From a predictive standpoint, some reports have linked high tumour mutational burden with response to immune checkpoint blockade, and although a general correlation between tumour PD-L1 expression ...and outcome has been reported, PD-L1 expression has relatively little predictive value in identifying potential responders. Subsequently, microsatellite instability has been proposed to be classified as a European Society for Medical Oncology Scale for Clinical Actionability of Molecular Targets (known as ESCAT) tier IC target is this in squamous cell carcinoma of the head and neck. Because complete response is a rare event (1–5%) in immune checkpoint blockade-treated squamous cell carcinoma of the head and neck, microsatellite instability could be speculated to have a role in the exceptional response observed in the case presented here, especially when comparing the exceptional result observed in case 1 with the relatively poor efficacy observed in case 2, in which the patient had microsatellite stability. In addition to identifying microsatellite instability and tumour mutational burden, comprehensive NGS profiling might also yield useful information about clinically informative or potentially actionable genetic alterations, such as ARID1A, PTEN, and FGFR1 in this case (figure). ...longitudinal assessment of the genomic landscape identifying loss of CBL, acquisition of ASXL1, FGFR1, and SMARCB1 alterations, and increasing allelic frequency of the MSH6 mutation might also provide evolutionary clues to tumour aggressiveness and heterogeneity (appendix p 1).
Introduction. Healthcare-associated infections (IAAS) increase neonatal morbidity and mortality. Identifying the microbiological profile and sensitivity of the microbiota allows us to reduce ...infection rates, rationalize the use of antibiotics and improve neonatal survival. Objectives. To know the environmental microbiota and antimicrobial sensitivity in the Department of Neonatology (DN). Methods. Observational, descriptive, cross-sectional study, carried out between April and May 2021, in the Intensive Care, Intermediate and Immediate Care services of the DN of the Instituto Nacional Materno Perinatal, a reference center for maternal and neonatal care. 144 surfaces were selected from the hospitalized patient environment. Using swabbing technique, samples were obtained and then seeded in common and selective culture media. Sensitivity was determined using Kirby-Bauer diffusion disks, the analysis of variables was performed with SPSS version 22.0 Results. Of 147 samples, 67% gave positive cultures with pathogenic bacteria. In immediate care 50% tested positive, in intermediate care 46.5% and in NICU 39.7%. The 100% contaminated surfaces were fan screens, electroencephalogram monitor, chart holders and scales. Of 41 hands of health personnel, 29.3% were contaminated: 54.5% nursing technicians, 30% doctors and 23% nursing graduates. The isolated germs were SCN (67%) sensitive to vancomycin, Enterococcus (16.5%) sensitive to ampicillin and vancomycin, Pseudomonas (8.2%) to meropenem, Escherichia coli (2.4%) to gentamicin and amikacin, Klebsiella (1.2%). Conclusion. Pathogens causing IAAS were isolated on surfaces in the environment of our patients. The bacterial agents found have high antimicrobial resistance and virulence.
Introducción. Las infecciones asociadas a atención en salud (IAAS) elevan la morbimortalidad neonatal. Identificar el perfil microbiológico y sensibilidad de la microbiota permite disminuir las tasas de infecciones, racionalizar uso de antibióticos y mejorar sobrevida de los neonatos. Objetivos. Conocer la microbiota ambiental y sensibilidad antimicrobiana en el Departamento de Neonatología (DN). Métodos. Estudio observacional, descriptivo, transversal, efectuado entre abril y mayo del 2021, en los servicios de Cuidados intensivos, Intermedios y atención inmediata del DN del Instituto Nacional Materno Perinatal, centro de referencia para atención materno neonatal. Se seleccionaron 144 superficies del entorno del paciente hospitalizado. Mediante técnica de hisopado se obtuvieron y luego sembraron muestras en medios de cultivos comunes y selectivos. Se determinó la sensibilidad usando discos de difusión de Kirby-Bauer, el análisis de variables se realizó con SPSS versión 22.0 Resultados. De 147 muestras, 67% dieron cultivos positivos con bacterias patógenas. De atención inmediata 50% dieron positivos, en intermedios 46.5% y en UCIN 39.7%. Las superficies contaminadas al 100% fueron pantallas de ventiladores, monitor de electroencefalograma, porta historias y balanzas. De 41 manos del personal de salud, 29.3% estuvieron contaminadas; 54.5% técnicas de enfermería, 30% médicos y 23% licenciadas de enfermería. Los gérmenes aislados fueron, Staphylococcus coagulasa negativo (SCN) (67%) sensible a vancomicina, Enterococcus (16.5%) sensible a ampicilina y vancomicina, Pseudomona (8.2%) a meropenem, Escherichia coli (2.4%) a gentamicina y amikacina, y Klebsiella (1.2%). Conclusión. En superficies del entorno de nuestros pacientes, se aislaron agentes patógenos causantes de IAAS. Los agentes bacterianos encontrados presentan elevada resistencia antimicrobiana y virulencia.
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