Combining Ultrafiltration and Nanofiltration to Obtain a Concentrated Extract of Purified Polyphenols from Wet Olive Pomace.

Despite the environmental concerns raised every year by the generation of high volumes of wet olive pomace, it contains valuable phenolic compounds that are essential for the valorization of this by-product. In this work, an integrated process to recover phenolic compounds from wet olive pomace is proposed. It consists of ultrasound-assisted solid-liquid extraction, followed by ultrafiltration and nanofiltration. Several commercial membranes were studied at different operational conditions. The ultrafiltration stage allowed the purification of biophenols, which were obtained in the permeate stream. Regarding organic matter, satisfactory rejection values were obtained with both commercial UH030 and UP005 membranes (Microdyn Nadir), but the latter provided more efficient purification and higher values of permeate flux, above 18 L·h-1·m-2 at 2.5 bar and 1.5 m·s-1. Later, this permeate stream was concentrated by means of a nanofiltration process, obtaining polyphenol rejection values that surpassed 85% with the commercial NF270 membrane (DuPont), then achieving the concentration of the previously purified polyphenols.

Enfermedad ósea metabólica del prematuro: revisión de tema / Metabolic bone disease of prematurity: topic review

Resumen La enfermedad ósea metabólica del prematuro es una patología multifactorial que representa una importante causa de morbilidad, cuya prevalencia ha aumentado. Su diagnóstico requiere criterios bioquímicos, radiológicos y, en etapas avanzadas, clínicos; por lo cual, muchos autores recomiendan estrategias de tamizaje y prevención. El objetivo del presente artículo es realizar una revisión de los aspectos más relevantes respecto a la enfermedad ósea metabólica del prematuro, con énfasis en la prevención y tratamiento precoz. Se realizó una revisión bibliográfica con términos MeSH, en las bases de datos de Pubmed, ClinicalKey, ScienceDirect, SciELO y LILACS. Aunque no hay consenso en las pautas de tamizaje, diagnóstico y tratamiento, la principal estrategia usada en la actualidad es el soporte nutricional individualizado que cubra las demandas de calcio, fósforo y vitamina D, asociado a métodos de intervención clínica y seguimiento de bebés de alto riesgo. La comprensión de esta patología permitirá mejorar las estrategias de tamización, diagnóstico precoz, y de esta forma evitará complicaciones.

Abstract Metabolic bone disease of prematurity is a multifactorial pathology that represents a significant cause of morbidity and has increased in prevalence. Its diagnosis requires biochemical, radiological, and, in advanced stages, clinical criteria; therefore, many authors recommend screening and prevention strategies. This article aims to review the most relevant aspects of the metabolic bone disease of prematurity, with emphasis on prevention and early treatment. A bibliographic review was carried out with MeSH terms in the Pubmed, ClinicalKey, ScienceDirect, SciELO, and LILACS databases. Although there is no consensus on screening, diagnosis and treatment guidelines, the main strategy currently used is to provide individualized nutritional support that covers the demands of calcium, phosphorus and vitamin D associated with clinical intervention methods and monitoring of high-risk babies. Understanding this pathology will improve screening strategies and early diagnosis and thus avoid complications.

Remote analysis of sputum smears for mycobacterium tuberculosis quantification using digital crowdsourcing.

Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent. Although the development and roll out of Xpert MTB/RIF has recently become a major breakthrough in the field of TB diagnosis, smear microscopy remains the most widely used method for TB diagnosis, especially in low- and middle-income countries. This research tests the feasibility of a crowdsourced approach to tuberculosis image analysis. In particular, we investigated whether anonymous volunteers with no prior experience would be able to count acid-fast bacilli in digitized images of sputum smears by playing an online game. Following this approach 1790 people identified the acid-fast bacilli present in 60 digitized images, the best overall performance was obtained with a specific number of combined analysis from different players and the performance was evaluated with the F1 score, sensitivity and positive predictive value, reaching values of 0.933, 0.968 and 0.91, respectively.

Development of Chitosan Microspheres through a Green Dual Crosslinking Strategy Based on Tripolyphosphate and Vanillin.

Microencapsulation procedures have recently focused attention on designing novel microspheres via green synthesis strategies. The use of chitosan (CS) as an encapsulating material has increased interest due to its unique bioactive properties and the various crosslinking possibilities offered by their functional groups. The consolidation of the microspheres by physical crosslinking using sodium tripolyphosphate (TPP) combined with chemical crosslinking using vanillin (VA) open new opportunities in the framework of green dual crosslinking strategies. The developed strategy, a straightforward technique based on an aqueous medium avoiding complex separation/washing steps, offers advantages over the processes based on VA, mostly using water-in-oil emulsion approaches. Thus, in this work, the combination of TPP crosslinking (3, 5, and 10 wt.%) via spray-coagulation technique with two VA crosslinking methods (in situ and post-treatment using 1 wt.% VA) were employed in the preparation of microspheres. The microspheres were characterized concerning morphology, particle size, physicochemical properties, thermal stability, and swelling behavior. Results revealed that the combination of 5 wt.% TPP with in situ VA crosslinking led to microspheres with promising properties, being an attractive alternative for natural bioactives encapsulation due to the green connotations associated with the process.

Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study.

The objective of this study was to assess the predictive value of a lung ultrasound (LUS) score in the development of moderate-severe bronchopulmonary dysplasia (sBPD). This was a prospective  observational diagnostic accuracy study in a third-level neonatal intensive care unit. Preterm infants with a gestational age below 32 weeks were included. A LUS score (range 0-24 points) was calculated by assessing aeration semiquantitatively (0-3 points) in eight lung zones on the 7th day of life (DOL) and repeated on the 28th DOL. ROC curves and logistic regression were used for analysis. Forty-two preterm infants were included. The LUS on the 7th DOL had an area under the receiver operating characteristic curve (AUROC) of 0.94 (95% CI: 0.87-1) for the prediction of sBPD (optimal cutoff of ≥8 points: sensitivity 93%, specificity 91%). The LUS score was independently associated with sBPD [OR 2.1 (95% CI: 1.1-3.9), p = 0.022, for each additional point in the score]. Conclusions: Lung aeration as assessed by LUS on the 7th DOL may predict the development of sBPD.

Síndrome WAGR por deleción en heterocigosis del gen WT1: Caso clínico pediátrico / WAGR syndrome by heterozygous deletion of the WT1 gene: Pediatric case report

El síndrome WAGR (tumor de Wilms, aniridia, anomalías genitourinarias y retraso mental) es un trastorno genético infrecuente debido a la deleción de la región 11p13, que contiene los genes WT1 y PAX6. Comprende una combinación distintiva de afecciones clínicas; la aniridia y el tumor de Wilms son las más notables. Se presenta a un lactante de 17 meses con microcefalia, alteraciones oculares (buftalmos, leucocoria, aniridia bilateral), hipoplasia escrotal, testículos en la región inguinal y retraso en el neurodesarrollo, a quien se le realizó el estudio de amplificación de sondas dependiente de ligandos múltiples para WT1, que mostró haploinsuficiencia en las sondas que hibridaban la región 11p13, compatible con una deleción en heterocigosis del gen. Posteriormente, se diagnosticó tumor de Wilms. Dada su baja prevalencia, es importante difundir sus características clínicas y hacer énfasis en un manejo interdisciplinario centrado en la identificación precoz del síndrome y de sus posibles complicaciones. .

WAGR syndrome (Wilms tumor, aniridia, genitourinary anomalies and mental retardation) is an uncommon genetic disorder due to the deletion of the 11p13 region that contains the WT1 and PAX6 genes. It involves a distinctive combination of clinical conditions, with aniridia and Wilms tumor being the most notable. We present a 17-month-old infant with microcephaly, ocular alterations (buphthalmos, leukocoria, bilateral aniridia), scrotal hypoplasia, undescended testes and neurodevelopmental delay who underwent multiplex ligation-dependent probe amplification study for WT1, showing haploinsufficiency in the probes that hybridize to the 11p13 region, compatible with an heterozygous deletion of the gene. Wilms tumor was later diagnosed. WAGR syndrome is infrequent; its report in Latin America is low. It is important to disseminate its clinical characteristics, emphasizing an interdisciplinary management focused on the early identification of both the syndrome and its possible complications.

[WAGR syndrome by heterozygous deletion of the WT1 gene. Pediatric case report]. / Síndrome WAGR por deleción en heterocigosis del gen WT1. Caso clínico pediátrico.

WAGR syndrome (Wilms tumor, aniridia, genitourinary anomalies and mental retardation) is an uncommon genetic disorder due to the deletion of the 11p13 region that contains the WT1 and PAX6 genes. It involves a distinctive combination of clinical conditions, with aniridia and Wilms tumor being the most notable. We present a 17-month-old infant with microcephaly, ocular alterations (buphthalmos, leukocoria, bilateral aniridia), scrotal hypoplasia, undescended testes and neurodevelopmental delay who underwent multiplex ligation-dependent probe amplification study for WT1, showing haploinsufficiency in the probes that hybridize to the 11p13 region, compatible with an heterozygous deletion of the gene. Wilms tumor was later diagnosed. WAGR syndrome is infrequent; its report in Latin America is low. It is important to disseminate its clinical characteristics, emphasizing an interdisciplinary management focused on the early identification of both the syndrome and its possible complications.

El síndrome WAGR (tumor de Wilms, aniridia, anomalías genitourinarias y retraso mental) es un trastorno genético infrecuente debido a la deleción de la región 11p13, que contiene los genes WT1 y PAX6. Comprende una combinación distintiva de afecciones clínicas; la aniridia y el tumor de Wilms son las más notables. Se presenta a un lactante de 17 meses con microcefalia, alteraciones oculares (buftalmos, leucocoria, aniridia bilateral), hipoplasia escrotal, testículos en la región inguinal y retraso en el neurodesarrollo, a quien se le realizó el estudio de amplificación de sondas dependiente de ligandos múltiples para WT1, que mostró haploinsuficiencia en las sondas que hibridaban la región 11p13, compatible con una deleción en heterocigosis del gen. Posteriormente, se diagnosticó tumor de Wilms. Dada su baja prevalencia, es importante difundir sus características clínicas y hacer énfasis en un manejo interdisciplinario centrado en la identificación precoz del síndrome y de sus posibles complicaciones.

Úlcera corneal micótica por Lasiodiplodia theobromae. Reporte de caso / Fungal corneal ulcer by Lasiodiplodia theobromae. Case report

Introducción: La úlcera corneal de etiología micótica por Lasiodiplodia theobromae es una patología infrecuente con menos de 50 casos de infección ocular por este patógeno reportados en la literatura. Objetivo: Dar a conocer un caso de una patología poco frecuente, haciendo una breve revisión de la literatura, y discutiendo el tratamiento elegido que resultó favorable. Diseño del estudio: Reporte de caso. Resumen del caso: Se presenta el caso de un paciente atendido en el Hospital Universitario de Santander (HUS) durante los años 2015 - 2017 con antecedente de trauma ocular con material vegetal quien desarrolla úlcera corneal micótica por Lasiodiplodia theobromae, que se confi rmó usando análisis microbiológico del frotis corneal. Se instauró tratamiento con una combinación de antimicóticos con un resultado final satisfactorio. Conclusión: L. theobromae es un patógeno oportunista. La importancia del diagnóstico precoz en estos casos, que requiere un alto índice de sospecha en pacientes con trauma vegetal, con la identificación del agente etiológico radica en evitar o minimizar consecuencias irreversibles mediante la instauración de un tratamiento oportuno.

Background: The corneal ulcer of mycotic etiology caused by Lasiodiplodia theobromae is an infrequent pathology with less than 50 cases of ocular infection by this pathogen reported in the literature. Objective: To present a case of a rare pathology, make a brief literature review, and discuss the chosen treatment that was favorable. Study design: Case report. Case summary: We present the case of a patient treated at the Hospital Universitario de Santander (HUS) during the years 2015 - 2017 with a history of ocular trauma with plant material who developed fungal corneal ulcer by Lasiodiplodia theobromae, which was confi rmed using microbiological analysis of the corneal smear. Treatment with a combination of antifungals was established with a satisfactory final result. Conclusion: L. theobromae is an opportunistic pathogen. The importance of early diagnosis in these cases, which requires a high index of suspicion in patients with plant trauma, with the identifi cation of the etiological agent lies in avoiding or minimizing irreversible consequences through the establishment of an opportune treatment.

N-terminal-probrain natriuretic peptide as a biomarker of moderate to severe bronchopulmonary dysplasia in preterm infants: A prospective observational study.

OBJECTIVE: N-terminal-probrain natriuretic peptide (NT-proBNP) is a marker of hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. In this study, we assessed whether NT-proBNP levels could predict the risk of moderate to severe bronchopulmonary dysplasia (BPD) and/or death. METHODS: This was an observational prospective study of preterm infants with GA ≤32 weeks. Infants who died within the first 48 h or who had major congenital malformations or incomplete information were excluded. NT-proBNP was determined at 48-96 h of life and at 5-10 days of life. The predictive capacity of NT-proBNP for the combined outcome of BPD and/or death was evaluated using receiver operator characteristic (ROC) curves and multivariate regression. RESULTS: Of the 125 eligible patients, 110 completed the analysis. Twenty-eight developed BPD (n = 15) and/or died (n = 13). Infants who developed BPD and/or died had higher NT-proBNP levels ​​at 48-96 h (26,848 ng/L, interquartile range [IQR] 7818-60,684 vs 3008 ng/L, IQR 1425-9876) and at 5-10 days (8849 ng/L, IQR 3796-19,526 vs 1427 ng/L, IQR 907-2889). The NT-proBNP levels at 5-10 days, but not at 48-96 h, were independently associated with BPD and/or death after adjustments for HsPDA and other confounders (OR = 3.36; 95%CI: 1.52-7.4, P = 0.006). For the prediction of this result, a cutoff of 3348 ng/L had a sensitivity and specificity of 82% and 83%, respectively (area under the curve [AUC] = 0.87; 95%CI: 0.79-0.95). CONCLUSION: The NT-proBNP levels at 5-10 days of life may identify preterm infants with an HsPDA who are at high risk of BPD or death and may be useful for individualized preventive and therapeutic strategies.

Miocardiopatía/displasia arritmogénica del ventrículo derecho. Revisión de la literatura además de un reporte de caso / Arrhythmogenic right ventricular cardiomyopathy/dysplasia. Literature review and case report

Resumen: La miocardiopatía/displasia arritmogénica del ventrículo derecho es una enfermedad hereditaria autosómica dominante con una prevalencia estimada de 1:2,500-1:5,000, siendo mayor en el género masculino (3:1). Se caracteriza histológicamente por reemplazo de los cardiomiocitos por tejido fibroadiposo, lo cual predispone a arritmias ventriculares, insuficiencia ventricular derecha y muerte súbita cardiaca. El objetivo principal del tratamiento es reducir el riesgo de muerte súbita y mejorar la calidad de vida de los pacientes. Se presenta el caso de una mujer de 23 años con clínica de palpitaciones, dolor torácico con actividad física, síncope y cefalea iniciada hace 6 años durante un primer embarazo. Por aumento de sintomatología se realizó prueba de esfuerzo, durante la cual presentó taquicardia ventricular monomórfica sostenida colapsante. Se realizó cardiorresonancia, evidenciando dilatación ventricular derecha, aumento en su trabeculación y disminución de su función. Se realizó ablación con mapeo tridimensional; durante la comprobación con infusión de isoproterenol se generó flutter ventricular polimórfico requiriendo cardioversión eléctrica. Se decidió implantar cardiodesfibrilador bicameral y realizar ablación de ganglio estrellado como prevención secundaria. Tras su egreso reconsultó múltiples veces por descargas del dispositivo asociadas a palpitaciones. Se realizó una revisión exhaustiva de la historia clínica encontrando que la paciente tiene características sugestivas de displasia arritmogénica del ventrículo derecho por lo cual se aplican los criterios de Task Force concluyendo que, al cumplir con más de 2 criterios mayores, la paciente presentaba un diagnóstico definitivo de esta enfermedad. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract: Arrhythmogenic right ventricular cardiomyopathy/dysplasia is an inherited autosomal dominant disease, with an estimated prevalence of 1:2,500 to 1:5,000, being higher in males (3:1). It is characterised histologically by the substitution of cardiomyocytes for fibrous-adipose tissue, which predisposes to ventricular arrhythmias, right ventricular failure, and sudden cardiac death. The main aim of treatment is to reduce the risk of sudden death and improve the quality of life of patients. The case is presented of a 23 year old woman whose clinical symptoms started with palpitations, chest pain with physical activity, syncope, and headache, 6 years ago during her first pregnancy. Due to an increase in symptomatology, a stress test was performed, during which she collapsed with a sustained monomorphic ventricular tachycardia. A cardiac magnetic resonance scan showed dilation, an increase in trabeculae, and decreased function of the right ventricle. A 3-dimensional mapping and ablation was performed, and during the isoproterenol infusion test, a polymorphic ventricular flutter was generated that required electrical cardioversion. The decision was made to implant a dual chamber cardioverter defibrillator and perform stellate ganglion ablation as secondary prevention. After her discharge, the patient re-consulted many times due to discharges of the device associated with palpitations. A comprehensive review of the patient's medical records was performed, finding characteristics that may suggest arrhythmogenic right ventricular dysplasia. The Task Force criteria was applied, concluding that, as she met more than 2 major criteria, the patient had a definitive diagnosis of this disease. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

[Arrhythmogenic right ventricular cardiomyopathy/dysplasia. Literature review and case report]. / Miocardiopatía/displasia arritmogénica del ventrículo derecho. Revisión de la literatura además de un reporte de caso.

Arrhythmogenic right ventricular cardiomyopathy/dysplasia is an inherited autosomal dominant disease, with an estimated prevalence of 1:2,500 to 1:5,000, being higher in males (3:1). It is characterised histologically by the substitution of cardiomyocytes for fibrous-adipose tissue, which predisposes to ventricular arrhythmias, right ventricular failure, and sudden cardiac death. The main aim of treatment is to reduce the risk of sudden death and improve the quality of life of patients. The case is presented of a 23 year old woman whose clinical symptoms started with palpitations, chest pain with physical activity, syncope, and headache, 6 years ago during her first pregnancy. Due to an increase in symptomatology, a stress test was performed, during which she collapsed with a sustained monomorphic ventricular tachycardia. A cardiac magnetic resonance scan showed dilation, an increase in trabeculae, and decreased function of the right ventricle. A 3-dimensional mapping and ablation was performed, and during the isoproterenol infusion test, a polymorphic ventricular flutter was generated that required electrical cardioversion. The decision was made to implant a dual chamber cardioverter defibrillator and perform stellate ganglion ablation as secondary prevention. After her discharge, the patient re-consulted many times due to discharges of the device associated with palpitations. A comprehensive review of the patient's medical records was performed, finding characteristics that may suggest arrhythmogenic right ventricular dysplasia. The Task Force criteria was applied, concluding that, as she met more than 2 major criteria, the patient had a definitive diagnosis of this disease.

Caracterización clínica de los pacientes con artritis reumatoide en un hospital universitario en Colombia / Clinical characterization of patients with rheumatoid arthritis in a university hospital in Colombia

Introducción y objetivo: La artritis reumatoide (AR) es una enfermedad inflamatoria crónica de naturaleza autoinmune caracterizada por una inflamación sinovial crónica. El diagnóstico es clínico e inmunológico. Nuestro objetivo es realizar una descripción de las características clínicas e inmunológicas en una cohorte de pacientes del Hospital Universitario de Santander, Colombia. Métodos: Estudio observacional, descriptivo de corte transversal retrospectivo. La población de estudio consistió en pacientes mayores de 13 años con AR que ingresaron al Hospital Universitario de Santander, entre el 2012 y el 2016.

Enfermedad cardiovascular y metabólica en pacientes infectados por el virus de la inmunodeficiencia humana / Cardiovascular and metabolic disease in patients with human immunodeficiency virus infection

RESUMEN Desde la instauración de la terapia antiretroviral, la morbimortalidad asociada al síndrome de la inmunodeficiencia adquirida ha disminuido drásticamente y la infección por el Virus de la Inmunodeficiencia Humana se ha convertido en una enfermedad crónica. Sin embargo, con la introducción del tratamiento antiretroviral para el control de la enfermedad se ha observado un aumento en la prevalencia de enfermedad cardiovascular en este grupo, convirtiéndose éste en un motivo de especial preocupación. Consecuentemente, la evaluación y prevención de la enfermedad cardiovascular se ha tornado de suma importancia y debe evaluarse de manera individual y rutinaria en estos pacientes. El objetivo de este artículo es hacer una revisión de las principales complicaciones cardiovasculares y metabólicas con el fin de consolidar los posibles hallazgos a los que se enfrenta el clínico al momento de un abordaje integral de un paciente seropositivo para el virus de inmunodeficiencia humana. MÉD.UIS. 2017;30(2):45-54.

ABSTRACT Since the introduction of antiretroviral therapy, morbidity and mortality associated with Acquired Immunodeficiency Syndrome has drastically decreased and human immunodeficiency virus infection has become a chronic disease. However, with the introduction of antiretroviral treatment for the control of the disease, an increase in the prevalence of cardiovascular disease in this group has been observed, making this a reason of particular concern. Consequently, the evaluation and prevention of cardiovascular disease has become of paramount importance and should be evaluated individually and routinely in these patients. The objective of this article is to make a review of the main cardiovascular and metabolic complications in order to objectify the possible findings that the clinician faces at the moment of an integral approach to the seropositive patient for human immunodeficiency virus. MÉD.UIS. 2017;30(2):45-54.

Cost-Effectiveness of Drug Treatments for Advanced Melanoma: A Systematic Literature Review.

BACKGROUND: Until recently, advanced melanoma (unresectable and metastatic) has had a poor prognosis and has been treated with chemotherapy. The introduction of new treatments (BRAF and MEK inhibitors and immunotherapy) has improved overall survival and progression-free survival of some patients. OBJECTIVE: The objective of this study was to review the published evidence on the cost-effectiveness of pharmacological treatments for advanced melanoma. METHODS: A systematic literature search was conducted, without date or language restrictions, in PubMed, EMBASE, Scopus, the Cochrane Library, the UK National Institute for Health and Care Excellence databases and the Health Technology Assessment journal. Internet searches were also made to identify possible grey literature. Main study characteristics, methods and outcomes were extracted and critically assessed. The quality of health economic studies was assessed by the Quality Assessment of Economic Evaluation in Health Care checklist. RESULTS: The search identified nine full-text pharmacoeconomic analyses of advanced melanoma treatments. According to the economic analyses published in the articles, the new treatments have been shown to be more effective (with more life-years and quality-adjusted life-years) than chemotherapy, although generally the cost per quality-adjusted life-year gained was above the commonly accepted threshold. Because of the variability of the available analyses comparing the new treatments, we cannot determine which treatment is the most cost-effective. CONCLUSIONS: From the available data, it cannot be concluded that the new drugs (BRAF and MEK inhibitors and immunotherapy) are cost effective compared with chemotherapy or which is the most cost-effective new treatment.

Carcinoma de glándulas sebáceas limitado a conjuntiva bulbar / Sebaceous gland carcinoma restricted to bulb conjunctiva

El carcinoma de glándulas sebáceas es un tumor infrecuente que puede desarrollarse a partir de cualquier glándula sebácea en la piel. El 75 por ciento de las veces es de origen ocular y afecta principalmente las glándulas de Zeiss, Meibomio y de la carúncula. Se caracteriza por un comportamiento agresivo, con alta probabilidad de invasión a piel, conjuntiva y córnea. Sin embargo, el compromiso de la conjuntiva como localización primaria es raro. Se presenta un caso con diagnóstico de carcinoma sebáceo de patrón nodular primario de la conjuntiva bulbar, atendido en el Hospital Universitario de Santander durante los años 2014-2016. El propósito del presente estudio es dar a conocer el caso de una patología infrecuente con pocos casos reportados en la literatura, enfatizar su importancia dentro de los diagnósticos diferenciales de masas en la conjuntiva y del estudio histopatológico como método para obtener un diagnóstico definitivo y realizar un abordaje temprano(AU)

Sebaceous gland carcinoma is an uncommon tumor that may derive from any sebaceous gland of the skin. In 75 percent of cases is ocular and mainly affects the Zeiss, Melbonium and caruncle glands. It is characterized for its aggressiveness, high probability of passing into the skin, the conjunctiva and the cornea. However, the involvement of the conjunctiva as a primary location is rare. This is a case diagnosed with sebaceous carcinoma of primary nodullary pattern of the bulb conjunctiva, which was seen at the university hospital of Santander from 2014 to 2016. The objective of the study was to show the case of an infrequent pathology with very few cases reported up to now in literature, to make emphasis on its importance within the differential diagnoses of masses present in the conjunctiva and of the histopathological study as a method to obtain a final diagnosis and to make an early intervention(AU)

Tracheal intubation of pediatric manikins during ongoing chest compressions. Does Glidescope® videolaryngoscope improve pediatric residents' performance?

UNLABELLED: Our objective was to test the ability of pediatric residents to intubate the trachea of infant and child manikins during continuous chest compressions (CC) by means of indirect videolaryngoscopy with Glidescope® versus standard direct laryngoscopy. A randomized crossover simulation trial was designed. Twenty-three residents trained to intubate child and infant manikins were eligible for the study. They were asked to perform tracheal intubation in manikins assisted by both standard laryngoscopy and Glidescope® while a colleague delivered uninterrupted chest compressions. In the infant cardiac arrest scenario, the median (IQR) total time for intubation was significantly shorter with the Miller laryngoscope [28.2 s (20.4-34.4)] than with Glidescope® [38.0 s (25.3-50.5)] (p = 0.021). The number of participants who needed more than 30 s to intubate the manikin was also significantly higher with Glidescope® (n = 13) than with the Miller laryngoscope (n = 7, p = 0.01). In the child scenario, the total time for intubation and number of intubation failures were similar with Macintosh and Glidescope® laryngoscopes. The participants' subjective difficulty of the procedure was similar for direct and videolaryngoscopy. CONCLUSION: In simulated infant and child cardiac arrest scenarios, pediatric residents are able to intubate the trachea during CC. The videolaryngoscope Glidescope® does not improve performance in this setting.

Serum concentrations of procalcitonin after cardiac surgery.

BACKGROUND AND AIM: Monitoring of complications in patients undergoing cardiac surgery may be difficult because cardiopulmonary bypass (CPB) can lead to a systemic inflammatory response syndrome because of exposure of blood to nonphysiological surfaces. The purpose of the study was to establish the baseline levels of procalcitonin (PCT) after cardiac surgery in our population in order to analyze a possible induction of the inflammatory response that might interfere with the diagnosis of infection by PCT. METHODS: Serum samples from patients undergoing coronary artery bypass grafting or valve replacement were collected at the time of admission to intensive care unit, after surgery as well as in the first and second postoperative days. Patients were followed for the development of postoperative complications. PCT levels were measured by immunoluminometric assay. RESULTS: The mean PCT values were significantly higher in the first postoperative day in all the groups except the control group. No increased PCT levels were found related neither to duration of CPB, nor to time of aortic clamping. Only patients who presented complications had significantly increased PCT values immediately after surgery (p = 0.004), in the first postoperative day (p < 0.0001), and in the second postoperative day (p < 0.0001) with respect to those who recovered uneventfully. CONCLUSIONS: A slight and transient increase in PCT levels was observed in the first postoperative day after cardiac surgery. Significant elevation of PCT was only observed when complications were present.

Evaluation of procalcitonin, neopterin, C-reactive protein, IL-6 and IL-8 as a diagnostic marker of infection in patients with febrile neutropenia.

Infectious complications in neutropenic patients are a major cause of morbidity and mortality. Clinical signs are unspecific and fever can be attributed to other causes. Inflammatory biomarkers have emerged as potentially useful in diagnosis of bacterial and fungal infection. Levels of several biomarkers were measured in patients with hematological malignancy at diagnosis and at the beginning of neutropenia due to cytostatic treatment or after hematopoietic stem cell transplantation, and daily until 6 days after presenting fever. Procalcitonin (PCT) and neopterin levels were not elevated at diagnosis or at the beginning of neutropenia. C-reactive protein (CRP) was moderately elevated. PCT levels were significantly higher in patients with Gram-negative bacteremia at 24-48 h after the onset of fever. Patients with probable fungal infection presented elevated PCT values when fever persisted for more than 4-5 days. CRP was more sensitive to predict bacteremia (both Gram-positive and Gram-negative) but the specificity was low. Neither neopterin, IL-6 nor IL-8 presented significant differences according to the origin or etiology of fever. Since it showed a high negative predictive value of Gram-negative bacteremia, clinical prediction rules that attempt to predict a high risk of severe infection might be improved by including measurement of PCT.

Comparison of two commercially available gamma interferon blood tests for immunodiagnosis of tuberculosis.

We evaluated the T-SPOT.TB and Quantiferon-TB Gold In tube (QFN-G-IT) tests for diagnosing Mycobacterium tuberculosis infection. T-SPOT.TB was more sensitive than QFN-G-IT in diagnosing both active and latent infection. Both gamma interferon tests were unaffected by prior Mycobacterium bovis BCG vaccination. Among children who were not BCG vaccinated but had a positive tuberculin skin test, QFN-G-IT was negative in 53.3% of cases, and T-SPOT.TB was negative in 50% of cases.