Clinical outcomes and complications of single anastomosis duodenal-ileal bypass with sleeve gastrectomy: A 2-year follow-up study in Bogotá, Colombia.

BACKGROUND: The global prevalence of obesity has increased over the past 40 years, and bariatric surgery has proven to be the most effective therapy for long-term weight loss. Its principles are based on modifying the brain-gut axis by altering the gastrointestinal anatomy and affecting the function of gastrointestinal hormones, thereby modifying satiety signals. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) combines both techniques and has become an alternative to gastric bypass and biliopancreatic diversion procedures for treating severe obesity and associated metabolic diseases in selected patients. AIM: To describe the outcomes and complications of SADI-S. METHODS: We retrospectively analyzed the data of patients who underwent SADI-S laparoscopically at the Clínica Reina Sofía in Bogotá, Colombia. This study assessed the therapeutic effectiveness of SADI-S in terms of short-term preoperative clinical characteristics, postoperative complications, comorbidities, nutritional defi-ciencies, and intraoperative complications during a 2-year follow-up. RESULTS: Sixty-one patients with a mean body mass index (BMI) of 50 ± 7.1 kg/m2 underwent laparoscopic SADI-S. The mean operative time and hospital stays were 143.8 ± 42 min and 2.3 ± 0.8 d, respectively. The mean follow-up period was 18 mo, and the mean BMI decreased to 28.5 ± 12.2 kg/m2. The excess BMI loss was 41.8% ± 13.5%, and the weight loss percentage was 81.1% ± 17.0%. Resolution of obesity-related comorbidities, including type 2 diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea, was achieved and defined as complete or partial remission. No intraoperative complications were observed. Short-term complications were observed in four (6.8%) patients. However, larger studies with longer follow-up periods are required to draw definitive conclusions. CONCLUSION: SADI-S has a low intraoperative and postoperative complication rate and is effective for weight loss and improving obesity-related comorbidities, including hypertension, type 2 diabetes mellitus, dyslipidemia, and sleep apnea syndrome.

Caracterización de pacientes con diagnóstico de uveitis en la consulta de reumatología pediátrica, estudio multicéntrico / Uveitis in children assessed in the paediatric rheumatology clinic, a multicentre study

RESUMEN Introducción: La uveitis es la inflamación de la capa media del tracto uveal, la población pediátrica afectada por esta enfermedad tiene riesgo de evolución crónica y pérdida visual permanente. Objetivos: Caracterizar a los niños diagnosticados con uveitis en cinco instituciones ubicadas en Bogotá, evaluados por el servicio de reumatología pediátrica y oftalmología. Materiales y métodos: Estudio de tipo cohorte retrospectiva en niños con diagnóstico de uveitis anterior entre enero del 2015 y enero del 2018, en 5 instituciones de Bogotá. Se llevó a cabo un análisis univariado y bivariado de las características demográficas y clinicas, de las complicaciones, del tratamiento y de la evolución de la enfermedad. Resultados: Se analizaron 91 historias de pacientes, el 51,65% de los cuales fue masculino, en tanto que la edad promedio fue de 8,44 arios (DE = 3,66 arios). Fueron más frecuentes la presentación bilateral (63,74%), la localización intermedia (35,16%) y la panuveítis (25,27%). La etiología idiopática e infecciosa predominó en la uveítis intermedia, mientras que el compromiso bilateral fue mayor en la uveítis intermedia y unilateral que en la uveítis anterior. El compromiso unilateral fue más frecuente en la etiología idiopática (42,1%), en tanto que fue predominantemente bilateral en la etiología autoinmune (60%) (p = 0,005). La uveitis asociada a artritis idiopática juvenil correspondió al 45,2% de las secundarias a autoinmunidad. La uveitis infecciosa fue más frecuente en niños, mientras que en las niñas lo fue la autoinmune. La causa infecciosa más frecuente fue tuberculosis (44%). El 25,7% llegó con alguna complicación al ingreso: sinequias (69,5%), desprendimiento de retina (30,5%) y glaucoma (26%). Al final del seguimiento, el 44% de los pacientes tuvo manejo con corticoide oral, el 64% manejo inmunosupresor no biológico (80% metotrexate) y el 30% terapia biológica. Conclusiones: La uveitis es un proceso inflamatorio intraocular que afecta a la población pediátrica. En este estudio se encontró mayor frecuencia de etiología idiopática, seguida de la autoinmune e infecciosa, como se ha descrito en la literatura. Cerca de la mitad de los pacientes presenta complicaciones, con importantes implicaciones en la calidad de vida.

ABSTRACT Introduction: Uveitis is inflammation of the middle layer of the uveal tract. The paediatric population is at risk of chronic evolution and permanent visual loss. Objectives: To characterize children diagnosed with uveitis in 5 institutions in Bogotá city, evaluated by the paediatric rheumatology and ophthalmology service. Materials and methods: A retrospective cohort study in children with a previous uveitis diagnosis between January 2015 and January 2018 in 5 Institutions of Bogotá. An univariate and bivariate analysis of the demographic, clinical characteristics, complications, treatment, and evolution of the disease was performed. Results: 91 patient histories were analysed. Of the patients, 51.65% were male. The average age was 8.44 years (SD 3.66 years). Bilateral presentation (63.74%), intermediate location (35.16%), and uveitis (25.27%) were more frequent. Idiopathic and infectious aetiology predominated in intermediate uveitis. Bilateral presentation was greater in intermediate uveitis and unilateral in anterior uveitis. Unilateral involvement was more frequent in idiopathic aetiology (42.1%) and bilateral in autoimmune aetiology (60%) (p = .005). Uveitis associated with juvenile idiopathic arthritis, corresponded to 45.2% of those secondary to autoimmunity. Infectious aetiology was more frequent in boys, while autoimmune aetiology was more frequent in girls. The most frequent infectious cause was tuberculosis in 44%. Of the children, 25.7% arrived with some complications on admission: 69.5% synechiae, 30.5% retinal detachment, and 26% glaucoma. Conclusions: Paediatric uveitis is an important disease in children, in our study the most frequent cause was idiopathic followed by an autoimmune disorder and infection. Almost half the patients had associated complications with a major impact on the children's lives.

Effect of neoadjuvant chemotherapy on tumor immune infiltration in breast cancer patients: Systematic review and meta-analysis.

The tumor immune infiltrate has an impact on cancer control and progression, additionally a growing body of evidence has proposed the role of neoadjuvant chemotherapy in modulating the contexture of the tumor immune infiltrate. Here, we performed a systematic review to evaluate the effect of chemotherapy in the immune infiltration of breast cancer tumors. We systematically searched Pubmed/MEDLINE, EMBASE, CENTRAL, and BVS databases with a cutoff date of 11/06/2022. Studies in patients with pathological diagnosis of BC, whose first line of treatment was only NAC, were included. Only published experimental studies that measured tumor immune infiltrate before and after NAC by hematoxylin and eosin (H&E) staining, immunohistochemistry (IHQ), or transcriptome were included. Reviews, studies with animal models and in-vitro models were excluded. Studies in which BC was not the primary tumor or studies with patients who received other types of neoadjuvant therapy were also excluded. The NIH quality assessment tool for before and after studies without control was used. We included 32 articles that evaluated the proximal tumor microenvironment before and after neoadjuvant chemotherapy in 2072 patients who received NAC as first line of treatment and who were evaluated for immune infiltrate in the pre- and post-chemotherapy tumor sample. Results were divided into two major categories immune cells and in-situ expression of immune checkpoints and cytokines. Qualitative synthesis was performed with the 32 articles included, and in nine of them a quantitative analysis was achieved, resulting in six meta-analyses. Despite high heterogeneity among the articles regarding treatment received, type of tumor reported, and techniques used to evaluate immune infiltrate, we found a significant decrease of TILs and FoxP3 expression after neoadjuvant chemotherapy. The study protocol was registered in PROSPERO 2021 (Protocol ID: CRD42021243784) on 6/29/2021.

Respiratory pathogens in children with acute lower respiratory infection detected through multiplex real-time PCR / Patógenos respiratorios en niños con infección respiratoria aguda baja detectados mediante PCR multiplex en tiempo real

Abstract Introduction: Acute respiratory infection in children has a high burden of disease. Detection of multiple micro -organisms through molecular testing of nasopharyngeal swab samples could change the paradigm of a single pathogen being the cause of respiratory disease in children and prove its usefulness in clinical practice. Objective: To characterize the pathogens identified in nasopharyngeal swab samples by means of multiplex realtime polymerase chain reaction (RT-PCR), as well as clinical variables and laboratory findings in children <5 years diagnosed with acute lower respiratory tract infection (ALRTI) and hospitalized in Bogotá D.C., Colombia. Materials and methods: Cross-sectional study conducted in 81 children hospitalized between September 2019 and March 2020 at the Clínica Cafam and in whom nasopharyngeal swab samples were collected for microbiological identification using the Allplex™ multiplex RT-PCR assay. Correlations between the number of pathogens and blood cells and C-reactive protein levels were determined by Spearman's rank correlation coefficient. Results: Patients' mean age was 17.23 months (±14.44), 54.32% were males, and 51.85% were young infants. A total of 149 microorganisms (60.40% viruses) were identified in 63 children (77.78%). Mixed infection and coinfection were reported in 48.15% and 11.11% of children, respectively. Regarding clinical findings, shortness of breath, upper airway obstruction, cough, fever and pharyngitis were the most common clinical signs and/or symptoms in patients with mixed infection (32.97%), coinfection (64.40%), mixed infection (29.78%), and absence of microorganism (22.00%), respectively. A negative correlation was observed between the number of leukocytes and the number of neutrophils and the number of microorganisms detected in the preschoolers group (r=-0.46; p =0.058 and r=-0.51; p =0.033, respectively). Furthermore, a positive correlation was found between monocyte count and the number of microorganisms detected (r=0.53; p =0.0096). Conclusion: Multiplex RT-PCR assay allowed the identification of microorganisms in most children, as well as cases of mixed infection and coinfection in more than half of the sample. In addition, clinical findings in these children were highly heterogeneous as per the assay result..

Resumen Introducción. La infección respiratoria aguda en niños tiene una alta carga de enfermedad. La detección de múltiples microorganismos a través de pruebas moleculares en hisopados nasales podría cambiar el paradigma de patógeno único causal de enfermedad respiratoria en niños y ser de utilidad en la práctica clínica. Objetivo. Caracterizar los patógenos identificados mediante la técnica de reacción en cadena de polimerasa multiplex en tiempo real (RT-PCR) en hisopado nasal, así como las variables clínicas y los resultados de laboratorio en niños <5 años diagnosticados con infección respiratoria aguda baja (IRAB) y hospitalizados en Bogotá D.C., Colombia. Materiales y métodos. Estudio transversal realizado en 81 niños hospitalizados entre septiembre de 2019 y marzo de 2020 en la clínica Cafam y en quienes se hizo hisopado nasal para realizar la identificación microbiològica mediante la prueba RT-PCR multiplex Allplex. Las correlaciones entre el número de patógenos y los niveles de células del hemograma y el nivel de proteína C reactiva se determinaron mediante el coeficiente de correlación de Spearman. Resultados. La edad promedio fue 17.23 meses (±14.44), 54.32% fueron varones y 51.85%, lactantes menores. Se identificaron 149 microorganismos (60.40% virus) en 63 niños (77.78%). Hubo infección mixta en el 48.15% y coinfección en 11.11% de los niños. Respecto a los hallazgos clínicos, la dificultad respiratoria, la obstrucción de la vía respiratoria alta, la tos, la fiebre y la faringitis fueron más comunes en los casos de infección mixta (32.97%), ausencia de microorganismo (16.00%), coinfección (64.40%), infección mixta (29.78%) y ausencia de microorganismo (22.00%), respectivamente. Se observó una correlación negativa entre el número de leucocitos y neutrófilos y el número de microorganismos detectados en preescolares (r=-0.46; p=0.058 y r=-0.51; p=0.033) y una positiva entre el recuento de monocitos y el número de microorganismos detectados (r=0.53; p =0.0096). Conclusión. La prueba RT-PCR multiplex permitió identificar microorganismos en la mayoría de niños, así como casos de infección mixta y coinfección en más de la mitad de la muestra. Además, los hallazgos clínicos fueron altamente heterogéneos entre los niños según el resultado de la prueba.

Human immune response to SARS-CoV-2: What is known? A scoping review / Respuesta inmune humana al SARS-CoV-2: ¿Qué se conoce? Una scoping review

Monitoring literature on the broad spectrum of the human immune response to SARS-CoV-2 is important to understand the mechanisms and progression of COVID-19. The present study undertakes a scoping review of the literature on human immune response to SARS-CoV-2 to determine the characteristics of innate and adaptive responses, as well as biomarkers and cells that play a role in the development of the infection. We searched papers in MEDLINE/PUBMED and EMBASE databases published since December 1st 2019 to to April 9th 2020 from which we selected 56 for this study. We found that the immune response is characterized by high levels of acute phase reactants, neutrophilia, low levels of NKs and eosinophils, lymphopenia, cytokine storm syndrome, exhausted T cells, impaired cytotoxic response, inadequate helper response and production of specific antibodies; concluding that immune dysregulation correlates with disease severity and high mortality.

El seguimiento de la literatura sobre la respuesta inmune humana al SARS-CoV-2 es importante para comprender los mecanismos y la progresión de COVID-19. En el presente estudio se realizó un Scoping Review de la literatura sobre la respuesta inmune humana al SARS-CoV-2 para determinar las características de la respuesta inmune innata y adaptativa, así como biomarcadores y células que juegan un papel en el desarrollo de la infección. Buscamos artículos en las bases de datos MEDLINE / PUBMED y EMBASE publicados desde el 1 de diciembre de 2019 hasta el 9 de abril de 2020, de los cuales seleccionamos 56 publicaciones para este estudio. Encontramos que la respuesta inmune se caracteriza por altos niveles de reactantes de fase aguda, neutrofilia, bajos niveles de NKs y eosinófilos, linfopenia, síndrome de tormenta de citoquinas, linfocitos T agotados, respuesta citotóxica alterada, respuesta T helper inadecuada y producción de anticuerpos específicos. En conclusión, el desequilibrio inmune se correlaciona con la severidad y la mortalidad de la enfermedad.

Immunosenescence Study of T Cells: A Systematic Review.

Background: Aging is accompanied by alterations in immune response which leads to increased susceptibility to infectious diseases, cancer, autoimmunity, and inflammatory disorders. This decline in immune function is termed as immunosenescence; however, the mechanisms are not fully elucidated. Experimental approaches of adaptive immunity, particularly for T cells, have been the main focus of immunosenescence research. This systematic review evaluates and discusses T cell markers implicated in immunosenescence. Objective: To determine the best flow cytometry markers of circulating T cells associated with immunosenescence. Methods: We systematically queried PubMed, MEDLINE, EBSCO, and BVS databases for original articles focused on two age groups of healthy humans: 18-44 (young adults) and >60 (older adults) years. In accordance with the Cochrane methodology, we synthesized data through qualitative descriptions and quantitative random effects meta-analysis due to extensive heterogeneity. Results: A total of 36 studies conducted in the last 20 years were included for the qualitative analysis and four out of these studies were used to perform the meta-analysis. A significant decrease in naïve T cell subset was observed in older adults compared to young adults. Primary markers used to identify senescent cells were loss of CD28 and increased expression of CD57 and KLRG1 in terminally-differentiated memory T cell subset in older adults. Moreover, we observed an increase in proinflammatory cytokines and decrease in telomere length in old adult T cells. It was not possible to perform quantitative synthesis on cell markers, cytokines, and telomere length because of the significant variations between the groups, which is attributed to differences in protocols and unreported measurements, thus generating a high risk of bias. Conclusions: Heterogeneity among studies in terms of data report, measurement techniques and high risk of bias were major impediments for performing a robust statistical analysis that could aid the identification of eligible flow cytometry markers of immunosenescence phenotype in T cells.