[Cross-cultural adaptation and reliability of the Argentine version of the trunk control test in subjects with sequelae of spinal cord injury] / Adaptación transcultural y fiabilidad del trunk control test versión argentina en sujetos con secuela de lesión medular espinal.

Background: spinal cord injury leaves as a sequel in the acute and chronic period, deficiencies in the stability of joint functions and in the function of voluntary movement control. Those with good trunk control have a greater probability of carrying out activities of daily living by themselves; up to now, we do not have reliable tools in Argentina that evaluate trunk control in these subjects. Objectives: to cross-culturally adapt the trunk control test to Argentinean Spanish in subjects with sequelae of spinal cord injury and to establish interobserver and intraobserver reliability. Methodology: the subjects were admitted using a non-probabilistic convenience sampling. Subjects who were between 15 and 75 years old and had a diagnosis of spinal cord injury were included. Subjects who had: another neurological diagnosis, alteration in sensory organs, conditions that prevent the performance of the test, and psychiatric illness were excluded. Results: 30 subjects were included for cross-cultural adaptation and 55 for reliability. Semantic modifications were made to all items and response options. The intraobserver and interobserver reliability of the scale or subdomains did not achieve a sufficient score. Conclusion: the trunk control test was adapted cross-culturally to Argentine Spanish and interobserver and intraobserver reliability was established. The adaptation was achieved through semantic changes and the reliability was not sufficient. In the future, studies should be carried out to improve the reliability and study the validity of the tool.

Introducción: la lesión de la médula espinal deja como secuela en el período agudo y crónico, deficiencias en la estabilidad de las funciones articulares y de la función del control de los movimientos voluntarios. Aquellos con buen control de tronco poseen una mayor probabilidad de realizar por sí mismos  actividades de la vida diaria, hasta el momento, no contamos en Argentina con herramientas fiables  que evalúen el control de tronco en estos sujetos. Objetivos: adaptar transculturalmente al castellano argentino el trunk control test  en sujetos con secuela de lesión medular espinal y establecer la fiabilidad interobservador, intraobservador. Metodología: los sujetos fueron ingresados mediante un muestreo no probabilístico  por conveniencia. Se incluyeron sujetos que: posean entre 15 años a 75 años y tengan diagnóstico de lesión medular espinal, se excluyeron sujetos que posean: otro diagnóstico neurológico, alteración en los órganos sensoriales, condiciones que impidan la realización de la prueba y enfermedad psiquiátrica. Resultados: 30 sujetos fueron incluidos para la adaptación transcultural y 55 para la fiabilidad. Se realizaron modificaciones semánticas en todos los ítems y opciones de respuesta. La fiabilidad intraobservador e interobservador de la escala o de los subdominios no logró un puntaje suficiente. Conclusión:  se adaptó transculturalmente al castellano argentino el trunk control test y se estableció la fiabilidad interobservador, intraobservador. La adaptación se logró a través de cambios semánticos y la fiabilidad no fue suficiente. A futuro se deberán realizar estudios para mejorar la fiabilidad y estudiar la validez de la herramienta.

Exploring atypical manifestations and multisystem involvement of Epstein-Barr virus infection in hospitalized pediatric patients from Mexico: insights from a tertiary hospital (2012-2022).

INTRODUCTION: Epstein-Barr virus (EBV) infection, with a global prevalence exceeding 95%, typically manifests in children as infectious mononucleosis. However, clinical practice frequently encounters diverse atypical presentations characterized by multisystem involvement, often resulting in an unfavorable clinical course. Our objective is to describe the clinical manifestations and results of EBV infection in a tertiary pediatric hospital in Mexico. METHOD: An observational, transversal, retrospective, and descriptive study that included a systematic review of medical records (2012-2022) of patients under 18 years of age with detectable EBV particles in peripheral blood. RESULTS: The study included 26 patients with a median age of 5 years and a male predominance of 53.8%. Predominant symptoms were fever (85%) and lymphadenopathy (35%). Sixty-five percent had severe and atypical manifestations, including pneumonia and hepatic, hematologic-oncologic, and autoimmune diseases. Anemia, thrombocytopenia and leukopenia were common, with lymphocytosis in 19% of cases. The median EBV viral load was 2816 copies/mL (range: 555-355,500 copies/mL). Four deaths related to EBV infection were reported. Viral load in these cases also varied widely from 594 to 121,000 copies/mL. Supportive care was administered to 85% of patients, while others received antiviral treatment, steroids, and rituximab. CONCLUSION: Atypical manifestations were common, especially in children with multisystem involvement. EBV should be considered as a potential contributor to a diverse spectrum of clinical presentations, emphasizing the need for comprehensive evaluation and awareness in clinical diagnosis.

INTRODUCCIÓN: La infección por el virus de Epstein-Barr (VEB) tiene una prevalencia mundial superior al 95%. Se considera que en los niños se manifiesta principalmente como mononucleosis infecciosa; sin embargo, en la práctica clínica, a menudo encontramos numerosas manifestaciones atípicas con compromiso multisistémico que llevan a un curso desfavorable. Nuestro objetivo es describir las manifestaciones clínicas y los resultados de la infección por VEB en un hospital pediátrico de tercer nivel en México. MÉTODO: Estudio observacional, transversal, retrospectivo y descriptivo, en el cual se revisaron sistemáticamente los expedientes médicos de pacientes menores de 18 años con una detección positiva de partículas de VEB en sangre periférica en el periodo 2012-2022. RESULTADOS: Se incluyeron 26 pacientes con una mediana de edad de 5 años y predominio de varones (53.8%). El 65% presentaron manifestaciones graves y atípicas, incluyendo enfermedades respiratorias, hepáticas, hematooncológicas y autoinmunitarias. Los síntomas más frecuentes fueron fiebre (85%) y linfadenopatía (35%). El 54% presentaron manifestaciones atípicas, incluyendo linfohistiocitosis hemofagocítica, neumonía y neoplasia. La anemia, la trombocitopenia y la leucocitopenia fueron comunes, mientras que el 19% presentaron linfocitosis. La media de la carga viral fue de 2816 copias/ml (555-355,500). Se informaron cuatro muertes atribuidas a la infección por VEB, con valores de carga viral de 594 a 121,000 copias/ml. El 85% de los pacientes recibieron solo tratamiento sintomático, mientras que otros recibieron antivirales, esteroides y rituximab. CONCLUSIÓN: Las manifestaciones atípicas se observaron comúnmente, en especial en niños con compromiso multisistémico. El VEB debe considerarse como un potencial factor contribuyente en el diagnóstico de una amplia gama de manifestaciones clínicas.

Macrophage Polarization Modulates FcγR- and CD13-Mediated Phagocytosis and Reactive Oxygen Species Production, Independently of Receptor Membrane Expression.

In response to microenvironmental cues, macrophages undergo a profound phenotypic transformation acquiring distinct activation phenotypes ranging from pro-inflammatory (M1) to anti-inflammatory (M2). To study how activation phenotype influences phagocytosis and production of reactive oxygen species (ROS) mediated by receptors for IgG antibodies (Fcγ receptors) and by CD13, human monocyte-derived macrophages were polarized to distinct phenotypes using IFN-γ (Mϕ-IFN-γ), IL-4 (Mϕ-IL-4), or IL-10 (Mϕ-IL-10). Phenotypically, Mϕ-IFN-γ were characterized as CD14+CD80+CD86+ cells, Mϕ-IL-4 as CD209highCD206+CD11b+CD14low, and Mϕ-IL-10 as CD16+CD163+ cells. Compared to non-polarized macrophages, FcγRI expression increased in Mϕ-IFN-γ and Mϕ-IL-10 and FcγRIII expression increased in Mϕ-IL-10. None of the polarizing cytokines modified FcγRII or CD13 expression. Functionally, we found that cytokine-mediated activation significantly and distinctively affected FcγR- and CD13-mediated phagocytosis and ROS generation. Compared to non-polarized macrophages, FcγRI-, FcγRII-, and CD13-mediated phagocytosis was significantly increased in Mϕ-IL-10 and decreased in Mϕ-IFN-γ, although both cytokines significantly upregulated FcγRI expression. IL-10 also increased phagocytosis of Escherichia coli, showing that the effect of IL-10 on macrophage phagocytosis is not specific for a particular receptor. Interestingly, Mϕ-IL-4, which showed poor FcγR- and CD13-mediated phagocytosis, showed very high phagocytosis of E. coli and zymosan. Coupled with phagocytosis, macrophages produce ROS that contribute to microbial killing. As expected, Mϕ-IFN-γ showed significant production of ROS after FcγRI-, FcγRII-, or CD13-mediated phagocytosis. Unexpectedly, we found that Mϕ-IL-10 can also produce ROS after simultaneous stimulation through several phagocytic receptors, as coaggregation of FcγRI/FcγRII/CD13 induced a belated but significant ROS production. Together, these results demonstrate that activation of macrophages by each cytokine distinctly modulates expression of phagocytic receptors, FcγR- and CD13-mediated phagocytosis, and ROS production.

Osteocondroma, relato de un caso / Osteochondroma, a case report

El osteocondroma representa la lesión tumoral más frecuente del hueso. La característica radiológica patognomónica de este tumor es la continuidad cortical y medular de las lesiones con el hueso del que surgen. Las lesiones pueden ser solitarias o múltiples, formando esta última parte del síndrome de exostosis hereditaria múltiple. Estas lesiones también se pueden presentar con complicaciones como deformidades óseas, fracturas, compromiso neurológico o vascular, formación de bursa y más raramente transformación maligna. El diagnóstico requiere de un trípode clave: clínica, estudio histopatológico/biopsia y estudios de imagen que son necesarios para el tratamiento y planificación de exéresis quirúrgica y anestésica como es el caso que se relata a continuación.

Osteochondroma represents the most frequent tumoral lesion of the bone. The pathognomonic radiological characteristic of this tumor is the cortical and medullary continuity of the lesions with the bone from which they arise. The lesions can be solitary or multiple, forming this last part of the syndrome of multiple hereditary exostosis. These lesions can also present with complications such as bone deformities, fractures, neurological or vascular compromise, bursa formation and, more rarely, malignant transformation. The diagnosis requires a key tripod: clinical, histopathological study / biopsy and imaging studies that are necessary for the treatment and planning of surgical and anesthetic excesses, as is the case reported below.

Fractura de la cabeza radial: un caso inusual / Fracture of the radial head: an unusual case

Las fracturas de la cabeza radial son infrecuentes y hay que hacer el diagnóstico diferencial con triada terrible de codo. El resultado de estas fracturas depende en gran medida de la gravedad de la lesión. Por lo general, resultan de una caída en el brazo extendido con el codo en pronación y flexión parcial. Por lo tanto, el diagnóstico en este tipo de lesiones óseas se basa en el mecanismo del trauma, la clínica y el estudio radiográfico y tomográfico en 3D. El tratamiento adecuado es esencial para recuperar la estabilidad y las actividades funcionales del codo y minimizar las secuelas. Debido a la importancia de este tema presentamos un caso quirúrgico de una fractura de cabeza radial Mason IV, manejada con artroplastia de cúpula radial que destaca el abordaje y procedimiento quirúrgico.

Fractures of the radial head are infrequent and the differential diagnosis must be made with a terrible elbow triad. The outcome of these fractures depends to a large extent on the severity of the injury. They usually result from a fall in the arm extended with the elbow in pronation and partial flexion. Therefore, the diagnosis in this type of bone lesions is based on the mechanism of the trauma, the clinic and the radiographic and tomographic study in 3D. Adequate treatment is essential to recover the stability and functional activities of the elbow and minimize the sequelae. Due to the importance of this topic we present a surgical case of a radial head fracture Mason IV, managed with radial dome arthroplasty that highlights the surgical approach and procedure.

PD-L2 induction on dendritic cells exposed to Mycobacterium avium downregulates BCG-specific T cell response.

The exposure to certain species of Nontuberculous Mycobacteria (NTM) can modulate the immune response induced by Mycobacterium bovis BCG. Mycobacterium avium has been postulated as a weak inducer of dendritic cell (DC) maturation. However, how the DC exposure to M. avium could contribute to the modulation of a BCG-specific CD4+ T cell response and the molecules involved remain unknown. Here, we exposed bone marrow-derived DCs (BMDCs) to M. avium either prior to exposure to BCG or as a unique stimulus. We found that M. avium induces high expression of PD-L2 (B7-DC) in BMDCs. This was dependent on IL-10 production through the TLR2-p38 MAPK signaling pathway. Exposure to M. avium prior to BCG results in BMDCs that do not express co-stimulatory molecules and pro-inflammatory cytokines, while the expression of PD-L2 and IL-10 was maintained. BMDCs exposed to M. avium impaired the activation of BCG-specific T cells through the PD-1: PD-L interaction. This suggests that a M. avium-induced phenotype in DCs might be implicated in the induction of mechanisms of tolerance that could impact the T cell response induced by BCG vaccination.

Transient lung-specific expression of the chemokine KC improves outcome in invasive aspergillosis.

Invasive aspergillosis is a common and devastating pneumonia in immunocompromised hosts. Neutrophils are critical for defense against this infection, and ELR+ CXC chemokines are potent neutrophil chemoattractants. We hypothesized that transient lung-specific overexpression of one such ligand, KC, in mice with invasive aspergillosis improves the outcome of disease. We generated mice in which transgenic expression of KC was limited to the lungs and occurred only upon exposure to tetracycline analogues, and we exposed them to doxycycline after the onset of invasive aspergillosis. Transgenic mice had a threefold greater survival, a 74% lower lung fungal burden, a greater magnitude of lung KC induction, and an earlier and higher peak of lung neutrophil influx compared with wild-type mice. In addition to a higher number of neutrophils, we found a 1.8-fold higher number of monocytes-macrophages in the lungs of transgenic mice as compared with wild-type mice. Furthermore, transgenic mice had greater lung expression of interferon-gamma and interleukin-12 in response to infection, suggesting that transgenic expression of KC indirectly regulated the expression of other cytokines associated with improved host defense against this pathogen. Taken together, these data suggest that overexpression of KC in the lung in the setting of established invasive aspergillosis results in improved host defense and outcome of disease.

A novel model for lymphocytic infiltration of the thyroid gland generated by transgenic expression of the CC chemokine CCL21.

Lymphocytic infiltrates and lymphoid follicles with germinal centers are often detected in autoimmune thyroid disease (AITD), but the mechanisms underlying lymphocyte entry and organization in the thyroid remain unknown. We tested the hypothesis that CCL21, a chemokine that regulates homeostatic lymphocyte trafficking, and whose expression has been detected in AITD, is involved in the migration of lymphocytes to the thyroid. We show that transgenic mice expressing CCL21 from the thyroglobulin promoter (TGCCL21 mice) have significant lymphocytic infiltrates, which are topologically segregated into B and T cell areas. Although high endothelial venules expressing peripheral lymph node addressin were frequently observed in the thyroid tissue, lymphocyte recruitment was independent of L-selectin or lymphotoxin-alpha but required CCR7 expression. Taken together, these results indicate that CCL21 is sufficient to drive lymphocyte recruitment to the thyroid, suggest that CCL21 is involved in AITD pathogenesis, and establish TGCCL21 transgenic mice as a novel model to study the formation and function of lymphoid follicles in the thyroid.

Cólera e insuficiencia renal aguda en el Hospital Regional "Eleazar Guzmán Barrón" de Chimbote / Cholera and acute renal failure in the Regional Hospital

Se estudiaron retrospectivamente 2268 pacientes con diagnóstico clínico de Cólera admitidos al Departamento de Medicina del Hospital Eleazar Guzmán Barrón de Chimbote, entre los meses de enero a mayo de 1991. El objetivo principal fue determinar los factores predisponentes, causas de Insuficiencia Renal Aguda (IRA) secundario al Cólera y a la letalidad. Se revisaron las historias clínicas, el libro de registro de Emergencia, los informes estadísticos de ingresos y egresos y se hizo una ficha de evaluación para cada paciente portador del Cólera. Se hospitalizaron 713 (31 por ciento) pacientes, de procedencia urbano marginal 53 por ciento (378) y de zonas rurales el 33 por ciento; 182 (26 por ciento) pacientes ingresaron en estado de choque, 102 (43.4 por ciento) procedían de zonas rurales. Hicieron IRA 206 (28.9 por ciento) pacientes, teniendo como factor predisponente la edad avanzada en el 78.5 por ciento (84) de los pacientes; menor porcentaje representaron lo diabéticos, hipertensos, gestantes y los tuberculosos. Los mayores de 60 años fueron los de mayor riesgo con 71 por ciento (84) de letalidad; la hipovolemia con choque fue causa de IRA en 91.2 por ciento (188) de los pacientes. En 97 por ciento (200) de pacientes con IRA el tratamiento fue conservador y solo 3 por ciento (6) recibió apoyo dialítico en el IPSS. De los casos de IRA fallecieron 24 (11.6 por ciento) y 1 por ciento de la muestra total. Los incrementos de úrea y creatinina en sangre se asociaron a la mortalidad, siendo uremia la principal causa de muerte en el 50 por ciento de los pacientes con compromiso renal.