Pembrolizumab autoimmune related diabetes: Moving forward, keep learning.

Immune checkpoint inhibitors (and more specifically programmed cell death 1/programmed cell death ligand 1 inhibitors as Pembrolizumab) initiated a revolution in the field of melanoma and have now expanded to several tumor subtypes and in increasingly broader clinical contexts, including the adjuvant and neoadjuvant setting, with potentially curable patients and prolonged survival. The side effects related to these drugs include a wide spectrum of manifestations, with endocrinological adverse events being some of the most frequent. Pembrolizumab-induced type 1 diabetes mellitus is an infrequent but potentially serious and not clearly reversible side effect that possesses characteristic clinical features and has high morbidity and mortality, with a chronic impact on quality of life. The etiopathogenesis of this phenomenom needs to be further investigated and a collaborative effort through the involvement of oncologists and other medical specialists is necessary for the correct identification and management of patients at risk.

Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study.

OBJECTIVE: To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU). DESIGN: Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups. SETTING: Four-bed BU, in a referral University Hospital in Spain. PATIENTS: All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded. INTERVENTION: SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU. MAIN VARIABLE OF INTEREST: Incidence of HAIs during the stay in the BU. SECONDARY OUTCOMES: incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints. RESULTS: We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p=0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21-3.82) and 1.13 (0.54-1.73), respectively (p=0.029). CONCLUSIONS: SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.

Anetoderma after disseminated Mpox.

Anetoderma or macular atrophy is a rare skin condition of unclear pathogenesis, often associated with autoimmune diseases and skin damage from various infections. Human immunodeficiency virus (HIV), syphilis, and poxviruses have been implicated in the development of anetoderma. A 37-year-old male patient with HIV and recent unprotected sexual encounters presented with more than 400 skin lesions, consistent with Mpox. Symptomatic treatment for Mpox resulted in acute symptom resolution. However, 8 months later he developed papular anetoderma lesions in areas previously affected by Mpox. Biopsy confirmed the loss of elastic fibers in the affected skin areas, leading to the diagnosis of Mpox-induced anetoderma. This report presents a unique case of anetoderma following Mpox in an HIV-positive patient.

Primary Care Professionals' Empathy and Its Relationship to Approaching Patients with Risky Alcohol Consumption.

The aim of this study was to estimate the level of empathy among primary care (PC) health professionals and its relationship with their approach to patients at risk due to alcohol consumption. This is an observational, descriptive, and multicenter study that included 80 PHC professionals. The professionals completed a questionnaire comprising socio-occupational questions and inquiries regarding their actions when dealing with patients suspected of risky alcohol consumption. The Jefferson Scale of Empathy was used to measure their level of empathy and was completed by 80 professionals, of whom 57.5% were family physicians, 10% were nurses, and 32.5% were family- and community-medicine residents. The mean age was 39.5 ± 13.1 (SD) (range of 24-65 years) and 71.3% were females. The mean empathy level score was 112.9 ± 11.1 (95% CI: 110.4-115.4; range: 81-132 points). Actions that stood out for their frequency were providing health advice in the general population, offering advice to pregnant women, and recommending abstinence to users of hazardous machinery or motor vehicles. The level of empathy was associated with age (p = 0.029), the health center's scope (p = 0.044), systematic alcohol exploration (p = 0.034), and follow-ups for patients diagnosed with risky consumption (p = 0.037). The mean score obtained indicated a high level of empathy among professionals. Professionals with greater empathy more frequently conducted systematic screening for risky alcohol consumption.

Prognostic Value of Diaphragmatic Ultrasound in Patients Admitted for COVID-19 Pneumonia.

Introduction: COVID-19 pneumonia results in an impairment of the diaphragmatic musculature that influences the development of respiratory failure during the patient's hospitalization. Diaphragmatic ultrasound is a useful, non-invasive, and accessible tool for measuring the function of this muscle. Objective: Assessing the morphological and functional ultrasound status of the diaphragm in patients admitted within the first 24 h for COVID-related pneumonia and its association with hospital morbidity and mortality (NCT05805579). Material and methods: Observational, prospective cohort study that included 68 patients admitted for COVID-19 pneumonia with respiratory failure. Diaphragmatic ultrasound was performed within the first 24 h of admission to the pulmonology ward. Clinical, analytical, and ultrasound variables were collected: excursion, thickness, and diaphragmatic shortening fraction (DSF). DSF < 20% was used to define diaphragmatic dysfunction (DD). Patients who showed favorable progression and were managed on the ward (HCONV) were compared to those who required admission to the respiratory monitoring unit (RMU). Results: A total of 68 patients were included, of which 22 (32.35%) were admitted to the RMU. Diaphragmatic excursion at maximum volume was higher in the HCONV group compared to the RMU group (58.41 ± 17.83 vs. 50.03 ± 16.23; p = 0.123). Diaphragmatic dysfunction (DD) was observed in 21 (30.88%) patients, with a higher prevalence in the RMU group than in the HCONV group (15 (68.18%) vs. 6 (13.04%); p = 0.0001). In the multivariate analysis, age and DSF at admission were the best predictors of failure to discharge. Conclusions: Performing diaphragmatic ultrasound to assess mobility and DSF within the first 24 h of admission for COVID-19 pneumonia proves valuable in determining short-term progression and the need for admission to a respiratory monitoring unit.

Introducción: La neumonía por COVID-19 provoca un deterioro de la musculatura diafragmática que influye en la aparición de insuficiencia respiratoria durante la hospitalización del paciente. La ecografía diafragmática es una técnica no invasiva accesible y útil para medir la función de este músculo. Objetivo: Evaluar mediante ecografía el estado funcional y morfológico del diafragma en pacientes con neumonía por COVID durante las primeras 24 h de su ingreso y su asociación con la morbimortalidad intrahospitalaria (NCT05805579). Materiales y métodos: Se realizó un estudio prospectivo y observacional de una cohorte compuesta por 68 pacientes ingresados por neumonía por COVID-19 con insuficiencia respiratoria. La ecografía diafragmática se practicó durante las 24 h siguientes al ingreso en la planta de neumología. Se recopilaron variables clínicas, analíticas y ecográficas: desplazamiento, grosor y fracción de acortamiento diafragmático (FAD). Se utilizó una FAD < 20% como definición de disfunción diafragmática. Se comparó a los pacientes que evolucionaron favorablemente y recibieron tratamiento en planta (hospitalización convencional) con los pacientes que tuvieron que ser ingresados en la unidad de monitorización respiratoria (UMR). Resultados: Se incluyó en el estudio a un total de 68 pacientes, de los cuales 22 ingresaron en la UMR (el 32,35%). El desplazamiento diafragmático con el volumen máximo fue más alto en el grupo de hospitalización convencional que en el grupo ingresado en UMR (58,41 ± 17,83 frente a 50,03 ± 16,23; p = 0,123). Presentaron disfunción diafragmática 21 pacientes (30,88%) y la prevalencia fue más alta en el grupo ingresado en UMR que en el de hospitalización convencional: 15 pacientes (68,18%) frente a 6 (13,04%); p = 0,0001. En el análisis multivariable, la edad y la FAD al ingreso son los factores que mejor predicen la imposibilidad del alta. Conclusiones: La ecografía diafragmática para evaluar la movilidad y la FAD en las primeras 24 h del ingreso por neumonía por COVID-19 resulta valiosa para determinar la evolución a corto plazo y la necesidad de ingreso en una unidad de monitorización respiratoria.

Mental health professionals' use of the ICD-11 classification of impulse control disorders and behavioral addictions: An international field study.

Background and aims: The ICD-11 chapter on mental, behavioral and neurodevelopmental disorders contains new controversial diagnoses including compulsive sexual behavior disorder (CSBD), intermittent explosive disorder (IED) and gaming disorder. Using a vignette-based methodology, this field study examined the ability of mental health professionals (MHPs) to apply the new ICD-11 diagnostic requirements for impulse control disorders, which include CSBD and IED, and disorders due to addictive behaviors, which include gaming disorder, compared to the previous ICD-10 guidelines. Methods: Across eleven comparisons, members of the WHO's Global Clinical Practice Network (N = 1,090) evaluated standardized case descriptions that were designed to test key differences between the diagnostic guidelines of ICD-11 and ICD-10. Results: The ICD-11 outperformed the ICD-10 in the accuracy of diagnosing impulse control disorders and behavioral addictions in most comparisons, while the ICD-10 was not superior in any. The superiority of the ICD-11 was particularly clear where new diagnoses had been added to the classification system or major revisions had been made. However, the ICD-11 outperformed the ICD-10 only in a minority of comparisons in which mental health professionals were asked to evaluate cases with non-pathological high involvement in rewarding behaviors. Discussion and Conclusions: Overall, the present study indicates that the ICD-11 diagnostic requirements represent an improvement over the ICD-10 guidelines. However, additional efforts, such as training programs for MHPs and possible refinements of diagnostic guidance, are needed to avoid over-diagnosis of people who are highly engaged in a repetitive and rewarding behavior but below the threshold for a disorder.

Suicide and Covid-19 in Mexico: an update to 2021.

OBJECTIVE: To update prior studies on the impact of Covid-19 on suicide in Mexico. MATERIALS AND METHODS: We used interrupted time-series analysis to model the national trend in monthly suicides before Covid-19 (January 1, 2010, to March 31, 2020), comparing the expected number of suicides with the observed number for the remainder of the period (April 1, 2020, to December 31, 2021). RESULTS: We observed a 5% increase in suicides, driven by suicides among the younger females ages <44 years and among older males ages 45+. CONCLUSION: Since in Mexico the impact of Covid-19 on suicide depended on sex and age, tailored public health strategies may be needed to confront the problem.

A Lamellar Zn-Based Coordination Polymer Showing Increasing Photoluminescence upon Dehydration.

The present study reports on a 2D lamellar coordination polymer (CP) of {[Zn(µ3-pmdc)(H2O)]·H2O}n formula (pmdc = pyrimidine-4,6-dicarboxylate). This CP is synthesized under an appropriate acid-base reaction between the gently mortared reagents in the solid state through a solvent-free procedure that avoids the presence of concomitant byproducts. The X-ray crystal structure reveals the occurrence of Zn2 entities connected through carboxylate groups of pmdc, which behave as triconnected nodes, giving rise to six-membered ring-based layers that are piled up through hydrogen bonding interactions. In addition to a routine physico-chemical characterization, the thermal evolution of the compound has been studied by combining thermogravimetric and thermodiffractometric data. The photoluminescence properties are characterized in the solid state and the processes governing the spectra are described using time-dependent density-functional theory (TD-DFT) with two different approaches employing different program packages. The emissive capacity of the material is further analyzed according to the dehydration and decreasing temperature of the polycrystalline sample.

Estimating the Prevalence of Cardiac Amyloidosis in Old Patients with Heart Failure-Barriers and Opportunities for Improvement: The PREVAMIC Study.

BACKGROUND: Cardiac amyloidosis (CA) could be a common cause of heart failure (HF). The objective of the study was to estimate the prevalence of CA in patients with HF. METHODS: Observational, prospective, and multicenter study involving 30 Spanish hospitals. A total of 453 patients ≥ 65 years with HF and an interventricular septum or posterior wall thickness > 12 mm were included. All patients underwent a 99mTc-DPD/PYP/HMDP scintigraphy and monoclonal bands were studied, following the current criteria for non-invasive diagnosis. In inconclusive cases, biopsies were performed. RESULTS: The vast majority of CA were diagnosed non-invasively. The prevalence was 20.1%. Most of the CA were transthyretin (ATTR-CM, 84.6%), with a minority of cardiac light-chain amyloidosis (AL-CM, 2.2%). The remaining (13.2%) was untyped. The prevalence was significantly higher in men (60.1% vs 39.9%, p = 0.019). Of the patients with CA, 26.5% had a left ventricular ejection fraction less than 50%. CONCLUSIONS: CA was the cause of HF in one out of five patients and should be screened in the elderly with HF and myocardial thickening, regardless of sex and LVEF. Few transthyretin-gene-sequencing studies were performed in older patients. In many patients, it was not possible to determine the amyloid subtype.

Dissecting operant alcohol self-administration using saccharin-fading procedure.

BACKGROUND: Although alcohol use disorder is a complex human pathology, the use of animal models represents an opportunity to study some aspects of this pathology. One of the most used paradigms to study the voluntary alcohol consumption in rodents is operant self-administration (OSA). AIMS: In order to facilitate the performance of this paradigm, we aim to describe some critical steps of OSA under a saccharin-fading procedure. MATERIAL & METHODS: We used 40 male Wistar rats to study the process of acquiring the operant response through a saccharin-fading procedure under a fixed ratio (FR1) schedule of reinforcement. Next, we analyze the alcohol introduction and concentration increase, the effect of an alcohol deprivation, and the analogy between this paradigm with the Drinking in the Dark-Multiple Scheduled Access paradigm. RESULTS: During alcohol concentration increase, animals reduced their lever presses in accordance with the increase in alcohol concentration. On the contrary, the consumption measured in g·kg-1 BW showed a great stability. The lever presses pattern within operant session changes with the introduction of different alcohol concentrations: at higher alcohol concentrations, animals tended to accumulate most of their presses in the initial period of the session. DISCUSSION: We show the utility of fading with low concentrations of saccharin and the evolution of the operant response through the different concentrations of alcohol. CONCLUSION: Taken together, our results aimed to dissect the acquisition and maintenance of OSA behavior as well as other related variables, to facilitate the understanding and performance of this paradigm.

IgG antibody response to pneumococcal-conjugated vaccine (Prevenar®13) in children with immunodeficiency disorders.

Measurement of anti-pneumococcal capsular polysaccharides (anti-PnPs) IgG titers is an important tool in the immunologic assessment of patients with suspected immunodeficiency disorders (ID) to reduce the morbi-mortality and minimize severe infections. Retrospectively, we studied the relationship among anti-PnPs IgG response to 3 doses of Prevenar®13, levels of immune system components, leukocyte populations, and clinical data in children with ID. Serum samples were collected at least 4 weeks post vaccination. Subsequently, multi-serotype enzyme-linked immunosorbent assay (ELISA) was performed. Eighty-seven children (under 12 years) were enrolled. Primary immunodeficiency disorder (PID) was the most common disorder (45) followed by possible immunodeficiency disorder (POID) (19), secondary immunodeficiency disorder (SID) (15), and mixed immunodeficiency disorder (MID) (8). The median age was 3 (1.50-5.33) years, 65% of patients were male. Deficient production of anti-PnPs IgG (titer ≤ 50 mg/L) was detected in 47 patients (54%), especially in the MID group, all of them under immunosuppressive therapy. In PCV13 responders, the mean of leukocyte population levels was higher with statistically significance differences in CD4 + /CD8 + T lymphocytes (p = 0.372, p = 0.014) and CD56 + /CD16 + NK (p = 0.016). Patients with previous bone marrow transplantation were the worst PCV13 responders. Pneumococcal IgG antibody titers (post-vaccination) along with clinical and analytical markers represented.

Lymph node metastasis in level IIb in oropharyngeal squamous cell carcinoma: a multicentric, longitudinal, retrospective analysis.

INTRODUCTION: Nowadays, 70% of patients in Europe and the USA are affected by a p16 + , potentially HPV driven oropharyngeal squamous cell carcinoma. However, despite the improved survival rate in this group, the quality-of-life remains low in cases which neck dissection took place. In this vein, in recent years, some surgeons have considered to avoid dissection of level IIB, proposing a supra-selective non-IIb neck dissection. MATERIALS AND METHODS: A retrospective, longitudinal, multicentric study was conducted, including patients with pathologically confirmed primary HPV + or HPV - OPSCC who went through surgical treatment for the primary lesion and neck dissection. RESULTS: 141 patients were included. Among them, 99 (70.2%) were male and 42 (29.8%) were female. The mean age was 62 ± 9 years (range 36-81). The most frequent anatomical location was the tonsil in 63 (44.7%) of patients. The most common approach was the classic transoral oropharyngectomy in 51 (36.2%) patients. Immunohistochemistry for p16 was positive in 62 (44%) patients. One-hundred and five (74.5%) patients received a unilateral ND, and a 36 (25.5%) a bilateral ND. Of those, a 12.8% (18/141) of patients were level IIb LN + . According to our results, level IIb ND should be considered in patients underwent therapeutic ND with positive LN metastasis in level IIa (OR = 9.83; 95% CI 3.463-27.917) or III (OR = 6.25; 95% CI 2.158-18.143), advanced (T3/T4) oropharyngeal primary tumors (OR = 3.38; 95% CI 1.366-8.405), and patients with ENE (OR = 6.56; 95% CI 2.182-19.770), regardless of p16 status. CONCLUSIONS: According to our results, level IIb ND should be considered in patients who underwent therapeutic ND with positive LN metastasis in level IIa or III, advanced oropharyngeal primary tumors, and patients with ENE, independently of p16 status. Prospective data are necessary to definitively ensure the safety of omitting ipsilateral or contralateral level IIb ND in cN - patients with early stage disease.

Transoral endoscopic ultrasonic surgery (TOUSS) in head & neck unknown primary carcinoma investigation.

Metastatic carcinoma of unknown primary (CUP) to cervical lymph nodes represents less than 5% of all head and neck malignancies. Recent publications support the use of transoral surgery during the diagnosis work-up, and transoral endoscopic ultrasonic surgery represent a recently described alternative technique in transoral surgery. A pilot study to assess the feasibility of trans-oral ultrasonic base of tongue (BOT) mucosectomy and bilateral tonsillectomy approach in CUP diagnosis work-up was conducted. Ten patients were included consecutively. In 2 cases (20%) the primary was found, in one case in the right tonsil, and another one in the left BOT. According to our results, the use of trans-oral ultrasonic surgery to perform the base of tongue mucosectomy and bilateral tonsillectomy in CUP patient's during the diagnosis work-up represents an effective option in patients with good anatomical exposure.

Melatonin: a multitasking indoleamine to modulate hippocampal neurogenesis.

Neurodegeneration affects a large number of cell types including neurons, astrocytes or oligodendrocytes, and neural stem cells. Neural stem cells can generate new neuronal populations through proliferation, migration, and differentiation. This neurogenic potential may be a relevant factor to fight neurodegeneration and aging. In the last years, we can find growing evidence suggesting that melatonin may be a potential modulator of adult hippocampal neurogenesis. The lack of therapeutic strategies targeting neurogenesis led researchers to explore new molecules. Numerous preclinical studies with melatonin observed how melatonin can modulate and enhance molecular and signaling pathways involved in neurogenesis. We made a special focus on the connection between these modulation mechanisms and their implication in neurodegeneration, to summarize the current knowledge and highlight the therapeutic potential of melatonin.

Lanthanide(III) Ions and 5-Methylisophthalate Ligand Based Coordination Polymers: An Insight into Their Photoluminescence Emission and Chemosensing for Nitroaromatic Molecules.

The work presented herein reports on the synthesis, structural and physico-chemical characterization, luminescence properties and luminescent sensing activity of a family of isostructural coordination polymers (CPs) with the general formula [Ln2(µ4-5Meip)3(DMF)]n (where Ln(III) = Sm (1Sm), Eu (2Eu), Gd (3Gd), Tb (4Tb) and Yb (5Yb) and 5Meip = 5-methylisophthalate, DMF = N,N-dimethylmethanamide). Crystal structures consist of 3D frameworks tailored by the linkage between infinite lanthanide(III)-carboxylate rods by means of the tetradentate 5Meip ligands. Photoluminescence measurements in solid state at variable temperatures reveal the best-in-class properties based on the capacity of the 5Meip ligand to provide efficient energy transfers to the lanthanide(III) ions, which brings intense emissions in both the visible and near-infrared (NIR) regions. On the one hand, compound 5Yb displays characteristic lanthanide-centered bands in the NIR with sizeable intensity even at room temperature. Among the compounds emitting in the visible region, 4Tb presents a high QY of 63%, which may be explained according to computational calculations. At last, taking advantage of the good performance as well as high chemical and optical stability of 4Tb in water and methanol, its sensing capacity to detect 2,4,6-trinitrophenol (TNP) among other nitroaromatic-like explosives has been explored, obtaining high detection capacity (with Ksv around 105 M-1), low limit of detection (in the 10-6-10-7 M) and selectivity among other molecules (especially in methanol).

Influence of Tartrate Ligand Coordination over Luminescence Properties of Chiral Lanthanide-Based Metal-Organic Frameworks.

The present work reports on a detailed discussion about the synthesis, characterization, and luminescence properties of three pairs of enantiopure 3D metal-organic frameworks (MOFs) with general formula {[Ln2(L/D-tart)3(H2O)2]·3H2O}n (3D_Ln-L/D, where Ln = Sm(III), Eu(III) or Gd(III), and L/D-tart = L- or D-tartrate), and ten pairs of enantiopure 2D coordination polymers (CPs) with general formula [Ln(L/D-Htart)2(OH)(H2O)2]n (2D_Ln-L/D, where Ln = Y(III), Sm(III), Eu(III), Gd(III), Tb(III), Dy(III), Ho(III), Er(III), Tm(III) or Yb(III), and L/D-Htart = hydrogen L- or D-tartrate) based on single-crystal X-ray structures. Enantiopure nature of the samples has been further corroborated by Root Mean Square Deviation (RMSD) as well as by circular dichroism (CD) spectra. Solid-state emission spectra of Eu(III), Tb(III), and Dy(III)-based compounds confirm the occurrence of ligand-to-metal charge transfers in view of the characteristic emissions for these lanthanide ions, and emission decay curves were also recorded to estimate the emission lifetimes for the reported compounds. A complete theoretical study was accomplished to better understand the energy transfers occurring in the Eu-based counterparts, which allows for explaining the different performances of 3D-MOFs and 2D-layered compounds. As inferred from the colorimetric diagrams, emission characteristics of Eu-based 2D CPs depend on the temperature, so their luminescent thermometry has been determined on the basis of a ratiometric analysis between the ligand-centered and Eu-centered emission. Finally, a detailed study of the polarized luminescence intensity emitted by the samples is also accomplished to support the occurrence of chiro-optical activity.