Disminución de la debilidad muscular adquirida en una unidad de cuidados intensivos con la implementación de un protocolo multicomponente: ensayo clínico cuasiexperimental / Decrease in the intensive care unit-acquired weakness with a multicomponent protocol implementation: A quasi-experimental clinical trial

Introducción. La debilidad adquirida en las unidades de cuidados intensivos es una complicación frecuente de los pacientes con enfermedades críticas, que puede tener un impacto negativo en su pronóstico a corto y a largo plazo. Objetivos. Evaluar si la utilización de un protocolo multicomponente, que incluye movilidad activa temprana, manejo efectivo del dolor, reducción de la sedación, medidas no farmacológicas para prevenir el delirium, estimulación cognitiva y apoyo familiar, puede disminuir la incidencia de debilidad adquirida en las unidades de cuidados intensivos al momento del egreso del paciente. Materiales y métodos. Se trata de un ensayo clínico, no aleatorizado, en dos unidades de cuidados intensivos mixtas de un hospital de tercer nivel. Los participantes fueron pacientes mayores de 14 años con ventilación mecánica invasiva por más de 48 horas. Se aplicó como intervención un protocolo multicomponente y como control se utilizó el cuidado usual o estándar. Resultados. Ingresaron 188 pacientes al estudio, 82 al grupo de intervención y 106 al grupo control. La tasa de debilidad adquirida en las unidades de cuidados intensivos al egreso de la unidad fue significativamente menor en el grupo de intervención (41,3 % versus 78,9 %, p<0,00001). La mediana del puntaje de movilidad al momento del alta de la unidad de cuidados intensivos fue mayor en el grupo de intervención (3,5 versus 2, p<0,0138). No se encontraron diferencias estadísticamente significativas en las medianas de días libres de respiración mecánica asistida, ni de unidad de cuidados intensivos al día 28, tampoco en la tasa de mortalidad general al egreso del hospital (18 versus 15 días, p<0,49; 18,2 % versus 27,3 %, p<0,167). Conclusiones. Un protocolo multicomponente que incluía movilidad activa temprana tuvo un impacto significativo en la reducción de la debilidad adquirida en las unidades de cuidados intensivos al egreso en comparación con el cuidado estándar.

Introduction. Intensive care unit-acquired weakness is a frequent complication that affects the prognosis of critical illness during hospital stay and after hospital discharge. Objectives. To determine if a multicomponent protocol of early active mobility involving adequate pain control, non-sedation, non-pharmacologic delirium prevention, cognitive stimulation, and family support, reduces intensive care unit-acquired weakness at the moment of discharge. Materials and methods. We carried out a non-randomized clinical trial in two mixed intensive care units in a high-complexity hospital, including patients over 14 years old with invasive mechanical ventilation for more than 48 hours. We compared the intervention -the multicomponent protocol- during intensive care hospitalization versus the standard care. Results. We analyzed 82 patients in the intervention group and 106 in the control group. Muscle weakness acquired in the intensive care unit at the moment of discharge was less frequent in the intervention group (41.3% versus 78.9%, p<0.00001). The mobility score at intensive unit care discharge was better in the intervention group (median = 3.5 versus 2, p < 0.0138). There were no statistically significant differences in the invasive mechanical ventilation-free days at day 28 (18 versus 15 days, p<0.49), and neither in the mortality (18.2 versus 27.3%, p<0.167). Conclusion. A multi-component protocol of early active mobility significantly reduces intensive care unit-acquired muscle weakness at the moment of discharge.

Validación Chilena del Cuestionario de Evaluación de Apego en el adulto CaMir versión abreviada

El Cuestionario de Evaluación de Apego en el adulto CaMir, es un instrumento de auto-reporte basado en la Teoría del Apego que evalúa los modelos de relación en adultos y permite describir las estrategias de apego. El objetivo de la presente investigación fue desarrollar una versión breve para el contexto chileno, para lo cual se llevaron a cabo dos estudios. En el Estudio 1 se obtuvo una versión reducida del CaMir bajo una estrategia de validación cruzada. En el Estudio 2, se aplicó la versión reducida obtenida en el estudio 1 a una amplia muestra de adultos/as chilenos/as (n=1246). Los resultados muestran evidencias que apoyan la estructura interna propuesta, y los análisis de invarianza apoyan la existencia de equivalencia/invarianza de medida entre hombres y mujeres. Adicionalmente, esta versión obtuvo correlaciones significativas con la Escala de Dificultades de Regulación Emocional, el cuestionario de Experiencias en Relaciones Cercanas y la Escala de Depresión del Centro de Estudios Epidemiológicos. En síntesis, los resultados muestran que esta nueva versión abreviada del CaMir, es un instrumento apropiado para el estudio de los modelos de relación y las estrategias de apego en adultos/as chilenos/as.

The CaMir Adult Attachment Assessment Questionnaire is a self-report instrument based on Attachment Theory that assesses relationship models in adults and allows describing attachment strategies. The objective of this research was to develop a short version for the Chilean context. The results of two studies are presented. In Study 1, a reduced version of CaMir was obtained under a cross-validation strategy. In Study 2, the reduced version obtained in Study 1 was applied to a large sample of Chilean adults (n=1246). The results show evidence that supports the proposed internal structure, and the invariance analysis support the existence of equivalence/invariance of measurement between men and women. Additionally, this version obtained significant correlations with the Difficulties in Emotion Regulation Scale, the Experiences in Close Relationships questionnaire and the Center for Epidemiologic Studies Depression Scale. In summary, the results show that this new abbreviated version of the CaMir is an appropriate instrument for the study of relationship models and attachment strategies in Chilean adults.

Los objetivos de la investigación

Introducción: Un objetivo, es la intención explícita de un investigador de alcanzar un resultado a lo largo de una investigación, son decisivos en un estudio investigativo pues constituyen el eje en torno al cual se diseña la estructura del estudio. Objetivo: Brindar información sobre la redacción de los objetivos en los trabajos de investigación. Métodos: Se realizó una revisión bibliográfica en las bases de datos TESEO, PubMed, Scopus, Latindex, SciELO, Redalycs, Hinari y Dialnet, donde se encontraron documentos que trataron el tema relacionado con los objetivos. Resultados: Se hace referencia a la definición, características, tipos y estructura de los objetivos de investigación, la importancia del alcance de la investigación en su formulación, relación de los objetivos con el problema y el título. Por último, se señalan los errores frecuentes que se repiten en la redacción de los objetivos. Se localizaron 28 publicaciones y se seleccionaron 23 que se consideraron relevantes para la revisión. Se consideró relevante a las publicaciones efectuadas en los últimos cinco años y aquellas que abordaron el tema a profundidad. Conclusiones: Los objetivos son decisivos en un estudio investigativo, su correcta formulación evita desviaciones del proceso y facilita la solución al problema que se investiga.

Introduction: Objectives are an important component to support and guide the implementation of a research proposal. Objective: To provide information about on the most important aspects to writing research objectives. Methods: A review of literature was done in the main database focused aspects related to writing research objectives. Results: Reference is made to definition, components, characteristics, types, and prioritization of research objectives, and the relationship between the research problem, objectives and title. Finally, it was pointed the frequent errors that are repeated in the writing of the objectives. Twenty-eight publications were located and 23 that were considered relevant to the review were selected. Publications made in the last five years and those that addressed the subject in depth were considered relevant. Conclusions: The objectives are decisive in an investigative study, their correct formulation avoids deviations from the process and facilitates the solution to the problem under investigation.

Shannon entropy as a reliable score to diagnose human fibroelastic degenerative mitral chords: A micro-ct ex-vivo study.

This paper is aimed at identifying by means of micro-CT the microstructural differences between normal and degenerative mitral marginal chordae tendineae. The control group is composed of 21 normal chords excised from 14 normal mitral valves from heart transplant recipients. The experimental group comprises 22 degenerative fibroelastic chords obtained at surgery from 11 pathological valves after mitral repair or replacement. In the control group the superficial endothelial cells and spongiosa layer remained intact, covering the wavy core collagen. In contrast, in the experimental group the collagen fibers were arranged as straightened thick bundles in a parallel configuration. 100 cross-sections were examined by micro-CT from each chord. Each image was randomized through the K-means machine learning algorithm and then, the global and local Shannon entropies were obtained. The optimum number of clusters, K, was estimated to maximize the differences between normal and degenerative chords in global and local Shannon entropy; the p-value after a nested ANOVA test was chosen as the parameter to be minimized. Optimum results were obtained with global Shannon entropy and 2≤K≤7, providing p < 0.01; for K=3, p = 2.86·10-3. These findings open the door to novel perioperative diagnostic methods in order to avoid or reduce postoperative mitral valve regurgitation recurrences.

Adenocarcinoma primario de pulmón con células en anillo de sello y reordenamiento de ALK. Reporte de dos casos / Primary adenocarcinoma of the lung with signet-ring cells and ALK rearrangement. Two case reports.

El adenocarcinoma primario de pulmón con células en anillo de sello representa una variante rara y muy agresiva de cáncer de pulmón. El carcinoma de células en anillo de sello es un tipo particular de adenocarcinoma secretor de mucina, que se deposita intracitoplasmáticamente y desplaza el núcleo hacia la periferia de la célula. El origen pulmonar de este subtipo tumoral es raro y el hallazgo de reordenamiento de ALK es una asociación común. Presentamos dos casos de adenocarcinomas mucinosos primarios de pulmón con células en anillo de sello y reordenamiento de ALK. Todos los pacientes con cáncer de pulmón deben contar con estudios histopatológicos, inmunohistoquímicos y de biología molecular con los que se puedan obtener las principales características del tumor, que permitan ofrecer la mejor opción terapéutica para el paciente.

Primary adenocarcinoma of the lung with signet-ring cells represents a rare and highly aggressive variant of lung cancer. Signet­ring cell carcinoma is a particular type of mucin­secreting adenocarcinoma, which is deposited intracytoplasmatically and displaces the nucleus towards the periphery of the cell. The pulmonary origin of this tumor subtype is rare, and the finding of ALK rearrangement is a common association. We present two cases of primary mucinous adenocarcinomas of the lung with signet-ring cells and ALK rearrangement. All patients with lung cancer must have histopathological, immunohistochemical, and molecular biology studies with which the main features of the tumor can be obtained, which allow the clinician to offer the best possible treatment for the patient.

Lung Metastasectomy from Colorectal Cancer, 10-year Experience in a South American Cancer Center.

Purpose: This study aimed to describe the survival outcomes and factors associated with prognosis in patients undergoing pulmonary metastasectomy with colorectal cancer (CRC) in a cancer center in South America. Material and methods: A retrospective analysis of patients that underwent lung metastasectomy due to CRC at National Cancer Institute (INC), Colombia between 2007 and 2017 was performed and Kaplan-Meier survival analysis along with log-rank test and Cox regression multivariate analysis were completed. Results: Seventy-five patients with colorectal adenocarcinoma were included in the study. Of them, 57.3% were women with a median age of 62 years [interquartile ranges (IQR): 18.5]. For 45.3% the adenocarcinoma was located in the rectum and 29.3% had stage IV at diagnosis. 56% had a history of controlled extrapulmonary metastasis and 20% of the cases had a history of the metastasis of the liver. The median follow-up was 36.8 months (IQR: 27.4). Three-year and five-year overall survival (OS) was 57.5% [95% confidence interval (CI), 47.0-70.4] and 33.2% (95% CI, 23.4-47.2), respectively. Patients with bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy carcinoembryonic antigen (CEA), history of liver metastasis, and disease-free interval (DFI) ≤12 months had worse OS. Three-year and five-year disease-free survival (DFS) was 30.1% (95% CI, 20.8-43.6) and 21.6% (95% CI, 13.0-35.9), respectively. Bilateral, more than one pulmonary metastasis, and patients with stage IV at diagnosis had the worst DFS. Multivariate analysis in the Cox regression model showed that abnormal postmetastasectomy CEA [Hazard Ratio (HR):1.97, 95% CI, 1.01-3.86, p = 0.045] and DFI ≤ 12 months (HR: 3.08, 95% CI, 1.26-7.53, p = 0.014) were independent factors for worst OS. Conclusions: The OS found falls within the wide range described in the world literature but interestingly it falls at the bottom end of this range. The factors associated with worst survival were identified as bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and DFI ≤12 months. Contribution to the field: Pulmonary metastasectomy is the standard of care in patients with metastatic CRC. However, the literature supporting this conduct is based on retrospective studies and the only randomized controlled trial conducted to date was stopped due to poor recruitment. Limited information is available in South America about survival and factors associated with prognosis in patients with metastatic CRC. While this study is another series that adds to the many studies across the world that describe the use of pulmonary metastasectomy in CRC, it presents critical data as it is one of the few studies carried out in South America. As described in a wide range of world literature, OS found falls in patients that underwent lung metastasectomy due to CRC however; interestingly, in the South American population analyzed here it falls at the bottom end of this range. This may be explained by a large number of patients included with a history of extrapulmonary metastasis as well as may reflect inadequate patient access to reference cancer centers in Colombia. Factors associated with worst survival in our population were bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and interval from diagnosis to development of pulmonary metastasis ≤12 months.

Propiedades psicométricas de la Escala de Confianza Diádica en personas gays y lesbianas en pareja / Psychometric Properties of the Dyadic Trust Scale in Gay and Lesbian People with a Partner

Resumen El presente estudio tuvo como objetivo evaluar las propiedades psicométricas de la Escala de Confianza Diádica (ECD, Larzelere & Huston, 1980) en personas gays y lesbianas de Chile. Para ello, se evaluó una muestra de 360 personas chilenas gay o lesbianas involucradas en una relación de pareja. Los datos obtenidos proporcionan evidencia de que el instrumento se ajusta de manera aceptable a una estructura unidimensional y que es invariante entre personas gay y lesbianas. Adicionalmente, se identificó que posee una consistencia interna adecuada, así como una asociación inversa entre los niveles de confianza diádica y la ansiedad y evitación del apego. En conclusión, la ECD posee propiedades psicométricas adecuadas para la evaluación de la confianza diádica en personas gays y lesbianas en el contexto chileno.

Abstract The present study aimed to evaluate the psychometric properties of the Chilean version of the Dyadic Trust Scale (DTS, Larzelere & Huston, 1980). For this purpose, a sample of 360 Chilean gay or lesbian people involved in a couple relationship was evaluated. The data obtained provide evidence that the instrument conforms acceptably to a unidimensional structure and scores are invariant between gay and lesbian persons. Additionally, it has adequate internal consistency, as well as an inverse association between levels of dyadic trust and attachment anxiety and avoidance. In conclusion, the ECD has adequate psychometric properties for the assessment of dyadic trust in gay and lesbian persons in the Chilean context.

Identification of an interactome network between lncRNAs and miRNAs in thyroid cancer reveals SPTY2D1-AS1 as a new tumor suppressor.

Thyroid cancer is the most common primary endocrine malignancy in adults and its incidence is rapidly increasing. Long non-coding RNAs (lncRNAs), generally defined as RNA molecules longer than 200 nucleotides with no protein-encoding capacity, are highly tissue-specific molecules that serve important roles in gene regulation through a variety of different mechanisms, including acting as competing endogenous RNAs (ceRNAs) that 'sponge' microRNAs (miRNAs). In the present study, using an integrated approach through RNA-sequencing of paired thyroid tumor and non-tumor samples, we have identified an interactome network between lncRNAs and miRNAs and examined the functional consequences in vitro and in vivo of one of such interactions. We have identified a likely operative post-transcriptional regulatory network in which the downregulated lncRNA, SPTY2D1-AS1, is predicted to target the most abundant and upregulated miRNAs in thyroid cancer, particularly miR-221, a well-known oncomiRNA in cancer. Indeed, SPTY2D1-AS1 functions as a potent tumor suppressor in vitro and in vivo, it is downregulated in the most advanced stages of human thyroid cancer, and it seems to block the processing of the primary form of miR-221. Overall, our results link SPTY2D1-AS1 to thyroid cancer progression and highlight the potential use of this lncRNA as a therapeutic target of thyroid cancer.

National evaluation of risk factors for unplanned readmission after lung resection.

OBJECTIVES: Unplanned readmission is defined as the return to inpatient hospitalization within 30 days after discharge. Worldwide, its incidence after lung resection ranges between 8% and 50%, and it has been shown to impact both patient recovery and healthcare resources. Our goal was to identify the risk factors to prioritize early follow-ups. METHODS: We analysed data from the database of the Grupo Español de Cirugía Torácica Video-Asistida from 33 thoracic surgery departments over 15 months. Standard tests were used to compare the different risk groups. Our goal was to present the most relevant explanatory variables for readmission. RESULTS: A total of 174 of 2808 patients (6%) underwent unplanned readmission after a lobectomy. Of all the preoperative individual characteristics, only lung function was found to be a risk factor for readmission [forced expiratory volume in 1 s < 80%, risk ratio (RR) 1.78, P < 0.001; diffusing capacity of carbon monoxide <60%, RR 1.6, P = 0.02; and VO2 < 20 ml/kg/min, RR 1.59, P = 0.02]. The tumour's characteristics and the stage of the disease did not have an influence on the readmission rates. In the readmitted cohort, an open approach or thoracotomy was associated with more frequent readmissions (RR 1.77; P < 0.001). Strong adhesions (RR 1.81; P < 0.001) or adhesions occupying more than half of the hemithorax (RR 1.73, P < 0.001) were also found to be risk factors for readmission and for longer operative times. A length of stay of >10 days after a lobectomy was found to be a risk factor for readmission (RR 1.9). CONCLUSIONS: We identified preoperative, intraoperative and postoperative risk factors for readmission. This information can be a useful tool to help with the prioritization of early follow-ups, especially in centres with high workloads.

Deficiencias en las tesis de grado de los residentes

Introducción: La tesis de grado es una investigación que se presenta en medicina como trabajo de terminación para optar por una especialidad. Es frecuente observar dificultades en los informes finales que se presentan para su evaluación, lo que constituye una preocupación. Objetivo: Señalar las deficiencias de los informes finales de las tesis de grado de los residentes de Medicina General Integral del municipio Guáimaro durante el quinquenio 2016-2021. Métodos: Se realizó un estudio cualitativo descriptivo a través de la revisión documental del informe final de las tesis de los residentes del municipio Guáimaro en el quinquenio 2016-2021. El universo quedó conformado por la totalidad de los informes finales de la tesis de los residentes que se presentaron en la predenfensa. La información se recolectó en un formulario de recogida de datos donde se listaron aspectos propios del informe de investigación. Resultados: El análisis de los informes finales de las tesis mostraron deficiencias en el título, el planteamiento y la formulación del problema de investigación, los objetivos generales y específicos, clasificación de los estudios, definición del universo y la muestra, operacionalización de variables, discusión de los resultados y en las conclusiones. Conclusiones: Los resultados evidencian que persisten deficiencias en muchos aspectos de los informes finales de la tesis, las sugerencias metodológicas realizadas pueden servir a los docentes que asesoran la formación académica y a los propios investigadores en su actividad científica.

Introduction: The grade thesis is a research work that is presented in medicine as a completion work to opt for a specialty. Difficulties are often observed in the final reports that are submitted for evaluation, which is a concern. Objective: To show the deficiencies of the final reports of the degree thesis of the residents of the Guáimaro municipality during a five-year period 2016-2021. Methods: A qualitative study was carried out with the purpose of identifying the committed deficiencies through a documental review of the grade thesis´ final reports of the residents of from the municipality of Guáimaro, between the school years 2016 and 2021.The universe was made up of all the final reports of the thesis of the residents who were presented in the pre-defense. For collecting the primary information, a collection sheet was elaborated listing items that are proper of the research reports. Results: The analysis of the final reports of the thesis showed deficiencies in the title, the approach and the formulation of the research problem, the general and specific objectives, classification of the studies, definition of the universe and the sample, operationalization of variables, discussion of the results and conclusions. Conclusions: The results show that deficiencies persist in many aspects of the final reports of the thesis, the methodological suggestions made can serve the teachers who advise the academic training and the researchers themselves in their scientific activity.

Factores no atópicos asociados a la sibilancia recurrente en el menor de cinco años / No atopic factors for recurrent wheeze in children under five years old

RESUMEN Fundamento: la sibilancia recurrente es la presencia de tres o más episodios de sibilancias y constituye la forma de presentación más frecuente del asma en el menor de cinco años. Objetivo: determinar factores no atópicos asociados a la sibilancia recurrente en el menor de cinco años. Métodos: se realizó un estudio observacional, analítico, retrospectivo de casos y controles en Guáimaro provincia Camagüey, desde junio de 2017 hasta enero de 2020. Los casos fueron 114 niños menores de cinco años con sibilancias recurrentes e igual cantidad de niños sin este diagnóstico conformaron los controles. La información se obtuvo mediante un cuestionario a los padres. Las variables que se analizaron fueron: duración de la lactancia materna exclusiva por menos de seis meses, inicio de la alimentación complementaria antes de seis meses, introducción de huevo o pescado antes de seis meses, alimentos chatarras antes de seis meses, diagnóstico de obesidad, historia de madre fumadora en el embarazo, convivencia con fumadores, convivencia en casa con perro o gato, antecedentes de bronquiolitis, historia de infecciones respiratorias bajas recurrentes, antecedentes de parasitismo intestinal y tratamiento reiterados con antibacterianos. Los datos se procesaron de forma computarizada, se utilizó el programa de análisis estadístico SPSS versión 25.0. Resultados: las variables que mostraron asociación significativa con la sibilancia recurrente fueron: convivencia con fumadores, lactancia materna exclusiva por menos de seis meses, antecedentes de bronquiolitis, madre fumadora en el embarazo y la obesidad. Conclusiones: la sibilancia recurrente apareció en los pacientes en presencia de factores de riesgo no atópicos como la convivencia con fumadores, lactancia materna exclusiva por menos de seis meses, antecedentes de bronquiolitis, madre fumadora en el embarazo y la obesidad.

ABSTRACT Background: the recurrent wheeze is the presence of the three or more episodes of wheeze and it is the main manifestation of asthma in children under five years old. Objective: to determine no atopic factors associated with recurrent wheeze in children less than five years. Methods: an analytic observational retrospective case-control study was made in Guáimaro, Camagüey province, Cuba from June 2017 to January 2020. The cases were 114 children under five years old with diagnostic of recurrent wheeze and the same number of children without diagnostic of recurrent wheeze was the controls. The information was obtained through a questionnaire applied to parents of children. The variables analyzed were: exclusive breast-feeding for less than six months, start of the complementary nutrition before six months, introduction of egg and or fish before six months, junk food before six months, obesity, smoker mother in pregnancy, cohabitation with smokers, indoor cohabitation with dog or cat, bronchiolitis history, history of recurrent low respiratory infections, intestinal parasitism and reiterated treatment with anti-bacterial. Data were computerized in SPSS 25 version. Results: cohabitation with smokers exclusive breast-feeding for less than six months, bronchiolitis history, smoker mother in pregnancy and obesity showed significant associations with recurrent wheeze. Conclusions: the no atopic risk factors for recurrent wheeze were: cohabitation with smokers, exclusive breast-feeding for less than six months, bronchiolitis history, smoker mother in pregnancy, obesity.

A South American Experience With Postoperative Complications Following Chest Wall Reconstruction for Neoplasms.

BACKGROUND: This study aims to report postoperative complications of chest wall reconstructions due to resections of primary or secondary neoplasms in a South American cancer institution and their association with prosthesis reconstruction. MATERIALS AND METHODS: We retrospectively reviewed clinical records of patients with primary or secondary chest wall neoplasms who underwent resection and reconstruction between November 2008 and October 2018 at the Instituto Nacional de Cancerología, Bogota, Colombia. RESULTS: A total of 77 patients were analyzed, 50 were women (64.9%), and the median age was 45.8 years. There were 22(28.6%) sternal resections and 55(71.4%) costal resections. Prosthetic material was used in 14(18.2%) sternal and 37(48.1%) costal reconstructions. There were 26(33.7%) early postoperative complications and 16(20.8%) reinterventions. Infections were observed in 12(15.6%) patients and 4(5.2%) patients developed respiratory complications. 33.3% of all the early infections were presented in patients with methyl methacrylate (MMA) reconstructions and the same percentage in those with titanium plates. There were six (7.8%) late complications and five were related to prosthetic material extrusion, all required prosthetic material removal. The mean overall survival was 77,3 months (SD = 8 months), and 1-year and 5-year overall survival was 85% and 61%, respectively. CONCLUSIONS: Infections were the more frequent postoperative complications in chest wall reconstructions. The use of either MMA or titanium plates was not related to early postoperative complications, although MMA reconstructions developed higher late complications and required prosthetic material removal.

Síndrome de Gianotti-Crosti o acrodermatitis papular de la infancia: presentación de un caso / Gianotti-Crosti syndrome or popular acrodermatitis of childhood: a case report

RESUMEN Fundamento: el síndrome de Gianotti-Crosti también llamado acrodermatitis papular de la infancia es un exantema infrecuente, que se presenta por lo general en niños entre uno y seis años de edad. Dado que estos pacientes son llevados a su pediatra, es fundamental el conocimiento de las características de este síndrome. Objetivo: conocer un paciente con diagnóstico de síndrome de Gianotti-Crosti, también llamado acrodermatitis papular de la infancia. Presentación del caso: paciente de 18 meses que presentó un exantema pápulo-vesicular asintomática de distribución simétrica en cara, nalgas y superficies extensoras de las extremidades precedido de fiebre. Que duró dos semanas y cedió sin tratamiento. Conclusiones: debe sospecharse la enfermedad en niños con exantema pápulo-vesicular de distribución simétrica en cara, nalgas y superficies extensoras de las extremidades, asintomático y auto limitado.

ABSTRACT Background: the Gianotti-Crosti syndrome, also known as popular acrodermatitis of childhood, is an uncommon rash that usually occurs in children between 1 and 6 years old. Given that these patients are usually brought to their pediatrician, it is essential to know the characteristics of this syndrome. Objective: to show a patient with Gianotti-Crosti syndrome or popular acrodermatitis of childhood. Case report: an 18-month-old female patient, with asymptomatic papulo-vesicular reaction, symmetrically distributed on the face, buttocks and extensor surfaces of the extremities, preceded by fever. It lasted two weeks and disappeared without treatment. Conclusions: the entity should be suspected in children between 1 and 6 years old with asymptomatic papulo-vesicular eruption, symmetrically distributed on the face, buttocks and extensor surfaces of the extremities, asymptomatic and self-limited.

Características de los pacientes con cáncer de pulmón de célula no pequeña en el Instituto Nacional de Cancerología de Colombia / Characteristics of patients with non-small cell lung cancer at the National Cancer Institute of Colombia

Resumen Objetivos: Describir las características demográficas, histopatológicas, biología molecular tumoral y estadificación de los pacientes con cáncer de pulmón de célula no pequeña atendidos entre diciembre de 2013 y diciembre de 2018 en el Instituto Nacional de Cancerología de Colombia. Métodos: Estudio descriptivo de corte transversal. Resultados: Se incluyeron 392 pacientes con cáncer de pulmón de célula no pequeña, la mediana de edad fue 65.9 años (rango, 28,9 a 88,9 años). 198 (50,5%) pacientes fueron mujeres, obteniendo una relación hombre mujer 1:1. El 90.6% de los casos eran mayores de 50 años. Antecedente de tabaquismo se presentó en 211 (53,8%) pacientes, 75.8% de la población masculina y 32,3% de la población femenina eran fumadores. El adenocarcinoma se encontró en 293 (74,7%) pacientes y el carcinoma escamocelular en 73 (18,6%) pacientes. La estadificación patológica fue: estadio I en 22 (5,6%) pacientes, estadio II en 18 (4,6%), estadio III en 40 (10,2%) pacientes, estadio IV en 311 (79,3%) pacientes y no hubo dato en un solo paciente. Se detectó la mutación del EGFR en 21,2% de los pacientes. Los reordenamientos de ALK se identificaron en 4,6% de los pacientes y el PDL 1 solo se midió en el 9% de la población. Conclusiones: este estudio nos muestra el panorama general del cáncer de pulmón de célula no pequeña en la población colombiana, en donde la mayoría de los pacientes se diagnostican en estadios avanzados de la enfermedad y nos expone la necesidad de nuevas estrategias para la detección temprana y el acceso oportuno de los pacientes con cáncer de pulmón.

Abstract Objectives: to describe the demographic and histopathologic characteristics, tumor molecular biology and staging of patients with non-small cell lung cancer treated between December 2013 and December 2018 at the National Cancer Institute of Colombia. Methods: a retrospective cohort study based on data from medical records. Results: 392 patients with non-small cell lung cancer were included. The median age was 65.9 years (range: 28.9 to 88.9 years); 198 (50.5%) patients were women, obtaining a 1:1 male-female ratio. 90.6% of the cases were older than 50 years. History of smoking occurred in 211 patients (53.8%), 75.8% of the male population and 32.3% of the female population were smokers. Adenocarcinoma was found in 293 (74.7%) patients, while squamous cell carcinoma was present in 73 (18.6%) patients. The pathological staging was: 22 (5.6%) patients were in stage I, 18 (4.6%) had stage II, 40 (10.2%) patients were in stage III, stage IV was found in 311 (79.3%) patients, and there was no data in one patient. EGFR mutation was detected in 21.2% of patients. ALK rearrangements were identified in 4.6% of patients and PDL-1 was only found in 9% of the population. Conclusions: this study presents a general panorama of non-small cell lung cancer in the Colombian population, where most patients are diagnosed in advanced stages of the disease, and highlights the need for new strategies for early detection and better access for patients with lung cancer.

Predicting MHC I restricted T cell epitopes in mice with NAP-CNB, a novel online tool.

Lack of a dedicated integrated pipeline for neoantigen discovery in mice hinders cancer immunotherapy research. Novel sequential approaches through recurrent neural networks can improve the accuracy of T-cell epitope binding affinity predictions in mice, and a simplified variant selection process can reduce operational requirements. We have developed a web server tool (NAP-CNB) for a full and automatic pipeline based on recurrent neural networks, to predict putative neoantigens from tumoral RNA sequencing reads. The developed software can estimate H-2 peptide ligands, with an AUC comparable or superior to state-of-the-art methods, directly from tumor samples. As a proof-of-concept, we used the B16 melanoma model to test the system's predictive capabilities, and we report its putative neoantigens. NAP-CNB web server is freely available at http://biocomp.cnb.csic.es/NeoantigensApp/ with scripts and datasets accessible through the download section.

Primary BRAF Mutant Melanoma of the Lung Treated with Immunotherapy and Pulmonary Bilobectomy: A Case Report.

BACKGROUND Primary melanoma of the lung is a rare tumor that represents 0.01% of primary lung tumors, with only 40 cases reported in the literature. Mucosal melanomas are tumors with a biological and clinical presentation that differs from that of cutaneous melanomas; therefore, the therapeutic approach differs as well. Survival rates of patients with primary melanoma of the lung are much lower than those of patients with cutaneous melanoma, and there are no diagnostic or treatment guidelines for this entity. Radical surgery is the treatment of choice when disease is resectable. The effectiveness of current established treatments for cutaneous melanoma (eg, immunotherapy and targeted therapy) is unknown in this particular subgroup. CASE REPORT We present the case of a patient who presented with cough and hemoptysis. The fiberoptic bronchoscopy revealed an endobronchial mass and the computed tomography images suggested an unresectable mass. The patient was initially diagnosed with an unresectable primary lung melanoma with a clinical stage IIIB (T4N2M0). This lesion achieved partial response after treatment with Pembrolizumab, which allowed radical surgery to be performed, achieving complete resection with negative margins and adequate postoperative evolution. Despite the delays in our health care system, she is currently alive and disease-free more than 24 months after diagnosis. CONCLUSIONS Immunotherapy can reduce the size of mucosal melanoma to the point that it can be resectable and this therapeutic approach increases the survival opportunities of these patients.

Lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection.

Since the introduction of lung nodule radio-guided localization, multiport video-assisted thoracoscopic surgery resection has been widely described. To date, only one series has reported the use of uniportal approach. Our objective is to describe the experience of a single institution of lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection. Retrospective cohort study based on data from medical records of patients between May 2012 and April 2019. Twenty-four patients were included, 13 were women (54.2%) with a median age of 59.5 years (range 19 and 81 years). Median nodule size was 7 mm (range 3-12 mm) and 19 (79.2%) patients had single lung nodule. The main indication was sub-centimetric nodule in 22 (91.6%) patients followed by a deep localization in 10 (41.6%) patients and sub-solid nodule in 9 (37.5%) patients. Median surgical time was 102.5 min (range 55-160 min). 4 (16.6%) patients had malignant neoplasm of the lung, 10 (41.7%) patients had lung metastases and 10 (41.7%) patients had benign lung lesions. The success rate found was 95.8%. Concordance analysis between palpation of the pulmonary nodule and the presence of the nodule in the histopathology was rated as poor, kappa value - 0.71 (P = 0.186) and between the resection of the pulmonary nodule according to the presence of the nodule in the pathology report was rated as good, Kappa value 0.625 (P = 0.001). Lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection has a similar success rate and complications to those described by multiport video-assisted thoracoscopic surgery resections.