Exploring parenthood in first episode of psychosis: the potential role of the offspring in the outcome of women.

PURPOSE: The study aimed to explore the role of parenthood at first episode of psychosis (FEP) on recovery, with a focus on potential sex differences. METHODS: Sociodemographic, clinical, and neurocognitive information was considered on 610 FEP patients form the PAFIP cohort (Spain). Baseline and three-year follow-up comparisons were carried out. Chi-square tests and ANCOVA analysis were performed controlling for the effect of age and years of education. RESULTS: Men comprised 57.54% of the sample, with only 5.41% having offspring when compared to 36.29% of women. Parenthood was related to shorter duration of untreated illness (DUI) in women with children (12.08 months mothers vs. 27.61 months no mothers), showing mothers better premorbid adjustment as well. Childless men presented the worst premorbid adjustment and the highest cannabis and tobacco consumption rates. Mothers presented better global cognitive function, particularly in attention, motor dexterity and executive function at three-year follow-up. CONCLUSIONS: Diminished parental rates among FEP men could be suggested as a consequence of a younger age of illness onset. Sex roles in caregiving may explain the potential role of parenthood on premorbid phase, with a better and heathier profile, and a more favorable long-term outcome in women. These characteristics may be relevant when adjusting treatment specific needs in men and women with and without offspring.

Síndrome cardiorrenal: diagnóstico y tratamiento / Cardiorenal syndrome: diagnosis and treatment

Introducción: Las enfermedades cardíacas y renales coexisten con frecuencia. El síndrome cardiorrenal es una entidad compleja; en ella, la disfunción primaria cardíaca produce daño renal (tipos 1 y 2) y viceversa (tipos 3 y 4) o efecto de una enfermedad sistémica que afecta a ambos órganos (tipo 5). Objetivo: Actualizar el diagnóstico y tratamiento de los pacientes con síndrome cardiorrenal. Métodos: Se utilizan métodos teóricos y empíricos para realizar análisis del conocimiento actualizado sobre el tema. Se ha definido la existencia de un síndrome cardiorrenal que compromete a ambos órganos, con interacción bidireccional. En su detección, el diagnóstico clínico es insuficiente y requiere marcadores bioquímicos; estas herramientas, junto con la medición del sodio urinario, permite vigilar la efectividad terapéutica. Otro recurso es la ultrafiltración, según complicaciones. Conclusiones: Se debe indicar tratamiento con base en la evidencia para mejorar la calidad de vida, reducir la mortalidad y retrasar el deterioro de la función renal y cardíaca a largo plazo; el trasplante renal se debe considerar en pacientes en diálisis con disfunción ventricular severa. Idealmente, deberían recibir un trasplante combinado: cardíaco y renal, lo cual es difícil; algunos pacientes sometidos exclusivamente a trasplante renal presentan una mejoría notable en su fracción de eyección y en la sobrevida.

Introduction: heart and kidney diseases frequently coexist. Cardiorenal syndrome is a complex entity in which primary cardiac dysfunction causes a kidney damage (types 1 and 2) and vice versa (types 3 and 4) or an effect of a systemic disease that affects both organs (type 5). Objective: to update the diagnosis and treatment of patients with cardiorenal syndrome. Methods: theoretical and empirical methods are used to carry out the analysis of updated knowledge on the subject. The existence of a cardiorenal syndrome that compromises both organs has been defined with bidirectional interaction. In its detection, clinical diagnosis is insufficient and requires biochemical markers; these tools, together with the measurement of urinary sodium, allow us to monitor therapeutic effectiveness. Another resource is ultrafiltration, according to complications. Conclusions: evidence-based treatment should be indicated to improve quality of life, reduce mortality, and delay the deterioration of renal and cardiac function in the long term; kidney transplantation should be considered in dialysis patients with severe ventricular dysfunction. Ideally, they should receive a combined transplant: heart and kidney, which is difficult; some patients undergoing exclusively a renal transplantation show a notable improvement in their ejection fraction and survival.

COVID-19 en las embarazadas. Riesgo de las complicaciones durante el embarazo y en el neonato / COVID-19 in pregnant women. Risk of complications during pregnancy and in the newborn

Sobre el tema COVID-19 se han publicado múltiples estudios que reflejan su elevada incidencia, transmisibilidad, morbilidad y mortalidad, con gran repercusión y severidad en los grupos poblacionales de riesgo. El embarazo no escapa a ello, y la inmunosupresión fisiológica que se presenta en esta condición, hace a la gestante y al neonato, ser más susceptibles a las enfermedades infecciosas. El objetivo de esta comunicación es profundizar en la fisiopatología y la repercusión de la enfermedad COVID-19 en las gestantes y el neonato, para mejorar el conocimiento relacionado con el tema, el cual repercutirá en un mejor manejo de estos pacientes. Para ello, se realizó una revisión de investigaciones publicadas en el período comprendido entre enero y diciembre de 2021, en las bases de datos: SciELO, SCOPUS, Medline, Dialnet, Cumed y Lilacs. De los 44 artículos obtenidos inicialmente, 33 cumplieron los criterios de inclusión.

Several studies on COVID-19 have been published reflecting its high incidence, transmissibility, morbidity and mortality, with great repercussions and severity in population groups at risk. Pregnancy does not escape from this, and the physiological immunosuppression that occurs in this condition makes the pregnant woman and the newborn more susceptible to infectious diseases. The objective of this communication is to deepen the pathophysiology and the repercussion of the COVID-19 disease in pregnant women and the newborn in order to improve knowledge related to the subject, which will have an impact on better management of these patients. For this, a review of research published between January and December 2021 was carried out in the databases such as SciELO, SCOPUS, Medline, Dialnet, Cumed and Lilacs. A number of 33 articles met the inclusion criteria from 44 initially obtained.

A systematic literature review on the utilization of extended operating room hours to reduce surgical backlogs.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Introduction: Hospital managers address elective patient surgical backlogs with different strategies: increasing installed capacity, managing demand and improving efficiency. Recently, and particularly since the COVID-19 elective surgery suspension, extended operating room hours has been used to reduce waiting lists by taking advantage of empty operating rooms and existing surgical teams. Methods: Two research questions are raised: (1) which are the scientific literature's insights related to the use of extended operating room hours to help reduce surgery backlogs? and (2) provided that a hospital decides to extend its operating room opening time, what are the main challenges and the key aspects to consider in the design and implementation of policies to manage extended operating room hours? A systematic review on Web of Science database was conducted to gather existing literature, published from January 2012 to December 2021, regarding strategies to reduce waiting lists using empty operating rooms outside regular working hours. Results: A total of 12 papers were selected as relevant to address the two research questions. Results were organized according to their main features, namely setting, type of strategy, methodology, and how human resources are handled. Discussion: The review suggests that extended operating room hours might be problematic if current staff is used and that a careful choice of patients should be made. However, its potential to reduce waiting times and its implications are discussed only superficially. Therefore, we analyze the implications of extending operating room hours from four different perspectives (management, staff, patients, and strategy deployment) and define some recommendations for policy makers and healthcare managers when implementing it in practice.

Portal hypertension has no role in perioperative bleeding during liver transplantation with systematic porto-caval shunt.

BACKGROUND: More than a half of patients undergoing liver transplantation (LT) receive intraoperative transfusion. Portal hypertension (PHT) may contribute to perioperative blood loss. We study the relationship between preoperative hepatic venous pressure gradient (HVPG) values and intraoperative transfusion requirements in adult patients undergoing LT. METHODS: 160 cirrhotic patients undergoing first elective LT (2009-2019) with an HVPG measurement within the previous 6 months were included. Surgical technique was piggyback with portocaval shunt (PCS). The association of HVPG and other variables with transfusion requirements and blood loss were studied. RESULTS: Blood loss (ml/kg) was positively correlated with HVPG, among other variables, but at multivariable analysis it only remained associated with MELD-Na and HCC indication. Regarding RBC transfusion, MELD-Na and hemoglobin were independently associated with the need and magnitude of RBC transfusion. Subanalysis by surgical stage (hepatectomy, anhepatic, neohepatic) and by serial HVPG cut-offs found no clear associations with either bleeding or transfusion. DISCUSSION: The severity of PHT plays a minor role on bleeding and transfusion during LT in a contemporary cohort with systematic PCS. Main determinants of transfusion are liver function and baseline hemoglobin, which would seem the suitable goal to optimize transfusion in LT.

Conectividad funcional a partir de la perfusión cerebral en pacientes epilépticos y con enfermedad de Parkinson / Functional connectivity from cerebral perfusion in patients with epilepsy and Parkinson's disease

Introducción: La epilepsia y la enfermedad de Parkinson han sido descritos como trastornos de redes neurales. El estudio de la conectividad por modalidades moleculares puede ser más relevante fisiológicamente que los basados en señales hemodinámicas. Objetivo: Proponer una metodología para la descripción de patrones de conectividad funcional a partir de la perfusión cerebral por tomografía por emisión de fotón único. Métodos: La metodología incluye cuatro pasos principales: preprocesamiento espacial, corrección del volumen parcial, cálculo del índice de perfusión y obtención de la matriz de conectividad funcional mediante el coeficiente de correlación de Pearson. Se implementó en 25 pacientes con distintos trastornos neurológicos: 15 con epilepsia farmacorresistente y 10 con enfermedad de Parkinson. Resultados: Se encontraron diferencias significativas entre los índice de perfusión de varias regiones de los hemisferios ipsilateral y contralateral tanto en pacientes con epilepsia del lóbulo frontal como en pacientes con epilepsia del lóbulo temporal. Igual resultado se obtuvo en los pacientes con enfermedad de Parkinson con distintos estadios de la enfermedad. Para cada grupo se identificaron patrones de conectividad funcional que involucran a regiones relacionadas con la patología en estudio. Conclusiones: Con el desarrollo de esta metodología se ha demostrado que la tomografía por emisión de fotón único aporta información valiosa para estudiar la organización de las redes funcionales del cerebro. Futuras investigaciones con mayor número de pacientes contribuirían a hacer inferencias sobre los correlatos neurales de los distintos trastornos cerebrales(AU)

Introduction: Epilepsy and Parkinson's disease have been described as disorders of neural networks. The study of connectivity by molecular modalities may be more physiologically relevant than those based on hemodynamic signals. Aim: The aim of the present work is to propose a methodology for the description of functional connectivity patterns from brain perfusion by single photon emission tomography. Methods: The methodology includes four main steps: spatial preprocessing, partial volume correction, calculation of the perfusion index and obtaining the functional connectivity matrix using Pearson's correlation coefficient. It was implemented in 25 patients with different neurological disorders: 15 with drug-resistant epilepsy and 10 suffering Parkinson's disease. Results: Significant differences were found between the perfusion indexes of various regions of the ipsilateral and contralateral hemispheres in both patients with frontal lobe epilepsy and patients with temporal lobe epilepsy. The same result was obtained in Parkinson's disease patients with different stages of the disease. For each group, functional connectivity patterns involving regions related to the pathology under study were identified. Conclusions: With the development of this methodology, it has been demonstrated that single photon emission tomography provides valuable information to study the organization of functional brain networks. Future research with a larger number of patients would contribute to make inferences about the neural correlates of the different brain disorders(AU)

pH-Responsive Metal-Organic Framework Thin Film for Drug Delivery.

In this work, surface-supportive MIL-88B(Fe) was explored as a pH-stimuli thin film to release ibuprofen as a model drug. We used surface plasmon resonance microscopy to study the pH-responsive behaviors of MIL-88B(Fe) film in real time. A dissociation constant of (6.10 ± 0.86) × 10-3 s-1 was measured for the MIL-88B(Fe) film in an acidic condition (pH 6.3), which is about 10 times higher than the dissociation of the same film in a neutral pH condition. MIL-88B(Fe) films are also capable of loading around 6.0 µg/cm2 of ibuprofen, which was measured using a quartz crystal microbalance (QCM). Drug release profiles were compared in both acidic and neutral pH conditions (pH 6.3 and 7.4) using a QCM cell to model the drug release in healthy body systems and those containing inflammatory tissues or cancerous tumors. It was found that the amount of drug released in acidic environments had been significantly higher compared to that in a neutral system within 55 h of testing time. The pH-sensitive chemical bond breaking between Fe3+ and the carboxylate ligands is the leading cause of drug release in acidic conditions. This work exhibits the potential of using MOF thin films as pH-triggered drug delivery systems.

Iron-containing metal-organic framework thin film as a drug delivery system.

Selective bulk metal-organic frameworks (MOFs) have exhibited great potential in biomedical applications. However, topical treatments and drug elution coatings will require uniform films as drug delivery systems. This work studies the use of surface supportive MOF thin films for drug loading and releasing. More specifically, we focus on an iron-containing MOF, MIL-88B(Fe), on a COOH-terminated self-assembled monolayer (SAM) modified Au surface for encapsulating ibuprofen as a model drug. A combined experimental and computational approach was employed to study the fabrication of MIL-88B(Fe) film on functionalized Au surfaces. We used several surface characterization techniques, including infrared spectroscopy and scanning electron microscopy, to confirm the chemical composition and morphological changes of the surface after each modification step. The resulting MIL-88B(Fe) thin film was found capable of loading 8.7 wt% of ibuprofen using quartz crystal microbalance analysis. Moreover, we applied cluster simulations to study the binding mechanisms of MIL-88B(Fe) and its interactions with ibuprofen based on the density functional theory (DFT). The unsaturated Fe site was confirmed kinetically more favorable to bind to the COOH-end group on the SAM. Hydrogen bonding and π-CH interactions between ibuprofen and MIL-88B(Fe) promote ibuprofen being retained inside of the cages of MIL-88B(Fe).

Endoscopy-Related Bleeding and Thromboembolic Events in Patients on Direct Oral Anticoagulants or Vitamin K Antagonists.

BACKGROUND & AIMS: Few prospective studies have assessed the safety of direct oral anticoagulants (DOACs) in elective endoscopy. Our primary aim was to compare the risks of endoscopy-related gastrointestinal bleeding and thromboembolic events in patients on DOACs or vitamin K antagonists (VKAs) in this setting. Secondarily, we examined the impact of the timing of anticoagulant resumption on the risk of delayed bleeding in high-risk therapeutic procedures. METHODS: We conducted a multicenter, prospective, observational study from January 2018 to March 2020 of 1602 patients on oral anticoagulants (1004 on VKAs and 598 on DOACs) undergoing 1874 elective endoscopic procedures. Our primary outcomes were 90-day thromboembolic events and 30-day endoscopy-related gastrointestinal bleeding. The inverse probability of treatment weighting propensity score method was used for baseline covariate adjustment. RESULTS: The 2 groups had similar risks of endoscopy-related gastrointestinal bleeding (VKAs vs DOACs, 6.2% vs 6.7%; adjusted odds ratio [OR], 1.05; 95% CI, 0.67-1.65) and thromboembolic events (VKAs vs DOACs, 1.3% vs 1.5%; adjusted OR, 0.90; 95% CI, 0.34-2.38). In high bleeding risk procedures (n = 747), delayed anticoagulant resumption (> 48 hours or 24-48 hours vs < 24 hours) did not reduce the risk of postprocedural bleeding (10.3%, 9%, and 5.8%, respectively; adjusted P = .43). Hot and cold snare polypectomy were the most frequent high-risk interventions (41.8% and 39.8%, respectively). CONCLUSION: In a prospective study of patients on DOACs or VKAs undergoing elective endoscopy, endoscopy-related bleeding and thromboembolic events showed similar risk. Our study suggests that early anticoagulant resumption is safe in most patients, but more data are needed for advanced high-risk therapeutic procedures.

Consenso mexicano para el diagnóstico y tratamiento de la trombastenia de Glanzmann / Mexican consensus on the diagnosis and treatment of Glanzmann thrombasthenia

Resumen Las plaquetas tienen un papel central en diferentes escenarios fisiológicos, incluyendo la hemostasia; se unen unas con otras en la agregación plaquetaria, lo cual permite formar un coágulo plaquetario. Para que la agregación sea apropiada se requiere del complejo glicoproteico IIb/IIIa (GPIIb/IIIa) en la superficie plaquetaria. Toda alteración funcional plaquetaria, hereditaria o adquirida, impide la formación adecuada del coágulo y se manifiesta como hemorragia. Las enfermedades plaquetarias hereditarias son raras y, hasta recientemente, fueron ignoradas. Una de las más reconocidas y estudiadas es la trombastenia de Glanzmann (TG), entidad en la cual el número de plaquetas puede ser normal pero la función está alterada. Es un padecimiento autosómico y recesivo que causa hemorragia de diferente intensidad toda la vida y en la cual el problema radica en precisamente en la GPIIb/IIIa. Las hemorragias son típicamente mucocutáneas: equimosis, púrpura, epistaxis, gingivorragia; menos frecuentes son la hemorragia gastrointestinal, hemartrosis o en sistema nervioso central. La hiperpolimenorrea es común en las mujeres y llega a ser tan importante que amerita transfusiones en la menarca. La TG afecta a todos los grupos étnicos y su prevalencia varía entre 1/40,000 y 1/400,000. A pesar de esta información acerca de la TG en el mundo, hay pocas guías o recomendaciones basadas en la opinión de expertos y experiencias unicéntricas. En México la TG es rara y no se cuenta con una recomendación general para su diagnóstico y tratamiento. El objetivo de este documento fue establecer un consenso y hacer sugerencias generales para su diagnóstico y tratamiento.

Abstract Platelets have a central role in several physiological scenarios including hemostasis. Platelets bind each other during platelet aggregation allowing the proper formation of the clot; to be appropriate, platelet aggregation requires the glycoproteic complex IIb/IIIa (GPIIb/IIIa). Every platelet function abnormality both, congenital or acquired, impedes clot formation and favors bleeding episodes. Hereditary platelet abnormalities are rare and, until recently, they were almost ignored. Among these disorders, Glanzmann Thrombasthenia (GT) is a widely recognized abnormality in which platelet counts may be normal, but their function is affected. GT is an autosomal, recessive disease that causes life-long bleeding of different intensity. Main biochemical abnormality resides in GPIIb/IIIa. Bleeding is typically mucocutaneous: easy bruising, purpura, and nose and gum bleeds; less frequently are gastrointestinal bleeds, hemarthrosis, or intracranial. Menorrhagia and hyperpolymenorrhea are common findings in in women and may be the cause of anemia requiring blood transfusions at fertile age. GT affects all ethnic groups and its prevalence ranges between 1/40,000 to 1/400,000. Despite this worldwide information regarding GT, only a few guidelines and recommendations have been published, most of them based on expert opinions. In Mexico, GT is rare and there is not a general recommendation regarding its diagnosis and treatment. The aim of this document was to establish a consensus to suggest a general guideline for the diagnosis and treatment of GT in Mexico.

Cirugías más frecuentes en el Centro Médico Naval en un período de 5 años / Most frequent surgeries at the Naval Medical Center in a 5-year period

Resumen: Introducción: El objetivo de este estudio es determinar los procedimientos quirúrgicos más frecuentemente realizados en el Centro Médico Naval, un Centro Médico de Tercer Nivel. Material y métodos: Se realizó un estudio observacional, exploratorio, descriptivo, trasversal y retrospectivo incluyendo todas las cirugías realizadas del 01 de enero de 2015 al 31 de julio de 2019, consultando los registros del quirófano y los expedientes electrónicos. Resultados: Se registraron 25,114 cirugías, con un promedio anual de 5,527 procedimientos y de 16 procedimientos diarios (rango de 2 a 25). Las especialidades que más cirugías realizaron fueron cirugía general, ortopedia, ginecoobstetricia y oftalmología. Las principales cirugías realizadas fueron la facoemulsificación de catarata con colocación de lente intraocular, endoscopías, cesáreas, colecistectomía laparoscópica, atención del trabajo de parto, reducción abierta con fijación interna de fracturas, apendicectomía abierta, hernioplastía inguinal y lavados quirúrgicos. El 59% de las cirugías se realizó en mujeres. El rango de edad de los pacientes fue desde recién nacido hasta los 101 años, estando la mayoría entre los 53 y 72 años. Conclusiones: El Centro Médico Naval destina la mayoría de los recursos de su quirófano para la atención obstétrica (cesárea y trabajo de parto), la atención de padecimientos crónico-degenerativos (cirugía de catarata, y endoscopías), atención de accidentes (reducción de fracturas y lavados quirúrgicos) y la resolución de padecimientos abdominales agudos como la apendicitis y la colecistitis.

Abstract: Introduction: The study objective was to determine the most frequently surgical procedures at the Naval Medical Center, a third level medical center. Material and methods: An observational, exploratory, descriptive, cross-sectional and retrospective study was conducted including all surgeries performed from January 1, 2015 to July 31, 2019, reviewing the surgical records and patient electronic files. Results: 25,114 surgeries were registered, with an annual average of 5,527 procedures and 16 daily procedures (range from 2 to 25). General surgery, orthopedics, gynecoobstetrics and ophthalmology were the specialties with the most amount of surgeries. The main surgeries were cataract phacoemulsification with intraocular lens placement, endoscopies, caesarean sections, laparoscopic cholecystectomy, labor delivery, open reduction with internal fracture fixation, open appendectomy, inguinal hernioplasty and surgical washes. 59% of the surgeries were performed in women. The age range of the patients was from newborn to 101 years, with most patients between 53 and 72 years. Conclusions: The naval medical center spend surgical resources for obstetric care (caesarean section and labor), care of chronic degenerative diseases (cataract surgery, and endoscopy), accident care (fracture reduction and surgical washes) and the resolution of acute abdominal conditions such as appendicitis and cholecystitis.

Discovery and 3D imaging of a novel ΔNp63-expressing basal cell type in human pancreatic ducts with implications in disease.

OBJECTIVE: The aggressive basal-like molecular subtype of pancreatic ductal adenocarcinoma (PDAC) harbours a ΔNp63 (p40) gene expression signature reminiscent of a basal cell type. Distinct from other epithelia with basal tumours, ΔNp63+ basal cells reportedly do not exist in the normal pancreas. DESIGN: We evaluated ΔNp63 expression in human pancreas, chronic pancreatitis (CP) and PDAC. We further studied in depth the non-cancerous tissue and developed a three-dimensional (3D) imaging protocol (FLIP-IT, Fluorescence Light sheet microscopic Imaging of Paraffin-embedded or Intact Tissue) to study formalin-fixed paraffin-embedded samples at single cell resolution. Pertinent mouse models and HPDE cells were analysed. RESULTS: In normal human pancreas, rare ΔNp63+ cells exist in ducts while their prevalence increases in CP and in a subset of PDAC. In non-cancer tissue, ΔNp63+ cells are atypical KRT19+ duct cells that overall lack SOX9 expression while they do express canonical basal markers and pertain to a niche of cells expressing gastrointestinal stem cell markers. 3D views show that the basal cells anchor on the basal membrane of normal medium to large ducts while in CP they exist in multilayer dome-like structures. In mice, ΔNp63 is not found in adult pancreas nor in selected models of CP or PDAC, but it is induced in organoids from larger Sox9low ducts. In HPDE, ΔNp63 supports a basal cell phenotype at the expense of a classical duct cell differentiation programme. CONCLUSION: In larger human pancreatic ducts, basal cells exist. ΔNp63 suppresses duct cell identity. These cells may play an important role in pancreatic disease, including PDAC ontogeny, but are not present in mouse models.

Platelet activation and aggregation response to dengue virus nonstructural protein 1 and domains.

BACKGROUND: Platelets are now recognized as immunological sentries in the first line of defense that participate in the detection and response to pathogens. This frequently results in a decrease in the number of circulating platelets. Different mechanisms have been hypothesized to explain the thrombocytopenia in patients with severe dengue, one of them is the participation of the non-structural protein 1 (NS1) of dengue virus (DENV), which can be secreted into circulation during DENV infection and promotes a more efficient infection. OBJECTIVE: The present study aimed to investigate the ability of platelet response to stimulation with full-length DENV NS1 protein and its domains. METHODS: DENV NS1 plasmid was transfected into HEK-293T. Proteins were purified by Niquel Sepharose affinity chromatography. Secreted proteins were assessed by sodium dodecylsulfate polyacrylamide gel electrophoresis, Coomassie staining and western blot. Platelet-rich plasma was directly incubated with DENV NS1 proteins. Platelet activation was confirmed by expression of αIIbßIII and P-selectin by flow cytometry. Platelet aggregation was also assessed using DENV NS1 protein and its individual domains as agonists. RESULTS: DENV NS1 protein and its domains induce P-selectin and αIIbß3 complex expression on platelet surfaces. DENV NS1 induce a stable platelet aggregation after the addition of a minimal dose of adenosine diphosphate (ADP), epinephrine (EPI), or collagen. Interestingly, only EPI could induce the formation of platelet aggregates after incubation with the protein domains of NS1. CONCLUSION: Our results suggest that the full DENV NS1 protein and also its domains promote platelet recognition, activation, and aggregation.

Pelvic abscess mistaken for malignant ovarian tumor in a postmenopausal woman. case report

ABSTRACT Introduction: Tubo-ovarian abscesses are rare in postmenopausal women. They have been associated with benign gynecological conditions such as endometriosis, uterine polyp or leiomyoma, and malignant diseases such as endometrial adenocarcinoma, epithelial and non-epithelial malignant ovarian tumors, squamous cell carcinoma of the cervix, and adenocarcinoma of the colon. Their presentation represents a diagnostic and therapeutic challenge for clinicians. Case report: A 72-year-old female patient was admitted with a 3-day history of abdominal pain and distension, fever, irritative urinary symptoms and urinary retention. Lab tests on admission showed elevated white blood cells and neutrophils count, and CA-1 25 at 222 U/mL. Ultrasound and magnetic resonance imaging revealed a solid retrouterine cystic mass of 15 cm. Suspecting tumor versus tubo-ovarian abscess, a tomography-directed biopsy was performed, finding foul-smelling purulent material. An exploratory laparotomy was performed with intraoperative findings of solid-cystic retrouterine pelvic mass with purulent content, adhesions, and inflammatory involvement of the uterine tubes. Pathology reported ovarian fibroma and tubo-ovarian abscess. The patient evolved satisfactorily in the postoperative period and in the subsequent follow-up appointments. Conclusions: The reported case illustrates how a possibility of ovarian cancer with peritoneal carcinomatosis can actually be a benign condition (tubo-ovarian abscess) that responds well to medical-surgical treatment. Diagnostic imaging and tumor markers are helpful in differentiating a malignant ovarian disease from a benign process.

RESUMEN Introducción. Los abscesos tubo-ováricos son poco frecuentes en la posmenopausia y se asocian con patologías ginecológicas benignas como endometriosis, pólipo endometrial o leiomioma uterino, y con patologías malignas como adenocarcinoma de endometrio, tumores malignos epiteliales y no epiteliales de ovario, carcinoma escamocelular de cérvix y adenocarcinoma de colon. Su presentación representa un reto diagnóstico y terapéutico para el médico. Presentación del caso. Paciente femenina de 72 años, quien consultó por cuadro clínico de tres días de evolución consistente en dolor y distensión abdominal asociados a fiebre y síntomas urinarios irritativos y retención urinaria. Los exámenes de ingreso mostraron leucocitosis con neutrofilia y CA-125 en 222 U/mL El ultrasonido y la resonancia magnética evidenciaron una masa retrouterina solido-quística de 15 cm. Ante sospecha de tumor versus absceso tubo-ovárico, se realizó biopsia dirigida por tomografía mediante la cual se encontró material purulento fétido. Se practicó laparotomía que confirmó masa pélvica retrouterina sólido-quística con contenido purulento, adherencias y compromiso inflamatorio de las trompas uterinas. El resultado de patología informó fibroma ovárico y absceso tubo-ovárico. La paciente evolucionó de satisfactoriamente en el posoperatorio y en los controles posteriores. Conclusiones. El caso reportado ilustra cómo, en ocasiones, un posible diagnóstico de car-cinomatosis por cáncer de ovario puede ser realmente una patología benigna (absceso tubo-ovárico) que responde bien a un tratamiento médico-quirúrgico. Las imágenes diagnósticas y los marcadores tumorales son de gran ayuda para diferenciar una patología ovárica maligna de un proceso benigno.

Outcomes From Brain Death Donors With Previous Cardiac Arrest Accepted for Pancreas Transplantation: A Single-center Retrospective Analysis.

OBJECTIVE: The aim of the study was to evaluate the effect of cardiac arrest time (CAT) in donors after brain death (DBD) donors on pancreas transplant outcome. SUMMARY OF BACKGROUND DATA: Results from donors after circulatory death report good outcomes despite warm ischemia times up to 57 minutes. Previous cardiac arrest in DBD has been addressed as a potential risk factor, but duration of the CAT has never been evaluated. METHODS: We conducted a retrospective analysis including 342 pancreas transplants performed at our center from 2000 to 2016, and evaluated the effect of previous cardiac arrest in DBD (caDBD) on pancreas transplant outcomes. RESULTS: A total of 49 (14.3%) caDBD were accepted for transplantation [median CAT of 5.0 min (IQR 2.5-15.0)]. Anoxic encephalopathy was most frequent and P-PASS higher (16.9 vs 15.6) in caDBD group when compared with other DBD. No differences were found in all other characteristics evaluated.Graft survival was similar between both groups, as was the incidence of early graft failure (EGF). CAT increased the risk for EGF [OR 1.09 (95% CI, 1.01-1.17)], and the duration of CPR discriminated for EGF [AUC of 0.86 (95% CI, 0.74-0.98)], with a sensitivity and specificity of 100% and 75% at a cutoff of 15 minutes. When evaluated separately, caDBD >15 min increased over 5 times the risk for EGF [HR 5.80 (95% CI, 1.82-18.56); P = 0.003], and these presented fewer days on the ICU (1.0 vs 3.0 d). CONCLUSION: CaDBD donors are suitable for routine pancreas transplantation without increasing EGF risk, and in those with longer CAT it may be prudent to postpone donation a few days to allow a thorough evaluation of organ damage following cardiac arrest.

Coagulopatía, tratamiento anticoagulante en COVID-19 y trombosis posvacunación / Coagulopathy, anticoagulant treatment in COVID-19 and thrombosis postvaccine

Resumen La coagulopatía y la trombosis son situaciones graves que afectan a los pacientes con enfermedad por coronavirus 2019 (COVID-19) que requieren hospitalización. En estos pacientes se alteran mecanismos procoagulantes y fibrinolíticos que condicionan un estado procoagulante progresivo y grave. La anticoagulación oportuna en estos pacientes es importante, pero han surgido preguntas sobre el tipo, la dosis y el momento adecuado de la anticoagulación. Las directrices y documentos de consenso existentes ofrecen sugerencias generales sobre la dosis de heparinas de bajo peso molecular en función de la gravedad de la enfermedad y el riesgo de trombosis, pero todavía falta una relación entre los marcadores de coagulación y el régimen de anticoagulación. Se están llevando a cabo muchos ensayos clínicos que abordan estas cuestiones; se alienta la participación en estos ensayos para determinar las mejores estrategias de tratamiento para los pacientes de COVID-19. Es necesario aumentar los conocimientos con un rápido intercambio para atender adecuadamente a los pacientes en esta pandemia.

Abstract Coagulopathy and thrombosis are serious situations that COVID-19 patients require hospitalization. In these patients, procoagulant and fibrinolytic mechanisms are altered that condition a progressive and severe procoagulant state. Timely anticoagulation in these patients is important, but questions have been raised about the type, dose, and timing of anticoagulation. The guidelines and consensus documents offer general suggestions on the dose of LMWH based on the severity of the disease and the risk of thrombosis, but a relationship between coagulation markers and anticoagulation regimen is still lacking. Many clinical trials are underway that address these issues; Participation in these trials to determine the best treatment strategies for COVID-19 patients is encouraged. Increasing knowledge with rapid exchange is necessary to adequately care for patients in this pandemic.

Herramienta basada en código abierto para el cálculo de blindaje en las instalaciones de Medicina Nuclear / Open Source Based Tool for Shielding Calculation in Nuclear Medicine Installations

Uno de los requerimientos indispensables en el diseño de las instalaciones donde se trabaja con radiación ionizante es la determinación del espesor adecuado de las paredes, pisos, techo y puertas de los locales, que garanticen dosis por debajo de las restricciones establecidas por la autoridad regulatoria. El objetivo del presente trabajo es desarrollar una herramienta interactiva, libre y de código abierto para calcular los blindajes requeridos en una instalación de Medicina Nuclear. En el código, desarrollado en Phyton utilizando el entorno interactivo Jupiter Notebook, se incluyó el análisis tanto para Tomografía por Emisión de Fotón Único como para Tomografía por Emisión de Positrones. La herramienta fue implementada para el cálculo de los blindajes de un departamento de Medicina Nuclear del Centro Internacional de Restauración Neurológica (CIREN). Esta herramienta libre y de código abierto facilita los cálculos de blindaje aumentando la velocidad, lo que contribuye a lograr una optimización de la protección radiológica, pero también puede usarse como herramienta pedagógica(AU)

One of the indispensable requirements in the design of the facilities where ionizing radiation is used is the determination of the adequate thickness of the walls, floors, ceiling and doors of the premises, which guarantee doses below the restrictions established by the regulatory authority. The goal of this work is to develop an interactive, free and open source tool to calculate the shields required in a Nuclear Medicine installation. Analysis for both Single Photon Emission Tomography and Positron Emission Tomography was included in the code, developed in Phyton using the interactive Jupiter Notebook environment. The tool was implemented to calculate the shields of a Nuclear Medicine department of the International Center for Neurological Restoration (CIREN). This free and open source tool facilitates shielding calculations by increasing speed, which contributes to the optimization of radiation protection, but can also be used as a pedagogical tool(AU)

Long-term follow-up after endoscopic submucosal dissection of colorectal lesions in a Spanish cohort.

INTRODUCTION: ESD in the colon is an increasingly important technique in Western countries. There are few studies that include long term follow-up. AIM: to analyze the long term recurrence free survival rate after ESD and to compare recurrence rates according to different variables. METHODS: this was a prospective observational study of patients with a planned ESD from September 2008 to December 2015. When it was not possible to achieve an ESD, hybrid ESD was performed, either en bloc or piecemeal. Kaplan-Meier survival curves were used to assess the five year local recurrence free survival rate and the recurrence rate. The results were compared according to different factors. RESULTS: of the 89 patients scheduled for ESD who were initially enrolled in the study, 69 were finally included for follow-up. ESD was performed in 31 (45%) patients, KAR in eleven (16%) and pKAR in 27 (39%). The median follow-up was 27 months (range 6-60). The five year disease free survival rate was 81%. The average number of endoscopies needed to eliminate recurrence was two (range 2-7) and no patient required surgery for this reason. The recurrence rate was significantly higher in piecemeal resections vs en bloc resections (27% vs 15%, p = 0.036) and R1 resections vs R0 resections (26% vs 0%, p = 0.034). The presence of affected or unknown lateral margins in en bloc resections without other poor prognosis factors had higher recurrence rates but the difference was not statistically significant (28% vs 0%, p = 0.09). CONCLUSIONS: in our study, the five year disease free survival rate was 81% and no patient required surgery during follow-up. Piecemeal and R1 resections had significantly higher recurrence rates, as well as LM involvement, although this was not statistically significant.

Endoscopic submucosal dissection for gastric epithelial lesions: long-term results in a Spanish cohort.

INTRODUCTION: endoscopic submucosal dissection for gastric lesions (ESD-G) is a technique that allows en-bloc resection of early gastric tumors, with a cure rate similar to that of surgery but lower morbidity and mortality rates. OBJECTIVE: to assess total survival, disease-free survival and relapse rate during the course of disease in a Spanish cohort of patients undergoing ESD-G. MATERIAL AND METHODS: this was a prospective observational study of patients undergoing ESD-G from 2008 to 2015, with a follow-up ranging from six to 60 months. Recurrence at five years was analyzed using Kaplan-Meier curves and the results were compared according to several factors using the log-rank test. These included en-bloc versus piecemeal resection and R0 curative resection versus resection with affected lateral margins (LM+). RESULTS: a total of 35 patients undergoing ESD-G were assessed, with a median follow-up of 33.62 months. Four relapses were identified (11.4%) during this period, of which three were managed with repeat ESD-G. A histological specimen with LM+ was associated with a higher local relapse rate during follow-up (p = 0.06). Piecemeal resections had a higher relapse risk, although no statistically significant differences were identified (p = 0.49). No deaths from gastric cancer occurred and no gastrectomies due to persistent disease were performed during this period. The overall survival rate in our series was 94.3%. CONCLUSIONS: ESD-G in our setting provides high long-term cure rates, while avoiding surgery. These results are similar to those reported by the European series and remain far removed from the cure and relapse rates obtained in Asian cohorts. Local relapse cases may be monitored with endoscopy.

A Novel Noninvasive Approach Based on SPECT and EEG for the Location of the Epileptogenic Zone in Pharmacoresistant Non-Lesional Epilepsy.

Background and objectives: The aim of this study is to propose a methodology that combines non-invasive functional modalities electroencephalography (EEG) and single photon emission computed tomography (SPECT) to estimate the location of the epileptogenic zone (EZ) for the presurgical evaluation of patients with drug-resistant non-lesional epilepsy. Materials and Methods: This methodology consists of: (i) Estimation of ictal EEG source imaging (ESI); (ii) application of the subtraction of ictal and interictal SPECT co-registered with MRI (SISCOM) methodology; and (iii) estimation of ESI but using the output of the SISCOM as a priori information for the estimation of the sources. The methodology was implemented in a case series as an example of the application of this novel approach for the presurgical evaluation. A gold standard and a coincidence analysis based on measures of sensitivity and specificity were used as a preliminary assessment of the proposed methodology to localize EZ. Results: In patients with good postoperative evolution, the estimated EZ presented a spatial coincidence with the resection site represented by high values of sensitivity and specificity. For the patient with poor postoperative evolution, the methodology showed a partial incoherence between the estimated EZ and the resection site. In cases of multifocal epilepsy, the method proposed spatially extensive epileptogenic zones. Conclusions: The results of the case series provide preliminary evidence of the methodology's potential to epileptogenic zone localization in non-lesion drug-resistant epilepsy. The novelty of the article consists in estimating the sources of ictal EEG using SISCOM result as a prior for the inverse solution. Future studies are necessary in order to validate the described methodology. The results constitute a starting point for further studies in order to support the clinical reliability of the proposed methodology and advocate for their implementation in the presurgical evaluation of patients with intractable non-lesional epilepsy.