treatment group of patients who underwent bariatric surgery, and a control group of patients with obesity. We compared incidence of new AIS in both groups using a univariate analysis and multivariate regression model. Covariates included were lifestyle (smoking status, alcohol habits, cocaine use), family history of stroke, co-morbidities (diabetes, hypertension, hyperlipidemia, atrial fibrillation) and long-term medical treatment (antiplatelet/antithrombotic treatment).A total of 91,640 patients met inclusion criteria, of which treatment patients were 12.3% (n = 11,284) and control patients 87.6% (n = 80,356). The average age of the treatment group was 62.9 ± 17.08 years, and the average of the control was 59.6 ± 12.74 years. The rate of AIS in the treatment group was significantly lower compared with the control group (2.8% versus 4.2%, P.0001). After adjusting for covariables, the risk difference of AIS was still significant between groups (odds ratio = 1.33, P.0001), showing that patients in the treatment group were less likely to have AIS compared with the control group.After analyzing nationwide information, we conclude bariatric surgery helps decrease risk of AIS in patients with a history of TIA. However, this comparison is limited by the nature of the database; further studies are needed to better understand these results.

La seguridad y la salud en el trabajo son de relevancia creciente para lograr la salud ocupacional y las competencias que los estudiantes deben mostrar en dichos programas académicos, por esto, la importancia de implementar metodologías que optimicen la didáctica, el pensamiento crítico y la construcción de saberes que respondan a las necesidades de la sociedad. Considerando las ventajas que ofrece el Aprendizaje Basado en Proyectos (ABP). El objetivo del estudio fue construir un cuerpo de orientaciones teórico-metodológicas para la implementación del ABP en el programa Profesional de Seguridad y Salud en el Trabajo en la Corporación Escuela Tecnológica del Oriente – Institución de Educación Superior. La metodología tuvo una perspectiva cualitativa, enfoque heurístico-hermenéutico, que derivó en el análisis e interpretación de documentos científicos y normativas, emergiendo un cuerpo de orientaciones teórico - metodológicas para el mejoramiento del proceso didáctico y el desarrollo de habilidades cognitivas-constructivistas de los estudiantes.

Obesity is commonly associated with increased sympathetic tone, changes in heart geometry, and mortality. The aforementioned translates into a higher and potentially modifiable mortality risk for this specific population.The aim of the study was to analyze the extent of changes in the heart ventricular structure following rapid weight loss after bariatric surgery.Academic, university-affiliated hospital.We retrospectively reviewed all the patients that underwent bariatric surgery at our institution between 2010 and 2015. Data analyzed included demographics, BMI, and associated medical problems. Preoperative and postoperative echography readings were compared looking at the heart geometry, cardiac volumes, and wall thickness.Fifty-one patients who had bariatric surgery and had echocardiography before and after the surgery were identified. There were 33 females (64.7%). The mean age was 63.4 ± 12.0 years with an average BMI of 40.3 ± 6.3. The mean follow-up was 1.2 years after the procedure. At 1 year follow-up 25 patients (49%, p = 0.01) showed normal left ventricular geometry. The left ventricular mass (229 ± 82.1 vs 193.2 ± 42.5, p0.01) and the left ventricular end diastolic volume (129.4 ± 53 vs 96.4 ± 36.5, p = 0.01) showed a significant modification following the procedure. There was a significant improvement in the interventricular septal thickness (p = 0.01) and relative wall thickness (p0.01) following surgery.The patients with obesity present a significant cardiac remodeling from concentric remodeling to normal geometry after bariatric surgery. The decrease in BMI has a direct effect on improvement of the left ventricular structure. Further studies must be carried out to define the damage of obesity to diastolic function.

Background Inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been widely implemented in low- and middle-income countries. However, immunogenicity in immunocompromised patients has not been established. Herein, we aimed to evaluate immune response to CoronaVac vaccine in these patients. Methods This prospective cohort study included 193 participants with 5 different immunocompromising conditions and 67 controls, receiving 2 doses of CoronaVac 8–12 weeks before enrollment. The study was conducted between May and August 2021, at Red de Salud UC-CHRISTUS, Santiago, Chile. Neutralizing antibody (NAb) positivity, total anti–SARS-CoV-2 immunoglobulin G antibody (TAb) concentrations, and T-cell responses were determined. Results NAb positivity and median neutralizing activity were 83.1% and 51.2% for the control group versus 20.6% and 5.7% (both P Conclusions Diverse immunocompromising conditions markedly reduce the humoral response to CoronaVac vaccine. These findings suggest that a boosting vaccination strategy should be considered in these vulnerable patients. Clinical Trials Registration NCT04888793.

Background Obesity is considered a major cardiovascular risk factor. The excess of pericardial fat (PF) in patients with obesity has been associated with a variety of electrocardiographic alterations. In previous studies, we demonstrated that rapid weight loss and bariatric interventions result in decreased PF. Objectives The aim of this study is to report the changes in PF after bariatric surgery and its effect on ventricular conduction. Setting US hospital, academic institution. Methods A linear measurement of PF thickness on computed tomography scans was obtained for 81 patients, as well as a retrospective review of electrocardiographic changes before and after bariatric surgery. We compared the changes in PF thickness and electrocardiographic components before and after procedures. Common demographics and co-morbidities were collected along with lipid profiles preoperative and postoperative. Results A total of 81 patients had electrocardiograms done before and 1 year after bariatric surgery. Females comprised 67.9% (n = 55), and the average age for our population was 55.07 ± 14.17 years. Pericardial fat thickness before surgery was 5.6 ± 1.84 and 4.5 ± 1.62 mm after surgery (P = .0001). Ventricular conduction (QT and QT corrected [QTc] intervals) showed a significant improvement from 438.7 + 29 before to 426.8 + 25.3 after bariatric surgery (P = .006). We found a statistically significant association between the decrease in PF and the decrease in QTc intervals (P = .002). Conclusion Obesity is a risk factor for arrhythmias and sudden cardiac death. Bariatric surgery and its effect on PF produce an improvement in ventricular conduction, which may reduce the ventricular electrical instability in patients with obesity.

Background The population undergoing bariatric surgery (BaS) has many cardiovascular risk factors that can lead to significant perioperative cardiovascular morbidity. Objectives We aimed to examine trends in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) after BaS. Setting Academic Hospital, United States METHODS: We performed a retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry for patients aged ≥18 years undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) from 2015 to 2019. Data on demographics, co-morbidities, and type of procedure were collected. MACCE was defined as a composite variable including perioperative acute myocardial infarction (AMI), cardiac arrest requiring cardiopulmonary resuscitation, acute stroke, and all-cause mortality. We utilized the Cochrane-Armitage and Jonckheere-Terpstra tests to assess for significant trend changes throughout the years. Results A total of 752,722 patients were included in our analysis (LSG = 73.2%, LRYGB = 26.8%). Postoperative MACCE occurred in 1058 patients (.14%), and was more frequent in patients undergoing LRYGB (.20%). The frequency of MACCE declined from .17% to .14% (P = .053), driven by a decline in the frequency of AMI (.04% to .02%, P = .002), cardiac arrest (.05% to .04%, P = .897), and all-cause death (.11% to .08%, P = .040), but with an increase in perioperative stroke (.01% to .02%, P = .057). Conclusion The overall risk of MACCE after BaS is .14% and has been declining in the last 5 years. This trend is likely multifactorial and further analysis is necessary to provide a detailed explanation.

Background Obesity independently increases the risk of hospitalization due to viral respiratory infections, including influenza virus and, more recently, severe acute respiratory syndrome coronavirus 2. As an independent risk factor, obesity impairs the immune response to viral infections and decreases the effectiveness of immunizations. Objectives Using influenza as a proxy, we aimed to determine the impact of bariatric surgery (BaS) on the risk of hospitalization due to viral respiratory infections. Setting Academic hospital, United States. Methods National (Nationwide) Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment subjects were defined as patients with a history of BaS and control subjects as patients with a body mass index ≥35 kg/m2 and without a history of BaS. Any hospitalization with influenza as a primary diagnosis was identified. Univariate analysis and multivariate regression models were performed to assess the differences between groups. Results A total of 2,300,845 subjects were reviewed, of which 2,004,804 were control subjects and 296,041 were treated patients. Univariate analysis showed that the hospitalization rate in the treatment group was significantly lower than in the control group (.007% versus .019%, P Conclusions BaS may decrease the risk of hospitalization due to influenza, but further prospective studies are needed to confirm these results. We also suggest that these results should be translated into the development of similar studies to determine the impact of BaS on the incidence and severity of the coronavirus disease 2019.

Introducción: las histiocitosis son un grupo heterogéneo de enfermedades; una de ellas es el síndrome hematofagocítico (SHF). Sus causas pueden ser infecciosas, neoplásicas, autoinmunes o relacionadas a inmunodeficiencias adquiridas; el linfoma de Hodgkin clásico (LHc) es una causa poco frecuente. Se reporta el caso de un hombre inmunodeprimido de 35 años que ingresa al hospital febril y con insuficiencia respiratoria grave. Métodos: se recopiló información clínica pertinente y se revisó material de biopsia estudiado con tinción de hematoxilina – eosina, técnica inmunohistoquímica e hibridación in situ cromogénica. Resultados: estudios de laboratorio muestran pancitopenia, alteración de pruebas hepáticas, hipertrigliceridemia, hipoalbuminemia e hiperferritinemia. El estudio de médula ósea hematopoyética con mielograma y biopsia muestran hallazgos compatibles con LHc, signos de hemofagocitosis e infección por virus Epstein-Barr (VEB). Se diagnostica SHF como primera manifestación de LHc e infección por VEB. Conclusiones: a la fecha, se describen 74 pacientes reportados con SHF como manifestación de LHc; en el 84% fue su primera manifestación. Si bien la presentación clínica presentada es infrecuente, se ha propuesto una asociación en hombres con inmunodeficiencia, SHF, LHc e infección por VEB; por lo que se sugiere una alta sospecha diagnóstica.

Aim Treatment of transsphincteric fistulas (TSFs) with fistulotomy after an indwelling seton is tempered by risks of incontinence and litigation. Thus, ligation of the TSF tract has been popularized as an alternative option. We previously reported on 107 patients who underwent ligation of the intersphincteric fistula tract (LIFT), with a 46% failure rate. Posterior fistula was the only predictor of recurrence. The aim of the present work was to investigate whether the length, width or depth of the fistula measured on preoperative MRI was correlated with recurrence. Method Following institutional review board approval, a retrospective analysis of our prospective Complex Anal Fistula Database from 1 January 2011 to 31 August 2019 was performed. Patients with TSF who underwent preoperative MRI and LIFT were included. Fistula location was classified as anterior, posterior or lateral. MRI measurements of fistula length, width and depth (in the intersphincteric groove) were performed. The type and rate of postoperative recurrence were analysed. Results 173 patients underwent MRI for an anal fistula; of these 40 underwent LIFT and 22/40 (55%) had preoperative MRI. There was no difference in the length, width or depth of anterior (n = 9), posterior (n = 7) or lateral (n = 6) fistula tracts. The overall recurrence rate was 9/22 (41%). Posterior TSFs had the highest recurrence rate (5/7, 71%). Conclusion The mean length, width, and depth of the fistula tract, measured at the preoperative site of LIFT in the intersphincteric groove, did not correlate with recurrence regardless of fistula location.

COVID-19 has rapidly become a major concern for the health systems worldwide. Its high contagiousness and associated mortality demand the discovery of helpful interventions with promising safety profile. Here, we report 3 severe COVID-19 cases, which achieved rapid and sustained improvement in outcome with the use of ruxolitinib, a JAK/STAT pathway inhibitor.

Introduction: Patients with benign or malignant blood disorders, who require allogeneic stem cell transplantation and lack an identical human leukocyte antigen HLA identicalHL sibling donor, could be transplanted with hematopoietic stem cells from unrelated adult or umbilical cord donors. However, in our country, both approaches are costly and time-consuming options. Methods: Over the last few years, haploidentical modalities have been investigated as an alternative donor source, showing similar results to those obtained with identical HLA donors. We started using T-cell-replete haploidentical with post-transplant cyclophosphamide in 2012 and we presented our experience with patients undergoing haploidentical ransplantation compared to SIB. Results: Since January 2012 to date, 91 allogeneic transplants have been performed, of which 49 were haploidentical and 42 were HLA identical. The mean age of the patients was 35 years (range: 17–62). The mean CD34/kg × 106 infused per group was 5.93 and 5.89, respectively. Time to granulocyte and platelet engraftment was 11 and 15 days, respectively, for haploidentical, and 12 and 14 days, respectively, for HLA identical (p = 0.10). The 100-day cumulative incidence of global acute GVHD was 34% for haploidentical and 29% for SIHLA identical (p = 0.9). The 2-year overall global graft-versus-host disease was 43% for haploidentical and 41% for HLA identical (p = 0.8). Overall survival, relapse, and transplant and relapse-related mortality were similar between both groups. Conclusion: Our experience showed that haploidentical has similar outcomes to those obtained with HLA idential and can be performed in our country safely. Keywords: Leukemia, Lymphoma, Haploidentical transplantation

Purpose The aim of this study is to describe the safety and effectiveness of laparoscopic ventral hernia repair with intraperitoneal fascial closure using a barbed suture prior to mesh placement. Materials and methods Patients who underwent laparoscopic ventral hernia repair were included in this retrospective review. Patients were divided into two groups. In the first group, primary fascial closure was performed with a 2-polypropylene non-absorbable unidirectional barbed suture followed by fixation of the intraperitoneal mesh. In the second group, the mesh was fixed intraperitoneally using tacks without closing the fascial defect. Results A total of 148 patients who underwent laparoscopic primary ventral hernia repair were included. A total of 72 (48.6%) patients were included in the barbed suture with mesh group and 76 (51.4%) patients in the mesh-only group. The mean fascial defect size was 25 cm

Obesity can worsen outcomes in patients with chronic respiratory diseases.The objective of the study was to determine the impact of bariatric surgery (BaS) on risk of hospitalization due to acute exacerbation (AE) of chronic obstructive lung diseases (OLDs).Academic, University-affiliated Hospital; United States.Nationwide Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment subjects were defined as patients with a previous history of BaS, and control subjects, as patients with a body mass index ≥35 kg/mWe included a total of 2,300,845 subjects: 2,004,804 controls and 296,041 treatments. Univariate analysis showed that the hospitalization rate was significantly lower for the treatment group than that for the control group (3.7% versus 9.8%, P.0001), confirmed after adjusting for covariates (control versus treatment: odds ratio [OR] = 2.46, P.0001). Subgroup analysis showed that the treatment group had a lower risk of LOS ≥3 days than controls (69.8% versus 77.4%, P.0001), confirmed by multivariate analysis (control versus treatment: OR = 1.40, P.0001).BaS-induced weight loss may decrease the risk of hospitalization due to AE in patients with OLD, also decreasing the LOS. We acknowledge that this comparison is limited by the nature of the database; hence, further prospective studies are needed to better understand these results.

Introduction: Graft-versus-host disease (GVHD) is a serious complication in allogeneic transplantation. The first-line treatment is high doses of corticosteroids. In the absence of response to corticosteroids, several immunosuppressive drugs can be used, but they entail an elevated risk of severe infections. Added to this, there are patients who do not improve on any immunosuppressive treatment, with subsequent deteriorated quality of life and high mortality. Ruxolitinib has been shown to induce responses in refractory patients. In this study we have presented our real-life experience. Methods: A retrospective analysis was performed on patients with severe GVHD refractory to corticosteroids. Demographic, previous treatment, response and mortality data were collected. Results: Since 2014, seventeen patients with GVHD were treated with ruxolitinib due to refractoriness to corticosteroids and immunosuppressants and a few to extracorporeal photopheresis, 8 with acute GVHD (1 pulmonary, 4 cutaneous grade IV and 3 digestive grade IV) and 9 with chronic GHVD (5 cutaneous sclerodermiform, 2 pulmonary and 1 multisystemic). The overall response to ruxolitinib treatment for acute GVHD was 80%, 40% with partial response and 40% with complete remission. Global response in chronic GVHD was 79%. The GVHD mortality was only seen in acute disease and was 40%. Causes of mortality in those patients were severe viral pneumonia, post-transplantation hemophagocytic syndrome and meningeal GVHD refractory to ruxolitinib. Conclusions: In our series, the use of ruxolitinib as a rescue strategy in acute or chronic GVHD was satisfactory. Ruxolitinib treatment in patients with a very poor prognosis showed encouraging results. However, the GVHD mortality remains high in refractory patients, showing that better therapeutic strategies are needed.

In the last 10 years, severe obesity and the associated metabolic syndrome have reached pandemic proportions and consequently have significantly increased the prevalence of related co-morbidities such as chronic kidney disease (CKD). One in 7 people in the United States have CKD, and 90% of those are not aware of it.Following sleeve gastrectomy (SG) in patients with severe obesity and baseline CKD stage ≥2, to determine improvement of glomerular function and analyze the relationship between kidney function and weight loss.US Hospital, Academic Institution.We retrospectively reviewed the charts of all patients who underwent SG at our institution from 2010 to 2019. Kidney function assessment using the Chronic Kidney Disease Epidemiology Collaboration Study (CKD-EPI) equation and classification was carried out preoperatively and postoperatively at 12-months follow-up. Propensity score matching (1:1 ratio) was used to balance the distribution of covariates between patients with a baseline estimated glomerular filtration rate (eGFR)90 mL/min/1.73 mWe calculated the eGFR of 1330 bariatric patients who underwent SG. Of these patients, 18.79% (n = 250) met the criteria for CKD-EPI eGFR calculation preoperatively and at 12-months follow-up after SG. From the 250 patients included in the analysis, 42% (n = 105) were classified as CKD stage ≥2. When comparing the baseline preoperative eGFR at 12-months follow-up after SG, we observed an improvement of 8.26 ± 11.89 mL/min/1.73 mThere is short-term improvement of the eGFR in patients with severe obesity following SG. This improvement is significant in CKD stages ≥2 and seems unrelated to weight loss.

Objetivo: Analizar la funcionalidad y aplicabilidad de la electroencefalografía en el diagnóstico de trastornos psiquiátricos y neurológicos. Método: Revisión sistematizada de artículos por selección de palabras clave en acerbos bibliográficos de alto impacto como PudMed, Web Of Science y LILACS, quedando con una selección final de 14 artículos publicados desde el año 2012 a 2022. Resultados: En los estudios revisados se evidenció la relación de aparición de los diferentes trastornos con alteraciones en los Potenciales Relacionados a Eventos siendo estos P200, P300, P500, así como también N100, N200 y N400. Conclusión: la EEG puede actuar como biomarcador para determinar la presencia de trastornos psiquiátricos y neurológicos, dato que acompaña a un diagnóstico diferencial.

La enfermedad renal crónica es una patología de alto costo, disminuye la calidad de vida, especialmente, la de los pacientes en hemodiálisis, es importante implementar estrategias para reducir su impacto clínico y económico. El ejercicio intradiálisis ha mostrado la reducción en la mortalidad por cualquier causa y mejoría en la calidad de vida. Por medio de esta revisión de la literatura disponible en las bases de datos Pubmed, OVID, VHL, Clinical Key y LILACS, se busca determinar la seguridad del ejercicio intradiálisis, se han revisado las características de la población intervenida, los tipos de intervención y los eventos adversos. Se incluyeron 8 artículos de la búsqueda sistemática y 15 más por búsqueda manual. Se encontró que la población era en su mayoría adulta (con edades entre los 19 a 88 años) y solo un estudio reportó una población más joven (edades entre los 9,1 a 24,2 años); la proporción entre géneros fue similar. Se encontró que la intervención más frecuente fue el ejercicio cardiovascular realizado con sistemas de pedales, de intensidades bajas a moderadas, con una frecuencia de 2 a 3 sesiones semanales durante mínimo 2 meses. Algunos estudios no reportaron efectos adversos, pero los que sí, mencionan complicaciones en el sistema cardiovascular (hipotensión/ hipertensión) y en otras se manifiesta lesiones músculo esqueléticas (poco frecuentes), pero ninguna considerada severa o frecuente. Con la información disponible se concluyó que el ejercicio intrahemodiálisis parece ser una intervención segura. Chronic kidney disease is a high-cost pathology; it has a negative impact on the quality of life, especially in those who underwent hemodialysis. Consequently, it is important to develop strategies to decrease the clinical and economic impact. Intradialytic exercise is a complementary intervention that has shown a decrease in mortality and improvement in the quality of life in these patients. This paper aimed to review the available literature and determine the security of intradialytic exercise, look for population characteristics, training characteristics and the occurrence of adverse effects and their severity. This document is a topic review with a systematic search on Pubmed, OVID, VHL, Clinical Key and LILACS. 8 articles appeared after a keyword search with 15 additional papers discovered by manual research by the authors, the population included adults between 19 and 88 years of age with only 1 paper including a younger population from 9 to 24 years of age. Sex distribution was similar between male and female. Endurance training with a pedal system was the most frequent intervention. The frequency of intervention was 2 to 3 times per week at least for 2 months, and the intensity was low to mild. Some trials mentioned no adverse effect. Those with adverse effects reported cardiovascular alterations (hypotensive/hypertensive episodes), muscular injuries, but none of the adverse effects were considered severe or frequent. With the available information, the authors conclude that intradialytic exercise will be a secure intervention. Key words: exercise therapy – renal dialysis – safety.

Indocyanine green (ICG) angiography is a real-time imaging modality that can be used to assess intraoperative tissue perfusion. ICG dye has proven to be feasible, safe, and cost-effective, especially for muscle flaps during complex reconstructions. To our knowledge, we discuss the first use of ICG angiography for the real-time assessment of a tongue flap following left lateral hemiglossectomy. ICG angiography showed excellent perfusion of the tongue and tongue flap, which subsequently led to an uncomplicated postoperative recovery.

Indocyanine green (ICG) angiography is a procedure that uses a fluorescent dye for a variety of medical diagnostics, including the real-time examination of blood flow in tissue. Herein, we report a case in which ICG angiography was used to assess the viability of a sternocleidomastoid (SCM) muscle flap during post-parotidectomy facial reconstruction. To our knowledge, this is the first report documenting the intraoperative use of ICG for the evaluation of SCM flap perfusion. ICG angiography may prove beneficial for cases involving complex reconstructions and suspected organ hypoperfusion.

Background Obesity is a major risk factor for the development of metabolic syndrome, coronary artery disease, and heart failure (HF). Rapid weight loss following bariatric surgery can significantly improve outcomes for patients with these diseases. Objectives To assess whether bariatric surgery improves ventricular ejection fraction in patients with obesity who have heart failure. Setting Private practice, United States. Methods We conducted a retrospective review of echocardiographic changes in systolic functions in patients with obesity that underwent bariatric surgery at our institution. Patients were divided into 2 groups, those (1) without known preoperative HF and (2) with preoperative HF. We compared the left ventricular ejection fraction (LVEF) before and after bariatric surgery in both groups. Common demographics and co-morbidities were also analyzed. Results A total of 68 patients were included in the analysis: 49 patients in group 1 and 19 in group 2. In group 1, 59.2% (n = 29) of patients were female, versus 57.9% (n = 11) in group 2. The excess body mass index lost at 12 months was 52.06 ± 23.18% for group 1 versus 67.12 ± 19.27% for group 2 (P = .0001). Patients with heart failure showed a significant improvement in LVEF, from 38.79 ± 13.26% before to 48.47 ± 14.57% after bariatric surgery (P = .039). Systolic function in patients from group 1 showed no significant changes (59.90 ± 6.37 mmHg) before and (59.88 ± 7.85 mmHg) after surgery (P = .98). Conclusion Rapid weight loss after bariatric surgery is associated with a considerable increase in LVEF and a significant improvement of systolic function.

Introduction: Currently, severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is a major public health problem worldwide. Although most patients present a mild infection, effective strategies are required for patients who develop the severe disease. Anti-inflammatory treatment with JAK inhibitors has been considered in SARS-CoV-2. Methods: In this study, we presented our experience in a group of severe SARS-CoV-2 Chilean patients. This prospective study was performed on consecutive patients presenting severe respiratory failure owing to COVID-19 or high-risk clinical condition associated with SARS-CoV-2, and who were treated with ruxolitinib for management of associated inflammation. Overall, 18 patients presenting SARS-CoV-2 viral-induced hyperinflammation were treated with ruxolitinib, with 16 patients previously treated with steroids, 4 with tocilizumab, and 3 with both treatments. Results: Ten patients evolved with favorable response, including 7 patients admitted with severe respiratory failure (PaFi less than 200 mm Hg in high-flow nasal cannula), presenting complete regression of hyperinflammation, regression of the lung lesions, and subsequent discharge. In the remaining 8 patients, 25% showed reduced inflammation, but early discharge was not achieved owing to the slow evolution of respiratory failure. Unfortunately, 3 patients demonstrated a severe respiratory failure. The early initiation of ruxolitinib was found to be associated with better clinical evolution (p < 0.005). Conclusion: In this study, ruxolitinib resolved hyperinflammatory state in 55% of the patients, regardless of the previous steroid or tocilizumab therapy. Unfortunately, few patients demonstrated severe evolution despite ruxolitinib therapy. Notably, the treatment starting time appears to play an important role in achieving good outcomes. Further validation in randomized controlled trials is crucial.

Background: In our country, transplantation centers differ in the age limit for allogeneic hematopoietic transplantation (ALOHT). In our program, transplants with age- adjusted conditioning are performed in patients until 70 years old. Currently more than 60% of ALOHT reported to the Center for International Bone Marrow Transplantation Research (CIBMTR) are performed in patients older than 40 years. Aim: To report our experience with ALOHT in acute myelogenous leukemia (AML), analyzing patient age at transplantation in different periods and transplant results in different age groups. Material and Methods: A retrospective analysis of the database of adult hematopoietic transplants in AML patients was performed. Demographic data, disease characteristics, transplant data, survival and relapse times, and mortality were collected. Results: In our program, 1030 transplants were performed in adults and 119 ALOHT were performed in AML patients, between 1990 and 2020. The median age of patients in all periods was 41 years, (range 16-69). The median age was 33 and 45 years, in the periods 1990-2000 and 2000-2020 respectively (p < 0.01). Seventy-eight patients received myeloablative conditioning (median age 44 years) and 41 reduced intensity conditioning (median age 53 years). Five-year overall survival was 44.6% (confidence intervals (CI) 41-48). Non relapse mortality of all periods was 19% (CI 17 - 40%) and relapse rate was 17 % (CI 16-22). No difference in five years overall survival among patients younger than 40, 41 to 50 and over 51 years was observed. Conclusions: Overall Survival, non-relapse mortality and relapse rate were similar in younger and older patients in our program and similar to those previously reported in other centers.

The pathophysiology of the inflammatory profile induced by SARS-COV2 infection has similarities with conditions of immune system activation with cytokine release such as hemophagocytic syndrome and some cases of acute graft-versus-host disease. There are encouraging results of clinical studies, performed with increasingly better methodological quality, supporting the use of targeted and specific anti-inflammatory therapy in selected groups of patients with COVID-19 with severe inflammation. In this review we describe the inflammatory pathophysiology of the disease and the recent findings about its treatment.