Does month of birth influence colorectal cancer prognosis?

PURPOSE: The main aim of this study was to identify a possible association between month of birth of colorectal cancer (CRC) patients and overall survival (OS) or disease-free survival (DFS). METHODS: This observational study included all consecutive adult patients diagnosed with CRC undergoing oncological surgery from January 2005 to December 2019 with a minimum follow-up of 10 years. The outcome variables were locoregional recurrence, death due to cancer progression, OS and DFS. Non-supervised learning techniques (K-means) were conducted to identify groups of months with similar oncologic outcomes. Finally, OS and DFS were analysed using Kaplan-Meier and Cox regression tests. The model was calibrated with resampling techniques and subsequently a cross-validation was performed. RESULTS: A total of 2520 patients were included. Three birth month groups with different oncologic outcomes were obtained. Survival analysis showed between-group differences in OS (p < 0.001) and DFS (p = 0.03). The multivariable Cox proportional hazards model identified the clusters obtained as independent prognostic factors for OS (p < 0.001) and DFS (p = 0.031). CONCLUSION: There is an association between month of birth and oncologic outcomes of CRC. Patients born in the months of January, February, June, July, October and December had better OS and DFS than those born in different months of the year.

A diagnostic challenge: chronic cutaneous ulcers as an isolated clinical finding in metastatic Crohn's disease.

Metastasic Crohn disease (MCD) is the most uncommon cutaneous manifestation of Crohn disease. The actual incidence is not clear. There are fewer than 200 cases described in the literature. We report a case of 21 years-old girl that came to our emergency care with large exudative ulcers in the inguinal folds, the vulva, the perianal region and the popliteal fossae. Histopathological examination of the ulcers revealed a non-caseating granulomatous inflammation with abundant multinucleated giant cells and intense lymphocytic infiltrate. Colonoscopy, contrast study of the small bowel and video capsule endoscopy were carried out without evidence of digestive disease. High potency topical steroids (betamethasone 0,5mg/gr twice daily) and 300mg intravenous Infliximab were initiated as the initial line therapy and the ulcers began to heal. We report this case to highlight the presence of cutaneous ulcers without intestinal disease in a young non-pediatric woman as the unique manifestation of the disease.

Enhancing glass ionomer cement features by using the calcium phosphate nanocomposite

Abstract This study showed the synthesis of Glass ionomer cements (GIC) modified with calcium phosphate nanoparticles (nCaP). The nCaP/GIC were submitted to mechanical compression and diametral tensile tests. The biocomposite were characterized by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD) and Fourier-transform infrared spectroscopy (FTIR). Cytotoxicity and cell viability tests were performed on the human bone marrow mesenchymal stem cells using a 3-(4,5-dimethylthiazol-2yl)2,5-diphenyl- tetrazolium-bromide assay and LIVE/DEAD assays. Statistically significant differences were observed for mechanical properties (Kruskal-Wallis, p<0.001), nCaP/GIC showed higher resistance to compression and diametral traction. The SEM analyses revealed a uniform distribution nCaP in the ionomer matrix. The EDX and XRD results indicated that hydroxyapatite and calcium β-triphosphate phases. The FTIR spectra revealed the asymmetric band of ν3PO43- between 1100-1030cm-1 and the vibration band associated with ν1PO43- in 963cm-1 associated with nCaP. The nCaP/GIC presented response to adequate cell viability and non-cytotoxic behavior. Therefore, the new nCaP/GIC composite showed great mechanical properties, non-cytotoxic behavior, and adequate response to cell viability with promising dental applications.

Resumo Este estudo apresenta a síntese de cimentos de ionômero de vidro (GIC) modificados com nanopartículas de fosfato de cálcio (nCaP). Os nCaP / GIC foram submetidos a ensaios mecânicos de compressão e tração diametral. Os biocompósitos foram caracterizados por microscopia eletrônica de varredura (MEV), espectroscopia de energia dispersiva de raios-X (EDX), difração de raios-X (XRD) e espectroscopia de infravermelho com transformada de Fourier (FTIR). Os testes de citotoxicidade e viabilidade celular foram realizados em células-tronco mesenquimais da medula óssea humana usando um ensaio de 3- (4,5-dimetiltiazol-2-il) 2,5-difeniltetrazólio-brometo e ensaios LIVE / DEAD. Diferenças estatisticamente significativas foram observadas para as propriedades mecânicas (Kruskal-Wallis, p <0,001), nCaP / GIC apresentou maior resistência à compressão e tração diametral. As análises de SEM revelaram uma distribuição uniforme de nCaP na matriz do ionômero. Os resultados de EDX e DRX indicaram fases de hidroxiapatita e β-trifosfato de cálcio. Os espectros de FTIR revelaram a banda assimétrica de ν3PO4 3- entre 1100-1030cm-1 e a banda de vibração associada a ν1PO4 3- em 963cm-1 associada a nCaP. O nCaP / GIC apresentou resposta adequada à viabilidade celular e comportamento não citotóxico. Portanto, o novo compósito nCaP / GIC apresentou ótimas propriedades mecânicas, comportamento não citotóxico e resposta adequada à viabilidade celular com promissoras aplicações odontológicas.

Utilización de las tecnologías de la información y comunicación (TIC) en estudiantes universitarios paraguayos / Use of information and communication technologies (ICT) in Paraguayan university students

Introducción: Las nuevas tecnologías son aquellos medios de comunicación que van surgiendo de los avances de la electrónica y herramientas conceptuales. El impacto de TIC en la investigación en Paraguay no es muy evidente, dejando la investigación en vías de desarrollo. Objetivos: Establecer los factores tecnológicos y educativos más frecuentes e influyentes de los estudiantes de la Universidad Nacional de Asunción. Materiales y métodos: Estudio observacional descriptivo, corte transversal, muestreo no probabilístico por conveniencia, entre abril a mayo del 2018 en la Universidad Nacional de Asunción. Se consideró una p<0,05 como significativa. Resultados: Edades entre 18 a 30 años (22,04±2,25); sexo femenino 61,1 % (210); Gran Asunción 56,9 % (196). Factores tecnológico- educativos más frecuentes fueron no poseer grupo de estudio en 79,9 % (275); inglés básico con 35,5 % (122). Pertenencia de computadora portátil (89 %), internet inalámbrico (79 %), teléfono inteligente (92 %). 10,19 horas promedio de acceso a internet diario. Uso de Google, Google Académico y SciELO. Conclusión: Es necesario demostrar la relevancia de la incorporación de las TIC en la educación de los universitarios del área de la salud y su beneficio del desarrollo personal y profesional. Se señala la importancia de la educación a nivel regional y local.

Introduction: New technologies are those sources of communication that are emerging from advances in electronics and conceptual tools. The impact of ICT on research in Paraguay is not very evident, leaving research under development. Objectives: To establish the most frequent and influential technological and educational factors of the students of the Universidad Nacional de Asunción. Materials and methods: Descriptive observational study, cross-sectional, non-probabilistic sampling for convenience, between April to May 2018 at the Universidad Nacional de Asunción. A p <0.05 was considered significant. Results: Ages between 18 to 30 years (22.04 ± 2.25); female sex 61.1% (210); Great Asunción 56.9% (196). The most frequent technological-educational factors were not having a study group in 79.9% (275); Basic English with 35.5% (122). Ownership of laptop (89%), wireless internet (79%), smartphone (92%). 10.19 average hours of daily internet access. Use of Google, Google Scholar and SciELO. Conclusion: It is necessary to demonstrate the relevance of the incorporation of ICT in the education of university students in the health area and its benefit for personal and professional development. The importance of education at regional and local level is pointed out.

Role of age and comorbidities in mortality of patients with infective endocarditis.

PURPOSE: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. METHODS: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. RESULTS: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. CONCLUSION: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.

Partial Hammock Valve: Surgical Repair and Long-Term Follow-Up in 23 Patients.

BACKGROUND: In 2006, we reported a "forme frustrée" of hammock valve involving the posterior mitral leaflet resulting in restricted leaflet motion and mitral regurgitation. The purpose of this retrospective report is to describe the surgical techniques and long-term outcome of 23 patients with partial hammock valve who underwent successful repaired over a 22-year period (1995 to 2017). METHODS: Partial hammock valve is defined as anomalous papillary muscles that have hypertrophied and fused together. There are three or four papillary muscles implanted high on the posterior wall, forming a palisade under the posterior leaflet. Twenty-three patients were operated on, 19 adults and 4 children. In all but 3 patients, repair consisted of posterior leaflet enlargement of the P2 and P3 segments with a semilunar patch of bovine pericardium. The fused papillary muscles were split longitudinally, and some secondary chordae were cut. All adult patients received a prosthetic ring. RESULTS: A satisfactory repair was achieved in all patients. Mean age at the time of operation was 62 ± 11 years (range, 6 days to 79 years). Hospital mortality occurred in 1 patient (1 of 23; 4.3%). Mean follow-up was 7 years (range, 1 to 22). Actuarial survival rate at 7 years was 70%. At last echocardiogram, all survivors were free from mitral regurgitation grade II or higher. There was no reoperation. CONCLUSIONS: Partial hammock valve is a rare congenital anomaly resulting in mitral regurgitation. Patch enlargement of the posterior leaflet achieves long-term repair. It is safe and reliable.

Adherencia a terapia médica nutricional en pacientes con diabetes mellitus tipo 2, de un hospital nacional de nivel III en Lima, Perú / Adherence to nutritional therapy in patients with type 2 diabetes mellitus in a level III national hospital in Lima, Peru

Objetivos: Determinar la adherencia a la terapia médica nutricional (TMN) en pacientes con Diabetes Mellitus tipo 2 (DM2) en un hospital nacional de nivel III de Lima-Perú y explorar factores asociados. Material y métodos: Estudio descriptivo transversal, realizado en 163 pacientes con diagnóstico de DM2 del servicio de Endocrinología del Hospital Cayetano Heredia. Se utilizó un Cuestionario de Frecuencia de Alimentos (CFA). La valoración calórica y de macronutrientes fue realizada con valores de referencia del Centro Nacional de Alimentación y Nutrición (CENAN). Se definió adherencia al cumplimiento de recomendación de carbohidratos, fibra, lípidos y proteínas según la American Diabetes Association (ADA). Resultados: El promedio de edad fue 61,1 ± 10,3 años, con predominancia del sexo femenino (61,9%). El 40,5% tenía instrucción primaria. El 38% de los participantes tenía sobrepeso. El 35,6% de los encuestados fueron adherentes a TMN. El tiempo de enfermedad fue mayor en el grupo adherente (9,8 años vs 7,5 años; p=0,035); la frecuencia de pie diabético del grupo adherente fue tres veces mayor que en los no adherentes (12,1% vs 3,8%; p=0,04). Conclusiones: Los resultados muestran una baja adherencia a la TMN. Este estudio da acceso a una de las primeras aproximaciones de la adherencia a TMN en el Perú. (AU)

Objectives: To ascertain the adherence to nutritional therapy (NT) among type 2 diabetes mellitus (DM2) in a level III national hospital in Lima, Peru and to explore factors associated with it. Methods: Cross-sectional study performed in 163 patients with DM2 at the Endocrinology service of Hospital Cayetano Heredia. A food frequency questionnaire was applied; caloric and macronutrient evaluation was performed with reference values from the Centro Nacional de Alimentación y Nutrición (CENAN). Adherence to recommendation for consumption of carbohydrates, proteins and lipids was evaluated based on recommendations by the American Diabetes Association (ADA). Results: Mean age was 61.1 ± 10.3 years; 61.9% were females; 40.5% had elementary education; 38% had obesity. Only 35.6% adhered to NT. Time with DM2 was higher in the adherent group (9.8 vs. 7.5 years; p=0.035); frequency of diabetic foot was three times higher than that of non-adherent patients (12.1% vs 3.8%; p=0.04). Conclusions: This is the first attempt to evaluate adherence to NT in Peru showing low adherence rates. (AU)

A rare presentation of gallstones: Bouveret´s syndrome, a case report.

CT images and endoscopic findings in a case of Bouveret's syndrome.

Partial hammock valve: surgical repair in adulthood.

We describe a forme frustrée of hammock valve involving only the posterior mitral leaflet. Three adult patients were referred to surgery with the diagnosis of severe mitral regurgitation due to fibrosis of the posterior mitral leaflet. The final diagnosis was done intraoperatively. In all of them the posterior leaflet was attached to some accessory papillary muscles arranged en palisade, with three to four fused muscle heads producing restrictive leaflet motion in systole. Repair consisted in division of the papillary muscles, patch augmentation, and ring annuloplasty. This previously unreported lesion is congenital but manifests itself in adulthood.

[Percutaneous closure of complex fistula between the internal mammary artery and a lobar branch of a pulmonary artery]. / Cierre percutáneo de una fístula compleja entre la arteria mamaria interna y la arteria lobar pulmonar.

A through review of the literature identified only 20 reported cases of fistula involving the internal mammary (internal thoracic) artery and a lobar branch of a pulmonary artery. Surgical closure was frequently done to avoid complications associated with this anomaly. We report the first patient in whom percutaneous treatment was accomplished with a combined technique involving an Amplatzer Duct Occluder device and coils.

Linfonodos com maior freqüência de localização para tuberculose bovina, em animais abatidos em um frigorífico sob inspeção federal, no município de Uberlândia - MG / Lymphonodus which have the most frequent localization in bovine tuberculosis in animals slaughtered on a fridge under federal inspection in Uberlândia - MG

A tuberculose é uma doença infecciosa de caráter crônico, caracterizada por processos inflamatórios específicos e é de grande importância por ser uma zoonose. É causada pelo Mycobacterium tuberculosis, especificamente em bovinos é causada pela variedade Mycobacterium tuberculosis. O objetivo é levantar dados arquivados nos últimos seis anos (1996-2001), sobre os linfonodos com maior freqüência de localização da tuberculose bovina. Foram estudadas fichas de abate, com diagnóstico macroscópico para tuberculose, bem como fichas com diagnóstico histopatológico, em um frigorífico sob Inspeção Federal, localizado no município de Uberlândia-MG. Como resultado desta pesquisa foram achados 324 casos, em 155 (47,85 por cento) foram encontrados danos na região torácica, 74 (22,85 por cento) foram encontrados na região anterior, 35 (10,80 por cento) foram encontrados na cabeça e 30 (9,25 por cento) foram encontrados na região abdominal. A maiori freqüênciva da tuberculose de acordo com o linfonodo da região afetada entre os 324 casos eram: linfonodos mediastinais - 139 casos (42,9 por cento); linfonodo pré-escapular - 47 casos (14,5 por cento); linfonodos mesentéricos - 19 casos (5,9 por cento), e linfonodos isquiáticos - 12 casos (3,7 por cento). Foram confirmadas as localizações das lesões da tuberculose, de acordo com os estudos já publicados, permitindo ao Inspetor Sanitário, uma maior segurança durante o diagnóstico macroscópico na inspeção post mortem.

Intramural cardiac myxoma in left ventricular wall: an unusual location.

A 27-year-old asymptomatic woman was investigated for an abnormal finding in the cardiac contour on routine chest radiography. Echocardiography revealed a heterogeneous mass in the anterolateral left ventricular wall. Excision of the tumor disclosed an absence of communication between the residual cavity and the left ventricular endocardium. Histological features of the tumor indicated an intramural myxoma.