Guillain-Barré syndrome associated with SARS-CoV-2 infection: A case series from 4 Colombian cities during the pandemic.

SARS-CoV-2 infection has been associated with multiple neurological manifestations. One such manifestation, which has been described since the early stages of the COVID-19 pandemic and is relevant for current neurological practice, is Guillain-Barré syndrome (GBS). The literature describes neurotoxic mechanisms of the virus itself and the possible pathways by which it may affect the peripheral nerves in experimental studies; however, we still lack information on the mechanisms causing the immune response that gives rise to GBS in the context of SARS-CoV-2 infection. Colombia is one of the Latin American countries worst affected by the pandemic, with the third-highest number of cases in the region; thus, it is essential to recognise GBS, as this potential postinfectious complication may severely compromise the patient's functional status in the absence of timely diagnosis and treatment. We present a series of 12 cases of GBS associated with SARS-CoV-2 infection from hospitals in 4 different Colombian cities and describe the clinical presentation, laboratory and electrophysiological study findings, and treatment.

En el año 2020 se declaro la pandemia ocasionada por la infección por el virus SARSCoV-2, virus de la familia del coronavirus, adoptándose el nombre de COVID-19 a la enfermedad 1. En Bogotá, Colombia, se confirmó el primer caso de COVID-19 el 6 de marzo de 2020 (2). Los principales síntomas reportados en la infección por SARSCoV-2 son fiebre (43.8% en la admisión y 88.7% durante la hospitalización) y tos (67.8%) (3). Otros síntomas encontrados son fatiga (38.1%), producción de esputo (33.7%) y cefalea (13.6%). Los principales signos neurológicos reportados en los pacientes con infección severa por SARS-Cov-2 son agitación (69%), compromiso en tracto corticoespinal (67%) y delirium (65%) (4). Las principales complicaciones neurológicas descritas asociadas a Covid 19 son: anosmia, disgeusia, encefalopatia, Síndrome de Guillain Barre, complicaciones cerebrovasculares y daño en musculo esquelético (5­8).En el presente articulo se presenta una serie de casos de pacientes con síndrome de Guillain-Barré asociado a infección por SARS-CoV-2. Se recolectaron casos de diferentes instituciones medicas de Colombia.

[Review of femoral component with proximal metaphyseal reconstruction using allograft cortical struts in a multioperated patient. Case report]. / Revisión de componente femoral con reconstrucción metafisaria proximal con aloinjerto óseo en lajas en paciente multioperado. Reporte de caso.

INTRODUCTION: Periprosthetic hip fractures are those that occur at the femoral and acetabular level. These fractures are associated with a wide variety of problems such as comminution, loose of bone stock and loosening of the femoral stem. Treatment of these fractures has historically been associated with high rates of treatment failures, complications and unsatisfactory outcomes. OBJECTIVE: To present the clinical-radiographic case of the treatment of a periprosthetic hip fracture, with a femoral revision and metaphyseal reconstruction with cortical strut allograft and cerclage cables, in a multioperated patient. MATERIAL AND METHODS: We present the case of a patient with a dislocation of a revision total hip prosthesis with a periprosthetic fracture type B3 of the Vancouver classification, who underwent a revision of the femoral component and a proximal metaphyseal reconstruction of the femur with cortical strut allograft and cerclage cables. RESULTS: The patient had an adequate evolution at the postoperative year, walking with a cane, radiographic control with adequate congruence of the prosthetic components and data of consolidation of the fracture. DISCUSSION: In the treatment of periprosthetic fractures, reconstruction can be done with use of cortical strut allograft and cerclage cables, with good functional and radiological results.

INTRODUCCIÓN: Las fracturas periprotésicas de cadera son aquéllas que ocurren a nivel femoral y acetabular. A estas fracturas se asocia una amplia variedad de problemas como la conminución, la pérdida ósea y con frecuencia el aflojamiento del vástago femoral. El tratamiento de estas fracturas ha estado históricamente asociado a altas tasas de fracasos del tratamiento, de complicaciones y de resultados insatisfactorios. OBJETIVO: Presentar el caso clínico-radiográfico del tratamiento de una fractura periprotésica con revisión femoral y reconstrucción metafisaria con lajas de cortical y cables de acero en un paciente multioperado. MATERIAL Y MÉTODOS: Se presenta el caso de un paciente con luxación de prótesis total de cadera izquierda de revisión + fractura periprotésica Vancouver B3, a quien se le realiza revisión de componente femoral y reconstrucción metafisaria proximal de fémur con aloinjerto óseo en lajas y fijación con cables de acero. RESULTADOS: El paciente cursa con adecuada evolución al año de postoperado, deambulando con apoyo de bastón, control radiográfico y adecuada congruencia de los componentes protésicos y datos de consolidación de la fractura. DISCUSIÓN: En el tratamiento de las fracturas periprotésicas es posible recurrir a la reconstrucción mediante el uso de aloinjertos en laja de cortical, cerclados con cables de acero, con buenos resultados funcionales y radiológicos.

[Bilateral total knee replacement]. / Reemplazo bilateral de rodilla.

Bilateral osteoarthrosis of the knee is very frequent and disabling; the treatment in severe cases is joint replacement. Bilateral condition and severe knee pain are common and the definitive treatment can be performed on both. MATERIAL AND METHODS: We reviewed the records of the first patients undergoing bilateral total knee replacement by our surgical group, between 1993-1998. RESULTS: The procedure was performed on 56 patients (112 knees) with degenerative joint disease; their age range was 60 to 82 years. The knee replacements were done either simultaneously, consecutively, or via two unique surgeries. The outcomes of each method were analyzed to assess its advantages and disadvantages. DISCUSSION: Based upon the results of the study, we find that total knee replacements done consecutively provide the best results for patients suffering from articular degeneration.

La patología degenerativa bilateral en las rodillas es muy frecuente e incapacitante; el manejo que se ofrece en los casos avanzados es el reemplazo articular por medio de una prótesis. La afección bilateral y el dolor severo de la rodilla son comunes y su tratamiento definitivo puede ser de forma bilateral. Material y métodos: Se revisaron los expedientes de los primeros pacientes operados de reemplazos bilaterales de rodilla por nuestro grupo quirúrgico, entre los años 1993 y 1998. Resultados: El procedimiento fue realizado en 56 pacientes (112 rodillas) con rango de edad de 60 a 82 años, con enfermedad articular degenerativa (EAD). Los reemplazos se llevaron a cabo de tres formas: simultánea, consecutiva y en dos tiempos. Se analizan los resultados de cada método, sus ventajas y desventajas. Discusión: En nuestra serie, practicar los reemplazos totales de rodilla en forma consecutiva es el método que mejores resultados mostró y fue el más balanceado en sus ventajas y desventajas.

Factor structure of the Beck Depression Inventory-Second Edition (BDI-II) with Puerto Rican elderly

The Beck Depression Inventory-Second Edition (BDI-II; (1) is one of the most useful measures for depressive symptomatology in many countries (2). The psychometric properties of this inventory, however, have not been reported with Puerto Rican elderly. This paper reports, exploratory psychometric results with a sample of 410 elderly Puerto Rican (65 years and older; men=94, women=316). The assessment of the construct validity of the BDI-II yielded four factors accounting for 52of total variance and an internal reliability coefficient (alpha Cronbach) of .89. A factor analysis with the 21 items of the BDI-II was performed using principal component analysis as the extraction method and Varimax rotation. This analysis revealed that the BDI-II was a good measure of the dimensions of depressive symptomatology in the present sample, which resembled prior findings reported with the general Puerto Rican Population (3). This study also reports further data supporting the reliability, validity, and practical utility of the BDI-II for the Puerto Rican population including elders. Implications for potential research with minorities and clinical uses of the BDI-II are also discussed.

Membrane-associated redox cycling of copper mediates hydroperoxide toxicity in Escherichia coli.

We are studying the action of tert-butylhydroperoxide (t-BOOH) on Escherichia coli as a model system for peroxide toxicity. In our previous report (De la Cruz-Rodriguez, L.C., Farías, R.N. and Massa, E.M. (1990) Biochim. Biophys. Acta 1015, 510-516), the respiratory chain was identified as a major target of t-BOOH. In the present paper, we study further the effect of t-BOOH on the NADH oxidase of the E. coli respiratory chain to clarify the mechanism of damage, especially regarding the identity and role of the metal ion involved. The results are: (a) t-BOOH toxicity is mediated by membrane-bound copper ions; (b) a small pool of the membrane-bound copper is reduced from Cu(II) to Cu(I) in the presence of NADH and other respiratory substrates (succinate, D-lactate); (c) this reduction of copper occurs at 37 degrees C but not at 0 degrees C or when the membranes are inactivated by previous heating; (d) the Cu(I) generated by reduction of Cu(II) during membrane preincubation with NADH, is oxidized by t-BOOH with simultaneous inactivation of the NADH oxidase, whereas treatment with only t-BOOH (without NADH) has no effect on the oxidase. It is concluded that the effect of t-BOOH on the respiratory chain is mediated by redox cycling of copper. It is proposed that the damage results from activation of the hydroperoxide through its interaction with Cu(I) in a site-specific Fenton-type reaction.

[Liver transplantation in Mexico. Report of the first successful case]. / Trasplante de hígado en México. Informe del primer caso exitoso.

This article reports the first successful human orthotopic liver transplantation performed in Mexico. The recipient was a 41 year old white male, with a history of essential hypertension and hepatitis in 1975. The diagnosis of postnecrotic cirrhosis was made in 1985 by liver biopsy. The HBsAg was negative and the functional reserve of the liver was limited (Stage "C" of the Child-Pugh classification). A liver graft was obtained through the National Cadaver Organ Transplant Program on May 2, 1988 and an orthotopic liver transplantation was performed without incidents, using the portosystemic veno-venous bypass. Inmunosuppression was carried out with triple drug therapy, cyclosporine, azathioprine, and prednisone. His postoperative course was characterized by idiopathic cholestasis, one episode of acute rejerction, arterial hypertension, renal dysfunction, esophageal herpes and inguinal lymphocele, all of which resolved. Currently the patient is alive 22 months postransplantation with normal liver function and adequate quality of life.

Damage of Escherichia coli cells by t-butylhydroperoxide involves the respiratory chain but is independent of the presence of oxygen.

The action of t-butylhydroperoxide (tBOOH) on Escherichia coli cells has been studied as a model system for organic peroxide toxicity. Exposure of E. coli cells to tBOOH led to progressive and irreversible impairment of the respiratory function, an effect which was dependent on the availability of substrate. The effect of tBOOH on growth of E. coli with different carbon sources and alternative terminal electron acceptors was investigated. It was found that the sensitivity of E. coli to tBOOH under diverse growth conditions implicating a functional respiratory chain was greater than when the bacterium grew by fermentation. Also the mutant E. coli SASX76, which requires exogenous 5-aminolevulinic acid to synthesize the cytochromes, was more resistant to tBOOH when lacking a functional respiratory chain. These data point to the respiratory chain as a major target in the in vivo action of tBOOH. Experiments with isolated membranes also showed a tBOOH-induced damage of the respiratory chain monitored by impairment of the NADH oxidase. The effect of tBOOH was produced even under anaerobiosis, indicating that development of cell damage was independent of oxygen and, therefore, that neither oxygen-derived radicals nor lipid peroxidation were involved.

[Acute-onset extrapyramidal syndromes caused by drugs]. / Síndromes extrapiramidales de evolución aguda causados por drogas.

In childhood, several drugs are the cause of acute extrapyramidal syndromes which are true medical emergencies. In the course of one year out of 321 children with acute poisoning, 49 (14.9%) showed these side effects. The responsible drugs were mainly the phenothiazines and haloperidol; only in two cases the metoclopramide. The extrapyramidal syndromes were characterized by akathisia, dyskinesia with dystonic reactions, parkinsonism and akinesia. Diphenhydramine has shown to be useful in treating acute extrapyramidal disturbances when used intravenously followed by oral administration.

Sindromes extrapiramidales de evolucion aguda causados por drogas. / Acute extrapyramidal syndromes caused by drugs

En la edad pediatrica, diversas drogas pueden causar sintomas extrapiramidales que por su evolucion aguda constituyen verdaderas urgencias medicas. En el transcurso de un ano, del total de 321 ninos internados con el diagnostico de intoxicacion aguda, 48 (14.9%) habian recibido ese tipo de drogas. De estas, las que con mayor frecuencia causaron los sintomas fueron las fenotiacinas y el haloperidol; la manera como los ninos se expusieron a ellas fue en la mayor parte de los casos por yatrogenia y despues por ingestion accidental. Las manifestaciones clinicas que predominaron fueron acatisia, discinesias paroxisticas del tipo de las crisis oculogiras, las distonias de torsion de cuello y tronco y las crisis bucolinguales, parkinsonismo caracterizado por temblores finos, sialorrea e hipertonia y finalmente, acinesia. Se propone un esquema de tratamiento empleando unicamente difenhidramina por via parenteral y bucal con lo que se obtienen buenos resultados terapeuticos

[Erythrocyte potassium in premature infants small for gestational age]. / Potasio eritrocitario en prematuros pequeños para la edad gestacional.

A direct method was used to study the concentration of intraerythrocytic sodium and postassium in 21 prematures with adequate weight for their gestational age and in 24 small for their gestational age. Intraerythrocytic potassium showed to be less, while sodium turned out to be greater in the group of prematures small for their gestational age when compared with those with adequates weight. No significant differences were found between concentrations of serum sodium and potassium in both groups. These results are in close relationship with the findings of potassium in the muscular cell and in the leukocytes of infants with protein-calorie malnutrition and may show importance in terms of the flow of ions through the erythrocytic membrane.