Determining personal exposure to high production volume chemicals (HPVCs) and polycyclic aromatic hydrocarbons (PAHs) with silicone wristbands: A pilot study.

High production volume chemicals (HPVCs) and polycyclic aromatic hydrocarbons (PAHs) are semi-volatile organic compounds (semi-VOCs) of great environmental concern because of their presence worldwide and health problems resulting from long-term exposure to some of them. It is essential to have robust analytical methods to monitor the concentrations of these compounds not only in environmental samples but also individual exposure. In this pilot study we develop and validate a multiresidue analytical method based on ultrasound-assisted extraction and gas-chromatography mass spectrometry for the simultaneous determination of 56 semi-VOCs using silicone wristbands (SWBs) as personal passive samplers. The developed method provided recoveries between 43% and 114% on sampled SWBs and method detection and quantification limits in the range of 0.1-35 ng/g and 0.3-119 ng/g, respectively. A preliminary study was performed with a small group of adults living in the industrial city of Tarragona (north-eastern Spain) to evaluate the applicability of SWBs for monitoring individual exposure to the studied HPVCs and PAHs. Benzothiazoles, benzenesulfonamides, UV stabilisers and phenolic antioxidants were determined for the first time in SWBs. Phthalates (PAEs), stood out above the rest, accounting for 52% of the total concentrations. Diethylhexyl phthalate was the compound found at the highest concentrations with values between 1.1 and 82 µg/g. Carcinogenic and non-carcinogenic dermal risk assessment was performed for adults and considering two scenarios (low and high). PAHs were the compounds with the highest carcinogenic and non-carcinogenic dermal risk regardless of the exposure scenario. The second family of compounds that contributed the most to the total risk were PAEs but high punctual concentrations of these compounds caused significant differences between exposure scenarios.

Hipertensión arterial nocturna: análisis según su gravedad / Nocturnal Hypertension: Analysis According to its Severity

RESUMEN Introducción: En el diagnóstico y seguimiento de la hipertensión arterial (HTA) la mayoría de las guías de práctica recomiendan el monitoreo ambulatorio de la presión arterial (MAPA). En este sentido, existe cada vez más evidencia que respalda la superioridad de la hipertensión arterial nocturna (HTAN) como predictor de eventos cardiovasculares. Se sabe poco sobre la relación con los eventos cardiovasculares según la gravedad de la HTAN. Además, no está claro a partir de qué valor de presión arterial nocturna comienza a aumentar el riesgo. Objetivos: Conocer si la presencia de HTAN y sus niveles de gravedad se asocian con resultados cardiovasculares adversos durante el seguimiento. Material y métodos: Estudio observacional. Realizamos un análisis de los datos obtenidos en un centro médico de alta complejidad de Buenos Aires, recopilados a partir de estudios de MAPA de 24 horas. Examinamos las características clínicas de los pacientes, los resultados de laboratorio, los estudios de imagen y sus resultados durante el período de seguimiento. Nuestro estudio incluyó personas de 18 años o más a las que se les había diagnosticado hipertensión. Definimos HTAN como aquellos casos con valores de presión arterial ≥ 120/70 mmHg durante el periodo nocturno. Resultados: Fueron incluidos 981 pacientes en el análisis final. De ellos, el 53 % eran hombres; la edad media era de 59,4 años. Presentaban HTAN 63,6 % (n=624). Clasificamos la HTAN en cuatro estratos de gravedad para comparar, según el valor de presión arterial sistólica nocturna: 83-119 mmHg, 120-139 mmHg, 140-159 mmHg y 160-220 mmHg. Se registraron eventos adversos cardiovasculares mayores en 8 (2,2 %), 17 (4,1 %), 8 (5,6 %) y 7 (11,3 %) sujetos, respectivamente, y esta diferencia entre grupos fue estadísticamente significativa (p=0,007). El análisis multivariado de regresión de Cox demostró que la presencia de HTAN fue un predictor independiente de eventos cardiovasculares adversos (HR 3,60; IC 95% 1,12-11,5; p=0,033), incluso al considerar la presencia de hipertensión arterial diurna. Conclusión: En esta cohorte contemporánea, la HTAN y su gravedad se asociaron independientemente con la incidencia de eventos cardiovasculares adversos.

ABSTRACT Background: In the diagnosis and follow-up of arterial hypertension (HTN) most practice guidelines recommend ambulatory blood pressure monitoring (ABPM). In this regard, there is increasing evidence supporting the superiority of nocturnal hy pertension (NHTN) as a predictor of cardiovascular events. Little is known about the relationship with cardiovascular events according to the severity of NHTN. Furthermore, it is unclear from what nighttime pressure value the risk begins to increase. Objectives: The aim of this study was to determine whether the presence of NHTN and its severity levels are associated with adverse cardiovascular outcomes during follow-up. Methods: An observational study was performed analyzing data collected from 24-hour ABPM studies obtained in a high complexity medical center in Buenos Aires. We examined patients' clinical characteristics, laboratory findings, imaging studies and their results during the follow-up period. Our study included ≥18 year-old persons who had been diagnosed with hypertension. We defined NHTN as those cases with blood pressure values ≥120/70 mmHg during the nighttime period. Results: The final analysis included 981 patients. Among these, 53% were men, mean age was 59.4 years and NHTN was present in 63.6% of cases (n=624). Nocturnal HTN was classified into four severity strata for comparison, according to the nighttime systolic blood pressure value: 83-119 mmHg, 120-139 mmHg, 140-159 mmHg and 160-220 mmHg. Major adverse cardiovascular events were recorded in 8 (2.2%), 17 (4.1 %), 8 (5.6%) and 7 (11.3%) subjects, respectively, and this differ ence between groups was statistically significant (p=0.007). Multivariate Cox regression analysis showed that the presence of NHTN was an independent predictor of adverse cardiovascular events (HR 3.60; 95% CI 1.12-11.5; p=0.033), even when considering the presence of daytime hypertension. Conclusion: In this contemporary cohort, NHTN and its severity were independently associated with the incidence of adverse cardiovascular events.

Presentación inusual de coriocarcinoma metastásico a hígado y pulmón: un reporte de caso / Unusual presentation of metastatic choriocarcinoma to liver and lung: a case report

La enfermedad trofoblástica gestacional (ETG) es un trastorno proliferativo del trofoblasto. Incluye la mola hidatidiforme, el coriocarcinoma, la mola invasiva, el tumor trofoblástico del lecho placentario y el tumor trofoblástico epitelioide. Las últimas cuatro hacen parte de la neoplasia trofoblástica gestacional, que agrupa menos del 1% de todos los tumores ginecológicos. La incidencia de la ETG puede variar, siendo aproximadamente de 1 a 3 de cada 1.000 embarazos en América del Norte y Europa. El coriocarcinoma es la forma más agresiva por su rápida invasión vascular y compromiso metastásico. Sin embargo, es un tumor muy quimiosensible con una alta tasa de respuestas y posibilidad de curación superior al 90%. Se presenta el caso de una paciente de 40 años quien ingresó al servicio de urgencias por disnea súbita secundaria a tromboembolia pulmonar y posteriormente tras el inicio de anticoagulación presentó hemoperitoneo debido a lesiones hepáticas metastásicas de un coriocarcinoma, además de compromiso metastásico pulmonar. Se presenta este caso por ser una patología poco frecuente, agresiva y con presentaciones inusuales, con el fin de mostrar la importancia de un diagnóstico y tratamiento oportuno.

Gestational trophoblastic disease (GTD) is a condition in which the trophoblast, a layer of cells surrounding the embryo, develops abnormally. GTD includes both pre-malignant and malignant pathologies, such as hydatidiform mole, choriocarcinoma, invasive mole, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Although GTD is rare, it affects about 1 to 3 out of every 1,000 pregnancies in North America and Europe. Choriocarcinoma is the most aggressive form of GTD, as it can quickly invade blood vessels and metastasize to other parts of the body. However, it is highly responsive to chemotherapy, with a cure rate of over 90%. In this case, a 40-year-old patient presented to the emergency department with sudden dyspnea due to pulmonary embolism. After starting anticoagulation therapy, she developed hemoperitoneum due to the spread of choriocarcinoma to her liver, as well as pulmonary metastases. This case is noteworthy because of its unusual presentation and aggressive nature, underscoring the importance of early diagnosis and treatment.

Quality of life of patients with thyroid cancer in Colombia.

INTRODUCTION: Quality of life (QoL) in thyroid cancer patients is comparable to patients with other tumours with worse prognosis. The aim was to evaluate QoL in Colombian patients with thyroid carcinoma and to explore the association of QoL scores with patient features. METHODS: This is a cross-sectional study. The present research was carried out from data obtained for the validation study of the Spanish version of the THYCA-QoL. Adult patients with thyroid carcinoma who underwent total or partial thyroidectomy were included and asked to complete the Spanish-validated versions of the THYCA-QoL and EORTC QLQ-C30 questionnaires. The scores of each domain and single items underwent linear transformation to values of 0-100. Comparisons of scale scores with clinical variables were performed. RESULTS: We included 293 patients. The global EORTC QLQ-C30 score was 73.2±22.1 and the domains with poorer values were emotional and cognitive and the symptoms with poorer values were insomnia and fatigue. The global THYCA-QOL score was 28.4±17.8. The domains with poorer values were neuromuscular and psychological and the single items with poorer values were headaches and tingling hands/feet. CONCLUSION: Colombian patients with thyroid cancer have a good prognosis, but they experience important problems related to QoL. QoL was influenced by demographic and clinical factors such as age, sex functional status and clinical stage.

Immune and oxidative stress biomarkers in pediatric psychosis and psychosis-risk: Meta-analyses and systematic review.

OBJECTIVE: While genetic and cohort studies suggest immune and reduction/oxidation (redox) alterations occur in psychosis, less is known about potential alterations in children and adolescents. METHODS: We conducted a systematic review to identify immune and redox biomarker studies in children and adolescents (mean age ≤ 18 years old) across the psychosis spectrum: from psychotic like experiences, which are common in children, to threshold psychotic disorders like schizophrenia. We conducted meta-analyses when at least three studies measured the same biomarker. RESULTS: The systematic review includes 38 pediatric psychosis studies. The meta-analyses found that youth with threshold psychotic disorders had higher neutrophil/lymphocyte ratio (Hedge's g = 0.40, 95 % CI 0.17 - 0.64), tumor necrosis factor (Hedge's g = 0.38, 95 % CI 0.06 - 0.69), C-reactive protein (Hedge's g = 0.38, 95 % CI 0.05 - 0.70), interleukin-6 (Hedge's g = 0.35; 95 % CI 0.11 - 0.64), and total white blood cell count (Hedge's g = 0.29, 95 % CI 0.12 - 0.46) compared to youth without psychosis. Other immune and oxidative stress meta-analytic findings were very heterogeneous. CONCLUSION: Results from several studies are consistent with the hypothesis that signals often classified as "proinflammatory" are elevated in threshold pediatric psychotic disorders. Data are less clear for immune markers in subthreshold psychosis and redox markers across the subthreshold and threshold psychosis spectrum. Immune and redox biomarker intervention studies are lacking, and research investigating interventions targeting the immune system in threshold pediatric psychosis is especially warranted.

Value of Prostate-Specific Antigen Kinetics in Patients with Low-Risk Prostate Cancer under Active Surveillance.

INTRODUCTION: This study analyzes the value of PSA kinetics, PSA speed (vPSA), and PSA doubling time (PSAdt), in patients with low-risk prostate cancer who are in an active surveillance (AS) program. METHODS: An observational, retrospective, and longitudinal study of a sample of 86 patients included in AS program between January 2014 and October 2021 was conducted. A review of their medical records was performed, and PSA kinetics were calculated, analyzing the causes of discontinuation of the AS program and its relationship with PSA kinetics. RESULTS: The mean age was 63.39 years, and the median follow-up was 62.55 months. The mean PSA at diagnosis was 8.27 ng/mL. A median of PSAdt of 62.55 months and 1.3 ng/mL/year for vPSA was obtained. 35 patients left the program, with a higher percentage of patients leaving with a PSAdt less than 36 months (73.7 vs. 31.1%) and a vPSA greater than 2 ng/mL/year (68.2 vs. 31.3%). The probability of permanence and the time of permanence in AS were statistically significantly higher for those patients with favorable kinetic parameters. CONCLUSION: PSA kinetics is a parameter to take into account when making decisions to keep patients in an AS program.

A Multi-institution Study on the Association of Virtual Reality Skills with Continence Recovery after Robot-assisted Radical Prostatectomy.

BACKGROUND: Virtual reality (VR) simulators are increasingly being used for surgical skills training. It is unclear what skills are best improved via VR, translate to live surgical skills, and influence patient outcomes. OBJECTIVE: To assess surgeons in VR and live surgery using a suturing assessment tool and evaluate the association between technical skills and a clinical outcome. DESIGN, SETTING, AND PARTICIPANTS: This prospective five-center study enrolled participants who completed VR suturing exercises and provided live surgical video. Graders provided skill assessments using the validated End-To-End Assessment of Suturing Expertise (EASE) suturing evaluation tool. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: A hierarchical Poisson model was used to compare skill scores among cohorts and evaluate the association of scores with clinical outcomes. Spearman's method was used to assess correlation between VR and live skills. RESULTS AND LIMITATIONS: Ten novices, ten surgeons with intermediate expertise (median 64 cases, interquartile range [IQR] 6-80), and 26 expert surgeons (median 850 cases, IQR 375-3000) participated in this study. Intermediate and expert surgeons were significantly more likely to have ideal scores in comparison to novices for the subskills needle hold angle, wrist rotation, and wrist rotation needle withdrawal (p < 0.01). For both intermediate and expert surgeons, there was positive correlation between VR and live skills for needle hold angle (p < 0.05). For expert surgeons, there was a positive association between ideal scores for VR needle hold angle and driving smoothness subskills and 3-mo continence recovery (p < 0.05). Limitations include the size of the intermediate surgeon sample and clinical data limited to expert surgeons. CONCLUSIONS: EASE can be used in VR to identify skills to improve for trainee surgeons. Technical skills that influence postoperative outcomes may be assessable in VR. PATIENT SUMMARY: This study provides insights into surgical skills that translate from virtual simulation to live surgery and that have an impact on urinary continence after robot-assisted removal of the prostate. We also highlight the usefulness of virtual reality in surgical education.

Case report: Accelerated regression of giant cardiac rhabdomyomas in neonates with low dose everolimus.

Cardiac rhabdomyoma (CRHM) is the principal cardiac tumor in children and is most often associated with tuberous sclerosis complex (TSC). Mutations in the TSC1 and TSC2 genes cause the overactivation of the mammalian Target of Rapamycin (mTOR). This protein family is responsible for abnormal cell proliferation leading to the formation of CRHMs and hamartomas in other organs. Despite the tendency for spontaneous regression, some CRHMs can cause heart failure and intractable arrhythmias, requiring surgical resection. In recent years, the use of everolimus and sirolimus (mTOR inhibitors) in the treatment of CRHMs has been reported. We report two cases of neonates with giant rhabdomyomas, with hemodynamic repercussions treated with low-dose everolimus (4.5 mg/m2/week). In both cases, we obtained an approximate decrease of 50% in the total area of the mass after three weeks of treatment. Despite rebound growth after stopping the drug, we were able to evidence that the use of low doses of everolimus immediately after birth is effective and safe in the treatment of giant CRHMs, avoiding surgical resection of the tumor and associated morbidity and mortality.

Related factors to non-adherence to antiretroviral therapy in HIV/AIDS patients.

OBJECTIVE: To identify sociodemographic, clinical, and pharmacological factors  associated with nonadherence to antiretroviral treatment in patients with  human immunodeficiency virus/acquired immunodeficiency syndrome treated  between 2017 and 2020 in four cities in Colombia. METHOD: An observational, cross-sectional, retrospective study was conducted of a population of patients with human immunodeficiency virus/acquired immunodeficiency syndrome treated between 2017 and 2020. The Morisky-Green scale, the simplified medication adherence  questionnaire, and the simplified scale to detect adherence problems to  antiretroviral treatment were applied to determine patient adherence. A  binomial multiple logistic regression was performed to evaluate the factors that  best explain nonadherence. RESULTS: A total of 9,835 patients were evaluated, of whom 74.4% were men,  71.1% were aged between 18 and 44 years, 76.0% had attended at most  secondary school, 78.1% were single, and 97.6% resided in an urban area.  After applying three different scales to each patient, 10% of the study  population were identified as nonadherent to treatment. The risk of  nonadherence was significantly higher in patients who presented any drug- related problem or had an adverse reaction to antiretroviral drugs. CONCLUSIONS: The variables most strongly associated with nonadherence to  antiretroviral treatment were drug-related problems, adverse drug reactions, a  history of nonadherence to treatment, and psychoactive substance use.

OBJETIVO: Identificar los factores sociodemográficos, clínicos y farmacológicos asociados a la no adherencia al tratamiento antirretroviral en pacientes con infección por virus de la inmunodeficiencia humana/sida atendidos entre 2017 y 2020 en diferentes ciudades de Colombia.Método: Se realizó un estudio observacional, de corte transversal y retrospectivo, con una población de pacientes con infección por virus de la  inmunodeficiencia humana/sida atendidos entre 2017 a 2020. Se aplicaron las  escalas Morisky-Green, el cuestionario simplificado de adherencia a la  medicación y la escala simplificada para detectar problemas de adherencia al  tratamiento antirretroviral, para determinar la adherencia de los pacientes. Se  realizó una regresión logística múltiple para evaluar los factores que mejor  explican la no adherencia. RESULTADOS: Se evaluaron 9.835 pacientes, de los cuales el 74,4% eran hombres, el 71,1% tenían una edad entre 18 a 44 años, el 76,0% cursó como máximo hasta secundaria, el 78,1% eran solteros y el 97,6%  residían en zona urbana. Se encontró una proporción de no adherencia al  tratamiento del 10% después de aplicar tres escalas diferentes a cada paciente. Las personas que presentaron algún problema relacionado con los medicamentos tuvieron un riesgo significativamente mayor de no ser adherentes, al igual que aquellos que tuvieron alguna reacción adversa a los medicamentos antirretrovirales. CONCLUSIONES: Los problemas relacionados con el uso de medicamentos, las  reacciones adversas a medicamentos, los antecedentes de no adherencia al  tratamiento y el consumo de sustancias psicoactivas fueron las variables que  más se asociaron con la no adherencia al tratamiento antirretroviral.

Perfiles de expresión de los genes ERG11, MDR1 y AFR1 en Cryptococcus neoformans var. grubii aislados de pacientes con HIV / Gene expression profiles of ERG11, MDR1 y AFR1 in Cryptococcus neoformans var. grubbi isolated from HIV patients

Introducción. El fluconazol es el antifúngico más utilizado para la prevención y el tratamiento de infecciones causadas por el género Cryptococcus, agente etiológico de la criptococosis. La resistencia al fluconazol en los aislamientos de Cryptoccocus neoformans puede hacer fracasar el tratamiento y generar recaídas de la infección. Objetivo. Evaluar los perfiles de expresión de los genes AFR1, MDR1 y ERG11 en aislamientos clínicos de C. neoformans var. grubii, durante la respuesta in vitro a la inducción con fluconazol. Materiales y métodos. Se estudiaron 14 aislamientos de C. neoformans var. grubii provenientes de pacientes con HIV, de los cuales 6 eran sensibles al fluconaol y 8 presentaban sensibilidad disminuida. Los niveles de expresión de los genes ERG11, AFR1 y MDR1 se determinaron mediante PCR en tiempo real. Resultados. Los aislamientos resistentes al fluconazol mostraron sobreexpresión de los genes AFR1 y MDR1, mientras que la expresión de los fenotipos de resistencia evaluados se mantuvo homogénea en ERG11, en todos los aislamientos de C. neoformans var. grubii. Conclusiones. La sobreexpresión de los genes AFR1 y MDR1 que codifican las bombas de eflujo, contribuye a la resistencia al fluconazol en los aislamientos estudiados. Sin embargo, los patrones de resistencia que se registran en este hongo, sumado a los casos de recaídas en pacientes con HIV, no pueden atribuirse únicamente a los casos de resistencia por exposición al fármaco. Otros mecanismos podrían también estar involucrados en este fenómeno, como la resistencia emergente (resistencia mediante otros genes ERG) y la heterorresistencia, los cuales deben ser estudiados en estos aislamientos.

Introduction: Fluconazole is the most used antifungal drug for prevention and treatment of Cryptococcus spp. infections, the etiological agent of cryptococcosis. Resistance to fluconazole among Cryptococcus neoformans isolates can lead to treatment failure and generate relapses. Objective: To evaluate the expression profles of the AFR1, MDR1 and ERG11 genes in C. neoformans var. grubii clinical isolates during the in vitro response to fluconazole induction. Materials and methods: Fourteen C. neoformans var. grubii isolates recovered from HIV patients were studied, in which 6 showed sensitivities to fluconazole and 8 decreased sensitivity. The expression levels of ERG11, AFR1 and MDR1 genes were determined by real-time PCR from extracted mRNA. Results: AFR1 and MDR1 genes from C. neoformans var. grubii were overexpressed in fluconazole resistant isolates, whereas ERG11 maintains homogeneous expression in all the evaluated resistance phenotypes of C. neoformans var. grubii isolates. Conclusions: The overexpression of AFR1 and MDR1 genes, which codify for efflux pumps, contributes to fluconazole resistance in the studied isolates. However, the resistance patterns in this fungus and the relapse cases in HIV patients cannot be attributed solely to the exposure to the drug. Heteroresistance and the emerging resistance (resistance through other ERG genes), might be other mechanisms involved in this phenomenon, which must be studied in these isolations.

Prognostic Value of the Neutrophil/Lymphocyte Ratio in Squamous Cell Carcinoma of the Penis.

INTRODUCTION: To determine the predictive role of the neutrophil/lymphocyte ratio (NLR) in the prognosis and survival of patients with squamous cell carcinoma of the penis. MATERIALS AND METHODS: A retrospective cohort study of 96 patients with squamous cell carcinoma of the penis (SCCP). Clinical and histological data, bloodwork and disease evolution information were collected. We determined neutrophil/lymphocyte ratios and analyzed their relationship to prognosis and survival. RESULTS: The mean age of patients was 72,1 years. The average follow-up time for the sample was 3,8 years (CI 95%: 3,0-4,6). Compared to patients with NLR <3, those with NLR >3 presented a higher proportion of cancers in stages cN1 (29.7% vs 6.8%; p = 0,004), stages pT3 and pT4 (24,3% vs 9,5%; p = 0,05), and stages TNM III and IV (32,4% vs 10,2%; p = 0,01); additionally, there were more cases of perineural invasion in the NLR >3 patients (29,7% vs 10,2%; p = 0,03). The mean overall survival (OS) was 7,9 years (CI 95%: 6,2-9,6) and the cancer-specific survival (CSS), 1,3 years (CI 95%: 0,7-1,9). There were no differences in OS, CSS or in progression-free survival (PFS) in patients with NLR >3 compared to those with NLR <3 . However, in the Cox regression analysis, a higher NLR was independently associated (along with metastasis and need for adjuvant treatment) with lower PFS, with an HR: 1,27 (CI 95%: 1,02-1,57; p = 0,02). CONCLUSIONS: The utilization of NLR in clinical practice can be considered an additional tool to aid in the diagnosis and prognosis of patients with squamous cell carcinoma of the penis.

Linfangiomatosis esplénica en un paciente adulto: Reporte de caso

Los linfangiomas son malformaciones benignas del sistema linfático que afectan con mayor frecuencia a los niños y en raras ocasiones a adultos. Presentamos el caso de una mujer de 36 años, con cuadro clínico de 6 meses de dolor abdominal difuso sin irritación peritoneal, y asociado a adinamia. Como parte de los estudios, se solicitó una tomografía axial computarizada con contraste de abdomen, que reveló múltiples lesiones esplénicas hipodensas hipovasculares, con sospecha diagnóstica de lesiones linfoproliferativas. Por tal motivo se solicitó una esplenectomía diagnóstica, que finalmente mostró hallazgos macroscópicos, microscópicos y de inmunohistoquímica (positividad de las lesiones quísticas para CD31 y D2-40) compatibles con linfagiomatosis esplénica difusa.

Lymphangiomas are benign malformations of the lymphatic system. They most often affect children and rarely adults. We present the case of a 36-year-old woman with a 6-month clinical picture of diffuse abdominal pain without peritoneal irritation associated with adynamia. As part of the studies, a computerized axial tomography with abdominal contrast was requested, which revealed multiple hypovascular hypodense splenic lesions with suspected diagnosis of lymphoproliferative lesions. For this reason, a diagnostic splenectomy was requested, which showed macroscopic, microscopic and immunohistochemical findings (positivity of cystic lesions for CD31 and D2-40) compatible with diffuse splenic lymphagiomatosis

Safety and efficacy of convalescent plasma for severe COVID-19: a randomized, single blinded, parallel, controlled clinical study.

BACKGROUND: Convalescent plasma (CP) has been widely used to treat COVID-19 and is under study. However, the variability in the current clinical trials has averted its wide use in the current pandemic. We aimed to evaluate the safety and efficacy of CP in severe coronavirus disease 2019 (COVID-19) in the early stages of the disease. METHODS: A randomized controlled clinical study was conducted on 101 patients admitted to the hospital with confirmed severe COVID-19. Most participants had less than 14 days from symptoms onset and less than seven days from hospitalization. Fifty patients were assigned to receive CP plus standard therapy (ST), and 51 were assigned to receive ST alone. Participants in the CP arm received two doses of 250 mL each, transfused 24 h apart. All transfused plasma was obtained from "super donors" that fulfilled the following criteria: titers of anti-SARS-CoV-2 S1 IgG ≥ 1:3200 and IgA ≥ 1:800 antibodies. The effect of transfused anti-IFN antibodies and the SARS-CoV-2 variants at the entry of the study on the overall CP efficacy was evaluated. The primary outcomes were the reduction in viral load and the increase in IgG and IgA antibodies at 28 days of follow-up. The per-protocol analysis included 91 patients. RESULTS: An early but transient increase in IgG anti-S1-SARS-CoV-2 antibody levels at day 4 post-transfusion was observed (Estimated difference [ED], - 1.36; 95% CI, - 2.33 to - 0.39; P = 0.04). However, CP was not associated with viral load reduction in any of the points evaluated. Analysis of secondary outcomes revealed that those patients in the CP arm disclosed a shorter time to discharge (ED adjusted for mortality, 3.1 days; 95% CI, 0.20 to 5.94; P = 0.0361) or a reduction of 2 points on the WHO scale when compared with the ST group (HR adjusted for mortality, 1.6; 95% CI, 1.03 to 2.5; P = 0.0376). There were no benefits from CP on the rates of intensive care unit admission (HR, 0.82; 95% CI, 0.35 to 1.9; P = 0.6399), mechanical ventilation (HR, 0.66; 95% CI, 0.25 to 1.7; P = 0.4039), or mortality (HR, 3.2; 95% CI, 0.64 to 16; P = 0.1584). Anti-IFN antibodies and SARS-CoV-2 variants did not influence these results. CONCLUSION: CP was not associated with viral load reduction, despite the early increase in IgG anti-SARS-CoV-2 antibodies. However, CP is safe and could be a therapeutic option to reduce the hospital length of stay. Trial registration NCT04332835.

Pigmentación violácea dolorosa, reto clínico y enfoque diagnóstico en un país tropical / Painful violaceous pigmentation, a clinical challenge and diagnostic approach in a tropical country

RESUMEN Contrario a lo que se cree, los milpiés no se consideran animales venenosos, su mecanismo de defensa puede resultar perjudicial para el ser humano, manifestándose como lesiones de carácter eritematoso, purpúrico y cianótico, concomitante dolor local y parestesia; Según la exposición, el cuadro clínico puede evolucionar a lesiones moderadas y severas, ampollas y úlceras. Describimos el caso de un paciente pediátrico de sexo masculino de la región andina de Colombia, con temperaturas diarias que oscilan entre 15° y 30°C y una humedad promedio de 72 %, quien accidentalmente pisó un milpiés, lo cual fue un desafío diagnóstico entre el personal de salud que generó su atención.

ABSTRACT Millipedes are not considered poisonous animals, although in some cases their chemical defense mechanisms may be deleterious for human beings, manifesting as erythematous, purpuric and/ or cyanotic lesions alongside local pain and paresthesia. According to the exposure, the clinical condition may progress to moderate and severe lesions such as ulcers and blisters. We describe a case of a male child from the Andean region in Colombia, an area with daily temperatures between 15° and 30° C and 72% average humidity. The boy accidentally stepped on a millipede, and this occurrence became a challenge for its diagnosis amongst staff who provided emergency health care.

Desnutrición crónica en niños menores de cinco años de la comunidad indígena awá, Barbacoas (Nariño, Colombia), 2019 / Chronic Malnutrition in Children under 5 Years Old in the Awá Indigenous Community, Barbacoas (Nariño ­ Colombia) in 2019 / Desnutrição crônica em crianças menores de cinco anos da comunidade indígena Awá, Barbacoas (Nariño, Colombia), 2019

Introducción: la desnutrición crónica en menores de 5 años se define como el retraso en el crecimiento, resultado de recurrentes carencias nutricionales, asociadas con pobreza, de salud y nutrición materna. El objetivo fue identificar la prevalencia de desnutrición crónica y factores asociados en menores de 5 años de la comunidad indígena awá, atendidos en la ips Unidad del Pueblo Indígena Awá (unipa) de Barbacoas (Nariño, Colombia) durante 2019. Materiales y métodos: estudio de corte transversal con enfoque analítico. Se incluyeron 527 niños menores de 5 años de la comunidad awá acudientes al programa de crecimiento y desarrollo de la ipsunipa. Se evaluó como desenlace la desnutrición crónica y, como factores asociados, características sociodemográficas, nutricionales y otras del estado de salud. Se consideró un valor de p menor al 5 % cuando se utilizó chi cuadrado, test exacto de Fisher y U de Mann-Whitney para determinar asociación estadística; además, se ajustó la relación a través de un modelo de regresión logística múltiple. Resultados: el 17.6 % de los niños pre-sentó desnutrición crónica. Se encontró asociación estadística con ser hijo de madre adolescente (p = 0.006), esquema de vacunación incompleto (p = 0.012), la edad (p = 0.017) y el peso al nacer (p = 0.017). Conclusión: en menores de 5 años de la comunidad awála frecuencia de desnutrición crónica está por encima de la media para esta población en general en Colombia. Es importante priorizar la búsqueda activa de desnutrición crónica en niños cuyas madres son adolescentes, niños con bajo peso al nacer y vacunación incompleta

Introduction: Chronic malnutrition in children under 5 years old is defined as stunting due to recurrent nutritional deficiencies associated with poverty, maternal health, and nutrition. This study aimed to iden-tify the prevalence of chronic malnutrition and associated factors in children under 5 years old from the indigenous Awá community, at Barbacoas, Nariño in 2019. Materials and methods: A cross-sectional study was conducted, which included 527 children under 5 years old from the Awá community who attended a health institution for growth and development program. Chronic malnutrition was evaluated as an outcome, whereas sociodemographic, nutritional and other health characteristics as associated factors. Chi-square, Fisher's exact, and Mann­Whitney's U test were used to determine statistical association. Additionally, the relationship was adjusted through a multiple logistic regression model. Results: Chronic malnutrition was found in 17.6% of children. The statistical association was found in children of the ado-lescent mother, incomplete vaccination schedule, and age and birth weight. Conclusion: In children under 5 years old in the Awá community, the frequency of chronic malnutrition is above the average for the general population in Colombia. Prioritizing the active search for chronic malnutrition in children whose mothers are adolescents and those with low birth weight and incomplete vaccination is important

Introdução: a desnutrição crônica em crianças menores de cinco anos é definida como retardo de crescimento como resultado de deficiências nutricionais recorrentes associadas à pobreza, saúde materna e nutrição. O objetivo é identificar a prevalência de desnutrição crônica e fatores associados em crianças menores de 5 anos da comunidade indígena Awá, atendidas na Unidade ips do Povo Indígena Awá (unipa) de Barbacoas, Nariño durante 2019. Materiais e métodos: estudo transversal de abordagem analítica. Foram incluídas 527 crianças menores de 5 anos da comunidade Awá que participaram do programa de crescimento e desen-volvimento da ipsunipa. A desnutrição crônica foi avaliada como desfecho e as características sociodemo-gráficas, nutricionais e outras características de saúde como fatores associados. Um valor de p inferior a 5% foi considerado quando o qui-quadrado, o teste exato de Fisher e o U de Mann Whitney foram usados para determinar a associação estatística, além disso, a relação foi ajustada por meio de um modelo de regressão logística múltipla. Resultados: 17,6% das crianças apresentavam desnutrição crônica. Associação estatística foi encontrada com os fatores ser filho de mãe adolescente (valor p: 0,006), esquema vacinal incompleto (valor p: 0,012), idade (valor p: 0,017) e peso ao nascer (valor p: 0,017). Conclusão: em crianças menores de 5 anos da comunidade Awá, a frequência de desnutrição crônica está acima da média geral para esta popu-lação na Colômbia. É importante priorizar a busca ativa da desnutrição crônica em crianças cujas mães são adolescentes, em crianças com baixo peso ao nascer e com esquema de vacinação incompleto

Delayed Immune Reconstitution Inflammatory Syndrome in an Immunosuppressed Patient With SARS-CoV-2.

Both immune reconstitution inflammatory syndrome (IRIS) and severe coronavirus disease 2019 (COVID-19) are marked by hyperinflammation as a consequence of dysfunction in myeloid cells and increased production of proinflammatory cytokines. Although these features are common to both diseases, their physiopathology remains unclear. Here we report the case of a 63-year-old woman admitted for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In her clinical course, she developed acute respiratory distress syndrome, probably triggered by the use of granulocyte colony-stimulating factor (G-CSF). We hypothesize that G-CSF unmasked IRIS.

Delayed Diagnosis of an Atypical Pneumonia Resembling a Solitary Pulmonary Nodule.

Atypical pneumonia shows clinical features that are different from those of typical pneumonia, and it can mimic other entities. We report the case of a 42-year-old male with a solitary pulmonary nodule found in an X-ray for a preoperative evaluation. Our patient was asymptomatic, and a pulmonary neoplasm was the first diagnostic suspicion. The round-shaped nodule seen in the X-ray turned out to be a linear ground glass opacity in a thoracic CT scan. Viral pneumonia due to SARS-CoV-2 was diagnosed. We emphasize here the educational value of this case report. We do not report a new radiological finding because lung nodules resembling neoplasms have already been reported in the medical literature. However, some clinical features of COVID-19 are relatively new and can mimic other entities, and the results of some investigations and clinicians' interpretations of them can be misleading. Atypical radiological findings make it necessary to widen the spectrum of alternative diagnoses.

Continuous erector spinae plane block at lumbar level for relief of severe pain due to hip fracture: case series / Bloqueo continuo del plano erector de la espina lumbar para manejo del dolor severo por fractura de cadera: serie de casos

Abstract Introduction Hip fracture pain is frequently acute and disabling and increases perioperative complications in the patient; hence it requires a multimodal analgesia approach. This case series describes the continuous erector spinae plane block at the lumbar level for hip fracture analgesia. Methods A search was conducted of patients with hip fracture referred to the pain service of Hospital Universitario San Vicente Fundación (HUSVF) from August 2019 to March 2020, who had undergone continuous erector spinae plane block as part of their analgesic regimen. Results A total of 6 patients, 4 females and 2 males with an average age of 75 years were identified. A reduction in pain intensity from acute to mild or absent was observed in every case, up to 24 hours after the initial injection. 66 % experienced a relapse of severe pain after 24 hours and 2 patients the catheter functionality failed after 24 hours. One patient underwent dermatome pinprick assessment. Conclusions The continuous erector spinae plane block with a single injection provided analgesic efficacy similar to other single injection peripheral blocks, although continuous analgesia for more than 24 hours was not achieved. Some variations in the block technique described may improve the analgesic effectiveness in patients with hip fracture pain.

Resumen Introducción El dolor de la fractura de cadera suele ser fuerte e incapacitante y aumenta las complicaciones perioperatorias en el paciente, lo que hace indispensable el enfoque de analgesia multimodal. En esta serie de casos se describe la experiencia del bloqueo continuo del plano erector de la espina a nivel lumbar para analgesia en fractura de cadera. Métodos Se realizó una búsqueda de los pacientes con fractura de cadera remitidos al servicio de dolor del Hospital Universitario San Vicente fundación (HUSVF) desde agosto de 2019 hasta marzo de 2020, a quienes se les realizó bloqueo continuo del plano erector de la espina como parte de su esquema analgésico. Resultados Se encontraron 6 pacientes, 4 mujeres y 2 hombres, con una edad promedio de 75 años. Se observó reducción de la intensidad del dolor de fuerte a leve o ausente en todos los casos hasta las 24 horas posteriores a la inyección inicial. El 66 % tuvo recaída del dolor fuerte posterior a las 24 horas y en 2 pacientes no se logró funcionalidad del catéter por más de 24 horas. En un paciente se hizo evaluación dermatómica por pinprick (prueba de pinchazo). Conclusiones El bloqueo continuo del plano erector de la espina con inyección única ofreció eficacia analgésica similar a otros bloqueos periféricos en inyección única, aunque no se logró analgesia continua con el catéter por más de 24 horas. Ciertas variaciones en la técnica del bloqueo descrita podrían mejorar la efectividad analgésica en pacientes con dolor por fractura de cadera.

Factores maternos asociados al peso del recién nacido en una IPS de Medellín, Colombia, 2018 / Maternal Factors Associated with Newborn Weight in a IPS in Medellin, Colombia, 2018

Resumen Antecedentes: la variabilidad en el peso del recién nacido, ya sea como bajo peso o macrosomía, puede ocasionar morbimortalidad infantil y materna, además de ser un predictor del estado de salud a lo largo de la vida. Objetivo: determinar factores sociodemográficos, antecedentes patológicos, exposición a sustancias psicoactivas, actividad física y características alimentarias de la madre relacionados con el peso de recién nacidos en una IPS de Medellín, Colombia, en 2018. Materiales y métodos: estudio de cohorte con información de madres seguidas hasta el nacimiento de los bebés. Resultados: la edad promedio de las madres fue de 24±6 años, el peso promedio del recién nacido fue de 3150 g. Embarazo previo, consumo de lácteos y derivados, consumo de proteínas y de suplementos dietarios fueron factores presentes en madres de recién nacidos con mayor peso. Haber fumado alguna vez en la vida, antecedente de preeclampsia, parto previo, aborto en el último embarazo y consumo de alimentos ultraprocesados se presentaron en madres de recién nacidos con menor peso. Conclusiones: se recomienda a las gestantes limitar el consumo de alimentos ultraprocesados, supervisar el consumo de lácteos y derivados, proteínas y suplementos dietarios en madres con embarazos previos, antecedente de preeclampsia, abortos o hábitos como haber fumado.

Abstract Background: The variability in newborn birthweight, whether low birth weight or macrosomia, can contribute to maternal and infant morbidity and mortality as well as be a predictor of lifelong health. Objective: Determine socio-demographic factors, pathologic history, exposure to psychoactive substances, physical activity levels, and maternal diet as related to birth weight in newborns an in IPS in Medellin, Colombia 2018. Materials and Methods: Cohort study using maternal information obtained from following a sample of mothers of newborns until their infant's birth. Results: Average age of the mothers was 24±6 years and average newborn birthweight was 3150g. Previous pregnancies, consumption of dairy products, intake of protein, and use of dietary supplements were factors present in mothers of newborns with higher birthweight. Having ever smoked, history of preeclampsia, previous delivery, abortion in previous pregnancy, and intake of ultra-high processed foods (UHPF) were factors found among mothers whose infants had lower birthweight. Conclusions: It is recommended that pregnant women limit intake of highly processed foods, supervise their intake of dairy products, protein and dietary supplements in women who have had previous pregnancies, history of preeclampsia, abortions, or who have ever smoked.