First Transcriptome Analysis of Hepatoblastoma in Brazil: Unraveling the Pivotal Role of Noncoding RNAs and Metabolic Pathways.

Hepatoblastoma stands as the most prevalent liver cancer in the pediatric population. Characterized by a low mutational burden, chromosomal and epigenetic alterations are key drivers of its tumorigenesis. Transcriptome analysis is a powerful tool for unraveling the molecular intricacies of hepatoblastoma, shedding light on the effects of genetic and epigenetic changes on gene expression. In this study conducted in Brazilian patients, an in-depth whole transcriptome analysis was performed on 14 primary hepatoblastomas, compared to control liver tissues. The analysis unveiled 1,492 differentially expressed genes (1,031 upregulated and 461 downregulated), including 920 protein-coding genes (62%). Upregulated biological processes were linked to cell differentiation, signaling, morphogenesis, and development, involving known hepatoblastoma-associated genes (DLK1, MEG3, HDAC2, TET1, HMGA2, DKK1, DKK4), alongside with novel findings (GYNG4, CDH3, and TNFRSF19). Downregulated processes predominantly centered around oxidation and metabolism, affecting amines, nicotinamides, and lipids, featuring novel discoveries like the repression of SYT7, TTC36, THRSP, CCND1, GCK and CAMK2B. Two genes, which displayed a concordant pattern of DNA methylation alteration in their promoter regions and dysregulation in the transcriptome, were further validated by RT-qPCR: the upregulated TNFRSF19, a key gene in the embryonic development, and the repressed THRSP, connected to lipid metabolism. Furthermore, based on protein-protein interaction analysis, we identified genes holding central positions in the network, such as HDAC2, CCND1, GCK, and CAMK2B, among others, that emerged as prime candidates warranting functional validation in future studies. Notably, a significant dysregulation of non-coding RNAs (ncRNAs), predominantly upregulated transcripts, was observed, with 42% of the top 50 highly expressed genes being ncRNAs. An integrative miRNA-mRNA analysis revealed crucial biological processes associated with metabolism, oxidation reactions of lipids and carbohydrates, and methylation-dependent chromatin silencing. In particular, four upregulated miRNAs (miR-186, miR-214, miR-377, and miR-494) played a pivotal role in the network, potentially targeting multiple protein-coding transcripts, including CCND1 and CAMK2B. In summary, our transcriptome analysis highlighted disrupted embryonic development as well as metabolic pathways, particularly those involving lipids, emphasizing the emerging role of ncRNAs as epigenetic regulators in hepatoblastomas. These findings provide insights into the complexity of the hepatoblastoma transcriptome and identify potential targets for future therapeutic interventions.

Primary follicular lymphoma of the duodenum as an incidental finding on upper gastrointestinal endoscopy.

Primary follicular lymphoma of the duodenum (FLD) is a rare variant of follicular lymphoma (FL), which represents only 1-4% of gastrointestinal non-hodgkin lymphomas (NHL). It usually appears in the second portion of the duodenum as micronodular lesions and the diagnosis is often incidental. Unlike other NHLs, the prognosis is excellent and the treatment ranges from "watch and wait" to rituximab-based immunochemotherapy regimens, depending on the symptoms and the presence of systemic involvement.

Association of microscopic colitis and enteropathy due to olmesartan.

We report the case of a patient with severe chronic diarrhea. He was admitted on multiple occasions for this reason, with the cause remaining undetected. After obtaining a detailed medical history and performing several studies, the patient was diagnosed with microscopic colitis and enteropathy due to Olmesartan. In the literature, both diseases appear concurrently only in a few cases. Here we highlight the importance of conducting a comprehensive medical history and maintaining high clinical suspicion to avoid delays in the diagnosis of these uncommon pathologies, as well as unnecessary tests and empirical treatments.

Budget impact analysis of venetoclax for the management of acute myeloid leukemia from the perspective of the social security and the private sector in Argentina.

OBJECTIVE: This study aimed to estimate the budget impact of the incorporation of venetoclax for the treatment of patients with Acute Myeloid Leukemia (AML) over 75 years of age or those with comorbidities and contraindications for the use of intensive chemotherapy, from the perspective of the social security and the private third-party payers in Argentina. METHODS: A budget impact model was adapted to estimate the cost difference between the current scenario (azacitidine, decitabine and low doses of cytarabine) and the new scenario (incorporation of venetoclax) for a third-party payer over a time horizon of three years. Input parameters were obtained from a literature review, validated or complemented by expert opinion using a modified Panel Delphi approach. All direct medical costs were estimated by the micro-costing approach and were expressed in US dollars (USD) as of September 2020 (1 USD = 76.18 Argentine pesos). RESULTS: For a third-party payer with a cohort of 1,000,000 individuals covered, incorporating venetoclax was associated with an average budget impact per-member per-month (PMPM) of $0.11 USD for the social security sector and $0.07 USD for the private sector. The duration of treatment with venetoclax was the most influential parameter in the budget impact results. CONCLUSION: The introduction of venetoclax was associated with a positive and slight budget impact. These findings are informative to support policy decisions aimed to expand the current treatment landscape of AML.

Genetic Ablation of C/EBPα-p300 Pathway Blocks Development of Obese Pregnancy Associated Liver Disorders in Offspring.

BACKGROUND & AIMS: The obesity-associated nonalcoholic fatty liver disease represents a common cause of pediatric liver diseases, including the pediatric liver cancer hepatoblastoma. The mechanisms behind the development of fatty liver in children are not yet known. We examined the role of the C/EBPα-p300 pathway in the development of maternal obesity-associated fatty liver phenotype in offspring. METHODS: Because the ability of C/EBPα to promote fatty liver phenotype is enhanced by CDK4-mediated phosphorylation of C/EBPα at Ser193 and subsequent formation of C/EBPα-p300 complexes, we used wild-type (WT) and C/EBPα-S193D and C/EBPα-S193A mutant mice to study the effects of maternal high-fat diet (HFD) on the liver health of offspring. The females of these mouse lines were fed an HFD before mating, and the pups were further subjected to either an HFD or a normal diet for 12 weeks. RESULTS: WT female mice on the HFD before and during pregnancy and their subsequent offspring on the HFD had severe fatty liver, fibrosis, and an increased rate of liver proliferation. However, the HFD in C/EBPα-S193A mice did not cause development of these disorders. In HFD-HFD treated WT mice, C/EBPα is phosphorylated at Ser193 and forms complexes with p300, which activate expression of genes involved in development of fatty liver, fibrosis, and proliferation. However, S193A-C/EBPα mice do not have complexes of C/EBPα-S193A with p300, leading to a lack of activation of genes of fatty liver, fibrosis, and proliferation. The mutant C/EBPα-S193D mice have accelerated cdk4-dependent pathway and have developed steatosis at early stages. CONCLUSIONS: These studies identified the epigenetic cause of obese pregnancy-associated liver diseases and suggest a potential therapy based on inhibition of cdk4-ph-S193-C/EBPα-p300 pathway.

Impact of First Wave of COVID-19 Pandemic on Mortality at Emergency Department in Older Patients with COVID and Non-COVID Diagnoses.

INTRODUCTION: Mortality in emergency departments (EDs) is not well known. This study aimed to assess the impact of the first-wave pandemic on deaths accounted in the ED of older patients with COVID and non-COVID diseases. METHODS: We used data from the Emergency Department and Elderly Needs (EDEN) cohort (pre-COVID period) and from the EDEN-COVID cohort (COVID period) that included all patients ≥65 years seen in 52 Spanish EDs from April 1 to 7, 2019, and March 30 to April 5, 2020, respectively. We recorded patient characteristics and final destination at ED. We compared older patients in the pre-COVID period, with older patients with non-COVID and with COVID-19. ED-mortality (before discharge or hospitalization) is the prior outcome and is expressed as an adjusted odds ratio (aOR) with 95% interval confidence. RESULTS: We included 23,338 older patients from the pre-COVID period (aged 78.3 [8.1] years), 6,715 patients with non-COVID conditions (aged 78.9 [8.2] years) and 3,055 with COVID (aged 78.3 [8.3] years) from the COVID period. Compared to the older patients, pre-COVID period, patients with non-COVID and with COVID-19 were more often male, referred by a doctor and by ambulance, with more comorbidity and disability, dementia, nursing home, and more risk according to qSOFA, respectively (p < 0.001). Compared to the pre-COVID period, patients with non-COVID and with COVID-19 were more often to be hospitalized from ED (24.8% vs. 44.3% vs. 79.1%) and were more often to die in ED (0.6% vs. 1.2% vs. 2.2%), respectively (p < 0.001). Compared to the pre-COVID period, aOR for age, sex, comorbidity and disability, ED mortality in elderly patients cared in ED during the COVID period was 2.31 (95% confidence interval [CI]: 1.76-3.06), and 3.75 (95% CI: 2.77-5.07) for patients with COVID. By adding the variable qSOFA to the model, such OR were 1.59 (95% CI: 1.11-2.30) and 2.16 (95% CI: 1.47-3.17), respectively. CONCLUSIONS: During the early first pandemic wave of COVID-19, more complex and life-threatening older with COVID and non-COVID diseases were seen compared to the pre-COVID period. In addition, the need for hospitalization and the ED mortality doubled in non-COVID and tripled in COVID diagnosis. This increase in ED mortality is not only explained by the complexity or severity of the elderly patients but also because of the system's overload.

Successful implementation of prophylactic veno-venoarterial extracorporeal membrane oxygenation in high-risk trauma surgery: A case report.

INTRODUCTION: Extracorporeal Membrane Oxygenation (ECMO) is increasingly utilized in trauma care, yet its elective use during high-risk surgeries remains unreported. CASE REPORT: We report a successful instance of prophylactic ECMO support via a Veno-Venoarterial (V-VA) configuration during high-risk surgery in a patient with extensive trauma, including severe thoracic damage and a highly unstable thoracic spine fracture. V-VA ECMO prevented complications such as hemodynamic and respiratory collapse associated with chest compression during the surgical procedure, as the patient should be in a prone position. DISCUSSION: The potential of ECMO as prophylactic support in high-risk surgery amongst trauma patients underscores a novel application of this technology. Complex configurations must be evaluated to avoid associated ECMO complications. CONCLUSION: Our case highlights the potential of prophylactic ECMO hybrid modes, indicating their safe application during high-risk procedures in select trauma patients.

From cultivation to cancer: formation of N-nitrosamines and other carcinogens in smokeless tobacco and their mutagenic implications.

Tobacco use is a major cause of preventable morbidity and mortality globally. Tobacco products, including smokeless tobacco (ST), generally contain tobacco-specific N-nitrosamines (TSNAs), such as N'-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-butanone (NNK), which are potent carcinogens that cause mutations in critical genes in human DNA. This review covers the series of biochemical and chemical transformations, related to TSNAs, leading from tobacco cultivation to cancer initiation. A key aim of this review is to provide a greater understanding of TSNAs: their precursors, the microbial and chemical mechanisms that contribute to their formation in ST, their mutagenicity leading to cancer due to ST use, and potential means of lowering TSNA levels in tobacco products. TSNAs are not present in harvested tobacco but can form due to nitrosating agents reacting with tobacco alkaloids present in tobacco during certain types of curing. TSNAs can also form during or following ST production when certain microorganisms perform nitrate metabolism, with dissimilatory nitrate reductases converting nitrate to nitrite that is then released into tobacco and reacts chemically with tobacco alkaloids. When ST usage occurs, TSNAs are absorbed and metabolized to reactive compounds that form DNA adducts leading to mutations in critical target genes, including the RAS oncogenes and the p53 tumor suppressor gene. DNA repair mechanisms remove most adducts induced by carcinogens, thus preventing many but not all mutations. Lastly, because TSNAs and other agents cause cancer, previously documented strategies for lowering their levels in ST products are discussed, including using tobacco with lower nornicotine levels, pasteurization and other means of eliminating microorganisms, omitting fermentation and fire-curing, refrigerating ST products, and including nitrite scavenging chemicals as ST ingredients.

How much of the Mexican agricultural supply is produced by small farms, and how?

The contribution of small farms to the global food supply is in debate due to lack of empirical evidence. In Mexico, small farms have been relatively important for national food supply due to an agrarian reform in the first half of the 20th century, but their role has been decreasing in the last decades. The aim of this study is to quantify how much small farms produce of the Mexican agricultural supply, and with which farming practices, using the 2019 National Agricultural Survey. The results show that small farms produce 19% of the national agricultural production with similar farming practices to those of medium and large farms. When considering imports and exports, small farms produce 15% of the national agricultural supply. The production of small farms consists mainly of cash crops (e.g. sugar cane, fruits & vegetables, animal products, fodder crops) and, to a lesser extent, staple crops such as maize and beans. The fact that small farms produce one fifth of the national production after decades of governmental support towards large farms suggests that they have resilient production systems. The results of this study support that stronger efforts should be made to enhance the role of small farms in achieving Mexican food sovereignty. This will not only have benefits in terms of food supply but may also have a wide range of social and environmental benefits.

Neurofibromatosis Type I Presenting with Incomplete Ileal Volvulus in a Pediatric Patient.

BACKGROUND Neurofibromatosis 1 is a neurocutaneous disorder with multisystemic manifestations. When patients are lacking overt cutaneous manifestations, diagnosis may be delayed and may complicate diagnosis and management of atypical presentations of this disease. It is thus important to strive to obtain relevant and/or complete history to arrive at the appropriate diagnosis. Furthermore, maintaining an index of suspicion in cases of vague abdominal pain may guide the clinician in establishing the correct diagnosis of mesenteric plexiform neurofibroma in the setting of known/presumed neurofibromatosis 1 patients presenting with acute and/or chronic vague abdominal symptoms. CASE REPORT This is a case of a teenage boy who presented with acute, vague abdominal pain over a period of 2 weeks. Laboratory tests and physical exam findings in primary and secondary care settings were unremarkable, and thus the patient was discharged home only to continue with abdominal pain, thus seeking additional medical care. After admission to our facility and exhaustive history taking, physical examination, and imaging, a prospective diagnosis of neurofibromatosis with mesenteric neurofibroma was made. Upon surgical exploration, a mesenteric mass with corresponding volvulized, ischemic small bowel was removed. Histopathology confirmed a plexiform neurofibroma. The patient recovered adequately and was discharged home without complications. CONCLUSIONS This case highlights the importance of exhaustive history taking to obtain an accurate diagnosis as well as the importance of a high index of clinical suspicion for mesenteric neurofibromatosis in patients with presumed or known neurofibromatosis and presenting with vague abdominal symptoms.

Debilidad neuromuscular del paciente crítico post covid-19: resultados de recuperación funcional en dos centros de tercer nivel / Neuromuscular weakness in the critically post COVID-19 patient: functional recovery results in two third-level Centers

Resumen Introducción : La efectividad de las terapias de reha bilitación física sobre los pacientes que requirieron ven tilación mecánica prolongada y egresaron de Unidad de Cuidados Intensivos (UCI) con debilidad neuromuscular post COVID-19 se conoce principalmente en el perio do agudo. El objetivo de este estudio fue caracterizar la recuperación funcional en personas con debilidad neuromuscular post UCI por COVID-19 admitidas a rehabilitación. Métodos : Estudio retrospectivo que incluyó a 42 pa cientes con debilidad neuromuscular post COVID-19, de dos centros de rehabilitación de tercer nivel, desde abril de 2020 hasta abril de 2022. Resultados : Encontramos diferencias estadísticamen te significativas entre las valoraciones funcionales de ingreso y alta. La Medida de Independencia Funcional (FIM) mejoró de 49 [41-57] a 107 [94-119] (p < 0.001). La escala de Berg de 4 [1-6] a 47 [36-54] (p < 0.001), el test de 6 minutos de 0 [0-0] a 254 [167-400] (p < 0.001), y el test de 10 metros de 0 [0-0] a 0.83 [0.4-1.2] (p < 0.001). No hubo diferencias estadísticamente significativas entre la puntuación total al ingreso y al alta de las evaluaciones funcionales con la edad y la complejidad respiratoria. Discusión : El tratamiento para la recuperación fun cional en un centro de tercer nivel y larga duración, sería beneficioso para personas con grave debilidad neuromuscular post UCI a causa del COVID-19, a pesar que el 43% no alcanzó el nivel de movilidad previo. La edad y la complejidad respiratoria son variables que no impactaron en la recuperación final.

Abstract Introduction : The effectiveness of physical rehabi litation therapies on patients who required prolonged mechanical ventilation and were discharged from the Intensive Care Unit (ICU) with post-COVID-19 neuro muscular weakness is known in the acute period. The objective of this study was to characterize the functional recovery in people hospitalized with post-ICU neuro muscular weakness due to COVID-19 admitted to rehab. Methods : Retrospective study which included 42 patients with post-COVID-19 neuromuscular weakness, who were admitted to two tertiary care rehabilitation centers, from April 2020 to April 2022. Results : We found statistically significant differen ces between the functional evaluations of admission and discharge. The Functional Independence Measure improved from 49 [41-57] a 107 [94-119] (p < 0.001). The Berg scale from 4 [1-6] a 47 [36-54] (p < 0.001), the 6-mi nute test from 0 [0-0] a 254 [167-400] (p < 0.001), and 421 the 10-meter test from 0 [0-0] a 0.83 [0.4-1.2] (p < 0.001). There were no statistically significant differences bet ween the admission and discharge total score of the functional assessments with age and respiratory com plexity. Discussion : Treatment for functional recovery in a tertiary and long-term center is beneficial for people with severe post-ICU neuromuscular weakness due to COVID-19, even though 43% did not reach the previous level of mobility. Age and respiratory complexity are variables that did not impact the final recovery.

Comparison of Central Aortic Pressure between Women with Preeclampsia and Normotensive Postpartum Women from an Urban Region of Western Mexico.

Background and Objectives: Central aortic pressure (CAP) can be measured through noninvasive methods, and CAP wave analysis can provide information about arterial stiffness. The objective of this study was to compare CAP in women with preeclampsia and normotensive postpartum women from an urban region in western Mexico. Materials and Methods: We recruited 78 women in immediate puerperium, including 39 with preeclampsia and 39 with normotension, who received delivery care in our hospital between September 2017 and January 2018. Pulse wave analysis was used to assess central hemodynamics as well as arterial stiffness with an oscillometric device. For this purpose, the measurement of the wave of the left radial artery was obtained with a wrist applanation tonometer and the ascending aortic pressure wave was generated using the accompanying software (V 1.1, Omron, Japan). Additionally, the systolic CAP, diastolic pressure, pulse pressure, heart rate, and rise rate adjusted for a heart rate of 75 bpm were determined. The radial pulse wave was calibrated using the diastolic and mean arterial pressures obtained from the left brachial artery. For all the statistical analyses, we considered p < 0.05 to be significant. Results: The results were as follows: a systolic CAP of 125.40 (SD 15.46) vs. 112.10 (SD 10.12) with p < 0.0001 for women with and without preeclampsia, respectively. Systolic CAP was significantly elevated in women with preeclampsia and could indicate an elevated risk of cardiovascular disease. Conclusion: CAP is an important parameter that can be measured in this group of patients and is significantly elevated in women with postpartum preeclampsia, even when the brachial blood pressure is normal.

[Neuromuscular weakness in the critically post COVID-19 patient: functional recovery results in two third-level centers]. / Debilidad neuromuscular del paciente crítico post COVID-19: resultados de recuperación funcional en dos centros de tercer nivel.

INTRODUCTION: The effectiveness of physical rehabilitation therapies on patients who required prolonged mechanical ventilation and were discharged from the Intensive Care Unit (ICU) with post-COVID-19 neuromuscular weakness is known in the acute period. The objective of this study was to characterize the functional recovery in people hospitalized with post-ICU neuromuscular weakness due to COVID-19 admitted to rehab. METHODS: Retrospective study which included 42 patients with post-COVID-19 neuromuscular weakness, who were admitted to two tertiary care rehabilitation centers, from April 2020 to April 2022. RESULTS: We found statistically significant differences between the functional evaluations of admission and discharge. The Functional Independence Measure improved from 49 [41-57] a 107 [94-119] (p < 0.001). The Berg scale from 4 [1-6] a 47 [36-54] (p < 0.001), the 6-minute test from 0 [0-0] a 254 [167-400] (p < 0.001), and the 10-meter test from 0 [0-0] a 0.83 [0.4-1.2] (p < 0.001). There were no statistically significant differences between the admission and discharge total score of the functional assessments with age and respiratory complexity. DISCUSSION: Treatment for functional recovery in a tertiary and long-term center is beneficial for people with severe post-ICU neuromuscular weakness due to COVID-19, even though 43% did not reach the previous level of mobility. Age and respiratory complexity are variables that did not impact the final recovery.

Introducción: La efectividad de las terapias de rehabilitación física sobre los pacientes que requirieron ventilación mecánica prolongada y egresaron de Unidad de Cuidados Intensivos (UCI) con debilidad neuromuscular post COVID-19 se conoce principalmente en el periodo agudo. El objetivo de este estudio fue caracterizar la recuperación funcional en personas con debilidad neuromuscular post UCI por COVID-19 admitidas a rehabilitación. Métodos: Estudio retrospectivo que incluyó a 42 pacientes con debilidad neuromuscular post COVID-19, de dos centros de rehabilitación de tercer nivel, desde abril de 2020 hasta abril de 2022. Resultados: Encontramos diferencias estadísticamente significativas entre las valoraciones funcionales de ingreso y alta. La Medida de Independencia Funcional (FIM) mejoró de 49 [41-57] a 107 [94-119] (p < 0.001). La escala de Berg de 4 [1-6] a 47 [36-54] (p < 0.001), el test de 6 minutos de 0 [0-0] a 254 [167-400] (p < 0.001), y el test de 10 metros de 0 [0-0] a 0.83 [0.4-1.2] (p < 0.001). No hubo diferencias estadísticamente significativas entre la puntuación total al ingreso y al alta de las evaluaciones funcionales con la edad y la complejidad respiratoria. Discusión: El tratamiento para la recuperación funcional en un centro de tercer nivel y larga duración, sería beneficioso para personas con grave debilidad neuromuscular post UCI a causa del COVID-19, a pesar que el 43% no alcanzó el nivel de movilidad previo. La edad y la complejidad respiratoria son variables que no impactaron en la recuperación final.

Evaluation of the Effects of Atorvastatin and N-Acetyl Cysteine on Platelet Counts in Patients with Primary Immune Thrombocytopenia: An Exploratory Clinical Trial.

Objective: We aimed to evaluate the efficacy of the combination of atorvastatin and N-acetyl cysteine in increasing platelet counts in patients with immune thrombocytopenia who were resistant to steroid therapy or had a relapse after treatment. Material and Methods: The patients included in this study received oral treatment of atorvastatin at a dose of 40 mg daily and N-acetyl cysteine at a dose of 400 mg every 8 h. The desired treatment duration was 12 months, but we included patients who completed at least 1 month of treatment in the analysis. The platelet counts were measured prior to the administration of the study treatment and in the first, third, sixth, and twelfth months of treatment (if available). A p value < 0.05 was considered statistically significant. Results: We included 15 patients who met our inclusion criteria. For the total treatment duration, the global response was 60% (nine patients); eight patients (53.3%) had a complete response and one patient (6.7%) had a partial response. Six patients (40%) were considered as having undergone treatment failure. Of the responder group, five patients maintained a complete response after treatment (55.5%), three patients maintained a partial response (33.3%), and one patient (11.1%) lost their response to the treatment. All of the patients in the responder group had significant increases in their platelet counts after treatment (p < 0.05). Conclusion: This study provides evidence of a possible treatment option for patients with primary immune thrombocytopenia. However, further studies are needed.

Anticoagulación en paciente con síndrome de Lemierre y embolias sépticas pulmonares / Anticoagulation in a patient with Lemierre syndrome and pulmonary septic embolisms

Resumen El síndrome de Lemierre, también denominado trom boflebitis séptica de la vena yugular interna, necrobaci losis o sepsis postanginal es una infección que inicia en el espacio orofaríngeo, se complica con tromboflebitis séptica de la vena yugular interna y metástasis infeccio sas. La rápida progresión a cuadros clínicos graves que comprometen la vida del paciente y su baja frecuencia justifican la divulgación de casos clínicos. Se presenta el caso de una mujer de 27 años de edad, que a las 48 horas de completar el tratamiento con fenoximetilpenicilina por una infección odontógena evolucionó con edema facial y trismus. En la angio-TC de macizo craneofacial se evidenció extenso trombo en la vena yugular interna y en la tomografía computarizada de tórax, embolias sépticas pulmonares. El tratamiento consistió en antibió ticos endovenosos de amplio espectro y anticoagulación de manera precoz.

Abstract Lemierre's syndrome, also called septic thrombo phlebitis of the internal jugular vein, necrobacillosis or postanginal sepsis, is an infection that begins in the oropharyngeal space, is complicated by septic throm bophlebitis of the internal jugular vein and infectious metastases. The rapid progression to serious clinical conditions that compromise the patient's life and its low frequency justify the disclosure of clinical cases. We present the case of a 27-year-old woman who de veloped facial edema and trismus 48 hours after com pleting treatment with phenoxymethylpenicillin for an odontogenic infection. An angio-CT of the craniofacial massif revealed an extensive thrombus in the internal jugular vein and a computed tomography of the chest showed septic pulmonary emboli. Treatment consisted of broad-spectrum intravenous antibiotics and early anticoagulation.

Euro-Burn I: Assessment of burnout syndrome in health workers in a mediterranean country during the SARS-CoV-2 pandemic.

BACKGROUND: Burnout syndrome (BS) has a negative impact among health professionals. AIMS: Our research objective is to quantify the level of burnout in health workers of the Spanish National Health System during the COVID-19 pandemic using and comparing two independent measurement instruments. METHODS: Cross-sectional, descriptive and multicenter study conducted through an anonymous online survey among health workers of the National Health System, measuring the level of burnout using the Maslach Burnout Inventory (MBI) and the Copenhagen Burnout Inventory (CBI). RESULTS: A total of 448 questionnaires were analyzed, the mean age of the participants was 43.53 years (range: 20-64), 365 (81.5%) women. 161 (35.9%) participants presented BS measured with the MBI and 304 (67.9%) measured with the CBI. Regarding work contract, those who had greater job stability presented a higher degree of cynicism with respect to the eventual ones (p = .010), the eventual ones presenting higher mean scores in professional efficacy (p = .034). Urban workers had higher scores of exhaustion (p < .001) and cynicism (p < .001) than those living in rural areas. When comparing both tests, a high predictive value for exhaustion and cynicism was found to measure BS through the CBI (AUC = 0.92 and 0.84, respectively) and a low AUC with respect to the predictive value for efficacy (AUC = 0, 59). CONCLUSIONS: The results obtained show a high level of BS among the health workers who participated in our study. Both tests have an excellent correlation in the degree of exhaustion and cynicism, but not in efficacy. The BS measurement must be performed with at least two validated instruments to increase its reliability.

Crystalline analysis of dental enamel by X-Ray diffraction on pediatric patients with chronic kidney disease.

This study aimed to analyze the crystalline structure of dental enamel in pediatric patients with chronic kidney disease (CKD) by X-ray diffraction (XRD). The six tested samples had a mineral composition similar to hydroxyapatite, according to sheet JCPDS(Joint Committee on Powder Diffraction Standards) card #09-0432, which is normally found in dentine, and presented a lower amount of whitlockites (Ca, Mg)3(PO4)2. Pattern phases showed an increase in organic matter and a decrease in inorganic matter. At an interval of approximately 2θ = 15.7° to 27.2°, amorphous organic matter corresponding to hydrated glucose was found. The hydroxyapatite patterns in this study differed from that of dental enamel found on permanent teeth.

Global shocks, cascading disruptions, and (re-)connections: viewing the COVID-19 pandemic as concurrent natural experiments to understand land system dynamics.

Context: For nearly three years, the COVID-19 pandemic has disrupted human well-being and livelihoods, communities, and economies in myriad ways with consequences for social-ecological systems across the planet. The pandemic represents a global shock in multiple dimensions that has already, and is likely to continue to have, far-reaching effects on land systems and on those depending on them for their livelihoods. Objectives: We focus on the observed effects of the pandemic on landscapes and people composing diverse land systems across the globe. Methods: We highlight the interrelated impacts of the pandemic shock on the economic, health, and mobility dimensions of land systems using six vignettes from different land systems on four continents, analyzed through the lens of socio-ecological resilience and the telecoupling framework. We present preliminary comparative insights gathered through interviews, surveys, key informants, and authors' observations and propose new research avenues for land system scientists. Results: The pandemic's effects have been unevenly distributed, context-specific, and dependent on the multiple connections that link land systems across the globe. Conclusions: We argue that the pandemic presents concurrent "natural experiments" that can advance our understanding of the intricate ways in which global shocks produce direct, indirect, and spillover effects on local and regional landscapes and land systems. These propagating shock effects disrupt existing connections, forge new connections, and re-establish former connections between peoples, landscapes, and land systems. Supplementary Information: The online version contains supplementary material available at 10.1007/s10980-023-01604-2.

[Anticoagulation in a patient with Lemierre syndrome and pulmonary septic embolisms]. / Anticoagulación en paciente con síndrome de Lemierre y embolias sépticas pulmonares.

Lemierre's syndrome, also called septic thrombophlebitis of the internal jugular vein, necrobacillosis or postanginal sepsis, is an infection that begins in the oropharyngeal space, is complicated by septic thrombophlebitis of the internal jugular vein and infectious metastases. The rapid progression to serious clinical conditions that compromise the patient's life and its low frequency justify the disclosure of clinical cases. We present the case of a 27-year-old woman who developed facial edema and trismus 48 hours after completing treatment with phenoxymethylpenicillin for an odontogenic infection. An angio-CT of the craniofacial massif revealed an extensive thrombus in the internal jugular vein and a computed tomography of the chest showed septic pulmonary emboli. Treatment consisted of broad-spectrum intravenous antibiotics and early anticoagulation.

El síndrome de Lemierre, también denominado tromboflebitis séptica de la vena yugular interna, necrobacilosis o sepsis postanginal es una infección que inicia en el espacio orofaríngeo, se complica con tromboflebitis séptica de la vena yugular interna y metástasis infecciosas. La rápida progresión a cuadros clínicos graves que comprometen la vida del paciente y su baja frecuencia justifican la divulgación de casos clínicos. Se presenta el caso de una mujer de 27 años de edad, que a las 48 horas de completar el tratamiento con fenoximetilpenicilina por una infección odontógena evolucionó con edema facial y trismus. En la angio-TC de macizo craneofacial se evidenció extenso trombo en la vena yugular interna y en la tomografía computarizada de tórax, embolias sépticas pulmonares. El tratamiento consistió en antibióticos endovenosos de amplio espectro y anticoagulación de manera precoz.