Clinical and radiographic characteristics of diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma: a single institution review.

PURPOSE: Genetic analyses of gliomas have identified key molecular features that impact treatment paradigms beyond conventional histomorphology. Despite at-times lower grade histopathologic appearances, IDH-wildtype infiltrating gliomas expressing certain molecular markers behave like higher-grade tumors. For IDH-wildtype infiltrating gliomas lacking traditional features of glioblastoma, these markers form the basis for the novel diagnosis of diffuse astrocytic glioma, IDH-wildtype (wt), with molecular features of glioblastoma (GBM), WHO grade-IV (DAG-G). However, given the novelty of this approach to diagnosis, literature detailing the exact clinical, radiographic, and histopathologic findings associated with these tumors remain in development. METHODS: Data for 25 patients matching the DAG-G diagnosis were obtained from our institution's retrospective database. Information regarding patient demographics, treatment regimens, radiographic imaging, and genetic pathology were analyzed to determine association with clinical outcomes. RESULTS: The initial radiographic findings, histopathology, and symptomatology of patients with DAG-G were similar to lower-grade astrocytomas (WHO grade 2/3). Overall survival (OS) and progression free survival (PFS) associated with our cohort, however, were similar to that of IDH-wt GBM, indicating a more severe clinical course than expected from other associated features (15.1 and 5.39 months respectively). CONCLUSION: Despite multiple features similar to lower-grade gliomas, patients with DAG-G experience clinical courses similar to GBM. Such findings reinforce the need for biopsy and subsequent analysis of molecular features associated with any astrocytoma regardless of presenting characteristics.

An unusual case of extensive polypoid high-grade dysplasia in Barrett's esophagus.

Barrett's esophagus (BE) is a known precursor of dysplasia and adenocarcinoma. Endoscopic resection and surgery are the techniques used to treat these kinds of lesions. However, endoscopic resection is considered the first choice for the management of superficial lesions. Dysplasia in BE most commonly appears like a flat lesion but here we describe an unusual case of dysplasia and superficial adenocarcinoma looking like an extensive polypoid lesion.

[Adherence to institutional clinical practice guideline on managing upper gastrointestinal bleeding, in a hospital in Lima - Peru]. / Adherencia a la guía de práctica clínica institucional sobre hemorragia digestiva alta, en un hospital de Lima - Perú.

INTRODUCTION: In 2018, the Clinical Practice Guideline (CPG) for the Evaluation and Management of upper gastrointestinal bleeding (UGB) was published by the Social Security of Peru (EsSalud). It provides evidence-based statements to optimize the management of these patients. OBJECTIVE: To evaluate the adherence to the statements of the CPG at the Edgardo Rebagliati Martins National Hospital (HNERM) of EsSalud (Lima, Peru). MATERIALS AND METHODS: Retrospective study, which analyzed the database of all patients who came to the HNERM emergency service with suspected UGB and were scheduled for endoscopy between October 19, 2019 and April 15, 2020. We included those with ≥ 18 years of age. This database contains the main characteristics of the standardized medical history for patients with UGB. Compliance with 13 of the 34 statements of the EsSalud CPG was evaluated. The results were presented descriptively, and the factors associated with compliance with the statements with insufficient adherence (<80%) and with more than 100 evaluated participants were evaluated. RESULTS: Data were obtained from 184 patients who met the inclusion criteria (men: 59.8%, median age: 70 years). The range of adherence to the 13 statements was from 63.2% to 99.5%. Only two statements had insufficient adherence (<80%). The statement with the least adherence was the recommendation to perform a restrictive transfusion. Noncompliance with this recommendation was found to be lower in those who had a higher score on the Glasgow-Blatchford index, a urea creatinine ratio > 60, and a lower hemoglobin on admission. CONCLUSION: Of the 13 statements evaluated, 11 had satisfactory adherence. It is important to explore the reasons why adherence is not adequate for some statements, and to evaluate methods to increase this adherence.

Association of congenital heart defects (CHD) with factors related to maternal health and pregnancy in newborns in Puerto Rico.

Background: Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States, there is a compelling need to investigate the intricate interplay among BMI, pregestational, and gestational maternal diabetes, and their potential impact on the occurrence of congenital heart defects (CHD) during neonatal development. Methods: Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico, we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020. Our assessment encompassed a range of variables, including maternal age, gestational age, BMI, pregestational diabetes, gestational diabetes, hypertension, history of abortion, and presence of preeclampsia. Results: A cohort of 673 patients was included in our study. The average maternal age was 26 years, within a range of 22 to 32 years. The mean gestational age measured 39 weeks, with a median span of 38 to 39 weeks. Of the 673 patients, 274 (41%) mothers gave birth to neonates diagnosed with CHD. Within this group, 22 cases were linked to pre-gestational diabetes, while 202 were not; 20 instances were associated with gestational diabetes, compared to 200 without; and 148 cases exhibited an overweight or obese BMI, whereas 126 displayed a normal BMI. Conclusion: We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD. However, our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD. These results may aid in developing effective strategies to prevent and manage CHD in neonates.

Extracavitary primary effusion lymphoma presenting as a solitary brain mass.

Primary effusion lymphoma (PEL) is an uncommon B-cell lymphoma associated with human herpesvirus 8 and comprises 3-4% of all HIV-related lymphomas. It traditionally presents as a pleural, pericardial, and/or peritoneal effusion, though it can occasionally manifest as an extracavitary or solid mass in the absence of an effusion. The extracavitary or solid variant of primary effusion lymphoma has been reported in the skin, gastrointestinal tract, lung, and lymph nodes. However, very few cases have been reported in the central nervous system. We describe a case of extracavitary or solid variant of primary effusion lymphoma presenting as a brain mass in an HIV-positive man, highlighting the clinicopathologic and immunophenotypic findings of a rare entity.

Primary effusion lymphoma (PEL) is an uncommon and aggressive form of large B-cell lymphoma with a grim outlook, making up less than 1% of all lymphomas. PEL is linked to human herpesvirus 8 and predominantly impacts individuals with HIV or weakened immune systems. The typical presentation of PEL involves cancerous fluid accumulating in the chest or abdominal cavities. Occasionally, PEL can appear as a solid mass outside these cavities, termed extracavitary PEL (EC-PEL). The case we are describing highlights the difficulties in diagnosing PEL/EC-PEL. It is crucial for healthcare providers to consider EC-PEL when dealing with human herpesvirus 8-positive B-cell lymphomas, especially when patients have weakened immune systems and an unusual clinical scenario involving a solid mass, as seen in this case.

Intramedullary Spinal Cord Tumors: Whole-Genome Sequencing to Assist Management and Prognosis.

Intramedullary spinal cord tumors (IMSCTs) harbor unique genetic mutations which may play a role in prognostication and management. To this end, we present the largest cohort of IMSCTs with genetic characterization in the literature from our multi-site institutional registry. A total of 93 IMSCT patient records were reviewed from the years 1999 to 2020. Out of these, 61 complied with all inclusion criteria, 14 of these patients had undergone genetic studies with 8 undergoing whole-genomic sequencing. Univariate analyses were used to assess any factors associated with progression-free survival (PFS) using the Cox proportional hazards model. Firth's penalized likelihood approach was used to account for the low event rates. Fisher's exact test was performed to compare whole-genome analyses and specific gene mutations with progression. PFS (months) was given as a hazard ratio. Only the absence of copy neutral loss of heterozygosity (LOH) was shown to be significant (0.05, p = 0.008). Additionally, higher risk of recurrence/progression was associated with LOH (p = 0.0179). Our results suggest LOH as a genetic predictor of shorter progression-free survival, particularly within ependymoma and glioblastoma tumor types. Further genomic research with larger multi-institutional datasets should focus on these mutations as possible prognostic factors.

Peroral endoscopic septotomy for Zenker's diverticulum with additional cut of mucosal flap: step by step.

Video 1Peroral endoscopic septotomy for Zenker's diverticulum with additional cut of mucosal flap: step by step.

Therapeutic response to pazopanib: case report and literature review on molecular abnormalities of aggressive prolactinomas.

Introduction: Aggressive prolactinomas (APRLs) pose a significant clinical challenge due to their high rate of regrowth and potentially life-threatening complications. In this study, we present a case of a patient with an APRL who had a trial of multiple therapeutic modalities with the aim to provide a review of molecular abnormalities and management of APRLs by corroborating our experience with previous literature. Methods: A total of 268 articles were reviewed and 46 were included. Case reports and series, and studies that investigated the molecular and/or genetic analysis of APRLs were included. Special care was taken to include studies describing prolactinomas that would fall under the APRL subtype according to the European Society of Endocrinology guidelines; however, the author did not label the tumor as "aggressive" or "atypical". Addiontionally, we present a case report of a 56-year-old man presented with an invasive APRL that was resistant to multiple treatment modalities. Results: Literature review revealed multiple molecular abnormalities of APRLs including mutations in and/or deregulation of ADAMTS6, MMP-9, PITX1, VEGF, POU6F2, CDKN2A, and Rb genes. Mismatch repair genes, downregulation of microRNAs, and hypermethylation of specific genes including RASSF1A, p27, and MGMT were found to be directly associated with the aggressiveness of prolactinomas. APRL receptor analysis showed that low levels of estrogen receptor (ER) and an increase in somatostatin receptors (SSTR5) and epidermal growth factor receptors (EGFR) were associated with increased invasiveness and higher proliferation activity. Our patient had positive immunohistochemistry staining for PD-L1, MSH2, and MSH6, while microarray analysis revealed mutations in the CDKN2A and POU6F2 genes. Despite undergoing two surgical resections, radiotherapy, and taking dopamine agonists, the tumor continued to progress. The patient was administered pazopanib, which resulted in a positive response and the patient remained progression-free for six months. However, subsequent observations revealed tumor progression. The patient was started on PD-L1 inhibitor pembrolizumab, yet the tumor continued to progress. Conclusion: APRLs are complex tumors that require a multidisciplinary management approach. Knowledge of the molecular underpinnings of these tumors is critical for understanding their pathogenesis and identifying potential targets for precision medical therapy.

Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms: A Latin American Cohort Study.

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is the preferred technique for treating early gastric cancer (EGC). However, very few studies have been conducted in South America. This study aimed to assess the efficacy and safety of ESD for EGC. METHODS: We analyzed data from a prospective cohort from 2013 to 2020. A total of 152 superficial gastric neoplasms that fulfilled the absolute or expanded criteria for ESD were included. Outcomes were en bloc, R0, and curative resection rates, incidence of adverse events, and length of procedure. RESULTS: The age of the enrolled patients was 68.4±11.3 years. The number of included patients based on the absolute and expanded indications was 150 and 2, respectively. En bloc, R0, and curative resections were achieved in 98.0%, 96.1%, and 89.5% of the cases, respectively. Bleeding and perforation were reported in 5.9% and 6.6% of the cases, respectively. Histopathological examination revealed lowgrade dysplasia, high-grade dysplasia, well-differentiated adenocarcinoma, and poorly differentiated adenocarcinoma in 13, 20, 117, and 2 cases, respectively. CONCLUSION: Our study shows that ESD performed by properly trained endoscopists in reference centers is safe and effective, with comparable therapeutic outcomes to those reported in the Eastern series.

Abordaje nutricional en pacientes con cirugía bariátrica / Nutritional management in patients with bariatric surgery / Gerenciamento nutricional em pacientes de cirurgia bariátrica

La cirugía bariátrica se establece como el tratamiento quirúrgico Gold estándar para la rápida reducción de peso, sin embargo, existe poca información sobre el adecuado manejo nutricional que debe tener el paciente antes y después de la operación. Objetivo. Analizar la influencia que tiene el abordaje nutricional en pacientes con obesidad sometidos a cirugía bariátrica. Metodología. Se trata de un estudio descriptivo, no experimental, basado en la aplicación del método PRISMA a través del cual se realizó una meticulosa revisión y análisis de investigaciones publicadas en bases de datos relevantes, considerando aquellas publicaciones con 5 años de antigüedad, que discutan sobre la nutrición en cirugía bariátrica. Resultados. Se identificaron 141 registros en las bases de datos, aplicando los criterios de selección, 35 de ellos se consideraron como fuentes importantes de información, sin embargo, en base al análisis de calidad metodológica y otros parámetros se llegaron a seleccionar 15 artículos con datos notables para esta revisión, se observó que a mayor restricción en la dieta mayor peso perdido, no obstante, menor adherencia y mayor pérdida de masa muscular. Conclusión. Mediante el análisis de información científica se llega a determinar que el abordaje nutricional tanto prequirúrgico como postquirúrgico, garantiza el éxito total de la cirugía, potenciando el resultado del procedimiento, además de permitir una compensación apropiada en cuanto a los requerimientos energéticos del paciente y así evitar deficiencias nutricionales.

Bariatric surgery is established as the Gold standard surgical treatment for rapid weight reduction, however, there is little information on the adequate nutritional management that the patient should have before and after the operation. Objective. To analyze the influence of the nutritional approach in patients with obesity undergoing bariatric surgery. Methodology. This is a descriptive, non-experimental study, based on the application of the PRISMA method through which a meticulous review and analysis of research published in relevant databases was carried out, considering those publications 5 years old, which discuss nutrition in bariatric surgery. Results. A total of 141 records were identified in the databases, applying the selection criteria, 35 of them were considered as important sources of information, however, based on the analysis of methodological quality and other parameters, 15 articles with remarkable data were selected for this review, it was observed that the greater the dietary restriction, the greater the weight lost, however, the lower the adherence and the greater the loss of muscle mass. Conclusion. Through the analysis of scientific information, it was determined that the nutritional approach, both pre-surgical and post-surgical, guarantees the total success of the surgery, enhancing the result of the procedure, besides allowing an appropriate compensation in terms of the patient's energetic requirements and thus avoiding nutritional deficiencies.

A cirurgia bariátrica está estabelecida como o tratamento cirúrgico padrão ouro para a redução rápida de peso; no entanto, há poucas informações sobre o manejo nutricional adequado do paciente antes e depois da operação. Objetivo. Analisar a influência da abordagem nutricional em pacientes com obesidade submetidos à cirurgia bariátrica. Metodologia. Trata-se de um estudo descritivo, não experimental, baseado na aplicação do método PRISMA, por meio do qual foi realizada uma meticulosa revisão e análise de pesquisas publicadas em bases de dados relevantes, considerando as publicações com 5 anos de idade, que discutem a nutrição na cirurgia bariátrica. Resultados. Foram identificados 141 registros nas bases de dados, aplicando os critérios de seleção, 35 deles foram considerados como fontes importantes de informação, porém, com base na análise da qualidade metodológica e outros parâmetros, 15 artigos com dados notáveis foram selecionados para esta revisão, observou-se que quanto maior a restrição alimentar, maior o peso perdido, porém, quanto menor a adesão e maior a perda de massa muscular. Conclusão. Por meio da análise de informações científicas, determinou-se que a abordagem nutricional, tanto no pré-cirúrgico quanto no pós-cirúrgico, garante o sucesso total da cirurgia, melhorando o resultado do procedimento, além de permitir uma compensação adequada em termos de necessidades energéticas do paciente e, assim, evitar deficiências nutricionais.

Hipertensión arterial como secuela de COVID-19. Reporte de un caso clínico / Arterial hypertension as a sequel to COVID-19. Clinical case report

La enfermedad COVID-19 ha ocasionado una de las crisis sanitarias más importantes de la historia. A propósito, se reporta el caso clínico de un trabajador de la salud sin antecedentes clínicos ni factores de riesgo cardiovascular que resultó contagiado, presentando secuela de hipertensión arterial que requirió tratamiento farmacológico. Existe la necesidad de continuar el estudio fisiopatológico de las consecuencias que genera esta patología, en especial de la relativa a la hipertensión arterial y la potencialidad de establecer una condición crítica y disfunción cardiovascular.

The COVID-19 disease has caused one of the most important health crises in history. In these terms, this clinical case is reported, which is related to a health worker with no medical history or cardiovascular risk factors. This patient was infected, presenting sequelae of arterial hyper-tension that required pharmacological treatment. It was showed the need to continue the pathophysiological study of the consequences generated by this pathology, especially regarding arterial hypertension and the potential to establish a critical condition and cardiovascular dysfunction.

An unusual case of extensive polypoid high-grade dysplasia in Barrett's esophagus

Barrett's esophagus (BE) is a known precursor of dysplasia and adenocarcinoma. Endoscopic resection and surgery are the techniques used to treat these kinds of lesions. However, endoscopic resection is considered the first choice for the management of superficial lesions. Dysplasia in BE most commonly appears like a flat lesion but here we describe an unusual case of dysplasia and superficial adenocarcinoma looking like an extensive polypoid lesion.

El esófago de Barrett (EB) es un precursor conocido de displasia y adenocarcinoma. La resección endoscópica y la cirugía son las técnicas utilizadas para tratar este tipo de lesiones. Sin embargo, la resección endoscópica se considera la primera opción para el manejo de las lesiones superficiales. La displasia en EB aparece más comúnmente como una lesión plana, pero aquí describimos un caso inusual de displasia y adenocarcinoma superficial que parece una lesión polipoide extensa.

Adherencia a la guía de práctica clínica institucional sobre hemorragia digestiva alta, en un hospital de Lima - Perú / Adherence to institutional clinical practice guideline on managing upper gastrointestinal bleeding, in a hospital in Lima - Peru

RESUMEN Introducción : El año 2018 se publicó la Guía de práctica clínica (GPC) para la evaluación y el manejo de la hemorragia digestiva alta (HDA) del Seguro Social de Salud del Perú (EsSalud). Esta emite enunciados basados en evidencias, que buscan optimizar el manejo de estos pacientes. Objetivo : Evaluar la adherencia a los enunciados de dicha GPC en el Hospital Nacional Edgardo Rebagliati Martins (HNERM) de EsSalud (Lima, Perú). Materiales y métodos : Estudio retrospectivo, que analizó la base de datos de todos los pacientes que acudieron al servicio de emergencia del HNERM con sospecha de HDA y fueron programados para endoscopía entre el 19 de octubre del 2019 y el 15 de abril del 2020. Se incluyó a aquellos con ≥ 18 años de edad. Esta base contiene las principales características de la historia clínica estandarizada para pacientes con HDA. Se evaluó el cumplimiento de 13 de los 34 enunciados de la GPC de EsSalud. Los resultados se presentaron descriptivamente, y se evaluaron los factores asociados al cumplimiento de los enunciados con inadecuada adherencia (< 80%) y con más de 100 participantes evaluados. Resultados : Se obtuvieron datos de 184 pacientes que cumplieron con los criterios de inclusión (varones: 59,8%, mediana de edad: 70 años). El rango de adherencia a los 13 enunciados fue de 63,2% a 99,5%. Sólo dos enunciados tuvieron adherencia inadecuada (<80%). El enunciado con menor adherencia fue la recomendación de realizar transfusión restrictiva. Se encontró que el cumplimiento de esta recomendación fue menor en quienes tuvieron mayor puntaje en el índice de Glasgow-Blatchford, relación urea creatinina > 60, y menor hemoglobina al ingreso. Conclusión : De los 13 enunciados evaluados, 11 tuvieron una adherencia adecuada. Resulta importante profundizar en los motivos por los cuales la adherencia no es adecuada para algunos enunciados, y valorar estrategias para aumentar esta adherencia.

ABSTRACT Introduction : In 2018, the Clinical Practice Guideline (CPG) for the Evaluation and Management of upper gastrointestinal bleeding (UGB) was published by the Social Security of Peru (EsSalud). It provides evidence-based statements to optimize the management of these patients. Objective : To evaluate the adherence to the statements of the CPG at the Edgardo Rebagliati Martins National Hospital (HNERM) of EsSalud (Lima, Peru). Materials and methods : Retrospective study, which analyzed the database of all patients who came to the HNERM emergency service with suspected UGB and were scheduled for endoscopy between October 19, 2019 and April 15, 2020. We included those with ≥ 18 years of age. This database contains the main characteristics of the standardized medical history for patients with UGB. Compliance with 13 of the 34 statements of the EsSalud CPG was evaluated. The results were presented descriptively, and the factors associated with compliance with the statements with insufficient adherence (<80%) and with more than 100 evaluated participants were evaluated. Results : Data were obtained from 184 patients who met the inclusion criteria (men: 59.8%, median age: 70 years). The range of adherence to the 13 statements was from 63.2% to 99.5%. Only two statements had insufficient adherence (<80%). The statement with the least adherence was the recommendation to perform a restrictive transfusion. Noncompliance with this recommendation was found to be lower in those who had a higher score on the Glasgow-Blatchford index, a urea creatinine ratio > 60, and a lower hemoglobin on admission. Conclusion : Of the 13 statements evaluated, 11 had satisfactory adherence. It is important to explore the reasons why adherence is not adequate for some statements, and to evaluate methods to increase this adherence.

Up-regulation of the vitamin C transporter SVCT2 upon differentiation and depolarization of myotubes.

In addition to its role as a strong antioxidant, vitamin C regulates the differentiation of several cell lineages. In vertebrate skeletal muscle, the vitamin C transporter SVCT2 is preferentially expressed in slow muscle fibers. To gain insights into the possible involvement of intracellular vitamin C on early myogenesis, we investigated the regulation of SVCT2 expression in cultures of chick fetal myoblasts. SVCT2 expression increases in cultures of both, slow and fast muscle-derived myoblasts, as they fuse to form mainly fast myotubes. Interestingly, we found that SVCT2 could be positively modulated by potassium-induced depolarization of myotubes. These findings suggest that SVCT2-mediated uptake of vitamin C could play diverse roles on skeletal muscle development and physiology.