Desenlaces clínicos en pacientes con hepatopatía crónica, con o sin antecedente de trasplante hepático, hospitalizados por neumonía por SARS-CoV-2 / Clinical outcomes in patients with chronic liver disease, with or without a history of liver transplantation, hospitalized for SARS-CoV-2 pneumonia

Introducción. La asociación entre SARS-CoV-2 y hepatopatías crónicas ha sido descrita mundial-mente con cohortes que reportan hasta un 11 % de pacientes hospitalizados con cirrosis hepática o trasplante hepático. Datos publicados reportan un aumento de la mortalidad en este grupo de pacientes. El objetivo de este estudio fue evaluar los desenlaces de mortalidad, necesidad de estan-cia en UCI y de ventilación mecánica, en pacientes hospitalizados por neumonía por SARS-CoV-2 e historia de hepatopatía crónica, con o sin antecedente de trasplante hepático. Metodología. Se realizó un estudio de cohorte observacional retrospectivo en un centro de referencia en trasplante hepático, con pacientes adultos hospitalizados por COVID-19 y antecedente de hepatopatía cróni-ca, trasplantados y no trasplantados. Resultados. Se incluyeron 100 pacientes, de ellos 42 pacien-tes (42 %) habían sido receptores de trasplante hepático. En el análisis al comparar trasplantados versus no trasplantados, se encontró mortalidad por cualquier causa 14 % versus 31 % (OR 0,37; IC95% 0,13-1,03), muerte por COVID-19 14 % versus 29 % (OR 0,52; IC95% 0,18-1,50), reque-rimiento de hospitalización en UCI 30 % versus 29 % (OR 1,48; IC95% 0,57-3,79) y ventilación mecánica 14 % versus 29 % (OR 1,53; IC95% 0,42-3,06), respectivamente. Conclusiones. Los resultados de este estudio sugieren que no hubo un incremento en el riesgo de mortalidad, necesi-dad de estancia en UCI o ventilación mecánica en los pacientes con antecedente de hepatopatía crónica, trasplantados y no trasplantados, que tenían neumonía por SARS-CoV-2.

Introduction. The association between SARS-CoV-2 and chronic liver disease has been described worldwide with cohorts reporting up to 11% of patients hospitalized with liver cirrhosis or liver transplantation. Published data has reported an increase in mortality in this group of patients. The objective of this study was to evaluate the outcomes of mortality, need for ICU stay and mechani-cal ventilation, in hospitalized transplanted and non-transplanted patients with history of chronic liver disease, who had SARS-CoV-2 pneumonia. Methodology. A retrospective cohort study was conducted in a liver transplant reference center with adult patients hospitalized for COVID-19 with a history of chronic liver disease either transplanted or not transplanted. A univariate analysis was performed to assess the outcomes of interest. Results. One hundred patients were included, of which 42 patients (42%) were liver transplant recipients. In the analysis comparing transplanted versus non-transplanted, mortality from any cause was 14% versus 31% (OR 0.37; 95% CI 0.13-1.03), death from COVID-19 14% versus 29% (OR 0.52; 95% CI 0.18-1.50), ICU hospitalization requirement 30% versus 29% (OR 1.48; 95% CI 0.57-3.79) and mechanical ventilation 14% versus 29% (OR 1.53; 95% CI 0.42-3.06), respectively. Conclusions. The results of this study suggest that there was no increased risk of mortality, need for ICU stay, or mechanical ventilation in transplanted and non-transplanted patients with a history of chronic liver disease who had SARS-CoV-2 pneumonia.

Emergency surgery workforce and its inverse relationship with multidimensional poverty in Colombia.

PURPOSE: General surgeons, anesthesiologists, obstetricians and gynecologists (ob-gyns), and orthopedic surgeons are the vital disciplines to provide emergency surgery within a healthcare system. This paper aims to examine the relationship (if any) between multidimensional poverty (MDP) and GDP per-capita with the emergency surgery workforce density in Colombia. METHODS: We performed an ecological study, where the observation units were the 32 Colombian departments. The total numbers of general surgeons, anesthesiologists, ob-gyns, and orthopedic surgeons were obtained from the "Registro Unico Nacional de Talento Humano en Salud" (ReTHUS) registry. The 2020 population projections, the incidence of MDP and the GDP per capita were obtained from the Colombian National Administrative Department of Statistics. A spearman's correlation coefficient was calculated to measure the strength of the correlations between the surgical workforce density with MDP and GDP per-capita. RESULTS: There were significant moderate inverse linear correlations between the incidence of multidimensional poverty and workforce density. The correlation coefficients for the incidence of multidimensional poverty and the workforce density were - 0.5273, - 0.5620, - 0.4704, and - 0.4612 for surgeons, anesthesiologists, ob-gyns, and orthopedic surgeons, respectively. Conversely, the correlation coefficients for the GDP per-capita and the workforce density were 0.4045, 0.3822, 0.4404, and 0.3742 for surgeons, anesthesiologists, ob-gyns, and orthopedic surgeons, respectively. CONCLUSION: This study found that Colombian trauma and emergency surgery workforce density was inversely and directly correlated with multidimensional poverty and GDP per-capita levels, respectively. The relationship of these economic indicators with the surgical capacity deserves further investigation.

Association of a rare variant of the TNFSF13B gene with susceptibility to Rheumatoid Arthritis and Systemic Lupus Erythematosus.

A rare variant (BAFF-var) of the tumor necrosis factor superfamily 13b (TNFSF13B) gene has been recently associated with multiple sclerosis (MS) and systemic lupus erythematosus (SLE). The aim of this study was to investigate the association between TNFSF13B BAFF-var and susceptibility to rheumatoid arthritis (RA) and replicate that association in SLE. 6,218 RA patients, 2,575 SLE patients and 4,403 healthy controls from three different countries were included in the study. TNFSF13B BAFF-var was genotyped using TaqMan allelic discrimination assay. PLINK software was used for statistical analyses. TNFSF13B BAFF-var was significantly associated with RA (p = 0.015, OR = 1.21, 95% CI = 1.03-1.41) in the Spanish cohort. A trend of association was observed in the Dutch (p = 0.115) and German (p = 0.228) RA cohorts. A meta-analysis of the three RA cohorts included in this study revealed a statistically significant association (p = 0.002, OR = 1.24, 95% CI = 1.10-1.38). In addition, TNFSF13B BAFF-var was significantly associated with SLE in the Spanish (p = 0.001, OR = 1.41, 95% CI = 1.14-1.74) and the German cohorts (p = 0.030, OR = 1.86, 95% CI = 1.05-3.28), with a statistically significant p-value obtained in the meta-analysis (p = 0.0002, OR = 1.46, 95% CI = 1.09-2.32). The results obtained confirm the known association of TNFSF13B BAFF-var with SLE and, for the first time, demonstrate that this variant contributes to susceptibility to RA.

Parámetros sanguíneos y perfil de hormonas reproductivas de hembras de Choloepus hoffmanni en cautiverio / Blood parameters and reproductive hormone profile of female Choloepus hoffmanni in captivity

Resumen El uso de técnicas no invasivas ni estresantes para determinar perfiles hormonales, como la medición de esteroides fecales, ha incrementado la comprensión de la fisiología reproductiva en animales silvestres. Debido a la escasa información con respecto a perfiles hormonales reproductivos del perezoso de dos dedos, Choloepus hoffmani, se realizó un estudio en hembras en cautiverio en el centro de rescate "Sloth Sanctuary" (Cahuita, Limón, Costa Rica) con el fin de determinar (i) la confiabilidad de la extracción de progesterona y estradiol en heces, y su cuantificación en el analizador AIA-360®, (ii) evaluar los parámetros sanguíneos en esta especie y (iii) establecer si existe una correlación entre los esteroides plasmáticos y fecales. El estudio se realizó en un periodo de tres meses, durante noviembre de 2013 a enero de 2014, con un total de 208 muestras de heces provenientes de cinco hembras sexualmente maduras, con peso promedio de 6.32 kg. El promedio de las concentraciones medianas en las heces de las cinco hembras fue 124.21 ng/g para progesterona y 1 708.95 pg/g de estradiol. En plasma, los valores de mediana fueron 1.26 ng/mL con un mínimo de 0.32 ng/mL y 12.84 ng/mL como valor máximo; los valores plasmáticos de estrógeno se encontraron por debajo del límite de detección del equipo (25 pg/mL). Aunque no se encontró una correlación estadísticamente significativa entre la progesterona plasmática y la fecal, nuestros datos sugieren que los eventos plasmáticos se reflejan en heces durante los dos días posteriores. Asimismo, los niveles de progesterona se mantuvieron elevados durante la primera mitad de noviembre, y posteriormente mostraron una reducción importante en todas las hembras. Nuestros resultados demuestran que las extracciones en heces y su medición en el AIA-360® permiten la detección y el seguimiento de variaciones hormonales en C. hoffmani, aunque no remplaza las mediciones plasmáticas para determinar valores absolutos.

Abstract In wild animal species, the use of non-invasive and non-stressful procedures to determine hormone profiles, such as fecal steroid measurements, has considerably increased the comprehension of their reproductive physiology. Since there is limited information related to the reproductive hormone profiles of the two-toed sloth, Choloepus hoffmani, a study was conducted in captive specimens at the "Sloth Sanctuary" (Cahuita, Limón, Costa Rica), in order to determine: (i) the reliability of the fecal progesterone and estrogen extraction and its quantification with an AIA-360® analyzer, (ii) assess blood parameters in this species and (iii) evaluate if there is a correlation between fecal and plasmatic steroids. The study was performed over a three-month period, from November, 2013 to January, 2014, with a total amount of 208 fecal samples collected from five sexually mature females weighing 6.32 kg in average. The average of the median concentrations of progesterone in feces of the five females was 124.21 ng/g, and 1 708.95 pg/g for estrogen. The average minimal and maximal values were 50.96 ng/g and 1 057.46 ng/g for progesterone and, 1 191.77 pg/g and 2 159.24 pg/g for estradiol. In plasma, progesterone median values were 1.26 ng/mL, showing a minimum of 0.32 ng/mL and 12.84 ng/mL as maximum values. The plasmatic estrogen levels were below the detection limit of the equipment (25 pg/mL). Although there was no strong statistical correlation between the fecal and plasmatic progesterone fluctuations, our data suggests that the plasmatic events are mostly reflected in feces two days afterwards. Also, the levels of progesterone were elevated during the first half of November and, subsequently, showed a successive and important reduction in all the females tested. Finally, our results demonstrated that fecal steroid extractions and their measurement in a AIA-360®, allowed the successful detection and represents an alternative non-invasive determination of hormone profiles in C. hoffmani. Rev. Biol. Trop. 66(1): 280-292. Epub 2018 March 01.

Contaminación fúngica ambiental en tres centros de enseñanza primaria del cantón central de la provincia de Heredia, Costa Rica / Aerial fungal contamination in three primary schools of the province of Heredia, Costa Rica

Justificación y objetivo: las esporas fúngicas aéreas son consideradas agentes etiológicos de la rinitis alérgica y el asma. El objetivo del presente estudio fue analizar la contaminación fúngica ambiental en tres centros de enseñanza primaria del cantón Central de la provincia de Heredia, midiendo la concentración de esporas fúngicas aéreas por metro cúbico. Métodos: se utilizó el equipo para muestreo volumétrico aéreo Burkard Personal Volumetric Air Sampler durante las épocas seca y lluviosa. Los conteos de esporas se relacionaron con los factores meteorológicos y las características estructurales de los centros educativos analizados. Resultados: se encontró un total de 1391,89 ± 119,70 esporas/m3 en marzo, 3194,45 ± 577,03 esporas/m3 en mayo, 3747,12 ± 568,05 esporas/m3 en octubre y 1009,99 ± 81,24 esporas/m3 en diciembre. En marzo, octubre y diciembre, aproximadamente el 91,0% de estas esporas pertenecían a cuatro grupos: Aspergillus/Penicillium, ascosporas, basidiosporas y Cladosporium. Sin embargo, en mayo el 78,46% de las esporas identificadas pertenecían al género Cladosporium. Al correlacionar la concentración de esporas fúngicas se encontró correlación negativa con la velocidad del viento (-0.418, p<0.05), correlación positiva con la precipitación pluvial (0,568, p<0,05), correlación positiva con el porcentaje de humedad relativa (0,504, p<0,05), y no se encontró correlación con los cambios de temperatura. Conclusión: la concentración de esporas fúngicas encontrada en las tres escuelas muestreadas es mayor al límite de 1000 esporas por metro cúbico, considerado saludable.

Background and aim: Fungal spores are considered etiological agents of allergic rhinitis and asthma; therefore, it is advised to monitor fungal levels within the classrooms. The aim of this paper was to study fungal aerial contamination in three public schools of Heredia by measuring the concentration of aerial fungal spores per cubic meter. Methods: We used the Burkard Personal Volumetric Air Sampler to collect and identify fungal spores during the dry and rainy season. The relationship between the fungal spore concentration, the meteorological factors and structural characteristics of the schools was determined. Results: A total of 1391.89 ± 119.70 spores/m3 was found in March, 3194.45 ± 577.03 spores/ m3 in May, 3747.12 ± 568.05 spores/m3 in October and 1009.99 ± 81.24 spores/m3 in December. Except for May, approximately 91.0 % of the spores identified belonged to four groups: Aspergillus/ Penicillium, ascospores, basidiospores and Cladosporium. In May, 78.46 % of the spores identified were Cladosporium. A negative correlation was found between spore concentration and wind velocity (-0.418; p<0.05), and a positive one with rain (0.568; p<0.05) and with humidity (0.504; p<0.05). No correlation was found with temperature changes. Conclusion: The three schools analysed presented fungal spore concentrations which exceeded the limit of 1000 spores per cubic meter which is considered as healthy.