Evaluation of serological lateral flow assays for severe acute respiratory syndrome coronavirus-2.

BACKGROUND: COVID-19 has resulted in significant morbidity and mortality worldwide. Lateral flow assays can detect anti-Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibodies to monitor transmission. However, standardized evaluation of their accuracy and tools to aid in interpreting results are needed. METHODS: We evaluated 20 IgG and IgM assays selected from available tests in April 2020. We evaluated the assays' performance using 56 pre-pandemic negative and 56 SARS-CoV-2-positive plasma samples, collected 10-40 days after symptom onset, confirmed by a molecular test and analyzed by an ultra-sensitive immunoassay. Finally, we developed a user-friendly web app to extrapolate the positive predictive values based on their accuracy and local prevalence. RESULTS: Combined IgG + IgM sensitivities ranged from 33.9 to 94.6%, while combined specificities ranged from 92.6 to 100%. The highest sensitivities were detected in Lumiquick for IgG (98.2%), BioHit for both IgM (96.4%), and combined IgG + IgM sensitivity (94.6%). Furthermore, 11 LFAs and 8 LFAs showed perfect specificity for IgG and IgM, respectively, with 15 LFAs showing perfect combined IgG + IgM specificity. Lumiquick had the lowest estimated limit-of-detection (LOD) (0.1 µg/mL), followed by a similar LOD of 1.5 µg/mL for CareHealth, Cellex, KHB, and Vivachek. CONCLUSION: We provide a public resource of the accuracy of select lateral flow assays with potential for home testing. The cost-effectiveness, scalable manufacturing process, and suitability for self-testing makes LFAs an attractive option for monitoring disease prevalence and assessing vaccine responsiveness. Our web tool provides an easy-to-use interface to demonstrate the impact of prevalence and test accuracy on the positive predictive values.

Comparison of shear wave elastography (supersonic) with liver biopsy in a cohort of patients from a medium-income country: an observational study.

INTRODUCTION: shear-wave elastography is a non-invasive diagnostic test that calculates the degree of liver fibrosis by measuring liver elasticity. This technique was recently introduced in Colombia. Thus, cutoff points delineating the change between fibrosis stages (using the Metavir scale) have not been previously defined in our patient population. PATIENTS AND METHODS: a retrospective study was performed of patients who had undergone two-dimensional shear-wave elastography (2D-SWE) and liver biopsy (LB) between June 2010 and June 2018 at a private outpatient hepatology center in Bogota, Colombia. We used a training dataset (subjects with time between biopsy and 2D-SWE of ≤ 6 months) to establish diagnostic cutoff values and a test dataset (subjects with time between biopsy and 2D-SWE of > 6 months) to validate our results. RESULTS: a total of 453 subjects (training dataset, n = 153; test dataset, n = 300) were included. In the training dataset, the cutoff points were 7.6, 8.4, 9.5 and 10.9 kPa, and the areas under the curve were 0.75, 0.83, 0.89 and 0.94 for mild fibrosis, significant fibrosis, advanced fibrosis and cirrhosis, respectively. In the test dataset, the areas under the curve were 0.77, 0.78, 0.83 and 0.89 for mild fibrosis, significant fibrosis, advanced fibrosis, and cirrhosis, respectively. CONCLUSION: two-dimensional shear-wave elastography was reliable and useful for the non-invasive evaluation of liver fibrosis, particularly in patients with advanced fibrosis and cirrhosis. Cutoff points for fibrosis in a Hispanic population were described.

Aquaporin-4 IgG seropositivity is associated with worse visual outcomes after optic neuritis than MOG-IgG seropositivity and multiple sclerosis, independent of macular ganglion cell layer thinning.

BACKGROUND: Comparative studies of characteristics of optic neuritis (ON) associated with myelin oligodendrocyte glycoprotein-IgG (MOG-ON) and aquaporin-4-IgG (AQP4-ON) seropositivity are limited. OBJECTIVE: To compare visual and optical coherence tomography (OCT) measures following AQP4-ON, MOG-ON, and multiple sclerosis associated ON (MS-ON). METHODS: In this cross-sectional study, 48 AQP4-ON, 16 MOG-ON, 40 MS-ON, and 31 healthy control participants underwent monocular letter-acuity assessment and spectral-domain OCT. Eyes with a history of ON >3 months prior to evaluation were analyzed. RESULTS: AQP4-ON eyes exhibited worse high-contrast letter acuity (HCLA) compared to MOG-ON (-22.3 ± 3.9 letters; p < 0.001) and MS-ON eyes (-21.7 ± 4.0 letters; p < 0.001). Macular ganglion cell + inner plexiform layer (GCIPL) thickness was lower, as compared to MS-ON, in AQP4-ON (-9.1 ± 2.0 µm; p < 0.001) and MOG-ON (-7.6 ± 2.2 µm; p = 0.001) eyes. Lower GCIPL thickness was associated with worse HCLA in AQP4-ON (-16.5 ± 1.5 letters per 10 µm decrease; p < 0.001) and MS-ON eyes (-8.5 ± 2.3 letters per 10 µm decrease; p < 0.001), but not in MOG-ON eyes (-5.2 ± 3.8 letters per 10 µm decrease; p = 0.17), and these relationships differed between the AQP4-ON and other ON groups (p < 0.01 for interaction). CONCLUSION: AQP4-IgG seropositivity is associated with worse visual outcomes after ON compared with MOG-ON and MS-ON, even with similar severity of macular GCIPL thinning.

MOG antibody-associated encephalomyelitis/encephalitis.

Myelin oligodendrocyte glycoprotein (MOG) antibody disease is a rare autoimmune disorder with antibodies against the MOG predominantly involving the optic nerve and spinal cord leading to vision loss and paralysis. When MOG antibody disease involves the brain, the phenotype is similar to acute disseminated encephalomyelitis (ADEM). In this review, we discuss MOG-positive cases presenting with encephalitis, encephalopathy, or ADEM-like presentation based on recently published series.

A point-of-care diagnostic test for aquaporin-4 antibody seropositive neuromyelitis optica.

BACKGROUND: Given the need for specialized laboratory techniques, diagnostic testing for serum antibodies to aquaporin-4, a protein associated with neuromyelitis optica spectrum disorder (NMOSD), is not globally accessible. We aimed to evaluate a novel point-of-care, filter paper-based test for serum AQP4 antibodies (AQP4-Ab). METHODS: Adults with AQP4-Ab seropositive NMOSD and seronegative controls (with other central nervous system demyelinating diagnoses) used lancets to place blood drops (∼1 mL) on filter paper cards. Samples were analyzed after an average of 9.4 days using transfected AQP4-GFP HEK293 cells, and results were compared to participants' prior serum AQP4-Ab test results by blinded laboratory staff. RESULTS: Of 40 participants (mean age 53.7 years; 83% female), 25 were cases and 15 were controls. The most common diagnosis of controls was multiple sclerosis (73%). The average NMOSD disease duration was 6.3 years. All AQP4-Ab seropositive participants were on disease modifying therapies at the time of participation. The point-of-care test yielded a sensitivity of 80% and specificity of 93% (positive and negative predictive values 95% and 74%). CONCLUSION: This point-of-care AQP4-Ab testing method may become a pragmatic option to diagnose AQP4-Ab seropositive NMOSD in difficult-to-reach settings. This method should be confirmed with other testing parameters and field tested in new populations.

TAFRO syndrome, variant of Castleman's disease: case report. / Síndrome TAFRO, variante de la enfermedad de Castleman: reporte de caso.

INTRODUCTION: Multicentric Castleman's disease is a rare benign lymphoproliferative disorder that involves multiple enlarged lymph nodes in different areas of the body. Recently, a unique clinic pathological variant of this disease called TAFRO syndrome has been described. CASE REPORT: A 23-year-old male with a history of one year and six months of evolution characterized by generalized lymphadenopathy with, night diaphoresis, dyspnea and weight loss. At the third month, hypertension was diagnosed and 8 months later type 2 diabetes mellitus. After his admission, microcytic anemia, thrombocytopenia, renal dysfunction, pleural effusion and ascites were documented. Based on the findings of the physical examination, a computed tomography scan was performed, where multiple lymph nodes and hepatosplenomegaly were identified. A lymph node biopsy was performed, which reported Castleman's disease, considering then a diagnosis of TAFRO syndrome due to its association with thrombocytopenia, microcytic anemia, anasarca, fever, renal dysfunction, adenomegaly and hepatosplenomegaly. CONCLUSIONS: There are still doubts about whether it corresponds to a different disease or a subtype of the Castleman disease. It is more frequent in women, occurs in the middle-aged and elderly and given its heterogeneous presentation, it usually represents a diagnostic challenge. Although its management is not standardized, therapeutic options include immunosuppressant such as steroids, cyclosporine, rituximab and anti-IL6.

INTRODUCCIÓN: La enfermedad de Castleman multicéntrica es un raro trastorno linfoproliferativo benigno que compromete múltiples nódulos linfáticos agrandados en distintas zonas del cuerpo. Se ha descrito una variante clinicopatológica única de esta enfermedad, denominada síndrome TAFRO. CASO CLÍNICO: Varón de 23 años con un cuadro de 1 año y 6 meses de evolución caracterizado por adenopatías generalizadas, diaforesis nocturna, disnea y pérdida de peso. Al tercer mes se diagnosticó hipertensión arterial, y 8 meses después, diabetes mellitus tipo 2. Tras su ingreso se documentó anemia microcítica, trombocitopenia, disfunción renal, derrame pleural y ascitis. Por los hallazgos de la exploración física, se realizó tomografía computarizada, que identificó múltiples adenomegalias y hepatoesplenomegalia. Se realizó biopsia de ganglio linfático, cuyo reporte informó enfermedad de Castleman, considerándose entonces el diagnóstico de síndrome TAFRO por su asociación con trombocitopenia, anemia microcítica, anasarca, fiebre, disfunción renal, adenomegalias y hepatoesplenomegalia. CONCLUSIONES: Aún existen dudas sobre si el síndrome TAFRO corresponde a una enfermedad diferente o a un subtipo de la enfermedad Castleman. Es más frecuente en mujeres y en personas de mediana edad o ancianas, y dada su presentación heterogénea suele representar un reto diagnóstico. Aunque su manejo no se encuentra estandarizado, las opciones terapéuticas incluyen inmunosupresores como esteroides, ciclosporina, rituximab y anti-IL6.

[Case fatality rate-related factors in patients with bacteremia hospitalized due medical conditions in an institution of third level in Colombia, 2014-2016]. / Factores relacionados con letalidad en pacientes con bacteriemia hospitalizados por patología médica en una institución de tercer nivel en Colombia, 2014-2016.

BACKGROUND: Bloodstream infections are an increasing problem and currently represent a threat to public health, overcoming diseases such as HIV. Bacteremia accounts for approximately 15% of all nosocomial infections and affects 1% of all hospitalized patients. AIM: To describe the clinical, epidemiological and microbiological characteristic of episodes of nosocomial bacteremia occurring in a Colombian hospital. METHODS: Retrospective, observational, cross-sectional study including adult patients, hospitalized in the internal medicine unit at the University Hospital of Santander, Bucaramanga, Colombia, during years 2014 to 2016, who met the criteria of the CDC for bloodstream infection. The protocol was approved by the Hospital Ethics Committee and by the Research Ethics Committee of the Industrial University of Santander. RESULTS: We reviewed 450 clinical records with 148 patients and 182 microbiological isolates. 53% were male. The most frequent comorbidities were: high blood pressure (46.6%), HIV infection (29.7%). The vascular and urinary systems were the most frequent anatomical sites as the source of the infection (respectively 37.3% and 38.3%). Case fatality rate was 29%. The pathogens most frequently isolated were: Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa (globally: 49.8%) and Staphylococcus aureus 12.1%. The multivariate analysis showed a relationship between anemia and in-hospital mortality (OR = 17.3, 95%CI 2.95-102.0). CONCLUSIONS: Bacteremia is a frequent infection during hospital care that presents high mortality. It is noteworthy the predominance of Enterobacteriaceae isolates with broad profiles of resistance. The history of HIV infection is one of the most frequent which deserves to be evaluated as a risk group.

Treatment of MOG-IgG-associated disorder with rituximab: An international study of 121 patients.

OBJECTIVE: To assess the effect of anti-CD20 B-cell depletion with rituximab (RTX) on relapse rates in myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD). METHODS: Retrospective review of RTX-treated MOGAD patients from 29 centres in 13 countries. The primary outcome measure was change in relapse rate after starting rituximab (Poisson regression model). RESULTS: Data on 121 patients were analysed, including 30 (24.8%) children. Twenty/121 (16.5%) were treated after one attack, of whom 14/20 (70.0%) remained relapse-free after median (IQR) 11.2 (6.3-14.1) months. The remainder (101/121, 83.5%) were treated after two or more attacks, of whom 53/101 (52.5%) remained relapse-free after median 12.1 (6.3-24.9) months. In this 'relapsing group', relapse rate declined by 37% (95%CI=19-52%, p<0.001) overall, 63% (95%CI=35-79%, p = 0.001) when RTX was used first line (n = 47), and 26% (95%CI=2-44%, p = 0.038) when used after other steroid-sparing immunotherapies (n = 54). Predicted 1-year and 2-year relapse-free survival was 79% and 55% for first-line RTX therapy, and 38% and 18% for second-/third-line therapy. Circulating CD19+B-cells were suppressed to <1% of total circulating lymphocyte population at the time of 45/57 (78.9%) relapses. CONCLUSION: RTX reduced relapse rates in MOGAD. However, many patients continued to relapse despite apparent B-cell depletion. Prospective controlled studies are needed to validate these results.

Clinical characteristics of myelin oligodendrocyte glycoprotein antibody neuromyelitis optica spectrum disorder.

BACKGROUND: Serological antibodies against myelin oligodendrocyte glycoprotein (MOG) are associated with a relapsing autoimmune demyelinating disease of the central nervous system. Initially identified in the context of acute disseminated encephalomyelitis, persistent seropositivity of MOG antibodies is now recognized as a variant of neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVES: The aim of the study is to describe the epidemiological and clinical features of MOG antibody positive cases and compare our findings with those previously published. METHODS: This is a retrospective descriptive study of 23 patients with MOG antibody disease who were cared for at Johns Hopkins Hospital over the period from 2015 to 2018. MOG testing was done at Johns Hopkins using the cell based assay (CBA). We describe their epidemiological and clinical features. RESULTS: Twenty-three patients were included in the study with a female to male ratio of 2.3:1. The mean age of the cohort was 42.6 years, while the mean age at onset was 37 years. The most frequent initial presentation was optic neuritis, followed by ADEM-like encephalopathic clinical picture and transverse myelitis. Five patients showed a monophasic disease course while the rest experienced a relapsing phenotype. Nine patients (39%) experienced immediate relapses on withdrawal of steroids. CONCLUSIONS: Our cohort showed clinical characteristics comparable with previously published reports of MOG antibody disease worldwide. Unique features of MOG antibody disease are: high frequency of optic neuritis attacks, good long term neurological recovery and sensitivity to steroid use and withdrawal.

Investigational drugs in development to prevent neuromyelitis optica relapses.

INTRODUCTION: In the short time since 2014, three pivotal, worldwide studies in neuromyelitis optica spectrum disorders have been launched: eculizumab, SA237 and inebelizumab, each based on a unique mechanism. AREAS COVERED: In this review, we provide a discussion on the trial data available for each drug, a brief description of the trial design, and our expert opinion on the potential benefits and risks. EXPERT OPINION: Eculizumab, a C5 complement inhibitor, may prove useful in the treatment of intractable cases of NMOSD, but physicians must be aware of the known risk of meningococcal infection. SA237, an interleukin-6 receptor blocker, may be effective at reducing relapse risk, and also has the potential to reduce neuropathic pain in NMOSD. Inebelizumab, a B cell depleting agent, has never been tested in NMOSD, but based on extensive evidence of efficacy with B cell depletion using rituximab, inebelizumab is expected to work at least as well.

MOG antibody disease: A review of MOG antibody seropositive neuromyelitis optica spectrum disorder.

MOG antibody disease is an autoimmune disease of the central nervous system associated with a serological antibody against MOG, myelin oligodendrocyte glycoprotein. MOG is a glycoprotein expressed on the outer membrane of myelin and solely found within the central nervous system, including in the brain, optic nerves and spinal cord. Clinically, the disease resembles neuromyelitis optica spectrum disorders in the predilection for relapses of optic neuritis and transverse myelitis. In addition, acute disseminated encephalomyelitis (ADEM) is a well-recognized phenotype of MOG antibody disease in children. In recent studies around the world where MOG testing is available, up to 42% of NMOSD patients who test seronegative for the AQP4 antibody test positive for MOG antibodies. MOG antibody disease has thus recently emerged as a distinct entity carved out of the patient population diagnosed with NMOSD. In this review, we examine the history of the MOG antibody and its relevance to demyelinating disease, as well as compare the clinical, radiographic and serological profiles of patients with MOG antibody with patients with AQP4 antibody.

Familial monophasic acute transverse myelitis due to the pathogenic variant in VPS37A.

OBJECTIVE: To identify genetic differences among siblings with a family history of idiopathic transverse myelitis (ITM). METHODS: We compared whole-exome sequencing (WES) on germline samples from the 2 affected sisters with ITM with 3 of their healthy siblings. RESULTS: The 2 sisters with ITM both had acute onset of sensory loss in the legs, weakness, and bowel/bladder dysfunction. The first developed ITM at age 15 years with a clinical nadir of complete paralysis, which slowly recovered over a few years. MRI demonstrated a persistent T2 lesion in the lower thoracic cord. The second developed ITM at age 50 years with a nadir of sensory loss from T6 down and paraparesis in the legs, associated with an MRI lesion at T6. She also made a partial recovery with treatment. Both sisters are homozygous for a missense variant in VPS37A (c.700C>A, p.Leu234Ile) identified by WES. We performed targeted sequencing of VPS37A in an additional 86 samples from patients with ITM and 175 with other diseases to investigate the p.Leu234Ile variant. We identified another patient with ITM homozygous for the same rare variant. No patients with multiple sclerosis, neuromyelitis optica, other neurologic conditions, or any healthy controls in public databases were homozygous for this variant. CONCLUSIONS: A rare missense variant in VPS37A may predispose to development of ITM. Further studies are necessary to determine the frequency of this variant in the patient population and the mechanism through which it contributes to the risk of disease.

Survival in Patients with Cirrhosis According to Etiology. Retrospective Cohort / Sobrevida en pacientes con cirrosis de acuerdo con su etiología. Cohorte retrospectiva

Abstract Introduction: Cirrhosis is the final stage of chronically progressive liver diseases of various etiologies. It is a common disease, with a variable prevalence in each country. Its peak incidence occurs between 40 and 50 years of age, predominantly in men. Aims: To compare a cohort of patients diagnosed with cirrhosis, evaluate their complications and survival according to etiology, describe clinical and laboratory aspects, and determine the role of a fatty liver. Materials and methods: A retrospective cohort study was carried out with patients who held a specialized hepatology consultation in the center of liver and digestive diseases (CEHYD) in Bogotá, Colombia, between January 2010 and June 2019. Results: We reviewed a total of 1,200 medical records (56.8 % women). There were no statistically significant differences in median survival between groups by etiology, sex, presence or absence of complications, or Child. We noted that the older the age at the diagnosis of cirrhosis, the higher the risk of death; HR 1.04 (95 % CI 1.02-1.075). For each month that follow-up increases, the risk of death decreases by 90 %; HR 0.1 (95 % CI 0.03-0.29). For each month that the follow-up of complications increases, the risk of death is reduced by 2 %; HR 0.98 (95 % CI 0.97-0.99). Conclusions: Survival by etiology was similar in the different groups. Nonalcoholic steatohepatitis (NASH) was the leading cause of cirrhosis in this cohort. Efforts should focus on its diagnosis and management in the early stages.

Resumen Introducción: la cirrosis es el estadio final de enfermedades hepáticas crónicamente progresivas de diferentes etiologías. Es una enfermedad frecuente, con una prevalencia variable en cada país. Su pico de incidencia se presenta entre los 40 y 50 años, predominantemente en hombres. Objetivos: comparar una cohorte de pacientes con diagnóstico de cirrosis, evaluar sus complicaciones y sobrevida de acuerdo con su etiología, describir los aspectos clínicos y de laboratorio, y determinar el papel del hígado graso. Materiales y métodos: se realizó un estudio de cohorte retrospectiva, en donde se incluyeron pacientes que asistieron a consulta especializada de hepatología en el centro de enfermedades hepáticas y digestivas (CEHYD), en la ciudad de Bogotá, durante enero de 2010 y junio de 2019. Resultados: se revisaron un total de 1200 historias clínicas (56,8 % mujeres). No se evidenció diferencias estadísticamente significativas en las medianas de sobrevida entre los grupos por etiologías, sexo, presencia o no de complicaciones, o Child. Se evidenció que entre mayor edad en el diagnóstico de cirrosis, el riesgo de muerte es mayor; HR 1,04 (IC 95 % 1,02-1,075). Por cada mes que aumenta el seguimiento se reduce el riesgo de muerte en 90 %; HR 0,1 (IC 95 % 0,03-0,29). Por cada mes que aumenta el seguimiento de las complicaciones se reduce el riesgo de muerte en 2 %; HR 0,98 (IC 95 % 0,97-0,99). Conclusiones: La sobrevida por etiología fue similar en los diferentes grupos. La esteatohepatitis no alcohólica (NASH) fue la principal causa de cirrosis en esta cohorte. Se deben orientar esfuerzos a su diagnóstico y manejo en fases tempranas.

Hepatocellular carcinoma: A real-life experience in a specialized center in Bogotá, Colombia / Hepatocarcinoma: experiencia de la vida real en un centro especializado de Bogotá, Colombia

Abstract Introduction: Hepatocellular carcinoma (HCC) is the most frequent malignant primary liver tumor globally. In 2018, it ranked sixth and represented the fourth cause of death from cancer; the five-year overall survival is 18 %. Most cases of HCC develop in patients with cirrhosis of any etiology, especially because of hepatitis B and C viruses, alcohol, and recently nonalcoholic steatohepatitis (NASH). Aim: To analyze the clinical characteristics, diagnostic methods, treatments, prognostic variables, and survival. Materials and methods: This retrospective descriptive study was conducted on a cohort of patients diagnosed with cirrhosis and treated between January 2011 and December 2020 at a health care center in Bogotá. The diagnosis of HCC was confirmed radiologically or by biopsy. We analyzed the information descriptively with absolute frequency measures in the case of categorical variables. For continuous variables, the information was summarized with measures of central tendency (mean or median) and their relevant measures of dispersion. Results: We included 152 patients diagnosed with HCC, with a mean age of 69.4 years; 51.3 % were men. The leading cause of HCC was nonalcoholic fatty liver disease (NAFLD), which accounted for almost a third of cases (32 %); other causes were alcohol (15 %) and hepatitis C virus (14 %). The median manifestation of the tumor was two nodules with a size close to 4 cm. Besides, 35 % of patients had a BCLC (Barcelona Clinic Liver Cancer) stage with curative options, and 25 % received curative treatment options. The first-line systemic therapy used in this cohort was sorafenib®, used in 35 patients (33.7 %). Survival curves showed that women, Child-Pugh class A, and BCLC stage 0 had higher median survival. Multivariate analysis showed a higher risk of death for males (hazard ratio [HR]: 2.16; confidence interval [CI]: 1.24-3.76), Child-Pugh class B (HR: 2.14; CI 1.16-3.95), and Child-Pugh class C (HR: 7.52; CI 2.88-19.57). Conclusions: NAFLD is the leading cause of HCC in this cohort. A third of patients are diagnosed in early BCLC stages with a curative treatment option, and 25 % are treated with curative therapies. Sorafenib was the first-line therapy in advanced HCC. Overall survival after diagnosis of HCC remains low, being necessary to join forces in the follow-up of patients with cirrhosis to improve these outcomes.

Resumen Introducción: el hepatocarcinoma (HCC) es el tumor hepático primario maligno más frecuente en el mundo: en 2018 ocupó la sexta posición y representó la cuarta causa de muerte por cáncer; la supervivencia global a 5 años es del 18 %. La mayoría de los casos de HCC se desarrolla en pacientes con cirrosis de cualquier etiología, especialmente por virus de la hepatitis B y C, alcohol y, recientemente, por la esteatohepatitis no alcohólica (NASH). Objetivo: analizar las características clínicas, métodos de diagnóstico, tratamientos, variables pronósticas y supervivencia. Metodología: estudio descriptivo retrospectivo de una cohorte de pacientes con diagnóstico de cirrosis atendidos entre enero de 2011 y diciembre de 2020 en un centro de atención médica de Bogotá, con diagnóstico de HCC confirmado radiológicamente o por biopsia. La información se analizó de forma descriptiva con medidas de frecuencia absoluta en el caso de las variables categóricas; para las variables continuas se resumió la información con medidas de tendencia central (media o medianas) y su respectiva medida de dispersión. Resultados: se incluyeron 152 pacientes diagnosticados con HCC, con edad promedio de 69,4 años, 51,3 % eran hombres. La principal causa de HCC fue el hígado graso no alcohólico (NAFLD), que representó casi una tercera parte de los casos (32 %); otras causas fueron el alcohol (15 %) y el virus de la hepatitis C (14 %). La mediana de presentación del tumor fue de 2 nódulos con un tamaño cercano a 4 cm. El 35 % de los pacientes tenía un estadio BCLC (Barcelona Clinic Liver Cancer) con opciones curativas y el 25 % de los pacientes recibió opciones curativas de tratamiento. La terapia sistémica de primera línea utilizada en esta cohorte fue el sorafenib®, que se utilizó en 35 pacientes (33,7 %). Las curvas de supervivencia mostraron que las mujeres, el estadio Child-Pugh A y el estadio BCLC 0 presentaron mayores medianas de supervivencia. El análisis multivariado evidenció un mayor riesgo de muerte al ser hombre (Hazard ratio [HR]: 2,16; intervalo de confianza [IC]: 1,24 a 3,76), estar en los estadios Child-Pugh B (HR: 2,14; IC: 1,16 a 3,95) y Child-Pugh C (HR: 7,52; IC: 2,88 a 19,57). Conclusiones: el NAFLD es la principal causa de HCC en la presente cohorte, una tercera parte de los pacientes se diagnostica en estadios BCLC tempranos con opción curativa de tratamiento, y un 25 % se trata con terapias curativas. El sorafenib fue la terapia de primera línea en HCC avanzado. La supervivencia global luego del diagnóstico de HCC sigue siendo baja, y es necesario aunar esfuerzos en el seguimiento de los pacientes con cirrosis para mejorar estos resultados.

The behavior of liver diseases in a cohort of Colombian patients with COVID-19 / Comportamiento de las enfermedades hepáticas en una cohorte de pacientes colombianos con COVID-19

Abstract Introduction: Severe acute respiratory syndrome type 2 coronavirus infection (SARS-CoV-2) is receiving the most attention now. The asymptomatic elevation of transaminases is typical in the liver, and liver involvement varies from 14 % to 78 %. The assessment of liver comorbidities is scarce, with prevalence ranging between 2 % and 11 %. Aim: To describe the behavior of a cohort of patients with liver diseases who fell ill with coronavirus disease 2019 (COVID-19). Materials and methods: This retrospective observational study analyzed the behavior of a cohort of patients with liver diseases who fell ill with COVID-19. Results: 543 patients became ill with COVID-19, of which 300 were women (55.3 %). The median age at diagnosis of liver disease was 52 years. The leading causes of liver disease were nonalcoholic steatohepatitis (49.5 %), cholestatic disease (7.7 %), and hepatitis C and B viruses (6.3 %). Alanine aminotransferase (ALT) had a median of 52 U/L (interquartile range [IQR]: 30-98) and aspartate aminotransferase (AST) 32 U/L (IQR: 23-62). Mortality due to viral infection was 5.7 %, with an incidence rate of 2.9 (95 % confidence interval [CI]: 2-4.2). Conclusions: It is a retrospective study but, until the preparation of the manuscript, it had been the first cohort in Colombia to describe the behavior of liver diseases in patients who become ill with COVID-19. No statistically significant differences were found between the causes of liver disease that confer a higher risk of mortality; however, having decompensated cirrhosis is the only condition related to mortality.

Resumen Introducción: la infección por coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) concentra la mayor atención en el momento. En el hígado es frecuente la elevación asintomática de transaminasas y la afectación hepática varía del 14 % al 78 %. La evaluación de las comorbilidades hepáticas es escasa, con prevalencias que oscilan entre el 2 % y el 11 %. Objetivo: describir el comportamiento de una cohorte de pacientes con enfermedades hepáticas que presentaron el coronavirus de 2019 (COVID-19). Materiales y métodos: estudio observacional retrospectivo que analizó el comportamiento de una cohorte de pacientes con hepatopatías que enfermaron por COVID-19. Resultados: 543 pacientes padecieron por COVID-19, de los cuales 300 fueron mujeres (55,3 %). La mediana de edad al diagnóstico de la enfermedad hepática fue de 52 años. Las principales causas de las hepatopatías fueron esteatohepatitis no alcohólica (49,5 %), enfermedad colestásica (7,7 %), virus de la hepatitis C y B (6,3 %). La alanina-aminotransferasa (ALT) presentó una mediana de 52 U/L (rango intercuartílico [RIC]: 30-98) y aspartato-aminotransferasa (AST) 32 U/L (RIC: 23-62). La mortalidad por la infección viral fue del 5,7 % con una tasa de incidencia de 2,9 (intervalo de confianza [IC] 95 %: 2-4,2). Conclusiones: es un estudio de carácter retrospectivo; sin embargo, hasta la elaboración del manuscrito es la primera cohorte en Colombia en describir el comportamiento de las enfermedades hepáticas en pacientes que enferman de COVID-19. No se encontraron diferencias estadísticamente significativas entre las causas de hepatopatía que confieran un mayor riesgo de mortalidad; sin embargo, tener una descompensación de cirrosis es la única condición que tiene una relación con la mortalidad.

Standardized Nutritional Intervention in Patients with COVID-19 Admitted to a Hospital in Bogotá, Colombia / Intervención nutricional estandarizada en pacientes hospitalizados por COVID-19 admitidos en un Hospital en Bogotá, Colombia

Summary Background: Patients with coronavirus disease 2019 (COVID-19) present an increase in oxidative stress, characterized by the production of reactive oxygen species and a concomitant deficiency of antioxidants. There are multiple defense mechanisms including enzymatic scavengers and non-enzymatic molecules (glutathione and vitamins A, C, D, E, and zinc). Methods: In this observational, cross-sectional, retrospective study, we aimed to describe the clinical behavior of patients hospitalized due to COVID-19 (those trea ted with a standardized nutritional intervention versus those who received the COVID-19 standard treatment available at the time). A total of 214 medical records of patients hospitalized due to COVID-19 who required nutritional intervention were analyzed. Descriptive analyses of continuous and categorical variables were performed, and an ANOVA test was performed for numerical variables. A logistic regression model and a propensity score matching determined the differences between the matched groups. Findings: 33·6% of the patients were admitted to the Intensive Care Unit (ICU), 28·5% required invasive mechanical ventilation, and the overall mortality was 19·6%. 44·8% of the patients received the standardized nutritional intervention. There were no statistically significant differences between intervention groups, except for the intervention time, in which the standardized nutritional intervention (days) was identified as a protective factor OR=0·550 (p <0·05; CI=0·324-0·936). Conclusions: This is the first study in Colombia to consider a standardized nutritional intervention in patients hospitalized due to COVID-19. Despite not being able to meet the primary objectives, controlled experiments must be carried out to determine the role and possible therapeutic effects of micro and macronutrients in patients with COVID-19.

Resumen Antecedentes: los pacientes con enfermedad por coronavirus 2019 (COVID-19) presentan un aumento del estrés oxidativo, caracterizado por la producción de especies reactivas de oxígeno y una deficiencia concomitante de antioxidantes. Existen múltiples mecanismos de defensa que incluyen eliminadores enzimáticos y moléculas no enzimáticas (glutatión y vitaminas A, C, D, E y zinc). Métodos: En este estudio observacional, transversal y retrospectivo, el objetivo fue describir el comportamiento clínico de los pacientes hospitalizados por CO VID-19 (aquellos tratados con una intervención nutricional estandarizada versus aquellos que recibieron el tratamiento estándar COVID-19 disponible en el tiempo). Un total de 214 historias clínicas de los pacientes hospitalizados por COVID-19 que requirieron intervención nutricional. Se realizaron análisis descriptivos de variables continuas y categóricas. Se realizó una prueba de ANOVA para las variables numéricas. Un modelo de regresión logística y un emparejamiento por puntuación de propensión determinaron las diferencias entre los grupos emparejados. Resultados: el 33,6% de los pacientes ingresaron en la Unidad de Cuidados Intensivos (UCI), el 28,5% requirió ventilación mecánica invasiva y la mortalidad global fue del 19,6%.44 · 8% de los pacientes recibieron la intervención nutricional estandarizada. No hubo diferencias estadísticamente significativas entre los grupos de intervención, excepto por el tiempo de intervención, en el que la intervención nutricional estandarizada (días) se identificó como factor protector OR = 0 · 550 (p <0 · 05; IC = 0 · 324-0 · 936). Conclusiones: Este es el primer estudio en Colombia que considera una intervención nutricional estandarizada en pacientes hospitalizados por COVID-19. A pesar de no poder alcanzar los objetivos primarios, se deben realizar experimentos controlados para determinar el papel y los posibles efectos terapéuticos de los micro y macronutrientes en pacientes con COVID-19

Glomus tumor in teen and repetition pneumonia: Case report.

Glomus tumors are uncommon tumors that are originated from smooth muscle cells of the neuromioarterials glomus bodies located in the arteriovenous anastomoses subcutaneous tissue or deep dermis of the extremities, mainly in the palms of the hands, wrists and subungual areas of the fingers. Carcinoid tumor, as the glomus tumor, can show an organoid pattern, increased vascularity, and uniform, round cells with eosinophilic cytoplasm, but usually are positive for cytokeratin and always stained with chromogranin and synaptophysin showing negative for smooth muscle markers which is presented in our case. Glomus tumors have a good prognosis and surgical resection is the treatment of choice. In our case, the patient underwent pulmonary bilobectomy because of the location of the tumor in the transition between the middle lobe and the basal bronchial trunk right lower lobe divisions. It is presented thus a glomus tumor with exceptional localization (pulmonary and bronchial) of benign histological features, according to most of the cases reported in the literature emphasizing their particular rare location, histological, and immunohistochemical profile, which helps the differential diagnosis with other most common tumors of bronchial location.

Pertinencia de la solicitud del dímero D en pacientes de un servicio de urgencias / Pertinence of D-dimer request in patients in emergency services / Relevância da solicitação de D-dímero em pacientes de um setor de emergência

Introducción. El tromboembolismo pulmonar y la trombosis venosa profunda son urgencias cardiovasculares relativamente comunes, se han descrito diferentes predictores clínicos para la estratificación del riesgo, biomarcadores séricos y pruebas de imagenología. Dentro de los biomarcadores séricos se ha descrito el dímero D. Debido a que la enfermedad tromboembólica venosa es un reto diagnóstico para el clínico, el objetivo del presente estudio fue evaluar la pertinencia de la solicitud del dímero D, en el servicio de urgencias de un centro de tercer nivel en la ciudad de Bogotá durante los años 2018-2019. Metodología. Estudio observacional, descriptivo y transversal retrospectivo de pacientes que consultaron al servicio de urgencias, de una clínica de tercer nivel, de la ciudad de Bogotá, durante el periodo 2018-2019. Resultados. Se revisaron 583 historias clínicas, se excluyeron 107 pacientes, con un total final de 474 (57.3% mujeres y 42.6% hombres). De estos, 21 pacientes presentaron estudios positivos (angiotomografía y Doppler venoso). El dímero D presentó un valor predictivo negativo inferior al 50%. Discusión. A pesar de los resultados y de ser un estudio de un solo centro se evidencian las dificultades que tienen los médicos de los servicios de urgencias al momento de solicitar pruebas diagnósticas. Conclusiones. Este estudio evidencia la dificultad que existe en los servicios de urgencias al momento de la evaluación diagnóstica y cómo la solicitud de los paraclínicos tiene que ser un proceso estandarizado, guiado por los motivos de consulta y hallazgos al examen físico, y así no perder las características operativas de las pruebas diagnósticas y su utilidad al momento de la evaluación clínica.

Introduction. Pulmonary thromboembolisms and deep vein thromboses are relatively common cardiovascular emergencies. Various clinical predictors, serial biomarkers and imaging tests have been described for the stratification of the risk. D-dimer has been described within the serial biomarkers. Since venous thromboembolic disease is a diagnostic challenge for doctors, the objective of this study was to assess the pertinence of the D-dimer request in emergency services in a level three center in Bogotá during 2018-2019. Methodology. An observational, descriptive and cross-sectional retrospective study of patients who resorted to emergency services in a level three clinic in Bogotá during 2018-2019. Results. 583 medical records were reviewed, and 107 patients were excluded, with a final total of 474 patients (57.3% women and 42.6% men). Of these, 21 patients had positive studies (angiotomography and venous doppler ultrasound). D-dimer had a negative predictive value of less than 50%. Discussion. Despite the results and it being a study in a single clinic, the difficulties emergency service doctors experience when requesting diagnostic tests can be observed. Conclusions. This study shows the difficulties in emergency services when performing a diagnosis. The request for complementary tests has to be a standardized process guided by the reasons for the consultation and findings from the physical exam, in order not to lose the operational characteristics of the diagnostic tests and their usefulness during the clinical evaluation.

Introdução. Tromboembolismo pulmonar e trombose venosa profunda são emergências cardiovasculares relativamente comuns. Têm sido descritos diferentes preditores clínicos para estratificação de risco, biomarcadores séricos e testes de imagem. Entre os biomarcadores séricos, foi descrito o D-dímero. Considerando que a doença tromboembólica venosa é um desafio diagnóstico para o clínico, o objetivo deste estudo foi avaliar a relevância da solicitação de D-dímero no serviço de emergência de um centro de terceiro nível na cidade de Bogotá ao longo dos anos 2018-2019. Metodologia. Estudo observacional, descritivo e transversal retrospectivo de pacientes que consultaram o serviço de emergência de uma clínica de terceiro nível na cidade de Bogotá, no período de 2018-2019. Resultados. Foram revisados 583 prontuários, excluídos 107 pacientes, totalizando 474 (57.3% mulheres e 42.6% homens). Destes, 21 pacientes apresentaram estudos positivos (angiotomografia e Doppler venoso). D-dímero apresentou valor preditivo negativo inferior a 50%. Discussão. Apesar dos resultados e do fato de se tratar de um estudo só de um centro, são evidentes as dificuldades que os médicos de emergência apresentam ao solicitarem exames diagnósticos. Conclusões. Este estudo mostra a dificuldade que existe nos serviços de emergência no momento da avaliação diagnóstica e como a solicitação dos testes paraclínicos tem que ser um processo padronizado, orientado pelos motivos da consulta e pelos resultados do exame físico, e assim não perder as características operacionais dos exames diagnósticos e sua utilidade no momento da avaliação clínica.

Alteraciones Hepaticas en pacientes con infeccion por VIH en un centro de investigacion en Bogotá Colombia 2009 - 2019 / Hepatic alterations in patients with HIV infection in a research center in Bogotá Colombia 2009 - 2019

Resumen Introducción: Las alteraciones de la bioquímica hepática son frecuentes en los pacientes con infección por VIH, la etiología es variada, la esteatosis hepática es frecuente con una prevalencia estimada del 60% Objetivos: Caracterizar las alteraciones hepáticas en una serie de pacientes con infección por VIH en un centro de investigación de Bogotá Colombia durante el periodo 2009 - 2019. Materiales y Métodos: Estudio descriptivo, retrospectivo, observacional de pacientes con infección por VIH que asistieron a un centro de investigación durante los años 2009-2019. Resultados: 94% fueron hombres y 6% mujeres con edad promedio de 44 años, 92,5% de los pacientes presentaba uso de terapia antiretroviral. Las principales hepatopatías fueron la coinfección VIH-Hepatitis C y el hígado graso en iguales porcentajes, 31,3%. El promedio del indice HOMA fue de 2,58. Discusión: Las enfermedades hepáticas son una causa importante de morbimortalidad en pacientes con infección por VIH, las coinfecciones virales y el hígado graso pueden ser muy frecuentes en nuestro medio a diferencia de otros estudios Conclusiones: Este es el primer estudio a nivel local en describir las alteraciones hepáticas en pacientes con VIH, las comorbilidades no SIDA, juegan un papel importante dentro de la enfermedad. La hepatitis C continúa siendo una coinfección frecuente en la población VIH.

Abstract Introduction: Alterations in liver biochemistry are frequent in patients with HIV infection, the etiology is varied and includes multiple causes, liver steatosis is one of the most frequent with an estimated prevalence of 60% after the appearance of antiretroviral treatment Objectives: To characterize liver disorders in a series of patients with HIV infection at a research center in Bogotá Colombia during the period 2009-2019. Materials and Methods: Descriptive, retrospective, observational study of patients with HIV infection who attended a disease research center during the years 2009-2019. Results: 67 clinical histories were reviewed, 94% were men and 6% women with an average age of 44 years, 92.5% of the patients had use of anti-retroviral therapy and the diagnosis of HIV was known 11.7 years ago on average. The main liver diseases were HIV-Hepatitis C coinfection and fatty liver in equal percentages, 31.3%. The average HOMA index was 2.58. Discussion: Liver diseases are an important cause of morbidity and mortality in patients with HIV infection. Viral coinfections and fatty liver can be very frequent in our setting, unlike other studies. Conclusions: This is the first study locally to describe the liver disorders in patients with HIV, non-AIDS comorbidities, including fatty liver, play an important role in the disease and could behave like the general population. Hepatitis C continues to be a frequent coinfection in the HIV population.