Tuberculosis miliar en pacientes en tratamiento con adalimumab, una asociación no tan frecuente en pediatría / Miliary tuberculosis in patients treated with adalimumab, an association not so frequent in pediatrics

Los antagonistas del Factor de Necrosis Tumoral-α, son medicamentos que en los últimos años han tenido un incremento de su uso en pacientes con condiciones inflamatorias inmunomediadas en pediatría, como la Artritis Idiopática Juvenil y la Enfermedad Inflamatoria Intestinal. El uso de estos medicamentos en adultos tiene una fuerte asociación con la primoinfección o reactivación por Mycobacterium tuberculosis, pero en niños la evidencia es limitada. Se presentan 2 casos de pacientes tratados con adalimumab, quienes, a pesar de un buen control de su enfermedad y una prueba de tuberculina negativa al inicio de la terapia, desarrollaron tuberculosis miliar en el seguimiento, con importantes implicaciones para su salud. El tamizaje de tuberculosis latente con tuberculina/IGRAS (Interferón-γ release assays, por sus siglas en inglés) y un alto índice de sospecha de tuberculosis, son las herramientas disponibles para una adecuada identificación de la tuberculosis en pacientes que reciben crónicamente estas terapias.

Tumor Necrosis Factor-α antagonists are drugs that in recent years have seen an increase in their use in patients with immune-mediated inflammatory conditions in pediatrics such as Juvenile Idiopathic Arthritis and Inflammatory Bowel Disease. The use of these drugs in adults has a strong association with primary infection or reactivation by mycobacterium tuberculosis, but in children the evidence is limited. We present 2 cases of patients treated with adalimumab who, despite good control of their disease and a negative tuberculin test at the beginning of therapy, developed miliary tuberculosis during follow-up with important implications for their health. Screening for latent tuberculosis with tuberculin / IGRAS (Interferón-γ release assays) and a high index of suspicion for tuberculosis are the tools available for an adequate identification of tuberculosis in patients who receive these therapies chronically.

Caracterización epidemiológica de las infecciones respiratorias agudas graves. Granma, marzo-mayo de 2020 / Epidemiological characterization of severe acute respiratory infections. Granma, March-May 2020 / Caracterização epidemiológica de infecções respiratórias agudas graves. Granma, março a maio de 2020

RESUMEN Existen pocos estudios acerca de la epidemiología de las infecciones respiratorias agudas graves tanto en la literatura mundial como en el país, los estudios se centran fundamentalmente en la epidemiologia y comportamiento de las IRA sin especificar que ocurre con las formas graves. Con la presente publicación se pretende caracterizar el comportamiento de las infecciones respiratorias agudas graves en la provincia Granma, marzo-mayo 2020. Para ello se realizó un estudio descriptivo, retrospectivo y transversal, teniendo en cuenta las siguientes variables: grupos de edad, sexo, municipio de residencia, antecedentes patológicos personales y diagnóstico. Obteniendo como resultados que el periodo que se describe resultaron hospitalizados 175 pacientes con IRAG. La tasa de incidencia de la provincia fue de 21,4 por 100 mil habitantes. Se notificaron casos en todos los municipios, el 62,9 % de los casos de IRAG se registraron en hombres y los de 65 y más años representaron el mayor porcentaje de casos. Se concluye que Bayamo el municipio de mayor tasa de incidencia, predominó el sexo masculino, las edades de 65 y más años, la hipertensión arterial fue la comorbilidad más referida y dentro de las formas clínicas la bronconeumonía.

ABSTRACT There are few studies on the epidemiology of severe acute respiratory infections in both world literature and the country, studies focus primarily on the epidemiology and behavior of undified IRAs that occur with severe forms. This publication is intended to characterize the behavior of severe acute respiratory infections in Granma province, March-May 2020. For this purpose, a descriptive, retrospective and transversal study was carried out, taking into account the following variables: age groups, sex, municipality of residence, personal pathological history and diagnosis. Obtaining as results that the period described was hospitalized 175 patients with IRAG. The incidence rate of the province was 21.4 per 100 thousand inhabitants. Cases were reported in all municipalities, 62.9% of IRAG cases were recorded in men and those in 65 and over accounted for the highest percentage of cases. It is concluded that Bayamo, the municipality with the highest incidence rate, dominated the male sex, the ages of 65 and older, high blood pressure was the most referred comorability and within the clinical forms bronchopneummony.

RESUMO Há poucos estudos sobre a epidemiologia de infecções respiratórias agudas graves tanto na literatura mundial quanto no país, os estudos focam principalmente na epidemiologia e comportamento de IRAs indignos que ocorrem com formas graves. Esta publicação pretende caracterizar o comportamento de infecções respiratórias agudas graves na província de Granma, março a maio de 2020. Para isso, foi realizado um estudo descritivo, retrospectivo e transversal, levando-se em conta as seguintes variáveis: faixas etárias, sexo, município de residência, histórico patológico pessoal e diagnóstico. Obtendo como resultados que o período descrito foi hospitalizado 175 pacientes com IRAG. A taxa de incidência da província foi de 21,4 por 100 mil habitantes. Os casos foram notificados em todos os municípios, 62,9% dos casos de IRAG foram registrados em homens e aqueles em 65 anos ou mais representaram o maior percentual de casos. Conclui-se que Bayamo, município com maior taxa de incidência, dominou o sexo masculino, com idades a 65 anos ou mais, a pressão alta foi a mais referida comorability e dentro das formas clínicas de broncopneummonia.

Comportamiento clínico epidemiológico de la COVID-19. Granma, marzo-mayo de 2020 / Clinical epidemiological behavior of COVID-19. Granma, March-May 2020 / Comportamento epidemiológico clínico do COVID-19. Granma, março a maio de 2020

RESUMEN El siglo XXI se ha caracterizado desde sus inicios por una problemática de salud que ha afectado al mundo y Cuba no ha podido escapar de esta situación. A fines de 2019, se identificó un nuevo coronavirus, denominado coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2), no identificado anteriormente en seres humanos, como la causa del COVID-19.Con el objetivo de caracterizar el comportamiento de los casos deCOVID-19 en la provincia Granma, se realizó un estudio descriptivo, retrospectivo y transversal. Se presenta a los 13 casos confirmados de la COVID-19 en la provincia Granma, entre el 11 de marzo de 2020 y 31 de mayo de 2020.Desde el comienzo de la Fase pre-epidémica en Cuba hasta el 31 de mayo de 2020 en la provincia Granma, se habían procesado mil 785 muestras de PCR en tiempo real, resultando positivas el 0,72 %. En el periodo que se describe la tasa de incidencia de la provincia fue de 1,6 por 100 mil habitantes. Predominó ligeramente el sexo masculino con 53,8 %, el grupo de edad con mayor incidencia fue el 20 a 49 años con seis casos (45,1 %), la mayoría correspondió a casos que refirieron como fuente de infección el contacto con extranjeros el 54,0 %. Granma en el periodo que se analiza es la provincia con menor riesgo de enfermar por COVID-19 en Cuba. En la serie predominaron: sexo masculino, grupo de edad 20-49 años, fuente de infección contacto con extranjeros y como síntoma, tos seca.

ABSTRACT The 21st century has been characterized from its beginnings by a health problem that has affected the world and Cuba has not been able to escape from this situation. In late 2019, a new coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously unidentified in humans, was identified as the cause of COVID-19, with the aim of characterizing the behavior of in the cases of COVID-19 in the Granma province, a descriptive, retrospective and cross-sectional study was carried out. It is presented to the 13 confirmed cases of COVID-19 in the Granma province, between March 11, 2020 and May 31, 2020, from the beginning of the pre-epidemic phase in Cuba until May 31, 2020 in in the Granma province, 1,785 real-time PCR samples had been processed, with 0.72% being positive. In the period described, the incidence rate of the province was 1.6 per 100,000 inhabitants. The male sex predominated slightly with 53.8%, the age group with the highest incidence was 20 to 49 years with six cases (45.1%), the majority corresponded to cases that referred contact with foreigners as the source of infection the 54.0%. Granma in the period analyzed is the province with the lowest risk of becoming ill with COVID-19 in Cuba. The series was dominated by: male sex, age group 20-49 years, source of infection contact with foreigners and as a symptom, dry cough.

RESUMO O século XXI foi caracterizado desde o início por um problema de saúde que afetou o mundo e Cuba não conseguiu escapar dessa situação. No final de 2019, um novo coronavírus, chamado síndrome respiratória aguda grave coronavírus 2 (SARS-CoV-2), anteriormente não identificado em seres humanos, foi identificado como a causa do COVID-19, com o objetivo de caracterizar o comportamento de Nos casos do COVID-19 na província de Granma, foi realizado um estudo descritivo, retrospectivo e transversal. É apresentado aos 13 casos confirmados de COVID-19 na província de Granma, entre 11 de março de 2020 e 31 de maio de 2020, desde o início da fase pré-epidêmica em Cuba até 31 de maio de 2020 em Na província de Granma, 1.785 amostras de PCR em tempo real foram processadas, sendo 0,72% positivo. No período descrito, a taxa de incidência da província foi de 1,6 por 100.000 habitantes. O sexo masculino predominou levemente com 53,8%, a faixa etária de maior incidência foi de 20 a 49 anos com seis casos (45,1%), a maioria correspondeu a casos que referiram o contato com estrangeiros como fonte de infecção. 54,0%. Granma, no período analisado, é a província com o menor risco de adoecer com o COVID-19 em Cuba. A série foi dominada por: sexo masculino, faixa etária 20-49 anos, fonte de contato de infecção com estrangeiros e, como sintoma, tosse seca.

Treatment planning considerations for 125I eye plaque brachytherapy.

Effective cancer brachytherapy requires a treatment plan that delivers high-dose to tumor, while minimizing the dose to critical normal tissues. Therefore, an accurate knowledge of the sources and magnitude of the techniques is essential for producing robust and well optimized-plans. The purpose of this technical note is to establish general procedures and strategies for optimization and customization of the plaques loaded with radioactive seeds, particularly focusing on the definition of useful tactics to limit high doses to organs at risk and adapt the treatment time to the necessity of institution.

Conocimiento y actitudes de los médicos sobre limitación de esfuerzo terapéutico / Knowledge and attitudes of physicians about limitation of therapeutic effort

RESUMEN Introducción: uno de los problemas bioéticos frecuentes es la limitación del esfuerzo terapéutico, la adecuación o la proporcionalidad del tratamiento para evitar la obstinación y la inutilidad. Objetivo: evaluar el conocimiento sobre la limitación del esfuerzo terapéutico en médicos de un hospital universitario. Método: se realizó una investigación cualitativa, de tipo evaluativa, empleando variables y técnicas cualitativas de recolección de la información con el propósito de evaluar el conocimiento sobre la limitación del esfuerzo terapéutico en médicos del hospital general universitario Carlos Manuel de Céspedes de Bayamo, provincia Granma; en el periodo comprendido desde el primero de abril al 25 de septiembre de 2018. Resultados: se encuestaron 124 profesionales médicos del centro para (21,7%). La mayoría de los encuestados (77%) que conocían el término de limitación del esfuerzo terapéutico. El 24,2% de los encuestados no están a favor de la aplicación dicho procedimiento. La validez de construcción de la escala, permitió clasificar a los encuestados sobre el conocimiento de la limitación del esfuerzo terapéutico de formas adecuada. Conclusiones: la aplicación de la encuesta fue útil para evaluar el nivel de conocimiento de los médicos sobre la limitación del esfuerzo terapéutico, demostrándose que existen limitaciones importantes.

ABSTRACT Introduction: one of the frequent bioethical problems is the limitation of the therapeutic effort, the adequacy or the proportionality of the treatment to avoid obstinacy and futility. Objective: to evaluate the knowledge about the limitation of the therapeutic effort in doctors of a university hospital. Method: qualitative, evaluative-type research was carried out, using variables and qualitative techniques of information collection with the purpose of evaluating the knowledge about the capacity of the therapeutic physician and the doctors in the general university hospital Carlos Manuel de Céspedes of Bayamo, province Granma; in the period from April 1 to September 25, 2018. Results: 124 medical professionals from the center were surveyed for (21.7%). The majority of the respondents (77%) knew the term limitation of the therapeutic effort. 24.2% of the respondents are not in favor of the application of said procedure. The validity of the construction of the escalation, classifies the respondents on the knowledge of the limitation of the therapeutic effort in appropriate ways. Conclusions: the application of the survey was useful to evaluate the level of knowledge of physicians on the limitation of therapeutic effort, demonstrating that there are important limitations.

Programmed cell death ligand-1 expression in tumor and immune cells is associated with better patient outcome and decreased tumor-infiltrating lymphocytes in uveal melanoma.

Programmed cell death-1/ligand (PD-1/PD-L1) interaction negatively regulates T cell activity. PD-L1 expression in tumor cells, antigen-presenting cells, and lymphocytes of the tumor microenvironment is associated with response to treatment with PD-1/PD-L1 inhibitors, but there is still debate on the cutoff value that correlates with responders. In uveal melanoma (UM), 40% of patients will develop liver metastases and, amongst them, 90% will succumb to their disease. The aim of this study was to analyze PD-L1 expression as a prognostic marker and as a possible therapeutic target for UM. Sixty-seven enucleated eyes from UM patients with relevant clinical information were analyzed. Univariate and multivariate analysis were used to evaluate association of PD-L1 with survival. PD-L1 expression was positive relatively to tumor cells, immune cells, and the tumor and tumor-infiltrating immune cell group scoring in 46, 34 and 55% of the cases, respectively. On univariate analysis, tumor cells and the tumor and tumor-infiltrating immune cell group PD-L1 expression was associated with a longer metastasis-free survival (P = 0.04 and P = 0.007). However, on multivariate analysis, only the tumor and tumor-infiltrating immune cell group positivity was associated with longer metastasis-free survival (P = 0.01). Furthermore, tumor cells and the tumor and tumor-infiltrating immune cell group PD-L1 expression was associated with decreased tumor-infiltrating lymphocytes (P = 0.02). PD-L1, when expressed in uveal melanoma, is associated with better patient outcome and decreased tumor-infiltrating lymphocytes. These results support the consideration of anti-PD-1/PD-L1 therapy in uveal melanoma. To determine the best cutoff value, further studies from patients enrolled in clinical trials treated with PD-1/PD-L1 inhibitors are necessary.

Iris color: validation of a new classification and distribution in a Spanish population-based sample.

PURPOSE: To design and validate a standard, simple, and reliable iris color classification and to study its distribution in a Spanish population. Iris color has a geographic distribution and has been correlated with different ocular diseases. However, there is no standard and validated iris color classification allowing comparison among different studies. METHODS: Classification was made in three grades (blue-gray, hazel-green, brown) and was validated by 3 independent readers. Initially, a preliminary study was made in 50 iris photographs to detect technical hitches. Afterwards, based on this procedure, 221 iris photographs were graded. RESULTS: Measures of interobserver reliability were 0.786 by kappa index with an agreement of 89.6%.Iris color distribution in the Spanish cohort was blue-grey 16.29%, hazel-green 55.2%, and brown 28.5%. CONCLUSIONS: This classification is simple, reliable, and easy to use in clinical research and by ophthalmologists or generalists in practice. The Spanish cohort from this study shows a different iris color distribution from those previously published in other countries.

Grupo racial e cirrose hepática / Hepatic cirrhosis and race

A característica racial de 52 cirróticos, comprovados em exame anatomopatológico na Faculdade de Medicina do Triângulo Mineiro, foi pesquisada. O controle de cada par era do mesmo sexo e de idade próxima. Enquanto 67,3% dos cirróticos eram brancos, no grupo-controle correspondem a 48,1% (p < 0,05). Quando os dois grupos de pacientes foram divididos em relaçäo a presença ou näo de Chagas, a associaçäo manteve-se somente no grupo näo -chagásico (p < 0,02), supostamente mais caucasóide. A concentraçäo de brancos cirróticos foi discutida como efeito da possível influência do componente genético