The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study.

BACKGROUND: Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes. METHODS: 1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category. RESULTS: The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02-1.97 and 2.78, 95% CI 1.83-4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06-2.74, and 2.62, 95% CI 1.65-4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42-0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03-2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50-3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight. CONCLUSIONS: EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.

Clinical validation of 3D-printed swabs in adults and children for SARS-CoV-2 detection.

Throughout the entire coronavirus disease 19 (COVID-19) pandemic, there were disruptions in the supply chain of test materials around the world, primarily in poor- and middle-income countries. The use of 3D prints is an alternative to address swab supply shortages. In this study, the feasibility of the clinical use of 3D-printed swabs for oropharyngeal and nasopharyngeal sampling for the detection of SARS-CoV-2 infection was evaluated. For that purpose, paired samples with the 3D printed and the control swabs were taken from 42 adult patients and 10 pediatric patients, and the results obtained in the detection of SARS-CoV-2 by reverse transcription and quantitative polymerase chain reaction (RT-qPCR) were compared. Additionally, in those cases where the result was positive for SARS-CoV-2, the viral load was calculated by means of a mathematical algorithm proposed by us. For both adults and children, satisfactory results were obtained in the detection of SARS-CoV-2 by RT-qPCR; no significant differences were found in the quantification cycle values between the 3D-printed swab samples and the control samples. Furthermore, we corroborated that the 3D-printed swabs caused less discomfort and pain at the time of sampling. In conclusion, this study shows the feasibility of routinely using 3D-printed swabs for both adults and children. In this way, it is possible to maintain local and cheaper consumption along with fewer distribution difficulties.

Two stage, hybrid endovascular and open surgical approach to treat difficult carotid body tumors.

OBJECTIVE: Present the feasibility, applicability, clinical effectiveness, and results of complicated Shamblin II or III carotid body tumors treated with a two-stage hybrid surgical approach. MATERIALS AND METHODS: Retrospective, observational, cross-sectional, descriptive study of the successful treatment of 16 cases of difficult Shamblin II or III carotid body tumors, consisting of a two-stage surgical approach. We conducted a retrospective, observational, cross-sectional, descriptive study of a series of patients with complicated Shamblin II or III carotid body tumors, which we treated with a two-stage hybrid surgical procedure, in which we first placed a carotid endoprosthesis and 45 days later performed surgical resection of the tumor, following our originally published technique. This study was conducted from February, 2007 to November, 2019, in a third level care centre. RESULTS: We treated 16 patients with a mean age of 50.5 years. All resided at more than 2000 meters above sea level. In all 16 a complete resection was performed. The average duration of surgery was 103.9 min, the average intraoperative bleeding was 69 ml. There were three cases of neuropraxia. The ansa cervicalis nerve had to be sectioned in three cases and there was permanent upper laryngeal nerve injury in two cases. There were no permanent cerebrovascular injuries from placement of the endoprostheses. One patient developed transient cerebral ischaemia (TIA) with no long-term sequelae. There were two cases of asymptomatic late occlusion of the endoprostheses. The average initial volume of the tumors was 54.4 cc. The average tumor volume 35 days after implant of the endoprosthesis was 30.9 cc. SYMPTOMS: Presence of tumors in the neck in all cases and two cases of dysphagia. CONCLUSION: This two-stage hybrid technique allowed for the complete resection of difficult Shamblin II or III carotid body tumors, with one case of TIA and two with permanent upper laryngeal nerve injuries and without mortality.

In Situ Pulmonary Thrombolysis and Perfusion Lung Angiography in Severe COVID-19 Respiratory Failure.

A proof-of-concept study using thrombolysis with catheter-directed tissue plasminogen activator (tPA) and pulmonary angiography imaging was performed to visualize perfusion deficits and reperfusion/therapeutic effects of tPA. DESIGN: A prospective, open-label, compassionate study. Descriptive statistics were presented for categorical variables and as means with sds for continuous variables. The Wilcoxon test was used to determine the differences between the two-related samples and a t test for continuous variables. Statistical significance was set at p value of less than 0.05. Agreement between observations was evaluated using the Kappa Cohen index and overall agreement using the Fleiss Kappa coefficient. SETTING: A single COVID-19 ICU of Mexico´s General Hospital Dr Eduardo Liceaga. SUBJECTS: Fifteen patients with severe Delta variant severe acute respiratory syndrome coronavirus 2 infection, 18-75 years old, requiring mechanical ventilation with a persistent Fio2 requirement of 70% or higher and Pao2/Fio2 ratio (or imputed ratio) less than 150 for more than 4 hours. The coagulation inclusion criteria were International Society on Thrombosis and Haemostasis score greater than 5, and presence of a d-dimer greater than 1,200, with viscoelastic testing using rotational thromboelastometry (Instrumentation Laboratories, Mexico City, Mexico) showing both hypercoagulability (EXTEM amplitude at 5 min > 65 FIBTEM > 30) and hypofibrinolysis (EXTEM maximum lysis < 8%). INTERVENTIONS: Catheter-directed tPA angiography and iFlow system analysis to assess pre-tPA baseline pulmonary perfusion and changes in response to thrombolysis. RESULTS: Nine patients had microvascular filling defects demonstrated by angiography, and good agreement was found with iFlow analysis (ƙ = 0.714). Statistically significant differences were identified in the area under the curve (AUC) region of interest/AUC reference tissue with and without filling defects in phase 2 DM -0.09206 (sd ± 0.16684) (p = 0.003). The Pao2/Fio2 values measured immediately and 48 hours after the procedure were significantly higher (p = 0.001 and p = 0.005, respectively). Statistically significant differences were found in d-dimer values (p = 0.007), Fio2 (p = 0.002), and oxygen saturation in arterial blood/Fio2 (p = 0.045), as well as in the number of patients who required prone positioning before, immediately after the procedure, and at 48 hours after the procedure (p = 0.002). CONCLUSIONS: Thrombolysis with catheter-directed tPA resulted in imaging evidence via pulmonary angiography and iFlow technology of improved lung perfusion in COVID-19 patients with severe respiratory failure.

Scrotal arteriovenous malformation: Case report.

Scrotal arteriovenous malformations (AVM) are extremely rare, making them difficult and complex to diagnose, and a therapeutic challenge; few cases of this type have been reported in the literature. This article reports the case of a male patient, 12 years old, with congenital AVM and background of treatment with sclerotherapy and embolization: it was decided to perform a surgical resection, which was successful. Angiography is obligatory in arteriolar cases, and it was backed up with surgical AVM treatment, taking into account the great importance of pre-surgical embolization.

May-Thurner syndrome with inferior mesenteric vein drainage and porta system - Case report.

We present the case of a 12-year-old girl with a history of vascular anomalies in the lower pelvic limbs and back, who developed unilateral deep vein thrombosis of the left lower limb after her pubertal development, she was diagnosed with May-Thurner syndrome with an abnormal venous drainage of the pelvic structures through the superior hemorrhoidal veins to the inferior mesenteric vein towards the porta system, this being a chronic manifestation. This kind of behavior has not been documented in the reviewed medical literature. Secondarily, balloon angioplasty was performed without breaking the stenotic ring. As a second attempt, it was decided to place the venous stent, with satisfactory resolution of the symptoms. There are controversies about the indications for the use of anticoagulants and antiplatelet agents, or the indications to place a venous stent in children. We must consider an approach to for effective therapeutic treatment in these cases is to control bleeding, the main goal being trying to avoid ulcerations in the lower limb due to venous insufficiency with irreversible affectation of the valvular system.

The Neutrophil-to-Monocyte Ratio and Lymphocyte-to-Neutrophil Ratio at Admission Predict In-Hospital Mortality in Mexican Patients with Severe SARS-CoV-2 Infection (Covid-19).

There is a deep need for mortality predictors that allow clinicians to quickly triage patients with severe coronavirus disease 2019 (Covid-19) into intensive care units at the time of hospital admission. Thus, we examined the efficacy of the lymphocyte-to-neutrophil ratio (LNR) and neutrophil-to-monocyte ratio (NMR) as predictors of in-hospital death at admission in patients with severe Covid-19. A total of 54 Mexican adult patients with Covid-19 that met hospitalization criteria were retrospectively enrolled, followed-up daily until hospital discharge or death, and then assigned to survival or non-survival groups. Clinical, demographic, and laboratory parameters were recorded at admission. A total of 20 patients with severe Covid-19 died, and 75% of them were men older than 62.90 ± 14.18 years on average. Type 2 diabetes, hypertension, and coronary heart disease were more prevalent in non-survivors. As compared to survivors, LNR was significantly fourfold decreased while NMR was twofold increased. LNR ≤ 0.088 predicted in-hospital mortality with a sensitivity of 85.00% and a specificity of 74.19%. NMR ≥ 17.75 was a better independent risk factor for mortality with a sensitivity of 89.47% and a specificity of 80.00%. This study demonstrates for the first time that NMR and LNR are accurate predictors of in-hospital mortality at admission in patients with severe Covid-19.

Toxicity prevention with amifostine in pediatric osteosarcoma patients treated with cisplatin and doxorubicin.

UNLABELLED: Amifostine has emerged as a pancytoprotectant shown protection against nephrotoxicity, neurotoxicity and ototoxicity in preclinical studies. METHODS: We designed a prospective comparative randomized trial to evaluate the cytoprotective effects of amifostine in patients with osteosarcoma receiving cisplatin and doxorrubicin. Patients were evaluated for renal, hearing and cardiac toxicity. RESULTS: We included 28 patients, mean age was 11.6 years, five had metastatic disease. Fifteen patients received amifostine and 13 did not. 20% of patients receiving amifostine developed renal toxicity compared to 30% in the control group (p = 0.318). Grade 1 and 2 audiologic toxicity was present in 100% of the experimental group against 85% of the controls (p = 0.501). Grade 1 cardiac toxicity was present in 2 patients in the control group (p = 0.175). There were no statistical significant differences between the two groups for chemotherapy-related toxicity. Response to chemotherapy was significantly better in the amifostine group. CONCLUSION: amifostine did not reduce the ototoxicity and nephrotoxicity of our treatment regime. It was not well tolerated due to emesis. It is a selective cytoprotectant without reducing the effect of chemotherapy.

Diagnóstico y tratamiento de anomalías vasculares auriculares / Diagnosis and treatment of auricular vascular anomaly

El objetivo del reporte es demostrar angiográficamente las características de las anomalías vasculares auriculares para poderlas clasificar de acuerdo a los hallazgos con base en los criterios descritos por Mullicken y Glowacki en hemangiomas, malformación arteriovenosa de alto flujo (MAV alto flujo) y MAV bajo flujo. El tratamiento propuesto para las diferentes anomalías vasculares depende del tipo de que se trate. Las MAV de alto flujo, deberán manejarse con embolización prequirúrgica y cirugía radical cuando sea posible para retirar nido malformativo y tejido redundante, evitando de esta forma el sangrado. Dentro de una serie de 85 pacientes con anomalías vasculares de cabeza y cuello, únicamente 3 fueron clasificados como MAV de alto flujo en territorio auricular.

Manejo de la estenosis biliar benigna con férulas intercambiables. Informe preliminar / Benign biliary stenosis. Treatment by Interventional Radiology

Los autores presentan su experiencia inicial en el tratamiento de las estenosis benignas de las vías biliares (EBVB, obtenida en un grupo de 21 pacientes, 15 de los cuales fueron consecutivos a colecistectomía abierta, convencional y seis a colecistectomía laparoscópica. En tres pacientes se colocó una prótesis metálica de Palmaz. En los 18 restantes, se colocaron férulas de teflón de calibre 9.5 Fr. que se cambiaron cada tres meses por calibres progresivos de los números 12,14 16 y 18 Fr. estos últimos de PVC. A los 18 meses se retiró toda instrumentación y se puso a los pacientes en observación. A la fecha la férula ha sido retirada en cuatro que están asintomáticos y en los restantes continuamos en proceso de recambio con buenos resultados clínicos y radiológicos. Los resultados iniciales hacen considerar que este método constituye una alternativa viable sobre la que buscamos tener mas experiencia

Pasta de Georam. Material embolizante permanente. Experiencia en el Hospital General de México / Georam paste. Permanent embolizing material. Experience in the Hospital General de Mexico

Desde el inicio de la Radiologúia Intervencionista como una rama terapéutica de la Radiología, se implementaron sustancias capaces de ocluir vasos anormales. Los agentes embolígenos existentes se pueden clasificar de acuerdo al tiempo de embolización, a su composición y por último a su aplicación clínica. Dentro de los materiales embolizantes temporales, el más utilizado en el Gelphoam* (esponja de gelatina absorbible) que tiene como ventajas ser accesible en cuanto a disponibilidad y costo. Sin embargo tiene la desventaja de que es aplicable únicamente a vasos de mediano y gran calibre y que es un material temporal para ser absorbible en un máximo de 21 días. Este informe, presentamos nuestra experiencia en el Hospital General de México con una pasta no absorbible, la cual esta compuesta de Gelphoam, fleboesclerosante y medio de contraste. La finalidad de la adición del fleboesclerosante es producrir un efecto permanente. Esta pasta se fragmenta de forma que se consigue un material embolizante que puede aplicarse en vasos de pequeño y mediano calibre, sin alcanzar la circulación capilar. La cual hemos utilizado en diferentes procedimientos y presentamos la forma como se prepara esta pasta y describimos los casos en que ha sido utilizada y en que tipo de patologías ha corroborado su eficacia, con estudios de control

Diagnóstico de sarcoma de kaposi en el tubo digestivo: estudio retrospectivo / Diagnosis of gatrointestinal tract Kaposi's sarcoma. Retrospective study

Desde 1981, en que por primera vez se describió el Síndrome de Inmunodeficiencia Adquirida, se ha informado más de cinco millones de casos de este padecimiento con una tasa de mortalidad superior a 50 por ciento. Se conoce el predominio en la población homosexual y sus frecuentes complicaciones. Dentro de las complicaciones neoplásicas, el sarcoma de Kaposi epidémico ocupa un lugar importante, sobre todo en sus presentaciones en piel y tórax. Se conoce que el tercer sitio de afección es el tubo digestivo, sin embargo poco se ha escrito acerca de esta presentación. Este informe es el resultado de un estudio retrospectivo realizado en el Hospital General de México, en el Servicio de Gastroenterología, tanto en los Departamentos de Endoscopia como de radiología e Imagen, donde se revisaron 26,000 estudios baritados del esófago, estómago y duodeno y 16,216 endoscopias, efectuadas en el lapso comprendido de enero de 1986 a diciembre de 1995. Se obtuvieron cinco resultados positivos para de Kaposi en tubo digestivo, uno en esófago y cuatro en estómago. Se descubren los caracteres morfológicos y epidemiológicos

Anomalías vasculares faciales: embolización arterial como alternativa de tratamiento / Facial vascular anomalies. Arterial embolization as an alternative treatment

Las anomalías vasculares constituyen una de las alteraciones congénitas más frecuentes. La clasificación biológica ha facilitado su entendimiento, ya que lesiones similares en apariencia externa pueden tener patrones de crecimiento diferentes y contrariamente, lesiones biológicamente idénticas pueden diferir en apariencia externa debido a la profundidad de su localización. En el presente informe, proponemos a la angiografía como método diagnóstico y la embolización como alternativa de tratamiento en aquellas anomalías con componente arterial, demostrando que es un método idóneo obteniendo una adecuada respuesta con mínima morbilidad. Durante un período de ocho meses; 25 niños de ocho meses a 18 años fueron estudiados por anomalías vasculares. Se clasificaron por examen físico y angiografía diagnóstica y se excluyeron dos pacientes. Resultaron 13 hemangiomas y 10 malformaciones vasculares. De los 23 pacientes estudiados, 19 se sometieron a embolización arterial superselectiva y cuatro no se embolizaron por no demostrarse aporte arterial. Todos los niños presentaron una respuesta buena o excelente con mínima morbilidad