Mielitis transversa aguda asociada a Covid-19. Reporte de caso

Desde el inicio de la pandemia por COVID-19 (coronavirus disease), en el 2019, se han descrito numerosas manifestaciones clínicas de la enfermedad causada por este virus, destacando el compromiso respiratorio, hematológico, cardiovascular y neurológico. Dentro de las manifestaciones y/o complicaciones neurológicas, se encuentra la mielitis aguda transversa por COVID-19(1), cuyo diagnóstico se ha realizado principalmente clínico-imagenológico y PCR (reacción de polimerasa en cadena), o serología (+) para COVID-19, con manejos y resultados no siempre afortunados. Presentamos el caso de un paciente con mielitis aguda transversa longitudinalmente extensa en relación a COVID-19, tratada con éxito clínico con rituximab.

Since the beginning of the COVID-19 pandemic in 2019, numerous clinical manifestations of the disease caused by this virus have been described, highlighting respiratory, hematological, cardiovascular, and neurological compromise. Among the neurological manifestations and/or complications, there is acute transverse myelitis due to COVID-19(1), whose diagnosis has been made mainly clinical-imaging and PCR or serology (+) for COVID-19, with management and results not always lucky. We present the case of a patient with longitudinally extensive acute transverse myelitis in relation to COVID-19, treated with clinical success with rituximab.

Chilean aquaculture and the new challenges: Pathogens, immune response, vaccination and fish diversification.

In Chile, the salmon and trout farmed fishing industries have rapidly grown during the last years, becoming one of the most important economic sources for the country. However, infectious diseases caused by bacteria, virus, mycoses and parasites, result in losses of up to 700 million dollars per year for the Chilean aquaculture production with the consequent increase of antibiotic and antiparasitic usage. After 30 years of its first appearance, the main salmon health problem is still the salmonid rickettsial septicaemia (SRS), which together with other disease outbreaks, reveal that vaccines do not provide acceptable levels of long-lasting immune protection in the field. On the other hand, due to the large dependence of the industry on salmonids production, the Chilean government promoted the Aquaculture diversification program by 2009, which includes new species such as Merluccius australis, Cilus gilberti and Genypterus chilensis, however, specific research regarding the immune system and vaccine development are issues that still need to be addressed and must be considered as important as the farm production technologies for new fish species. Based on the experience acquired from the salmonid fish farming, should be mandatory an effort to study the immune system of the new species to develop knowledge for vaccination approaches, aiming to protect these aquaculture species before diseases outbreaks may occur. This review focuses on the current status of the Chilean aquaculture industry, the challenges related to emerging and re-emerging microbial pathogens on salmonid fish farming, and the resulting needs in the development of immune protection by rational designed vaccines. We also discussed about what we have learn from 25 years of salmonid researches and what can be applied to the new Chilean farmed species on immunology and vaccinology.

SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019).

In 2011, the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of venous thromboembolism (VTE) and cancer. This guideline was updated in 2014, and since then, multiple studies and clinical trials have changed the landscape of the treatment and prophylaxis of VTE in cancer patients. To incorporate the most recent evidence, including data from direct oral anticoagulants (DOACs) randomized clinical trials, SEOM presents a new update of the guideline.

Síndrome de Kounis tras la administración de Cefditorén / Kounis syndrome after Cefditorén administration

El síndrome de Kounis fue definido, por primera vez, en 1991, como la aparición simultánea de episodios coronarios agudos y reacciones alérgicas anafilácticas o anafilactoides. Los agentes etiológicos asociados a su aparición son múltiples y los más frecuentes son los fármacos, en especial, los antibióticos. Su diagnóstico es eminentemente clínico, no existe ninguna prueba patognomónica. No hay consenso ni guías de práctica clínica específicas; se recomienda el tratamiento específico para el síndrome coronario agudo enfocado en tratar el vasoespasmo y la anafilaxia, con el agravante de que puede haber contraindicaciones cuando se usan conjuntamente y que dichos fármacos antianginosos pueden desencadenar el cuadro. Se presenta un caso clínico de síndrome de Kounis asociado a cefditorén, el primero descrito en la literatura(AU)

Kounis syndrome was first described in 1991 as the simultaneous occurrence of acute coronary events and allergic anaphylactic or anaphylactoid reactions. Multiple etiologic agents are associated with this syndrome, the most common are drugs, especially antibiotics. Diagnosis is eminently clinical, there are not pathognomonic tests. Consensus and specific clinical practice guidelines are lacking; specific acute coronary syndrome treatment is recommended focusing on vasospasm and anaphylaxis, with the aggravating circumstance that contraindications can be present when used together and such antianginal drugs may trigger the condition. We present a case of Kounis syndrome associated with cefditoren, the first reported in the literature.(AU)

Encefalitis por Anticuerpos contra el Receptor N-metil D-aspartato(NMDAR) en Pediatría. Reporte de caso y revisión de la literatura / Encephalitis associated with antibodies against the N-methyl-D-aspartate receptor (NMDAR) in pediatrics. Case report

La Encefalitis por Anticuerpos contra el Receptor N-metil D-aspartato (NMDAR) es un trastorno grave conuna presentación inicial puramente neuropsiquiátrica, que evoluciona hacia una encefalopatía severa, y es acompañadopor movimientos involuntarios, convulsiones e inestabilidad autonómica; el curso de la enfermedadusualmente se prolonga y necesita tratamiento inmunomodulador agresivo.Se describe el caso de un paciente de 5 años con diagnóstico de Encefalitis por Anticuerpos contra el ReceptorN-metil D-aspartato (NMDAR), manejado con tratamiento inmunomodulador, logrando así control y noprogreso de enfermedad...

Anti-NMDA receptor encephalitis is a severe disorder with a dramatic clinical presentation, often showing apurely initial neuropsychiatric phase, and evolving into a severe encephalopathy accompanied by involuntarymovements, seizures and autonomic instability; the disease course is typically prolonged and needs intensivecare treatment.We report the case of a 5-year-old child, diagnosed with Anti-NMDA receptor encephalitis with immunemodulatory therapy...

Young male survivor of a spontaneous left main coronary artery dissection treated with surgery.

Spontaneous dissection of the coronary arteries is a rare disease with a wide range of clinical presentations ranging from angina to myocardial infarction (MI); its pathophysiology has not yet been fully established. In this paper, we present the case of a 31-year-old male with an acute coronary syndrome. The initial results of the electrocardiogram and cardiac enzymes were consistent with MI. However, a coronary angio-tomography revealed a dissection of the left main coronary artery and the patient underwent emergent surgery with coronary artery bypass grafting. The treatment of spontaneous dissection of the coronary arteries depends on the anatomical location and the patient's clinical presentation. Coronary revascularization is associated with good results.

Sleep disorders in the adult population of Santiago of Chile and its association with common psychiatric disorders.

INTRODUCTION: Sleep disorders are a frequent problem and they are a usual reason of primary care consultation, because they cause a significant deterioration in the quality of life. Insomnia is the most common sleep disorder and it has a total prevalence in adults estimated of 19.1%, of whom 85% are chronic insomnia, which in turn is closely related to psychiatric disorders and even more it has been described as a depressive episode marker. AIMS: To characterize the Santiago adult population suffering from sleep disorders and analyze their statistical association with common mental disorders. METHODOLOGY: It corresponds to a secondary analysis of the survey "Common Mental Disorders in Santiago". A cross-sectional survey that used as a sampling frame the adult population of Santiago aged between 16 to 64 years was carried out. A structured interview covering sociodemographic factors and the Revised Clinical Interview Schedule (CIS-R) to measure emotional symptoms, were applied. RESULTS: 3867 people representative of the adult population were evaluated (52.3% women, 47.7% men). The prevalence of sleep disorders was 26.3%. Sociodemographic risk factors, statistically significants, were detected like female gender, unemployed seeking employment, the presence of a common mental disorder, alcohol and drugs consumption in the last month, among others. CONCLUSIONS: There is a high prevalence of sleep disorders among the population of Santiago; this is closely associated to female gender, social disadvantages and potently to the presence of a common mental disorder.

Evaluation of early embrionic development after natural mating using ultrasonography in bos indicus cows in the humid tropics of Costa Rica.

Fifty-eight nursing Zebu cows averaging 5922 days postpartum were used to evaluate the early embryonic development by ultrasound under a natural mating system (bulls A to F). Three consecutive mating periods of 21 days were established. Sixty two percent of the animals were diagnosed as pregnant (36/58). During the first period (AB) 76% (27/36) of the animals become pregnant, 17% (6/36) during the second (CD) and 9% (3/36) in the last mating period (EF). Sixty two percent of the animals were true positives (animals found pregnant diagnosed by ultrasound (US), and conforming with the embryonic scale proposed by Rosiles et al. (2006); 12% (n = 7) of false negatives (pregnant cows by US but not conforming with the scale); 2% (n = 1) of false positives (pregnant cows, evaluated with US and conforming with the embryonic scale but not pregnant at the end of the study); and a 26% (n = 15) of true negatives (not pregnancy evaluated with US). The sensitivity of the test was 97%, with a specificity of 68% with a positive predictive value of 83% and a negative predictive value of 6%. Relation between the measuring scale of embryo development and the results obtained by ultrasonography was k = 0.69. No significant correlation were observed between body condition score (BCS) evaluation and body fat (BF) measurement at any of the three evaluations performed after mating, however, measurements of BCS and BF among time showed a positive correlation (0.48 P < 0.05, 0.29, P < 0.07, respectively) from the beginning of the evaluation period to the end of the trial. Ultrasonography to monitor embryonic development to determine the early establishment of pregnancy in natural mating reproductive programs can be a valuable technique to monitor reproductive efficiency.

Benzodiazepine use in Santiago, Chile.

INTRODUCTION: To describe benzodiazepine use in the adult population from Santiago, Chile and attempt to establish associations with different sociodemographic and medical variables. METHODS: This is a cross-sectional study whose sampling frame was the adult population, aged 16 to 64 years (n = 3,237,286). The sampling strategy was probabilistic, poly-stage and stratified. RESULTS: A total of 3,870 persons were interviewed. Prevalence of benzodiazepine use was 3.84 %. Statistically significant associations were found between benzodiazepine use and gender, age, marital status, income, presence of a common mental disorder and health perception. DISCUSSION: Training of the general practitioner to regulate the use of benzodiazepine is necessary.

[Multiple intracranial aneurysms in Camagüey, Cuba]. / Aneurismas intracraneales múltiples en Camagüey, Cuba.

INTRODUCTION: It is considered multiple intracranial aneurysms when a patient harbors two or more intracranial aneurysms. OBJECTIVE: To analyze clinical characteristic and microneurosurgical results of patients with multiple intracranial aneurysms attended in Camagüey. PATIENTS AND METHODS: Between 524 patients operated on to clip aneurysms, we searched 113 patients with multiple intracranial aneurysms. Patients were operated on by microneurosurgical methods and specialized neuroanesthesia. We performed one or two stage operations. Patients were evaluated three month later with Glasgow Outcome scale. RESULTS: There were 21.5% of multiple aneurysms. Age average was 46 years. There were 85 (75%) women and 28 (25%) men. Associated diseases were high blood pressure, carotid fibromuscular dysplasia and familiar aneurysms. There were 264 aneurysms: 252 at the carotid system and 12 at the vertebrobasilar circulation. Sacs average per patients was 2.3. There were 36% of bilateral aneurysms and 30% of symmetric or mirror sacs. Nehls algorithm permitted to localize symptomatic lesions at: posterior communicating region, anterior cerebral anterior communicating artery, basilar bifurcation, ophthalmic region, and middle cerebral artery. We utilized 128 surgical procedures and two stage operations were applied in 15 patients. 90% of aneurysms were clipped. Ninety patients (79%) obtained complete recuperation, 15 (12%) partial incapacity; 3 (4%) severe incapacity and there were not vegetative patients. Five patients died and the mortality rate was 4.4%. CONCLUSION: Multiple intracranial aneurysms are complex lesions but each one has a similar behavior to sporadic aneurysms. Association to different medical conditions is frequent and microneurosurgery offers good results.

[Hemangioblastomas of the central nervous system in Camagüey (Cuba)]. / Hemangioblastomas del sistema nervioso en Camagüey (Cuba).

INTRODUCTION AND OBJECTIVE: Hemangioblastomas of the central nervous system are the most frequent vascular tumours. They are 1 2% of primary nervous system tumours and 8 12% of the posterior fossa neoplasms. The objective is to analize clinical behaviour and long term results of sporadic and Von Hippel Lindau linked hemangioblastomas. PATIENTS AND METHODS: It was searched the vacular Neurosurgical Data Bank at Manuel Ascunce Dom nech Hospital between January 1981 and January 2001 to select patients harvoring central nervous system hemangioblastomas histological confirmed. Melmo and Rosen criteria were utilized in Von Hippel Lindau syndrome. We performed a twenty years follow up of this patients. RESULTS: There were 12 patients with central nervous system hemangioblastomas. Average age of presentation was 41 years old. The first case had twenty years since the operation and the last, eight months. 83% were cystic and 17% were solids. There was not surgical mortality. One patient died of renal carcinoma 15 years after the operation on craneal fossa. CONCLUSION: Central nervous system hemangioblastomas are a cluster of challenge tumours. They are intraxial benign tumours with potential good outcome. We observed sporadic and Von Hippel Lindau linked hemangioblastomas. Patients with this syndrome need clinico imagenological screening to identify new associated lesions.

Transplante ortópico de hígado en animales de experimentación con bomba de bypass veno-venoso. Hospital Nacional Edgardo Rebagliati Martins - HNERM / Liver orthotopic transplantation in experimental animals with veno-venous bypass pump. Hospital Nacional Edgardo Rebagliati Martins - HNERM

El presente trabajo se realizó en el HNERM, entre Setiembre de 1996 a Julio de 1998. Se realizaron 61 procedimientos quirúrgicos en animales de experimentación, 39 en canes y 22 en cerdos. De estos procedimientos 14 fueron transplante ortotópico de hígado. (TOH), 7 en canes y 7 en cerdos. Durante la fase anhepática se utilizó en 6 animales el bypass veno-venoso con bomba centrífuga sin heparinización sistémica y en 8 se utilizó el bypass veno-venoso pasivo con heparinización sistémica. Los animales fueron sacrificados 2 horas después de concluído el procedimiento, para precisar el estado de la anastomosis y la presencia o no de trombos.

[LIVER ORTHOTOPIC TRANSPLANTATION IN EXPERIMENTAL ANIMALS WITH VENO-VENOUS BYPASS PUMP HOSPITAL NACIONAL EDGARDO REBAGLIATI MARTINS-HNERM- 09/1996 TO 07/1998] / Transplante Ortotópico de Hígado en animales de experimentación con bomba de bypass veno-venoso.Hospital Nacional Egardo Rebagliati Martins - HNERM.

This study was carried at at the Hospital Nacional Edgardo Rebagliati Martins, from September 1996 to July 1998. 61 surgical procedures were performed in experimental animals, 39 in dogs and 22 in pigs. During the anhepatic phase, we used veno-venous bypass with centrifugal pumps and without systemic anticoagulation drugs in 6 animals, and passive venovenous bypass with systemic anticoagulation drugs in 8 animals. Experimental animals were sacrified two hours after the procedures were concluded in order to assess the status of vascular anastomosis and thrombus formation.

Altered profile of urinary arsenic metabolites in adults with chronic arsenicism. A pilot study.

Relationships between alterations in the profile of urinary arsenic (As) species and the presence of cutaneous signs of arsenicism were studied in Region Lagunera, Mexico. The use of urinary concentrations of putative substrates and products of the As metabolism pathway, as indicators of metabolic efficiency is also discussed. Arsenic was determined by hydride generation atomic absorption spectrophotometry and separation of As species was performed by ion exchange chromatography. The exposed group had an average of 0.408 mg As/l of total As (TAs) in their drinking water, whereas "control' individuals had 0.031 mg/l. Urinary concentrations of arsenic species and TAs were 20 to 95 times higher in the exposed group. Significant increases in the relative proportions of inorganic arsenic (Asi) and monomethylarsonic acid (MMA), accompanied by decreases of dimethylarsinic acid (DMA) were also found in exposed individuals. Therefore, significant decreases in the value of the MMA/Asi, DMA/MMA and DMA/ Asi ratios were observed, suggesting a decreased As methylating ability. Exposed individuals bearing cutaneous signs had a significantly longer time of exposure, higher urinary concentrations and proportions of MMA and MMA/Asi values, and significantly lower DMA/ MMA than exposed individuals without cutaneous signs. Further research is needed to identify better parameters for assessing the efficiency of As metabolism in chronically exposed populations and to confirm the potential relationship between metabolic alterations and overt signs of As toxicity.

Genotoxic activity of praziquantel.

Praziquantel is a synthetic drug with a remarkable activity against parasites, particularly treamatodes and cestodes. Initial genotoxicity tests used a spectrum of endpoints including tests in bacteria, yeasts, mammalian cells and Drosophila and each one gave negative results. Effects on reproductive cells of mice were negative as well. However, host mediated studies in mice and humans were contradictory and a comutagenic effect with several mutagens and carcinogens was found. Later studies, including monitoring in humans and pigs have shown that Praziquantel induces a greater frequency of hyperploid lymphocytes as well as structural chromosomal aberrations, but not in all the individuals treated. In vitro studies have demonstrated that Praziquantel can induce micronuclei in syrian hamster embryonic (SHE) cells and in lymphocytes of some individuals. The same was found about structural chromosomal aberrations. Fetal death and fetal resorption were found when Praziquantel was administered in high doses to pregnant rats between the 6th and 10th day of gestation. Due to its efficiency as a parasiticide, Praziquantel is in use in Latin-American, Asiatic, African and East-European countries where infections by trematodes and cestodes are frequent. However, the extensive use of Praziquantel in multiple reinfections, in non-infected and non-diagnosed individuals for prevention, in higher doses or repeated doses for cysticercosis treatment and in individuals exposed to environmental mutagens, in conjunction with new findings about its metabolism and genotoxic properties, make it necessary to further evaluate the potential of this drug not only to be mutagenic per se, but to contribute in the development of neoplasm.

[Sleep changes in elderly patients at a general medical practice]. / Alteraciones del sueño en senescentes consultantes a la práctica médica general.

In order to determine the prevalence of sleeping disorders and their relationship with sociodemographic and medical variables in elderly attending to general morbidity physicians, 144 individuals from 65 years and up from 2 primary care centers in Santiago were interviewed. An structured interview which included sociodemographic data, reason of the visit, and benzodiazepine use; CIS-R, GHQ-12; BI; MMSE, and a questionnaire for physicians were applied. Mean age of the sample was 72.9 +/- 6.2 years old, most women, schooling less than 8 years, 52.1% had no partner, mean family income was U$A 112 +/- 61.8. There was a significant statistical association between sleeping and psychiatric disorders. General physicians made significantly more the diagnosis of psychiatric disorder among individuals with sleeping disorder, being also them who received significantly more benzodiazepine and antidepressive prescriptions.

Genotoxic monitoring of workers at a hazardous waste disposal site in Mexico.

Chromosomal aberration and sister chromatid exchange (SCE) frequencies were determined in lymphocytes cultured from 12 high-risk individuals working at a landfill for hazardous waste disposal. Cell proliferation kinetics (CPK) was also determined. Compared with 7 control individuals, no effects were observed with respect to SCE nor on CPK. However, the workers exhibited significantly higher frequencies of chromatid and chromosomal deletions, the magnitude of which was related with exposure time. This study suggests that when high-risk exposure is suspected, determining biomarkers of genotoxic damage (e.g., chromosomal aberrations), is useful for risk assessments.

Alteraciones del sueño en senescentes consultantes a la práctica médica general. / [Sleep changes in elderly patients at a general medical practice]

In order to determine the prevalence of sleeping disorders and their relationship with sociodemographic and medical variables in elderly attending to general morbidity physicians, 144 individuals from 65 years and up from 2 primary care centers in Santiago were interviewed. An structured interview which included sociodemographic data, reason of the visit, and benzodiazepine use; CIS-R, GHQ-12; BI; MMSE, and a questionnaire for physicians were applied. Mean age of the sample was 72.9 +/- 6.2 years old, most women, schooling less than 8 years, 52.1

had no partner, mean family income was U$A 112 +/- 61.8. There was a significant statistical association between sleeping and psychiatric disorders. General physicians made significantly more the diagnosis of psychiatric disorder among individuals with sleeping disorder, being also them who received significantly more benzodiazepine and antidepressive prescriptions.

Altered urinary porphyrin excretion in a human population chronically exposed to arsenic in Mexico.

1. A detailed study of the urinary excretion pattern of porphyrins in humans chronically exposed to As via drinking water was performed using high performance liquid chromatography (HPLC) 2. Thirty-six individuals (15 men and 21 women) were selected from a town which had 0.400 mg L-1 of As in drinking water. The control group consisted of thirty-one individuals (13 men and 18 women) whose As concentration in drinking water was 0.020 mg L-1. 3. The major abnormalities in the urinary porphyrin excretion pattern observed in arsenic-exposed individuals were: (a) significant reductions in coproporphyrin III excretion resulting in decreases in the COPRO III/COPRO I ratio, and (b) significant increases in uroporphyrin excretion. Both alterations were responsible for the decrease in the COPRO/URO ratio. 4. No porphyrinogenic response was found in individuals with urinary As concentrations below 1,000 micrograms of As g-1 of creatinine. However, as arsenic concentrations exceeded this value, the excretion of porphyrins (except coproporphyrin III) increased proportionally. 5. The prevalence of clinical signs of arsenicism showed a direct relationship to both As concentration in urine and time-weighted exposure to As. A direct relationship between time-weighted exposure and alterations in urinary porphyrin excretion ratios was also observed. 6. The alterations found are compatible with a lower uroporphyrinogen decarboxylase activity in arsenic-exposed individuals. However, the similarities in the urinary porphyrin excretion pattern between As-exposed individuals and Dubin-Johnson syndrome patients suggest that impairments in the excretion of coproporphyrin isomers may also contribute to the pattern observed.