El mejillón Semimytilus patagonicus (Mytilida: Mytilidae) y el gusano Pseudonereis gallapagensis (Phyllodocida: Nereididae) como herramientas ecotoxicológica para la contaminación por detergentes en ambientes marinos / The mussel Semimytilus patagonicus (Mytilida: Mytilidae) and the worm Pseudonereis gallapagensis (Phyllodocida: Nereididae) as ecotoxicological tools for detergent pollution in marine environments

Introduction: The bivalve Semimytilus patagonicus is a potentially useful bioindicator because of its feeding mechanism, and the worm Pseudonereis gallapagensis is also interesting as a bioindicator because it is benthonic, abundant, and a food source for the squid Doryteuthis gahi. However, their sensitivity to contaminants has not been sufficiently studied. Objective: To test the usefulness of the mussel Semimytilus patagonicus and the polychaete Pseudonereis gallapagensis as ecotoxicological tools for detergents in the marine environment. Methods: We used 120 individuals of S. patagonicus from Miraflores and 120 of P. gallapagensis from Barranco (both near the city of Lima, Peru). For the bioassays, we used two anionic detergents (active ingredient, ai, Sodium Dodecylbenzene Sulfonate). For S. patagonicus, with an average valve length of 32.3 ± 6.4 mm, we tested "Double power Ariel®" (90 %) at concentrations of 17.5, 35, 70 and 140 mg ai l-1, evaluated after 48 and 72 h of exposure; and for P. gallapagensis, with a total body length of 20.4 ± 8.8 mm, we tested "Caricia®" at 62.5, 125, 250, 500 and 1 000 mg of ai l-1 at 24, 48 and 72 h of exposure. Results: The LC50 values (Mean Lethal Concentration) were 34.95 mg ia l-1 for S. patagonicus and 102.48 mg ia l-1 for P. gallapagensis at 72 h of exposure. The detergents were toxic for S. patagonicus and slightly toxic for P. gallapagensis. The risk classification for S. patagonicus is "harmful" and for P. gallapagensis "not classifiable". Conclusions: These two bioindicators allow evaluating the acute toxicity of SDBS-based commercial detergents in the marine aquatic environment.

Introducción: El bivalvo Semimytilus patagonicus es un bioindicador potencialmente útil por su mecanismo de alimentación, y el gusano Pseudonereis gallapagensis también es interesante como bioindicador por ser bentónico, abundante y fuente de alimento para el calamar Doryteuthis gahi. Sin embargo, su sensibilidad a los contaminantes no ha sido suficientemente estudiada. Objetivo: Probar la utilidad del mejillón S. patagonicus y el poliqueto P. gallapagensis como herramientas ecotoxicológicas para detergentes en el medio marino. Métodos: Se utilizaron 120 individuos de S. patagonicus de Miraflores y 120 de P. gallapagensis de Barranco (ambos cerca de la ciudad de Lima, Perú). Para los bioensayos se utilizaron dos detergentes aniónicos (ingrediente activo, ia, dodecilbenceno sulfonato de sodio). Para S. patagonicus, con una longitud valver promedio de 32.3 ± 6.4 mm, probamos Ariel Doble Poder® (90 %) a concentraciones de 17.5, 35, 70 y 140 mg·ia·l-1, evaluadas a las 48 y 72 h de exposición; y para P. gallapagensis, con una longitud corporal total de 20.4 ± 8.8 mm, probamos Caricia® a 62.5, 125, 250, 500 y 1 000 mg·ia·l-1 a las 24, 48 y 72 h de exposición. Resultados: Los valores de CL50 (Concentración Letal Media) fueron de 34.95 mg·ia·l-1 para S. patagonicus y 102.48 mg·ia·l-1 para P. gallapagensis a las 72 h de exposición. Los detergentes fueron tóxicos para S. patagonicus y levemente tóxicos para P. gallapagensis. La clasificación de riesgo para S. patagonicus es "nocivo" y para P. gallapagensis "no clasificable". Conclusiones: Estos dos bioindicadores permiten evaluar la toxicidad aguda del detergente comercial a base de SDBS en el ambiente acuático marino.

Lista de espera para transplante hepático: impacto clínico e econômico / Waiting list for liver transplantation: clinical and economic burden

ABSTRACT Background Burden of disease is an indicator that relates to health status. United States and European epidemiological data have shown that the burden of chronic liver disease has increased significantly in recent decades. There are no studies evaluating the impact of complications of chronic liver disease on the waiting list for deceased donor liver transplantation (LTx). Objective: To determine the clinical and economic burden of complications of liver disease in wait-listed patients from the perspective of a transplant center. Methods The study retrospectively analyzed medical records of 104 patients wait-listed for deceased donor LTx from October 2012 to May 2016 and whose treatment was fully provided at the study transplant center. Clinical data were obtained from electronic medical records, while economic data were collected from a hospital management software. To allocate all direct medical costs, two methods were used: full absorption costing and micro-costing. Results: The most common complication was refractory ascites (20.2%), followed by portosystemic encephalopathy (12.5%). The mean number of admissions per patient was 1.37±3.42. Variceal hemorrhage was the complication with longest median length of stay (18 days), followed by hepatorenal syndrome (13.5 days). Hepatorenal syndrome was the costliest complication (mean cost of $3,565), followed by portosystemic encephalopathy ($2,576) and variceal hemorrhage ($1,530). Conclusion: The burden of chronic liver disease includes a great cost for health systems. In addition, it is likely to be even greater as a result of the insidious course of the disease.

RESUMO Contexto O impacto da doença é um indicador relacionado ao estado de saúde. Dados epidemiológicos norte-americanos e europeus mostraram que, nas últimas décadas, o impacto da doença hepática crônica tem aumentado significativamente. Não há estudos que avaliem o impacto das descompensações da doença hepática crônica na lista de espera para transplante hepático (TxH) com doador falecido. Objetivo: Determinar o impacto clínico e econômico das descompensações da doença hepática nos pacientes em lista de espera sob a perspectiva do centro transplantador. Métodos Foram analisados, retrospectivamente, os prontuários de 104 pacientes incluídos em lista de espera para TxH com doador falecido entre outubro de 2012 e maio de 2016 e acompanhados integralmente no centro transplantador. Dados clínicos foram obtidos do prontuário eletrônico, enquanto dados econômicos foram coletados através de software de gestão hospitalar. A apropriação dos custos médicos diretos foi realizada sob duas metodologias: custeio por absorção pleno e microcusteio. Resultados: A descompensação com maior incidência foi a ascite refratária (20,2%) seguida de encefalopatia portossistêmica (12,5%). A média de internações por paciente foi de 1,37±3,42. A hemorragia digestiva alta varicosa foi a descompensação com maior tempo mediano de internação (18 dias), seguida da síndrome hepatorrenal (13,5 dias). A descompensação mais onerosa foi a síndrome hepatorrenal (custo médio de US$ 3.565), seguida encefalopatia portossistêmica (US$ 2.576) e a hemorragia digestiva alta varicosa (US$ 1.530). Conclusão O impacto da doença hepática crônica inclui um custo importante para os sistemas de saúde. Além disso, é provável que seja ainda maior em decorrência do curso insidioso da doença.

Post-cardiac arrest syndrome in adult hospitalized patients / Síndrome posparo cardiaco en pacientes adultos hospitalizados

Abstract Adult In-hospital Cardiac Arrest (IHCA) is defined as the loss of circulation of an in-patient. Following high-quality cardiopulmonary resuscitation (CPR), if the return of spontaneous circulation (ROSC) is achieved, the post-cardiac arrest syndrome develops (PCAS). This review is intended to discuss the current diagnosis and treatment of PCAS. To approach this topic, a bibliography search was conducted through direct digital access to the scientific literature published in English and Spanish between 2014 and 2020, in MedLine, SciELO, Embase and Cochrane. This search resulted in 248 articles from which original articles, systematic reviews, meta-analyses and clinical practice guidelines were selected for a total of 56 documents. The etiologies may be divided into 56% of in-hospital cardiac, and 44% of non-cardiac arrests. The incidence of this physiological collapse is up to 1.6 cases/1,000 patients admitted, and its frequency is higher in the intensive care units (ICU), with an overall survival rate of 13% at one year. The primary components of PCAS are brain injury, myocardial dysfunction and the persistence of the precipitating pathology. The mainstays for managing PCAS are the prevention of cardiac arrest, ventilation support, control of peri-cardiac arrest arrythmias, and interventions to optimize neurologic recovery. A knowledgeable healthcare staff in PCAS results in improved patient survival and future quality of life. Finally, there is clear need to do further research in the Latin American Population.

Resumen El paro cardiaco intrahospitalario en el adulto (IHCA) se define como el cese de circulación ocurrido dentro de las instalaciones hospitalarias. Después de la reanimación cardiopulmonar (RCP) de alta calidad, si se logra el retorno de circulación espontánea (ROSC), aparece entonces el síndrome posparo cardiaco (SPPC). En esta revisión se pretende presentar el estado actual del diagnóstico y tratamiento del SPPC. Para abordar este tema, se realizó una búsqueda bibliográfica mediante la consulta digital directa de la literatura científica publicada entre 2014 y 2020 en inglés y español recogida en las bases de datos MedLine, SciELO, Embase y Cochrane. La búsqueda inicial arrojó 248 artículos, de los cuales se eligieron artículos originales, revisiones sistemáticas, metaanálisis y guías de práctica clínica, para una selección final de 56 documentos. Las etiologías del paro cardiaco intrahospitalario se pueden dividir en cardiacas y no cardiacas, en el 56 % y 44 %, respectivamente. El colapso fisiológico tiene incidencias de hasta 1,6 casos/1.000 pacientes admitidos, y es más frecuente en las unidades de cuidado intensivo (UCI), con una tasa de supervivencia general de 1 año del 13 %. Los componentes principales del SPPC son la lesión cerebral, la disfunción miocárdica y la persistencia de la patología precipitante. Los pilares del manejo del SPPC son la prevención del paro cardiaco, soporte ventilatorio, control de arritmias periparo cardiaco y las intervenciones para optimizar la recuperación neurológica. El conocimiento del SPPC por parte del personal de la salud ofrece mejor sobrevida y futura calidad de vida a los pacientes. Finalmente, se resalta la clara necesidad de ahondar en mayores investigaciones en la población latinoamericana.

Evaluación del desgaste laboral (burnout) y ansiedad en personal de salud burante la pandemia por Covid-19 / Assessment of Burnout and Anxiety in Health Personnel during the Covid-19 Pandemic

Objetivo La pandemia por Covid-19 ha tenido consecuencias en la sanidadmental del personal de salud, una población vulnerable que se encuentra en la primera línea de atención contra el virus. Los horarios de trabajo, así como el miedo de contagiarse y contagiar a la familia, generan niveles elevados de ansiedad y desgaste laboral. El objetivo de este estudio es evaluar la presencia de desgaste laboral y ansiedad en el personal de salud durante la pandemia de Covid-19. Métodos Se aplicaron prospectivamente el Maslach Burnout Inventory y la escala de ansiedad de Hamilton de manera electrónica a 566 trabajadores de salud en Colombia durante marzo y abril del 2020. Adicionalmente, se evaluaron la edad, el nivel educativo, el estado civil, la ocupación, la fuente de ingresos, el tipo de contratación, el número de empleos, y las horas de trabajo del personal anteriormente mencionado. Resultados En total, se evaluaron 566 profesionales de la salud, de los cuales 60,8% eran mujeres, y el 39.2%, hombres. La muestra comprendía 85,3% de médicos, 9,2% de enfermeros, y el 5.5% restante correspondió a personal administrativo, odontólogos y paramédicos. De estos, 19,3% tenía 3 o más empleos. En términos de desgaste laboral, se evidenciaron altos niveles de agotamiento emocional y despersonalización, con bajos niveles de realización personal. Adicionalmente, se evidenció ansiedad leve. Conclusiones Unas de las consecuencias más importantes de la pandemia por Covid- 19 son los efectos a nivel de desgaste laboral y ansiedad en el personal de salud. Dados nuestros resultados, es esencial resaltar la importancia de un acompañamiento psicológico al personal de salud en tiempos de miedo e incertidumbre.

Objective The Covid-19 pandemic has had consequences on the mental health of health personnel, a vulnerable population that is on the front lines of attention. Long working hours, as well as the fear of getting sick and transmitting the virus to their families, generate high levels of anxiety and burnout. The objective of the present study is to evaluate the presence of burnout and anxiety in health personnel during the Covid-19 pandemic. Methods The Maslach Burnout Inventory and the Hamilton anxiety scale were distributed electronically and prospectively to 566 health workers in Colombia from March to April 2020. Additionally, age, level of schooling, marital status, occupation, source of income, type of contract, and the number of jobs and working hours were evaluated. Results A total of 566 health professionals were evaluated, 60.8% of whom were women, and 39.2% of whom were men. The sample was composed of 85.3% of doctors, 9.2% of nurses, and the other 5.5% corresponded to administrative staff, dentists, and paramedics. Of the aforementioned, 19.3% had 3 or more jobs. The survey reported high levels of emotional exhaustion and depersonalization, with low levels of personal fulfillment. Additionally, mild anxiety was evident. Conclusions One of the most important consequences of the Covid-19 pandemic is the effects of burnout and anxiety in health personnel. Given our results, it is essential to highlight the importance of psychological support for health personnel in these times of fear and uncertainty.

Caracterización de pacientes con fractura de cadera, intervenidos con artroplastia / Characterizing Patients with Hip Fracture, Operated with Arthroplasty

Introducción: Las lesiones traumáticas de la cadera ocupan uno de los propósitos más importantes de la cirugía traumatológica. El uso de la artroplastia como regla de oro en el tratamiento quirúrgico de las mismas, es el fundamento del trabajo. Objetivo: Caracterizar los pacientes con diagnóstico de fractura de cadera, intervenidos con artroplastia total y parcial y estudiar la mortalidad, según el tipo de prótesis utilizada. Métodos: Se realizó un estudio descriptivo de corte transversal retrospectivo en 1506 pacientes del Hospital Ortopédico Docente Fructuoso Rodríguez entre 2015 y 2019, portadores de fractura de cadera, y tratados con artroplastia. Se analizaron variables tales como edad, sexo y comorbilidades presentes. Resultados: Se colocaron prótesis totales a 427 pacientes y en 1079 se utilizó la modalidad de prótesis parcial. Predominaron las personas entre 61 y 80 años de edad. El sexo femenino prevaleció en el estudio, con una relación 3:1. Predominó el grupo de pacientes con 1 o 2 enfermedades asociadas. La mortalidad < 30 días resultó el 1,1 por ciento y ≥ 30 días el 9,2 por ciento. Conclusiones: La utilización de prótesis totales dista mucho de la media interpuesta actualmente en el mundo, donde la prótesis total se maneja como herramienta de elección. Las prótesis parciales quedan reservadas para pacientes que tienen una corta expectativa de vida y muy poco validismo(AU)

Introduction: Traumatic hip injuries occupy one of the most important purposes of trauma surgery. The use of arthroplasty as a golden rule in their surgical treatment is the foundation of the work. Objectives: To characterize patients with a diagnosis of hip fracture, who underwent total and partial arthroplasty and to study mortality, according to the type of prosthesis used. Methods: A descriptive retrospective cross-sectional study was carried out in 1506 patients from Fructuoso Rodríguez Orthopedic Teaching Hospital from 2015 to 2019, with hip fracture, and treated with arthroplasty. Variables such as age, sex, and present comorbidities were analyzed. Results: Total prostheses were placed in 427 patients and in 1079 the partial prosthesis modality was used. Persons between 61 and 80 years of age predominated. The female sex prevailed in this study, with a 3: 1 ratio. The group of patients with 1 or 2 associated diseases predominated. Mortality <30 days was 1.1 percent and ≥30 days was 9.2 percent. Conclusions: The use of total prostheses is far from the current average in the world, where the total prosthesis is used as the tool of choice. Partial prostheses are reserved for patients who have short life expectancy and very little validity(AU)

Mercurio total en bagre rayado y bocachico del río Meta, Colombia / Total mercury in striped catfish and bocachico from river Meta, Colombia

RESUMEN El consumo de pescado contaminado con mercurio representa un grave problema para la salud humana, en especial, en poblaciones, en las cuales, forma parte de su dieta diaria. Este problema requiere un seguimiento de la concentración de mercurio en peces depredadores y no depredadores de agua dulce, especialmente, en zonas poco estudiadas, como la región de la Orinoquia colombiana. Por lo tanto, el objetivo de este estudio fue determinar la concentración de mercurio total en muestras de bagre rayado (Pseudoplatystoma fasciatum metaense) y de bocachico (Prochilodus mariae), de la parte alta del río Meta, Colombia, peces muy consumidos por las poblaciones aledañas. Ocho muestras de cada especie de pez se analizaron por duplicado, por espectrofotometría de absorción atómica, con generador de hidruros. Se estableció, que el método aplicado es trazable al material de referencia certificado Dorm-4; también, se realizó la validación del método. El valor promedio de mercurio total en bagre rayado fue de 0,055 ± 0,0107 mg/kg y para el bocachico, 0,026 ± 0,0054 mg/kg de pescado fresco. Las muestras analizadas no sobrepasan el valor límite establecido por la Organización Mundial de la Salud y Environmental Protection Agency; sin embargo, el índice de riesgo por efectos no cancerígenos, en algunas muestras de bagre rayado, presentan un valor superior a uno, por lo que su consumo representa un riesgo para la salud, especialmente, durante la gestación y la primera infancia, así como de pescadores y aquellas comunidades de la región, que dependen del consumo de este alimento.

ABSTRACT The consumption of fish contaminated with mercury represents a serious problem for human health, especially in populations in which it is part of their daily diet. This problem requires the monitoring of mercury concentration in freshwater predatory and non-predatory fish, especially in poorly studied areas such as the Orinoquia region of Colombia. The aim of this study was to determine total mercury concentration in samples of catfish (Pseudoplatystoma fasciatum metaense) and bocachico (Prochilodus mariae) from the river Meta, Meta-Colombia. Fishes very much consumed by the adjacent populations. Eight samples of each fish species were analyzed in duplicate by atomic absorption spectrophotometry with a hydride generator. It was established that the applied method is traceable to the Dorm-4 certified reference material; the method was also validated. The average value of total mercury in striped catfish was 0.055 ± 0.0107 mg / kg, and for bocachico 0.026 ± 0.0054 mg / kg of fresh fish. These data obtained do not exceed the limit value established by the World Health Organization and Environmental Protection Agency. However, the risk index for non-carcinogenic effects in some samples of striped catfish have a value greater than one, therefore their consumption represents a health risk, especially during pregnancy and early childhood, as well as for fishermen and those communities in the area that depend on the consumption of this food.

Urological Cancer Treatment by a Multidisciplinary Teamthroughout the Covid-19 Pandemic: What Have We Learned? / Tratamiento del cáncer urológico por un equipo multidisciplinario durante la pandemia de Covid-19: ¿Qué hemos aprendido?

Introduction It is known that cancer care is best approached by a multidisciplinary team (MDT). This became specifically true in the Covid-19 pandemic in which choices for urological cancer treatment are influenced by many factors. In some cases, delayed treatment may have consequences regarding the patient's oncological outcomes. The aim of the present article is to report our experience throughout the Covid-19 pandemic treating patients with urological neoplasms at a high-volume center. Methods We used a convenience sampling method. Cases were evaluated and discussed on an individual basis at the MDT meetings, and, after a consensus regarding delaying or scheduling treatment, patients were scheduled according to the risk of postponing the procedures. The Medically Necessary, Time-Sensitive (MeNTS) scoring system was measured in each patient; all patients answered the Centers for Disease Control and Prevention (CDC) Covid-19 self-screening questionnaire prior to surgery. The Covid-19-free survival rate was estimated. Results A total of 194 patients were assessed by themultidisciplinary team and finally treated, with median follow-up of 4 (interquartile range [IQR]: 2.75 to 6) months. Only two patients had Covid-19 confirmed by real-time polymerase chain reaction (RT-PCR). In total, 54 patients underwent oncological surgery, 129 were treated with radiotherapy, and 11 were treated with intravenous chemotherapy. Themedian age was 66 years (IQR: 59 to 94 years), and the median MeNTS score in the surgically-treated cohort was 35 points (IQR: 31 to 47 points). Conclusions The evaluation and treatment of urological cancer should be conducted by an MDT; this is of utmost importance, especially during the Covid-19 pandemic. The data collected in our institution showed that most patients could be safely treated by taking all necessary precautions and discussing each case individually in the MDT meetings and performing a close follow-up.

Introduccion La atención del cáncer se aborda mejor con un equipo multidisciplinario (EMD), aspecto que se tornó más importante en la pandemia por Covid-19, en que las opciones para tratar el cáncer urológico están influenciadas por muchos factores. En algunos casos, el tratamiento retrasado puede tener consecuencias en los resultados oncológicos del paciente. El objetivo de este estudio es describir nuestra experiencia en un centro de referencia y de alto volumen para el tratamiento de neoplasias urológicas durante la pandemia por Covid-19. Métodos Realizamos un muestreo por conveniencia. Posteriormente, los casos fueron evaluados y discutidos de forma individual en las reuniones del EMD. Posterior a la obtención de un consenso sobre el tratamiento del paciente, los pacientes fueron programados según el riesgo individual de posponer el manejo. Se midió la puntuación de cada paciente en el sistema Medically Necessary Time-Sensitive (MeNTS, "Médicamente necesario, sensibles al tiempo"). Todos los pacientes respondieron el cuestionario de autoevaluación del Centers for Disease Control and Prevention (CDC) COVID-19 antes de la cirugía. Se estimó la tasa de supervivencia libre de Covid-19. Resultados Un total de 194 pacientes fueron evaluados por el EMD y finalmente tratados, con una mediana de seguimiento de 4 (rango intercuartil [RIC]: 2,75 a 6) meses. Solo dos tenían Covid-19 confirmado por reacción en cadena de la polimerasa en tiempo real (RCP-TR). Un total de 54 pacientes fueron sometidos a cirugía oncológica, 129 fueron tratados con radioterapia, y 11 fueron tratados con quimioterapia intravenosa. La mediana de edad fue de 66 años (RIC: 59 a 94 años), la puntuación mediana en el MeNTS de la cohorte tratada quirúrgicamente fue de 35 puntos (RIC: 31 a 47 puntos). Conclusiones La evaluación y el tratamiento del cáncer urológico debe ser realizado por un EMD durante la pandemia de Covid-19. Los datos recopilados en nuestra institución mostraron que la mayoría de los pacientes podrían ser tratados de manera segura, discutiendo cada caso individualmente y haciendo un seguimiento cercano.

Caso clínico: tumor sólido pseudopapilar de páncreas / Solid-pseudopapillary tumour of the pancreas, clinical case / Tumor sólido pseudopapilar de pâncreas, relato de caso

Resumen: Introducción: el tumor sólido pseudopapilar de páncreas (TSP) es un tumor poco frecuente de bajo potencial de malignidad que afecta principalmente a mujeres jóvenes. Objetivo: reportar una adolescente en quien se documentó un TSP. Caso clínico: paciente de 12 años de sexo femenino, en la cual se confirmó un TSP luego de presentar episodio de dolor abdominal intenso a nivel de hipocondrio izquierdo y vómitos. En su historial destacó la ausencia de antecedentes patológicos y un examen físico sin alteraciones. La resonancia nuclear magnética (RNM) identificó a nivel del sector caudal del páncreas una tumoración mixta sólido quística; por sus características se planteó que podría corresponder a un TSP. Se realizó su resección completa. La anatomía patológica confirmó el planteo diagnóstico. Conclusiones: debe ser considerado su diagnóstico en adolescentes de sexo femenino que presentan una tumoración pancreática e imagen compatible. La resección quirúrgica es el Gold Standard del manejo terapéutico.

Summary: Introduction: solid pseudopapillary tumor (SPT) of the pancreas is a rare low-level malignant tumor which mainly affects young women. Objective: report the case of an adolescent with a SPT. Clinical case: twelve-year old female adolescent diagnosed with a SPT after an episode of severe abdominal pain on the left hypochondriac region and vomiting. Her medical record did not show a pathological history nor were there findings in the physical examination. The MRI showed a mixed cystic and solid tumor in the caudal portion of the head of the pancreas, which was initially thought to be a SPT. A total surgical resection was performed and the anatomical pathology confirmed the diagnosis. Conclusions: SPT diagnosis should be considered in female adolescents who show a pancreatic tumor and compatible image. A total surgical resection is the Gold Standard regarding the SPT's therapeutic management.

Resumo: Introdução: o tumor sólido pseudopapilar do pâncreas (TSPP) é um tumor raro com baixo potencial de malignidade que afeta principalmente mulheres jovens. Objetivo: relatar o caso de uma adolescente diagnosticada com um TSPP. Caso clínico: paciente do sexo feminino, 12 anos de idade, confirmada com TSPP após apresentar episódio de dor abdominal intensa em quadrante superior esquerdo e vômitos. Em seu prontuário, destacou-se a ausência de antecedentes patológicos e um exame físico sem alterações. A ressonância magnética (RM) identificou um tumor cístico sólido misto no setor caudal do pâncreas que, por suas características, sugeriu-se que pudesse corresponder a um TSPP. Realizou-se sua ressecção completa. A anatomia patológica confirmou a abordagem diagnóstica. Conclusões: deve se considerar o diagnóstico de TSPP em adolescentes do sexo feminino que apresentam tumor pancreático e imagem compatível. A ressecção cirúrgica é o padrão ouro para o manejo terapêutico.

Development of a hyperimmune equine serum therapy for COVID-19 in Argentina

The disease named COVID-19, caused by the SARS-CoV-2 coronavirus, is currently generating a global pandemic. Vaccine development is no doubt the best long-term immunological approach, but in the current epidemiologic and health emergency there is a need for rapid and effective solutions. Convalescent plasma is the only antibody-based therapy available for COVID-19 patients to date. Equine polyclonal antibodies (EpAbs) put forward a sound alternative. The new generation of processed and purified EpAbs containing highly purified F(ab’)2 fragments demonstrated to be safe and well tolerated. EpAbs are easy to manufacture allowing a fast development and scaling up for a treatment. Based on these ideas, we present a new therapeutic product obtained after immunization of horses with the receptor-binding domain of the viral Spike glycoprotein. Our product shows around 50 times more potency in in vitro seroneutralization assays than the average of convalescent plasma. This result may allow us to test the safety and efficacy of this product in a phase 2/3 clinical trial to be conducted in July 2020 in the metropolitan area of Buenos Aires, Argentina.

La enfermedad denominada COVID-19 es causada por el coronavirus SARS-CoV-2 y es actualmente considerada una pandemia a nivel global. El desarrollo de vacunas es sin duda la mejor estrategia a largo plazo, pero debido a la emergencia sanitaria, existe una necesidad urgente de encontrar soluciones rápidas y efectivas para el tratamiento de la enfermedad. Hasta la fecha, el uso de plasma de convalecientes es la única inmunoterapia disponible para pacientes hospitalizados con COVID-19. El uso de anticuerpos policlonales equinos (EpAbs) es otra alternativa terapéutica interesante. La nueva generación de EpAbs incluyen el procesamiento y purificación de los mismos y la obtención de fragmentos F(ab’)2 con alta pureza y un excelente perfil de seguridad en humanos. Los EpAbs son fáciles de producir, lo cual permite el desarrollo rápido y la elaboración a gran escala de un producto terapéutico. En este trabajo mostramos el desarrollo de un suero terapéutico obtenido luego de la inmunización de caballos utilizando el receptor-binding domain de la glicoproteína Spike del virus. Nuestro producto mostró ser alrededor de 50 veces más potente en ensayos de seroneutralización in vitro que el promedio de los plasmas de convalecientes. Estos resultados nos permitirían testear la seguridad y eficacia de nuestro producto en ensayos clínicos de fase 2/3 a realizarse a partir de julio de 2020 en la zona metropolitana de Buenos Aires, Argentina.

Pacientes com carcinoma hepatocelular são favorecidos no atual sistema brasileiro de alocação de fígados para transplante. Análise de riscos competitivos / Hepatocellular carcinoma patients are advantaged in the current brazilian liver transplant allocation system. a competing risk analysis

ABSTRACT BACKGROUND: In Brazil, the Model for End-Stage Liver Disease (MELD) score is used to prioritize patients for deceased donor liver transplantation (DDLT). Patients with hepatocellular carcinoma (HCC) receive standardized MELD exception points to account for their cancer risk of mortality, which is not reflected by their MELD score. OBJECTIVE: To compare DDLT rates between patients with and without HCC in Rio Grande do Sul, the Southernmost state of Brazil. METHODS - We retrospectively studied 825 patients on the liver-transplant waiting list from January 1, 2007, to December 31, 2016, in a transplant center located in Porto Alegre, the capital of Rio Grande do Sul, to compare DDLT rates between those with and without HCC. The time-varying hazard of waiting list/DDLT was estimated, reporting the subhazard ratio (SHR) of waiting list/DDLT/dropout with 95% confidence intervals (CI). The final competing risk model was adjusted for age, MELD score, exception points, and ABO group. RESULTS: Patients with HCC underwent a transplant almost three times faster than patients with a calculated MELD score (SHR 2.64; 95% CI 2.10-3.31; P<0.001). The DDLT rate per 100 person-months was 11.86 for HCC patients vs 3.38 for non-HCC patients. The median time on the waiting list was 5.6 months for patients with HCC and 25 months for patients without HCC. CONCLUSION: Our results demonstrated that, in our center, patients on the waiting list with HCC have a clear advantage over candidates listed with a calculated MELD score.

RESUMO CONTEXTO: No Brasil, o escore MELD (Model for End-Stage Liver Disease) é utilizado para priorizar os pacientes para transplante hepático de doador falecido (THDF). Pacientes com carcinoma hepatocelular (CHC) recebem pontos de exceção padronizados pelo MELD para contrapesar o risco de mortalidade do seu câncer, que não é refletido pelo seu escore MELD. OBJETIVO: Comparar as taxas de THDF entre pacientes com e sem CHC no Rio Grande do Sul, o Estado mais ao sul do Brasil. MÉTODOS: Foram estudados retrospectivamente 825 pacientes em lista de espera de transplante de fígado entre 1 de janeiro de 2007 e 31 de dezembro de 2016 em um centro de transplantes localizado em Porto Alegre, capital do Rio Grande do Sul, para comparação das taxas de THDF entre aqueles com e sem CHC. Foi estimado o risco variável no tempo de lista de espera/THDF, com relato da taxa de sub-risco (SHR) de lista de espera/THDF/desistência com intervalos de confiança (IC) de 95%. O modelo final de risco competitivo foi ajustado para idade, escore MELD, pontos de exceção e grupo ABO. RESULTADOS: Os candidatos com CHC foram submetidos a um transplante quase três vezes mais rápido do que os pacientes com um escore MELD calculado (SHR 2,64; IC 95% 2,10-3,31; P<0,001). A taxa de THDF por 100 pessoas-mês foi de 11,86 para os pacientes com CHC vs 3,38 para os pacientes sem CHC. O tempo mediano de permanência em lista de espera foi de 5,6 meses para os pacientes com CHC e 25 meses para os pacientes sem CHC. CONCLUSÃO: Nossos resultados demonstraram que, em nosso centro, pacientes em lista de espera com CHC têm evidente vantagem sobre candidatos listados com um escore MELD calculado.

Avaliação e seleção de candidatos para transplante hepático: uma perspectiva econômica / Evaluation and selection of candidates for liver transplantation: an economic perspective

ABSTRACT BACKGROUND: Over the next 20 years, the number of patients on the waiting list for liver transplantation (LTx) is expected to increase by 23%, while pre-LTx costs should raise by 83%. OBJECTIVE: To evaluate direct medical costs of the pre-LTx period from the perspective of a tertiary care center. METHODS: The study included 104 adult patients wait-listed for deceased donor LTx between October 2012 and May 2016 whose treatment was fully provided at the study transplant center. Clinical and economic data were obtained from electronic medical records and from a hospital management software. Outcomes of interest and costs of patients on the waiting list were compared through the Kruskal-Wallis test. A generalized linear model with logit link function was used for multivariate analysis. P-values <0.05 were considered statistically significant. RESULTS: The costs of patients who underwent LTx ($8,879.83; 95% CI 6,735.24-11,707.27; P<0.001) or who died while waiting ($6,464.73; 95% CI 3,845.75-10,867.28; P=0.04) were higher than those of patients who were excluded from the list for any reason except death ($4,647.78; 95% CI 2,469.35-8,748.04; P=0.254) or those who remained on the waiting list at the end of follow-up. CONCLUSION: Although protocols of inclusion on the waiting list vary among transplant centers, similar approaches exist and common problems should be addressed. The results of this study may help centers with similar socioeconomic realities adjust their transplant policies.

RESUMO CONTEXTO: Nos próximos 20 anos, estima-se um aumento de 23% no número de pacientes em lista de espera para transplante de fígado (TxF) e de 83% nos custos no período pré-TxF. OBJETIVO: Avaliar os custos médicos diretos do período pré-TxF sob a perspectiva de um centro de atenção terciária. MÉTODOS: Foram incluídos no estudo 104 adultos em lista de espera para TxF, com doador falecido, entre outubro de 2012 e maio de 2016, tratados integralmente no centro transplantador do estudo. Dados clínicos e econômicos foram obtidos do prontuário eletrônico e do software de gestão hospitalar. Os desfechos de interesse e os custos dos pacientes em lista de espera foram comparados através do teste de Kruskal-Wallis. Um modelo linear generalizado com função de ligação logarítmica foi utilizado para a análise multivariável. Valores de P<0.05 foram considerados estatisticamente significativos. RESULTADOS: Os custos com pacientes submetidos a TxF (US$ 8.879,83; IC 95% 6.735,24-11.707,27; P<0,001) ou que morreram enquanto estavam em lista (US$ 6.464,73; IC 95% 3.845,75-10.867,28; P=0,04) foram maiores do que com pacientes excluídos da lista por qualquer motivo, exceto óbito (US$ 4.647,78; IC 95% 2.469,35-8.748,04; P=0,254) ou daqueles que permaneceram em lista de espera ao final do seguimento. CONCLUSÃO: Embora os protocolos de inclusão em lista de espera variem entre os centros transplantadores, existem condutas semelhantes e problemas comuns devem ser considerados. Os resultados deste estudo podem auxiliar os centros com realidades socioeconômicas semelhantes na adequação das suas políticas de transplante.

O custo do transplante hepático adulto em um centro de referência na região sul do Brasil / The cost of adult liver transplantation in a referral center in southern brazil

ABSTRACT BACKGROUND: Liver transplantation (LTx) is the primary and definitive treatment of acute or chronic cases of advanced or end-stage liver disease. Few studies have assessed the actual cost of LTx categorized by hospital unit. OBJECTIVE: To evaluate the cost of LTx categorized by unit specialty within a referral center in southern Brazil. METHODS: We retrospectively reviewed the medical records of 109 patients undergoing LTx between April 2013 and December 2014. Data were collected on demographic characteristics, etiology of liver disease, and severity of liver disease according to the Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores at the time of LTx. The hospital bill was transformed into cost using the full absorption costing method, and the costs were grouped into five categories: Immediate Pretransplant Kit; Specialized Units; Surgical Unit; Intensive Care Unit; and Inpatient Unit. RESULTS: The mean total LTx cost was US$ 17,367. Surgical Unit, Specialized Units, and Intensive Care Unit accounted for 31.9%, 26.4% and 25.3% of the costs, respectively. Multivariate analysis showed that total LTx cost was significantly associated with CTP class C (P=0.001) and occurrence of complications (P=0.002). The following complications contributed to significantly increase the total LTx cost: septic shock (P=0.006), massive blood transfusion (P=0.007), and acute renal failure associated with renal replacement therapy (dialysis) (P=0.005). CONCLUSION: Our results demonstrated that the total cost of LTx is closely related to liver disease severity scores and the development of complications.

RESUMO CONTEXTO: O transplante hepático (TxH) é o principal e definitivo tratamento de casos agudos ou crônicos de doenças hepáticas avançadas ou terminais. Poucos estudos têm avaliado o custo real do TxH categorizado por setores hospitalares. OBJETIVO: Avaliar o custo do TxH categorizado por especialidade da unidade em um centro de referência na região sul do Brasil. MÉTODOS: Analisamos retrospectivamente os prontuários de 109 pacientes submetidos a TxH entre abril de 2013 e dezembro de 2014. Foram coletados dados sobre características demográficas, etiologia da doença hepática e gravidade da doença hepática de acordo com os escores Child-Turcotte-Pugh (CTP) e Model for End-stage Liver Disease (MELD) no momento do TxH. A conta hospitalar foi transformada em custo pelo método de custeio por absorção integral, e os custos foram agrupados em cinco categorias: Kit Pré-Transplante Imediato; Unidades Especializadas; Centro Cirúrgico; Unidade de Terapia Intensiva; e Unidade de Internação. RESULTADOS: O custo médio total do TxH foi de US$ 17.367. O Centro Cirúrgico, as Unidades Especializadas e a Unidade de Terapia Intensiva responderam por 31,9%, 26,4% e 25,3% dos custos, respectivamente. A análise multivariada demonstrou que o custo total do TxH se associou significativamente ao escore CTP classe C (P=0,001) e ao desenvolvimento de intercorrências (P=0,002). As seguintes intercorrências contribuíram para aumentar significativamente o custo do TxH: choque séptico (P=0,006), politransfusão sanguínea (P=0,007) e insuficiência renal aguda associada à terapia renal substitutiva (diálise) (P=0,005). CONCLUSÃO: Nossos resultados demonstraram que o custo total do TxH guarda uma estreita relação com os escores de gravidade da doença hepática e com o desenvolvimento de intercorrências.

Revista Médica Vozandes: 32 años generando evidencia científica / Vozandes Medical Magazine: 32 years generating scientific evidence

Biomedical journals from their beginnings in the seventeenth century have been and they continue to be the most important source of scientific communication and currently represent the main communication channel and Continuing education for health professionals. (1,2) The application of the scientific method gave rise to a growing and fruitful activity: research, which allowed to establish the bases of modern science. The different authors found in biomedical journals the ideal field to contrast opinions, spread your results and generate evidence, necessary actions and important for the researcher as for the scientific community and society as a whole. (1,2) With the improvement of different computer and communication systems, disseminate knowledge scientist and get statistical data of clinical relevance, are now more easy; but at the same time it became A great challenge. How do we verify the quality of the information? (3.4) Currently, the publications of health sciences count with internal quality control mechanisms to select and publish relevant manuscripts.

Tiempo para el trasplante como predictor de la recurrencia del Carcinoma Hepatocelular después del trasplante hepático: Un estudio de cohorte retrospectivo / Time to transplantation as predictor of hepatocellular recurrence after liver transplantation: a retrospective cohort study

Hepatocellular recurrence after liver transplantation (LTx) is a major cause of morbidity and mortality. We aimed to investigate the association between waiting time and hepatocellular carcinoma (HCC) recurrence in patients undergoing LTx for HCC. We studied 250 patients who underwent LTx between 2007-2015. Survival and recurrence curves were calculated according to the Kaplan­Meier method and compared by the log-rank test. Univariate hazard ratios for predictors of post-LTx HCC recurrence were determined by Cox proportional hazards regressions. There were no signifcant differences in recurrence rates when stratifed by wait time to transplant. There were also no signifcant differences in rates of recurrence when the short (< 165 days) and long (> 335 days) wait-time groups were combined, although in this pooled group the 1-year and 5-year cumulative likelihoods of HCC recurrence were higher than in the group with a wait time of 165-334 days. Other predictors of recurrence were microvascular invasion, explant beyond Milan Brazil criteria and tumor diameter ≥ 2.6. This study found no association between wait time to transplantation and recurrence rates in patients who received LTx for HCC and confrmed that variables associated with tumor biology are associated with HCC recurrence.

La recurrencia hepatocelular después del trasplante de hígado (TxH) es una de las principales causas de morbi-mortalidad. Nuestro objetivo fue investigar la asociación entre el tiempo de espera y la recurrencia del carcinoma hepatocelular (CHC) en pacientes sometidos a TxH para CHC. Estudiamos 250 pacientes que se sometieron a TxH entre 2007-2015. Las curvas de supervivencia y recurrencia se calcularon de acuerdo con el método Kaplan-Meier y se compararon mediante logrank test. Las proporciones de riesgo univariados para los predictores de recurrencia posterior al TxH fueron determinadas por las regresiones proporcionales de riesgos de Cox. No hubo diferencias signifcativas en las tasas de recurrencia cuando se estratifcaron por el tiempo de espera para el trasplante. Tampoco hubo diferencias signifcativas en las tasas de recurrencia cuando se combinaron los grupos de tiempo de espera cortos (< 165 días) y largos (> 335 días), aunque en este ultimo grupo las probabilidades acumuladas de recurrencia de HCC de 1 año y 5 años fueron mayores que en el grupo con un tiempo de espera de 165-334 días. Otros predictores de recurrencia fueron la invasión microvascular, nu cumplir con criterios de Milán Brasil y el diámetro del tumor ≥2,6. Este estudio no encontró ninguna asociación entre el tiempo de espera para trasplante y las tasas de recurrencia en pacientes que recibieron LTx para HCC y confrmó que las variables asociadas con la biología tumoral están asociadas con la recurrencia del HCC.

Polisomnografía en la altura: necesitamos usar el sentido común / Polysomnography at high altitude: common sense is needed

The sleep physiology associated to high altitude hypobaric hypoxia is different from that observed at sea level. Normal parameters set by the North American and European consensus for interpretation of polysomnography (PSM) do not apply to high altitude (HA) conditions. This article reviews the PSM studies carried out in children at altitudes >2,500 m and provides a comparison with studies undertaken at sea level. The importance of interpreting PSM taking HA normal values into consideration is highlighted.

La fisiología del sueño, en el entorno de la hipoxia hipobárica que caracteriza a la altura, es diferente de la del nivel del mar. Los parámetros de normalidad de la polisomnografía (PSM) de los consensos norteamericano y europeo no son aplicables en la gran altura. Este artículo revisa los estudios publicados sobre PSM en niños en lugares ubicados por encima de los 2.500 metros y los compara con los del nivel del mar. Se insiste en la necesidad de interpretar la PSM de acuerdo a la normalidad de la altura donde se realizó.

Stendhal syndrome: a clinical and historical overview / Síndrome de Stendhal: una revisión histórica y clínica

ABSTRACT It could be argued that one of the few unifying qualities all human beings share is the ability to appreciate beauty. While the object of beauty may change from one person to another, the awe and the thrill experienced by an enthralled beholder remains the same. Sometimes, this experience can be so overwhelming it can bring someone to the edge of existence. A very rare condition, known as aesthetic syndrome and, more commonly, Stendhal syndrome, entails a clinical phenomenon in which the presence of a beautiful piece of work or architecture causes dysautonomic symptoms such as tachycardia, diaphoresis, chest pains and loss of consciousness. We present an historical and clinical review of this condition.

RESUMO Podría decirse que una de las pocas cualidades comunes a todos los seres humanos es la capacidad de apreciar la belleza. Si bien, es cierto que el objeto considerado como bello cambia de una persona a otra, la admiración y profunda emoción que experimenta un espectador en trance, es la misma. En ocasiones, esta experiencia puede llevar una persona hasta el borde mismo de la existencia. Una condición muy rara, conocida como síndrome estético, y en algunos casos, síndrome de Stendhal, comprende un cuadro clínico en el que la presencia de una magnífica y bella pieza de arte o arquitectura, produce síntomas disautonómicos como taquicardia, diaforesis, dolor torácico y pérdida de la consciencia. Presentamos aquí una revisión clínica e histórica de esta condición.

Hepatolitiasis a propósito de un caso / Hepatolithiasis: with regard to a case

Introducción: La hepatolitiasis es endémica de las regiones del sudeste asiático con una prevalencia que puede llegar hasta el 50%, pero es rara en el mundo occidental. El diagnóstico temprano y una detallada investigación son imprescindibles para el manejo adecuado, que es todo un reto debido a la alta tasa de recurrencia y complicaciones. Caso: Paciente femenina de 24 años de edad sin antecedentes patológicos personales que ingresa a por un cuadro de ictericia de siete meses de evolución. Dolor a nivel de epigastrio e hipocondrio derecho, intermitente. Siete días antes del ingreso inicia un cuadro de coluria y luego cefalea holocraneana. Los exámenes de laboratorio muestran hiperbilirrubinemia a expensas de las dos bilirrubinas (Directa 8.82 mgdl y BI: 6.16 mg/dl), enzimas hepáticas elevadas (AST (SGOT) 138 mg/dl y ALT (SGPT): 116 mg/dl; Fosfatasa-Alkalina: 997 y GGT: 226 mg/dl. Discusión: Las opciones terapéuticas están encaminadas a erradicar o disminuir los factores predisponentes para el desarrollo de colangiocarcinoma incluyéndose en este la recurrencia de la hepatolitiasis. Pese a que el enfoque no quirúrgico es una herramienta diagnóstica y terapéutica no ha demostrado ventajas de su aplicación.

Introduction: Hepatolithiasisis is endemic in regions like Southeast Asia with a prevalence that may reach 50%, but in the Western world it is rare. The proper management requires a precise research and early diagnosis. This is a real challenge due to the high rate of recurrence and complications. Case report: A twenty-four year-old female patient, was admitted witn a six months history of jaundice. She complained of epigastric and upper right quadrant intermitent pain. A week before admission she presented coluria and headache. Lab-tests were the fololowing: Conjugated bilirrubin 8.82 mg/dl, unconjugated bilirrubin 6.16 mg/dl, AST 138mg/dl, ALT 116 mg/dl, alkaline phosphatase 997mg/dl and GGT 226 mg/dl. Discusion: Therapeutic alternatives are focused to erradicate predisposing risk factors of liver carcninoma, one of the is recurrent hepatolitiasis. Though, the surgical approach is a diangostic and therapeutic tool, there is no evidence of its advantages.

Parasites of two coexisting invasive sailfin catfishes (Siluriformes: Loricariidae) in a tropical region of Mexico

Currently many species of Amazon sailfin catfishes (Loricariidae) have been introduced to wild environments outside their native range. There is, however, little knowledge about their role as vectors of parasites that can infect native fish or even humans through its consumption. The aim of the present study was to determine the parasitic fauna of the invasive sailfin catfish species Pterygoplichthys pardalis (leopard pleco) and P. disjunctivus (vermiculated pleco) from freshwater systems in the southeast of Mexico. Four ectoparasite species were found in P. pardalis (1 protozoan: Ichthyophthirius multifiliis ; 2 monogeneans: Urocleidoides vaginoclastrum and Heteropriapulus heterotylus ; 1 digenean: Clinostomum sp.), and only one in Heteropriapulus disjunctivus (H. heterotylus ). No endoparasites were found. Ichthyophthirius multifiliis , U. vaginoclaustrum and Clinostomum sp. , were considered as rare species (prevalence <5%) since they were found in a single individual of P. pardalis . H. heterotylus was the only species shared among both host species and it occurs throughout the year. This monogenean species represents 96% of total parasites recorded in P. pardalis and 100% in P. disjunctivus. Monthly values of prevalence, intensity and abundance of H. heterotylus in both host species showed important intra-annual variations, but not differ significantly between both hosts.(AU)

Actualmente muchas especies de peces conocidos como plecos o peces diablo (Loricariidae) han sido introducidas en ambientes silvestres fuera de su área de distribución natural. Sin embargo, hay poco conocimiento acerca de su papel como vectores de parásitos que puedan infectar a los peces nativos o incluso los seres humanos a través de su consumo. El objetivo del presente estudio fue determinar la fauna parasitaria de las especies de plecos Pterygoplichthys pardalis (pleco leopardo) y P. disjunctivus (pleco vermiculado) en sistemas de agua dulce del sureste de México. Fueron encontradas cuatro especies de ectoparásitos en P. pardalis (1 protozoario: Ichthyophthirius multifiliis ; 2 monogeneos: Urocleidoides vaginoclastrum y Heteropriapulus heterotylus ; 1 digeneo: Clinostomum sp.) y una en P. disjunctivus (H. heterotylus ). No se encontraron endoparásitos. Ichthyophthirius multifiliis, U. vaginoclaustrum y Clinostomum sp. fueron consideradas como especies raras (prevalencia <5%), ya que estuvieron en un solo individuo de P. pardalis . Heteropriapulus heterotylus fue la única especie compartida entre ambas especies de peces y que estuvo presente durante todo el año, y representó el 96% del total de parásitos registrados en P. pardalis y el 100% en P. disjunctivus. La prevalencia, intensidad media y abundancia media de H. heterotylus mostraron importantes variaciones intra-anuales en ambas especies de peces, pero no difirió significativamente entre ambos hospederos.(AU)