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The decision to get involved in the study and practice of medicine is not easy. Within the scientific environment, achieving both professional and personal success requires a strict discipline, where effort becomes an essential part of daily life; in addition, having family support becomes crucial in order for not to lose hope when confronting the different adversities that arise during medical training.To identify families where at least two members belong to the Academia Nacional de Medicina de México (ANMM).A cross-sectional study was carried out to identify families of Mexican doctors where at least two members, consanguineous or in-laws, have been or are ANMM members through a review of 2017 ANMM Directory and personal contact with the different academics.Information on 45 families belonging to the ANMM was collected.From this study, it is possible to show the great influence that some doctors have in their family environment, which makes the study of medicine attractive as a life project.La decisión de involucrarse en el estudio y la práctica de la medicina no es fácil. Dentro del ambiente científico, alcanzar el éxito tanto profesional como personal requiere de una disciplina estricta en donde el esfuerzo se vuelve parte esencial de la vida diaria, además, el tener el apoyo familiar se vuelve un pilar para no perder la ilusión ante las distintas adversidades que se presentan en la formación médica.Identificar a las familias donde mínimo dos miembros pertenecen a la Academia Nacional de Medicina.Se llevó a cabo un estudio transversal para analizar las familias de médicos mexicanos en las que por lo menos dos miembros, consanguíneos o políticos, han sido o son miembros de la Academia Nacional de Medicina de México por medio de la consulta del Directorio de la Academia Nacional de Medicina del año 2017 y el contacto de manera personal con los distintos académicos.Se recolectó información de 45 familias pertenecientes a la Academia Nacional de Medicina de México.A partir de este estudio es posible evidenciar la gran influencia que emiten algunos médicos en su entorno familiar, que hace que el estudio de la medicina sea atractivo como proyecto de vida.

Micro-RNAs (miRNAs) are noncoding, single stranded segments of RNA measuring 19 to 25 nucleotides in length. They play an active role in autoimmune diseases, including multiple sclerosis (MS). These structures have been studied given their implication in the process of diagnosis, disease development, treatment and prognosis of MS. Given the progressive and neurodegenerative nature of MS, miRNAs have been identified as critical mediators and molecular pinpoints of the disease, which poses them as excellent candidates for the obtention of suitable biomarkers and treatment targets. This review condenses recent findings on the role of miRNAs in multiple sclerosis, including their role in MS etiology and molecular mechanisms of the disease, exploitation of miRNAs as diagnostic tools and biomarkers, miRNAs as treatment option or target for MS, and their significance as predictors of disease prognosis.

The results of treatment of adolescents and adults with acute lymphoblastic leukemia (ALL) remain unsatisfactory. Pediatric-inspired treatments seem to be related with better outcomes. 126 adolescent and adult patients with ALL were treated in a 37-year period with a pediatric inspired combined chemotherapy (PICC) schedule, delivered on an outpatient basis and based on the St. Jude´s TOTAL XI pediatric protocol employing vincristine, prednisone, asparaginase, daunorubicin, etoposide, cytarabine, methotrexate, mercaptopurine and triple intrathecal therapy. 80 % of patients were able to receive the initial seven-week period of induction / consolidation fully as outpatients and 77 % achieved a complete remission. In adolescents and young adults (AYAs) the median probability of overall survival (OS) was 44 months, whereas the 5-year OS was 48 %. In adults, the median probability of OS was 24 months, and the 5-year OS was 32 %. Patients with T-cell ALL did significantly worse than those with a B cell phenotype (OS at 5 years 17 versus 40 %, respectively). These figures are better than those informed in our country employing more aggressive, in-hospital schedules such as the hyper-CVAD. We found that, in AYAs and adult patients with ALL, the use of an asparaginase-containing PICC delivered on an outpatient basis renders acceptable results, better than those obtained in similar socioeconomic circumstances employing adult-oriented schedules. Additional studies are needed to assess the usefulness of these PICC treatments in adult individuals with ALL treated in underprivileged circumstances, such as those prevailing in LMIC.

Introduction One important aspect of quality assurance in transplantation relates to the maintenance of central venous access (CVA), especially in outpatient conditions in which patients have a higher degree of activity and manipulation of CVA tends to be more frequent. A comprehensive program oriented to prevent and control complications related to CVA insertion, maintenance and removal is thought to be a highly effective strategy to improve safety outcomes. Methods A retrospective study evaluating complications related to central venous access (CVA) in patients undergoing hematopoietic stem cell transplantation (HSCT) was conducted using electronic medical records (EMR) at our center. Laboratory and radiology reports were collected in order to identify complications related to CVA. Patients from May 2015 to July 2021 were included in the study. As per local protocol, insertion of Mahurkar catheter for cell collection is conducted by an experienced surgeon under general anesthesia on day -3 and after a short-stay (6 hours) in hospital patients are discharged. On day -2, cell collection is accomplished following all cautionary measures and removal of catheter is done on day -1. Maintenance and care of CVA is guided by standardized protocols related to cleaning, manipulation, blood sample collection and removal. All patients signed a consent to participate in the study and the study protocol was approved by Clínica Ruiz IRB. To be considered as statistically significant, results had to display a two-sided p value Results A total of 1088 patients recruited since May 2015 were included in the study. Main indication for auto-HSCT was multiple sclerosis with 1066 (98%), followed by chronic inflammatory demyelinating polyneuropathy with 16 (1.5%) and 5 (0.5%) patients with other autoimmune disorders. Median age of donors was 46 (40 - 54) years. Median dose of CD34 + cells x10 6/kg infused per patient was 7.0 (3.7 - 11.3) and the median of collection events per patient was 1 (1 - 2). Cell collection was accomplished via apheresis in (99.5%) of patients, of those CVA was used as collection site in 998 (92%) patients, while a change for peripheral venous access occurred in 85 (8%) patients, due to different reasons, most frequent being any type of CVA obstruction in 62 (83%) of donors. Pneumothorax occurred in 11 (1.1%) patients in whom CVA was used for collection. All cases were successful managed with pleural drainage and hospital admission longer than 24 hours was required for 3 (27%). Furthermore, catheter-related bloodstream infections were identified in 3 (0.3%) patients whom were admitted and treated with broad-spectrum antibiotics and discharged with no further events. There were no misplacement, thrombotic- nor hemorrhagic-related events in patients with CVA. A multifactorial analysis revealed that relevant factors such as, age, sex and type of disease were not correlated with any type of CVA-related complications. Conclusions We have shown that prevention and control of complications related to CVA at our campuses are highly effective. The proportion of patients experiencing a CVA-related complication was minimal in comparison with other experiences. Disclosures Gomez-Almaguer: Roche: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau; Bristol-Myers-Squibb: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau.

Introduction Several autoimmune disorders such as multiple sclerosis, Stiff man syndrome or chronic inflammatory demyelinating polyneuropathy (CIDP) can benefit from autologous hematopoietic stem cell transplantation (HSCT) due to its immunomodulatory effects at short- and long-term. Here we present the results from the conduction of an outpatient HSCT procedures in 16 patients with CIDP. Methods Prospective study of HSCT in persons with CIDP recruited since 2015. Patients with and without previous immunomodulatory therapy were enrolled and a 3-month wash-out period was recquired; previous or current use of walking support was not a contraindication. All patients signed a consent before starting the study and the study protocol was approved by Clínica Ruiz IRB. Before the conditioning, all participants underwent a comprehensive evaluation. On day -11 and -10, patients received cyclophosphamide (Cy) at 50 mg/kg, followed by a 7-day course of G-CSF previous to cell collection (day -2) through apheresis using a Mahurkar catheter. Then, on day -2 and -1 a second round of Cy at 50 mg/kg was given (Figure 1). Transfusions and antimicrobial prophylaxis were administered per local protocol. Upon hematological recovery (>500 ANC) all patients received a rituximab infusion at 1000 mg. Results Sixteen patients with CIDP underwent screening for transplantation clearance and all of them proceeded to HSCT. Of those, 8 (50%) patients were male. Median age at transplantation was found to be 44 years (SD 10.5). Walking support was employed at the time of HSCT by 7 (44%) patients and most frequent previous therapy was intravenous immunoglobulin in 4 (25%) patients. On average a mean 8.5x10 6/kg (SD 4.2) of CD34 + cells were infused. The mean nadir neutropenia was found to be 0.11x10 9/L (SD 0.13) and the median time of granulocytes recovery was 7.0 days (SD 2.9) while median time of platelet recovery was 5.5 days (SD 3.0). One (6%) patient was admitted to hospital due to febrile neutropenia and 4 (25%) patients required red-blood cell and platelet transfusion support. In 3 of 5 persons the need of walking support reverted. Conclusions Our experience suggests that people with CIDP may undergo HSCT with no major complications on an outpatient basis. Hospital admissions, hematological recovery, and infectious complications seem to be relatively low-severity complications that could be manage with standard protocols. Figure 1 Figure 1. Disclosures Gomez-Almaguer: Bristol-Myers-Squibb: Honoraria, Speakers Bureau; Roche: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau.

The sticky platelet syndrome (SPS) was described by Mammen in 1983. Since then, scientists in several countries have identified the condition and published cases or series of patients, thus enabling the description of the prevalence of the inherited condition, its salient clinical features, and the treatment of the disease. The diagnosis of the SPS phenotype requires fresh blood samples and special equipment which is not available in all coagulation laboratories. In the era of molecular biology, up to now it has not been possible to define a clear association of the SPS phenotype with a specific molecular marker. Some molecular changes which have been described in platelet proteins in some persons with the phenotype of the SPS are here discussed. Nowadays, the SPS phenotype may be considered as a risk factor for thrombosis and most cases of the SPS developing vaso-occlussive episodes are the result of its coexistence with other thrombosis-prone conditions, some of the inherited and some of them acquired, thus leading to the concept of multifactorial thrombophilia. Ignoring all these evidence-based concepts is inappropriate, same as stating that the SPS is a nonentity simply because not all laboratories are endowed with adequate equipment to support the diagnosis.