Progressive Acute Lower Extremity Ischemia Resulting From Cardiac Myxoma Embolization: A Case Report.

Cardiac myxomas are the most common primary benign tumors of the heart. The occlusion of peripheral arteries and complete obstruction of the abdominal aorta by a tumor embolus presents with distinct clinical manifestations. Herein, we present the case of a 38-year-old male with acute paresthesia, muscle weakness, erythematous, and violaceous changes in skin color localized to the dorsum of the left forefoot initially treated as cutaneous vasculitis. Further studies revealed the total occlusion of the terminal abdominal aorta by a saddle embolus from a cardiac myxoma. A multidisciplinary team consisting of cardiothoracic and vascular surgeons were involved in treating the patient, which resulted in full resolution of the case. This paper details the progression of acute bilateral limb ischemia to chronic limb threatening ischemia resulting from the total occlusion of the terminal abdominal aorta by a saddle embolus.

Conocimiento en estudiantes de enfermería sobre sepsis quirúrgico / Knowledge in nursing students about surgical sepsis

Objetivo: Determinar el nivel de conocimiento de los estudiantes de enfermería de la Universidad Técnica de Ambato sobre sepsis quirúrgica. Material y método: La presente investigación tiene un diseño de desarrollo observacional, de tipo descriptivo, cohorte transversal, con un enfoque cuantitativo, ya que el nivel de cono-cimiento se verá representado mediante tablas y gráficos para des-cribir la problemática del periodo octubre 2023 febrero 2024. Re-sultados: Se evidencia un alto porcentaje de respuestas incorrectas por cada ítem por parte de los estudiantes. La categoría Nivel de Conocimiento sobre Definición de Sepsis, fue respondida de ma-nera incorrecta con un porcentaje del 83,9%, la categoría Nivel de Conocimiento sobre Diagnóstico de Sepsis obtuvo 51,7% y, por úl-timo, la Nivel de Conocimiento sobre Tratamiento de Sepsis con el 29,2%. Conclusiones: El nivel de conocimiento de los estudiantes sobre Sepsis Quirúrgica es malo, debido a que existe una subesti-mación de la gravedad de la sepsis como afección potencialmente mortal, lo que puede traer un impacto negativo en los pacientes[AU]

Objective: Determine the level of knowledge of nursing students at the Technical University of Ambato about surgical sepsis. Mate-rials and methods: This research has an observational, descriptive, transversal development design, with a quantitative approach since the level of knowledge will be represented through tables and gra-phs to describe the problems of the period October 2023-February 2024. Results: A high percentage of incorrect answers for each item by the students is evident. The category Level of Knowledge about Definition of Sepsis was answered incorrectly with a percentage of 83.9%, the category Level of Knowledge about Diagnosis of Sepsis obtained 51.7% and, finally, the category Level of Knowledge about Treatment of Sepsis. Sepsis with 29.2%. Conclusions: The level of knowledge of students about Surgical Sepsis is poor because there is an underestimation of the severity of sepsis as a potentially fatal condition, which can have a negative impact on patients[AU]

Objetivo: Determinar o nível de conhecimento dos estudantes de enfermagem da Universidade Técnica de Ambato sobre sepse ci-rúrgica. Material e método: Esta pesquisa possui desenho de coor-te observacional, descritivo, transversal, com abordagem quantita-tiva, uma vez que o nível de conhecimento será representado por meio de tabelas e gráficos para descrever o problema no período de outubro de 2023 a fevereiro de 2024. Resultados: Uma parada. É evidente o percentual de respostas incorretas para cada item por parte dos alunos. A categoria Nível de Conhecimento sobre Defi-nição de Sepse foi respondida incorretamente com percentual de 83,9%, a categoria Nível de Conhecimento sobre Diagnóstico de Sepse obteve 51,7% e por fim, a categoria Nível de Conhecimen-to sobre Tratamento de Sepse com 29,2%. Conclusões: O nível de conhecimento dos estudantes sobre a Sepse Cirúrgica é baixo, pois há uma subestimação da gravidade da sepse como uma condição potencialmente fatal, que pode ter um impacto negativo nos pa-cientes[AU]

Biofilm formation and increased mortality among cancer patients with candidemia in a Peruvian reference center.

BACKGROUND: Candidemia is an invasive mycosis with an increasing global incidence and high mortality rates in cancer patients. The production of biofilms by some strains of Candida constitutes a mechanism that limits the action of antifungal agents; however, there is limited and conflicting evidence about its role in the risk of death. This study aimed to determine whether biofilm formation is associated with mortality in cancer patients with candidemia. METHODS: This retrospective cohort study included patients treated at Peru's oncologic reference center between June 2015 and October 2017. Data were collected by monitoring patients for 30 days from the diagnosis of candidemia until the date of death or hospital discharge. Statistical analyses evaluated the association between biofilm production determined by XTT reduction and mortality, adjusting for demographic, clinical, and microbiological factors assessed by the hospital routinary activities. Survival analysis and bivariate and multivariate Cox regression were used, estimating the hazard ratio (HR) as a measure of association with a significance level of p < 0.05. RESULTS: A total of 140 patients with candidemia were included in the study. The high mortality observed on the first day of post-diagnosis follow-up (81.0%) among 21 patients who were not treated with either antifungal or antimicrobial drugs led to stratification of the analyses according to whether they received treatment. In untreated patients, there was a mortality gradient in patients infected with non-biofilm-forming strains vs. low/medium and high-level biofilm-forming strains (25.0%, 66.7% and 82.3%, respectively, p = 0.049). In treated patients, a high level of biofilm formation was associated with increased mortality (HR, 3.92; 95% p = 0.022), and this association persisted after adjusting for age, comorbidities, and hospital emergency admission (HR, 6.59; CI: 1.87-23.24, p = 0.003). CONCLUSIONS: The association between candidemia with in vitro biofilm formation and an increased risk of death consistently observed both in patients with and without treatment, provides another level of evidence for a possible causal association. The presence of comorbidities and the origin of the hospital emergency, which reflect the fragile clinical condition of the patients, and increasing age above 15 years were associated with a higher risk of death.

Long COVID: a new disease?

The definition of quaternary prevention as the set of interventions that avoids or mitigates the consequences of unnecessary or excessive activity of medical interventionism and the health system. The definition of a new disease is a complex process that involves the identification, characterization and description of a medical condition that has not been previously recognized or documented. Since mid-2020, the term chronic COVID/long COVID has been used to describe the presence of signs and symptoms after an acute SARS-CoV-2 infection, with multiple terminologies and definitions in international literature. Post-infectious syndromes, myalgia encephalomyelitis and fibromyalgia, are some of the diseases that have similarities with chronic COVID. This article presents an analysis relating the concepts of new disease and quaternary prevention with chronic COVID and other diseases described in the literature.

Se define prevención cuaternaria como el conjunto de intervenciones que evita o atenúa las consecuencias de la actividad innecesaria o excesiva del intervencionismo médico y del sistema sanitario. La definición de una nueva enfermedad es un proceso complejo que involucra la identificación, caracterización y descripción de un cuadro clínico que no ha sido previamente reconocida o documentada. Desde mediados del año 2020 se utiliza el término COVID crónico/long COVID para describir la presencia de signos y síntomas luego de una infección aguda por SARS-CoV-2, con múltiples terminologías y definiciones en la literatura internacional. Los síndromes posinfecciosos, la encefalomielitis mialgia y la fibromialgia, son algunas de las enfermedades que tienen similitudes con el COVID crónico. En este artículo se presenta un análisis relacionando los conceptos de nueva enfermedad y prevención cuaternaria con el COVID crónico y otras enfermedades descritas en la literatura.

[Meningitis and myelitis by hypervirulent Klebsiella pneumoniae]. / Meningitis y mielitis por Klebsiella pneumoniae hipervirulenta.

Invasive liver abscess syndrome caused by hypervirulent Klebsiella. pneumoniae is a rare disease. This type of K. pneumoniae is aggressive and invasive, despite its sensitivity profile. We report the case of a 62-year-old man with diabetes mellitus, who was admitted to our hospital with meningeal syndrome. Within 24 hours of admission, Gram negative bacilli were isolated blood and cerebrospinal fluid cultures, which were later identified as K. pneumoniae. Liver abscess was detected by computed tomography. Despite early antibiotic treatment, the patient developed back pain that prevented him from moving and right hemiparesis. Increased signal from the central region of the spinal medulla compatible with myelitis was identified by magnetic resonance, for which he received methylprednisolone 1 g/day for 5 days. The patient evolved favorably. Infections caused by hypermucoviscous K. pneumoniae are aggressive and invasive, and more common in men with a history of diabetes mellitus, as in this case. These infections require early antibiotic treatment and the search of metastatic infections.

El síndrome de absceso hepático invasivo causado por cepas hipermucoviscosas de Klebsiella pneumoniae es una enfermedad poco frecuente. Esta serovariedad de Klebsiella se caracteriza por ser agresiva e invasiva pese a su perfil de sensibilidad. Se presenta el caso de un varón de 62 años con antecedentes de diabetes mellitus, que ingresó a nuestro centro con síndrome meníngeo. A las 24 horas del ingreso se aislaron en hemocultivos y en líquido cefalorraquídeo (LCR) bacilos Gram negativos que luego fueron tipificados como Klebsiella pneumoniae. Se identificó la presencia de un absceso hepático mediante tomografía computarizada. Pese al tratamiento antibiótico instaurado de manera temprana, el paciente evolucionó con dolor dorsal que le impedía movilizarse y hemiparesia derecha. En la resonancia magnética nuclear de columna se identificó aumento de la señal de la región central de la médula espinal compatible con mielitis por lo cual recibió tratamiento con metilprednisolona 1g/día por 5 días consecutivos. El paciente evolucionó de manera favorable. Las infecciones por K. pneumoniae hipermucoviscosas son agresivas e invasoras y más frecuentes en varones con antecedentes de diabetes mellitus, como en este caso. Su control requiere de un tratamiento antibiótico temprano y búsqueda de focos a distancia.

[Benign infant myositis associated to influenza B]. / Miositis benigna de la infancia asociada a influenza B.

Benign childhood myositis is a self-limiting inflammatory condition that primarily affects schoolaged boys during the winter months. It is associated with respiratory viral infections, such as influenza A and B viruses, respiratory syncytial virus (RSV), and Mycoplasma pneumoniae, among others. In September 2022, an epidemiological alert was raised due to a high number of reported cases in the metropolitan area of Buenos Aires. We present two cases of female adolescents, aged 10 and 14 years, who developed this condition in association with influenza B virus infection. Their treatment and follow-up differed based on their clinical presentation and laboratory findings. This entity should be considered in the differential diagnosis of lower limb myalgia, difficulty walking, and functional impotence. It is necessary to establish management guidelines according to the clinic and laboratory. The search for respiratory viruses, mainly influenza, should be done taking into account the local epidemiology.

La miositis benigna de la infancia es un cuadro inflamatorio, asociado a infecciones virales respiratorias, autolimitado que no deja secuelas. Afecta principalmente a varones en edad escolar, durante los meses de invierno. Puede asociarse a virus influenza A y B, VRS, Mycoplasma pneumoniae, entre otros. En el mes de septiembre de 2022 se generó una alerta epidemiológica por el elevado número de casos reportados en el área metropolitana de Buenos Aires. Presentamos los casos de dos adolescentes mujeres de 10 y 14 años con este cuadro asociado a influenza B. El tratamiento y el seguimiento fueron diferentes en base a la clínica y el laboratorio. Hay que tener en cuenta esta entidad como un diagnóstico diferencial de mialgias de miembros inferiores, dificultad en la marcha e impotencia funcional. Es necesario establecer las pautas de manejo según clínica y laboratorio. La búsqueda de virus respiratorios, principalmente influenza, debe hacerse teniendo en cuenta la epidemiología local.

[Simultaneous presentation of bullous pemphigoid and mycosis fungoides]. / Presentación simultánea de penfigoide ampollar y micosis fungoide.

The relationship between bullous pemphigoid (BP) and neoplasms has been debated in the medical literature. Although numerous case reports have described the coexistence of BP with various neoplasms, case-control studies have yielded conflicting results. We present the case of a male patient who developed BP shortly after being diagnosed with mycosis fungoides (MF). He was a 77-year-old man with a history of type 2 diabetes mellitus and hypertension who was diagnosed with MF. Subsequently, he developed blisters after sun exposure, and was diagnosed with BP through histopathology and direct immunofluorescence. The patient was treated with prednisone and methotrexate, with favorable evolution without recurrence of MF or appearance of new blisters. The association between cutaneous T-cell lymphoma and autoimmune blistering disease is rare, although similar cases have been reported, some associated with phototherapy. In this case, the onset of BP after sun exposure suggests a potential connection. The coexistence of BP and MF remains controversial, and this case highlights the importance of considering autoimmune blistering diseases in patients with oncohematological neoplasms.

La relación entre el penfigoide ampollar (PA) y las neoplasias ha sido objeto de debate en la literatura médica. Aunque numerosos informes de casos han descrito la coexistencia del PA con diversas neoplasias, estudios de casos y controles han arrojado resultados contradictorios. Presentamos el caso de un paciente masculino que desarrolló un PA poco después de ser diagnosticado con una micosis fungoide (MF). Se trata de un hombre de 77 años con antecedentes de diabetes mellitus tipo 2 e hipertensión arterial que fue diagnosticado con MF. Posteriormente, desarrolló ampollas después de una exposición solar, siendo diagnosticado con PA mediante histopatología e inmunofluorescencia directa. El paciente fue tratado con meprednisona y metotrexato, evolucionando favorablemente sin recurrencia de MF ni aparición de nuevas ampollas. La asociación entre un linfoma cutáneo de células T y una enfermedad ampollar autoinmune es rara, aunque han sido reportados casos similares, algunos asociados con fototerapia. En este caso la aparición del PA después de la exposición solar sugiere una conexión potencial. La coexistencia entre PA y MF sigue siendo controvertida, y este caso destaca la importancia de considerar enfermedades ampollares autoinmunes en pacientes con neoplasias oncohematológicas.

[Complicated right Bochdalek hernia]. / Hernia de Bochdalek derecha complicada.

The clinical case of a 53-year-old woman diagnosed with a right Bochdalek hernia complicated by intestinal obstruction is presented. This type of diaphragmatic hernia is rare, especially those located on the right side, but is the most common non-hiatal hernia. Her diagnosis focused on the computed tomography of the chest and abdomen and the repair was performed using a laparoscopic approach. A primary closure was carried out associated with the placement of polypropylene mesh. Her evolution was favorable, with no complications associated with the procedure.

Se presenta el caso clínico de una mujer de 53 años diagnosticada con una hernia de Bochdalek derecha complicada con oclusión intestinal. Este tipo de hernias diafragmáticas son raras, especialmente las localizadas en lado derecho, pero constituyen aquellas no hiatales más frecuentes. El diagnóstico se centró en la tomografía computarizada de tórax y abdomen, y la reparación se realizó mediante una malla de polipropileno. La evolución fue favorable, sin complicaciones asociadas al procedimiento.

[Pancreatic tuberculosis]. / Tuberculosis pancreática.

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is currently considered a public health problem due to the socioeconomic conditions of the world population and the increase in other infections such as that due to Human Immunodeficiency Virus (HIV). Pulmonary involvement is the most common form of clinical presentation, although in recent decades extrapulmonary involvement has increased. Among these, digestive disorders represent less than 10%. We present a case of exclusive pancreatic tuberculosis, in the context of an immunocompromised patient. A 43-year-old man with a history of HIV with a low CD4 count and high viral load, without antiretroviral treatment, with one-month history of symptoms characterized by low-grade fever associated with weight loss and nonspecific abdominal pain. An abdominal tomography was performed which showed a collection in the tail of the pancreas; the puncture revealed material with positive culture for M. tuberculosis. Antifimic and antiretroviral treatment was started with a good response. Primary pancreatic tuberculosis is an uncommon extrapulmonary form, given that it is a gland that would be biologically protected by the enzymes it produces. We highlight the rarity of the case and although the prognosis is good with anti-tuberculosis treatment, it could be fatal without correct diagnosis and treatment. The high index of suspicion of pancreatic tuberculosis by the physician and the performance of fine needle aspiration puncture to obtain histopathological evidence are important for a correct diagnosis, especially in HIV patients.

La tuberculosis es una enfermedad infectocontagiosa producida por el Mycobacterium tuberculosis. Actualmente se considera un problema de salud pública debido a las condiciones socioeconómicas de la población mundial y al incremento de otras infecciones causantes de inmunosupresión, como el virus de la inmunodeficiencia humana (HIV). La afección pulmonar es la forma de presentación clínica más frecuente aunque en las últimas décadas el compromiso extrapulmonar se ha visto incrementado. Dentro de este la afección digestiva representa menos del 10%. Presentamos un caso de localización exclusivamente pancreática en un paciente inmunocomprometido. Varón de 43 años HIV positivo, con bajo recuento de CD4 y alta carga viral, sin tratamiento antirretroviral, consultó por cuadro de un mes de evolución caracterizado por registros subfebriles asociado a pérdida de peso y dolor abdominal inespecífico. Se realizó tomografía de abdomen la cual arrojó colección en cola de páncreas, y posteriormente punción del material con rescate en cultivo de M. tuberculosis. Se inició tratamiento antifímico y antirretroviral con buena respuesta al mismo. La tuberculosis pancreática primaria es una forma extrapulmonar infrecuente, dado que es una glándula que estaría biológicamente protegida por las enzimas que origina. Destacamos la infrecuencia del caso y aunque el pronóstico es bueno con el tratamiento antifímico, podría ser fatal sin un diagnóstico y tratamiento correctos. El alto índice de sospecha de tuberculosis pancreática por parte del médico y la realización de punción aspiración con aguja fina (PAAF) para obtener evidencia histopatológica son importantes para un diagnóstico correcto, especialmente en pacientes HIV.

Association of Vitamin D and magnesium levels with severity and mortality in patients with COVID-19.

OBJECTIVE: The study aimed to determine the association between serum magnesium and Vitamin D levels with the severity and mortality by coronavirus disease 19 (COVID-19) in hospitalized patients. METHOD: Men and women over 18 years of age with probable COVID-19 were enrolled in a case-control study. Patients with a positive or negative test for Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were allocated into case or control groups, respectively. Vitamin D deficiency was defined by concentrations < 20 ng/mL and hypomagnesemia by serum levels < 1.8 mg/dL. RESULTS: A total of 54 patients, 30 women and 24 men, were enrolled and allocated into the groups with (n = 27) and without (n = 27) COVID-19. The logistic regression analysis showed that Vitamin D deficiency (odds ratio [OR] = 6.13; 95% confidence intervals [CI]: 1.32-28.34) and insufficiency (OR = 0.12; 95% CI: 0.02-0.60) are significantly associated with hospitalization. However, Vitamin D disorders and hypomagnesemia were not associated with mortality. CONCLUSIONS: The results of the present study revealed that Vitamin D disturbances, but not hypomagnesemia, are associated with the severity of SARS-CoV-2.

OBJETIVO: Determinar la asociación entre los niveles séricos de vitamina D y de magnesio con la gravedad y la mortalidad de la COVID-19 en pacientes hospitalizados. MÉTODO: Hombres y mujeres mayores de 18 años con probable COVID-19 fueron enrolados en un estudio de casos y controles. Los pacientes con una prueba positiva o negativa para SARS-CoV-2 fueron asignados en los grupos de casos y de controles, respectivamente. RESULTADOS: Un total de 54 pacientes, 30 mujeres y 24 hombres, fueron enrolados y asignados a los grupos COVID-19 (n = 27) y control (n = 27). El análisis de regresión logística mostró que la deficiencia de vitamina D (odds ratio [OR]: 6.13; intervalo de confianza del 95% [IC95%]: 1.32-28.34) y la insuficiencia de vitamina D (OR: 0.12; IC95%: 0.02-0.60) se asocian significativamente con hospitalización. Sin embargo, las alteraciones de la vitamina D y la hipomagnesemia no se asociaron con mortalidad. CONCLUSIONES: Los resultados del presente estudio revelaron que las alteraciones de la vitamina D, pero no la hipomagnesemia, se asocian con la gravedad de la COVID-19.

Proximal jejunal GIST associated with massive gastrointestinal bleeding. Case report.

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are rare, reported incidence is between 10 to 15 cases per million of habitants. They are usually located in the stomach (56%), small intestine (32%), colon-rectum (6%), and esophagus (<1%). Its symptoms include nausea, vomiting and abdominal fullness; 30% are asymptomatic. Incidental finding during abdominal surgery or imaging studies is common. Resection with negative margins is the standard treatment. CASE REPORT: A 69-year-old female patient who debuted with massive digestive tract bleeding, requiring surgical treatment. A tumor was detected at jejunum compatible with a GIST.

INTRODUCCIÓN: Los tumores del estroma gastrointestinal (GIST) son poco frecuentes, con una incidencia de 10 a 15 casos por millón de habitantes. Suelen localizarse en el estómago (56%), el intestino delgado (32%), el colon-recto (6%) y el esófago (< 1%). Sus síntomas incluyen náusea, vómito y plenitud abdominal; el 30% son asintomáticos. Es común su hallazgo incidental durante una cirugía abdominal o en estudios de imagen. La resección con márgenes negativos es el tratamiento estándar. CASO CLÍNICO: Mujer de 69 años que debuta con hemorragia masiva de tubo digestivo, requiriendo tratamiento quirúrgico. Se detecta un tumor de yeyuno compatible con GIST.

Acute kidney injury and mortality in patients with critical COVID-19 in Mexico: case-control study.

OBJECTIVE: We aimed to test the association between acute kidney injury (AKI) and mortality in critically ill patients with Coronavirus disease 2019 (COVID-19). METHOD: We conducted a single-center case-control study at the intensive care unit (ICU) of a second-level hospital in Mexico. We included 100 patients with critical COVID-19 from January to December 2021, and collected demographic characteristics, comorbidities, APACHE II, SOFA, NEWS2, and CO-RADS scores at admission, incidence of intrahospital complications, length of hospital and ICU stay, and duration of mechanical ventilation, among others. RESULTS: The median survival of deceased patients was 20 days. After multivariable logistic regression, the following variables were significantly associated to mortality: AKI (adjusted odds ratio [AOR] 6.64, 95% confidence intervals [CI] = 2.1-20.6, p = 0.001), age > 55 years (AOR 5.3, 95% CI = 1.5-18.1, p = 0.007), and arrhythmias (AOR 5.15, 95% CI = 1.3-19.2, p = 0.015). Median survival was shorter in patients with AKI (15 vs. 22 days, p = 0.043), as well as in patients with overweight/obesity (15 vs. 25 days, p = 0.026). CONCLUSION: Our findings show that the development of AKI was the main risk factor associated with mortality in critical COVID-19 patients, while other factors such as older age and cardiac arrhythmias were also associated with this outcome. The management of patients with COVID-19 should include renal function screening and staging on admission to the Emergency Department.

OBJETIVO: Probar la asociación entre lesión renal aguda y mortalidad en pacientes con COVID-19 grave. MÉTODO: Realizamos un estudio de casos y controles unicéntrico en la unidad de cuidados intensivos (UCI) de un hospital de segundo nivel en México. Incluimos 100 pacientes con COVID-19 grave de enero a diciembre 2021, recolectando características demográficas, comorbilidad, APACHE II, SOFA, NEWS2 y CO-RADS al ingreso, incidencia de complicaciones intrahospitalarias, duración de la estancia hospitalaria y en la UCI, duración de ventilación mecánica, etc. RESULTADOS: La mediana de supervivencia de los pacientes que fallecieron fue de 20 días. Al realizar el análisis de regresión logística multivariable, las siguientes variables se asociaron significativamente con la mortalidad: lesión renal aguda (odds ratio ajustada [ORa]: 6.64; intervalo de confianza del 95% [IC95%]: 2.1-20.6; p = 0.001), edad > 55 años (ORa: 5.3; IC95%: 1.5-18.1; p = 0.007) y arritmias (ORa: 5.15; IC95%: 1.3-19.2; p = 0.015). La supervivencia fue menor en pacientes con lesión renal aguda (15 vs. 22 días; p = 0,043), así como en pacientes con sobrepeso u obesidad (15 vs. 25 días; p = 0.026). CONCLUSIONES: Nuestros resultados muestran que el desarrollo de lesión renal aguda es el principal factor de riesgo asociado a mortalidad en pacientes con COVID-19 grave, mientras que otros factores, como la edad > 55 años y la presencia de arritmias cardiacas, también se asocian a mortalidad por COVID-19. El manejo de pacientes con COVID-19 debe incluir el tamizaje y la estadificación de la función renal al ingreso a urgencias.

Effect of laparoscopic gastric sleeve vs. laparoscopic gastric bypass in Roux-Y on long-term weight loss in obese mexican population.

OBJECTIVE: Compare the weight loss results between long-term procedures up to 5 years, after undergoing MGL and RYGB in Mexican patients with obesity and associated comorbidity. The most common bariatric surgical procedures worldwide are, laparoscopic gastric sleeve (MGL) and laparoscopic Roux-en-Y gastric bypass (RYGB), as a treatment for weight loss and remission of comorbidity associated with obesity; however, they are the long-term weight loss results in the Mexican population are unknown. METHOD: Retrospective, observational cohort of patients with obesity undergoing MGL or RYGB in a private hospital Medica Sur, in Mexico City, in the period from 2013 to 2021. Instrumental variables analysis and standardized mean differences were used to calculate outcomes up to 5 years at 5 follow-up visits (S1-S5), at 7 days, 2 months, 6 months, 10 months and 2-5 years after surgery, to compare results of the groups. RESULTS: 104 patients were included in two groups: 31 (30.09%) with MG and 73 (70.87%) with RYGB. The last follow-up (S5), the MG group recorded a mean EW 9.61 kg, EW% 12.72% and EWL% 73.50%, and the RYGB group EW 10.1 kg, EW% 14.72% and EWL% 70.41%. CONCLUSIONS: No significant difference was found between groups for long-term EW loss (p = 0.082); however, there is a greater decrease in weight loss in RYGB at 6-12 months compared to MGL.

OBJETIVO: Comparar los resultados de pérdida de peso con los procedimientos MGL y BGYRL a largo plazo (hasta 5 años) en pacientes mexicanos con obesidad y comorbilidad asociada. Son dos los procedimientos quirúrgicos bariátricos más frecuentes en todo el mundo: la manga gástrica lapa-roscópica (MGL) y el bypass gástrico en Y de Roux laparoscópico (BGYRL); ambos como tratamiento para pérdida ponderal y remisión de la comorbilidad asociadas a la obesidad. Sin embargo, se desconocen los resultados de pérdida de peso a largo plazo en la población mexicana. MÉTODO: Cohorte retrospectiva, observacional, de pacientes con obesidad sometidos a MGL o BGYRL en el hospital privado Médica Sur, de Ciudad de México, en el período de 2013 a 2021. Se utilizó el análisis de variables instrumentales y diferencias de medias estandarizadas para calcular los desenlaces hasta 5 años posquirúrgicos en cinco consultas de seguimiento (S1-S5) a los 7 días, 2 meses, 6 meses, 10 meses y 2-5 años posquirúrgicos, para comparar los resultados de los grupos. RESULTADOS: Se incluyeron 104 pacientes en dos grupos: 31 (30.09%) con MG y 73 (70.87%) con BGYR. En el último seguimiento (S5), el grupo de MG registró media de EW 9.61 kg, EW% 12.72% y EWL% 73.50%, y el grupo BGYR tuvo EW 10.1 kg, EW% 14.72% y EWL% 70.41%. CONCLUSIONES: No se encontró diferencia significativa entre grupos para pérdida de EW a largo plazo (p = 0.082); sin embargo, hay una mayor disminución de pérdida ponderal en los pacientes con BGYRL a los 6-12 meses en comparación con los tratados con MGL.

Gram-Negative Bacilli Blood Stream Infection in Patients with Severe Burns: Microbiological and Clinical Evidence from a 9-Year Cohort.

Bloodstream infection is one of the most important and increasing complications in patients with severe burns. Most of the species affecting this population are Gram-negative bacilli that exhibit antimicrobial resistance. We conducted this study to determine the antimicrobial susceptibility profile and resistance mechanisms of these bacterial infections and their clinical associations on morbidity and mortality. We analyzed a retrospective cohort of burn patients. All patients included in this study had monobacterial blood stream infections during their hospital stay. We performed phenotypic and genotypic tests to determine the antimicrobial resistance mechanism and profile of each strain. Univariate and multivariate logistic regression analysis was performed between variables. We found 109 patients with monobacterial bacteremia. Pseudomonas spp. (50.7%), A. baumannii (46.4%), and Klebsiella spp. (13.8%) were the most common causative microorganisms. The Pseudomonas spp. isolates showed resistance to imipenem (81.5%), mainly by class A and class B carbapenemases. The A. baumannii isolates conferred resistance to imipenem (56.2%), mainly by class D carbapenemases. One quarter of Klebsiella spp. showed resistance to 3rd generation cephalosporins. We also observed that a total body surface area greater than 40% and three or more different types of invasive procedures might be related to increased mortality. Multidrug resistance is highly present. The extent of the burned area and a high number of different types of invasive procedures had an impact in decreasing survivorship in burn patients with bacteremia.

Radiofrequency ablation of bilateral splanchnic nerves in a 15-year-old patient with visceral abdominal pain cancer.

Pain, a prevalent and debilitating symptom in cancer patients, significantly diminishes the quality of life for both individuals and their families. Addressing this critical issue, our study presents the case of a 15-year-old diagnosed with synchronous multifocal multicentric osteosarcoma. We utilized radiofrequency ablation of bilateral splanchnic nerves, a strategy of multimodal pain and palliative care. This approach not only proved to be safe and effective but also markedly improved the patient's quality of life. Our findings shine a light of hope, emphasizing the paramount importance of innovative pain management in pediatric oncology, especially in the final stages of life. This case report highlights the unwavering dedication to excellence in relieving suffering, offering hope for patients grappling with cancer.

Pain is a common and serious problem for cancer patients, osteosarcoma is a type of bone cancer that often affects children. making life hard for them and their families. We used a therapy called radiofrequency ablation on specific nerves to manage the pain. In the case of the patient's abdominal pain, this therapy was safe, worked well, and greatly improved the patient's quality of life. Our findings show the importance of new pain management methods in helping children with cancer, helping them reduce pain, using fewer strong pain medications and helping children in this case in the final stage of life.

[Thorns in hands, think in spiny keratoderma]. / Espinas en manos, piense en queratodermia espinosa.

Spiny keratoderma is a rare dermatological manifestation that occurs sporadically or hereditarily. These are millimetric hyperkeratotic lesions on the palms and/or soles, usually asymptomatic. Histopathologically, they consist of well-defined columns of parakeratosis on a thinned stratum corneum. Sporadic cases can be associated with chronic diseases or neoplasms. We present a case of palmar spiny keratoderma in a man in the seventh decade of life with cirrhosis due to primary sclerosing cholangitis, and hepatocellular carcinoma. He had remission of the skin lesions two months after performing a liver transplant. This behavior favors the interpretation of spiny keratoderma as a paraneoplastic manifestation of hepatocellular carcinoma. We have not found previous reports of spiny keratoderma from Argentina. We review the literature on this entity.

La queratodermia espinosa palmar es una manifestación dermatológica infrecuente que se presenta de forma esporádica o hereditaria. Se trata de lesiones hiperqueratósicas milimétricas en palmas y/o plantas, habitualmente asintomáticas. Histopatológicamente consisten en columnas de paraqueratosis bien delimitadas sobre un estrato córneo adelgazado. Los casos esporádicos se pueden asociar a enfermedades crónicas o neoplasias. Presentamos un caso de queratodermia espinosa palmar en un hombre en la séptima década de la vida con cirrosis secundaria a colangitis esclerosante primaria y hepatocarcinoma. Presentó remisión de las lesiones cutáneas a los dos meses de realizarse un trasplante hepático. Este comportamiento favorece la interpretación de la queratodermia espinosa como manifestación paraneoplásica del hepatocarcinoma. No hemos encontrado informes previos de queratodermia espinosa en Argentina. Realizamos una revisión de la literatura sobre esta entidad.

Association of the rs9896052 Polymorphism Upstream of GRB2 with Proliferative Diabetic Retinopathy in Patients with Less than 10 Years of Diabetes.

Growth factor receptor-bound protein 2 (GRB2) is a negative regulator of insulin signaling and a positive regulator of angiogenesis. Its expression is increased in a mouse model of retinal neovascularization and in patients with type 2 diabetes mellitus (T2DM). This case-control study aimed to investigate the association between the rs9896052 polymorphism (A>C) upstream of GRB2 and proliferative diabetic retinopathy (PDR) in patients with T2DM from Southern Brazil, taking into consideration self-reported skin color (white or non-white) and the known duration of diabetes (<10 years or ≥10 years). Genotypes were determined by real-time PCR in 838 patients with T2DM (284 cases with PDR and 554 controls without DR). In the total study group and in the analysis stratified by skin color, the genotype and allele frequencies were similar between cases and controls. However, among patients with less than 10 years of diabetes, the C allele was more frequent in cases than in controls (63.3% versus 51.8%, p = 0.032), and the CC genotype was independently associated with an increased risk of PDR (adjusted OR = 2.82, 95% CI 1.17-6.75). In conclusion, our findings support the hypothesis that the rs9896052 polymorphism near GRB2 is associated with PDR in Brazilian patients with T2DM.

Between a Rock and a Short Place-The Impact of Nephrolithiasis on Skeletal Growth and Development Across the Lifespan.

PURPOSE OF REVIEW: The impact of nephrolithiasis on skeletal growth and bone health across the life span of kidney stone formers is reviewed. MAIN FINDINGS: Bone disease is an early event among kidney stone formers (SF), with distinct phenotypes according to each age, sex, menopausal status, dietary, hormonal and genetic factors. Nephrolithiasis-associated bone disorder is characterized by reduced bone mineral density (BMD) and histologically discloses low bone formation, high bone resorption and abnormal mineralization. Although hypercalciuria has been presumed to be pathogenic for bone loss in SF, the association of BMD with urinary calcium is not uniform in all studies. Hypocitraturia, metabolic disturbances, cytokines and receptors, growth factors and acid-base status may all influence skeletal outcomes. The potential link of bone disease with vascular calcification and cardiovascular disease among SF is discussed. The unique vulnerability of the younger skeleton to the effects of nephrolithiasis on attainment of peak bone mass and strength is highlighted and the association of bone loss with kidney stone formation early in life indicate the opportunity for intervention to reduce the risk of future bone fractures.

PD-L1 immunohistochemical expression considering HPV status in oropharyngeal squamous cell carcinoma.

This systematic review aims to determine whether the presence of human papillomavirus (HPV) influences the immunohistochemical expression of programmed cell death-1 ligand (PD-L1) in oropharyngeal squamous cell carcinoma (OPSCC). PD-L1 immunohistochemical expression varies in OPSCC, and the presence of HPV is a plausible explanation for this variability. Comprehending these findings is crucial, as high PD-L1 expression in the tumor microenvironment of OPSCC can help identify patient subgroups that could be suitable for immunotherapy. Therefore, a systematic review was conducted following PRISMA guidelines (CRD42023437800). An electronic literature search was performed without time or language restrictions. The search included PubMed/MEDLINE, Embase, Scopus, Web of Science, https://clinictrials.gov, and relevant journals. A meta-analysis was performed using RStudio. Fourteen studies involving 1,629 participants were included. The sample consisted predominantly of males (81.26%) with a mean age of 58.3 years. Concerning clinical and pathological characteristics, the most frequently described anatomical location was the tonsils (68.54%), and most participants were either current or former smokers (78%) and alcohol users (79%). Advanced TNM IV was the most common stage. Regarding histopathological characteristics, HPV 16 was the only type mentioned, and half of the cases were detected through immunohistochemistry. The SP142 clone (35.7%) and the pattern of membrane immunostaining in tumor cells (71%) were the most commonly employed methods. The most prevalent findings were positive expression of PD-L1 (64.28%) and negative HPV status (57.14%). The association between PD-L1 positivity and HPV positivity (78.57%) was confirmed by meta-analysis. The conclusion was that HPV-positive status has an impact on immunohistochemical expression of PD-L1 in OPSCC.