Use of direct oral anticoagulants and low molecular weight heparin in venous thromboembolism associated with cancer: real-world evidence in Argentina.

BACKGROUND: Venous thromboembolism (VTE) and major bleeding (MB) are common in cancer patients. Reduced-doses of antithrombotics as secondary prophylaxis have limited data. This work aims to describe and to compare treatments and outcomes for cancer-associated VTE. RESEARCH DESIGN AND METHODS: Retrospective study. Adults with cancer-associated VTE were included. After 3-6 months of full-doses of anticoagulants, three strategies were considered: A) lowering the doses; B) maintaining full-doses; C) stopping treatment. The strategy and medication used were shown in a descriptive analysis and the rate of bleeding and VTE-recurrence between those in a comparative analysis. RESULTS: A total of 420 patients were included, 56.2% received DOACs, 43.8% enoxaparin. Strategy was defined in 257 patients: A (50.2%), B (46.3%), and C (3.5%). Forty-one (9.8%) had VTE-recurrence and 15 (3.6%) had MB or clinically relevant non-major bleeding (CRNMB).According to strategy, recurrent-VTE was 8.5% (A), 4.2% (B), and 11.1 (C) (p = 0.22), MB or CRNMB was 0.8% (A), 1.7% (B), and 0% (C) (p = 0.64). CONCLUSIONS: DOACs and strategy A were the most frequently used agent and strategy, respectively. There were no differences between medications or strategies used. The results must be interpreted with caution, and it is a retrospective single-center study, probably with information and selection bias.

Opinions, attitudes, and barriers to pediatric vaccination in Argentina.

In Argentina, vaccines included in the national calendar are mandatory, free of charge, and access to vaccination services with social equity for all stages of life are guaranteed by law. However, vaccination coverages are still suboptimal and have shown a constant decrease in the last five years. This study aimed to perform a survey to describe the parent's confidence, risk perception, sources of information and access barriers to vaccines and vaccination in Argentina. A survey was designed for parents in charge of children under 12 years of age to answer. The questionnaire was constructed based on validated questions of the international peer-reviewed literature adapted to our country's characteristics. The survey was performed on 1,202 respondents, covering all regions of Argentina, between 19th May and 18th June 2020. To highlight, 76.6 % were female and the mean age was 40.72 (±9.36 years). 9 % participants reported to assist to the private vaccination center, while 64 % and 23 % referred to take their children to the public vaccination point (primary care center and hospital, respectively). Additionally, respondents agreed that vaccines are safe (92 %), effective (94 %), and important for children to receive them (98 %). 48 % could identify-one or more barriers to vaccination, access and affordability were the most reported ones (74 %) being the lack of vaccine the main reason. In conclusion, this study showed that the great majority of parents trust in vaccines and health care teams but access and affordability reasons emerged as the main barriers to vaccination in our country.

Effect of supplementation with vitamins D3 and K2 on undercarboxylated osteocalcin and insulin serum levels in patients with type 2 diabetes mellitus: a randomized, double-blind, clinical trial.

BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) are characterized by chronic hyperglycemia as a consequence of decreased insulin sensitivity, which contributes to bone demineralization and could also be related to changes in serum levels of osteocalcin and insulin, particularly when coupled with a deficiency in the daily consumption of vitamins D3 and K2. The objective of this study was to evaluate the effect of vitamin D3 and vitamin K2 supplements alone or in combination on osteocalcin levels and metabolic parameters in patients with T2DM. METHODS: A double-blind, randomized clinical trial was carried out in 40 patients aged between 30 and 70 years old for 3 months. Clinical and laboratory assessment was carried out at the beginning and at the end of the treatment. The patients were divided into three groups: (a) 1000 IU vitamin D3 + a calcinated magnesium placebo (n = 16), (b) 100 µg of Vitamin K2 + a calcinated magnesium placebo (n = 12), and (c) 1000 IU vitamin D3 + 100 µg vitamin K2 (n = 12). RESULTS: After treatment in the total studied population, a significant decrease in glycemia (p = 0.001), HOMA-IR (Homeostatic model assessment-insulin resistance) (p = 0.040), percentage of pancreatic beta cells (p < 0.001), uOC/cOC index and diastolic blood pressure (p = 0.030) were observed; in vitamin D3 group, differences in serum undercarboxylated osteocalcin (p = 0.026), undercarboxylated to carboxylated osteocalcin index (uOC/cOC) (p = 0.039) glucose (p < 0.001) and  % of functional pancreatic beta cells (p < 0.001) were demonstrated. In vitamin K2 group a significant decrease in glycemia (p = 0.002), HOMA-IR (p = 0.041), percentage of pancreatic beta cells (p = 0.002), and in cOC (p = 0.041) were observed, conversely cOC concentration was found high. Finally, in the vitamins D3 + K2 a significant decrease in glycemia (p = 0.002), percentage of pancreatic beta cells (p = 0.004), and in the uOC/cOC index (p = 0.023) were observed. CONCLUSION: Individual or combined supplementation with vitamins D3 and K2 significantly decreases the glucose levels and  % of functional pancreatic beta cells, while D3 and D3 + K2 treatments also induced a reduction in the uOC/cOC index. Only in the group with vitamin D3 supplementation, it was observed a reduction in undercarboxylated osteocalcin while vitamin K2 increased the carboxylated osteocalcin levels.Trial registration NCT04041492.

[Hand-assisted laparoscopic nephrectomy in challenging cases]. / Nefrectomía laparoscópica asistida por la mano en casos difíciles.

OBJECTIVE: To assess the outcome of hand-assisted laparoscopic nephrectomy in patients with significant complicating clinical factors. METHODS: A retrospective assessment was made of 100 laparoscopic nephrectomies performed at a single hospital from 2001 to 2005. Patients with a history of prior abdominal surgery, prior procedures on the involved kidney, evidence of perirenal inflammation, renal lesions 10 cm or more in diameter, or level I renal vein thrombosis were enrolled. RESULTS: Twelve patients were enrolled. Of these, 5 had a lesion at least 10 cm in diameter, 2 had renal vein thrombosis, and 5 reported major abdominal surgery. Most patients had more than one of these findings. Three patients showed inflammatory conditions (staghorn calculi) and a T4 renal tumor was successfully treated without conversion to open surgery. Mean operating time and blood loss were 210 minutes and 310 ml respectively, while mean length of hospital stay was 3 days. No patient required conversion to open surgery. CONCLUSIONS: Hand-assisted laparoscopic nephrectomy is an attractive minimally invasive option for technically challenging tumors and has reasonable operating times, blood losses, and complication rates.

[Clinical efficacy of prostatic biopsy. Experience in our center from 1990 to 2002]. / Eficacia clínica de la biopsia prostática. Experiencia en nuestro centro 1990-2002.

INTRODUCTION: The prostate biopsy is the only valid tool to diagnose the existence of cancer of prostate. The indications of the biopsy, according with EAU, are the existence of high PSA, increased velocity PSA and a rectal suspicious tact. OBJECTIVES: validation of the utility of the prostate biopsy, to know the value of the PSA as a marker of prostate cancer in our way and to value the indication and efficiency of repeated biopsies. MATERIAL AND METHODS: we practice a manual review of the biopsies in our hospital, between the years 1990 and 2002. We study the level of PSA before the biopsy, number of prostatic cores and histologic information of the biopsy. A statistical descriptive and inferencial study has been performed by SPSS 12.0 package. RESULTS: The total number of biopsies registered was a 1202, with 36.96% of biopsy positive. The PSA before the biopsy (available in the biopsies realized between the year 1999 and 2002: 578 biopsies, 48.08% of the whole) was > 10 ng/ml in 55,88% of these patients, 4-10 ng/ml in 39.27% and 0-4 ng/ml in 4.84%. The average and PSA's median is of 19.09 (standard error: 1.87) and 10.6, respectively. The positividad of the biopsy increases with PSA's level: 48,61% with PSA > 10; 25.11% with PSA 4-10 and 21,4% in patients with PSA < 4. There was realized prostate rebiopsy (2 or more biopsies) in 132 patients (21.97% positive) 88,36% of the cancers was diagnosed in the first biopsy, and 6.62% in the second one (94,98% of the diagnoses of cancer of prostate carried out with the first 2 biopsies). CONCLUSIONS: The information obtained in the study by means of the descriptive analysis of our series meets in conformity the published in other studies and publications. There exists a need to increase the diagnostic profitability of the biopsy of prostate, for which we have introduced a protocol of biopsy under local anesthesia in order to be able to increase the number of obtained cylinders.

[Nonsurgical correction of congenital auricular deformities a new method of neonatal molding and splinting]. / Tratamiento no quirúrgico de las deformaciones auriculares. Una nueva técnica de modelado y ferulización auricular en el período neonatal.

INTRODUCTION: The utility of the nonsurgical correction of congenital auricular deformities by ear molding and splinting has been previously established. Occasionally, its application cannot be easy, and the later collaboration of the parents is necessary. We report a new method of splinting that simplifies the procedure. DESIGN: prospective, case series. PATIENTS AND METHODS: Twenty ears in 15 patients between 7 and 60 days of age (average 22 days) were treated. They were 12 prominent ears, 4 Stahl's ears, 2 lop ears, 1 Crinkled ear, and 1 case of increase of antihelix folder. Cotton impregnated with 2-Octyl-Cyanoacrylate is placed as splint for 6 weeks. RESULTS: The bilateral application lasted less than 5 minutes, end there were no spills to the external auditory canal. The splint was given off to the 2 weeks, and a second procedure was necessary in all the cases. There were no dermatitis or skin ulcers. The treatment was successful in 11 cases, partial improvement in 3, poor correction in 4, and recurrence in 2. CONCLUSIONS: The splint therapy is an easy nonsurgical method for the treatment of congenital auricular deformities that applied during the first weeks of life provides good aesthetic results in more than 50% of the patients.

[Anterior approach otoplasty for treatment of prominent ears in children. A minimally invasive technique]. / Otoplastia por vía anterior para el tratamiento de las orejas prominentes. Una técnica mínimamente invasiva.

INTRODUCTION: In adult patients, it has been reported that prominent ears can be treated by mattress sutures placed through the anterior aspect of the ear, with a minimally invasive technique. In order to verify the utility of this method in children, we used this technique in our patients. MATERIAL AND METHODS: Twenty-two prominent ears were treated in 12 patients between 8 and 11 years of ages. All were operated under general anesthesia. The anterior surface of the auricular cartilage is scored with a rasp. The antihelix shape is obtained, and mattress sutures are placed through the anterior surface of the ear. RESULTS: A good aesthetic result was obtained in all the cases. Superficial skin necrosis happened in three. Partial loss of correction in the superior pole was noted in four ears. In 6, some knots were visible through the skin. CONCLUSIONS: This repair is a simple technique for the treatment of the prominent ears in children, of good aesthetic results, that it avoids the necessity of dorsal skin resection and produces folds of antihelix more naturally curved. In children, to avoid the exteriorization of the suture material, the knots must be placed in the posterior surface of de auricular cartilage.

Dietary threonine reduces plasma phenylalanine levels in patients with hyperphenylalaninemia.

BACKGROUND: In order to achieve normal intellectual development, the plasma phe-nylalanine (PHE) levels of patients with hyperphenylalaninemia should not exceed toxic levels. This goal is usually accomplished by employing special diets in which the patient's protein intake is in the form of PHE-free mixtures of amino acids. There is evidence from our own observations in animals and a preliminary observation in patients with hyperphenylalaninemia that supplemental dietary threonine (THR) might decrease plasma PHE concentrations. METHODS: In this placebo-controlled crossover study, the effect of supplemental oral THR on the plasma amino acid concentrations of 12 patients with hyperphenylalaninemia was investigated. Before starting the first treatment period of this cross-over study, the patients were randomly assigned to one of two groups supplemented either with approximately 50 mg THR/kg per day or with a similar amount of maltodextrin as placebo. After a feeding period of 8 weeks and a wash-out period of 8 weeks, the supplements were crossed over and the study continued for an additional 8 weeks. Blood was obtained at the start and the end of each supplementation period. RESULTS: Dietary THR supplementation of approximately 50 mg/kg per day resulted in a significant decrease of plasma PHE levels ( P = 0.0234). There was a close positive correlation between plasma and urinary PHE concentrations ( P < 0.001) indicating that the lower plasma PHE levels in the THR supplemented patients were not caused by higher urinary excretion of PHE. CONCLUSIONS: The data of the present study show that oral THR supplementation has a clear plasma-PHE-reducing effect but they do not allow any conclusion about the mechanisms responsible for the observed effect. Although it seems attractive on the basis of the present data to use THR supplementation in patients with hyperphenylalaninemia, the mechanism of the observed effect should be clarified before introduction of such a treatment in these patients.

Gamalgamation: current situation.

A review of the historic evolution of gallium alloys and their manipulation characteristics is presented. Although they have similar, or even better, mechanic properties than modern silver amalgams, their use is restricted. This restriction is due to difficulties in their manipulation, their tendency to corrosion, their controversial biocompatibility and the lack of knowledge about gallium's environmental impact. However gallium alloys are still considered as improvable alternatives to silver amalgams.

Longitudinal study of fatty acids in plasma and erythrocyte phospholipids during pregnancy.

AIM: To assess the modifications of the main fatty acids (FA) in plasma and red blood cells during pregnancy. METHODS: A longitudinal study of 36 normal pregnant women was carried out with 3 cut-off points: first trimester, second trimester and third trimester. 14 FA in plasma and erythrocyte phospholipids were measured using capillary gas chromatography. Measurements were expressed in percentages and in absolute values. RESULTS: In plasma there was a significant increase in the proportion of saturated FA and a decrease in the proportion of long chain polyunsaturated fatty acids (PUFA) both in the omega 6 (omega 6) and omega 3 (omega 3) series. On the other hand, in erythrocyte phospholipids there was a decrease in the proportion of eicosapentaenoic acid and an increase in that of docosahexaenoic acid. In the omega 6 series, dihomo-gamma-linolenic acid increased, whereas the omega 6 docosapentaenoic acid decreased. CONCLUSION: There was a significant decrease in the proportion of omega 3 PUFA in plasma from the first to the third trimester. Thus, it is suggested that the omega 3 PUFA intake during pregnancy should be increased in the last trimester.

Prognostic value of cystocopically pseudotumoral lesions (inflammation/granuloma) in primary stage T1 grade 3 bladder tumors treated with BCG.

OBJECTIVE: The aim of this study is to find out whether the pseudotumoral lesions (inflammation/granuloma) seen at the follow-up cystoscopy performed three to six months after transurethral resection of primary stage T1 grade 3 bladder tumor and instillations of BCG therapy might have some prognostic value as far as recurrence and/or long term progression are concerned. MATERIAL AND METHODS: From the first group of one hundred and thirteen patients with primary stage of T1 grade 3 bladder tumor treated with 81 mg of BCG Connaught (weekly/during six weeks), those with recurrent tumor at the 3rd and 6th month were excluded, so we evaluated 99 patients. We identified 13 patients with cystoscopically pseudotumoral lesions. RESULTS: of the 13 cystoscopically pseudotumoral lesions, we observed recurrence in two cases (15%), while among the rest of the 86 patients, we observed 22 recurrences (26%) (p = 0.9; not significant). Concerning progression, eight cases were reported out of 86 patients (9%) within the cistocopically normal group. No cases of progression were reported among the 13 patients with cystoscopically pseudotumoral lesions. This difference was not statistically significant (p = 0.5). CONCLUSIONS: The patients with cystoscopically pseudotumoral lesions (inflammation/granuloma) are a reduced group (13%) with less tendency to recurrence and without progression, even though this relationship is not significant.

Intake of long chain w3 polyunsaturated fatty acids during pregnancy and the influence of levels in the mother on newborn levels.

OBJECTIVE: To assess the relationship between the free intake of long chain w3 polyunsaturated fatty acid (w3 LCP) during pregnancy and the levels in the mother with the levels in the neonate. DESIGN: Cross-sectional study. SETTING: University hospital. SUBJECTS: One hundred and sixty-two mother-neonate pairs from normal at-term pregnancies. MAIN OUTCOME MEASURE: Dietetic interview in order to assess the w3 LCP intake. w3 LCPs were analyzed by capillary gas chromatography in plasma (expressed as percentage and as total amount) and in erythrocyte phospholipids (expressed as percentage) from mothers and neonates. RESULTS: The w3 LCP intake assessed by the dietetic interview was significantly correlated with w3 LCP levels in the plasma of both mothers and neonates. The levels of w3 LCPs in mothers and neonates were significantly correlated both in plasma fatty acids (expressed both as a percentage and absolute values) and in erythrocyte phospholipids (in percentage) (r=0.49-0.22). CONCLUSION: In an apparently well-nourished population the w3 LCP levels of the newborn infants are clearly influenced by those of their mothers. The higher the levels in mothers, the higher those in the neonates. The w3 LCP intake assessed by an interview also showed a significant influence, but to a lesser extent.

Long chain W3 polyunsaturated fatty acids and lipid pattern in the mother and the newborn infant.

We studied 162 mother-neonate pairs to determine the relationship between w3 long chain polyunsaturated fatty acid (w3LCP) intake during pregnancy and their levels in the mother and the neonate, and the general lipid pattern in the mother and the neonate. A dietetic interview was performed to assess the w3LCP intake during pregnancy. In both mothers and neonates we studied the w3LCPs in plasma and erythrocyte phospholipids and also the general lipid profile (total cholesterol, HDL-c, LDL-c, triglycerides, apo A1 and apo B). The w3LCP intake assessed by the dietetic interview (0.74 +/- 0.52 g/day) did not correlated with any of the parameters of the general lipid pattern in mothers or neonates. In mothers, the w3LCP levels in plasma expressed in percentages showed a positive correlation with apo A1 and HDL-c, and a negative correlation with triglycerides and apo B. The w3LCPs levels in mothers showed an inconsistent and weak correlation with triglycerides and apo B in neonates. When w3LCPs levels were assessed in the neonates themselves a consistent positive correlation was found with triglycerides. We concluded that in the dietetic range of our population, the intake of w3LCPs was not associated to any changes in the general lipid pattern of mothers or neonates. Whereas the w3LCP levels in mothers were correlated with the changes in the general lipid pattern reported outside pregnancy, such correlations were not present in regard to the neonate general profile, whereas the newborn's w3LCP levels were correlated with triglycerides. We believe that the hypertriglyceridemia of pregnancy, the placenta and the peculiarities of fetal metabolism are the causes of the aforementioned findings.

Fatty acid composition of fertilization-failed human oocytes.

The aim of the study was to assess the fatty acid composition of human fertilization-failed oocytes. A total of 150 unfertilized oocytes from 43 women undergoing in-vitro fertilization (IVF) were analysed using capillary gas chromatography. The majority of fatty acids were saturated (79.22%), of which stearic (38.65%) and palmitic (32.66%) acids were the most abundant. Of the monounsaturated fatty acids (14.27%) oleic acid was the most abundant (9.77%). Polyunsaturated fatty acids comprised 6.50% of fatty acids, the n-6:n-3 ratio being 7.73. The ratio of eicosapentaenoic acid:docosahexaenoic acid was approximately 5. It is concluded that the most common fatty acids in human unfertilized oocytes are either saturated or monounsaturated fatty acids, whose main function is to provide an energy source. A number of differences in fatty acid composition were observed, in comparison with other biological samples. In particular, stearic and eicosapentaenoic acids were more prominent, and oleic and linoleic acids were less prominent; this may reflect some specific peculiarity of oocyte metabolism.

Quantification in the subnanomolar range of phospholipids and neutral lipids by monodimensional thin-layer chromatography and image analysis.

A sensitive, rapid, and simple method is presented for the simultaneous quantitation of the major phospholipids and neutral lipids using an image analyzer after separation by one-dimensional thin-layer chromatography. A clear-cut separation of the lipids was achieved on one EDTA-impregnated chromatoplate with five step-wise developments. An image was acquired, and the integrated optical densities of the individual spots were quantitated by a camera-equipped image analyzer against an internal standard of cholesteryl formate. Calibration curves for each lipid followed linear or hyperbolic functions permitting quantification of as little as 0.015 nmol of lysophosphatidylcholine and as much as 7.50 nmol of triglyceride from a single application. Quantitation of the major lipids in human plasma by TLC and image analysis and standardized enzymatic methods were well correlated. The method is suitable for routine analysis of biological samples having lipid profiles as different as rat hepatocyte subcellular fractions, and very low density lipoproteins secreted by rat hepatocyte suspensions.

Inborn errors of metabolism with a protein-restricted diet: effect on polyunsaturated fatty acids.

Previous studies have shown that phenylketonuric patients display a deficiency in long-chain polyunsaturated fatty acids. A study has now been performed on 13 cases (5 with methylmalonic acidaemia and 8 with urea cycle disorders) whose dietary treatment also implies a limitation in protein-rich food. Plasma and red-cell phospholipid fatty acid profiles were studied. The most relevant results were a lower percentage of docosahexaenoic acid in plasma and red-cell phospholipids (0.91% +/- 0.53% vs 2.88% +/- 1.17% and 2.07% +/- 0.92% vs 3.62% +/- 1.01% (p < 0.001)) and a lower percentage of arachidonic acid in plasma (5.22% +/- 2.02% vs 8.3% +/- 2.11% (p < 0.001)). A long-chain polyunsaturated acid deficiency has also been confirmed in this group of metabolic patients and a dietary supplement is recommended since this population is subject to a special risk factor with regard to adequate psychomotor development. By extrapolating these data to the general population, the possibility can be inferred that long-chain polyunsaturated fatty acids are semi-essential in infant nutrition far beyond the breast-feeding period.