Protective Barriers and Radiant Exposure Delivered from Light-curing Units.

OBJECTIVE: To evaluate the influence of different protective barriers as a function of the photoactivation distances on the radiant exposure of several light-curing units (LCU). The influence of the protective barriers on the degree of conversion of an adhesive resin was also evaluated. METHODS: Five LCUs were evaluated: Valo Cordless-used in standard mode (Ultradent, South Jordan, USA); Radii-cal-used in continuous mode (SDI, Bayswater, AU); Emitter D-used in continuous mode (Schuster, Santa Maria, BR); Bluephase N-used in high-intensity mode (Ivoclar Vivadent, Schaan, LI); and Rainbow Curing Light-used in continuous mode (Axdent, Guangdong, CN). For each LCU, radiant exposure was measured with a spectrometer (MARC Resin Calibrator) using three different protective barriers (low-density polyethylene, polyvinyl chloride, or Radii-cal barrier sleeves) and five photoactivation distances (0, 2, 5, 10, and 20 mm). The degree of conversion of an adhesive resin (Adper Scotchbond Multi-Purpose, 3M ESPE, St. Paul, USA) was measured through Fourier-transform infrared spectroscopy. The translucency parameter of protective barriers was measured with a spectrophotometer. For all statistical tests, a significance level of α = 0.05 was set. RESULTS: For all LCUs tested, radiant exposure was found to be significantly influenced by both protective barriers and curing distance (p≤0.001). In general terms, all the protective barriers significantly decreased the radiant exposure. Radii-cal barrier sleeves were the protective barrier that most decreased the radiant exposure. Irrespective of the protective barrier used, none of the LCU equipment reached the required minimum radiant exposure of 16 J/cm2 at 10 mm of curing distance. The degree of conversion was not effected by either LCU or a protective barrier (p≥0.211). CONCLUSIONS: Protective barriers and photoactivation distance reduced the radiant exposure emitted by different LCUs.

Characterization of Contemporary Conventional, Bulk-fill, and Self-adhesive Resin Composite Materials.

OBJECTIVE: To evaluate the physical and biological properties of different types of flowable resin composites and their bonding ability to dentin, comparing the performance of self-adhesive and bulk-fill materials with a conventional control. METHODS AND MATERIALS: Four flowable resin composites were tested: two self-adhesive (Y-flow [SA_YF]; and Dyad Flow [SA_DF]); one bulk-fill (Filtek Bulk Fill Flow [BF]); and one conventional composite (Opallis Flow [OF]). The microshear bond strength (µSBS) to dentin (bovine samples) was investigated at 24 hours and 6 months of storage. The materials were also characterized by degree of conversion, cross-link density, water contact angle, color stability, and cell viability (ISO 10993-5/2009) analyses. Data were analyzed using Analysis of Variance and Tukey tests (α=0.05). RESULTS: The µSBS values were higher for control specimens at 24 hours, whereas the resin-dentin bonds were similarly distributed among the groups after aging. Adhesive failure was the most frequent pattern observed at both time intervals. SA_YF was the only material that increased the bond strength over time. Degree of conversion increased in the following order: SA_YF (28.6±1.4%) < BF (49.7±0.8%) < OF (60.0±2.0%) = SA_DF (63.6±2.3%). Cross-link density was similar among all materials. The self-adhesive composites were more hydrophilic than the other types, with BF showing the lowest water contact angle and the greatest color alteration. All resin composites had a biocompatible behavior. CONCLUSION: Chemical composition appeared to be an influential factor affecting the physico-mechanical and biological behavior of the materials tested.

Traqueostomías en pacientes con SARS COV-2 Protocolo de seguridad del equipo de cabeza y cuello / TRACHEOSTOMY IN PATIENTS WITH SARS CoV-2 HEAD AND NECK EQUIPMENT SAFETY PROTOCOL

Introducción: El virus SARS-CoV-2, se presentó en la ciudad de Wuhan, una provincia de Hubei en China, a finales del mes de diciembre de 2019, como un brote de neumonía viral consecuencia de un nuevo tipo de coronavirus B, el cual fue denominado COVID-19; posteriormente, de manera oficial, se declarará al virus como SARS-Cov-2. Los cirujanos de cabeza y cuello realizan traqueostomías en pacientes con COVID-19, lo que supone mayor exposición de aerosolización para estos especialistas. El presente trabajo tiene como finalidad describir la técnica quirúrgica de la traqueostomía abierta con la adecuada protección del equipo de cirugía de cabeza y cuello en los pacientes con SAR-CoV-2-. Métodos: Este estudio se realizó en el Centro Médico Docente la Trinidad, a cargo del servicio de cabeza y cuello. El equipo multidisciplinario estuvo conformado por cirujanos de cabeza y cuello, intensivistas y enfermeros especialistas del área. La traqueostomía fue abierta y fue realizada en los pacientes ingresados en la unidad de cuidados intensivos con resultado positivo de la infección por SARS-CoV-2, en el periodo entre agosto de 2020 a agosto de 2021, previa discusión con el equipo multidisciplinario y con el consentimiento de los familiares del paciente, idealmente, entre el día 15 y 21. Resultados: Se realizaron 14 traqueotomías abiertas, la primera traqueostomía se llevó a cabo el 01/08/2020 y la ultima el 28/08/2021. Todas fueron realizadas en la unidad de terapia intensiva. El personal médico fue el mínimo posible y consto de: Cirujano de cabeza y cuello, primer y segundo ayudante, instrumentista, intensivista, residente de terapia intensiva y enfermera de terapia intensiva. En todos los casos se llevó a cabo la adecuada higiene de manos y colocación del equipo de protección personal. Conclusiones: Mantener a los pacientes relajados durante el procedimiento, desinflar el manguito del tubo endotraqueal y cerrar el circuito previo a la incisión y rápidamente luego de la incisión en tráquea, insertar el traqueostomo y conectar el sistema de circuito cerrado, parece ser una técnica que preserva la seguridad del equipo quirúrgico

Introduction: The SARS-CoV-2 virus appeared in the city of Wuhan, a province of Hubei in China, at the end of December 2019, as an outbreak of viral pneumonia because of a new type of coronavirus B, the was called COVID-19; later, officially, the virus will be declared as SARS-Cov-2. Head and neck surgeons perform tracheostomies in patients with CIVD-19, which results in increased aerolization exposure. The present work aims to describe the surgical technique of open tracheostomy with adequate protection of the head and neck surgery team in patients with SAR-CoV-2. Methods: This study was carried out at the La Trinidad Teaching Medical Center, in charge of the head and neck service. The multidisciplinary team was made up of head and neck surgeons, intensivists, and specialist nurses in the area. The technique was open tracheostomy in patients admitted to the intensive care unit with a positive result for SARS-CoV-2 infection, in the period between August 2020 to August 2021, after discussion with the multidisciplinary team and with the consent of the patient's relatives, ideally between the 15th and 21st. Results: 14 open tracheostomies were performed, the first tracheostomy was performed on 01 / 08/2020 and the last one on 08/28/2021. All tracheostomies were performed in the intensive care unit. The medical staff was the minimum possible and consisted of: Head and neck surgeon, first and second assistant, scrub nurse, intensivist, intensive care resident and intensive care nurse. In all cases, proper hand hygiene and placement of personal protective equipment was carried out. Conclusions: Keeping patients relaxed during the procedure, deflating the endotracheal tube cuff, and closing the circuit prior to the incision and quickly after the incision in the trachea and inserting the tracheostoma, connecting the closed-circuit system, seems to be a technique that preserves the safety of the surgical team

Performance of the case definition of suspected influenza before and during the COVID-19 pandemic.

OBJECTIVE: This study aimed to evaluate the performance, before and during the COVID-19 pandemic, of the case definition of suspected influenza used in community surveillance in Mexico. METHODS: A cross-sectional analysis of a cohort study was performed and cases that met the suspected case criteria (n = 20,511) and that had laboratory-conclusive evidence (quantitative real-time polymerase chain reaction) to confirm or discard influenza virus infection were analysed. RESULTS: A high sensitivity and modest specificity were documented, which later decreased during the COVID-19 outbreak, as well as its diagnostic accuracy. However, no significant differences were observed in the area under the receiver operating characteristics curve among the analysed periods. CONCLUSIONS: The evaluated case definition remains to be a cost-effective alternative for identifying patients who may benefit from influenza-specific antiviral drugs, even during the global COVID-19 outbreak.

Survival in adult pneumonia inpatients fulfilling suspected COVID-19 criteria and baseline negative RT-qPCR.

OBJECTIVES: The objective of this study was to evaluate the survival experience of suspicion COVID-19 hospitalized patients with pneumonia and negative baseline reverse-transcription quantitative polymerase chain reaction (RT-qPCR) test results. STUDY DESIGN: We conducted a nationwide retrospective cohort study in Mexico. METHODS: Adult pneumonia inpatients fulfilling suspected COVID-19 criteria, and hospital entry from March to August 2020, were enrolled. The Kaplan-Meier method was to use to compare survival estimates among patients with negative RT-qPCR nasopharyngeal or oropharyngeal swabs and those with a baseline positive test. RESULTS: Data from 64,624 individuals fulfilling suspected COVID-19 criteria were analyzed and 1.6% of them had negative RT-qPCR tests. The overall mortality rate was higher among laboratory-positive patients (48.5% vs. 34.2%, P < 0.001) and, at any given threshold, the survival estimates were higher among RT-qPCR-negative pneumonia inpatients. CONCLUSIONS: The pathogenic mechanism of COVID-19 remains poorly understood and suspected cases with pneumonia and negative laboratory results represent a major challenge for healthcare systems. Our findings suggest that RT-qPCR-negative inpatients may have an improved disease prognosis, but the in-hospital mortality was still high among them. However, further research is needed to clarify the clinical and epidemiological implications of our results.

Predictors of severe symptomatic laboratory-confirmed SARS-CoV-2 reinfection.

OBJECTIVE: The aim of the study was to evaluate factors predicting severe symptomatic laboratory-confirmed (via Reverse transcription polymerase chain reaction, RT-PCR polymerase chain reaction) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection. STUDY DESIGN: This is a nationwide retrospective cohort study that was conducted in Mexico. METHODS: Data from 258 reinfection cases (at least 28 days between both episodes onset) were analyzed. We used risk ratios (RRs) and 95% confidence intervals (CIs) to evaluate predictors of severe (dyspnea requiring hospital admission) secondary SARS-CoV-2 infection. RESULTS: The risk of severe disease was 14.7%, and the observed overall fatality rate was 4.3%. Patients with more serious primary disease were more likely to develop severe symptoms (39.5% vs. 5.5%, P < 0.001) during reinfection. In multiple analysis, factors associated with an increased risk of severe symptomatic SARS-CoV-2 reinfection were increasing age (RRper year = 1.007, 95% CI = 1.003-1.010), comorbidities (namely, obesity [RR = 1.12, 95% CI = 1.01-1.24], asthma [RR = 1.26, 95% CI = 1.06-1.50], type 2 diabetes mellitus [RR = 1.22, 95% CI = 1.07-1.38]), and previous severe laboratory-confirmed coronavirus disease 2019 (RR = 1.20, 95% CI = 1.03-1.39). CONCLUSIONS: To the best of our knowledge, this is the first study evaluating disease outcomes in a large set of laboratory-positive cases of symptomatic SARS-CoV-2 reinfection, and factors associated with illness severity were characterized. Our results may contribute to the current knowledge of SARS-CoV-2 pathogenicity and to identify populations at increased risk of a poorer outcome after reinfection.

Survival in adult inpatients with COVID-19.

BACKGROUND: The mortality of the coronavirus disease 2019 (COVID-19) pandemic is high, and data regarding its prognosis are scarce. We aimed to assess the survival experience and determining factors in adult inpatients with laboratory-confirmed COVID-19. METHODS: We conducted a nationwide and retrospective cohort study. Data from 66,123 individuals were analyzed using the Kaplan-Meier method, and a multivariate Cox proportional hazard regression model was fitted. RESULTS: The 7-day survival was 72.2% and went to 47.6%, 35.0%, and 23.9% on days 15, 21, and 30 of hospital stay, respectively. In the multiple analysis, factors associated with an increased risk of dying were male gender, age, pneumonia at hospital admission, immunosuppression, and personal history of chronic non-communicable diseases. Reduced risk of a fatal outcome was observed among patients with asthma history. CONCLUSIONS: To the best of our knowledge, this is the largest study analyzing the survival probability in a large subset of Latin-American adults with COVID-19, in whom the disease burden has been high. Our results contribute to achieving a better understanding of disease evolution.

Predictors of laboratory-positive COVID-19 in children and teenagers.

OBJECTIVE: The aim of the study was to identify factors predicting laboratory-positive coronavirus disease 2019 (COVID-19) in pediatric patients with acute respiratory symptoms. STUDY DESIGN: We conducted a cross-sectional analysis of a prospective cohort study. METHODS: Data from 1849 individuals were analyzed. COVID-19 was confirmed (reverse transcription-quantitative polymerase chain reaction) in 15.9% of patients, and factors predicting a positive test result were evaluated through prevalence odds ratios and 95% confidence intervals. RESULTS: Increasing age, personal history of obesity, and household contact with a case were found to be associated, in the multiple regression model, with increased odds of a positive test result. Young patients residing in areas with higher population sizes, as well as those with severe respiratory symptoms, were less likely to be laboratory confirmed. CONCLUSIONS: Early identification and isolation of children and teenagers with suggestive symptoms of COVID-19 is important to limit viral spread. We identified several factors predicting the laboratory test result. Our findings are relevant from a public health policy perspective, particularly after the restart of in-person academic activities.

Latest progress in molecular biology and treatment in genitourinary tumours.

The management of genitourinary cancer, including bladder, prostate, renal and testicular cancer, has evolved dramatically in recent years due to a better understanding of tumour genetic mutations, alterations in molecular pathways, and to the development of new kinds of drugs such as targeted therapies and immunotherapies. In the field of immunotherapy, new drugs focused on stimulating, enhancing and modulating the immune system to detect and destroy cancer, have been recently discovered. Research in oncology moves quickly and new data of great relevance for clinical practice are communicated every year. For this reason, a group of experts, focused exclusively on the treatment of genitourinary tumours and who get together every year in the BestGU conference to assess the latest progress in this field have summarized the most important advances in a single review, along with a critical assessment of whether these results should alter daily clinical practice.

SEOM clinical guideline for treatment of kidney cancer (2019).

In this article, we review de state of the art on the management of renal cell carcinoma (RCC) and provide recommendations on diagnosis and treatment. Recent advances in molecular biology have allowed the subclassification of renal tumours into different histologic variants and may help to identify future prognostic and predictive factors. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. No adjuvant therapy has demonstrated a clear benefit in overall survival. Considering the whole population of patients with advanced disease, the combination of axitinib with either pembrolizumab or avelumab increase response rate and progression-free survival, compared to sunitinib, but a longer overall survival has only been demonstrated so far with the pembrolizumab combo. For patients with IMDC intermediate and poor prognosis, nephrectomy should not be considered mandatory. In this subpopulation, the combination of ipilimumab and nivolumab has also demonstrated a superior response rate and overall survival vs. sunitinib. In patients progressing to one or two antiangiogenic tyrosine-kinase inhibitors, both nivolumab and cabozantinib in monotherapy have shown benefit in overall survival compared to everolimus. Although no clear sequence can be recommended, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in patients with metastatic RCC.

Correction to: SEOM clinical guideline for treatment of kidney cancer (2017).

The conflict of interest declaration was published incorrectly in the original version.

SEOM clinical guideline for treatment of kidney cancer (2017).

The goal of this article is to provide recommendations about the management of kidney cancer. Based on pathologic and molecular features, several kidney cancer variants were described. Nephron-sparing techniques are the gold standard of localized disease. After a randomized trial, sunitinib could be considered in adjuvant treatment in high-risk patients. Patients with advanced disease constitute a heterogeneous population. Prognostic classification should be considered. Both sunitinib and pazopanib are the standard options for first-line systemic therapy in advanced renal cell carcinoma. Based on the results of two randomized trials, both nivolumab and cabozantinib should be considered the standard for second and further lines of therapy. Response evaluation for present therapies is a challenge.

Hemangioma cavernoso como causa de hemorragia digestiva oculta manifiesta: reporte de caso / A Case Report of Cavernous Hemangioma as a Cause of Occult Gastrointestinal Bleeding

Resumen Se realizó un estudio descriptivo tipo reporte de caso de un paciente valorado por el servicio de gastroenterología en la Clínica Nuestra en la ciudad de Cali, por sospecha de sangrado digestivo oculto cuyos estudios previos no habían mostrado causa de sangrado. Se realizó videocápsula endoscópica (MiroCam®) con un hallazgo positivo de lesión en el intestino delgado. Se llevó a enteroscopia en Clínica Farallones de la Ciudad de Cali con enteroscopio Olympus 180 Q que confirmó el hallazgo. Ulteriormente, se llevó a cirugía, en la que se confirmó el diagnóstico. Los datos y las fotografías se obtuvieron en bases de datos de los servicios de endoscopia y las fotos de patología se obtuvieron del registro del médico patólogo. Finalmente, se realizó una búsqueda en PubMed sobre literatura existente de historia clínica y reportes de casos similares.

Abstract This is a descriptive study based on the case report of a patient suspected of occult gastrointestinal bleeding who was evaluated by the gastroenterology service in Clínica Nuestra in Cali. Previous studies had not shown cause of bleeding. Video endoscopy (Mirocam) found a lesion in the small intestine. Enteroscopy at performed at Clínica Farallones in Cali with an Olympus 180 Q enteroscope confirmed the finding. Surgery further confirmed the diagnosis. Data and photographs were obtained from the database of endoscopy services and the pathology photos were obtained from the pathologist's registry. A literature review based on a Pubmed search of the existing literature on clinical histories and reports of similar cases is included.

Ideación suicida y su relación con la inteligencia emocional en universitarios colombianos / Suicidal ideation and its relationship to emotional intelligence in Colombian college students

Introducción: El suicidio es un problema de salud mundial que se encuentra en aumento, especialmente entre la población joven. Pensamientos sobre la muerte e ideas de quitarse la vida pueden presentarse de manera frecuente en estudiantes universitarios a lo largo del semestre académico por las nuevas experiencias de vida a los jóvenes, quienes se ven confrontados con importantes presiones sociales, personales, económicas y académicas. Algunos universitarios logran hacer frente a éstas demandas de manera efectiva mientras otros no. La habilidad emocional que permite responder con éxito ante experiencias adversas se le conoce como "inteligencia emocional". El presente estudio busca comprender de qué manera la aparición de ideas suicidas se encuentra relacionada con limitaciones en las habilidades emocionales de los universitarios colombianos para tolerar episodios de estrés. Objetivos: Identificar la relación entre ideación suicida e inteligencia emocional en jóvenes universitarios colombianos. Metodología: Estudio descriptivo correlacional, de diseño transversal. Se analizó la presencia de ideas suicidas en una muestra de 186 estudiantes universitarios, entre los 18 y 37 años de edad. Como instrumentos de medición se aplicaron los inventarios de ideación suicida de Beck y el Trait Meta Mood Scale-24. Se analizaron los datos en comparación a hallazgos previos en el tema del suicidio en en país. Resultados: El mantenimiento de ideas suicidas entre universitarios colombianos responde a dificultades de éstos jóvenes para comprender sus estados emocionales, reparar emociones negativas y afrontar problemas. Conclusión: las habilidades de inteligencia emocional son factores psicológicos que juegan un rol fundamental en la aparición y mantenimiento de ideas suicidas en los jóvenes universitarios colombianos.

Introduction: Suicide is a world health problem that is increasing around the world, especially amongst young of committing people. Thoughts about death and ideas of commiting suicide can occur frequently in college students during an academic semester by new life experiences to young people, who are confronted with important social, personal, economic and academic pressures. Some college students succeed by managing these demands effectively while others do not. The emotional competences that allow an individual to successfully cope with adverse situations are known as "emotional intelligence". The present research work seeks to gain some understanding about the way in which suicidal ideation is related to flaws in the emotional intelligence abilities for coping with adversity. Objectives: To identify the relationship between suicide ideation and emotional intelligence in Colombian college students Methodology: Correlational descriptive study, cross-sectional design. The presence of suicidal ideation was assessed for a sample of 186 college students between 18 and 37 years of age. The Beck Suicidal Ideation Inventory and the Trait Meta Mood Scale -24 were used as measurement instruments. Data analysis is presented in relation to previous findings of suicide studies in Colombia. Results: College students with difficulties for understanding their emotional states, for repairing their negative emotions and for coping with stressors are more likely to develop suicidal thoughts during the academic semester. Conclusions: Emotional intelligence skills are psychological factors that play a fundamental role in the development and maintenance of suicidal thoughts in young Colombian college students.

Factores de riesgo asociados a hígado graso de origen no alcohólico en una población del Caribe Colombiano / Risk Factors Associated with Nonalcoholic Fatty Liver Disease in a Colombian Caribbean Population

La enfermedad hepática grasa no alcohólica NAFLD (Non-alcoholic fatty liver disease) es un problema de salud, así lo demuestran las diversas investigaciones alrededor del mundo, donde se evidencia una alta prevalencia de la patología. El objetivo del estudio piloto fue describir en términos de variables demográficas, epidemiológicas y bioquímicas la relación de factores de riesgo asociados a NAFLD de una muestra de pacientes que acudieron a la sección de Hígado y vías biliares del Hospital Universitario del Caribe (Cartagena, Colombia). El estudio piloto fue descriptivo prospectivo, fueron revisadas historias clínicas para análisis de variables epidemiológicas-demográficas y valorados por medición espectrofotométrica la actividad enzimática de transaminasas para la relación De Ritis (AST/ALT), niveles de colesterol y triglicéridos. Los resultados sugieren que la población subdividida en obesos, diabetes mellitus, hipertensos/obesos, diabetes/obesos y principalmente del género femenino presenta mayor riesgo de padecer hígado graso, con lo que amerita un estudio bioquímico molecular y un diagnóstico definitivo de NAFLD en la población de estudio.

Nonalcoholic fatty liver disease (NAFLD) is a health problem that has been demonstrated by research from everywhere around the world where the disease's prevalence appears to be high. The aim of this pilot study was to describe the relationship of risk factors associated with NAFLD in terms of demographic, epidemiological and biochemical variables. Patients included in the study were drawn from people who came to the liver and biliary tract section of the Hospital Universitario del Caribe in Cartagena, Colombia. This was a prospective and descriptive pilot study that reviewed medical records for analysis of epidemiological and demographic variables. It assessed spectrophotometric measurement of transaminases for determination of De Ritis ratios (AST/ALT), and relationship to levels of cholesterol and triglycerides. The results suggest that risks of developing NAFLD were higher among women, among patients who were obese, among patients who had diabetes mellitus, among patients who had hypertension and obesity, and among patients who had diabetes combined with obesity. Patients at risk merit biochemical molecular study and a definitive diagnosis.

Trends in lung cancer incidence by histologic subtype in the south of Spain, 1985-2012: a population-based study.

PURPOSE: To analyze and interpret age- and sex-specific incidence trends of lung cancer in Granada over the period 1985-2012 and to further analyze these trends by histologic subtype. METHODS: Incidence data were obtained from the population-based cancer registry located in Granada (Southern Spain). All cases with newly diagnosed primary lung cancer over the period 1985-2012 (n = 8658) and defined by International Classification of Diseases 10th Revision (codes C33-C34) were included. Joinpoint regression analysis of age-standardized incidence rates was used to estimate the annual percent change (APC) and 95% confidence intervals. Results are presented overall and by sex, age groups (0-34, 35-54, 55-64, 65-74, ≥75 years) and histologic subtypes. RESULTS: Temporal trends of incidence rates by sex, over the period 1985-2012, showed a distinct pattern. A significant change point of the trend was observed in males in 1994 (APC: +2.5%; 95% CI 0.7-4.4 from 1985 to 1994 and -1.4%; 95% CI -2.0 to -0.7 from 1994 onward). This general change was mainly caused by the age group 65-74 years and by the higher incidence of squamous cell carcinoma histologic subtype. In females, lung cancer incidence increased over the entire study period by +4.2% per year (95% CI 3.1-5.4); this trend was mainly caused by the age group 55-64 years (APC = +7%) and by adenocarcinoma incidence between women (APC = +6.8%). CONCLUSION: Male lung cancer incidence rates have decreased in Granada, while female rates have increased overall especially in younger women. These trends may reflect the increased consumption of cigarettes in women, especially during younger ages. Lung cancer prevention through tobacco control policies are therefore of utmost importance.

Colestasis neonatal: reporte de 21 casos en un hospital infantil de Cartagena, Colombia / Report of 21 Cases of Neonatal Cholestasis in a Children’s Hospital in Cartagena, Colombia

La colestasis es una alteración en el flujo biliar que se presenta por la disminución o el cese de excreción biliar. En la actualidad, son pocos los estudios en Colombia sobre esta patología. Se presentan 21 casos de colestasis neonatal en un hospital infantil de la ciudad de Cartagena (Colombia) entre 2010 y 2013, con el objetivo de caracterizar la etiología y clínica de la enfermedad. Se seleccionaron los pacientes entre 0 y 3 meses de edad con bilirrubina directa >2 mg/dL. En este estudio se encontró que según el género, el 52,4% fueron de sexo masculino y el 47,6%, de sexo femenino. La edad gestacional predominante fue a término en el 76,2% y sin antecedentes perinatales en el 57,1%. Los hallazgos clínicos se presentaron en los primeros 30 días de nacido en un 71% y 4 pacientes fueron remitidos a trasplante hepático. La etiología más frecuente fue de tipo infeccioso en 13 de los pacientes estudiados y 4 pacientes se relacionaron con atresias. La causa más frecuente de colestasis neonatal en este estudio resultó estar asociada con etiologías infecciosas. Sin embargo, las alteraciones obstructivas, como la atresia de vías biliares, siguen ocupando un renglón importante y requieren un estudio y manejo prioritario, dado su mejor pronóstico relacionado con la intervención temprana.

Cholestasis is an alteration in the flow of bile resulting from decreases or cessation of biliary excretion. To date, there have been only a few studies on this topic in Colombia. This article presents twenty-one cases of neonatal cholestasis from a Children’s Hospital in Cartagena, Colombia that occurred between 2010 and 2013. The aim of this study is to characterize the etiology and clinical characteristics of the disease. Patients between birth and 3 months old with direct bilirubin levels over 2 mg/dl were selected. By gender, 52.4% of the patients were male, and 47.6% were female. 76.2% of the patients were full term, and 57.1% had no perinatal antecedents. Clinical symptoms presented in the first 30 days after birth in 71% of the patients, and 4 patients were referred for liver transplantation. The most common etiology was infectious (13 patients), and 4 patients had atresia. The most common cause of neonatal cholestasis in this study was infection, but obstructive disorders such as biliary atresia still account for an important proportion of the patients. They require priority study and handling because early intervention results in better prognoses.

GAL3ST2 from mammary gland epithelial cells affects differentiation of 3T3-L1 preadipocytes.

INTRODUCTION: In the mammary gland, the involution that occurs when lactation ends is an important period for cancer development. We have previously demonstrated stromal-epithelium interactions evaluating conditioned medium of adipose tissue on breast epithelial metalloproteases activity (Creydt et al., Clin Transl Oncol 15:124-131, 2013). Here, we evaluated the effects of conditioned medium of breast epithelial mammary cells on stromal cells. MATERIALS AND METHODS: Conditioned medium from normal murine mammary gland cell line (NMuMG) and conditioned medium proteins were obtained. Then, they were evaluated on modulation of adipocyte differentiation, using 3T3-L1 cell line. RESULTS: We described, for the first time, that breast epithelial mammary cells could produce the enzyme galactose 3-O-sulfotransferase 2 (GAL3ST2). Importantly, GAL3ST2 is present in NMMuMG and two human breast cancer cell lines, and it is more strongly expressed in more metastatic tumors. When 3T3-L1 preadipocyte differentiation was triggered in the presence of conditioned medium from NMuMG or GAL3ST2, triglyceride accumulation was decreased by 40 % and C/EBPß expression by 80 % in adipocytes. In addition, the expression of FABP4 (aP2), another marker of adipocyte differentiation, was inhibited by 40 % in GAL3ST2-treated cells. CONCLUSIONS: Taken together, these results suggest that GAL3ST2 would interfere with normal differentiation of 3T3-L1 preadipocytes; raising the possibility that it may affect normal differentiation of stromal preadipocytes and be a link to tumor metastatic capacity.

Tissue damage modeling in gene electrotransfer: the role of pH.

Optimal gene electrotransfer (GET) requires a compromise between maximum transgene expression and minimal tissue damage. GET in skeletal muscle can be improved by pretreatment with hyaluronidase which contributes to maximize transgene uptake and expression. Nevertheless, tissue damage remains severe close to the electrodes, with a concomitant loss of GET efficiency. Here we analyze the role of pH in tissue damage in GET protocols through in vivo modeling using a transparent chamber implanted into the dorsal skinfold of a mouse (DSC) and intravital microscopy, and in silico modeling using the Poisson-Nernst-Planck equations for ion transport. DSC intravital microscopy reveals the existence of pH fronts emerging from both electrodes and that these fronts are immediate and substantial thus giving rise to tissue necrosis. Theoretical modeling confirms experimental measurements and shows that in GET protocols whether with or without hyaluronidase pretreatment, pH fronts are the principal cause of muscle damage near the electrodes. It also predicts that an optimal efficiency in GET protocols, that is a compromise between obtaining maximum electroporated area and minimal tissue damage, is achieved when the electric field applied is near 183 V/cm in a GET protocol and 158 V/cm in a hyaluronidase+GET protocol.

Do patients with metastatic urothelial carcinoma benefit from docetaxel as second-line chemotherapy?

PURPOSE: To evaluate the efficacy and toxicity of docetaxel regimen as second-line after failure of a platinum-based chemotherapy. METHODS: Between May 2005 and June 2008, we retrospectively analyzed the data of 22 patients who had evidence of disease progression after one prior platinum-based regimen for metastatic urothelial carcinoma. Patients were treated with two different docetaxel dose schedules: (1) docetaxel 60 mg/m(2) every 21 days for unfit patients or (2) docetaxel 75 mg/m(2) every 21 days for fit patients. RESULTS: Median number of docetaxel cycles was three. Overall disease control rate was 18 %. Of the 22 patients, no patient achieved complete or partial response and four patients had stable disease. Median progression-free survival was 1.67 months and median overall survival was 3.12 months. Neutropenia was the most common adverse event. CONCLUSIONS: This study identifies that docetaxel as second-line chemotherapy has low activity and was associated with significant toxicity.