Abstract: Las hemorragias externas derivadas de los traumas ocasionados por conflictos armados, accidentes viales e incidentes cotidianos son “cada vez más frecuentes y representan el 9% de la mortalidad anual en el mundo, se considera que la hemorragia es responsable del 30 al 40% de estas muertes” (Mejia Mantilla, Puentes Manosalva, Ciro, & Morales , 2009). Lo anterior incentivó al grupo de investigadores a identificar los escenarios de uso y efectividad de agentes hemostáticos disponibles mediante una revisión literaria; Se tomaron en cuenta conceptos claves en inglés y en español para la búsqueda en las bases de datos, tales como Pubmed, Lilacs, Scopus y Science Direct, en los que se hallaron métodos, medicamentos, dispositivos y formas farmacéuticas que son empleados para el control de las hemorragias. En un conglomerado y procesamiento de la información se llevó a cabo una tabla de análisis en Microsoft Excel donde se incluyeron 64 documentos tanto nacionales como internacionales del uso de agente hemostáticos en el entorno civil y militar. Estos fueron clasificados de acuerdo con sus ingredientes activos, tecnología biomédica, mecanismos de acción, efectos hemostáticos, fuente de material, escenarios de uso y efectividad. Se concluyó que definir el ingrediente activo en base a la fuente del material, para un desarrollo futuro de un agente hemostático facilitará su disponibilidad y el acceso, por otra parte la formación y capacitación en el uso de los agentes hemostáticos y la implementación biotecnológica hemostática, podría influir en la facilidad y el acceso a los mismos, estos aspectos podrían contribuir a la reducción la morbimortalidad en pacientes con hemorragias externas

Abstract: The long-term impact of intentional weight loss on cardiovascular events remains unknown. We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention. RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years (n = 626) were randomized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet, physical activity promotion, and behavioral support (IG) or a control group (CG). The primary and secondary outcomes were changes in weight and cardiovascular risk markers, respectively. RESULTS Diet and physical activity changes were in the expected direction, with significant improvements in IG versus CG. After 12 months, IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG (P & lt; 0.001), a mean difference of −2.5 kg (95% CI −3.1 to −1.9). Weight loss ≥5% occurred in 33.7% of IG participants compared with 11.9% in the CG (P & lt; 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL cholesterol, significantly improved in IG participants (P & lt; 0.002). Reductions in insulin resistance, HbA1c, and circulating levels of leptin, interleukin-18, and MCP-1 were greater in IG than CG participants (P & lt; 0.05). IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity, along with triglycerides and HDL cholesterol levels compared with their CG counterparts. CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome, as well as in individuals with or at risk for diabetes.

Abstract: Introduction. The prognosis of patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) is poor. Chimeric antigen receptor (CAR) T-cell therapy is approved for R/R DLBCL (≥3 rd line) in Spain since April 2019, based on data from single-arm phase 2 trials that showed complete response (CR) rates between 40-50% and prolonged remissions in 30-40% of patients. Real-world (RW) data from different countries have shown similar efficacy to pivotal trials, but there are no studies focused on the global Spanish experience, including different constructs with a large number of patients and no comparative studies have been carried out in Spain between commercial CAR-T therapy and the standard treatment of the pre-CAR era. Methods This is a multicenter, retrospective, observational study that included all patients with R/R DLBCL treated with CAR-T therapy who were registered in the GELTAMO/GETH database of patients treated with CAR-T therapy in Spain (n=255). The main objective was to analyze efficacy in terms of response rates and survival and analyze prognostic factors influencing survival. In addition, this cohort was compared with a historical population of R/R DLBCL patients from the GELTAMO-IPI study (Montalbán et al, Br J Haematol 2017), treated in the pre-CAR era (n = 158). From both cohorts, refractory patients according to the Scholar-1 criteria (primary refractoriness, refractoriness to last treatment, or early relapse after autologous stem-cell transplant) were identified and included in the comparative analysis. Results Characteristics of the CAR-T group at diagnosis and at infusion are shown in Table 1. From the 255 patients registered, 13 were excluded due to absence of follow up data and 4 for mantle cell lymphoma histology. Finally, 238 patients were included in the intention-to-treat analysis and 226 received the CAR-T infusion (124 axicabtagene ciloleucel, 101 tisagenlecleucel and 1 lisocabtagenemaraleucel). Median time from official approval to infusion was 60 days (34-363), and median time from apheresis to infusion was 46 days (16-349). Regarding adverse events of special interest, 79% of patients had cytokine release syndrome (7% ≥ grade 3), and 32% of patients had neurotoxicity (13.7% ≥ grade 3). Best response rates after CAR-T infusion were: CR 42%, partial response (PR) 27%, stable disease (SD) 7% and progressive disease (PD) 24%. With a median follow up from infusion of 8 months, median progression-free survival (PFS) was 3.5 months (95% CI: 1.9-5), and median overall survival (OS) was not reached, with a 12-month OS of 53% (95% CI: 45-62); 12-month OS and PFS for patients who achieved CR was 86% (Figure 1) and 78% respectively. Factors influencing PFS and OS in the univariate analysis are shown in table 2. In the multivariate analysis, the factors with independent influence on both PFS and OS were R-IPI and Eastern Cooperative Oncology Group-Performance status (ECOG-PS) pre-CAR, and presence of refractory disease to last treatment, as shown in table 3. Regarding the comparative analysis with the historical cohort, the groups were well balanced, except for age and median follow up (Table 4). The survival for this analysis was calculated since the failure to last treatment. Patients treated with CAR T-cells vs standard of care pre-CAR had significantly better PFS (median of 7.9 vs 5.7 months, p=0.002), and OS (median of 16 vs 9.2, p & lt;0.001). Conclusions: We conclude that efficacy results obtained from RW CAR T-cell therapy in Spain are comparable to the pivotal trials. The results of the comparative analysis suggest that the efficacy of CAR-T therapy in refractory patients is superior to that of the treatments available in the pre-CAR era. Figure 1 Figure 1. Disclosures Bastos-Oreiro: F. Hoffmann-La Roche: Honoraria, Research Funding, Speakers Bureau; Takeda: Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Kite: Speakers Bureau; Gilead: Honoraria; BMS-Celgene: Honoraria, Speakers Bureau. Reguera: Janssen, Kite/Gilead, Novartis: Speakers Bureau; BMS-Celgene, Novartis: Membership on an entity's Board of Directors or advisory committees. Iacoboni: BMS/Celgene, Gilead, Novartis, Janssen, Roche: Honoraria. Corral: Gilead: Consultancy; Novartis: Consultancy; Gileqd: Honoraria. Terol: Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel, Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees, Other: Travel; Roche: Consultancy; Hospital Clinico Valencia: Current Employment; Roche: Membership on an entity's Board of Directors or advisory committees, Other: Travel; Janssen: Membership on an entity's Board of Directors or advisory committees, Other: Travel, Research Funding; BMS: Consultancy; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Travel. Ortiz-Maldonado: Kite, Novartis, BMS, Janssen: Honoraria. Mussetti: Gilead: Other: Unspecified, Research Funding; Novartis: Honoraria, Other: Unspecified; Takeda: Honoraria. Luzardo Henriquez: Kyte/Gilead. Takeda. Roche: Honoraria. Sancho: F. Hoffmann-La Roche Ltd: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers-Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria; Incyte: Membership on an entity's Board of Directors or advisory committees. Salar: Roche: Consultancy, Speakers Bureau; Celgene: Consultancy, Speakers Bureau; Gilead: Research Funding; Janssen: Consultancy, Speakers Bureau. Herrero: Novartis: Consultancy, Honoraria. Sureda: Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Bluebird: Membership on an entity's Board of Directors or advisory committees; Roche: Other: Support for attending meetings and/or travel; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings and/or travel, Research Funding, Speakers Bureau; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Mundipharma: Consultancy; GSK: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Kite, a Gilead Company: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; BMS/Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings and/or travel, Speakers Bureau; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; MSD: Consultancy, Honoraria, Speakers Bureau. Barba: Novartis: Honoraria; BMS: Honoraria; Amgen: Honoraria; Pfizer: Honoraria; Gilead: Honoraria. Kwon: Novartis, Celgene, Gilead, Pfizer: Consultancy, Honoraria. Martin Garcia-Sancho: Celgene: Honoraria, Other: travel; Roche: Consultancy, Honoraria, Other: Travel/Accommodations/Expenses; Celgene/BMS: Consultancy; Janssen: Honoraria, Research Funding; Servier: Consultancy, Honoraria, Other: Travel/Accommodations/Expenses; Gilead: Consultancy, Honoraria; Morphosys: Consultancy; Kyowa Kirin: Consultancy; Clinigen: Consultancy; Eusa Pharma: Consultancy; Novartis: Consultancy; Takeda: Honoraria; Incyte: Consultancy; Kern Pharma: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company).

Abstract: A  Estratégia Nacional de Educação para o Desenvolvimento (PORTUGAL, 2018) acompanha a Agenda 2030 (UNITED NATIONS, 2015), sob o lema “Transformar o nosso mundo, não deixar ninguém para trás”. Uma sociedade que procura soluções para as  problemáticas sociais assume  a Educação para o Desenvolvimento, pela sua prática comprometida com o respeito pelos direitos humanos, contra a discriminação, face a acontecimentos que põem em risco o direito à liberdade, à justiça e à paz, promovendo o desenvolvimento integral. Considerando a estratégia supracitada, foi realizado um estudo no qual se assumiu como objetivo geral conhecer as conceções de estudantes que frequentam cursos na fileira da formação de educadores/professores, sobre diferentes temáticas inscritas na educação para o desenvolvimento, com particular incidência nos direitos humanos e na discriminação. Construiu-se, para o efeito, um questionário com questões abertas e fechadas, sendo os dados objeto de análise quantitativa (Statistical Package for the Social Sciences) e qualitativa (análise de conteúdo). Verifica-se que a maioria dos participantes se identificou com as duas temáticas, destacando contextos formais e não formais, nos quais tomaram contato com as mesmas. Os resultados conduzem ao questionamento sobre o  papel das instituições de ensino superior enquanto promotoras de uma reflexão critíca e participativa sobre aos direitos humanos e a não discriminação. A educação para os direitos humanos é crucial uma vez que todas as pessoas têm responsabilidade na defesa dos seus direitos e dos seus deveres enquanto seres humanos.

Abstract: En el contexto perioperatorio, el daño renal agudo (acute renal injury o AKI) es una complicación frecuente. Por sí mismo, la presencia de AKI se asocia con resultados adversos, tales como mayor riesgo de enfermedad renal crónica (ERC) y de mortalidad. Varios factores de riesgo están asociados con la aparición de AKI perioperatorio e identificarlos es crucial para iniciar medidas de protección renal.  Algunas estrategias renoprotectoras han demostrado ser útiles, otras se encuentran aún en investigación y otras ya no se recomiendan porque son ineficaces o incluso dañinas. La falta de eficacia de estas terapias podría deberse al hecho de que la terapia se inició demasiado tarde. Los nuevos biomarcadores renales permiten identificar el daño renal sin pérdida de función permitiendo así la implementación de medidas preventivas.  El propósito de esta revisión es mostrar un resumen actualizado de la evidencia actual acerca de los factores de riesgo y los mecanismos que nos conducen a la aparición de AKI perioperatorio y en unidad de cuidados críticos así como las diferentes estrategias y tratamientos renoprotectores.