Eficacia de una estrategia para mejorar los indicadores de calidad del Proceso Asistencial Integrado Diabetes Mellitus 2 en el Centro Avanzado de Diabetes Macarena

Introduction

The assessment of the Diabetes Mellitus 2 Care Process (PAI-DM2) through the assessment tool for the chronic illness’ care models (IEMAC-Diabetes) allows the design of health interventions for the improvement of medical care.

Coverage of the Hospital and Outpatient Information Form (CIHA) using births recorded in the Information System on Live Births (SINASC), Brazil, 2006-2009

The Brazilian Ministry of Health established mandatory completion of the Hospital and Outpatient Information Form (CIHA) in all the country's health services in order to monitor care funded by sources other than the Unified National Health System (SUS). Considering that data quality is essential, this study analyzed coverage of the CIHA in the States and Federal District, taking data from the Information System on Live Births (SINASC) from 2006 to 2009 as the standard. Coverage of the CIHA was low in nearly all of the States, corresponding to fewer than one-fourth of the births recorded in the SINASC, decreasing from 24.4% in 2006 to 19.7% in 2009. There was a wide variation between the States, with the best results in S?o Paulo (71.9% in 2006; 46.4% in 2009), Rio Grande do Sul (35.8% in 2006; 29.5% in 2009), and Santa Catarina (31.6% in 2006; 37.7% in 2009). The other States showed less than 20% coverage. Mechanisms for data collection and use of the CIHA to support decision-making are important for planning and evaluating healthcare.     

Inequalities in health: the value of sex-related indicators

My laboratory has previously shown that the sex differences in tumor incidence in Europe can be related to the female social condition and that the pattern of this relationship varies according to the different historical contexts. In this article, I have extended the study worldwide to all cancer registries, and I present the sex differences in life expectancy at birth. A close link between the health of the populations and socioeconomic and cultural factors was confirmed. The sex-related indicators had a distribution independent from the parent variables cancer incidence and life expectancy; thus, they carry complementary information and provide an additional, sensitive probe for monitoring the health of the populations.     

Granulocyte macrophage colony-stimulating factor as an adjuvant for hepatitis B vaccination: a meta-analysis

The efficacy of granulocyte macrophage colony-stimulating factor (GM-CSF) to enhance the immune response to hepatitis B virus vaccine has been object of several reports. We searched for randomized controlled clinical trials comparing GM-CSF given concomitantly to hepatitis B virus vaccine to vaccine given alone or with placebo. Data on rates of seroconversion (anti-HBs titers >10 IU/ml) from 13 studies (734 subjects) produced combined estimates that favored GM-CSF as compared to controls: rate ratio after a single immunization was 1.54 [95% confidence interval (CI), 1.04-2.27] and 1.20 (95% CI, 1.02-1.42) at the end of the vaccination cycle. Using a logistic approach a significant dose/response effect of GM-CSF was seen. Moreover, in renal failure patients who have responded to the vaccine, GM-CSF increased anti-HBs titers. Our findings suggest that GM-CSF induced a significant effect in terms of response rate and achievement of an earlier seroconversion to the vaccine in the overall populations examined, in renal failure patients and in healthy individuals.     

Comparative growth and toxin profile of cultured Ostreopsis ovata from the Tyrrhenian and Adriatic Seas

Massive blooms of the benthic dinoflagellate Ostreopsis ovata Fukuyo have recently occurred along the whole Italian coastlines, both Tyrrhenian and Adriatic, resulting sometimes in benthonic biocenosis sufferings and, occasionally, in human health problems. In this work, two strains of O. ovata collected in 2006 along the Adriatic and Tyrrhenian coastlines and grown in culture were studied to characterize their growth and toxin profile. The two strains showed different cell volumes, the Adriatic strain being nearly twice bigger than the Tyrrhenian, but they had similar slow growth rates. Liquid chromatography-mass spectrometry (LC-MS) analyses indicated that both strains produce putative palytoxin (pPLTX) and ovatoxin-a (OVTX-a), a palytoxin-like compound presenting 2 oxygen atoms less than palytoxin.Toxin content was determined at the end of the stationary and exponential growth phases and reached the highest value in the Adriatic strain at the end of the stationary phase, with concentrations of 353.3 μg l^?1 for OVTX-a and 30.4 μg l^?1 for pPLTX. Toxin released in the growth medium was also measured and resulted to be the highest at the end of the stationary phase, suggesting that a long lasting bloom could enhance the toxin content in the water and cause toxic effects in people inhaling the aerosol.     

Endocrine dysfunction induced by immune checkpoint inhibitors: Practical recommendations for diagnosis and clinical management

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy. However, because ICIs block coinhibitory molecules on T cells and other immune cells, unleashing them to mediate tumor cell killing, they also can disrupt the maintenance of immunological tolerance to self‐antigens. Compared with chemotherapy, ICIs have a different toxicity profile, especially the occurrence of autoimmune‐like manifestations against multiple organ systems, including endocrine glands, commonly referred to as immune‐related adverse events. The aim of this review was to provide practical recommendations regarding the proper assessment and clinical management related to the new onset of endocrinopathies after the use of ICIs in patients with cancer. Cancer 2018;124:1111‐21. © 2018 American Cancer Society.     

Side reactions in peptide synthesis

During the hydrogenolytic removal of the benzyl ester from the pentapeptide Boc-Asp(OBzl)-Ala-Phe-Ile-Gly-OEt, either with hydrogen gas or ammonium formate in the presence of palladium-on-charcoal as catalyst, variable amounts (5–30%) of an unexpected by-product were always obtained. The compound was eventually identified as Boc-Asc-Ala-Phe-Ile-Gly-OEt (Asc = aminosuccinyl). The application of field desorption mass spectrometry as a diagnostic tool is reported. The study of this side reaction, carried out on the pentapeptide and two other dipeptide models, showed that: 1) palladium-on-charcoal may induce Asc formation; 2) the contemporary presence of the catalyst and a base (even in trace amounts) greatly increases the by-product formation; 3) the side reaction is sequence and solvent dependent; 4) the Asc formation is completely prevented by adding a few equivalents of acetic or formic acid. Some mechanistic considerations are also reported.     

Alternative strategies for carcinogenicity assessment: an efficient and simplified approach based on in vitro mutagenicity and cell transformation assays

The need for tools able to predict chemical carcinogens in less time and at a lower cost in terms of animal lives and money is still a research priority, even after several decades of effort in that direction. Now, new regulatory requirements (e.g. the Registration, Evaluation, Authorisation and Restriction of Chemical substances recently implemented in Europe) have even increased the pressure to develop new tools in this field. Drawbacks of the present testing strategies have come to light again recently especially in view of new requirements in worldwide regulations. Among these are (i) the lack of assays able to identify non-genotoxic carcinogens, (ii) the exaggerated rate of misleading (false) positive results of the in vitro mammalian cell-based short-term mutagenicity tests and (iii) the extremely low sensitivity of in vivo short-term mutagenicity tests. Within this perspective, we analyse the contribution of cell transformation assays (CTAs), and we show that they are a valid complement to tools able to detect DNA-reactive carcinogens. We also show that a tiered strategy, with inexpensive and fast tests in Tier 1 (e.g. the Ames test or structural alerts) and the Syrian hamster embryo CTA in Tier 2, is able to identify up to 90% of carcinogens.     

Stem cell transplantation for the Wiskott-Aldrich syndrome: a single-center experience confirms efficacy of matched unrelated donor transplantation

The treatment of Wiskott-Aldrich syndrome (WAS), a once uniformly fatal disorder, has evolved considerably as the use of hematopoietic stem cell transplant has become more widespread. For the majority of patients who lack an human leukocyte antigen-identical sibling, closely matched unrelated donor bone marrow transplant (MUD BMT) at an early age is an excellent option that nevertheless is not uniformly chosen. We retrospectively analyzed our experience with transplantation in 23 patients with WAS from 1990 to 2005 at the University of Brescia, Italy, of whom 16 received MUD BMT. Myeloablative chemotherapy was well tolerated with median neutrophil engraftment at day 18, and no cases of grade III or IV graft-vs-host disease. Overall survival was very good with 78.2% (18/23) of the whole cohort and 81.2% (13/16) of MUD BMT recipients surviving. Among 18 survivors, full donor engraftment was detected in 12 patients, and stable mixed chimerism in all blood lineages in four patients. Deaths were limited to patients who had received mismatched related BMT or who had severe clinical symptomatology at the time of transplantation, further emphasizing the safety and efficacy of MUD BMT when performed early in the clinical course of WAS.