Postreperfusion Syndrome in Patients Receiving Vasoactive Drugs During Liver Graft Reperfusion.

OBJECTIVES: The most widely used definition of postreperfusion syndrome in liver transplant is a 30% decrease in mean arterial pressure during the first 5 minutes after vascular unclamping. With these criteria, increased postoperative morbidity has been reported. Vasoactivedrugs couldpreventthis syndrome.Themain objective of our study was to determine the incidence and complications associated with postreperfusion syndrome inpatientswho receivedvasoactive support. MATERIALS AND METHODS: We studied 246 patients who received norepinephrine infusions to maintain mean arterial pressure ≥60 mm Hg and who were monitored with a Swan-Ganz catheter. Patients received a bolus of adrenaline after vascular unclamping in cases of insufficient response to norepinephrine. RESULTS: Among the study patients, 57 (23.17%) developed postreperfusion syndrome. Patients who developed postreperfusion syndrome did not present with morepostoperative complications interms ofrenal dysfunction (P = .69), repeat surgery (P = .15), graft rejection (P = .69), transplant replacement surgery (P = .76), hospital stay (P = .70), or survival (P = .17) compared with patients without postreperfusion syndrome. CONCLUSIONS: In patients who underwent orthotopic liver transplant, in whom vasoactive drugs were administered, a diagnosis of self-limited postreperfusion syndrome during the first 5 minutes after unclamping may not be associated with postoperative complications. The administration of vasoconstrictors may have a preventive effect on the postoperative complications associated with postreperfusion syndrome or they may mask the real incidence of postreperfusion syndrome. A broader definition of postreperfusion syndrome should be accepted.

Treatment of orbital lymphatic malformation with oral sirolimus: a case report / Malformação linfática orbital tratada com sirolimo oral: relato de caso

ABSTRACT It is estimated that lymphatic malformations in children account for 6% of all benign vascular malformations. New medical therapies have been developed for the management of lymphatic orbital disease. The purpose of this article was to describe a clinical case of orbital venolymphatic malformation in a 10-year-old boy, causing proptosis and palpebral edema. The lesion was initially treated with local sclerotherapy. However, the lesion relapsed, and was successfully treated with oral sirolimus. Prospective studies are warranted to determine the appropriate dose and extend the indications of sirolimus in these patients.

RESUMO A incidência de malformações linfáticas em crianças é estimada em 6% de todas as malformações vasculares benignas. Têm sido desenvolvidos novos tratamento para doenças linfáticas orbitárias. Nosso objetivo é descrever um caso clínico de malformação venolinfática orbitária em um menino de 10 anos de idade, causando proptose e edema palpebral. A lesão foi tratada inicialmente com escleroterapia local. No entanto, a lesão teve recidiva e foi tratada com sucesso com sirolimo oral. Ainda são necessários estudos prospectivos para estabelecer a dose apropriada e a duração do tratamento com sirolimo nesses pacientes.

Comparación cesáreas de no emergencia y parto normal, en servicios públicos/privados durante los años 2016-2019 en Chile / Comparison of non-emergency cesarean section and normal childbirth, in public/private services during the years 2016-2019 in Chile

Introducción: La Organización Mundial de la Salud (OMS) propuso que el porcentaje de cesáreas debería ser entre un 10 y 15%. Sin embargo, en los últimos años, a nivel mundial, se ha visto un aumento en su realización. El objetivo de este estudio fue describir la población de embarazadas en Chile durante los años 2016-2019 que tuvieron parto vaginal (PV) o cesárea de no emergencia (CNE), y compararlos entre servicio público y privado. Material y Método: Estudio ecológico realizado en embarazadas que se sometieron a CNE o PV en Chile entre los años 2016-2019. Se obtuvieron datos del Departamento de estadística e información de Salud. No se requirió comité de ética. Resultados: Durante el periodo estudiado hubo 57,60% (339.592) de PV y 42,39% (249.925) de CNE. En el sistema público hubo una diferencia de 54,94% (187.046) de PV por sobre el sistema privado. Mientras que la diferencia de CNE en el sistema privado fue un 10,06% (25.153) por sobre el sistema público. Discusión: Durante los cuatro años, las PV superaron a las CNE, sin embargo, las CNE representaron más del 40% del total de nacimientos, superando ampliamente las recomendaciones de la OMS. Las falencias a nivel nacional en el sistema de clasificación, y en la recopilación de datos limitan el desarrollo de estudios más acabados. Conclusión: Para enfrentar las altas cifras de CNE, es necesario unificar, ampliar y regularizar un base de datos nacional que dé paso a la creación de guías y protocolos que limiten el uso mal justificado de CNE.

Introduction: The World Health Organization (WHO) proposed that the percentage of caesarean sections should be between 10 and 15%. However, in recent years, worldwide, there has been an increase in its realization. The objective of this study was to describe the population of pregnant women in Chile during the years 2016-2019 who had a vaginal delivery (VD) or non-emergency cesarean section (NECS), and to compare them between public and private services. Material and Method: Ecological study carried out in pregnant women who underwent NECS or VD in Chile between the years 2016-2019. Data were obtained from the Department of Statistics and Health Information. No ethics committee was required. Results: During the studied period there were 57.60% (339,592) of VD and 42.39% (249,925) of NECS. In the public system there was a difference of 54.94% (187,046) of VD over the private system. While the difference of NECS in the private system was 10.06% (25,153) over the public system. Discussion: During the four years, VD exceeded NECS, however, NECS represented more than 40% of all births, far exceeding the WHO recommendations. Shortcomings at the national level in the classification system and in data collection limit the development of more complete studies. Conclusion: To face the high numbers of NECS, it is necessary to unify, expand and regularize a national database that gives way to the creation of guides and protocols that limit the poorly justified use of NECS.

Prognostic value of testosterone castration levels following androgen deprivation and high-dose radiotherapy in localized prostate cancer: Results from a phase III trial.

BACKGROUND/OBJECTIVE: The optimal prognostic value of testosterone following androgen deprivation therapy (ADT) is controversial. We studied the effect of serum testosterone levels on clinical outcome in localized prostate cancer (PCa) treated with ADT and high-dose radiotherapy (HRT). PATIENTS AND METHODS: The DART01/05 trial randomized 355 men with intermediate and high-risk PCa to 4 months of ADT plus HRT (STADT, N = 178) or the same treatment followed by 24 months of ADT (LTADT, N = 177). This study included patients treated with LTADT who had at least 3 determinations of testosterone during ADT (N = 154). Patients were stratified into 3 subgroups by testosterone level: minimum <20 ng/dL; median 20-49 ng/dL; and maximum ≥50 ng/dL. Kaplan-Meyer and Cox regression analysis were used for overall survival (OS) and Fine & Gray regression model for metastasis free survival (MFS), biochemical disease-free survival (bDFS) and time to TT recovery. RESULTS: There were no statistically significant differences in 10-year bDFS, MFS, or OS between the <20 ng/mL and 20-49 ng/dL subgroups. Multivariate analysis showed that a median testosterone ≥50 ng/dL was significantly associated with a decrease in bDFS (HR: 6.58, 95%CI 1.28-33.76, p = 0.03). Time to testosterone recovery after ADT did not correlate with bDFS, MFS, or OS and was not significantly associated with any of the testosterone subgroups. CONCLUSIONS: Our results do not support the concept that additional serum testosterone suppression below 20 ng/dL is associated with better outcomes than 20-49 ng/dL. Time to testosterone recovery after ADT and HRT did not impact clinical failure.

Dural Plasmacytoma with Meningeal Myelomatosis in a Patient with Multiple Myeloma.

Here, we describe the case of a 66-year-old male diagnosed with multiple myeloma who presented with generalized tonic-clonic seizures. Magnetic resonance imaging demonstrated a right solid extra-axial parieto-occipital lesion with typical characteristics of meningeal myelomatosis. Biopsy was performed, which diagnosed a dural plasmacytoma. Because of this, we started concomitant therapy with radiotherapy and lenalidomide, but the patient has a poor response to treatment and died few weeks after its initiation. Myelomatous involvement of the dura mater is a rare occurrence, given that only few cases were reported in the English literature. This presentation confers an ominous prognosis and must be a suspect diagnosis in patients diagnosed with multiple myeloma presenting neurological symptoms.

Three linked nomograms for predicting biochemical failure in prostate cancer treated with radiotherapy plus androgen deprivation therapy.

BACKGROUND: Nomograms were established to predict biochemical recurrence (BCR) after radiotherapy (RT) with a low weight of the characteristic variables of RT and androgen deprivation therapy (ADT). Our aim is to provide a new stratified tool for predicting BCR at 4 and 7 years in patients treated using RT with radical intent. MATERIALS AND METHODS: A retrospective, nonrandomized analysis was performed on 5044 prostate cancer (PCa) patients with median age 70 years, who received RT-with or without ADT-between November 1992 and May 2007. Median follow-up was 5.5 years. BCR was defined as a rise in serum prostate-specific antigen (PSA) of 2 ng/ml over the post-treatment PSA nadir. Univariate association between predictor variables and BCR was assessed by the log-rank test, and three linked nomograms were created for multivariate prognosis of BCR-free survival. Each nomogram corresponds to a category of the Gleason score-either 6,7, or 8-10-and all of them were created from a single proportional hazards regression model stratified also by months of ADT (0, 1-6, 7-12, 13-24, 25-36, 36-60). The performance of this model was analyzed by calibration, discrimination, and clinical utility. RESULTS: Initial PSA, clinical stage, and RT dose were significant variables (p < 0.01). The model showed a good calibration. The concordance probability was 0.779, improving those obtained with other nomograms (0.587, 0.571, 0.554) in the database. Survival curves showed best clinical utility in a comparison with National Comprehensive Cancer Network (NCCN) risk groups. CONCLUSION: For each Gleason score category, the nomogram provides information on the benefit of adding ADT to a specific RT dose.

La atención al cuidador, problema de salud necesario de abordar en los estudios médicos / Assistance to the caregiver, a health problem which is necessary to approach in the medical studies

Fundamento: la figura del cuidador surge por el incremento de las enfermedades que aparecen en edades avanzadas, y la necesidad de que una persona se encargue de prodigarle los cuidados necesarios a los aquejados de estas dolencias. En consecuencia se justifica ahondar en este problema de salud a fin de darle solución. Objetivo: expresar la necesidad de incluir la atención al cuidador como problema de salud en los estudios médicos. Métodos: se realizó una investigación descriptiva transversal. La población de estudio estuvo conformada por la totalidad de los cuidadores pertenecientes a los 3 grupos básicos de trabajo del Policlínico Universitario "Chiqui Gómez Lubián" de la ciudad de Santa Clara, desde enero a marzo del 2012. Como métodos teóricos se emplearon: análisis y síntesis de la información; empírico: el cuestionario, y los datos fueron procesados mediante el SPSS. Resultados: en la caracterización de la población de cuidadores se identificaron las alteraciones somáticas y la sintomatología de índole psíquica más frecuentes, estas últimas presentan una mayor incidencia en la medida que se incrementa el tiempo en que se presta este tipo de cuidados; 27 de ellos estuvieron necesitados de asistencia calificada tanto de psiquiatras como de otras especialidades médicas. Conclusiones: la aparición del cuidador como figura encargada de prestarle atención al anciano con una enfermedad demencial degenerativa requiere de modos de actuación médica integral, ello implica la necesidad de que el tema sea abordado en los procesos formativos del pregrado y posgrado de los profesionales de la salud.

Background: the figure of the caregiver arises because of the increase in the illnesses of the elderly people, and the need that a person be in charge to give them the necessary care to the sufferers of these illnesses. Therefore, it is convenient to deepen in this health problem in order to find its solution. Objective: to express the need to include the assistance to the caregiver as a health problem in the medical studies. Methods: a descriptive transversal research project was done. The population was composed of all the caregivers belonging to the three basic work groups from the "Chiqui Gómez Lubián" University Clinic in the city of Santa Clara, from January to March of 2012. As theoretical methods the analysis and synthesis of the information collected were used; empirical: a questionnaire and the data were processed through the SPSS. Results: in the characterization of the population of caregivers were identified the somatic disturbances and the symptomatology of psychic nature as most frequent. This symptomatology presents a greater incidence in relation to the time in which this caregiving lasts; twenty-seven of these caregivers needed qualified assistance from psychiatrists and other medical specialities. Conclusions: the appearance of the caregiver as figure in charge of giving assistance to an elderly person with a degenerative mental disease requires of ways of integral medical behavior, and it implies the need that this theme be approached in the training processes of undergraduate and postgraduate studies of the health professionals.

Shelf-life extension and sanitation of fresh pork loin by E-beam treatment.

The usefulness of electron beam (E-beam) irradiation to increase the shelf life of whole fresh pork loin stored at 4°C has been studied. The shelf life was extended from 5 to 11 and 20 days after the application of 1 and 2 kGy, respectively. If a temperature abuse situation were to occur during product distribution (e.g., increase to 8°C), the shelf life would be extended from 3 to 8 and 15 days, respectively, after application of the same doses. When considering Listeria monocytogenes from a public health point of view, the irradiated whole fresh loin may be marketable for periods longer than 2 weeks, thus guaranteeing a practically Listeria-free product. Irradiation produced no important changes in the rheological characteristics of the meat. Although the sensory quality of irradiated meat was scored lower than the control immediately after irradiation, after 5 days in storage, irradiated meat scored higher than or not different from the control.

Sanitation of selected ready-to-eat intermediate-moisture foods of animal origin by E-beam irradiation.

To optimize the sanitation treatment of ready-to-eat (RTE) intermediate-moisture foods (IMF), the behavior of Listeria monocytogenes Scott A (CIP 103575), L. innocua (NTC 11288), Salmonella enterica serovar Typhimurium (CECT 443), and Escherichia coli O157:H7 (CECT 4972) following treatment with electron-beam irradiation has been studied. As food matrixes, three RTE vacuum-packed products (Iberian dry-cured ham, dry beef [cecina], and smoked tuna) were used. Although an irradiation treatment is not necessary when the 10(2) colony-forming units/g microbiological criterion for L. monocytogenes is applied, a treatment of 1.5 kGy must be applied to IMFs to meet the food safety objective in the case of the "zero tolerance" criterion for the three strains. The IMF products presented negligible modifications of color (L*, a*, and b*), sensory (appearance, odor, and flavor), and rheology (hardness, springiness, adhesiveness, cohesiveness, gumminess, chewiness, and breaking strength) parameters at doses lower than 2 kGy. Therefore, the treatment of 1.5 kGy warrants safe IMF with sensory properties similar to those of the genuine products.

Relationship between HIV/Highly active antiretroviral therapy (HAART)-associated lipodystrophy syndrome and stavudine-triphosphate intracellular levels in patients with stavudine-based antiretroviral regimens.

BACKGROUND: The link between human immunodeficiency virus/highly active antiretroviral therapy (HAART)-associated lipodystrophy syndrome (HALS) and the use of thymidine analogues has been well established. However, to our knowledge, no relationship has been proven between intracellular levels of stavudine (d4T) and HALS. METHODS: We measured peripheral blood mononuclear cell intracellular levels of d4T-triphosphate (TP) in patients who were receiving d4T as part of their antiretroviral regimens. d4T-TP levels were determined by a validated liquid chromatography-tandem mass spectrometry assay method. The diagnosis of HALS was made in accordance with the criteria of a lipodystrophy severity grading scale. The Student t test, Pearson correlations, 1-way analysis of variance with Bonferroni correction, and stepwise logistic regression were used for statistic analyses. RESULTS: This was a cross-sectional study. There were 33 patients: 17 with HALS and 16 without HALS. The median concentration of d4T-TP for patients with HALS was 20.60 femtomoles (fmol)/1 x 10(6) cells (interquartile range [IQR], 14.90-26.92 fmol/1 x 10(6) cells) and for patients without HALS was 13.85 fmol/1 x 10(6) cells (IQR, 8.65-20.15 fmol/1 x 10(6) cells) (P=.013). The median d4T-TP intracellular level in patients who had developed an AIDS-defining condition was 22.50 fmol/1 x 10(6) cells (IQR, 15.80-27.37 fmol/1 x 10(6) cells) and in those who had not was 14.40 fmol/1 x 10(6) cells (IQR, 10.80-20.40 fmol/1 x 10(6) cells) (P=.037). There were no statistically significant differences in d4T-TP intracellular levels with respect to the presence of metabolic syndrome, the clinical form of HALS (pure lipoatrophic vs mixed), the degree of facial lipoatrophy, the presence of hepatitis C virus infection, and the pair of nucleosides in HAART. d4T-TP levels correlated only with cumulative d4T exposure in time and dose. d4T-TP intracellular levels were independently associated with HALS (odds ratio, 1.58; 95% confidence interval, 1.08-2.32; P=.019). CONCLUSIONS: Intracellular levels of d4T-TP are strongly associated with the development of HALS.

Tumor-promoting activity of p-hydroxybenzenediazonium is accelerated in Mg-deficient rats.

Tumor-promoting activity caused by the short-term administration of p-hydroxybenzenediazonium (PDQ) has been assayed in rats fed on a Mg-deficient diet as a reference model versus rats fed on a standard diet as controls. For 5 weeks groups of 20 rats, fed either on the Mg-deficient or standard diet, were treated simultaneously with PDQ. A group of 10 Mg-deficient rats remained untreated. Topical application of PDQ was followed by the appearance of macroscopic alterations in the skin, which were more evident in the Mg-deficient rats. No deaths occurred during the treatment. After 5 weeks' PDQ treatment the rats were killed and histological analyses were made. Tissues from the skin, liver, heart, kidney, lung and thymus were screened by conventional staining methods. Both the PDQ-treated Mg-deficient and PDQ-treated control rats presented tissue lesions, although to a different extent. The untreated Mg-deficient rats showed no such lesions. Mg-deficient rats treated with PDQ developed significant incipient fibrosarcomas (p<0.05) and extended hyperplasia (p<0.001), particularly in the skin, accompanied by a significant increase in the thickness of collagen (mean value: 445.4+/-47.2microm, p<0.05) compared to the control PDQ-treated group (mean values: 258.7+/-36.4microm). The overall results provide objective proof of tumor-promoting activity after 5 weeks' treatment with PDQ. Such a fast response is interpreted as being linked to the increased vulnerability of the membrane caused by Mg deficiency, which would more readily facilitate the toxic activity of p-hydroxybenzenediazonium ions.