ABSTRACT Introduction: Acute myeloid leukemia (AML) is most commonly presented in older adults; however, it appears 10 years earlier in Latin American countries. Clinical evolution in older adults from this populations has not been characterized. We analyzed outcomes and survival predictors. Methods: Patients ≥ 55 years old diagnosed with AML at a hematology referral center from 2005 to 2020 receiving intensive chemotherapy (IC), low-dose cytarabine (LDAC) and best supportive care (BSC) were included. Survival analysis included the Kaplan-Meier and Cox models and the cumulative incidence of relapse (CIR). Results: Seventy-five adults were included and the overall survival (OS) was 4.87, 1.67 and 1.16 months, using IC, LDAC and BSC, respectively. The IC led to a higher OS (p < 0.001) and was a protective factor for early death, at a cost of more days spent hospitalized and more non-fatal treatment complications; non-significant differences were found between the LDAC and BSC. Eight (10.7%) patients underwent hematopoietic cell transplantation, with a higher OS (p = 0.013). Twenty (26.7%) patients achieved complete remission; 12 (60%) relapsed with a 6-month CIR of 57.9% in those < 70 years old vs. 86.5% in those ≥ 70 years old, p = 0.034. Multivariate analysis showed the white blood cell count (WBC) and IC had a significant impact on the patient survival, whereas chronological age and the Charlson comorbidity index (CCI) did not. Conclusion: AML in low-middle income countries demands a different approach; the IC improves survival, even with a high incidence of relapse, and should be offered as first-line treatment. Eligibility criteria should include WBC and a multidimensional evaluation. The age per se and the CCI should not be exclusion criteria to consider IC. Introduction (AML however 1 characterized predictors Methods 5 200 202 , (IC) lowdose low dose (LDAC BSC (BSC KaplanMeier Kaplan Meier CIR. . (CIR) Results Seventyfive Seventy five (OS 487 4 87 4.87 167 67 1.6 116 16 1.1 months respectively 0.001 0001 0 001 death nonfatal non fatal complications nonsignificant 10.7% 107 7 (10.7% transplantation 0.013. 0013 0.013 013 0.013) 26.7% 267 26 (26.7% remission 60% 60 (60% 6month month 6 579 57 9 57.9 vs 865 86 86.5 0034 034 0.034 (WBC (CCI Conclusion lowmiddle middle approach firstline first line evaluation 20 (IC (CIR 48 8 4.8 1. 11 0.00 000 00 10.7 (10.7 0.01 01 26.7 2 (26.7 (60 57. 86. 003 03 0.03 4. 0.0 10. (10. 26. (26. (6 0. (10 (26 ( (1 (2

Abstract Introduction and objectives: The adenoma detection rate (ADR) is defined as the presence of at least 1 adenoma in patients ≥ 50 years on a screening colonoscopy. This becomes important due to the association of adenomas and colorectal cancer. It is recommended to have an ADR of 25% in men and women ≥ 50 years. Our goal was to know the ADR of gastroenterology fellows versus attending physicians. Materials and methods: We performed an observational, descriptive, and retrospective study where we reviewed medical records of patients who underwent a colonoscopy in the period of 2 years. Demographic, clinical data and the ADR of fellows and attending physicians were analyzed. Results: We evaluate 363 procedures: Fellows performed 279 and attending physicians performed 84. Polyps were found in 112 patients, and the mean age was 58 years (17-90). The ADR for men and women ≥ 50 years for fellows and attending physicians was 23% versus 31.7% (p = 0.18) respectively. Conclusion: Gastroenterology fellows achieved an ADR slightly below the international standards, with an ADR of 23% among men and women ≥ 50 years, compared to 31.7% of attending physicians.

Resumen Introducción y objetivos: La tasa de detección de adenomas (TDA) es la presencia de al menos 1 adenoma en pacientes ≥ 50 años en colonoscopia de escrutinio. Cobra importancia por la asociación de adenomas con cáncer colorrectal. Se recomienda una TDA de 25% entre hombres y mujeres ≥ 50 años. Nuestro objetivo fue determinar la TDA en residentes de gastroenterología vs profesores. Material y métodos: Desarrollamos un estudio observacional, descriptivo y retrospectivo donde revisamos los expedientes de pacientes con colonoscopia en el periodo de 2 años. Se analizaron los datos demográficos, clínicos y la TDA de residentes vs profesores. Resultados: Evaluamos 363 procedimientos, 279 fueron realizados por residentes y 84 por los profesores. Se encontraron pólipos en 112 pacientes, la media de edad fue 58 años (17-90). La TDA para hombres y mujeres ≥ 50 años para residentes y profesores fue de 23% vs 31.7% (p = 0.18) respectivamente, al dividirlo por género, en hombres fue 27.8% vs 44.8% (p = 0.08) respectivamente, y en mujeres 19.1% vs 20.6% (p = 0.84) respectivamente. Conclusión: Los residentes de gastroenterología mantuvieron una TDA ligeramente menor a los estándares internacionales, con una TDA de 23% entre hombres y mujeres ≥ 50 años, comparado con un 31.7% de los profesores.

ABSTRACT Background: Secondary immune thrombocytopenia (ITP) is a heterogeneous and unpredictable disease associated with various underlying conditions. Objective: The objective of the study was to investigate clinical evolution and chronicity predictors in secondary ITP. Methods: Patients treated at an academic medical center during 2008-2019 were stratified by age as children <16 years and adults >16 years. Responses to steroids, intravenous immunoglobulin G (IVIG), rituximab, and eltrombopag were classified as response (R) and complete response (CR). Risk factors for chronic ITP were determined by multiple regression with uni- and multi-variate analysis. Results: Eighty-three patients were included, 37 children and 46 adults. The most frequent associated conditions were infections 53%, systemic lupus erythematosus (SLE) 24%, thyroid disease 9.6%, and Evans syndrome 3.6%. Response to first-line treatment in the whole cohort was 94%; CR 45.7%; and R 50.6%. Initial response to steroids alone was 91.3% (n = 21/23), rituximab plus high-dose dexamethasone (HDD) 93.3% (n = 14/15); children receiving IVIG alone 100% (n=12/12); and eltrombopag in adults 100% (n = 3/3). Relapse was documented in 19.4% of children and 34% of adults, at a median time of 15 and 2 months, respectively; 30.4% of adults (15.2% from the miscellaneous group, 10.9% SLE-associated, and 4.3% infection-associated) and 18.9% of children followed a chronic course; age ≥10 years and platelets ≥20 × 109/L were risk factors for chronic ITP in children. Conclusion: Evolution was heterogeneous: a better and more sustained response was documented in the infections group compared to SLE or the miscellaneous group. (REV INVEST CLIN. 2021;73(1):31-8)