Training and Verification Requirements for Interpretation of Cardiac CT and MRI: AJR Expert Panel Narrative Review.

The use of cardiac CT and MRI is rapidly expanding based on strong evidence from large international trials. The number of physicians competent to interpret cardiac CT and MRI may be unable to keep pace with the increasing demand. Societies and organizations have prescribed training requirements for interpreting cardiac CT and MRI, with recent updates focusing on the increased breadth of competency that is now required due to ongoing imaging advances. In this AJR Expert Panel Narrative Review, we discuss several aspects of cardiac CT and MRI training, focusing on topics that are uncertain or not addressed in existing society statements and guidelines, including determination of competency in different practice types in real-world settings and the impact of artificial intelligence on training and education. The article is intended to guide updates in professional society training requirements and also inform institutional verification processes.

Multimodality Imaging of Infective Endocarditis.

Infective endocarditis (IE) is a complex multisystemic disease resulting from infection of the endocardium, the prosthetic valves, or an implantable cardiac electronic device. The clinical presentation of patients with IE varies, ranging from acute and rapidly progressive symptoms to a more chronic disease onset. Because of its severe morbidity and mortality rates, it is necessary for radiologists to maintain a high degree of suspicion in evaluation of patients for IE. Modified Duke criteria are used to classify cases as "definite IE," "possible IE," or "rejected IE." However, these criteria are limited in characterizing definite IE in clinical practice. The use of advanced imaging techniques such as cardiac CT and nuclear imaging has increased the accuracy of these criteria and has allowed possible IE to be reclassified as definite IE in up to 90% of cases. Cardiac CT may be the best choice when there is high clinical suspicion for IE that has not been confirmed with other imaging techniques, in cases of IE and perivalvular involvement, and for preoperative treatment planning or excluding concomitant coronary artery disease. Nuclear imaging may have a complementary role in prosthetic IE. The main imaging findings in IE are classified according to the site of involvement as valvular (eg, abnormal growths [ie, "vegetations"], leaflet perforations, or pseudoaneurysms), perivalvular (eg, pseudoaneurysms, abscesses, fistulas, or prosthetic dehiscence), or extracardiac embolic phenomena. The differential diagnosis of IE includes evaluation for thrombus, pannus, nonbacterial thrombotic endocarditis, Lambl excrescences, papillary fibroelastoma, and caseous necrosis of the mitral valve. The location of the lesion relative to the surface of the valve, the presence of a stalk, and calcification or enhancement at contrast-enhanced imaging may offer useful clues for their differentiation. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Epicardial Space: Comprehensive Anatomy and Spectrum of Disease.

The epicardial space (ES) is the anatomic region located between the myocardium and the pericardium. This space includes the visceral pericardium and the epicardial fat that contains the epicardial coronary arteries, cardiac veins, lymphatic channels, and nerves. The epicardial fat represents the main component of the ES. This fat deposit has been a focus of research in recent years owing to its properties and relationship with coronary gossypiboma plaque and atrial fibrillation. Although this region is sometimes forgotten, a broad spectrum of lesions can be found in the ES and can be divided into neoplastic and nonneoplastic categories. Epicardial neoplastic lesions include lipoma, paraganglioma, metastases, angiosarcoma, and lymphoma. Epicardial nonneoplastic lesions encompass inflammatory infiltrative disorders, such as immunoglobulin G4-related disease and Erdheim-Chester disease, along with hydatidosis, abscesses, coronary abnormalities, pseudoaneurysms, hematoma, lipomatosis, and gossypiboma. Initial imaging of epicardial lesions may be performed with echocardiography, but CT and cardiac MRI are the best imaging modalities to help characterize epicardial lesions. Due to the nonspecific onset of signs and symptoms, the clinical history of a patient can play a crucial role in the diagnosis. A history of malignancy, multisystem diseases, prior trauma, myocardial infarction, or cardiac surgery can help narrow the differential diagnosis. The diagnostic approach to epicardial lesions should be made on the basis of the specific location, characteristic imaging features, and clinical background. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Differential BroadBand (1-16 GHz) MMIC GaAs mHEMT Low-Noise Amplifier for Radio Astronomy Applications and Sensing.

A broadband differential-MMIC low-noise amplifier (DLNA) using metamorphic high-electron-mobility transistors of 70 nm in Gallium Arsenide (70 nm GaAs mHEMT technology) is presented. The design and results of the performance measurements of the DLNA in the frequency band from 1 to 16 GHz are shown, with a high dynamic range, and a noise figure (NF) below 1.3 dB is obtained. In this work, two low-noise amplifiers (LNAs) were designed and manufactured in the OMMIC foundry: a dual LNA, which we call balanced, and a differential LNA, which we call DLNA. However, the paper focuses primarily on DLNA because of its differential architecture. Both use a 70 nm GaAs mHEMT space-qualified technology with a cutoff frequency of 300 GHz. With a low power bias Vbias/Ibias (5 V/40.5 mA), NF < 1.07 dB "on wafer" was achieved, from 2 to 16 GHz; while with the measurements made "on jig", NF = 1.1 dB, from 1 to 10 GHz. Furthermore, it was obtained that NF < 1.5 dB, from 1 to 16 GHz, with a figure of merit equal to 145.5 GHz/mW. Finally, with the proposed topology, several LNAs were designed and manufactured, both in the OMMIC process and in other foundries with other processes, such as UMS. The experimental results showed that the NF of the DLNA MMIC with multioctave bandwidth that was built in the frequency range of the L-, S-, C-, and X-bands was satisfactory.

Indole-3-carbinol loaded-nanocapsules modulated inflammatory and oxidative damages and increase skin wound healing in rats.

This study evaluated the effects of topically applied hydrogels (HG) containing nanoencapsulated indol-3-carbinol (I3C) and its free form in a rat model of skin wounds. Formulations were topically applied twice a day for five days to the wounds. On days 1, 3, and 6, the wound area was measured to verify the % of regression. On the sixth day, the animals were euthanized for the analysis of the inflammatory and oxidative profile in wounds. The nanocapsules (NC) exhibited physicochemical characteristics compatible with this kind of suspension. After five hours of exposure to ultraviolet C, more than 78% of I3C content in the suspensions was still observed. The NC-I3C did not modify the physicochemical characteristics of HG when compared to the HG base. In the in vivo study, an increase in the size of the wound was observed on the 3rd experimental day, which was lower in the treated groups (mainly in HG-NC-I3C) compared to the control. On the 6th day, HG-I3C, HG-NC-B, and HG-NC-I3C showed lower regression of the wound compared to the control. Additionally, HG-NC-I3C exhibited an anti-inflammatory effect (as observed by decreased levels of interleukin-1B and myeloperoxidase), reduced oxidative damage (by decreased reactive species, lipid peroxidation, and protein carbonylation levels), and increased antioxidant defense (by improved catalase activity and vitamin C levels) compared to the control. The current study showed more satisfactory results in the HG-NC-I3C group than in the free form of I3C in decreasing acute inflammation and oxidative damage in wounds.

I3C nanocapsules exhibited characteristics compatible with this kind of suspension;On 3rd day, I3C nanocapsules prevented the increase of wound area;I3C nanocapsules decreased oxidative damage in wound tissue;Inflammatory proteins were decreased in I3C nanocapsules treated group.

Resilience of rotifers and cladocerans communities in four reservoirs with eutrophication pollution and lead concentrations in Aguascalientes, Mexico.

Pollution in aquatic ecosystems has been increasing drastically worldwide changing their water quality. Therefore, species must be adapted to these new scenarios. In Aguascalientes City, four representative urban reservoirs contain lead in the water column and extremely high concentrations of sediments. Therefore, an analysis was conducted to evaluate the resilience of zooplankton species to lead exposure in each reservoir using dormant and organisms. Results demonstrated a decrease range from 57.5 to 22.5% in overall diapausing egg hatching rate, while survivorship rate also decreased from 98 to 54% when organisms were exposed to the water of the four reservoirs and increasing lead concentrations. When Pb exposure increased, results showed a global negative effect on both hatching rate (decreasing from 58 to 30% at 0.09 mg L-1) and survivorship levels (decreasing from 100% to 0.07% at 0.09 mg L-1). We provide Species Sensitivity Distribution for both water reservoir dilutions and lead concentration to analyze diapausing eggs hatching and survivorship of offspring in the presence of same polluted conditions or lead of the autochthonous species found in reservoirs. Furthermore, specific analysis with two populations of the cladoceran Moina macrocopa showed clear dissimilar hatching patterns that suggested a different adaptive mechanism. Niagara population shows a hatching rate of approximately 25% in the first two days of reservoir water exposure, while UAA population drastically increased hatching rate to 75% on exposure at day seven. We provide the first record of bioaccumulation in ephippia of M. macrocopa.

Comparative Analysis of Ventilatory Responses during Stress Tests in Patients with Chronic Pain: Implications for Therapeutic Interventions.

Understanding the differences in ventilatory responses during exercise between patients with fibromyalgia and those with other chronic pain disorders is crucial for developing effective therapeutic interventions, especially in exercise to identify the better physical therapy prescription. Both populations face unique challenges that impact their ability to engage in physical activity; yet, the underlying physiological responses can vary significantly. In this context, the methodology of this study entailed conducting a comparative analysis of the ventilatory response during exercise in patients with fibromyalgia and those with other chronic pain disorders. The experimental protocol included a total of 31 participants (n = 13 diagnosed with fibromyalgia and n = 18 diagnosed with other chronic pain conditions). All participants completed a stress test, where the ventilatory parameters were measured in three stages (i.e., resting, incremental exercise, and recovery). The results revealed significant differences (p<0.05) in ventilatory responses between both groups. Patients with fibromyalgia exhibited reduced time for the aerobic threshold and a higher respiratory frequency in the anaerobic threshold compared to those with other chronic pain disorders. Furthermore, fibromyalgia patients demonstrated higher values in the ventilatory coefficient during the test and in the recovery stage. In conclusion, these differences underscore the need for tailored exercise programs that specifically address the unique ventilatory challenges faced by fibromyalgia patients to improve their physical function and overall quality of life.

Dielectric Characterization of Ex-Vivo Breast Tissues: Differentiation of Tumor Types through Permittivity Measurements.

Early analysis and diagnosis of breast tumors is essential for either quickly launching a treatment or for seeing the evolution of patients who, for instance, have already undergone chemotherapy treatment. Once tissues are excised, histological analysis is the most frequent tool used to characterize benign or malignant tumors. Dielectric microwave spectroscopy makes use of an open-ended coaxial probe in the 1-8 GHz frequency range to quickly identify the type of tumor (ductal carcinoma, lobular carcinoma, mucinous carcinoma and fibroadenoma). The experiment was undertaken with data from 70 patients who had already undergone chemotherapy treatment, which helped to electrically map the histological tissues with their electric permittivity. Thus, the variations in the permittivity of different types of tumors reveal distinctive patterns: benign tumors have permittivity values lower than 35, while malignant ones range between 40 and 60. For example, at a frequency of 2 GHz, the measured permittivity was 45.6 for ductal carcinoma, 33.1 for lobular carcinoma, 59.5 for mucinous carcinoma, and 27.6 for benign tumors. This differentiation remains consistent in a frequency range of 1 to 4.5 GHz. These results highlight the effectiveness of these measurements in the classification of breast tumors, providing a valuable tool for quick and accurate diagnosis and effective treatment.

Parasomnias related to shift work disorder among medical residents during the first year of training in Mexico.

Shift work disorder (SWD) may affect medical residents because their workload, academic demands and extended work hours. This condition set residents at risk of more sleep disorders. The study compared parasomnias among residents with and without shift work disorder (SWD) and weighed their relative risk (RR) for each parasomnia. One hundred twenty-six residents participated in the study. The Munich Parasomnia Screening questionnaire and the Barger Questionnaire for SWD were used for the screening of parasomnias and SWD, respectively. Means and percentages of studied variables were compared between groups. Relative risk (RR) was calculated for each type of parasomnia. The more frequent parasomnias in residents with SWD the RR (and 95% confidence intervals) were: sleep terrors, 5.60 (1.84-17.01); confusional arousals, 3.73 (1.84-7.56); sleep paralysis, 3.27 (1.53-6.93); hypnagogic/hypnopompic hallucinations, 2.55 (1.03-6.28); somniloquies, 2.45 (1.21-4.92); and nightmares, 2.01 (1.54-2.62). Our data suggest that residents who experience SWD may be at risk of having lower threshold for the occurrence of rapid eye movement (REM) and non-REM (NREM) sleep parasomnias. Additional research is needed to confirm these results, and to further identify the contribution to this association.

Clinical characterization and outcomes of a cohort of colombian patients with AL Amyloidosis.

Background: Amyloid light chain (AL) amyloidosis is characterized by amyloid fibril deposition derived from monoclonal immunoglobulin light chains, resulting in multiorgan dysfunction. Limited data exist on the clinical features of AL amyloidosis. Objective: This study aims to describe the clinical characteristics, treatments, and outcomes in Colombian patients with AL amyloidosis. Methods: A retrospective descriptive study was conducted at three high-complexity centers in Medellín, Colombia. Adults with AL amyloidosis diagnosed between 2012 and 2022 were included. Clinical, laboratory, histological, treatment, and survival data were analyzed. Results: The study included 63 patients. Renal involvement was most prevalent (66%), followed by cardiac involvement (61%). Multiorgan involvement occurred in 61% of patients. Amyloid deposition was most commonly detected in renal biopsy (40%). Bortezomib-based therapy was used in 68%, and 23.8% received high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDCT-ASCT). Hematological response was observed in 95% of patients with available data. Cardiac and renal organ responses were 15% and 14%, respectively. Median overall survival was 45.1 months (95% CI: 22.2-63.8). In multivariate analysis, cardiac involvement was significantly associated with inferior overall survival (HR 3.27; 95% CI: 1.23-8.73; p=0.018), HDCT-ASCT had a non-significant trend towards improved overall survival (HR 0.25; 95% CI: 0.06-1.09; p=0.065). Conclusions: In this study of Colombian patients with AL amyloidosis, renal involvement was more frequent than cardiac involvement. Overall survival and multiorgan involvement were consistent with data from other regions of the world. Multivariate analysis identified cardiac involvement and HDCT-AHCT as possible prognostic factors.

Antecedentes: La amiloidosis por amiloide de cadenas ligeras (AL) se caracteriza por el depósito de fibrillas amiloides derivadas de cadenas ligeras de inmunoglobulinas monoclonales, lo que resulta en disfunción multiorgánica. Existen datos limitados sobre las características clínicas de la amiloidosis AL. Objetivo: Este estudio tiene como objetivo describir las características clínicas, tratamientos y desenlaces en pacientes colombianos con amiloidosis AL. Métodos: Se llevó a cabo un estudio descriptivo retrospectivo en tres centros de alta complejidad en Medellín, Colombia. Se incluyeron adultos con diagnóstico de amiloidosis AL entre 2012 y 2022. Se analizaron datos clínicos, de laboratorio, histológicos, de tratamiento y de supervivencia. Resultados: El estudio incluyó 63 pacientes. La afectación renal fue más prevalente (66%), seguida de la afectación cardíaca (61%). El 61% de los pacientes presentaron afectación multiorgánica. El depósito amiloide se detectó con mayor frecuencia en la biopsia renal (40%). El tratamiento basado en bortezomib se utilizó en el 68%, y el 23.8% recibió altas dosis de quimioterapia con trasplante autólogo de progenitores hematopoyéticos (ADQT-TAPH). Se observó respuesta hematológica en el 95% de los pacientes con datos disponibles. La respuesta de órgano cardíaca y renal fue del 15% y 14%, respectivamente. La mediana de la supervivencia global fue de 45.1 meses (IC del 95%: 22.2-63.8). En el análisis multivariado, la afectación cardíaca se asoció significativamente con una supervivencia global inferior (HR 3.27; IC del 95%: 1.23-8.73; p=0.018), ADQT-TAPH mostró una tendencia no significativa hacia una mejora en la supervivencia global (HR 0.25; IC 95%: 0.06-1.09; p=0.065). Conclusiones: En este estudio de pacientes colombianos con amiloidosis AL, la afectación renal fue más frecuente que la afectación cardíaca. La supervivencia global y la afectación multiorgánica fueron consistentes con datos de otras regiones del mundo. El análisis multivariado identificó la afectación cardíaca y ADQT-TAPH como posibles factores pronósticos.

Clinical characterization and outcomes of a cohort of colombian patients with AL Amyloidosis

Background: Amyloid light chain (AL) amyloidosis is characterized by amyloid fibril deposition derived from monoclonal immunoglobulin light chains, resulting in multiorgan dysfunction. Limited data exist on the clinical features of AL amyloidosis. Objective: This study aims to describe the clinical characteristics, treatments, and outcomes in Colombian patients with AL amyloidosis. Methods: A retrospective descriptive study was conducted at three high-complexity centers in Medellín, Colombia. Adults with AL amyloidosis diagnosed between 2012 and 2022 were included. Clinical, laboratory, histological, treatment, and survival data were analyzed. Results: The study included 63 patients. Renal involvement was most prevalent (66%), followed by cardiac involvement (61%). Multiorgan involvement occurred in 61% of patients. Amyloid deposition was most commonly detected in renal biopsy (40%). Bortezomib-based therapy was used in 68%, and 23.8% received high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDCT-ASCT). Hematological response was observed in 95% of patients with available data. Cardiac and renal organ responses were 15% and 14%, respectively. Median overall survival was 45.1 months (95% CI: 22.2-63.8). In multivariate analysis, cardiac involvement was significantly associated with inferior overall survival (HR 3.27; 95% CI: 1.23-8.73; p=0.018), HDCT-ASCT had a non-significant trend towards improved overall survival (HR 0.25; 95% CI: 0.06-1.09; p=0.065). Conclusions: In this study of Colombian patients with AL amyloidosis, renal involvement was more frequent than cardiac involvement. Overall survival and multiorgan involvement were consistent with data from other regions of the world. Multivariate analysis identified cardiac involvement and HDCT-AHCT as possible prognostic factors.

Antecedentes: La amiloidosis por amiloide de cadenas ligeras (AL) se caracteriza por el depósito de fibrillas amiloides derivadas de cadenas ligeras de inmunoglobulinas monoclonales, lo que resulta en disfunción multiorgánica. Existen datos limitados sobre las características clínicas de la amiloidosis AL. Objetivo: Este estudio tiene como objetivo describir las características clínicas, tratamientos y desenlaces en pacientes colombianos con amiloidosis AL. Métodos: Se llevó a cabo un estudio descriptivo retrospectivo en tres centros de alta complejidad en Medellín, Colombia. Se incluyeron adultos con diagnóstico de amiloidosis AL entre 2012 y 2022. Se analizaron datos clínicos, de laboratorio, histológicos, de tratamiento y de supervivencia. Resultados: El estudio incluyó 63 pacientes. La afectación renal fue más prevalente (66%), seguida de la afectación cardíaca (61%). El 61% de los pacientes presentaron afectación multiorgánica. El depósito amiloide se detectó con mayor frecuencia en la biopsia renal (40%). El tratamiento basado en bortezomib se utilizó en el 68%, y el 23.8% recibió altas dosis de quimioterapia con trasplante autólogo de progenitores hematopoyéticos (ADQT-TAPH). Se observó respuesta hematológica en el 95% de los pacientes con datos disponibles. La respuesta de órgano cardíaca y renal fue del 15% y 14%, respectivamente. La mediana de la supervivencia global fue de 45.1 meses (IC del 95%: 22.2-63.8). En el análisis multivariado, la afectación cardíaca se asoció significativamente con una supervivencia global inferior (HR 3.27; IC del 95%: 1.23-8.73; p=0.018), ADQT-TAPH mostró una tendencia no significativa hacia una mejora en la supervivencia global (HR 0.25; IC 95%: 0.06-1.09; p=0.065). Conclusiones: En este estudio de pacientes colombianos con amiloidosis AL, la afectación renal fue más frecuente que la afectación cardíaca. La supervivencia global y la afectación multiorgánica fueron consistentes con datos de otras regiones del mundo. El análisis multivariado identificó la afectación cardíaca y ADQT-TAPH como posibles factores pronósticos.

Amiloidosis AL: conceptos actuales / AL amyloidosis: current concepts

Las amiloidosis sistémicas constituyen un grupo de enfermedades con diversas etiologías, caracterizadas por la síntesis de proteínas con plegado defectuoso, capaces de agregarse y depositarse en el medio extracelular de diferentes órganos y tejidos, alterando su estructura y función. Se conocen más de 14 formas de amiloidosis sistémica, de las cuales la más frecuente es la amiloidosis AL, objeto de esta revisión, en la que las proteínas precursoras son cadenas ligeras de inmunoglobulina inestables, secretadas por un clon de células plasmáticas o, con menor frecuencia, por un linfoma linfoplasmocítico o de células del manto. La amiloidosis AL puede llevar a una amplia gama de manifestaciones clínicas y compromiso de órganos, como el corazón y el riñón. El reconocimiento temprano de la enfermedad y el diagnóstico oportuno son determinantes para mejorar la supervivencia de los pacientes. El tratamiento deberá ser individualizado de acuerdo con la condición de cada paciente, lo que hace necesaria una correcta clasificación de los individuos según su pronóstico. La terapia dirigida a la amiloidosis está enfocada esencialmente en disminuir el compromiso orgánico, y por ende, prolongar la supervivencia con mejoría en los síntomas. En esta revisión se discutirán aspectos importantes de la fisiopatología, epidemiología, manifestaciones clínicas, diagnóstico y tratamiento de la amiloidosis AL

Systemic amyloidosis constitutes a group of diseases with diverse etiologies characterized by the synthesis of proteins with defective folding, capable of aggregating and depositing in the extracellular matrix of different organs and tissues, altering their structure and function. More than 14 forms of systemic amyloidosis are known, of which the most frequent is AL amyloidosis, the subject of this review, in which the precursor proteins are unstable immunoglobulin light chains, secreted by a clone of plasma cells or, to a lesser extent, often due to lymphoplasmacytic or mantle cell lymphoma. AL amyloidosis can lead to a wide range of clinical manifestations and organ involvement, such as the heart and kidney. Early recognition of the disease and timely diagnosis are crucial to improve patient survival. Treatment should be individualized according to the condition of each patient, which requires a properly classification of individuals according to their prognosis. Amyloidosis-targeted therapy is essentially focused on reducing organ involvement, and therefore prolonging survival with improvement in symptoms. In this review, important aspects of the pathophysiology, epidemiology, clinical manifestations, diagnosis, and treatment of AL amyloidosis are discussed

Enfermedad gonocócica diseminada: Reporte de caso

Introducción: La infección por Neisseria gonorrhoeae (NG) es la segunda causa enfermedad de transmisión sexual (ETS), con una incidencia en aumento, altas tasas de resistencia antibiótica y con su mayor presentación a nivel genital. Su presentación con bacteriemia es menor del 3 %, con limitante en su diagnóstico por su bajo rendimiento. Por lo anterior reportamos el caso. Presentación caso: Hombre de 60 años con antecedente de diabetes mellitus, quien ingresa por cuadro poliarticular con sinovitis, asociado a un síndrome febril, sin otro hallazgo al examen físico. Se documenta bacteriemia por NG, con nexo temporal con relación sexual previa. Se indica tratamiento antibiótico según antibiograma con profilaxis a pareja. Paciente egresa sin ninguna complicación. Conclusión : La diseminación hemática por NG es una condición rara, con síntomas iniciales muy inespecíficos, con bajo rendimiento de pruebas diagnósticas en esta condición, por lo cual requiere alta sospecha clínica y cobra gran importancia una historia clínica muy detallada. Como en nuestro caso, los síntomas inespecíficos condicionaron a descartar otras condiciones hasta el aislamiento en hemocultivos lleva a diagnósticos definitivo. Es un caso con presentación clínica inusual.

Introduction: Infection by Neisseria gonorrhoeae (NG) is the second cause of sexually transmitted disease (ETS), with an increasing incidence, high rates of antibiotic resistance and with its greatest presentation at the genital level. Its presentation with bacteriemia is less than 3%, limiting its diagnosis due to its low performance. Therefore, we report the case. Case presentation: 60-year-old man with a history of diabetes mellitus, who was admitted due to polyarticular symptoms with synovitis, associated with a febrile syndrome, with no other finding on physical examination. Bacteremia due to Neisseria gonorrhoeae is documented, with a temporal link with previous sexual intercourse. Antibiotic treatment is indicated according to antibiogram with partner prophylaxis. Patient is discharged without any complications. Conclusion: Hematic dissemination by NG is a rare condition, with very non-specific initial symptoms, with low performance of diagnostic tests in this condition, which requires high clinical suspicion, and a very detailed clinical history is of great importance. As in our case, nonspecific symptoms led to ruling out other conditions until isolation in blood cultures leads to a definitive diagnosis. It is a case with unusual clinical presentation

Síndrome de burnout en los neurólogos colombianos: prevalência y factores asociados / Burnout syndrome in Colombian neurologists: prevalence and associated factors

RESUMEN INTRODUCCIÓN: El síndrome de burnout es una condición de prevalência creciente que afecta la calidad de vida y los resultados laborales de quienes lo padecen. OBJETIVO: Describir la prevalencia y factores asociados del síndrome de burnout en neurólogos colombianos. METODOLOGÍA: Mediante encuesta autoadministrada se obtuvo información de 119 neurólogos laboralmente activos en Colombia. Se incluyeron datos correspondientes a variables sociodemográficas junto con la escala Maslasch Burnout Inventory. Para calcular la correlación estadística de variables se utilizó regresión logística. RESULTADOS: El síndrome de burnout se determinó en el 49,6 % de los entrevistados (afectación de 2 o más dimensiones). Esta condición se correlacionó con el sexo femenino (P=0,036), el número de horas trabajadas por semana (P=0,040) y la frecuencia de satisfacción con el trabajo (P<0,001). La práctica de actividades de esparcimiento fue estadísticamente significativa (P=0,024) como factor protector. CONCLUSIÓN: El síndrome de burnout es una condición prevalente en los neurólogos en Colombia. Esta información es útil para la creación de políticas encaminadas a mejorar las condiciones del ejercicio de esta especialidad en nuestro país.

SUMMARY INTRODUCTION: Burnout syndrome is a condition of increasing prevalence that affects quality of life and labor outcomes. OBJECTIVE: To describe the prevalence and factors related to burnout syndrome in Colombian neurologists. METHODOLOGY: By mean of a self-administered survey we obtained information from 119 neurologists currently working in Colombia. Sociodemographic and Maslasch Burnout Inventory data were collected. To calculate statistical correlation of variables related to the syndrome a logistic regression model was used. RESULTS: Burnout syndrome was determined in 49.6% of interviewed neurologists (2 or more affected dimensions).This condition was related to female gender (P=0.036), number of hours worked weekly (P=0.040) and level of work satisfaction (P<0.001). Having a hobby was determined as protector for burnout (P=0.024). CONCLUSION: Burnout syndrome is a prevalent condition in Colombian neurologists. This information should be considered for designing policies directed to better labor conditions for this specialty in our country.

Characterization of Venezuelan patients with systemic sclerosis: a study in a tertiary hospital in Caracas / Caracterización de los pacientes venezolanos con esclerosis sistémica: estudio en un hospital terciario en Caracas

Objective: The aim of the study was to investigate the demographic and clinical characteristics of Venezuelan patients with systemic sclerosis (SSc) seen in a tertiary hospital. Methods: Consecutive patients 18 years and older who fulfilled the 2013 ACR/EULAR classification criteria for SSc and who were followed up in the outpatient clinic of the Division of Rheumatology at the Hospital Universitario de Caracas were selected for the study. Demographic and clinical variables were registered at the time of inclusion using a standard protocol. Results: Forty-eight SSc patients were included; 46 (95.8%) were female; the mean age was 55.1±13.7 (mean±SD) years and all were of Hispanic ethnicity. Thirty-one (64.6%) had limited SSc and 17 (35.4%) had diffuse SSc. The mean duration of disease was 13.4±11.7 (mean±SD) years, 16.74±12.99 years for limited SSc and 7.52±5.25 years for diffuse SSc (p=0.0077). Raynaud's phenomenon was the most frequent manifestation (100%), followed by arthritis (68.8%), telangiectasia (60.4%), dyspnea (60.4%), dysphagia (58.3%) and puffy hands (56.3%). The modified Rodnan Skin Score (mRSS) and the frequency of dyspnea were higher in those with diffuse as compared to limited SSc (p=0.0211 and p=0.0003, respectively). We performed high-resolution computed tomography (HRCT) of the lungs in 31 patients; 14 (45.2%) had evidence of interstitial lung disease (ILD), 11 (68.8%) with diffuse SSc (p=0.0052). The most frequent anti-nuclear antibody pattern was nucleolar, accounting for 18 (42.8%) of the cases. Anti-centromere antibodies were present in 16.7% of the cases and were associated with the limited SSc subset (p=0.0443) and with calcinosis (p=0.0020). Anti-topoisomerase antibodies were associated with ILD (p=0.0077).(AU)

Objetivo: El objetivo de este estudio fue investigar las características demográficas y clínicas de los pacientes venezolanos con esclerosis sistémica (ES) examinados en un hospital terciario. Métodos: Se seleccionaron para el estudio pacientes consecutivos mayores de 18 años, que cumplieron los criterios de la clasificación ACR/EULAR de 2013 para ES, sometidos a seguimiento en la clínica ambulatoria del Departamento de Reumatología del Hospital Universitario de Caracas. Se registraron las variables demográficas y clínicas en el momento de la inclusión, utilizando un protocolo estándar. Resultados: Se incluyó a 48 pacientes con ES, de los cuales 46 (95,8%) eran mujeres; la edad media fue de 55,1±13,7 (media±DE) años, todos ellos de etnia hispana. Treinta y uno de ellos (64,6%) tenían ES limitada y 17 (35,4%) ES difusa. La duración media de la enfermedad fue de 13,4±11,7 (media±DE) años: 16,74±12,99 años para ES limitada y 7,52±5,25 años para ES difusa (p=0,0077). El fenómeno de Raynaud fue la manifestación más frecuente (100%), seguida de la artritis (68,8%), la telangiectasia (60,4%), la disnea (60,4%), la disfagia (58,3%) y la hinchazón de manos (56,3%). La puntuación de la escala cutánea de Rodnan modificada (mRSS) y la frecuencia de la disnea fueron más altas en aquellos sujetos con ES difusa con respecto a los sujetos con ES limitada (p=0,0211 y p=0,0003, respectivamente). Realizamos una TAC de alta resolución pulmonar a 31 pacientes; 14 (45,2%) tenían evidencia de enfermedad pulmonar intersticial (EPI), 11 (68,8%) de ellos con ES difusa (p=0,0052). El patrón más frecuente de anticuerpos anti-nucleares fue de tipo nucleolar, representando 18 (42,8%) de los casos. Los anticuerpos anti-centrómeros estuvieron presentes en el 16,7% de los casos, asociándose al subconjunto de ES limitada (p=0,0443) con calcinosis (p=0,0020). Los anticuerpos anti-topoisomerasa estuvieron asociados a la EPI (p=0,0077).(AU)

Costos del cáncer ocupacional: una scoping review / Costs of occupational cancer: a scoping review

RESUMEN Introducción: la carga debida al cáncer es alta, y además de su impacto en la salud de las personas tiene efectos económicos. Objetivo: identificar los costos asociados al cáncer como resultado de la exposición ocupacional. Métodos: se realizó una scoping review. Para esta se hizo una búsqueda sistemática de acuerdo con la pregunta PECO en las siguientes bases de datos indexadas: Scopus, Web of Science, Embase, Science Direct, Academic Search Complete (EBSCO), BVS y PubMed. Como criterios de elegibilidad de los escritos estaba que se tratara sobre cáncer de origen ocupacional y que mencionara los costos; se seleccionaron 19 artículos. Resultados: entre los estudios se identificaron los países donde se han hecho investigaciones al respecto, el tipo de estudio, los tipos de cáncer, sus costos y métodos de estimación. En cuanto a los costos, se encontraron principalmente trabajos centrados en los costos directos, es decir, los que representan la atención en salud, dejando de lado el análisis de los que son indirectos, es decir los que están relacionados con la pérdida de la productividad. Conclusión: se concluye que se requiere de un abordaje interdisciplinario para el análisis de los costos, con el fin de mejorar la comprensión de estos y particularmente la de los indirectos.

SUMMARY Background: The burden of disease due to cancer is high and has an impact on people's health and economic cost. Objective: Identify the costs associated with occupational cancer. For this purpose, a scoping review was carried out. Methods: First, a systematic search was performed according to the PECO question, we used the following indexed databases: Scopus, Web of Science, Embase, Science Direct, Academic Search Complete (EBSCO), BVS and PubMed. The eligibility criteria were that the study focus in any type of occupational cancer and mention the cost related. After the selection and screening process, 19 articles were included. Results: The studies identified the countries where research has been carried out, the type of study, the types of cancer, the methods of cost estimations and types of cost. In relation with the costs, we mainly found articles focused on direct costs, that is, what health care represents; but there are few studies that included analysis of indirect costs that are related to lost productivity. Conclusion: It is concluded that an interdisciplinary approach to cost analysis is required to improve understanding of costs, particularly indirect costs.

Analysis of body mass index and risk factors of interstitial lung disease in systemic sclerosis patients / Análisis del índice masa corporal y factores de riesgo de neumopatía intersticial en pacientes con esclerosis sistémica

ABSTRACT Objective: To determine the risk factors and the potential relationship between body mass index (BMI) and the development of interstitial lung disease (ILD) in patients with systemic sclerosis. Methods: A cross-sectional, correlational, study with a non-probabilistic sample was conducted on consecutive patients with scleroderma seen in the Rheumatology Division at Hospital Universitario de Caracas during the period April to September 2018. Patients underwent clinical and laboratory assessments, anthropometric measurements, pulmonary function tests, and high-resolution computed axial tomography scan of the chest. Results: Of 48 patients, 95.8% were female, with a high prevalence of limited cutaneous systemic sclerosis (lcSSc) (64.6%). Underweight (BMI<18.5kg/m2) was a risk factor for the development of ILD (OR 4.60; 95% CI 1.12-18.86). There was directly proportional relationship between BMI and forced vital capacity, with no statistical significance (CC 0.23; p = 0.1180). However, other predictors of ILD included diffuse systemic sclerosis (OR 6.91,95% CI; 1.78-26.85), modified Rodnan skin score (mRSS) (OR 1.25; 95% CI; 1.04-1.30), and a speckled pattern of antinuclear antibody (OR 5.62; 95% CI; 1.33-23.62). Multivariate analysis showed that mRSS (OR 1.34; 95% CI; 1.04-1.72) and the presence of a speckled antinuclear antibody (OR 25.99; 95% CI; 1.02-16.02) were independent predictors of ILD. The percentage of BMI lost in a period of time of 2008-2018 was 14.3% (p = 0.0021), which was higher than rheumatoid arthritis (p = 0.0000), systemic lupus erythematosus (p = 0.0025), and healthy patients (p = 0.0331). Conclusion: BMI and ILD are inversely correlated. Age, underweight, higher mRSS, and speckled pattern of antinuclear antibody were risk factors for development of ILD in patients with systemic sclerosis. The mRSS could be used as a clinical predictive tool for ILD in systemic sclerosis.

RESUMEN Objetivo: Determinar los factores de riesgo y la asociación entre el índice de masa corporal (IMC) y enfermedad pulmonar intersticial difusa (EPID) en pacientes con esclerosis sistémica. Métodos: Estudio transversal, correlacional, con muestra no probabilística constituida por pacientes consecutivos con esclerosis sistémica que acudieron al Servicio de Reumatología del Hospital Universitario de Caracas durante el período abril-septiembre de 2018. Se realizó evaluación clínica, paraclínica, mediciones antropométricas, pruebas de función pulmonar y tomografía de tórax de alta resolución. Resultados: De 48 pacientes, el 95,8% fueron del sexo femenino, con mayor prevalencia de esclerosis sistémica limitada (64,6%). Un peso bajo (IMC < 18,5 kg/m2) fue un factor de riesgo de EPID (OR 4,60; IC 95% 1,12-18,86). El IMC se relacionó de forma directamente proporcional con la capacidad vital forzada sin alcanzar significación estadística (CC 0,23; p = 0,1180), sin embargo, otros predictores de EPID fueron: la esclerosis sistémica difusa (OR 6,91; IC 95% 1,78-26,85), el índice modificado de Rodnan (mRSS) (OR 1,25; IC 95% 1,04-1,30) y el patrón moteado de anticuerpos antinucleares (OR 5,62; IC 95% 1,33-23,62). El análisis multi-variado demostró asociación independiente con EPID de: mRSS (OR 1,34; IC 95% 1,04-1,72) y el patrón moteado de anticuerpos antinucleares (OR 25,99; IC 95% 1,02-16,02). El estudio del IMC durante 10 arios (2008-2018) reveló una pérdida de 14,3% (p = 0,0021), que fue mayor en comparación con pacientes con artritis reumatoide (p = 0,0000), lupus eritematoso sistémico (p = 0,0025) e individuos sanos (p = 0,0331). Conclusión: El IMC y la EPID se correlacionan de forma inversamente proporcional. La edad, un bajo peso corporal, un puntaje alto en mRSS y el patrón moteado de anticuerpos antinucleares fueron factores de riesgo para el desarrollo de EPID en pacientes con esclerosis sistémica. El mRSS podría ser utilizado como herramienta clínica predictiva de EPID en esclerosis sistémica.

Incidencia de adenocarcinoma en zona transicional de próstata en institución pública. Cochabamba, Bolivia / Incidence of Adenocarcinoma in Transitional Zone of Prostate in public

El cáncer en la zona de transición representa el 20-25% de los casos (en piezas de prostatectomías radicales), su diagnóstico con frecuencia es de manera incidental, siendo identificados clínicamente como supuestos adenomas. OBJETIVO: determinar la incidencia de Adenocarcinoma en la Zona transicional de Próstata e identificar etapas precancerosas en pacientes con clínica de HPB. MÉTODS: estudio longitudinal de tipo retrospectivo desde el 2013-2018 en la ciudad de Cochabamba-Bolivia; población de estudio: pacientes sometidos a prostatectomía simple, retropúbica y/o transvesical. Recolección de datos: a partir de historias clínicas, en pacientes con clínica de hiperplasia benigna de próstata y PSA total < 4 ng/ml. RESULTADOS: se identificó 76 pacientes, de los cuales; 5 pacientes resultaron con Adenocarcinoma y 9 pacientes con: Neoplasia Intraepitelial Prostática de Alto Grado 2,6 %, Proliferación acinar pequeña atípica 7,9%, representando así un 10,5%. En cuanto a la invasión representaron un 5,3% con invasión perineal, 2,6% invasión linfovascular y ninguno con invasión extravascular. DISCUSIÓN: pacientes con cáncer de próstata zona transicional, presentan un Antígeno prostático específico alto susceptibles a Adenocarcinoma. Sin embargo, en esta investigación se encontró Adenocarcinoma de próstata de alto riesgo con Antígeno prostático específico total menor a 4 ng/ml. A pesar de los instrumentos clínicos e indicaciones para la decisión de terapia quirúrgica de una supuesta hiperplasia prostática benigna, existe en el estudio una incidencia del 6,5% de Adenocarcinoma en Zona Transicional, con un 10,5 % de incidencia de presentación de formas precancerosas y el 17,1% de los pacientes del estudio se encuentran en riesgo de letalidad de la enfermedad.

Cancer in the transition zone represents 20-25% of cases, its diagnosis is often incidental, being identified clinically as suspected adenomas. OBJECTIVE: to determine the incidence of adenocarcinoma in the transitional Prostate Zone and identify the degree of adenocarcinoma and precancerous stages thereof. METHODS: longitudinal retrospective study from 2013-2018 in the city of Cochabamba-Bolivia; Study population: patients undergoing simple, retropubic and / or transvesical prostatectomy. Data collection: from medical records, in patients with benign prostatic hyperplasia and who have no atypia and neoplasms. RESULTS: 76 patients were identified, of which; 5 patients resulted with adenocarcinoma and 9 patients among: High Grade Prostatic Intraepithelial Neoplasia 2.6%, small atypical acinar proliferation 7.9%, thus representing 10.5%. As for the invasion, they represented 5.3% with perineal invasion, 2.6% lymphovascular invasion and none with extravascular invasion. DISCUSSION: Patients with transitional prostate cancer have a high specific prostate antigen susceptible to adenocarcinoma. However, this investigation found high-risk prostate adenocarcinoma with total prostate antigen total less than 4 ng / ml. Despite the clinical instruments and indications for the decision of surgical therapy of an alleged benign prostatic hyperplasia, there is a 6.5% incidence of adenocarcinoma in the Transitional Area, with a 10.5% incidence of presentation of forms of Proliferation of Atypical Small Acini and 17.1% of the patients in the study are at risk of lethality of the disease.

Evaluación de condiciones de extracción asistida por ultrasonido de compuestos bioactivos de cáscara de pitahaya amarilla / Evaluation of conditions of ultrasound assisted extraction of yellow pitahaya peel bioactive compounds / Avaliação das condições da extração com ultrassom dos compostos bioactivos da casca da pitaia amarela

Resumen Introducción: la extracción de los polifenoles ha tomado un interés debido a la relación que tiene con la prevención del estrés oxidativo y efectos benéficos sobre la salud en la prevención de enfermedades no transmisibles; estos están comúnmente en algunas frutas por lo que su extracción se ha convertido en una tendencia para obtener productos de alto valor agregado. El ultrasonido es una técnica que puede disminuir el tiempo de extracción de estos biocomponentes. Objetivo: evaluar las condiciones de la extracción asistida por ultrasonido de polifenoles con actividad antioxidantes en cáscara de pitahaya amarilla deshidratada. Materiales y métodos: Se deshidrataron las cáscaras y construyó cinéticas de secado a 60°C, con el fin de disminuir las reacciones de deterioro. Para la extracción, una solución de etanol al 96% (V/V) fue usada como disolvente, en una relación cáscara-disolvente 1:1. El proceso fue realizado a 25 °C en un sistema de ultrasonido indirecto con una frecuencia de 37 kHz. Se usó un diseño central compuesto, fueron evaluados el efecto de la potencia (40 - 80%) y tiempo de sonicación (11,90 - 33,10 minutos). Se hizo extracción con el método soxhlet (control). Los polifenoles totales y capacidad antioxidantes fue determinado por lo métodos Folin-Ciocalteau y ABTS respectivamente. Resultados: Bajos tiempos y altas potencias de sonicación fueron asociados con incremento en la extracción de polifenoles y capacidad antioxidante. En particular, la extracción asistida con ultrasonido con 60% de potencia y 11 minutos, se obtuvo un 77% más de polifenoles que 24 horas de proceso con método Soxhlet. Conclusión: El ultrasonido tiene potencial en comparación con la técnica tradicional para reducir el tiempo de procesamiento en extracción de biocomponentes, en este caso aprovechar la cáscara de pitahaya amarilla que es considerada como un residuo, se encontraron concentraciones de polifenoles de 973,10 mg/L que pueden ser extraídos por ultrasonido a 222 W de potencia nominal (60%), 35kHz de frecuencia y 22 minutos y con una capacidad antioxidante superior al 90%.

Abstract Introduction: the extraction of polyphenols has taken an interest due to the relationship it has with the prevention of oxidative stress and beneficial effects on health in the prevention of non-communicable diseases. These are commonly found in some fruits, so their extraction has become a trend to obtain products with high added value. Ultrasound is a technique that can decrease the extraction time of these biocomponents. Objective: the main objective of this work was to evaluate the conditions of the ultrasound-assisted extraction of polyphenols with antioxidant activity in dehydrated peel yellow pitahaya. Materials and methods: the kinectis drying was made at 60 °C, in order to decrease deterioration reactions. For the extraction, a solution of 96% ethanol (V / V) was used as disolvent; the ratio Peel-Disolvent was 1:1. The process was performed at 25 °C and 37 kHz frequency. A central composite design was used, in which the effect of power (40 - 80%) and ultrasonication time (11.90 -33.10 minutes) were evaluated. One control point was evaluated with Soxhlet extraction. The extracted amount of polyphenols and antioxidant capacity was determined by Folin-Ciocalteau and ABTS methods, respectively. Results: lower time exposures and higher sonication power were associated with increases in polyphenols and antioxidant capacity. In particular, ultrasound-assisted extraction in 60% power and 11 min, obtained 77% more polyphenols than 24-h standard method (Soxhlet). Conclusion: Ultrasound has potential compared to the traditional technique to reduce the processing time in biocomponent extraction, in this case taking advantage of the yellow pitahaya peel that is considered as a residue, polyphenol concentrations of 973.10 mg / L were found that They can be extracted by ultrasound at 222 W nominal power (60%), 35kHz frequency and 22 minutes and with an antioxidant capacity of over 90%.

Resumo Introdução: Muita atenção tem o efeito benéfico dos polifenóis e antioxidantes na obesidade relacionada ao estresse oxidativo. O ultra-som é uma técnica que pode diminuir o tempo de extração desses biocompostos. A extração de polifenóis interessou-se pela relação que tem com a prevenção do estresse oxidativo e efeitos benéficos à saúde na prevenção de doenças não transmissíveis; como são comumente encontradas em algumas frutas, sua extração tornou-se uma tendência para obter produtos com alto valor agregado. O ultrassom é uma técnica que pode diminuir o tempo de extração desses biocomponentes. Objetivo: foi avaliar as condições da extração assistida por ultrassom de polifenóis com atividade antioxidante em pitaia amarela desidratada. Materiais e métodos: as cascas foram desidratadas e construídas cinéticas de secagem a 60 °C, a fim de diminuir as reações de deterioração. Para extração, utilizou-se uma solução de etanol 96% (V/V) como dissolvente, numa proporção escudo-dissolvente 1:1. O processo foi feito a 25°C e uma frequência de 37 kHz. Foi utilizado μM projeto central composto, avaliando-se o efeito da potência (40-80%) e do tempo de sonificação (11,9-33,1 minutos). A extração foi feita com o método soxhlet (controle). A quantidade de polifenóis e capacidade antioxidantes extraídos foi determinada pelos métodos Folin-Ciocalteau e ABTS, respectivamente. Resultados: os tempos baixos e as altas potências de sonicação foram associados com aumento da extração de polifenóis e antioxidantes. Em particular, a extração assistida com ultra-som ao 60% de potência e 11 minutos, 77% a mais de polifenóis foram obtidos a 24 horas do método soxhlet. Conclusão: Ultra-som tem o potencial comparado à técnica tradicional de reduzir o tempo de processamento na extração de biocomponentes, neste caso, aproveitando a casca de pitaiaiás amarela que é considerada μM resíduo, foram encontradas concentrações de polifenóis de 973,10 mg / L que. Eles podem ser extraídos por ultrassom a 222 W de potência nominal (60%), frequência de 35kHz e 22 minutos e com uma capacidade antioxidante acima de 90%..