Diabetes mellitus is associated to high-risk late gadolinium enhancement and worse outcomes in patients with nonischemic dilated cardiomyopathy.

BACKGROUND: Diabetes mellitus (DM) is associated with a worse prognosis in patients with heart failure. Our aim was to analyze the clinical and imaging features of patients with DM and their association with outcomes in comparison to nondiabetic patients in a cohort of patients with nonischemic dilated cardiomyopathy (DCM). METHODS: This is a prospective cohort study of patients with DCM evaluated in a tertiary care center from 2018 to 2021. Transthoracic echocardiography and cardiac magnetic resonance findings were assessed. A high-risk late gadolinium enhancement (LGE) pattern was defined as epicardial, transmural, or septal plus free-wall. The primary outcome was a composite of heart failure hospitalizations and all-cause mortality. Multivariable analyses were performed to evaluate the impact of DM on outcomes. RESULTS: We studied 192 patients, of which 51 (26.6%) had DM. The median left ventricular ejection fraction was 30%, and 106 (55.2%) had LGE. No significant differences were found in systolic function parameters between patients with and without DM. E/e values were higher (15 vs. 11.9, p = 0.025), and both LGE (68.6% vs. 50.4%; p = 0.025) and a high-risk LGE pattern (31.4% vs. 18.5%; p = 0.047) were more frequently found in patients with DM. The primary outcome occurred more frequently in diabetic patients (41.2% vs. 23.6%, p = 0.017). DM was an independent predictor of outcomes (OR 2.01; p = 0.049) and of LGE presence (OR 2.15; p = 0.048) in the multivariable analysis. Patients with both DM and LGE had the highest risk of events (HR 3.1; p = 0.003). CONCLUSION: DM is related to a higher presence of LGE in DCM patients and is an independent predictor of outcomes. Patients with DM and LGE had a threefold risk of events. A multimodality imaging approach allows better risk stratification of these patients and may influence therapeutic options.

Coronary microvascular dysfunction is associated with impaired cognitive function: the Cerebral-Coronary Connection study (C3 study).

BACKGROUND: It remains unknown whether the presence of coronary microcirculatory dysfunction (CMD) correlates with its equivalent condition in the brain, cerebral small vessel disease (CSVD). The cerebral-coronary connection (C3), a prospective blinded study, investigated the prevalence of CMD in patients with coronary artery disease (CAD) and its association with CSVD and cognitive function. METHODS AND RESULTS: Patients with documented CAD fulfilling inclusion criteria underwent physiological assessment of epicardial vessels and the microcirculation using intracoronary pressure and Doppler. Coronary microcirculation-related indices included coronary flow reserve (CFR) and hyperaemic microvascular resistance. Brain magnetic resonance imaging, transcranial Doppler (TCD), and neurocognitive examination were performed. Overall, 67 patients were included in the study (mean age 66 years, 73% female). Patients with abnormal CFR (<2.0) (55.2%) showed higher burden of white-matter hyperintensities: 43.2 vs. 20.0% (P = 0.044). After statistical adjustment, low CFR was associated with lower grey matter volume (P = 0.024) and with parameters of white-matter microstructural damage in diffusion-tensor imaging (lower fractional anisotropy and higher mean diffusivity, P = 0.029 and P = 0.032, respectively). Low CFR was associated with higher resistive (P = 0.027) and pulsatility (P = 0.043) values on TCD, and worse neurocognitive test scores (lower mini mental state examination, P = 0.025, and slower Trail Making Test A, P = 0.034). CONCLUSIONS: Coronary microcirculatory dysfunction is frequent in patients with CAD and correlates with CSVD, abnormal cerebral flow haemodynamics, and significant cognitive impairment. These findings support the hypothesis that microvascular dysfunction in the heart and the brain are part of a single pathological process affecting microcirculation in patients with CAD. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT04131075.

Characterization of substrate specificity and inhibitory mechanism of bile salt hydrolase from Lactobacillus reuteri CRL 1098 using molecular docking analysis.

OBJECTIVES: To elucidate the molecular mechanisms involved in the substrate interaction of the bile salt hydrolase of Lactobacillus reuteri CRL 1098 (LrBSH) with bile acids (BAs) and to evaluate potential enzyme inhibitors based on computer and in vitro modeling assays. RESULTS: Asp19, Asn79, and Asn171 participated in the LrBSH interaction with all BAs tested while Leu56 and Glu 222 played an important role in the interaction with glyco- and tauro-conjugated BAs, respectively. A great percentage of hydrophobic and polar interactions were responsible for the binding of LrBSH with glyco- and tauro-conjugated BAs, respectively. Remarkably, the four binding pocket loops participated in the substrate binding site of LrBSH unlike most of the reported BSHs. Inhibition assays showed that ascorbic acid, citric acid, penicillin G, and ciprofloxacin decreased LrBSH activity by 47.1%, 40.14%, 28.8%, and 9%, respectively. Docking analysis revealed that tetracycline and caffeic acid phenethyl ester had the low binding energy (-7.32 and -7.19 kcal/mol, respectively) and resembled the interaction pattern of GDCA (-6.88 kcal/mol) while penicillin (-6.25 kcal/mol) and ascorbic acid (-5.98 kcal/mol) interacted at a longer distance. CONCLUSION: This study helps to delve into the molecular mechanisms involved in the recognition of substrates and potential inhibitors of LrBSH.

Antifungal and antimycotoxigenic effect of Lactobacillus plantarum CRL 778 at different water activity values.

Ochratoxin A (OTA) is a mycotoxin produced by filamentous fungi with high impact in food safety due to its toxicity. In the last decade, the presence of OTA was widely reported in different foods. In this study, the ability of Lactobacillus (L.) plantarum CRL 778 to control growth and OTA production by Aspergillus (A.) niger 13D strain, at different water activity (aw) values (0.955, 0.964, 0.971, 0.982, and 0.995) was determined in vitro. Both parameters were significantly (p<0.05) reduced by the lactobacilli and the effect depended on aw. Greatest growth rate inhibition (46.9%) was obtained at aw=0.995, which is the most suitable value for growth and production of antifungal metabolites (lactic acid, acetic acid, phenyllactic and hydroxyl-phenyllactic acids) by L. plantarum CRL 778. Besides, morphological changes and inhibition of melanin synthesis were observed in colonies of A. niger 13D in presence of L. plantarum CRL 778 at aw ranged between 0.971 and 0.995. In addition, maximum reduction (90%) of OTA production took place at aw=0.971, while inhibition of fungi growth was more evident at aw=0.995. These findings suggest that L. plantarum CRL 778 could be used for control of ochratoxigenic fungal growth and OTA contamination in different fermented foods with aw values between 0.971 and 0.995.

Effects of Lysozyme on the Activity of Ionic of Fluoroquinolone Species.

Fluoroquinolones (FQs) constitute an important class of biologically active broad-spectrum antibacterial drugs that are which are in contact with many biological fluids under different acidity conditions. We studied the reactivity of ciprofloxacin (Cpx) and levofloxacin (Lev) and their interaction with lysozyme (Lyz) at different pH values, using UV-visible absorption, fluorescence, infrared spectroscopies supported by DFT calculation and docking. In addition, by antimicrobial assays, the biological consequences of the interaction were evaluated. DFT calculation predicted that the FQ cationic species present at acid pH have lower stabilization energies, with an electric charge rearrangement because of their interactions with solvent molecules. NBO and frontier orbital calculations evidenced the role of two charged centers, NH2⁺ and COO-, for interactions by electronic delocalization effects. Both FQs bind to Lyz via a static quenching with a higher interaction in neutral medium. The interaction induces a structural rearrangement in ß-sheet content while in basic pH a protective effect against the denaturation of Lyz was inferred. The analysis of thermodynamic parameters and docking showed that hydrophobic, electrostatic forces and hydrogen bond are the responsible of Cpx-Lyz and Lev-Lyz associations. Antimicrobial assays evidenced an antagonist effect of Lyz in acid medium while in neutral medium the FQs' activities were not modified by Lyz.

Lactic Acid Fermentation Improved Textural Behaviour, Phenolic Compounds and Antioxidant Activity of Chia (Salvia hispanica L.) Dough.

In this work, autochthonous lactic acid bacteria (LAB) were isolated from chia (Salvia hispanica L.) dough and selected on the basis of the kinetics of acidification and proteolytic activity. Strain no. C8, identified as Lactobacillus plantarum C8, was selected and used as starter to obtain chia sourdough. Lactic acid fermentation increased the organic acid mass fractions (lactic, acetic and phenyl lactic acids to 12.3 g, 1.0 g and 23.8 µg per kg of dough respectively), and antioxidant activities, which increased by approx. 33-40% compared to unfermented chia flour dough. In addition, total phenolic content increased 25% and its composition was strongly modified after 24 h of fermentation by L. plantarum C8. Chlorogenic acid was only found in the fermented dough (2.5 mg/g), while ferulic acid was detected from the beginning of fermentation, being 32% higher in chia sourdough (5.6 mg/g). The use of fermented chia sourdough improved the overall characteristics of white bread, including physical (e.g. reduced hardness and chewiness of the crumb) and antioxidant properties (25% on average), compared to the white bread. These results indicate that the use of chia sourdough could be a promising alternative to improve the technological and antioxidant properties of wheat bread. In addition, this work has shown, for the first time, that lactic acid bacterium is able to ferment chia dough, improving its overall characteristics.

Recent Advances in the Understanding of Stress Resistance Mechanisms in Probiotics: Relevance for the Design of Functional Food Systems.

In recent years, more and more scientific community, food producers, and food industry show increased interest in functional foods containing probiotics, which is a big challenge. The consumption of probiotics in the context of a balanced diet through the consumption of functional foods or through the intake of pharmaceutical preparations has proven to contribute to the improvement of human health, even contributing to the prevention of diseases. In order for probiotics to be considered suitable for consumption, they must contain a minimum concentration of viable cells, namely, at least 107 colony forming units of beneficial microbes per gram. Ensuring the viability of bacterial cells until the moment of consumption is the overriding priority of functional probiotic food manufacturers. Probiotic bacteria are subject to stress conditions not only during food manufacturing but also during gastrointestinal passage, which limit or even compromise their functionality. This paper first examines all the stressful conditions faced by probiotic cells in their production stages and related to the conditions present in the bioreactor fermentation and drying processes as well as factors related to the food matrix and storage. The stress situations faced by probiotic microorganisms during the gastrointestinal transit especially during stomach and intestinal residence are also analyzed. In order to understand the adaptation mechanisms of probiotic bacteria to gastrointestinal stress, intrinsic and adaptive mechanisms identified in probiotic strains in response to acid stress and to bile and bile acid stress are analyzed. In addition, improvement strategies for multiple stress tolerance of lactic acid bacteria through directions dealing with stress, accumulation of metabolites, use of protectants, and regulation of technological parameters are examined. Finally, the definition of postbiotics, inanimate microorganisms and/or their components conferring health benefits, is also introduced. Postbiotics include cell lysates, enzymes, and cell wall fragments derived from probiotic bacteria and may represent an alternative to the use of probiotics, when they do not tolerate stressful conditions.

Relationship between bile salt hydrolase activity, changes in the internal pH and tolerance to bile acids in lactic acid bacteria.

The effect of the conjugated bile acid (BA) on the microbial internal pH (pHin) values in lactic acid bacteria with and without ability to hydrolyze bile salts (BSH[+] and BSH[-] strains, respectively) was evaluated. BSH(+) strains showed a gradual increase in the pHin following the addition of conjugated BA; this behavior was more pronounced with GDCA than with TDCA may be due to the higher affinity of BSH for the glyco-conjugates acids. Conversely, the BSH(-) strains showed a decrease in internal pH probably as a consequence of weak acid accumulation. As expected, a decrease in the cytoplasmatic pH affected the cell survival in this last group of strains, while the BSH(+) strains were more resistant to the toxic effect of BA. PURPOSE OF WORK: To evaluate bile salt hydrolase activities, changes in the internal pH and cell survival to bile acids in lactic acid bacteria to establish the relationship between these parameters.

Low-dose Radiation Therapy in the Management of COVID-19 Pneumonia (LOWRAD-Cov19). Final results of a prospective phase I-II trial.

BACKGROUND AND PURPOSE: To evaluate the results of low-dose radiation therapy (LD-RT) to lungs in the management of patients with COVID-19 pneumonia. MATERIAL AND METHODS: We conducted a prospective phase I-II trial enrolling COVID-19 patients ≥50 years-old, with bilateral lung involvement at imaging study and oxygen requirement (oxygen saturation ≤93% on room air). Patients received 1 Gy to whole lungs in a single fraction. Primary outcome was a radiological response assessed as severity and extension scores at days +3 and +7. Secondary outcomes were toxicity (CTCAE v5.0), days of hospitalization, changes in inflammatory blood parameters (ferritin, lymphocytes, C-reactive protein, d-dimer and LDH) and SatO2/FiO2 index (SAFI), at day +3 and +7. Descriptive analyses were summarized as means with standard deviation (SD) and/or medians with interquartile ranges (IQR). A Wilcoxon sign rank test for paired data was used to assess the CT scores and Chi Square was used to assess for comparison of categorical variables. RESULTS: Forty-one patients were included. Median age was 71 (IQR 60-84). Eighteen patients (44%) previously received an anti-COVID treatment (tocilizumab, lopinavir/ritonavir, remdesivir) and thirty-two patients (84%) received steroids during LD-RT. The extension score improved significantly (p = 0.02) on day +7. Mean baseline extension score was 13.7 (SD ± 4.9) with a score of 12.2 (±5.2) at day 3, and 12.4 ± 4.7 at day 7. No differences were found in the severity score. SAFI improved significantly on day +3 and +7 (p < 0.01). Median SAFI on day 0 was 147 (IQR 118-264), 230 (IQR 120-343) on day +3 and 293 (IQR 121-353) on day +7. Significant decrease was found in C-reactive protein on day +7 (p = 0.02) and in lymphocytes counts on day +3 and +7 (p = 0.02). The median number of days in hospital after RT was 11 (range 4-78). With a median follow-up of 60 days after LD-RT, 26 (63%) patients were discharged, 11 (27%) died because of COVID respiratory failure and 4 (10%) died of other causes. CONCLUSIONS: LD-RT is a feasible and well-tolerated treatment that could lead to rapid clinical improvement. Large randomized trials would be required to establish the efficacy of LD-RT to treat COVID-19 pneumonia.

Efflux of bile acids in Lactobacillus reuteri is mediated by ATP.

PURPOSE OF WORK: To study whether an active bile acid (BA) efflux occurs in Lactobacillus reuteri CRL 1098 as well as the nature (ATP or proton motive force [PMF] mediated primary transport) of the BA extrusion mechanism. BAs are powerful detergents which disorganize the lipid bilayer structure of cellular membranes. Specific bile resistance mechanisms (bile efflux, bile salt hydrolysis, and intrinsic architecture and composition of cell membrane the most prevalent) have been described in intestinal bacteria. L. reuteri, showed a significant degree of resistance to the toxic action of BA and the presence of an active efflux ATP-dependent of conjugated (taurocholic [TCA]) and free (cholic [CA]) BA in the CRL 1098 strain is now reported. However, due the high pKa (5.5) of cholic acid (CA) compared with the conjugated species, a significant fraction (between 35 and 50% at pH 6.5 and 5.2, respectively) of free BA also diffused passively, even in the absence of ATP. To our knowledge, our results represent the first evidence of ATP as the energy source involved in the BA extrusion in L. reuteri.

Application of fluorescent techniques to evaluate the survival of probiotic lactobacilli to bile acid.

PURPOSE OF WORK: To apply a fluorescent dye as an alternative technique to evaluate the survival of potentially probiotic lactobacilli to bile acids (BA) as first step in the design of probiotic functional foods. The use of lactic acid bacteria (LAB) in the functional food design depends on their ability to survive in the gastrointestinal tract where bile is an important natural barrier. Bile is mainly constituted by conjugated BA, which can be hydrolyzed to free BA and taurine or glycine. Changes in the transmembrane electrical potential (ΔΨ) of probiotic LAB strains due to the effect of conjugated and free BA were measured and showed that the majority of the tested LAB strains had greater sensibility to free BA than to their respective conjugated acids. Variations in the ΔΨ of the microorganism correlated well with bacterial viability determined by standard plate count method. We therefore propose the DiSC(3)-based fluorescent technique as a rapid and effective method to evaluate the resistance of probiotic lactobacilli to bile as first step for strain selection to be included in functional foods.

[Lymphocutaneous sporotrichosis in a pediatric patient, a case report]. / Esporotricosis linfocutánea en un paciente pediátrico, a propósito de un caso.

Sporotrichosis is a subacute-chronic fungal infection caused by dimorphic fungi of the Sporothrix schenckii Complex. It is more common in tropical areas. The prevalence in Argentina is estimated between 0.01 and 0.02%. In half of the patients it manifests as lymphocutaneous sporotrichosis, which occurs after inoculation of the fungus into the skin after minor trauma. The initial lesion is a papule or nodule that occurs with the appearance of an ascending chain of mobile, painless and erythematous subcutaneous nodules. The diagnosis is made from mycological culture. The antifungal of choice is itraconazole and the prognosis is usually favorable. We present the case of a healthy 4-year-old girl who consulted for subacute axillary lymphadenopathy without response to multiple antimicrobial regimens, arriving at the diagnosis of lymphocutaneous sporotrichosis from the culture of a lymph node biopsy sample.

Complete Spontaneous Regression of Lung Metastases after Resection of CIC-Rearranged Sarcoma: A Case Report.

The vast majority of patients with soft tissue sarcomas (STS) of the trunk and bilateral lung metastases at diagnosis are considered incurable. These tumors have poor prognosis as only a palliative therapeutic approach can be offered to patients. We report on an extremely rare case in which bilateral lung metastases disappeared spontaneously following surgical resection of the primary CIC-rearranged sarcoma with no addition of chemotherapy or any other systemic therapy. A 53-year-old female presented with a rapidly swelling mass on her back. A magnetic resonance imaging scan of the chest revealed a large soft tissue mass on the posterior chest wall and bilateral lung metastases. Soon after stereotactic core-needle biopsy confirmation of round-cell sarcoma, the patient underwent surgery of the primary tumor as it started to be increasingly symptomatic. The resected specimen was pathologically diagnosed a poorly differentiated grade 3 sarcoma. Approximately 1 month later, a new CT scan revealed that the lung metastases were smaller and some of them had completely disappeared. Shortly afterward, the patient started adjuvant external beam radiotherapy of the tumor bed for 14 months. During the last follow-up visit, the patient confirmed no evidence of disease for 35 months postoperatively. In parallel, a histological study of pulmonary nodules, molecular analyses of the tumor, and a comprehensive study of the patient's immunophenotype were performed to gain some additional insights in the potential causes of this rare phenomenon.

Low-Dose Radiation Therapy in the Management of Coronavirus Disease 2019 (COVID-19) Pneumonia (LOWRAD-Cov19): Preliminary Report.

PURPOSE: Low-dose radiation therapy (LD-RT) has been shown to have an anti-inflammatory effect, and preliminary results suggest it is feasible to treat patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS: We conducted a prospective, single-arm, phase 1/2 clinical trial enrolling patients aged ≥50 years, who were coronavirus disease 2019 (COVID-19) positive, at phase 2 or 3 with lung involvement at imaging study and oxygen requirement. Patients received 100 cGy to total lungs in a single fraction. Primary outcome was radiologic response using severity and extension score on baseline computed tomography (CT), at days 3 and 7 after LD-RT. Secondary outcomes were toxicity using Common Terminology Criteria for Adverse Events v.5.0, duration of hospitalization, blood work evolution, and oxygen requirements using SatO2/FiO2 index (SAFI), at days 3 and 7 after LD-RT. RESULTS: Nine patients were included. Median age was 66 (interquartile range, 57-77). Severity score was stable or decreased in the third CT but was not statistically significant (P = .28); however, there were statistically significant changes in the extension score (P = .03). SAFI index significantly improved 72 hours and 1 week after LD-RT (P = .01). Inflammatory blood parameters decreased 1 week after RT compared with baseline; only lactate dehydrogenase decreased significantly (P = .04). Two patients presented grade 2 lymphopenia after RT and another (with baseline grade 3) worsened to grade 4. Overall, the median number of days of hospitalization was 59 (range, 26-151). After RT the median number of days in the hospital was 13 (range, 4-77). With a median follow-up after RT of 112 days (range, 105-150), 7 patients were discharged and 2 patients died, 1 due to sepsis and the other with severe baseline chronic obstructive pulmonary disease from COVID-19 pneumonia. CONCLUSIONS: Our preliminary results show that LD-RT was a feasible and well-tolerated treatment, with potential clinical improvement. Randomized trials are needed to establish whether LD-RT improves severe pneumonia.

Myocardial strain in nonischemic dilated cardiomyopathy with feature tracking. Feasibility and prognostic implications.

INTRODUCTION AND OBJECTIVES: Myocardial strain analysis could provide additional information to left ventricular ejection fraction (LVEF) in nonischemic dilated cardiomyopathy (NIDC). Our aim was to analyze the feasibility of left ventricular strain evaluation using cardiac magnetic resonance feature tracking (FT) in NIDC, and to determine its clinical and prognostic impact. METHODS: We retrospectively included consecutive patients with NIDC who underwent cardiac magnetic resonance. Left ventricular global longitudinal, circumferential and radial strain were obtained from standard cine sequences using FT analysis software. We evaluated their association with a composite endpoint (heart failure, implantable cardioverter-defibrillator in secondary prevention, or death). RESULTS: FT analysis could be performed in all of the 98 patients (mean age 68±13 years, 72% men). Intra- and interobserver concordance was good for global longitudinal and circumferential strain but was worse for radial strain. Global circumferential strain was independently associated (OR, 1.16; P=.045) with LVEF normalization during follow-up and was the only morphological parameter independently associated with the composite endpoint (OR, 1.15; P=.038). A cutoff value <-8.2% was able to predict the incidence of this event during follow-up (log-rank 4.6; P=.032). CONCLUSIONS: Left ventricular strain analysis with FT is feasible and reproducible in NIDC. Global circumferential strain was able to predict LVEF recovery and the appearance of major cardiovascular events during follow-up.

[Modification to surgical technique of cesarean hysterectomy]. / Modificación a la técnica quirúrgica de cesárea-histerectomía.

BACKGROUND: Bleeding is a significant cause of maternal mortality in the world. Obstetric hysterectomy increases maternal morbidity and mortality. OBJECTIVES: To describe a modified technique of cesarean-hysterectomy to limit bleeding during surgery in cases of placenta accreta and placenta previa, which consist of hypogastric artery ligation before the removal of the uterus. Another objective of this study is to compare maternal outcomes of patients undergoing this technique with the usual technique. PATIENTS AND METHOD: Comparative, longitudinal, closed stydy. We analyzed the records of 86 patients undergoing cesarean-hysterectomy surgery, from July 1, 2008 to July 31, 2009, were programmed 29 patients with the modified technique and 57 with the usual. The main outcomes analyzed were: estimated bleeding during surgery, number of packed red blood cells and plasma units transfused and hospital stay in intensive care. RESULTS: Bleeding during surgery, blood transfusion and admission to intensive care demand, and hospital stay were significantly lower in patients with the modified technique. Also there were fewer trans and postoperative complications in this group. CONCLUSIONS: The results of this study show that the modified technique of cesarean-hysterectomy derives significant reduction of maternal morbidity, less massive transfusions demand to manage intensive care units.

[Pregnancy and tetralogy of Fallot with and without surgical correction]. / Embarazo y tetralogía de Fallot con y sin corrección quirúrgica.

BACKGROUND: Tetralogy of Fallot is the most common cyanotic congenital cardiac lesions. Although pregnancy in patients with corrected tetralogy of Fallot usually have a satisfactory outcome, there may have maternal cardiovascular complications. OBJECTIVE: To report our experience in monitoring and treatment of 16 pregnancies in 14 women with tetralogy of Fallot. PATIENTS AND METHOD: Prospective study performed in 16 pregnancies of 14 patients with tetralogy of Fallot, who attended the services of Cardiology and High Risk Pregnancy in the Hospital de Gineco-Obstetricia of the Centro Médico de Occidente (Mexico), from January 1997 to January 2010. Nine women had total surgical correction and five hadn't. All patients obtained complete study protocol and tests of fetal wellbeing. RESULTS: Hemoglobin and hematocrit were significantly higher in the group without surgical correction; this group also had lower oxygen saturation and right ventricular enlargement. Of the 16 pregnancies, five were resolved vaginally, the other by cesarean section. The cyanotic mothers had premature termination of pregnancy, lower birth weight and Apgar slightly deteriorated. There were no maternal or neonatal deaths, neither cardiac malformation in newborns. CONCLUSIONS: There are more risks for the binomial in patients with uncorrected tetralogy of Fallot and in those operated with significant residual lesions. A greater anatomical impact was significantly correlated with major hemoglobin and minor oxygen saturation, which are the most important risk factors for adverse fetal outcomes.

[Tuberculosis and immune reconstitution inflammatory syndrome. Pediatric case]. / Tuberculosis y síndrome inflamatorio de reconstitución inmunológica. Caso pediátrico.

Tuberculosis is a very frequent disease in our environment. Although early detection and adequate treatment achieve cure in most patients, the difficulty in diagnosis, the abandonment of treatment and the appearance of resistance to traditional drugs generate that at present it continues to represent an important public health problem. In Argentina, the morbidity rate is 25/100,000 inhabitants, with a slight increase in mortality. We present the case of a pediatric patient with tuberculosis and multiple complications associated with the disease and its treatment. One of these complications was the immune reconstitution inflammatory syndrome or paradoxical reaction to antituberculosis treatment. It represents an adverse clinical consequence of the restoration of immunity in the patient suffering from a serious systemic infection such as miliary tuberculosis.

La tuberculosis es una enfermedad muy frecuente en nuestro medio. A pesar de que la detección precoz y el tratamiento adecuado logran la curación en la mayoría de los pacientes, la dificultad en el diagnóstico, el abandono del tratamiento y la aparición de resistencia a los fármacos tradicionales generan que, en la actualidad, continúe siendo un importante problema de salud pública. En la Argentina, la tasa de morbilidad es de 25/100 000 habitantes, con un leve aumento en la mortalidad. Se presenta el caso de una paciente pediátrica con tuberculosis, que tuvo múltiples complicaciones asociadas a la enfermedad y a su tratamiento, entre las cuales se incluye el síndrome inflamatorio de reconstitución inmunológica, también conocido como reacción paradojal al tratamiento antituberculoso. Este representa una consecuencia clínica adversa al restablecimiento de la inmunidad en el paciente que padece una infección sistémica grave, como la tuberculosis miliar.

Evaluation of tumor response after stereotactic body radiation therapy for lung cancer: Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

BACKGROUND: Early identification of patients who fail to lung stereotactic body radiation therapy (SBRT) is vital as they can benefit from salvage therapy. Main guidelines recommend computed tomography (CT) to assess response and use of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT only when a local recurrence is suspected in CT. The pattern of radiation-induced lung injury caused by SBRT is different from changes seen after conventional radiation therapy in terms of extent, time of manifestation, and morphologic characteristics, and knowing this is crucial for proper monitoring of the tumor response. In certain cases, it may be difficult to differentiate response from progression or recurrence on CT and, in addition, some changes in CT take a long time to evolve before they are considered suspicious, making early diagnosis difficult. Metabolic changes often precede morphological changes, so 18F-FDG PET/CT quantitative and qualitative metabolic criteria can be useful in assessing early response and detecting relapses. However, the optimal practice for follow-up remains unclear and there is an active search for imaging markers for recurrent disease, including CT texture analysis, biomarker assays, new PET/CT isotopes, and magnetic resonance imaging. AIM: The aim of the study was to review the radiological changes that are objectified after pulmonary SBRT and the metabolic changes in 1F-FDG PET/CT, to assess the usefulness of following up patients with 18F-FDG PET/CT. RELEVANCE FOR PATIENTS: At present, the evaluation of response and diagnosis of relapse after SBRT are difficult and the incorporation of routine 18F-FDG PET/CT may have value in early diagnosis of relapse when the patient may still benefit from rescue treatment.

Diagnosing Aortic Intramural Hematoma: Current Perspectives.

Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. This review is focused on all aspects related to diagnosis of patients with AIH, from clinical to imaging and analytical.