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Brasó-Maristany F, Palafox M, Monserrat L, Bellet M, Oliveira M, Capelán M, Galván P, Martínez D, Chic N, Viaplana C, Dienstmann R, Nuciforo P, Saura Manich C, Prat A, Serra V. 16P Understanding the biologic determinants of ribociclib efficacy in breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Palafox M, Mina L, Malfettone A, Monserrat L, Rodriguez M, Rodríguez O, Guzmán M, Grueso J, Scaltriti M, Miquel T, Saura C, Capelán M, Gil-Gil M, Llombart Cussac A, Cortés J, Perez Garcia J, Del Campo M, Bellet Ezquerra M, Serra V. 1933MO TransFAL: Establishment of clinical trial-matched luminal breast cancer patient-derived xenografts (PDX) for translational studies. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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An Chiu C, Werge DA, Arab N, Palafox M, Minejima E. 1486. Evaluation of the Impact of Homelessness on Presentation and Outcomes of Gram-Negative Sepsis. Open Forum Infect Dis 2019. [PMCID: PMC6809121 DOI: 10.1093/ofid/ofz360.1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Low socioeconomic status has been shown to contribute to an increase in mortality and intensive care unit (ICU) admission in patients with sepsis. The role of homelessness on outcomes of gram-negative sepsis is currently unknown. The primary objective was to evaluate the impact of homelessness on presentation and outcomes compared with low socio-economic status patients with housing. Methods Single-center, retrospective cohort study of hospitalized adults with Enterobacteriaceae infections between 2015 and 2017. Medical charts were reviewed for pertinent data. Patients were grouped as homeless (H) vs. non-homeless (NH) and compared for patient characteristics, clinical presentation, and course. Primary outcome was 30-day mortality. Secondary outcomes were 30-day re-admission and hospital length of stay (LOS). Results 198 patients were included; 68 in H group vs. 130 in NH group. H group were younger (mean 51 years vs. 57 years, P = 0.01), more likely to be male (71% vs. 37%, P < 0.01) and non-Hispanic White (57% vs. 21%, P < 0.01). Two groups had similar comorbidities, except H group had more liver dysfunction (16% vs. 7%, P = 0.05); however, less heart failure (7% vs. 18%, P = 0.03). H group had a more severe presentation with higher rate of ICU admission (57% vs. 41%, P = 0.04) although initial SOFA score (median 6 vs. 4, P = 0.14) and need for vasopressors (16% vs. 18%, P = 0.19) were similar. Urinary tract infection (37% vs. 45%, P = 0.36) and bacteremia (38% vs. 42%, P = 0.76) were the most common sources. Total antibiotic duration was similar (median 7d, P = 0.61); H group received more empirical vancomycin (16% vs. 7%, P = 0.05) and fluoroquinolones as definitive therapy (13% vs. 8%, P = 0.05). 30d mortality was similar (13% vs. 8%, P = 0.21); however, H group had significantly prolonged LOS by 4d (median 9 days vs. 5 days, P < 0.01) and higher 30 days re-admission (41% vs. 18%, P < 0.01). Conclusion Within a medically underserved population, homeless patients with gram-negative sepsis were younger and had more liver disease compared with patients with housing. As this group had increased utilization of healthcare resources including need for ICU-level care, prolonged LOS, and 30-day re-admission, additional targeted interventions to prevent and optimally treat Enterobacteriaceae infections in homeless patients may be needed. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Chiao An Chiu
- University of Southern California, Cypress, California
| | | | - Niki Arab
- West Coast University, Los Angeles, California
| | | | - Emi Minejima
- University of Southern California, Cypress, California
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Saei A, Palafox M, Benoukraf T, Kumari N, Iyengar P, Bin Adam Isa Z, Yang H, Tam W, Serra V, Eichhorn P. Downregulation of USP28 confers poorer overall survival to melanoma patients and causes resistance to RAF inhibitors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy048.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Saei A, Palafox M, Benoukraf T, Kumari N, Jaynes P, Iyengar P, Charles Richard J, Isa Z, Pang B, Guzman M, Yang H, Tam W, Serra V, Eichhorn P. Loss of USP28 drives resistance to BRAF targeted therapy in melanoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx377.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Palafox M, Herrera M, Bellet M, Arribas J, Saura C, Di Tomaso E, Turner N, Cortés J, Baselga J, Serra V. Identification of CDK4/6-response biomarkers using estrogen receptor-positive breast cancer patient-derived xenografts (PDX). Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61474-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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So L, Lee J, Palafox M, Mallya S, Woxland CG, Arguello M, Truitt ML, Sonenberg N, Ruggero D, Fruman DA. The 4E-BP-eIF4E axis promotes rapamycin-sensitive growth and proliferation in lymphocytes. Sci Signal 2016; 9:ra57. [PMID: 27245614 DOI: 10.1126/scisignal.aad8463] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Rapamycin has been used as a clinical immunosuppressant for many years; however, the molecular basis for its selective effects on lymphocytes remains unclear. We investigated the role of two canonical effectors of the mammalian target of rapamycin (mTOR): ribosomal S6 kinases (S6Ks) and eukaryotic initiation factor 4E (eIF4E)-binding proteins (4E-BPs). S6Ks are thought to regulate cell growth (increase in cell size), and 4E-BPs are thought to control proliferation (increase in cell number), with mTORC1 signaling serving to integrate these processes. However, we found that the 4E-BP-eIF4E signaling axis controlled both the growth and proliferation of lymphocytes, processes for which the S6Ks were dispensable. Furthermore, rapamycin disrupted eIF4E function selectively in lymphocytes, which was due to the increased abundance of 4E-BP2 relative to that of 4E-BP1 in these cells and the greater sensitivity of 4E-BP2 to rapamycin. Together, our findings suggest that the 4E-BP-eIF4E axis is uniquely rapamycin-sensitive in lymphocytes and that this axis promotes clonal expansion of these cells by coordinating growth and proliferation.
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Affiliation(s)
- Lomon So
- Department of Molecular Biology and Biochemistry, and Institute for Immunology, University of California, Irvine, Irvine, CA 92697, USA
| | - Jongdae Lee
- Department of Molecular Biology and Biochemistry, and Institute for Immunology, University of California, Irvine, Irvine, CA 92697, USA. Department of Medicine, University of California, San Diego, San Diego, CA 92103, USA
| | - Miguel Palafox
- Department of Molecular Biology and Biochemistry, and Institute for Immunology, University of California, Irvine, Irvine, CA 92697, USA
| | - Sharmila Mallya
- Department of Molecular Biology and Biochemistry, and Institute for Immunology, University of California, Irvine, Irvine, CA 92697, USA
| | - Chaz G Woxland
- Department of Molecular Biology and Biochemistry, and Institute for Immunology, University of California, Irvine, Irvine, CA 92697, USA
| | - Meztli Arguello
- Department of Biochemistry and Goodman Cancer Research Centre, McGill University, Montreal, Quebec H3A 1A3, Canada
| | - Morgan L Truitt
- School of Medicine and Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Nahum Sonenberg
- Department of Biochemistry and Goodman Cancer Research Centre, McGill University, Montreal, Quebec H3A 1A3, Canada
| | - Davide Ruggero
- School of Medicine and Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA
| | - David A Fruman
- Department of Molecular Biology and Biochemistry, and Institute for Immunology, University of California, Irvine, Irvine, CA 92697, USA.
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Schultess J, Sickinger E, Dhein J, Hausmann M, Smith D, Frias E, Palafox M, Prostko J, Pucci D, Stricker R, Stricker R, Thulliez P, Braun H. P552 Improved performance of the automated toxoplasmosis IgG, IgM & IgG avidity assays on the Abbott ARCHITECT Instrument. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70395-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guiscafré H, Gutiérrez G, Verver H, Palafox M, López A, Martínez H. Quality improvement of integrated child health care management after in-service training for physicians. Fam Pract 2003; 20:74-6. [PMID: 12509375 DOI: 10.1093/fampra/20.1.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the quality of integrated child health care management (ICHCM) promoted by the World Health Organization (WHO) after an in-service training course. METHODS The training was carried out in a rural and an urban health unit and in the paediatric ward of the local reference hospital. Tutorial courses were given to small groups (4-6 students) over a 5-day period (40 h in total). The courses consisted of demonstrations, discussions, analyses, applications and evaluations of the ICHCM (in-service training). The training was evaluated by comparing the quality of ICHCM given by each physician in their work place on three different occasions: 15 days before the course began (pre-course evaluation), 15 days after the course (post-course evaluation) and 6 months after the course had ended (follow-up evaluation). Each physician was observed in each period during his or her consultation with a child under 5 years of age who presented with acute diarrhoea or acute respiratory infection. A series of possible behaviours by physicians was checked against a list of behaviours that would indicate effective training. RESULTS The average grades obtained by the 24 physicians evaluated (pre- and post-course) increased from 74.5 to 96.6 (22.1 points, P < 0.01). Physicians whose baseline grade was <80 had the greatest increases. Their averages grades increased from 68.2 to 91.3 (23.1 points, P < 0.001). The overall change for the whole group was sustained for up to 6 months (post-course 96.6 points and follow-up 90.9 points, P > 0.05). CONCLUSION The quality of ICHCM improved after the in-service training. No additional resources were necessary in the clinical units. This type of training can be extended to other countries or health programmes.
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Affiliation(s)
- Héctor Guiscafré
- Interinstitutional Health Systems Research Group: Mexican Social Security Institute-Ministry of Health and Ministry of Health, Zacatecas, Mexico.
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Guiscafré H, Martínez H, Palafox M, Villa S, Espinosa P, Bojalil R, Gutiérrez G. The impact of a clinical training unit on integrated child health care in Mexico. Bull World Health Organ 2001; 79:434-41. [PMID: 11417039 PMCID: PMC2566412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
This study had two aims: to describe the activities of a clinical training unit set up for the integrated management of sick children, and to evaluate the impact of the unit after its first four years of operation. The training unit was set up in the outpatient ward of a government hospital and was staffed by a paediatrician, a family medicine physician, two nurses and a nutritionist. The staff kept a computerized database for all patients seen and they were supervised once a month. During the first three years, the demand for first-time medical consultation increased by 477% for acute respiratory infections (ARI) and 134% for acute diarrhoea (AD), with an average annual increase of demand for medical care of 125%. Eighty-nine per cent of mothers who took their child for consultation and 85% of mothers who lived in the catchment area and had a deceased child received training on how to recognize alarming signs in a sick child. Fifty-eight per cent of these mothers were evaluated as being properly trained. Eighty-five per cent of primary care physicians who worked for government institutions (n = 350) and 45% of private physicians (n = 90) were also trained in the recognition and proper management of AD and ARI. ARI mortality in children under 1 year of age in the catchment area (which included about 25,000 children under 5 years of age) decreased by 43.2% in three years, while mortality in children under 5 years of age decreased by 38.8%. The corresponding figures for AD mortality reduction were 36.3% and 33.6%. In this same period, 11 clinical research protocols were written. In summary, we learned that a clinical training unit for integrated child care management was an excellent way to offer in-service training for primary health care physicians.
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Affiliation(s)
- H Guiscafré
- Interinstitutional Health Systems Research Group, Mexican Social Security Institute, Ministry of Health, Mexico
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Abstract
OBJECTIVE To evaluate whether sensitivity and specificity of tachypnoea for the diagnosis of pneumonia change with age, nutritional status, or duration of disease. METHODS Diagnostic testing of 110 children with acute respiratory infection, 51 of whom presented with tachypnoea. The gold standard was a chest roentgenogram. Thirty five children had a radiological image of pneumonia; 75 were diagnosed as not having pneumonia. Sensitivity, specificity, and percentage of correct classification of tachypnoea, by itself or in combination with other clinical signs for all children, by age groups, nutritional status, and disease duration were calculated. RESULTS Tachypnoea as the sole clinical sign showed the highest sensitivity (74%) and a specificity of 67%; 69% of cases were classified correctly. Sensitivity was reduced when other clinical signs were combined with tachypnoea, and there was no significant increase in correct classification, although specificity increased to 84%. In children with a disease duration of less than three days, tachypnoea had a lower sensitivity and specificity (55% and 64%, respectively), and a lower percentage of correct classification (62%). In children with low weight for age (< 1 Z-score), tachypnoea had a sensitivity of 83%, a specificity of 48%, and 60% correct classification. Sensitivity and specificity did not vary with age groups. CONCLUSIONS Tachypnoea used as the only clinical sign is useful for identifying pneumonia in children, with no significant variations for age. In children with low weight for age, tachypnoea had higher sensitivity, but lower specificity. However, during the first three days of disease, the sensitivity, specificity, and percentage of correct classification were significantly lower.
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Affiliation(s)
- M Palafox
- Research Unit on Epidemiology and Health Services, Mexican Social Security Institute, Centro Médico Nacional Siglo XXI, Unidad de Congresos, Bloque B, 4o. Piso, Avenida Cuauhtémoc 330, Col. Doctores, Mexico 06725 DF
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Bojalil R, Guiscafré H, Espinosa P, Viniegra L, Martínez H, Palafox M, Gutiérrez G. A clinical training unit for diarrhoea and acute respiratory infections: an intervention for primary health care physicians in Mexico. Bull World Health Organ 1999; 77:936-45. [PMID: 10612890 PMCID: PMC2557759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
In Tlaxcala State, Mexico, we determined that 80% of children who died from diarrhoea or acute respiratory infections (ARI) received medical care before death; in more than 70% of the cases this care was provided by a private physician. Several strategies have been developed to improve physicians' primary health care practices but private practitioners have only rarely been included. The objective of the present study was to evaluate the impact of in-service training on the case management of diarrhoea and ARI among under-5-year-olds provided by private and public primary physicians. The training consisted of a five-day course of in-service practice during which physicians diagnosed and treated sick children attending a centre and conducted clinical discussions of cases under guidance. Each training course was limited to six physicians. Clinical performance was evaluated by observation before and after the courses. The evaluation of diarrhoea case management covered assessment of dehydration, hydration therapy, prescription of antimicrobial and other drugs, advice on diet, and counselling for mothers; that of ARI case management covered diagnosis, decisions on antimicrobial therapy, use of symptomatic drugs, and counselling for mothers. In general the performance of public physicians both before and after the intervention was better than that of private doctors. Most aspects of the case management of children with diarrhoea improved among both groups of physicians after the course; the proportion of private physicians who had five or six correct elements out of six increased from 14% to 37%: for public physicians the corresponding increase was from 53% to 73%. In ARI case management, decisions taken on antimicrobial therapy and symptomatic drug use improved in both groups; the proportion of private physicians with at least three correct elements out of four increased from 13% to 42%, while among public doctors the corresponding increase was from 43% to 78%. Hands-on training courses thus seemed to be effective in improving the practice of physicians in both the private and public sectors.
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Affiliation(s)
- R Bojalil
- Division of Epidemiological and Health Services Investigation, Mexican Social Security Institute, Mexico City, Mexico.
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Bojalil R, Guiscafré H, Espinosa P, Martínez H, Palafox M, Romero G, Gutiérrez G. The quality of private and public primary health care management of children with diarrhoea and acute respiratory infections in Tlaxcala, Mexico. Health Policy Plan 1998; 13:323-31. [PMID: 10187601 DOI: 10.1093/heapol/13.3.323] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In Tlaxcala, Mexico, 80% of the children who died from diarrhoea or acute respiratory infections (ARI) in 1992-1993 received medical care; in more than 70% of cases it was provided by a private general practitioner (GP). The present study evaluated the quality of case management by private and public GPs to children under five years of age with diarrhoea and ARI. During the clinical observation, the treatment and counselling given to the mother were assessed with the WHO guidelines as reference standard. A total of 41 private and 40 public GPs were evaluated for the management of diarrhoea, and 59 private and 40 public GPs for the management of ARI. For diarrhoea, half of the private GPs gave inadequate rehydration therapy, 63% gave incorrect advice on diet, 66% and 49% made an incorrect correct decision in the prescription of antimicrobial and symptomatic drugs, respectively. Public GPs generally performed better in diarrhoea management: 7% gave inadequate rehydration therapy, 13% gave wrong advice on diet, 3% made a wrong decision in the prescription of symptomatic drugs and 28% gave a wrong decision in antimicrobial prescription. In the management of ARI, 66% and 58% of private GPs made a wrong decision in the prescription of antimicrobial and symptomatic drugs, respectively, compared to 30% and 20% of public GPs, respectively. Counselling to the mother given by both private and public GPs was considered inadequate in most cases of diarrhoea and ARI. These results clearly show that private doctors, as important providers of medical care, need to be included in the strategies to improve the quality of care of children with diarrhoea and ARI. Future research needs to address the determinants of the clinical practice of private doctors in countries like Mexico.
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