Fusion imaging for guidance of pulmonary arteriovenous malformation embolisation with minimal radiation and contrast exposure.

Hereditary haemorrhagic telangiectasia is an inherited disorder characterised by vascular dysplasia that leads to the development of arteriovenous malformations. Pulmonary arteriovenous malformations occur in approximately 30% of patients with haemorrhagic telangiectasia. Given the complex characteristics of haemorrhagic telangiectasia lesions, the application of three-dimensional fusion imaging holds significant promise for procedural guidance and decrease in contrast and radiation dosing. We reviewed all patients who underwent transcatheter approach for pulmonary arteriovenous malformation occlusion with fusion image guidance from June 2018 to September 2023 from a single centre. A total of nine cases with haemorrhagic telangiectasia and transcatheter occlusion of pulmonary arteriovenous malformations using fusion imaging were identified. Five (56%) were male, mean age at procedure was 15.7 years (10-28 years) and mean number of pulmonary arteriovenous malformations intervened was three per patient (1-7). Two of the cases were complex repeat embolisations. The mean fluoroscopy time was 40.6 min (10.7-68.8 min), with mean contrast dose of 28.8 mL (11-60 mL; mean of 0.51 mL/kg) and mean radiation dose of 66.3 mGy (25.6-140 mGy; mean of 40.5 mGy/m2). There were no complications reported during the procedures, with no additional interventions necessary. Fusion imaging in pulmonary arteriovenous malformations embolisation for patients with haemorrhagic telangiectasia is feasible and has the potential to reduce contrast and radiation doses. To our knowledge, we describe the lowest radiation and contrast doses per patient using fusion imaging technology reported in the literature to date.

Quality of life in children with infrequent congenital heart defects: cohort study with one-year of follow-up.

BACKGROUND: The evidence regarding patient related outcomes in children with infrequent congenital heart defects (I-CHD) is very limited. We sought to measure quality of life (QoL) in children with I-CHD, and secondarily, to describe QoL changes after one-year of follow-up, self-reported by children and through their caregivers' perspective. METHODS: We assembled a cohort of children diagnosed with an I-CHD in a cardiovascular referral center in Colombia, between August 2016 and September 2018. At baseline and at one-year follow-up, a clinical psychology assessment was performed to establish perception of QoL. The Pediatric Quality of Life Inventory (PedsQL) 4.0 scale was used in both general and cardiac modules for patients and for their caregivers. We used a Mann-Whitney U test to compare scores for general and cardiac modules between patients and caregivers, while a Wilcoxon test was used to compared patients' and caregivers' baseline and follow-up scores. Results are presented as median and interquartile range. RESULTS: To date, QoL evaluation at one-year follow-up has been achieved in 112/157 patients (71%). Self-reported scores in general and cardiac modules were higher than the QoL perceived through their caregivers, both at baseline and after one-year of follow-up. When compared, there was no statistically significant difference in general module scores at baseline between patients (median = 74.4, IQR = 64.1-80.4) and caregivers scores (median = 68.4, IQR = 59.6-83.7), p = 0.296. On the contrary, there was a statistical difference in baseline scores in the cardiac module between patients (median = 79.6, IQR = 69.7-87.4) and caregivers (median = 73.6, IQR = 62.6-84.3), p = 0.019. At one-year of follow-up, scores for the general module between patients (median = 72.8, IQR = 59.2-85.9) and caregivers (median = 69.9, IQR = 58.1-83.7) were not statistically different (p = 0.332). Finally, a significant difference was found for cardiac module scores between patient (median = 75.0, IQR = 67.1-87.1) and caregivers (median = 73.1, IQR = 59.5-83.8), p = 0.034. CONCLUSIONS: QoL in children with I-CHD can be compromised. However, children have a better perception of their QoL when compared with their caregivers' assessments. To provide high-quality care, besides a thorough clinical evaluation, QoL directly elicited by the child should be an essential aspect in the integral management of I-CHD.

Rare breast tumors: Review of the literature.

Breast cancer tumors have different morphological phenotypes and specific histopathological types with particular prognostic and clinical characteristics. The treatment of rare malignant lesions is frequently controversial due to the absence of trials to determine the optimal managements. This review describes the spectrum of rare breast tumors indicating the clinical, epidemiological and treatment characteristics.

Severity and mortality of acute respiratory failure in pediatrics: A prospective multicenter cohort in Bogotá, Colombia.

Background and Aims: Acute respiratory failure (ARF) is the most frequent cause of cardiorespiratory arrest and subsequent death in children worldwide. There have been limited studies regarding ARF in high altitude settings. The aim of this study was to calculate mortality and describe associated factors for severity and mortality in children with ARF. Methods: The study was conducted within a prospective multicentric cohort that evaluated the natural history of pediatric ARF. For this analysis three primary outcomes were studied: mortality, invasive mechanical ventilation, and pediatric intensive care unit (PICU) length of stay. Eligible patients were children older than 1 month and younger than 18 years of age with respiratory difficulty at the time of admission. Patients who developed ARF were followed at the time of ARF, 48 h later, at the time of discharge, and at 30 and 60 days after discharge. It was conducted in the pediatric emergency, in-hospital, and critical-care services in three hospitals in Bogotá, Colombia, from April 2020 to June 2021. Results: Out of a total of 685 eligible patients, 296 developed ARF for a calculated incidence of ARF of 43.2%. Of the ARF group, 90 patients (30.4%) needed orotracheal intubation, for a mean of 9.57 days of ventilation (interquartile range = 3.00-11.5). Incidence of mortality was 6.1% (n = 18). The associated factors for mortality in ARF were a history of a neurologic comorbidity and a higher fraction of inspired oxygen at ARF diagnosis. For PICU length of stay, the associated factors were age between 2 and 5 years of age, exposure to smokers, and respiratory comorbidity. Finally, for mechanical ventilation, the risk factors were obesity and being unstable at admission. Conclusions: ARF is a common cause of morbidity and mortality in children. Understanding the factors associated with greater mortality and severity of ARF might allow earlier recognition and initiation of prompt treatment strategies.

Tricuspid Regurgitation Related to Cardiac Implantable Electronic Devices: An Integrative Review.

The use of cardiac implantable electronic devices, including permanent pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy, has dramatically increased in recent years. The interaction between the device lead and tricuspid valve leaflets is a potential cause of tricuspid regurgitation that in turn has an impact on morbidity and mortality. Echocardiography is necessary to grade tricuspid regurgitation severity. The use of three-dimensional imaging helps determine whether the device lead is interfering with normal leaflet coaptation. Early identification of lead-related tricuspid regurgitation is critical to select the optimal treatment, which may include lead extraction or even tricuspid valve repair or replacement in severe cases. The aims of this review are to provide a thorough assessment of the evidence about lead-associated tricuspid regurgitation and the benefits of using three-dimensional echocardiography with some technical considerations and to propose a treatment algorithm.

Assessment of Placental Extracellular Vesicles-Associated Fas Ligand and TNF-Related Apoptosis-Inducing Ligand in Pregnancies Complicated by Early and Late Onset Preeclampsia.

Preeclampsia (PE) is a hypertensive disorder that affects 2-8% of pregnancies and is one of the main causes of fetal, neonatal, and maternal mortality and morbidity worldwide. Although PE etiology and pathophysiology remain unknown, there is evidence that the hyperactivation of maternal immunity cells against placental cells triggers trophoblast cell apoptosis and death. It has also been reported that placenta-derived extracellular vesicles (EV) carry Fas ligand (FasL) and Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and trigger apoptosis in Jurkat T cells. This study aimed to quantify and compare FasL and TRAIL expression in EV derived from cultures of placenta explants from women with PE (early versus late) and women with uncomplicated pregnancies. Also, the study assessed EV capacity to induce apoptosis in Jurkat T cells. The authors isolated EV from placenta explant cultures, quantified FasL and TRAIL using ELISA, and analyzed EV apoptosis-inducing capability by flow cytometry. Results showed increased FasL and TRAIL in EV derived from placenta of women with PE, and increased EV apoptosis-inducing capability in Jurkat T cells. These results offer supporting evidence that EV FasL and TRAIL play a role in the pathophysiology of PE.

Wide Dissection and Intercostal Vessel Division Allows for Repair of Hypoplastic Aortic Arch Through Thoracotomy.

BACKGROUND: The approach to coarctation of the aorta with hypoplastic aortic arch is controversial. We evaluated the outcomes in patients with coarctation of the aorta with or without hypoplastic aortic arch operated through a posterior left lateral thoracotomy. METHODS: A retrospective cohort of patients with aortic coarctation, who underwent repair between January 2009 and October 2017, was analyzed. Preoperative, postoperative, and echocardiographic characteristics were reviewed. Statistical analysis examined survival, freedom from reintervention, and freedom from recoarctation. RESULTS: In nine years, 389 patients who underwent surgical treatment for coarctation of the aorta were identified; after exclusion criteria and complete echocardiographic reports, 143 patients were analyzed, of which 29 patients had hypoplastic aortic arch. The modification in the extended end-to-end anastomosis technique was a wide dissection and mobilization of the descending aorta that was achieved due to the ligation and division of 3 to 5 intercostal vessels. In both groups, patients were close to one month of age and had a median weight of 3.6 and 3.4 kg for hypoplastic and nonhypoplastic arch, respectively. In postoperative events, there was no statistically significant difference between the groups ( P = .57 for renal failure, P = .057 for transient, nonpermanent neurologic events, P = .496 for sepsis), as for intensive care unit ( P = .502) and total in-hospital stay ( P = .929). There was one case of postoperative mortality in each group and both were associated with noncardiac comorbidities. Regarding survival (log-rank = 0.060), freedom from reintervention (log-rank = 0.073), and freedom from recoarctation (log-rank = 0.568), there was no statistically significant difference between the groups. CONCLUSION: We believe that it is the modified technique that allowed greater mobilization of the aorta and successful repair of hypoplastic arch through thoracotomy, without an increase in paraplegia or other adverse outcomes.

Ethnic difference in risk of toxicity in prostate cancer patients treated with dynamic arc radiation therapy.

AIMS AND BACKGROUND: The objective of this study was to assess the influence of ethnicity on toxicity in patients treated with dynamic arc radiation therapy (ART) for prostate cancer (PC). METHODS: From June 2006 to May 2012, 162 cT1-T3 cN0 cM0 PC patients were treated with ART (primary diagnosis, n = 125; post-prostatectomy/brachytherapy biochemical recurrence, n = 26; adjuvant post-prostatectomy, n = 11) at 2 institutions. Forty-five patients were Latin Americans and 117 were Europeans. The dose prescribed to the prostate ranged between 68 Gy and 81 Gy. RESULTS: The median age was 69 years (range 43-87 years). The median follow-up was 18 months (range 2-74 months). Overall, only 3 patients died, none due to a cancer-related cause. Biochemical recurrence was seen in 7 patients. The rates of acute grade 2 gastrointestinal (GI) and genitourinary (GU) toxicities were 19.7% and 17%, respectively. Only 1 patient experienced acute grade 3 GI toxicity, whereas 11 patients (6.7%) experienced acute grade 3 GU toxicity. Multivariate analysis showed that undergoing whole pelvic lymph node irradiation was associated with a higher grade of acute GI toxicity (OR: 3.46; p = 0.003). In addition, older age was marginally associated with a higher grade of acute GI toxicity (OR: 2.10; p = 0.074). Finally, ethnicity was associated with acute GU toxicity: Europeans had lower-grade toxicity (OR: 0.27; p = 0.001). CONCLUSIONS: Our findings suggest an ethnic difference in GU toxicity for PC patients treated with ART. In addition, we found that ART is associated with a very low risk of severe toxicity and a low recurrence rate.

Phase II trial of 3D-conformal accelerated partial breast irradiation: lessons learned from patients and physicians' evaluation.

INTRODUCTION: The present study prospectively reported both physicians' and patients' assessment for toxicities, cosmetic assessment and patients' satisfaction after 3D-conformal accelerated partial breast irradiation (APBI). MATERIALS AND METHODS: From October 2007 to September 2009, 30 early breast cancer patients were enrolled in a 3D-conformal APBI Phase II trial (40 Gy/10 fractions/5 days). Treatment related toxicities and cosmetic results were assessed by both patients and physicians at each visit (at 1, 2, 6 months, and then every 6 months). Patient satisfaction was also scored. RESULTS: After a median follow-up of 27.7 months, all patients were satisfied with APBI treatment, regardless of cosmetic results or late adverse events. Good/excellent cosmetic results were noticed by 80% of patients versus 92% of cases by radiation oncologists. Breast pain was systematically underestimated by physicians (8-20% vs. 16.6-26.2%; Kappa coefficient KC=0.16-0.44). Grade 1 and 2 fibrosis and/or breast retraction occurred in 7-12% of patients and were overestimated by patients (KC=0.14-0.27). CONCLUSIONS: Present results have shown discrepancies between patient and physician assessments. In addition to the assessment of efficacy and toxicity after 3D-conformal APBI, patients' cosmetic results consideration and satisfaction should be also evaluated.

Problemática jurídica de los estados intersexuales: el caso colombiano / Legal problematic of intersexual states: the Colombian case

En este artículo de reflexión, basado en una investigación, se describe la problemática jurídica planteada por los estados intersexuales en los menores de edad, y cómo la misma centra su discusión en la teoría del consentimiento informado, punto nodal en el que convergen, por un lado, la existencia de un sujeto titular de derechos, y por el otro, el modo en que debe darse la autorización para ciertos tratamientos médicos o quirúrgicos, así como para algunas intervenciones preventivas. Igualmente, se plantea la necesidad de articular el saber jurídico con el de otros campos como la medicina y la bioética, a fin de construir un marco teórico, analítico y práctico que aporte nuevas herramientas e instrumentos para resolver esta problemática. La Corte Constitucional Colombiana, como máximo órgano jurisdiccional, estableció algunos parámetros jurídicos para adoptar decisiones en estos casos pero cada uno de ellos plantea matices y opciones diferentes, y la solución que se pretenda adoptar debe ir dirigida a optimizar el bienestar del paciente.

This is a reflection article based on research. In it, we describe the legal issues raised by intersexual states in minors. Individual rights and the way in which authorization should be given for certain medical and surgical treatments are analyzed in the perspective of the informed consent theory. We emphasize on the need to combine legal, medical, and bioethical knowledge with the aim of building a theoretical and practical framework for approaching this problematic. The Colombian Constitutional Court established certain legal parameters for reaching decisions in cases of children with intersexual states. However, each case poses different challenges and should be approached with the aim of optimizing benefits for the patient.

Incorporación química de la sonda fluorescente FlAsH en la proteína Hha: aplicación al estudio del complejo Hha/H-NS / Chemical incorporation of fluorescent probe flAsH on the Hha protein: application to the study of complex Hha/H-NS

El objetivo de esta investigación fue realizar estudios de incorporación de la sonda FlAsH como posible herramienta para el estudio in vitro e in vivo de la proteína Hha y de su interacción con H-NS. Se construyó una proteína con la secuencia específica “CCPGCC” capaz de unir la sonda fluorescente FlAsH; posteriormente se desarrollaron procesos de transformación, expresión y purificación, con los cuales se evidenció que a pesar de introducir una secuencia adicional no nativa a la proteína, se pudo obtener proteína en buena cantidad, estabilidad, rendimiento y con un alto nivel de pureza. La optimización del protocolo de incorporación del FlAsH se hizo teniendo en cuenta el rendimiento y el tiempo de reacción. El complejo FlAsH/HhaCCPGCC se caracterizó mediante fluorescencia y se comprobó mediante MALDI TOF. La incorporación HhaCCPGCC1/ FlAsH no se obtuvo en un alto porcentaje como se esperaba, por esta razón no se pudieron hacer los estudios de interacción entre el complejo de proteínas Hha y H-NS.

Diseño y construcción de un medidor de la fuerza durante la brazada de natación en estilo libre / Design and construction of a measurer of the force during the stoke in free style swimming

La medición de la fuerza aplicada durante la brazada en estilo libre de natación puede constituirse como herramienta para prevenir las lesiones del hombro en deportistas, para corregir fallas en la rutina de entrenamiento y para mejorar el rendimiento físico del nadador. Sin embargo, la ausencia de investigaciones sobre biomecánica de la natación en Colombia hace difícil el acceso a dispositivos que permitan evaluar, de manera cuantitativa y cualitativa, el desempeño de un nadador. Este proyecto presenta un prototipo para medir la fuerza de la brazada en natación en la modalidad de estilo libre, mediante la implementación de sensores de fuerza localizados en la mano. El prototipo consta de un circuito electrónico para la adquisición de la señal y un software para el procesamiento de la señal. Las pruebas realizadas con el prototipo, en investigaciones preliminares, arrojaron resultados satisfactorios en cuanto al patrón de fuerza aplicado durante la brazada. Es importante resaltar que los sujetos de prueba utilizados en este proyecto fueron sujetos no entrenados, por lo que se espera obtener valores de fuerza más bajos respecto a valores de investigaciones preliminares realizadas por otros grupos de investigación en donde utilizaron sujetos entrenados. Los resultados mostraron patrones similares a los reportados por otros autores en los que se pueden apreciar los picos representativos de las fases de la brazada de la natación en estilo libre

The force measurement during the stroke in freestyle swimming can be established as a tool to prevent shoulder injuries in swimmers, correcting faults in training routines and improving the physical performance of the swimmer. However, the lack of research on swimming biomechanics in Colombia makes it difficult to have access to devices that allow the performance evaluation of a swimmer, both quantitatively and qualitatively. This project involves the development of a prototype that measures the force of the freestyle stroke in swimming through force sensors located at the hand; the prototype consists of an electronic circuit for signal acquisition and a signal processing software. Preliminary research tests made with the prototype yielded satisfactory results regarding force patterns applied at the stroke. It should be noted that test subjects who participated in this project were not trained, so it is expected to obtain lower force values than those obtained by other groups where subjects were trained. The final results contain similar patterns to those reported by other authors in which the peaks represent the phases of the stroke of freestyle swimming

Prolactina en pacientes con trastornos endocrinos y de fertilidad

Se analizan 926 historias clínicas de la consulta externa de las de endocrinología ginecológica e infertilidad para conocer la frecuencia en los niveles de prolactina (PRL) en las pacientes que asistieron al Instituto Materno Infantil de Bogotá en el período del 1§ de enero de 1984 al 31 de marzo de 1989. De los 926 casos se les solicitó PRL a 210 (22.6 por ciento), de estos, 152(72.4 por ciento) reportó niveles normales y elevada mayor de 20 ng/ml en 58 pacientes(27.6 por ciento), distribuidos así; oligomenorrea 16(27.5 por ciento),Amenorrea 2 RIA 11(18.9 por ciento),galactorrea 9 (15.5 por ciento), polimenorrea 8 (13.8 por ciento), amenorrea-galactorrea 4 e infertilidad 4 para (6.8 por ciento). Los niveles de PRL de acuerdo al motivo de consulta presentó los siguientes niveles: amenorrea-galactorrea 225.3 ng/ml, amenorrea IRIA 128.0 ng/ml, oligomenorrea 58.14 ng&ml, galactorrea 53.5ng/ml , polimenorrea 37.5 ng/ml. En los casos de hiperprolactinemia de 21 sillas turcas analizadas 9 (19.3 por ciento) fueron anormales, de 15 campimetrías 4 (26.7 por ciento) presentaron alteraciones y de 9 TAC 3 resultaron con alteración a nivel hipofisiario. La etiología no fue posible determinarla en 39 casos (53.5 por ciento), debida a hipotiroidismo 5 (8.6 por ciento), microadenoma 4 (6.9 por ciento), de origen farmacológico 4 (6.9 por ciento), síndrome de ovario poliquístico 3 (5.2 por ciento),macroadenoma 1 (1.7 por ciento). Recibieron inductores de ovulación. El seguimeinto promedio de las pacientes con tratamiento farmacológico fue de 19.1 meses dismunuyendo los niveles de PRL y mejoría de su disfunción ovárica. Estos resultados confirman que en pacientes con alteraciones del ciclo e infertilidad debe descartarse una hiperprolactinemia