A Comparison of Multiple Odor Source Localization Algorithms.

There are two primary algorithms for autonomous multiple odor source localization (MOSL) in an environment with turbulent fluid flow: Independent Posteriors (IP) and Dempster-Shafer (DS) theory algorithms. Both of these algorithms use a form of occupancy grid mapping to map the probability that a given location is a source. They have potential applications to assist in locating emitting sources using mobile point sensors. However, the performance and limitations of these two algorithms is currently unknown, and a better understanding of their effectiveness under various conditions is required prior to application. To address this knowledge gap, we tested the response of both algorithms to different environmental and odor search parameters. The localization performance of the algorithms was measured using the earth mover's distance. Results indicate that the IP algorithm outperformed the DS theory algorithm by minimizing source attribution in locations where there were no sources, while correctly identifying source locations. The DS theory algorithm also identified actual sources correctly but incorrectly attributed emissions to many locations where there were no sources. These results suggest that the IP algorithm offers a more appropriate approach for solving the MOSL problem in environments with turbulent fluid flow.

A non-coding RNASEH1 gene variant associates with type 1 diabetes and interacts with HLA tagSNPs in families from Colombia.

OBJECTIVES: RNASEH1 gene has recently been associated with type 1 diabetes (T1D) in Colombia. The purpose of this study was to fine mapping the putative functional variant in RNASEH1 and testing its interaction with HLA tagSNPs. METHODS: Two-hundred nuclear families with T1D were included in this study. Probands were tested for GAD65 and IA-2 autoantibodies. Genotyping was performed using 20 coding tagSNPs uncovered through Sanger sequencing (N = 96), in addition to 23 tagSNPs chosen from 1000genomes to cover the extent of the gene region. Also, 45 tagSNPs for classic HLA alleles associated with T1D were also genotyped. The transmission disequilibrium test (TDT) was used to test for association and a multiple testing correction was made using permutation. Interaction between RNASEH1 variants and HLA was evaluated by means of the M-TDT test. RESULTS: We identified 20 variants (15 were novel) in the 96 patients sequenced. None of these variants were in linkage disequilibrium. In total, 43 RNASEH1 variants were genotyped in the 200 families. Association between T1D and rs7607888 was identified (P = .002). Haplotype analysis involving rs7607888 variant revealed even stronger association with T1D (most significative P = .0003). HLA tagSNPs displayed stronger associations (OR = 6.39, 95% CI = 4.33-9.44, P-value = 9.74E-28). Finally, we found several statistically significant interactions of HLA variants with rs7607888 (P-value ranged from 8.77E-04 to 5.33E-12). CONCLUSION: Our results verify the association of rs7607888 in RNASEH1 gene with T1D. It is also shown in the interaction between RNASEH1 and HLA for conveying risk to T1D in Northwest Colombia. Work is underway aiming to identify the actual classic HLA alleles associated with the tagSNPs tested here.

Surface contamination in the operating room: use of adenosine triphosphate monitoring.

PURPOSE: We prospectively investigated contamination of high-contact surfaces in the operating room (OR) using adenosine triphosphate (ATP) monitoring. We tested whether contamination would increase from morning (AM) to afternoon (PM), despite cleaning between cases. Second, we compared the degree of OR contamination to non-OR control sites. METHODS: ORs with high case volumes were selected for the study. Ten sites in each OR were swabbed using the AccuPoint® HC ATP Sanitation Monitoring device, which provided a numerical measure of contamination (relative light units, RLUs). According to the manufacturer, surfaces are considered clean at ≤ 400 RLUs. AM measurements were taken before the start of surgical cases and PM measurements were taken after cases were completed. RESULTS: Eighty morning and 70 afternoon samples were obtained from 8 ORs. Apart from the OR floor, laryngoscope handles had the highest level of morning contamination (1204 RLUs, interquartile range 345, 2603), with 75% of AM samples and 100% of PM samples exceeding 400 RLUs. This contamination was comparable to hospital toilet seats (87% of samples exceeding 400 RLUs). No sites showed statistically significant increases in contamination from AM to PM. CONCLUSION: Apart from the OR floors, laryngoscope handles emerged as a key OR site where improved cleaning practices may reduce cross-contamination risk. While some sites showed increased contamination over the course of the day, none of these met statistical significance thereby offering tentative evidence that current cleaning practices during case turnover are effective for most sites.

Production and purification of chimeric HBc virus-like particles carrying influenza virus LAH domain as vaccine candidates.

BACKGROUND: The lack of a universal influenza vaccine is a global health problem. Interest is now focused on structurally conserved protein domains capable of eliciting protection against a broad range of influenza virus strains. The long alpha helix (LAH) is an attractive vaccine component since it is one of the most conserved influenza hemagglutinin (HA) stalk regions. For an improved immune response, the LAH domain from H3N2 strain has been incorporated into virus-like particles (VLPs) derived from hepatitis B virus core protein (HBc) using recently developed tandem core technology. RESULTS: Fermentation conditions for recombinant HBc-LAH were established in yeast Pichia pastoris and a rapid and efficient purification method for chimeric VLPs was developed to match the requirements for industrial scale-up. Purified VLPs induced strong antibody responses against both group 1 and group 2 HA proteins in mice. CONCLUSION: Our results indicate that the tandem core technology is a useful tool for incorporation of highly hydrophobic LAH domain into HBc VLPs. Chimeric VLPs can be successfully produced in bioreactor using yeast expression system. Immunologic data indicate that HBc VLPs carrying the LAH antigen represent a promising universal influenza vaccine component.

Type 2 diabetes in latin America: recommendations on the flash glucose monitoring system.

OBJECTIVE: To establish recommendations through the consensus of a Latin American experts panel on the use of the flash glucose monitoring system (fCGM) in people living with type 2 diabetes mellitus (T2DM) regarding the benefits and challenges of using the fCGM. METHODS: An executive committee of experts was created, comprised by a panel of fifteen physicians, including endocrinologists and internal medicine physicians, with expertise in management of adult patients with T2DM. The experts were from various countries: Colombia, Chile, Peru, Mexico, Argentina, and Brazil. The modified Delphi method was used, considering a consensus level of at least 80% of the participants. A seventeen-item instrument was developed to establish recommendations on the use of fCGM in patients with T2DM in Latin American. RESULTS: The number of glucose scans recommended per day with the fCGM for patients managed with oral antidiabetic drugs or basal insulin was a median of 6 scans per day, and for those managed with multiple insulin doses, a median of 10 scans per day was recommended. Additionally, a holistic and individualized management approach was recommended, taking into account new treatment directions and identifying patients who would benefit from the use of the fCGM. CONCLUSION: Continuous use of the fCGM is recommended for people living with T2DM, regardless of their type of treatment. These metrics must be evaluated individually for each patient profile.

Minimally Invasive Treatment of Facet Osteoarthritis Pain in Spine: A Clinical Approach Evaluating Cryotherapy.

BACKGROUND: Chronic pain management remains a challenging aspect of neurosurgical care, with facet arthrosis being a significant contributor to the global burden of low back pain. This study evaluates the effectiveness of cryotherapy as a minimally invasive treatment for patients with facet arthrosis. By focusing on reducing drug dependency and pain intensity, the research aims to contribute to the evolving field of pain management techniques, offering an alternative to traditional pain management strategies. METHODS: Through a retrospective longitudinal analysis of patients with facet osteoarthritis treated via cryotherapy between 2013 and 2023, we evaluated the impact on medication usage and pain levels, utilizing the Visual Analog Scale for pre- and posttreatment comparisons. RESULTS: The study encompassed 118 subjects, revealing significant pain alleviation, with Visual Analog Scale scores plummeting from 9.0 initially to 2.0 after treatment. Additionally, 67 patients (56.78%) reported decreased medication consumption. These outcomes underscore cryotherapy's potential as a pivotal tool in chronic pain management. CONCLUSIONS: The findings illuminate cryotherapy's efficacy in diminishing pain and curtailing medication dependency among patients with facet arthrosis. This study reaffirms cryotherapy's role in pain management and propels the discourse on nontraditional therapeutic avenues, highlighting the urgent need for personalized and innovative treatment frameworks.

ReLA, a local alignment search tool for the identification of distal and proximal gene regulatory regions and their conserved transcription factor binding sites.

MOTIVATION: The prediction and annotation of the genomic regions involved in gene expression has been largely explored. Most of the energy has been devoted to the development of approaches that detect transcription start sites, leaving the identification of regulatory regions and their functional transcription factor binding sites (TFBSs) largely unexplored and with important quantitative and qualitative methodological gaps. RESULTS: We have developed ReLA (for REgulatory region Local Alignment tool), a unique tool optimized with the Smith-Waterman algorithm that allows local searches of conserved TFBS clusters and the detection of regulatory regions proximal to genes and enhancer regions. ReLA's performance shows specificities of 81 and 50% when tested on experimentally validated proximal regulatory regions and enhancers, respectively.

Disparities in Telehealth use During the COVID-19 Pandemic.

The coronavirus 2019 pandemic led to rapid expansion of outpatient telemedicine. We sought to characterize patient factors influencing outpatient teleneurology utilization at an urban safety-net hospital. We reviewed all neurology televisits scheduled between June 15, 2020 to April 15, 2021. We used the chi-squared test and multivariate logistic regression to characterize patient demographic factors associated with televisit completion and video use. Of 8875 scheduled televisit encounters, 7530 were completed successfully, 44% via video. Non-English speaking patients, Black patients, Latinx patients, and those with a zip code-linked annual income less than $50,000 were less likely to successfully complete a scheduled televisit. The same demographic groups other than Latinx ethnicity were also less likely to use the video option. Our study found unequal telehealth utilization based on patients' demographic factors. Currently declining telemedicine reimbursement rates asymmetrically affect audio-only visits, which may limit telehealth access for vulnerable patient populations.

Understanding the #longCOVID and #longhaulers Conversation on Twitter: Multimethod Study.

BACKGROUND: The scientific community is just beginning to uncover the potential long-term effects of COVID-19, and one way to start gathering information is by examining the present discourse on the topic. The conversation about long COVID-19 on Twitter provides insight into related public perception and personal experiences. OBJECTIVE: The aim of this study was to investigate the #longCOVID and #longhaulers conversations on Twitter by examining the combined effects of topic discussion and social network analysis for discovery on long COVID-19. METHODS: A multipronged approach was used to analyze data (N=2500 records from Twitter) about long COVID-19 and from people experiencing long COVID-19. A text analysis was performed by both human coders and Netlytic, a cloud-based text and social networks analyzer. The social network analysis generated Name and Chain networks that showed connections and interactions between Twitter users. RESULTS: Among the 2010 tweets about long COVID-19 and 490 tweets by COVID-19 long haulers, 30,923 and 7817 unique words were found, respectively. For both conversation types, "#longcovid" and "covid" were the most frequently mentioned words; however, through visually inspecting the data, words relevant to having long COVID-19 (ie, symptoms, fatigue, pain) were more prominent in tweets by COVID-19 long haulers. When discussing long COVID-19, the most prominent frames were "support" (1090/1931, 56.45%) and "research" (435/1931, 22.53%). In COVID-19 long haulers conversations, "symptoms" (297/483, 61.5%) and "building a community" (152/483, 31.5%) were the most prominent frames. The social network analysis revealed that for both tweets about long COVID-19 and tweets by COVID-19 long haulers, networks are highly decentralized, fragmented, and loosely connected. CONCLUSIONS: This study provides a glimpse into the ways long COVID-19 is framed by social network users. Understanding these perspectives may help generate future patient-centered research questions.

Associations of physical activity with gut microbiota in pre-adolescent children.

PURPOSE: To determine whether physical activity (PA), primarily the recommended 60 minutes of moderate-to-vigorous PA, is associated with gut bacterial microbiota in 10-year-old children. METHODS: The Block Physical Activity Screener, which provides minutes/day PA variables, was used to determine whether the child met the PA recommendations. 16S rRNA sequencing was performed on stool samples from the children to profile the composition of their gut bacterial microbiota. Differences in alpha diversity metrics (richness, Pielou's evenness, and Faith's phylogenetic diversity) by PA were determined using linear regression, whereas beta diversity (unweighted and weighted UniFrac) relationships were assessed using PERMANOVA. Taxon relative abundance differentials were determined using DESeq2. RESULTS: The analytic sample included 321 children with both PA and 16S rRNA sequencing data (mean age [SD] =10.2 [0.8] years; 54.2% male; 62.9% African American), where 189 (58.9%) met the PA recommendations. After adjusting for covariates, meeting the PA recommendations as well as minutes/day PA variables were not significantly associated with gut richness, evenness, or diversity (p ≥ 0.19). However, meeting the PA recommendations (weighted UniFrac R2 = 0.014, p = 0.001) was significantly associated with distinct gut bacterial composition. These compositional differences were partly characterized by increased abundance of Megamonas and Anaerovorax as well as specific Christensenellaceae_R-7_group taxa in children with higher PA. CONCLUSION: Children who met the recommendations of PA had altered gut microbiota compositions. Whether this translates to a reduced risk of obesity or associated metabolic diseases is still unclear.

Epitope Presentation of Dengue Viral Envelope Glycoprotein Domain III on Hepatitis B Core Protein Virus-Like Particles Produced in Nicotiana benthamiana.

Dengue fever is currently ranked as the top emerging tropical disease, driven by increased global travel, urbanization, and poor hygiene conditions as well as global warming effects which facilitate the spread of Aedes mosquitoes beyond their current distribution. Today, more than 100 countries are affected most of which are tropical Asian and Latin American nations with limited access to medical care. Hence, the development of a dengue vaccine that is dually cost-effective and able to confer a comprehensive protection is ultimately needed. In this study, a consensus sequence of the antigenic dengue viral glycoprotein domain III (cEDIII) was used aiming to provide comprehensive coverage against all four circulating dengue viral serotypes and potential clade replacement event. Utilizing hepatitis B tandem core technology, the cEDIII sequence was inserted into the immunodominant c/e1 loop region so that it could be displayed on the spike structures of assembled particles. The tandem core particles displaying cEDIII epitopes (tHBcAg-cEDIII) were successfully produced in Nicotiana benthamiana via Agrobacterium-mediated transient expression strategy to give a protein of ∼54 kDa, detected in both soluble and insoluble fractions of plant extracts. The assembled tHBcAg-cEDIII virus-like particles (VLPs) were also visualized from transmission electron microscopy. These VLPs had diameters that range from 32 to 35 nm, presenting an apparent size increment as compared to tHBcAg control particles without cEDIII display (namely tEL). Mice immunized with tHBcAg-cEDIII VLPs showed a positive seroconversion to cEDIII antigen, thereby signifying that the assembled tHBcAg-cEDIII VLPs have successfully displayed cEDIII antigen to the immune system. If it is proven to be successful, tHBcAg-cEDIII has the potential to be developed as a cost-effective vaccine candidate that confers a simultaneous protection against all four infecting dengue viral serotypes.

Validating a knowledge transfer framework in health services.

The study of knowledge transfer (KT) has been proceeding in parallel but independently in health services and in business, presenting an opportunity for synergy and sharing. This paper uses a survey of 32 empirical KT studies with their 96 uniquely named determinants of KT success to identify ten unique determinants for horizontal knowledge transfer success. These determinants, the outcome measure of Knowledge Use, and separate explicit and tacit transfer flows constitute the KT Framework, extending the work of previous KT framework authors. Our Framework was validated through a case study of the transfer of clinical practice guideline knowledge between the cardiac teams of selected Ontario hospitals, using a survey of senders and receivers developed from the KT literature. The study findings were: 8 of 10 determinants were supported by the Successful Transfer Hospitals; and 4 of 10 determinants were found to a higher degree in the Successful than non-Successful transfer hospitals. Taken together, the results show substantive support for the KT Framework determinants, indicating aggregate support of 9 of these determinants, but not the 10th - Knowledge Complexity. The transfer of tacit knowledge was found to be related to the transfer of the explicit knowledge and expressed as the transfer or recreation of resource profile and internal process tacit knowledge, where this tacit transfer did not require interactions between Sender and Receiver. This study provides managers with the building blocks to assess and improve the success rates of their knowledge transfers.

Response to therapy in patients with cryptococcosis and AIDS: Association with in vitro susceptibility to fluconazole.

BACKGROUND: The implications of the Cryptococcus neoformans resistance to fluconazole on patient therapy have not been fully elucidated due to the discordant results found in published studies. AIMS: To establish the influence of C. neoformans resistance to fluconazole in the therapy of individuals with cryptococcosis and AIDS. METHODS: This study retrospectively compared the clinical course of patients with cryptococcosis according to the level of fluconazole resistance of their C. neoformans isolates. RESULTS: This study included 71 episodes of cryptococcosis, defined as those isolates of C. neoformans obtained from patients with mycosis, of which 36 isolates were sensitive to fluconazole, 20 susceptible dose-dependent (SDD), and 15 were resistant. There were 5 treatment failures in the consolidation phase; two occurred in patients who had a susceptible strain, 2 in patients who had SDD strains, and one in a patient who had a resistant strain. During the maintenance treatment, relapses occurred in 4 of 33 patients (12%), seen during the follow-up period, none of which occurred in the group with resistant isolates. There were no significant differences in survival time free of treatment failure (p=0.65) or survival time free of failure or relapse (p=0.38). These results were not affected when tested in a Cox model that included age, CD4T lymphocyte counts, and use of antiretroviral therapy. CONCLUSIONS: In HIV patients with cryptococcosis, the resistance of C. neoformans appeared not to increase the risk of failure or relapse during treatment.

Progress in the Diagnosis and Classification of Pituitary Adenomas.

Pituitary adenomas are common neoplasms. Their classification is based upon size, invasion of adjacent structures, sporadic or familial cases, biochemical activity, clinical manifestations, morphological characteristics, response to treatment and recurrence. Although they are considered benign tumors, some of them are difficult to treat due to their tendency to recur despite standardized treatment. Functional tumors present other challenges for normalizing their biochemical activity. Novel approaches for early diagnosis, as well as different perspectives on classification, may help to identify subgroups of patients with similar characteristics, creating opportunities to match each patient with the best personalized treatment option. In this paper, we present the progress in the diagnosis and classification of different subgroups of patients with pituitary tumors that may be managed with specific considerations according to their tumor subtype.

Epidemiological characterization of diabetic patients on therapy with continuous subcutaneous insulin infusion and continuous glucose monitoring in real time.

OBJECTIVE: To describe baseline characteristics of diabetic patients who were started on insulin pump and real time continuous glucose monitor (CSII-rtCGM) in a specialized center in Medellin, Colombia. MATERIALS AND METHODS: All patients with diabetes with complete data who were started on CSII-rtCGM between February 2010 and May 2014 were included. This is a descriptive analysis of the sociodemographic and clinical characteristics. RESULTS: 141 of 174 patients attending the clinic were included. 90,1% had type 1diabetes (T1D). The average age of T1D patients at the beginning of therapy was 31,4 years (SD 14,1). 75.8% of patients had normal weight (BMI<25), 21.0% were overweight (BMI 25-30) and 2,3% were obese (BMI>30). The median duration of T1D was 13 years (P25-P75=10.7-22.0). 14,2% of the patients were admitted at least once in the year preceding the start of CSII-rtCGM because of diabetes related complications. Mean A1c was 8.6%±1.46%. The main reasons for starting CSII-rtCGM were: poor glycemic control (50.2%); frequent hypoglycemia, nocturnal hypoglycemia, hypoglycemia related to exercise, asymptomatic hypoglycemia (30.2%); severe hypoglycemia (16.44%) and dawn phenomena (3.1%). CONCLUSION: Baseline characteristics of patients included in this study who were started on CSII-rtCGM are similar to those reported in the literature. The Clinic starts CSII-rtCGM mainly in T1D patients with poor glycemic control, frequent or severe hypoglycemia despite being on basal/bolus therapy.

Intervalo QTc prolongado en pacientes de Clínica Médica: estudio multicéntrico

RESUMEN Antecedentes: el síndrome de QT prolongado (SQTP) adquirido se asocia al uso de ciertos fármacos. La detección oportuna del SQTP permite tomar medidas para prevenir arritmias ventriculares potencialmente letales. Objetivo: determinar la frecuencia de SQTP en pacientes adultos internados en Servicios de Clínica Médica, describir las características demográficas, clínicas, laboratoriales y el uso de fármacos asociados con la prolongación del intervalo QTc. Materiales y métodos: se aplicó diseño observacional, prospectivo, longitudinal, en varones y mujeres, mayores de 16 años de edad, internados en el Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) y del Hospital Militar Central (Asunción, Paraguay) en 2019. Se midieron variables demográficas, clínicas, laboratoriales y un electrocardiograma (ECG) al ingreso y a la semana de internación. Se consideró STQL todo valor del intervalo QTc ≥0,45 seg en hombres y ≥0,47 seg en mujeres. Resultados: ingresaron al estudio 257 sujetos, 55% varones y 45% mujeres, con edad media 58±20 años. Se detectó SQTP en 55 pacientes (21%). Los fármacos más utilizados en los pacientes con SQTP fueron omeprazol, furosemida, piracilina-tazobactam, tramadol, ondasentrón, amiodarona, salbutamol, ciprofloxacina, antirretrovirales, levofloxacina, metoclopramida y cotrimoxazol. Conclusión: la frecuencia de SQTP fue 21%. La comorbilidad más frecuente fue la hipertensión arterial (62%). Los fármacos más utilizados en los pacientes con SQTP fueron los de uso común en las salas de Clínica Médica.

ABSTRACT Background: Acquired prolonged QT syndrome (SQTP) is associated with the use of certain drugs. Timely detection of SQTP allows measures to be taken to prevent potentially lethal ventricular arrhythmias. Objective: To determine the frequency of SQTP in adult patients admitted to Clinical Medicine Services, to describe the demographic, clinical, laboratory characteristics and the use of drugs associated with prolongation of the QTc interval. Materials and methods: Observational, prospective, longitudinal design was applied in men and women, over 16 years of age, admitted to the Clinical Medicine Service of the National Hospital (Itauguá, Paraguay) and the Central Military Hospital (Asunción, Paraguay) in 2019. Demographic, clinical, laboratory variables and an electrocardiogram (ECG) were measured at admission and at one week of hospitalization. All values ​​of the QTc interval ≥0.45 sec in men and ≥0.47 sec in women were considered STQL. Results: Two hundred fifty-seven subjects, 55% men and 45% women, with a mean age of 58±20 years, entered the study. SQTP was detected in 55 patients (21%) while the most commonly used drugs in patients with SQTP were omeprazole, furosemide, piperacillin-tazobactam, tramadol, ondansetron, amiodarone, salbutamol, ciprofloxacin, antiretroviral drugs, levofloxacin, metoclopramide and cotrimoxazole. Conclusion: The frequency of SQTP was 21% and the most frequent comorbidity was arterial hypertension (62%). The most commonly used drugs in patients with SQTP were those commonly used in the Clinical Medicine rooms.

Síndrome del hombre en el barril: manifestación atípica de la arteritis de células gigantes / "Man-in-the-barrel" syndrome: atypical manifestation of giant cell arteritis

Conclusiones. Si bien las manifestaciones clínicas típicas de la arteritis de células gigantes son cefalea, claudicación mandibular, pérdida visual, síntomas constitucionales y polimialgia reumática, se debe sospechar su presencia en pacientes mayores de 50 años que manifiesten alteraciones del nervio periférico, entre ellas, diplejía braquial sin otra causa demostrable

Introduction. "Man-in-the-barrel" syndrome refers to diplegia of the upper extremities in which mobility of the head and lower limbs is preserved. Brachial plexitis that presents as "man-in-the-barrel" syndrome is an unusual manifestation of giant cell arteritis. We report a case of C5-C6 plexitis as part of the clinical features of a patient with giant cell arteritis. CASE. Report: A 70-year-old male with a two-month history of weight loss, headache, facial pain and jaw claudication, associated with a persistent elevation of acute phase reactants and bilateral brachial plexopathy, with no evidence of neck or brain injuries or occult neoplasm and with negative autoimmunity tests. Results of the biopsy study of the temporal artery were compatible with giant cell arteritis, and the positron emission tomography scan revealed extensive vascular involvement of the aorta and its branches. Cconclusions: Although the typical clinical manifestations of giant cell arteritis are headache, jaw claudication, loss of sight, constitutional symptoms and polymyalgia rheumatica, its presence must be suspected in patients over the age of 50 who manifest alterations affecting the peripheral nerve, including brachial diplegia with no other demonstrable cause

Síndrome de Cushing exógeno e insuficiencia adrenal relacionada con consumo de producto natural / Exogenous Cushing's syndrome and adrenal insufficiency related to consumption of alternative medicinal product

Resumen La insuficiencia adrenal es una endocrinopatía cuya principal causa se debe a la deficiencia en la producción de hormona adrenocorticotrópica, generalmente explicada por factores iatrogénicos y en menor número de casos al defecto primario de la glándula adrenal (enfermedad de Adisson). Su diagnóstico y la búsqueda de una etiología específica es muy importante, dado las implicaciones a largo plazo que conlleva por necesidad de suplencia hormonal, manejo en condiciones críticas, riesgo de muerte y compromiso de la actividad laboral. Presentamos el caso de una mujer quien consultó por ganancia excesiva de peso, signos de hipercortisolismo e hipertensión, se documentó una probable fuente exógena de esteroides, encontrando un cortisol sérico suprimido. Dos años antes estaba recibiendo artrivid PLUS, un producto natural para el manejo del dolor articular. Después de suspender ésta medicación presentó síntomas compatibles con insuficiencia adrenal, requiriendo el reinicio de prednisolona, con mejoría clínica y logrando su desmonte gradual posterior. (Acta Med Colomb 2017; 42: 243-246).

Abstract Adrenal insufficiency is an endocrinopathy whose main cause is due to the deficiency in the production of adrenocorticotropic hormone, usually explained by iatrogenic factors and in a smaller number of cases to the primary defect of the adrenal gland (Adisson's disease). Diagnosis and the search for a specific etiology is very important, given the long-term implications involved by the need of hormone replacement, management in critical conditions, risk of death and the compromise of work activity. The case of a woman who consulted for excessive weight gain, signs of hypercortisolism and hypertension, is presented. A probable exogenous source of steroids was documented, finding a suppressed serum cortisol. Two years before she was receiving artrivid PLUS, a natural product for joint pain management. After stopping this medication, she presented symptoms compatible with adrenal insufficiency, requiring the resumption of prednisolone, with clinical improvement and achieving its subsequent gradual removal. (Acta Med Colomb 2017; 42: 243-246).

Helical prospective ECG-gating in cardiac computed tomography: radiation dose and image quality.

Helical prospective ECG-gating (pECG) may reduce radiation dose while maintaining the advantages of helical image acquisition for coronary computed tomography angiography (CCTA). Aim of this study was to evaluate helical pECG-gating in CCTA in regards to radiation dose and image quality. 86 patients undergoing 64-multislice CCTA were enrolled. pECG-gating was performed in patients with regular heart rates (HR) < 65 bpm; with the gating window set at 70-85% of the cardiac cycle. All patients received oral and some received additional IV beta-blockers to achieve HR < 65 bpm. In patients with higher or irregular HR, or for functional evaluation, retrospective ECG-gating (rECG) was performed. The average X-ray dose was estimated from the dose length product. Each arterial segment (modified AHA/ACC 17-segment-model) was evaluated on a 4-point image quality scale (4 = excellent; 3 = good, mild artefact; 2 = acceptable, some artefact, 1 = uninterpretable). pECG-gating was applied in 57 patients, rECG-gating in 29 patients. There was no difference in age, gender, body mass index, scan length or tube output settings between both groups. HR in the pECG-group was 54.7 bpm (range, 43-64). The effective radiation dose was significantly lower for patients scanned with pECG-gating with mean 6.9 mSv +/- 1.9 (range, 2.9-10.7) compared to rECG with 16.9 mSv +/- 4.1 (P < 0.001), resulting in a mean dose reduction of 59.2%. For pECG-gating, out of 969 coronary segments, 99.3% were interpretable. Image quality was excellent in 90.2%, good in 7.8%, acceptable in 1.3% and non-interpretable in 0.7% (n = 7 segments). For patients with steady heart rates <65 bpm, helical prospective ECG-gating can significantly lower the radiation dose while maintaining high image quality.

Response to therapy in patients with cryptococcosis and AIDS: association with in vitro susceptibility to fluconazole / Respuesta al tratamiento en pacientes con criptococosis y sida: relación con la sensibilidad in vitro al fluconazol

Background. The implications of the Cryptococcus neoformans resistance to fluconazole on patient therapy have not been fully elucidated due to the discordant results found in published studies. Aims. To establish the influence of C. neoformans resistance to fluconazole in the therapy of individuals with cryptococcosis and AIDS. Methods. This study retrospectively compared the clinical course of patients with cryptococcosis according to the level of fluconazole resistance of their C. neoformans isolates. Results. This study included 71 episodes of cryptococcosis, defined as those isolates of C. neoformans obtained from patients with mycosis, of which 36 isolates were sensitive to fluconazole, 20 susceptible dose-dependent (SDD), and 15 were resistant. There were 5 treatment failures in the consolidation phase; two occurred in patients who had a susceptible strain, 2 in patients who had SDD strains, and one in a patient who had a resistant strain. During the maintenance treatment, relapses occurred in 4 of 33 patients (12%), seen during the follow-up period, none of which occurred in the group with resistant isolates. There were no significant differences in survival time free of treatment failure (p = 0.65) or survival time free of failure or relapse (p = 0.38). These results were not affected when tested in a Cox model that included age, CD4T lymphocyte counts, and use of antiretroviral therapy. Conclusions. In HIV patients with cryptococcosis, the resistance of C. neoformans appeared not to increase the risk of failure or relapse during treatment (AU)

Antecedentes. Las implicaciones de la resistencia de Cryptococcus neoformans al fluconazol en el tratamiento de pacientes infectados con esta levadura no han sido completamente definidas debido a hallazgos discordantes obtenidos previamente. Objetivos. Dilucidar la influencia de la resistencia de C. neoformans al fluconazol en el tratamiento de los pacientes con criptococosis y sida. Métodos. En este estudio se compara retrospectivamente la evolución clínica de los pacientes con criptococosis según el grado de resistencia al fluconazol de los aislamientos de C. neoformans obtenidos de ellos. Resultados. Se incluyeron 71 episodios de criptococosis definidos por el aislamiento de C. neoformans de pacientes con la micosis, que se distribuyeron de la siguiente manera: 36 aislamientos fueron sensibles, 20 sensibles dosis-dependiente y 15 resistentes. En la fase de consolidación, cinco fallos en el proceso de tratamiento tuvieron lugar: dos en pacientes con aislamientos sensibles, dos en pacientes con aislamientos dosis-dependiente y uno en un paciente con un aislamiento resistente. Durante la fase de mantenimiento se presentaron 4 recurrencias en los 33 pacientes que tuvieron seguimiento (12%), ninguna de las cuales ocurrió en el grupo con aislamientos resistentes. No se encontraron diferencias estadísticamente significativas en el tiempo de supervivencia de los casos sin fallo terapéutico (p = 0.65) o en el tiempo de supervivencia de los casos sin fallo terapéutico o recaída (p = 0.38). Estos resultados no se modificaron cuando fueron evaluados en un modelo de regresión de Cox en el que se incluyeron la edad, el conteo de linfocitos T CD4 y el uso de terapia antirretroviral. Conclusiones. En pacientes con VIH y criptococosis la resistencia de C. neoformans a fluconazol parece no incrementar el riesgo de fallo terapéutico o recaída (AU)