Vancomicina contra metronidazol en infección por Clostridioides difficile leve-moderada de manejo ambulatorio / Vancomycin or metronidazole in the outpatient treatment of mild-moderate Clostridioides difficile infection

INTRODUCCIÓN: En la diarrea asociada a Clostridioides dfficile (DACD) leve-moderada se recomienda tratar con vancomicina por sobre metronidazol, a pesar de su difícil acceso y poca evidencia en el medio ambulatorio. OBJETIVO: Comparar la tasa de cura clínica y recurrencia entre vancomicina y metronidazol en adultos chilenos con primer episodio leve-moderado de DACD de manejo ambulatorio. MÉTODOS: Cohorte retrospectiva entre enero 2015 y diciembre 2020 en centros de una red de salud universitaria de pacientes de ≥ 18 años con DACD tratados ambulatoriamente. RESULTADOS: Se obtuvieron 161 pacientes, 59% mujeres, edad promedio de 53 años (entre 18 y 94 años). De ellos, 109 (67,7%) usaron metronidazol y 52 (32,3%) vancomicina. En el análisis multivariado ajustado por edad y comorbilidades se obtuvo un OR 3,00 (IC 95% 1,12-9,59) para cura clínica y 0,27 (IC 95% 0,06-0,88) para recurrencia a ocho semanas, ambos a favor de vancomicina, sin diferencias en recurrencia a 12 meses, necesidad de hospitalización o mortalidad. CONCLUSIÓN: La terapia con vancomicina comparada contra metronidazol en el tratamiento ambulatorio de la infección leve-moderada por C. dfficile se asocia a mayor cura clínica y menor tasa de recurrencia a corto plazo, sin diferencias en desenlaces a largo plazo.

BACKGROUND: Recommended treatment against mild cases of Clostridioides difficile associated diarrhea is vancomycin despite the difficulties of access compared to metronidazole. AIM: To compare the effectiveness of vancomycin and metronidazole in Chilean adults with first mild-moderate episode of Clostridiodes difficile infection (CDI). METHODS: Retrospective cohort of patients with CDI between January 2015 and December 2020 treated in centers of a university health network. The patients were adults treated for C. difficile infection on an outpatient basis. Recurrent and severe cases were excluded. Outcomes included clinical cure and recurrence rate. RESULTS: Data from 161 patients was recovered. Fifty-nine percent were women and average age was 53 (18-94). One hundred and nine patients were treated with metronidazole (67.7%) and 52 (32.3%) used vancomycin. Multivariate analysis adjusted by age and comorbidities showed an Odds Ratio of 3.00 (IC 95% 1.12-9.59) for clinical cure and 0.27 (IC 95% 0.06-0.88) for 8-week recurrence rate, both in favor of vancomycin, without differences in 12-month recurrence rate, hospitalization rate nor mortality. CONCLUSIONS: Vancomycin is associated with better short-term outcomes in the treatment of outpatient mild-moderate first episode C. difficile infection, without differences in long term recurrence or mortality when compared with metronidazole.

One-Pot Solvothermal Synthetic Route of a Zinc Oxide Nanoparticle-Decorated Reduced Graphene Oxide Nanocomposite: An Advanced Material with a Novel Anticancer Theranostic Approach.

This study focuses on a one-pot solvothermal synthetic route for the preparation of uniformly decorated zinc oxide nanoparticles on the surface of reduced graphene oxide (rGO/ZnO-NC) by using Andrographis paniculata leaf aqueous extract as an eco-friendly reducing agent. After characterizing the samples by different physical and chemical techniques, the anticancer activity of the synthesized rGO/ZnO-NC was examined on two human cancerous cell lines (HCT116 and A549) and one normal cell line (hMSCs). The MTT assays revealed that rGO/ZnO-NC exhibited dose-dependent cytotoxicity at a maximum concentration range of 10 ppm and the viability of the cells was drastically decreased to 95-96%. Measurement of reactive oxygen species (ROS) generation and Annexin V-FTIC staining assay revealed that rGO/ZnO-NC induced apoptosis in HCT116 and A549 cell lines. Thus, this study shows that the green-synthesized rGO/ZnO-NC has great potential in developing an efficacious novel therapeutic agent for cancers.

Elevated serum progesterone levels before frozen embryo transfer do not negatively impact reproductive outcomes: a large retrospective cohort study.

OBJECTIVE: To evaluate whether patients with high-serum progesterone levels before frozen embryo transfer (FET) under hormonal replacement therapy present with worse reproductive outcomes. DESIGN: A cohort retrospective study. SETTING: A university-affiliated fertility center. PATIENT(S): A total of 3,183 FET cycles in patients receiving hormonal replacement therapy between March 2009 and December 2020 were included. The luteal phase was covered with 200 mg per 8 hours of vaginal micronized progesterone either alone or in combination with a daily subcutaneous injection of 25 mg of progesterone. A total of 1,360 cycles corresponded to frozen homologous embryo transfer (ET) (hom-FET), 1,024 were euploid ET (eu-FET) after preimplantation genetic testing for aneuploidies, and 799 cycles were frozen heterologous ET (het-FET). All patients had adequate serum progesterone levels (≥10.6 ng/mL) before the procedure. INTERVENTION(S): Frozen embryo transfer cycles. MAIN OUTCOME MEASURE(S): Clinical pregnancy, miscarriage, and live birth rates (LBRs). RESULTS: Median (P25; P75) serum progesterone level before FET was 14.39 (12.43-17.49) ng/mL. Progesterone levels were significantly higher in the group under vaginal plus subcutaneous progesterone (15.96 [13.74-21.60] vs. 14.09 [12.19-16.95]). No differences in clinical pregnancy, miscarriage, and LBR were observed based on the use of vaginal or vaginal plus subcutaneous progesterone for each of the groups (hom-FET, eu-FET, and het-FET). Live birth rates were comparable among patients in the highest centile of serum progesterone levels (≥p90) (22.33 ng/mL) and the rest of the patients (p<90) (43.9% vs. 41.3%). Patients with progesterone levels ≥p90 presented lower body mass index than those in the lower centiles (

Seguimiento de dilatación del tracto urinario neonatal diagnosticada en la evaluación de infección del tracto urinario / Follow-up of Neonatal Urinary Tract Dilatation Diagnosed in the Evaluation of Urinary Tract Infection

Objetivo: Mostrar las características y seguimiento de la dilatación del tracto urinario en recién nacidos con infección del tracto urinario. Métodos: Estudio observacional, descriptivo, realizado desde 1992 hasta 2019, en neonatos ingresados con infección del tracto urinario. A todos se les realizó ultrasonido renal y uretrocistografía miccional. Se analizaron las características clínicas y de radioimagen de presentación en el seguimiento de la dilatación del tracto urinario. Resultados: Se estudiaron 403 pacientes. La mediana de seguimiento fue de 13 meses. El ultrasonido renal resultó positivo para dilatación del tracto urinario en 148 (36,7 por ciento). Predominaron los grados de dilatación ligera (5-10 mm.) sobre grados moderados y severos. En 38 casos (9,4 por ciento) la dilatación del tracto urinario se asoció a reflujo vésico-ureteral. La condición más común fue la dilatación transitoria con una mediana de desaparición de la dilatación 5 meses. Hubo asociación estadística significativa de la desaparición de la dilatación del tracto urinario con el grado de esta y entre aquellos casos calificados de transitoria con los otros portadores de alguna anomalía del tracto urinario que también tuvieron desaparición de la dilatación en algún momento de su evolución. Conclusiones: Cerca de una tercera parte de los neonatos con infección del tracto urinario tuvieron dilatación del tracto urinario en ultrasonido renal, con predominio de grado ligero, como probable expresión de una anomalía del tracto urinario subyacente. Con frecuencia ocurre resolución de la dilatación del tracto urinario en aquellos casos no asociados con anomalía del tracto urinario, habitualmente dentro del primer año de vida(AU)

OBjective: To show the characteristics and follow-up of urinary tract dilatation in neonates with urinary tract infection. Methods: Observational, descriptive study performed from 1992 to 2019, in neonates admitted with urinary tract infection. All underwent renal ultrasound and voiding urethrocystography. The clinical and radioimaging features of presentation were analyzed in the follow-up of urinary tract dilatation, Results: 403 patients were studied. The median follow-up was 13 months. Renal ultrasound was positive for urinary tract dilatation in 148 (36.7 percent). Mild degrees of dilatation (5-10 mm) predominated over moderate and severe degrees. In 38 cases (9.4 percent) urinary tract dilatation was associated with vesico-ureteral reflux. The most common condition was transient dilatation with a median disappearance of dilatation 5 months. There was significant statistical association of the disappearance of urinary tract dilatation with the degree of dilatation and between those cases qualified as transient with the other carriers of some urinary tract anomaly who also had disappearance of dilatation at some point in their evolution. Conclusions: About one third of neonates with urinary tract infection had dilatation of the urinary tract on renal ultrasound, predominantly of mild degree, probably expression of an underlying anomaly. Resolution of dilatation frequently occurs in those cases not associated with urinary tract anomaly, usually within the first year of life(AU)

Impacto de la nutrición enteral temprana en la mortalidad y días de estancia en la unidad de cuidados intensivos / Impact of early enteral nutrition over mortality and days of stay in the intensive care unit / Impacto da nutrição enteral precoce na mortalidade e dias de permanência na unidade de terapia intensiva

Resumen: Introducción: el retraso en el inicio de la nutrición enteral (NE), a diferencia de la NE precoz, está asociado a resultados adversos en los pacientes críticos. Objetivos: correlacionar el tiempo de inicio de la nutrición con la mortalidad, días de ventilación mecánica, estancia en la unidad de cuidados intensivos (UCI) y estancia hospitalaria. Material y métodos: se realizó un estudio tipo cohorte, retrospectivo, comparativo de los pacientes hospitalizados durante un periodo de enero a julio de 2022 en la Unidad de Cuidados Intensivos del Hospital Centro Médico ABC Campus Observatorio. Se incluyeron todos los pacientes ingresados que recibieron nutrición enteral. Resultados: de 242 pacientes, 62.8% son masculinos, con una mediana de edad de 65 (62.8-67.7) años, de los cuales 22% de la población requirió ventilación mecánica, encontrando una mortalidad global de 6.3%. Se observó diferencia significativa con p = 0.001, con un OR 0.210 (0.087-0.509) en la mortalidad de los pacientes con nutrición temprana 5.5 versus 13.2% nutrición tardía, sin diferencia en días de ventilación, estancia en la unidad de cuidados intensivos adultos (UCIA) ni hospitalización. Conclusiones: el retraso en la NE se asoció significativamente con menos días libres de UCI, estancia más prolongada en la UCI, hospitalizaciones más largas y mortalidad en comparación con la NE temprana.

Abstract: Introduction: the delay in the start of enteral nutrition (EN) or late EN, unlike early EN, is associated with adverse outcomes in critically ill patients. Objectives: to correlate the start time of nutrition with mortality, days of mechanical ventilation, Intensive Care Unit (ICU) and hospital length of stay. Material and methods: a retrospective, comparative, cohort study of hospitalized patients during the period from January to July 2022 in the ICU of the ABC Medical Center Observatory Campus was carried out. All hospitalized patients who received enteral nutrition were included. Results: of 242 patients, 62.8% were male, with a median age of 65 (62.8-67.7) years, 22% of the population required mechanical ventilation, finding an overall mortality of 6.3%. A significant difference was found with p = 0.001, with an OR 0.210 (0.087-0.509) in the mortality of patients with early nutrition 5.5 vs 13.2% late nutrition, without difference in days of mechanical ventilation, ICU or hospitalization length of stay. Conclusions: delayed EN was significantly associated with less ICU-free days, longer intrahospital length of stay and mortality, compared with early EN.

Resumo: Introdução: o atraso no início da nutrição enteral (NE) ou NE tardia, ao contrário da NE precoce, está associado a desfechos adversos em pacientes críticos. Objetivos: correlacionar o tempo de início da nutrição com mortalidade, dias de ventilação mecânica, internação na UTI e internação. Material e métodos: realizou-se um estudo de coorte, retrospectivo e comparativo de pacientes internados no período de janeiro a julho de 2022 na UTI do Hospital Centro Médico ABC Campus Observatorio. Todos os pacientes admitidos que receberam nutrição enteral foram incluídos. Resultados: dos 242 pacientes, 62.8% são do sexo masculino, com idade média de 65 (62.8-67.7) anos, dos quais 22% da população necessitou de ventilação mecânica, encontrando-se uma mortalidade geral de 6.3%. Uma diferença significativa foi encontrada com p = 0.001, com OR 0.210 (0.087-0.509) na mortalidade de pacientes com nutrição precoce 5.5 vs 13.2% nutrição tardia, sem diferença em dias de ventilação, permanência na UTI ou hospitalização. Conclusões: o atraso da NE foi significativamente associada a menos dias livres de UTI, estadias mais longas na UTI, internações mais longas e mortalidade, em comparação com NE precoce.

Vigilancia epidemiológica de la COVID-19 en instituciones penitenciarias de la provincia de Santiago de Cuba / Epidemiological survillance of COVID-19 in penal institutions from Santiago de Cuba province

Introducción: Las instituciones penitenciarias en muchos países han sido escenarios de brotes de la COVID-19, debido a los inconvenientes para mantener el distanciamiento social, a la falta de protección individual y la mala cobertura sanitaria, que se conjugan para condicionar esta situación. Objetivo: Caracterizar el cumplimiento de la vigilancia y las medidas de prevención y control de la COVID-19 en instituciones penitenciarias. Métodos: Se realizó un estudio descriptivo y transversal en 8 centros penitenciarios de la provincia de Santiago de Cuba durante mayo del 2020. Con independencia de los datos numéricos aportados, se decidió efectuar resúmenes fundamentalmente cualitativos de los aspectos considerados en cada una de las visitas. Resultados: En la evaluación de la organización y la estructura de cada una de las instituciones visitadas, así como del cumplimiento de las medidas de control y prevención individuales y colectivas, se obtuvieron resultados satisfactorios. También se comprobó que las unidades disponían de los recursos humanos y materiales que garantizaban la observancia de las medidas. Conclusiones: Quedaron demostrados el cuidado y la atención sanitaria a este grupo vulnerable a la COVID-19 y se identificaron otras posibles acciones para ello.

Introduction: In many countries penal institutions have been scenary of COVID-19 outbreaks, due to the adverse conditions for maintaining social distancing, lack of individual protection and bad sanitary structure, which confluence to make possible this situation. Objective: To characterize the fulfilment of survillance and the control and prevention measures for COVID-19 in penal institutions. Methods: A descriptive and cross-sectional study was carried out in 8 penal institutions from Santiago de Cuba during May, 2020. Independently from the obtained numerical data, it was decided to carry out summaries mainly of qualitative type, of those aspects considered in each of the visits. Results: Satisfactory results were obtained in the evaluation of the organization and the structure of each of the visited institutions, as well as in the fulfilment of the individual and collective control and prevention measures. It was also verified that the institutions had the human and material resources guarranting the fulfilment of the measures. Conclusions: Care and sanitary survillance to this vulnerable group to COVID-19 were demostrated, and other possible actions were identified for this purpose.

Comportamiento epidemiológico de SARS-CoV-2 en población trabajadora afiliada al Instituto Mexicano del Seguro Social / SARS-CoV-2 epidemic behavior in worker population affiliated to the Mexican Social Security Institute

Resumen: Objetivo: Describir el comportamiento de la epidemia de SARS-CoV-2 entre los trabajadores afiliados al Instituto Mexicano del Seguro Social (IMSS). Material y métodos: Se analizaron las incapacidades temporales para el trabajo por enfermedades respiratorias (ITT-ER), las hospitalizaciones y defunciones asociadas durante el periodo del 1 marzo al 31 diciembre 2020. Se estimó la tasa de ataque (TA) por SARS-CoV-2, así como los riesgos relativos (RR) de ITT-ER, hospitalización y defunción. Resultados: De los trabajadores afiliados al IMSS, 8.8% (n=1 730 334) recibió al menos una ITT-ER. La TA fue mayor en mujeres y en ambos sexos fue menor en el grupo de >60 años. Los RR de hospitalización y defunción fueron mayores en hombres y aumentaron con la edad. Comparado con las ITT-ER de 2015-2019, Durango, Tamaulipas y Nuevo León tuvieron un RR mayor de ITT-ER que el resto del país. Conclusiones: La epidemia de SARS-CoV-2 tuvo repercusiones importantes en los trabajadores afiliados al IMSS; se observó un exceso de ITT-ER de 4.6 veces respecto a la frecuencia esperada y cerca de un millón de casos de SARS-CoV-2. Los datos sugieren que el sistema de ITT-ER puede ser utilizado como elemento adicional para la vigilancia epidemiológica de enfermedades emergentes.

Abstract: Objective: To describe the behavior of SARS-CoV-2 epidemic among workers affiliated to the Mexican Social Security Institute. Materials and methods: We analyzed Short Term Disability Claims due to Respiratory Diseases (RD-STDC), associated hospitalizations and deaths (March 1 - December 31, 2020). We estimated the attack rate (AR) for SARS-CoV-2, and relative risks (RR) of TWD-RD, hospitalization and deaths. Results: 1 730 334 workers received at least one RD-STDC. AR was higher in women and in both sexes it was lower in >60 years old. RR of hospitalization and death were higher in men and increased with age. Compared with RD-STDC of 2015-2019, the states of Durango, Tamaulipas and Nuevo Leon had a higher RR of RD-STDC than the rest of the country. Conclusions: The SARS-CoV-2 epidemic impacted IMSS-affiliated workers significantly. We observed a 4.6 fold excess in RD-STDC compared to the expected frequency and nearly 1 million SARS-CoV-2 cases in this population. Our data suggest that the RD-STDC system can be used as an additional resource for epidemiological surveillance of emerging diseases.

Malakoplakia mimicking a locally advanced colorectal neoplasm.

Malakoplakia is a rare disease. Clinical presentation is non-specific, making its diagnosis an incidental finding on histopathological analysis. The aim of this case report is to describe a patient diagnosed with colon, renal and soft tissue malacoplakia mimicking a locally advanced colorectal cancer. A 75-year-old man was admitted due to intense abdominal pain. No relevant findings at the physical examination. Computed tomography showed parietal thickening of the descending colon with left kidney, iliopsoas muscle and retroperitoneum involvement. An elevated blood serum creatinine, elevated glycated hemoglobin and urinary infection were detected. Surgery was decided for suspicious symptomatic colonic neoplasm. Left segmental colectomy with left partial nephrectomy and retroperitoneal soft tissue resection was performed. Pathology report was compatible with malakoplakia. Malakoplakia is a rare disease and may affect multiple organs. Because there are no clinical-specific findings, diagnosis is usually made with histopathological study of the surgical specimen.

Microorganismos causales más comunes y factores de riesgo según la clasificación de las infecciones neonatales / Most common causal microorganisms and risk factors based on the classification of neonatal infections

Una manera para lograr más efectividad en la decisión terapéutica en recién nacidos que cursan con infecciones, es tener conocimiento del microorganismo causal más común, según el tipo de infección por la cual cursa el paciente. Por ello el médico debe estar familiarizado con el mapa microbiológico de la institución donde trabaja y estar actualizado en el espectro de microorganismos habituales que informa la literatura, así como aquellos emergentes y reemergentes. Se revisa el estado actual de reportes de frecuencia de los microorganismos causales en recién nacidos con infecciones, tomados de la literatura médica nacional e internacional con el propósito de orientar al médico de asistencia del posible microorganismo causal más probable en base a la clínica del paciente y además, a tomar la clasificación de las infecciones como herramienta que aporta una guía de los agentes que afectan con más frecuencia al paciente recién nacido, y los factores de riesgo asociados. Se concluye que es factible y beneficioso este enfoque que le permite al médico asistencial ser más efectivo en la decisión del tratamiento a seguir. Es su deber estar familiarizado con el mapa microbiológico de la institución donde trabaja y estar actualizado en el espectro de microorganismos habituales que informa la literatura, así como aquellos emergentes y reemergentes(AU)

One way to achieve more effectiveness in therapeutic decisions related to newborns with infections is to be aware of the most common causal microorganism, depending on the type of infection the patient is suffering. Therefore, the physician should be familiar with the microbiological map of the institution where he/she works and be updated in the spectrum of common microorganisms reported by the literature, as well as those emerging and re-emerging. The current status of frequency reports of causal microorganisms in newborns with infections, taken from national and international literature, is reviewed to guide the assistance physician on the most likely possible causal microorganism based on the patient's clinic and also to use the classification of infections as a tool that provides guidance on the agents that most often affect the newborn patients, and associated risk factors. It is concluded that this approach that allows the assistance physician to be more effective in the decision of treatment to follow is feasible and beneficial. It is the physician's duty to be familiar with the microbiological map of the institution where he/she works and be updated on the spectrum of common microorganisms reported by the literature, as well as those emerging and re-emerging(AU)

Characterization of a New Lightened Gypsum-Based Material Reinforced with Fibers.

This paper shows the characterization of a new lightened gypsum-based material for use in buildings. A plaster material has been designed with a polymeric compound based on polyvinyl acetate, bicarbonate and a boric acid solution, which reduce the density and thermal conductivity by up to 20% and 30%, respectively. In addition, tests have been carried out with the lightened plaster material reinforced with glass (GF), basalt (BF), polypropylene (PPF) and wood (WF) fibers. A significant improvement in mechanical properties was achieved. All samples obtained resistance values greater than 2 MPa in flexion and 3 MPa in compression. Physico-chemical analysis were also carried out. The study is completed with a statistical analysis, where confidence intervals have been obtained for the mean at 95% confidence for each of the physical properties studied.

Individualised luteal phase support in artificially prepared frozen embryo transfer cycles based on serum progesterone levels: a prospective cohort study.

STUDY QUESTION: Does an individualised luteal phase support (iLPS), according to serum progesterone (P4) level the day prior to euploid frozen embryo transfer (FET), improve pregnancy outcomes when started on the day previous to embryo transfer? SUMMARY ANSWER: Patients with low serum P4 the day prior to euploid FET can benefit from the addition of daily subcutaneous P4 injections (Psc), when started the day prior to FET, and achieve similar reproductive outcomes compared to those with initial adequate P4 levels. WHAT IS KNOWN ALREADY: The ratio between FET/IVF has spectacularly increased in the last years mainly thanks to the pursuit of an ovarian hyperstimulation syndrome free clinic and the development of preimplantation genetic testing (PGT). There is currently a big concern regarding the endometrial preparation for FET, especially in relation to serum P4 levels around the time of embryo transfer. Several studies have described impaired pregnancy outcomes in those patients with low P4 levels around the time of FET, considering 10 ng/ml as one of the most accepted reference values. To date, no prospective study has been designed to compare the reproductive outcomes between patients with adequate P4 the day previous to euploid FET and those with low, but restored P4 levels on the transfer day after iLPS through daily Psc started on the day previous to FET. STUDY DESIGN, SIZE, DURATION: A prospective observational study was conducted at a university-affiliated fertility centre between November 2018 and January 2020 in patients undergoing PGT for aneuploidies (PGT-A) IVF cycles and a subsequent FET under hormone replacement treatment (HRT). A total of 574 cycles (453 patients) were analysed: 348 cycles (leading to 342 euploid FET) with adequate P4 on the day previous to FET, and 226 cycles (leading to 220 euploid FET) under iLPS after low P4 on the previous day to FET, but restored P4 levels on the transfer day. PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall we included 574 HRT FET cycles (453 patients). Standard HRT was used for endometrial preparation. P4 levels were measured the day previous to euploid FET. P4 > 10.6 ng/ml was considered as adequate and euploid FET was performed on the following day (FET Group 1). P4 < 10.6 ng/ml was considered as low, iLPS was added in the form of daily Psc injections, and a new P4 analysis was performed on the following day. FET was only performed on the same day when a restored P4 > 10.6 ng/ml was achieved (98.2% of cases) (FET Group 2). MAIN RESULTS AND THE ROLE OF CHANCE: Patient's demographics and cycle parameters were comparable between both euploid FET groups (FET Group 1 and FET Group 2) in terms of age, weight, oestradiol and P4 levels and number of embryos transferred. No statistically significant differences were found in terms of clinical pregnancy rate (56.4% vs 59.1%: rate difference (RD) -2.7%, 95% CI [-11.4; 6.0]), ongoing pregnancy rate (49.4% vs 53.6%: RD -4.2%, 95% CI [-13.1; 4.7]) or live birth rate (49.1% vs 52.3%: RD -3.2%, 95% CI [-12; 5.7]). No significant differences were also found according to miscarriage rate (12.4% vs 9.2%: RD 3.2%, 95% CI [-4.3; 10.7]). LIMITATIONS, REASONS FOR CAUTION: Only iLPS through daily Psc was evaluated. The time for Psc injection was not stated and no serum P4 determinations were performed once the pregnancy was achieved. WIDER IMPLICATIONS OF THE FINDINGS: Our study provides information regarding an 'opportunity window' for improved ongoing pregnancy rates and miscarriage rates through a daily Psc injection in cases of inadequate P4 levels the day previous to FET (P4 < 10.6 ng/ml) and restored values the day of FET (P4 > 10.6 ng/ml). Only euploid FET under HRT were considered, avoiding one of the main reasons of miscarriage and implantation failure and overcoming confounding factors such as female age, embryo quality or ovarian stimulation protocols. STUDY FUNDING/COMPETING INTEREST(S): No external funding was received. B.C. reports personal fees from MSD, Merck Serono, Ferring Pharmaceuticals, IBSA and Gedeon Richter outside the submitted work. N.P. reports grants and personal fees from MSD, Merck Serono, Ferring Pharmaceuticals, Theramex and Besins International and personal fees from IBSA and Gedeon Richter outside the submitted work. The remaining authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: NCT03740568.

Desensibilización rápida en pacientes con hipersensibilidad al ácido acetilsalicílico con indicación de doble antiagregación por enfermedad arterial coronaria. Una guía para el clínico en la unidad de cuidado intensivo / Rapid desensitization in patients with hypersensitivity to acetylsalicylic acid with indication for dual antiplatelet therapy due to coronary artery disease. A guide for the clinician in the intensive care unit

Resumen El ácido acetilsalicílico (Aspirina) es un inhibidor irreversible de la acetil ciclooxigenasa (COX) y su actividad no es restaurada hasta la formación de nuevas plaquetas. Sus efectos benéficos terapéuticos cardiovasculares lo han convertido en la piedra angular del tratamiento del paciente con enfermedad arterial coronaria. Existe una población de pacientes con indicación absoluta para su uso; sin embargo, la presencia o antecedente de hipersensibilidad a esta molécula conlleva un alto riesgo de complicaciones no relacionadas con enfermedad cardiovascular. En algunos de estos pacientes es crucial conocer e implementar protocolos de desensibilización para el ácido acetilsalicílico y, de esta manera, continuar con el uso de esta estrategia terapéutica necesaria e idónea en esta población.

Abstract Acetylsalicylic acid (Aspirin) is an irreversible inhibitor of acetyl cyclooxygenase (COX) and its activity is not restored until new platelets are formed. Its beneficial therapeutic cardiovascular effects have made it the cornerstone of the treatment of patients with coronary artery disease. There is a population of patients with absolute indication for its use, however, the presence or history of hypersensitivity to this molecule leads to a high risk of complications unrelated to their cardiovascular disease. It is vital to know and implement in some of these patients, desensitization protocols for acetyl salicylic acid and in this way to continue the use of this therapeutic strategy necessary and appropriate in this population.

Criterios de retorno al trabajo y determinación del valor de vulnerabilidad por Covid-19 / Criteria for returning to work and determination of the vulnerability value for Covid-19

Resumen: Objetivo: Establecer criterios médicos de retorno al trabajo en personal con riesgo de complicaciones por Covid-19. Material y métodos. Se realizó una revisión sistemática para identificar las condiciones y las características clínicas que influyen en el riesgo de desarrollar Covid-19 grave. Resultados: Se ha demostrado incremento del riesgo en obesidad, edad >60 años, diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiovascular, enfermedad renal crónica y cáncer. Solamente en diabetes se ha estudiado si el control previo influye. Se proponen condiciones específicas y el nivel de riesgo epidemiológico para el retorno al trabajo. Conclusiones: El retorno laboral de estos grupos debe priorizarse buscando favorecer el control de la enfermedad, identificando el estado de salud que incrementa el riesgo y protegiendo el derecho al trabajo. Se presentan recomendaciones para guiar la reincorporación al trabajo.

Abstract: Objective: To establish medical criteria for return to work to people with increased risk of severe illness from Covid-19. Materials and methods. We performed a systematic review to identify the conditions and clinical characteristics that influence the risk of developing severe Covid-19. Results: Increased risk has been shown in obesity, age >60 years old, diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, cardiovascular disease, chronic kidney disease and cancer. Only in diabetes it has been studied whether prior control influences. Specific medical conditions and epidemiological risk level for return to work are proposed. Conclusions: Return to work of vulnerable groups should be prioritized, seeking to promote disease control, identifying health conditions that increase risk, and protecting the right to work. We present recommendations to guide the return to work.

Encefalitis por Anticuerpos contra el Receptor NMDA: un diagnóstico diferencial neuropsiquiátrico

La Encefalitis por Anticuerpos contra el Receptor NMDA es un reto debido a la amplia lista de posibilidades diagnósticas a las que se asemeja la sintomatología inicial. Es una enfermedad cuya fisiopatología está dada por la generación y acción de anticuerpos, inducidos mayormente por agentes externos (virus) e internos (algunos tumores), sobre NMDAR (receptor N-metil-D-aspartato) que puede cursar con alteraciones neurológicas, psiquiátricas y autonómicas, usualmente afectando a población femenina adulta joven y que en ocasiones forma parte de un síndrome paraneoplásico. Su manejo se basa en inmunoterapia con corticosteroides, inmunoglobulina intravenosa o en casos refractarios, plasmaféresis. La eficacia de estas terapias aumenta con el diagnóstico oportuno, sin embargo con frecuencia el tratamiento se aplica tardíamente por lo difícil del acierto diagnóstico. Presentamos el caso clínico de una femenina de 22 años, que debutó con manifestaciones neuropsiquiátricas, inicialmente medicada con antipsicóticos y que desarrolló rigidez, aumento de creatina quinasa y estatus epiléptico, por lo cual se sospechó síndrome neuroléptico maligno, ameritando hospitalización en la unidad de cuidados intensivos. Ante la nula mejoría, se replanteó el diagnóstico, con sospecha de encefalitis autoinmune y se instauró el tratamiento específico, con lo cual la paciente pudo retornar a su vida diaria sin déficit. (provisto por Infomedic International)

Leucocituria significativa como indicador de probable infección del tracto urinario sin cultivo positivo

Introducción: La presencia de leucocituria nos orienta hacia la probabilidad de infección del tracto urinario en niños. Objetivo: Determinar si la leucocituria significativa es un marcador de infección urinaria aun sin cultivo de orina positivo. Métodos: Estudio descriptivo y retrospectivo en pacientes egresados de los Servicios de Neonatología y Nefrología del Hospital Pediátrico Universitario "Juan Manuel Márquez", entre enero 2018-diciembre 2019, que incluyó 124 niños de 2 años de edad; un grupo con infección del tracto urinario confirmada (clínica, leucocituria mayor 10 000 leucocitos/ml y con urocultivos positivos) y otro sospechada (clínica, con leucocituria significativa de más 100 000 leucocitos/ml, pero sin cultivo de orina positivo). Se compararon variables clínicas, de laboratorio y de radioimagen. Resultados: En 78,6 % de los niños se aisló Escherichia coli. La fiebre fue un hallazgo clínico frecuente. El reactante de fase aguda con mayor variación fue la velocidad de sedimentación globular (71,0 %), presentaron alteraciones del ultrasonido (79,8 %) y uretrocistografía miccional (50,0 %). No hubo diferencias estadísticamente significativas al comparar las variables clínicas, de laboratorio y de radioimagen entre el grupo de pacientes con infección del tracto urinario confirmada por urocultivo positivo y el grupo sospechado por la clínica, con leucocituria significativa de más 100 000 leucocitos/ml, pero sin urocultivo positivo. Conclusiones: En los niños con manifestaciones clínicas de infección, con presencia de una leucocituria significativa (más 100 000 leucocitos/ml), aunque no cuenten con un resultado positivo del urocultivo, se les debe proporcionar la atención médica establecida para un paciente con infección del tracto urinario.

Introduction: The presence of leukocyturia guides towards the probability of urinary tract infection in children. Objective: Determine whether significant leukocyturia is a marker of urinary tract infection even without positive urine culture. Methods: Descriptive and retrospective study in patients discharged from the Neonatology and Nephrology Services of "Juan Manuel Márquez" University Pediatric Hospital, from January 2018 to December 2019, which included 124 children of 2 years of age; one group with confirmed urinary tract infection (clinical, leukocyturia of more than 10 000 leukocytes/ml and with positive urine cultures) and another group of suspected ones (clinical, with significant leukocyturia of more than 100 000 leukocytes/ml, but without positive urine culture). Clinical, laboratory and radioimaging variables were compared. Results: Escherichia coli was isolated in 78.6% of the children. Fever was a common clinical finding. The reactant acute phase with the greatest variation was the erythrocyte sedimentation rate (71.0 %), there were ultrasound alterations (79.8 %) and voiding urethrocystography (50.0 %). There were no statistically significant differences when comparing clinical, laboratory and radioimaging variables between the group of patients with urine tract infection confirmed by positive urine culture and the group suspected by the clinic findings, with significant leukocyturia of more than 100 000 leukocytes/ml, but without positive urine culture. Conclusions: In children with clinical manifestations of infection, with the presence of significant leukocyturia (more than 100 000 leukocytes/ml), even if they do not have a positive urine culture result, they should be provided with the medical care established for a patient with urinary tract infection.

Low progesterone levels on the day before natural cycle frozen embryo transfer are negatively associated with live birth rates.

STUDY QUESTION: Are progesterone (P) levels on the day before natural cycle frozen embryo transfer (NC-FET) associated with live birth rate (LBR)? SUMMARY ANSWER: Regular ovulatory women undergoing NC-FET with serum P levels <10 ng/ml on the day before blastocyst transfer have a significantly lower LBR than those with serum P levels >10 ng/ml. WHAT IS KNOWN ALREADY: The importance of serum P levels around the time of embryo transfer in patients undergoing FET under artificial endometrial preparation has been well established. However, no study has analyzed the importance of serum P levels in patients undergoing FET under a true natural endometrial preparation cycle. STUDY DESIGN, SIZE, DURATION: This was a retrospective cohort study including 294 frozen blastocyst transfers under natural cycle endometrial preparation at a university-affiliated fertility centre between January 2016 and January 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS: All patients had regular menstrual cycles and underwent NC-FET with their own oocytes. Only patients who had undergone serum P measurement between 8 am and 11 am on the day before FET were included. Patients did not receive any external medication for endometrial preparation or luteal phase support. Patients were divided into two groups according to serum P levels below or above 10 ng/ml on the day before FET. Univariate analysis was carried out to describe and compare the cycle characteristics with reproductive outcomes. To evaluate the effect of P, a multivariable logistic model was fitted for each outcome after adjusting for confounding variables. MAIN RESULTS AND THE ROLE OF CHANCE: Mean serum P levels on the day before FET were significantly higher in patients who had a live birth compared to those who did not (14.5 ± 7.0 vs 12.0 ± 6.6 ng/ml, 95% CI [0.83; 4.12]). The overall clinical pregnancy rate (CPR) and LBR were 42.9% and 35.4%, respectively. Patients in the higher P group (>10 ng/ml) had a higher LBR (41.1% vs 25.7%: risk difference (RD) 15.4%, 95% CI [5; 26]) and CPR (48.6% vs 33.0%: RD 15.6%, 95% CI [4; 27]). Patients with higher serum P levels on the day before FET (63% of patients) had an improved LBR (odds ratio: 1.05; 95% CI [1.02; 1.09]). Women with serum P levels <10 ng/ml on the day before FET (37% of patients) had significantly higher weights (62.5 ± 9.9 vs 58.1 ± 7.1 kg, 95% CI [1.92; 6.90]) and BMI (22.9 ± 3.6 vs 21.6 ± 2.7 kg/m2, 95% CI [0.42; 2.25]) compared to patients with P levels >10 ng/ml. LIMITATIONS, REASONS FOR CAUTION: The main limitation of our study is its retrospective design. Other potential limitations are the detection of LH surge through urine testing and the inclusion of patients who did and did not undergo preimplantation genetic testing for aneuploidies. The protocol used in our institution for monitoring NC-FET does not look for the onset of progesterone secretion by the corpus luteum, and a slow luteinisation process or delay of corpus luteum function cannot be ruled out. WIDER IMPLICATIONS OF THE FINDINGS: We provide evidence that a minimum serum P threshold (P >10 ng/ml) might be required for improved reproductive outcomes in NC-FET. This result suggests that there are different mechanisms by which P is produced and/or distributed by each patient. This study also provides an excellent model to evaluate the impact of luteal phase defect through NC-FET. A prospective evaluation to assess whether P supplementation should be individualised according to patient's needs is necessary to support our findings. STUDY FUNDING/COMPETING INTEREST(S): No external funding was used, and there are no competing interests.

Factors associated with serum progesterone concentrations the day before cryopreserved embryo transfer in artificial cycles.

RESEARCH QUESTION: What factors determine serum progesterone concentrations the day before cryopreserved embryo transfer in artificially prepared cycles? DESIGN: Retrospective cohort study at a university-affiliated fertility centre including infertile women under 45 years old using own oocytes who underwent a total of 685 single cryopreserved blastocyst transfers under hormonal therapy. Determinants that affected live birth rate (LBR) were analysed using a multivariate logistic regression. Univariate analysis and multivariate linear regression were used to evaluate independent factors that affect serum progesterone concentrations. RESULTS: Age (odds ratio [OR] 0.93; 95% confidence interval [CI] 0.89-0.96), duration of oestradiol (OR 0.96; 95% CI 0.92-0.99), serum progesterone concentrations (OR 1.04; 95% CI 1.01-1.08) and patients who underwent preimplantation genetic testing for aneuploidies (PGT-A) (OR 2.17; 95% CI 1.55-3.03) were independently associated with LBR. After univariate analysis, determinants of progesterone concentrations were: age, weight, history of a previous cryopreserved embryo transfer with serum progesterone concentrations <10 ng/ml, and time of blood extraction. The multivariate linear regression showed that increasing age presented a positive correlation with progesterone concentrations (ß = 0.11; 95% CI 0.01-0.20). On the contrary, significant negative correlations with progesterone concentrations were shown for a previous history of serum progesterone value <10 ng/ml (ß = -3.13; 95% CI -4.45 to -1.81]), higher weight (ß = -0.05; 95% CI -0.08 to -0.01) and the time of blood sampling during the day (ß = -0.13; 95% CI -0.25 to -0.01). CONCLUSIONS: This study adds more evidence regarding the importance of serum progesterone concentrations before frozen embryo transfer (FET). It also showed that body weight, age, time of blood sampling and a history of low progesterone are determinants associated with progesterone concentrations before blastocyst FET.

Criterios de retorno al trabajo y determinación del valor de vulnerabilidad por Covid-19.

Objetivo. Establecer criterios médicos de retorno al trabajo en personal con riesgo de complicaciones por Covid-19. Material y métodos. Se realizó una revisión sistemática para identificar las condiciones y las características clínicas que influyen en el riesgo de desarrollar Covid-19 grave. Resultados. Se ha demostrado incremento del riesgo en obesidad, edad >60 años, diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiovascular, enfermedad renal crónica y cáncer. Solamente en diabetes se ha estudiado si el control previo influye. Se proponen condiciones específicas y el nivel de riesgo epidemiológico para el retorno al trabajo. Conclusiones. El retorno laboral de estos grupos debe priorizarse buscando favorecer el control de la enfermedad, identificando el estado de salud que incrementa el riesgo y protegiendo el derecho al trabajo. Se presentan recomendaciones para guiar la reincorporación al trabajo.

El adulto mayor practicante sistemático: pruebas para evaluar su condición física / Older adult systematic practitioner: tests to assess your physical condition

Resumen En Cuba, la atención al Programa del Adulto Mayor está priorizada y los profesionales de la actividad física, que se desempeñan, en esta esfera pedagógica, están conscientes de ello. Con los adultos mayores, practicantes sistemáticos, se promueve potenciar su independencia funcional, teniendo en cuenta el trabajo con todas las capacidades físicas, implicadas dentro de las acciones motrices. El objetivo principal de la investigación fue crear un instrumento que permitiera la evaluación de la condición física con su correspondiente metodología, el cual permitiera incrementar su calidad de vida, a partir del mejoramiento de su estado funcional. Además, de proveer las normas para planificar un trabajo diferencial que tuviera en cuenta las diferencias de sexo, edad y las enfermedades crónicas no trasmisibles del practicante, como complemento importante de la batería elaborada. El programa estuvo dirigido a aquellos adultos mayores que practican ejercicios físicos, como mínimo, tres veces a la semana. Los materiales empleados se corresponden con cintas métricas, conos, tizas, sillas y pesas de 8 kilos para los hombres y de cinco para las féminas. Los métodos y técnicas empleados fueron: la encuesta, la entrevista, la observación y la medición. Con los resultados de la evaluación de la condición física, los docentes podrán planificar mejor su trabajo y los adultos mayores, practicantes sistemáticos, se beneficiarán con una atención óptima ya que podrán ser atendidos de manera diferenciada. En esta oportunidad, se está socializando la batería y su metodología solamente; las normas para la evaluación serán motivo de otro artículo.

Abstract In Cuba, attention to the Elderly Programme is a priority and physical activity professionals working in this pedagogical field are aware of it. Systematic practitioners of older adults are encouraged to enhance their functional independence, taking into account work with all the physical capacities involved in motor actions. The main objective of the research was to create an instrument that would allow the evaluation of the physical condition with its corresponding methodology, which would allow to increase their quality of life from the improvement of their functional state. In addition to providing the rules to plan a differential work that took into account the differences of sex, age and chronic diseases nontransmissible to the practitioner as an important complement to the battery developed. The program was aimed at older adults who practice physical exercise at least three times a week. The materials used correspond to metric tape, cones, chalks, chairs and weights of 8 kilos for men and five for women. The methods and techniques used were: survey, interview, observation and measurement. With the results of the physical condition assessment, teachers will be able to plan their work better and older adults who are systematic practitioners will benefit from optimal care as they can be attended to in a differentiated manner. In this opportunity the battery is being socialized and its methodology only, the norms for the evaluation will be reason for another article.