Gurvits syndrome in diabetic ketoacidosis.

Gurvits syndrome, black esophagus or acute esophageal necrosis (AEN) is a rare and multifactorial disorder resulting from a combination of ischemic insult, corrosive injury of the mucosa from gastric contents, and impaired reparative mechanism in the setting of acute illness. The diagnosis is made by visualization of a circumferential black discoloration of the distal oesophagus that abruptly ends at the gastroesophageal junction. We report a case of Gurvits syndrome secondary to diabetic ketoacidosis (DKA).

An unusual cause of anemia: Bean syndrome.

Bean syndrome or blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by venous malformations (VM) of the skin, soft tissues and visceral organs, most frequently affecting the gastrointestinal (GI) tract. BRBNS is mainly sporadic but can be inherited in an autosomal pattern. The most common symptoms are GI bleeding and secondary iron deficiency anemia. Treatment is largely symptomatic.

Image-Guided Radiation Therapy for Squamous Cell Cancer of the Head and Neck in a Specialized Peruvian Public Hospital.

Squamous cell cancer of the head and neck (SCCHN) often requires adjuvant radiotherapy. Radiotherapy for SCCHN is a challenge because the head and neck contain several critical organs that should receive minimal doses of radiation. These organs include the eyes, parotid glands, brainstem, spinal cord, mandible, and thyroid gland. Approaches like image-guided radiotherapy (IGRT) combined with volumetric modulated arc therapy hold the promise to focus radiation to the planning target volume and spare nearby structures while observing potential changes to patient anatomy during treatment to determine whether replanning is required. IGRT, however, requires the frequent imaging of patients to update the treatment plan. In this retrospective study, we present our findings of SCCHN patients treated in a public hospital in Peru. The patients reflected overall demographic trends associated with SCCHN. Each patient was imaged using computed tomography once before radiotherapy and once by cone-beam computed tomography (CBCT) during treatment, for a total of two images. Tumor displacement, planning target volume, gross tumor volume, and neck diameter were compared between the two images. Among the measurements, only a small statistically significant increase in gross tumor volume was observed between the images. However, a minority of patients did experience changes to anatomy, which highlights the need for continued research into criteria to determine which patients are likely to benefit from treatment replanning due to intra-treatment anatomical changes. Alternatively, a lack of frequent CBCT imaging before each session, due to high patient flows and limited staff resources, made it difficult to observe transient changes and trends in each patient. We conclude that the treatment and outcome improvements associated with IGRT are likely associated with frequent imaging during radiotherapy and properly selecting which patients will benefit most from this resource-intensive technique.

Adaptation of international coronavirus disease 2019 and breast cancer guidelines to local context.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (a novel coronavirus), which was first identified amid an outbreak of respiratory illness cases in Wuhan, China and declared a global health emergency, is currently considered an additional challenge in the management of patients with breast cancer (BC). Cancer patients are more vulnerable to becoming infected with severe acute respiratory syndrome coronavirus 2 and are more likely to suffer additional complications that can increase mortality. Identifying those BC patients who require more urgent therapy than others in the current situation is essential. These recommendations are based on and have been adapted from those similarly published by international scientific societies for BC management. They are divided mainly by clinical stage (early, advanced), subtype [luminal, human epidermal growth factor receptor 2 (HER2), triple-negative], or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes are similar, whereas in luminal subtype there are various options of management. The objective is to adapt guidelines to local context through relevant decision-makers, avoiding duplication of efforts and optimizing use or resources. We hope that these recommendations will help medical oncologists provide the best quality care to BC patients during the COVID-19 pandemic with information tailored to our healthcare system. AIM: To establish and adapt recommendations from those published by international scientific societies for BC management. METHODS: The Peruvian Society of Medical Oncology developed a consensus and propose here a manuscript with recommendations for oncological medical treatment of BC during the COVID-19 pandemic. The Peruvian Society of Medical Oncology invited a panel of experts and opinion leaders on BC working in major health care systems around Peru. Panel experts selected three international clinical practice guidelines (National Comprehensive Cancer Network, European Society for Medical Oncology, Spanish Foundation Research Group in Breast Cancer), considering that these are more representative in COVID-19 management. Also, the panel agreed to include at least one European and American clinical practice guideline. RESULTS: Recommendations about BC management during the COVID-19 pandemic were divided mainly by clinical stage (early, advanced), subtype (luminal, HER2, triple-negative), or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes were similar between clinical practice guidelines, whereas in luminal subtype there were various options of management. One hundred twelve recommendations were reviewed, adapted, and voted. A consensus was made in order to provide best decisions of management, avoid duplication of efforts, and optimize medical resources, considering health care system reality. These recommendations are not intended to replace clinical judgment. CONCLUSION: Most of recommendations are similar, mainly in high-risk subtypes (HER2, triple-negative). Certain societies adapt them to deal with different situations involving the best decision in the management of BC patients.

Acesulfame potassium: Its ecotoxicity measured through oxidative stress biomarkers in common carp (Cyprinus carpio).

Acesulfame potassium (ACS) is a widely-used sweetener worldwide. Its presence has been demonstrated in diverse bodies of water. However, the deleterious effects this causes in aquatic organisms has not yet been identified, which generates controversy concerning the risks that ACS represents after its disposal into the bodies of water. Thus, the objective of this work was to evaluate if the exposure of ACS in environmentally-relevant concentrations was capable of producing oxidative stress in blood, liver, gill, brain and muscle of common carp (Cyprinus carpio). With this finality, the carp were exposed to two environmentally-relevant concentrations (0.05 and 149 µg L-1) at different exposure times (12, 24, 48, 72 and 96 h), having controls in the same conditions for each exposure time. Posteriorly, the following biomarkers of damage were evaluated: hydroperoxide content (HPC), level of lipoperoxidation (LPX) and protein carbonyl content (PCC), as well as the activity of antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT). The results showed that ACS produces significant increase in damage biomarkers evaluated in all organs, mainly in gill, brain and muscle, as well as significant changes in the activity of antioxidant enzymes in the same organs. Thus, it is concluded that ACS is capable of producing oxidative stress in common carp (Cyprinus carpio).

A New Binucleating Ligand Based on Anthracene and Its Cofacial Dirhodium(I) and Diiridium(I) Complexes.

A new bis(beta-keto enamine) ligand (2a, ABIH(2)) containing a 1,8-anthracenediyl bridging group has been synthesized by a four-step procedure that relies on the Pd-catalyzed cross-coupling between (3,5-dimethylisoxazol-4-yl)trialkyltin and 1,8-dibromoanthraquinone or -anthracene. The molecular structures of the 1,8-bis(3,5-dimethylisoxazol-4-yl)anthraquinone (8) and -anthracene (10) intermediates were determined by X-ray analysis. Crystal data for 8: orthorhombic, space group Pbca; a = 14.351 (2), b = 11.932 (1), c = 23.278 (2) Å; V = 3986 (1) Å(3); Z = 8; R = 0.057 for 2615 reflections. Crystal data for 10: orthorhombic, space group P2(1)2(1)2(1); a = 7.104 (1), b = 12.805 (1), c = 22.280 (2) Å; V = 2026.7 (6) Å(3); Z = 4; R = 0.066 for 3423 reflections. The rigid ABIH(2) ligand, whose chelating moieties are constrained to be cofacial, allows the preparation of a new family of cofacial bimetallic complexes (ABI)[ML(2)](2) with controllable environments around the metal centers. Two novel cofacial binuclear complexes 4 and 5, with ML(2) = dicarbonylrhodium(I) and (eta(4)-1,5-cyclooctadiene)iridium(I), have been synthesized by reaction of ABIH(2) with [(&mgr;-Cl)Rh(CO)(2)](2) and [(&mgr;-Cl)Ir(COD)](2), respectively. NMR data indicate the formation of meso and racemic atropisomers for 2a, 4, and 5.

Radioterapia paliativa a dosis masiva en cáncer avanzado irresecable de cabeza y cuello / Palliative radiation therapy at massive dose in unresectable advanced head and neck cancer

Se presentan 02 pacientes con cáncer de cabeza y cuello localmente avanzado e irresecable que fueron admitidos en el Instituto Nacional de Enfermedades Neoplásicas; el primero con el diagnóstico histológico de carcinoma epidermoide y el segundo con sarcoma fusocelular. A ambos pacientes se les brindo tratamiento con radioterapia externa en dosis masiva de 10Gy/sesión/mes, obteniendo como resultado una marcada disminución del volumen tumoral y con ello una mejora de la calidad de vida según lo referido por los pacientes. Se optó por este esquema de tratamiento por lo avanzado de la enfermedad, alto riesgo de pérdida de vista e intención paliativa. (AU)

We present 02 patients with head and neck cancer, locally advanced, unresectable who were admitted to the National Institute of Neoplastic Diseases, the first with the histological diagnosis of squamous cell carcinoma and spindle cell sarcoma second. Both patients were provided with external radiotherapy 10Gy/sesión/mes massive doses, resulting in a marked decrease in tumor volume and thereby improving the quality of life as reported by patients. We chose this treatment schedule so advanced disease, high risk of vision loss and palliative intent.(AU)

Prevalencia de infección por parásitos intestinales en escolares de primaria de Santiago de Surco, Lima, Perú / Prevalence of intestinal parasitic infection in primary schoolchildren of Santiago de Surco, Lima, Peru

In Peru, parasitoses of digestive gut has been widely studied, because they are a very frequent problem in Public Health. These diseases of nature infectiose-parasitarie can affect growth and development of schoolchildren. The aim of current research was to determinate prevalence of infection of enteroparasites in primary schoolchildren of three national schools of an urban zone from Santiago de Surco district, Lima, Peru between 2004 and 2005. A coproparasitological survey to 192 children in fresh faeces fixed in 10% formaline, previous homogenization employing conventional exams by direct microscopy dyed with lugol, and by spontaneous Tube Sedimentation technique were performed. In addition, eggs of Enterobius vermicularis employing Graham technique were searched. Twelve pathogen enteroparasites or commensals were diagnosed: Giardia duodenalis (4.7%), Chilomastix mesnilii (0.5%), Entamoeba coli (22.9%), Endolimax nana (19.3%), Iodamoeba butschlii (3.1%), Blastocystis hominis (12.5%), Hymenolepis nana (1.0%), Hymenolepis diminuta (0.5%), Ancylostoma duodenale - Necator americanus (1.6%), Trichuris trichiura (0.5%), Ascaris lumbricoides (1.6%), and E. vermicularis (10.4%). Total prevalence of infection, polyparasitism, helminth infection, and protozoan infection were 54.7%, 18.2%, 14.6% and 47.4%, respectively. PCA, showed in PC1, helminths are more relationed with presence of domestic animals, and in PC2, patogenic protozoan with absence of drinking water and sewage services, and with absence of animals in houses. Programs of sanitary and environmental education of coproparasites should be improved and implemented in Lima, Peru.

Migraña en el Perú: a propósito de una serie de casos / Hemicrania in Peru: with regard to a series of cases

El presente artículo describe las características clínicas de una serie de pacientes peruanos dentro de un estudio clínico multicéntrico internacional, al momento de presentación en el consultorio externo con cuadro de migraña aguda. Resultados: 93 pacientes con cuadro de migraña aguda moderada (53 por ciento) a severa (47 por ciento) fueron evaluados, la edad promedio fue de 36.7 años, 86 por ciento fueron de sexo femenino. El 90 por ciento de pacientes no presentó aura durante el ataque de migraña, y los síntomas acompañantes de la migraña fueron fotofobia, fonofobia, naúseas y vomitos en 56, 56, 51 y 8 por ciento respectivamente. Se apreció incapacidad funcional de grado leve moderada y severa durante la fase aguda de la migraña en un 38.7, 38.7 y 19.3 por ciento respectivamente. Conclusiones: Se presenta las características clínicas de los cuadros de migraña aguda en una serie de pacientes peruanos dentro de un estudio clínico internacional. Durante el cuadro agudo se vió un marcado grado de incapacidad funcional.