Recall patterns and risk of primary liver cancer for subcentimeter ultrasound liver observations: a multicenter study.

BACKGROUND: Patients with cirrhosis and subcentimeter lesions on liver ultrasound are recommended to undergo short-interval follow-up ultrasound because of the presumed low risk of primary liver cancer (PLC). AIMS: The aim of this study is to characterize recall patterns and risk of PLC in patients with subcentimeter liver lesions on ultrasound. METHODS: We conducted a multicenter retrospective cohort study among patients with cirrhosis or chronic hepatitis B infection who had subcentimeter ultrasound lesions between January 2017 and December 2019. We excluded patients with a history of PLC or concomitant lesions ≥1 cm in diameter. We used Kaplan Meier and multivariable Cox regression analyses to characterize time-to-PLC and factors associated with PLC, respectively. RESULTS: Of 746 eligible patients, most (66.0%) had a single observation, and the median diameter was 0.7 cm (interquartile range: 0.5-0.8 cm). Recall strategies varied, with only 27.8% of patients undergoing guideline-concordant ultrasound within 3-6 months. Over a median follow-up of 26 months, 42 patients developed PLC (39 HCC and 3 cholangiocarcinoma), yielding an incidence of 25.7 cases (95% CI, 6.2-47.0) per 1000 person-years, with 3.9% and 6.7% developing PLC at 2 and 3 years, respectively. Factors associated with time-to-PLC were baseline alpha-fetoprotein >10 ng/mL (HR: 4.01, 95% CI, 1.85-8.71), platelet count ≤150 (HR: 4.90, 95% CI, 1.95-12.28), and Child-Pugh B cirrhosis (vs. Child-Pugh A: HR: 2.54, 95% CI, 1.27-5.08). CONCLUSIONS: Recall patterns for patients with subcentimeter liver lesions on ultrasound varied widely. The low risk of PLC in these patients supports short-interval ultrasound in 3-6 months, although diagnostic CT/MRI may be warranted for high-risk subgroups such as those with elevated alpha-fetoprotein levels.

Multiple Organ Failure Associated with SARS-CoV-2 Infection in a Child with Down Syndrome: Is Trisomy 21 Associated with an Unfavourable Clinical Course?

INTRODUCTION: Down syndrome (DS) is one of the most frequent genomic disorders around the globe (∼1:700 births). During the COVID-19 pandemic, it has been recognized that children with DS are patients with a greater risk of presenting SARS-CoV-2 infection-related poor outcomes. Nonetheless, a few cases with DS and SARS-CoV-2 infection have been reported. Our aim is to describe the unfavorable clinical course of a child with DS infected with SARS-CoV-2 virus. CASE: Female, 2 years old, karyotype 47,XX,+21[30], previously diagnosed with a cyanotic congenital heart disease (tricuspid atresia and infundibular pulmonary stenosis, type Ib) who started with diarrhea, developed shortness of breath, and cyanosis and was admitted to the hospital presenting low-oxygen saturation (33%) requiring invasive mechanical ventilation support. The patient tested positive for SARS-CoV-2 infection. During hospitalization, the patient presented hypotension, anuria, retarded capillary filling, and metabolic acidosis; management with vasoactive drugs was needed. Nonetheless, the patient developed respiratory and cardiac failure, acute renal injury (AKIN-III), and septic shock. After 24 days of hospitalization, the patient died. CONCLUSIONS: Multiple organ failure observed in the patient presented could be related to the triple gene dose of four interferon receptors (IFNAR1, IFNAR2, IFNGR2, and IL10RB) located at 21q22.11. Additionally, overexpression of TMPRSS2 at the pulmonary level, located also at 21q22.3, could be related with an increased susceptibility for the development of SARS-CoV-2 infection in DS patients.

Enhancement of alkaline-oxidative delignification of wheat straw by semi-batch operation in a stirred tank reactor.

This paper compares a semi-batch operation and a conventional one of an alkaline oxidative pretreatment of wheat straw carried out in a stirred tank reactor. For the pretreatment, different concentrations of biomass (6% up to 12% w/v) and two different particle sizes (mesh #40-60 and #>60) were experimented. The performance of processes was evaluated through the analysis of lignocellulosic composition of the biomass, and the enzymatic hydrolysis of pretreated biomass using the Cellic® CTec2 enzyme complex by Novozymes®. The process time of semi-batch operation is significantly lower than the batch one and enables a higher load of biomass, showing a delignification yield between 55 and 60%. In the first 5 h of reaction time, the enzymatic hydrolysis experiments reached their maximum yields of 72 and 66% according to reducing sugars conversion when using the mesh #>60 mesh and #40-60, respectively.

Las Curvas Para Medir Circunferencia Cefálica Y Las Potenciales Diferencias Antropométricas En Latinoamérica Y El Mundo / Cephalic Circumference Curves And Potential Anthropometric Differences In Latin America And The World

Resumen La circunferencia cefálica (CC) es una medición que detecta alteraciones del crecimiento adecuado del cerebro. Las curvas de CC más utilizadas mundialmente son las propuestas por los CDC, NCHS y OMS. A pesar de las críticas sobre la metodología para crearlas, se han hecho actualizaciones para corregir inconsistencias. Esto ha servido para detectar y tratar oportunamente problemas de tamaño craneal tanto en los extremos pequeños (microcefalia) o grandes (macrocefalia). Algunos autores opinan que existe la necesidad de contar con curvas regionales para mejorar el valor diagnóstico de éstas en cada población. Otros, como Kenton Holden y colaboradores, han propuesto nuevas curvas que consolidan diferentes bases de datos con el objetivo de reducir el riesgo de errores en el diagnóstico de microcefalia o macrocefalia leve. Es necesario estudiar cuál es el patrón de crecimiento craneal normal de niños/as latinoamericanos por cada región o país, así como conocer las diferencias interétnicas.

Abstract The cephalic circumference (CC) is a measurement that detects alterations in the proper growth of the brain. CC curves most used worldwide are those proposed by the CDC, NCHS and WHO. Despite criticism of the methodology used to create them, updates have been made to correct inconsistencies, and that has helped to detect and treat on time problems of cranial size at both the small (microcephaly) and large (macrocephaly) ends. Several authors have suggested that regional reference curves should be made, and others, like Kenton Holden and colleagues, have proposed new curves that consolidate different databases, aiming to reduce the risk of errors in the diagnosis of microcephaly or mild macrocephaly. It is necessary to study what the normal cranial growth pattern of Latin American children is for each region or country, as well as to determine the interethnic differences.

Efectividad del programa psicoeducativo de educación sexual y salud reproductiva / Effectiveness of the psychoeducational program of sexual education and reproductive health

Introducción: una conducta sexual adecuada basada en conocimientos sólidos sobre salud sexual y reproductiva contribuye a que los adolescentes posean una vida sexual satisfactoria. Objetivo: demostrar efectividad de la intervención psicoeducativa en féminas de la enseñanza secundaria, en un antes y un después. Métodos: estudio cuasi-experimental comparativo de valor metodológico desarrollado en las secundarias básicas urbanas de Cumanayagua, con un universo de 180 estudiantes femeninas pertenecientes al 9no grado. Se elaboró un cuestionario con las variables de interés por el método de encuesta, para caracterizar el comportamiento sexual manifiesto en sus relaciones con el medio social e identificar los conocimientos de las féminas de la enseñanza secundaria relacionados con la educación sexual y salud reproductiva, el cual se utilizó después de aplicado el programa. Se usaron técnicas afectivo-participativas, grupales, de análisis, de integración, de formación de grupo y de evaluación. Resultados: se logra elevar el conocimiento: del momento oportuno para iniciar las relaciones sexuales, de 18 por ciento a un 71 por ciento; acerca del riesgo del embarazo en la primera relación sexual, de 37 por ciento al 75 por ciento; riesgos del embarazo y el aborto, de 57 por ciento a un 71 pr ciento; identificación de las Infecciones de Transmisión Sexual y sus consecuencias de 27 por ciento al 75 pr ciento y de 26 por ciento al 83 por ciento respectivamente. De forma general se logra modificar, de forma creciente, el conocimiento en las categorías de: muy suficientes de un 13,9 por ciento a un 26,7 por ciento y suficientes de un 28,9 por ciento a un 53,9 por ciento y los insuficientes decrecen de un 57,2 por ciento a un 19,4 por ciento, siendo efectivo el programa en un 85,7 por ciento. Conclusiones: el nivel de conocimientos en los adolescentes sobre este tema fue bajo, por lo que mantienían un comportamiento riesgoso; lográndose mejoría después de las intervenciones educativas(AU)

Introduction: Adequate sexual behavior based on sound knowledge on sexual and reproductive health helps adolescents to have satisfactory sexual life. Objective: To prove the effectiveness of psychoeducational intervention in high school female students before and after that intervention. Methods: Comparative quasi-experimental study with methodological value that was carried out in urban junior high schools of Cumanayagua municipality and the universe of study was one hundred and eighty 9th grade female students. A questionnaire was designed using the variables of interest by the survey-type method, in order to characterize the sexual behavior present in its relationships with the social setting and to identify the knowledge of junior high school female students associated with sexual education and reproductive health, which was applied after the program. Affective-participatory, group, analysis, integration, group formation and evaluation techniques were all used in this study. Results: It was possible to raise the level of knowledge about the right time to start the sexual relationship from 18 percent to 71 percent; about the risk of getting pregnant in the first sexual intercourse from 37 percent to 75 percent; pregnancy risks and abortion from 57 to 71 percent; identification of sexually transmitted infections and their consequences from 27 percent to 75 percent and 26 to 83 percent, respectively. The study managed to change in a significant way the knowledge in the following categories: highly sufficient from 13.9 to 26.7percent and sufficient from 28.9 percent to 53.9 percent whereas insufficient category decreased from 57.2 percent to 19.4 percent. The program reached 85.7 percent effectiveness. Conclusions: The level of knowledge shown by adolescents about this topic was low, that is the reason why they kept risky attitudes; after the educational interventions, their knowledge improved(AU)