Thyrotoxicosis following SARS-COV-2 vaccination: a case series and discussion.

AIM: To describe a case series of thyrotoxicosis likely triggered by SARS-CoV-2 vaccination and to warn physicians about this potential correlation. To report clinical, laboratory and imaging findings and provide further information that goes in line with the underlying mechanisms. METHODS: Single-center case series based on all the information collected in the hospital medical records, as well as the temporal sequence between the onset of symptoms and COVID-19 vaccination. RESULTS: We report 8 cases with thyrotoxicosis after SARS-CoV-2 vaccination. 4 cases of Graves' disease (GD), 2 cases of subacute painful thyroiditis (SAT), 1 case of concurrent GD and SAT and 1 case of atypical subacute thyroiditis. Five patients received BNT162b2 mRNA vaccine, 3 patients 1273 mRNA vaccine. The onset of symptoms following vaccination ranged from 10 to 14 days in six of eight patients and from 7 to 8 weeks in two patients. CONCLUSIONS: Several hypotheses have been proposed to explain the potential correlation between SARS-CoV-2 vaccination and thyrotoxicosis, including immune system hyper-stimulation, molecular mimicry and Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA). We should pay greater attention to thyroid disorders in patients receiving vaccine against SARS-CoV-2.

[Primary hypospadias]. / Hipospadias primario.

Hypospadias is one of the most frequent male congenital anomalies. Its surgical correction is under permanent review and it is always controversial. The best surgical technique can only be chosen intraoperatively, since it is the level of corpus spongiosum division what marks the severity of the case, although it is essential to evaluate position of the meatus, penile curvature, quality of the preputial skin and penile size. It is recommended treatment age between 6-12 months. Nowadays, The most frequently used technique for hypospadias repair is the Snodgrass tubularized incised urethral plate (TIP). Moreover, distal and medial hypospadias may be treated with urethral advance or flap techniques and proximal hypospadias with modifications of these in one-step or two-step procedures. Nevertheless, there are other controversies about hypospadias, such as to preserve or not the prepuce, the use of central or peripheral anesthesia blockade, or the use of wound dressings.

Early identification of infectious complications in lung transplant recipients using procalcitonin.

OBJECTIVES: The purpose of this study was to determine how sequential measurements of procalcitonin (PCT) could improve the diagnosis of early infectious complications after lung transplantation, and to compare this molecule with other commonly used markers (serum C-reactive protein [CRP] and leukocyte count). METHODS: Prospective observational study in a 34-bed university hospital intensive care unit (ICU). All lung transplant (LT) recipients between January and November 2010 were included. Biomarkers were measured just before surgery, on ICU admission, and daily on postoperative days 2, 3, 4, and 7. RESULTS: A total of 25 patients were included. Those patients with infectious complications presented with significantly higher levels of PCT as early as the first day after transplantation and during subsequent days. The area under receiver operating characteristic curve for PCT as a predictor of infection ranged between 0.83 and 0.97. PCT cutoff of 8.18 ng/mL on day 2 had a sensitivity of 80% and specificity of 100% for prediction of infection development. Neither CRP levels nor leukocyte count could discriminate between the patients with and without infections at any time. CONCLUSIONS: In contrast with CRP levels and leukocyte counts, measurement of PCT appears to be a useful diagnostic tool in detecting early infectious complications in LT patients.

[Lung transplantation using donors 55 years and older]. / Trasplante pulmonar con donantes de edad marginal (≥ 55 años).

OBJECTIVE: We analyzed short, medium and long-term mortality in transplant recipients who received lungs from donors aged 55 years or more. PATIENTS AND METHODS: All patients who underwent lung transplantation from donors aged 55 years or more were included. The association between the different study variables and early death and death at 1 year and 5 years was studied. A logistic regression model was used to study the association between early death and variables with a trend towards significance (P<.2) in the bivariate analysis. The risk factors for mortality at 1 year and 5 years were analyzed with a Cox regression model. The Kaplan-Meier method was used to analyze survival. RESULTS: A total of 33 patients were included. The probability of survival was 90.9%, 78.5% and 44.8% at 1 month, 1 year, and 5 years after lung transplantation, respectively. The elevated age of the recipient (P=.16) and single-lung transplantation (P=.09) were the variables associated to or with a trend towards significant associations with mortality. CONCLUSIONS: The final decision to accept a lung graft should be based on individual evaluation of each donor and recipient. However, given the lack of lung donors, donors aged 55 years or more should be considered for lung transplantation.

Use of povidone-iodine during the first trimester of pregnancy: a correct practice?

Povidone-iodine (PVP-I) has been widely used as an antiseptic agent during invasive procedures for prenatal diagnosis. Women have been reported of thyroid dysfunction after simple exposure to PVP-I. We studied the effect on thyroid function and urinary iodine excretion after a single topical application of PVP-I in 31 women who had a miscarriage during the first trimester of pregnancy. PVP-I is absorbed through the skin and the vaginal mucosa, resulting in a sudden increase in the urinary excretion of iodine and a short-term variation in concentrations of thyroid hormones in maternal serum. This metabolic effect could have consequences for the embryo and the fetus during crucial stages of development.

Early outcome after single vs bilateral lung transplantation in older recipients.

BACKGROUND: Lung transplantation (LT) has been increasingly performed in patients older than 60 years. The outcome of LT in this recipient age group has not been extensively analyzed. The purpose of this study was to evaluate the early death (30 days) in LT recipients older than 60 years according to the type of procedure, that is, single vs bilateral LT. METHODS: We retrospectively reviewed our experience with older recipients between January 1999 and August 2007. Probability of survival was compared using the two-tailed Fisher exact test. The odds ratio for death at 30 days was estimated using multiple logistic regression. RESULTS: During the study, 167 LT procedures were performed in 164 patients, of whom 51 (30.5%) were aged 60 years or older (age range, 60-70 years; mean [SD], 63.3 [2.4] years). Thirty-seven recipients aged 60 years or older underwent single LT, and 14 underwent bilateral LT. The 30-day survival was 81% (95% confidence interval [CI], 65%-92%) in patients who underwent single LT, and 92% (95% CI, 64%-100%) in patients who underwent bilateral LT. No differences were observed in the survival probability between the two groups (P = .42). Logistic regression analysis for death at 30 days showed an odds ratio of 1.10 (95% CI, 0.08-14.5; P = .94) in the unilateral LT group. CONCLUSIONS: Early survival in LT recipients aged 60 years or older who underwent bilateral LT was comparable with that in who underwent single LT. The type of procedure is not a predictor of death in this age group. Recipients older than 60 years should not be excluded from consideration for bilateral LT.

Toxicity of seven foliar insecticides to four insect parasitoids attacking citrus and cotton pests.

Laboratory studies were carried out to compare the toxicity of seven foliar insecticides to four species of adult beneficial insects representing two families of Hymenoptera: Aphelinidae (Aphytis melinus Debach, Eretmocerus eremicus Rose & Zolnerowich, and Encarsiaformosa Gahan) and Mymaridae (Gonatocerus ashmeadi Girault) that attack California red scale, Aonidiella aurantii (Maskell); sweetpotato whitefly, Bemisia tabaci (Gennadius) (both E. eremicus and E. formosa); and glassy-winged sharpshooter, Homalodisca vitripennis (Germar), respectively. Insecticides from four pesticide classes were evaluated using a petri dish bioassay technique across a range of concentrations to develop dosage-mortality regressions. Insecticides tested included acetamiprid (neonicotinoid); chlorpyrifos (organophosphate); bifenthrin, cyfluthrin, and fenpropathrin (pyrethroids); and buprofezin and pyriproxyfen (insect growth regulators [IGRs]). Chlorpyrifos was consistently the most toxic pesticide to all four species of beneficial insects tested based on LC50 values recorded 24 h posttreatment compared with 48-h LC50 values with the neonicotinoid and pyrethroids or 96 h with the IGRs. Among the three pyrethroids, fenpropathrin was usually less toxic (except similar toxicity to A. melinus) than was cyfluthrin, and it was normally less toxic (except similar toxicity with E. formosa) than was bifenthrin. Acetamiprid was generally less toxic than bifenthrin (except similar toxicity with G. ashmeadi). The IGRs buprofezin and pyriproxyfen were usually less toxic than the contact pesticides, but we did not test for possible impacts on female fecundity. For all seven pesticides tested, A. melinus was the most susceptible parasitoid of the four test species. The data presented here will provide pest managers with specific information on the compatibility of select insecticides with natural enemies attacking citrus and cotton, Gossypium hirsutum L., pests.

[Effectiveness and complications of bariatric surgery in the treatment of morbid obesity]. / Eficacia y complicaciones de la cirugia bariátrica en el tratamiento de la obesidad mórbida.

INTRODUCTION AND OBJECTIVES: Bariatric surgery represents an affective therapeutic alternative for patients with morbid obesity refractory to medical treatment. However, these surgical techniques increase the risk of producing a protein-energy hyponutrition or a selective deficit of some micronutrient. The aim of this work has been to analyze the anthropometrical, nutritional, digestive and cardiovascular risk factors changes and quality of life in patients with morbid obesity submitted to bariatric surgery. MATERIAL AND METHODS: Retrospective descriptive study evaluating a group of patients with morbid obesity submitted to bariatric surgery (45 by means of biliopancreatic bypass according to Scopirano's procedure, and 25 by laparoscopic gastric bypass). Anthropometrics (height, weight, body mass index), cardiovascular risk factors (arterial blood pressure, lipid and glycemic profiles, serum uric acid) and nutritional parameters (serum albumin, complete blood count, and phosphorus and calcium) were assessed before the bariatric procedure and one and two years after surgical treatment. Quality of life was evaluated through the B.A.R.O.S. system. RESULTS: Seventy patients with morbid obesity have been analyzed (56 women and 14 men) with a mean age of 36.5 +/- 11 years. Mean pre-surgical weight was 129.7 +/- 25.6 kg and BMI 48.8 +/- 8.8 kg/m2. Two years after the surgical procedure BMI was 31.0 +/- 6.6 kg/m2, the ponderal reduction 47.7 kg and the percentage of weight loss 36.5%. Hundred percent of dislipidemic patients, 90% of diabetic patients, and 72% of hypertensive patients normalized their corresponding profiles after surgery. The most common nutritional complications were anemia and iron deficiency, which occurred in 54.4% and 36.6% of the cases, respectively. Other observed nutritional deficits were: mild hypoalbuminemia in 20.3% of the patients, hypothrombinemia in 14.9%, folic acid decrease in 17.8%, vitamin B12 deficiency in 12.5%, hypocalcaemia in 23.8%, and secondary hyperparathyroidism in 45.4% of the cases. All nutritional complications were more frequent in patients submitted to biliopancreatic bypass, with the exception for vitamin B12 deficiency that occurred more frequently in patients with gastric bypass. The most frequently observed digestive complication was diarrhea/steatorrhea in 39.1% of the cases. Sixty-four point two percent of the patients considered the surgery outcome as excellent or very good. CONCLUSION: In patients with morbid obesity, bariatric surgery is a technique by which a great improvement in anthropometrical parameters, cardiovascular risk factors, and quality of life of patients is achieved, but it associates an important percentage of nutritional complications that we should take into account in order to prevent them.

Intestinal anisakiasis mimicking intestinal obstruction.

We report one case of acute abdomen after the ingestion of raw or undercooked fish containing nematode larvae of the genus Anisakis. Early diagnosis is very important as it could prevent unnecessary surgical procedures since the symptoms of intestinal anisakiasis may mimic other illnesses such as appendicitis, ileitis or peritonitis. We suggest that anisakiasis should be considered in the differential diagnosis of patients with acute abdomen.

Conservation of predatory arthropods in cotton: role of action thresholds for Bemisia tabaci (Homoptera: Aleyrodidae).

Studies were conducted in 1994 and 1995 to examine the effects of a range of action thresholds for managing Bemisia tabaci (Gennadius) Biotype B (= B. argentifolii Bellows & Perring) with insecticides in cotton on populations of arthropod predators in Imperial Valley, CA, and Maricopa, AZ. Application of insecticides significantly reduced population densities of spiders, Geocoris punctipes (Say), G. pallens (Stål), Orius tristicolor (White), Nabis alternatus Parshley, Zelus renardii Kolenati, Hippodamia convergens Guerin-Méneville, Spanogonicus albofasciatus (Reuter), Drapetis sp., and Chrysoperla carnea Stephens in one or both years and sites compared with untreated controls. Use of higher B. tabaci thresholds conserved some species and groups relative to lower thresholds. Stepwise regression analyses indicated that reductions in predator populations were generally influenced more strongly by the timing of the first insecticide application than by the total number of sprays necessary to maintain suppression of the pest below any given action threshold. A predation index, which weights the importance of each predator species based on their known frequency of predation on B. tabaci and another key pest, Pectinophora gossypiella (Saunders), was developed and analyzed. Patterns were similar to results based on changes in abundance alone, but the index generally revealed less severe effects of insecticides on overall predator function. The current action threshold for conventional insecticidal control of B. tabaci in Arizona and southern California is five adults per leaf. Results here suggest that predator conservation may be enhanced by raising the initial threshold to delay the first application or initially using more selective materials such as insect growth regulators.

The 14q22.2 colorectal cancer variant rs4444235 shows cis-acting regulation of BMP4.

Common genetic variation at human 14q22.2 tagged by rs4444235 is significantly associated with colorectal cancer (CRC) risk. Re-sequencing was used to comprehensively annotate the 17kb region of strong linkage disequilibrium encompassing rs4444235. Through bioinformatic analyses using H3K4Me1, H3K4Me3, and DNase-I hypersensitivity chromatin signatures and evolutionary conservation we identified seven candidate disease-causing single-nucleotide polymorphisms mapping to six regions within the 17-kb region predicted to have regulatory potential. Reporter gene studies of these regions demonstrated that the element to which rs4444235 maps acts as an allele-specific transcriptional enhancer. Allele-specific expression studies in CRC cell lines heterozygous for rs4444235 showed significantly increased expression of bone morphogenetic protein-4 (BMP4) associated with the risk allele (P<0.001). These data provide evidence for a functional basis for the non-coding risk variant rs4444235 at 14q22.2 and emphasizes the importance of genetic variation in the BMP pathway genes as determinants of CRC risk.

Phenology and demography of Homalodisca coagulata (Hemiptera: Cicadellidae) in southern California citrus and implications for management.

Populations of Homalodisca coagulata (Say) were sampled from citrus orchards in southern California, USA to characterize and quantify seasonal occurrences of nymphs and adults with the goal of identifying management opportunities through well-timed treatments and/or natural enemy releases. Higher densities of H. coagulata in 2001 contributed to a complete seasonal profile that began in early spring with the emergence of first instar nymphs and their progression through five nymphal instars lasting until mid-August. Adult emergence began in mid-June with peak adult densities attained from mid to late August followed by a gradual decline through autumn. A persistent and significant male bias was observed in the adult sex ratio from the time of first emergence through mid-October in oranges; the same trend was present in lemons, but with more variability. Adult densities gradually declined through the winter months into the following spring before rapidly increasing again in June as the 2002 spring generation of nymphs began emerging as adults. The seasonal timing of nymphs and adults in 2002 was nearly identical to that observed the previous year. Phenology data from both years were incorporated into a stochastic, temperature-dependent model that predicts the occurrences of H. coagulata stages through time. Applications of imidacloprid early in the spring generation of nymphs proved very effective at reducing nymphs and sustaining lower densities of adults through summer.

A clinical evaluation of trichomoniasis in San Jose, Costa Rica using the InPouch TV test.

OBJECTIVE: to determine the prevalence of trichomoniasis in San Jose, Costa Rica, comparing two methods, the InPouch TV test and the saline wet mount. METHODS: One hundred symptomatic and asymptomatic female patients at two hospitals and at a sexually transmitted disease (STD) clinic were evaluated. Vaginal discharge was the most prevalent genitourinary abnormality among symptomatic patients. The patients were between 18 and 70 years old. Fifty-seven were from the STD clinic, 43 from the two hospitals. A saline wet mount and a culture were taken from each patient. The culture employed a new procedure for diagnosis of trichomonads, the InPouch TV test (BioMed Diagnostics, San Jose, CA). RESULTS: Thirteen of the 100 patients were culture positive, two of whom were wet mount positive. No wet mount positives were culture negative. Eleven of the positive tests were from the STD clinic and two were from the hospitals. CONCLUSIONS: The results of this initial epidemiologic study indicate a prevalence of 19% for trichomoniasis in the STD clinic population and 4.6% in the hospitals group. Trichomonas vaginalis was not diagnosed by laboratory methods prior to this study. The InPouch TV test has a selective fungicidal and bactericidal, enriched proteose-peptone medium which provides a sensitivity of 4 organisms per ml and a 1 year shelf life at room temperature. This in vitro culture test demonstrated unique capabilities as a transport and culture medium. Its procedure offers simplicity in application and an excellent visualisation of trichomonads.