Clinical characteristics and outcome of hospitalized elderly patients with COVID- 19 after vaccine failure.

We described clinical characteristics and outcome of 160 patients over 65 years (01 September to 31 August 2021) who had a first positive SARS-CoV-2 PCR- test more than 14 days after full vaccination and were hospitalized with COVID-19. Median age of included patients was 84 years, 61.2% were over 80 years; 50.6% were male and most (82.5%) has at least one comorbidity. Up to 84% received specific treatment against COVID-19, including 76.9% low-flow oxygen therapy. We found that overall mortality was 25.6% and 30.6% in those older than 80 years. A higher mortality was significantly associated with older age and treatment with tocilizumab. Our data showed that although COVID-19 vaccines continue protecting elderly patients against hospitalization and death and might improve the prognosis after hospitalization in patients with breakthrough infections, mortality in this population -especially in those older than 80 years- remains very high.

[Complex extraction of Küntscher nails. Trephines and other surgical strategies]. / Extracción compleja de clavos de fémur tipo Küntscher. Trefinas y otras técnicas.

INTRODUCTION: Removing an intact or broken intramedullary nail can be a real surgical challenge. In clinical cases many methods have been described, and there are many tools to allow their extraction. In this article, the experience in one of them is presented: the use of trephines. CLINICAL CASES: Three cases of Küntscher intramedullary nails are described, in which it was used, also listing in detail the steps to be followed in a nail extraction, arranging the techniques and assorted tools required to take the nail out, enable the surgeon to make a better extraction plan and prepare in advance any of the necessary resources in the case of failure during the surgery. CONCLUSION: The use of trephines as an extraction system is an infrequent technique. It can be an alternative when the usual methods fail. It does not require new approaches, does not require the integrity of the proximal end of the nail, and can be used in most designs.

INTRODUCCIÓN: La extracción de un clavo intramedular íntegro o roto puede ser un verdadero desafío quirúrgico. Mediante casos clínicos se han descrito diferentes métodos y existen multitud de herramientas que permiten su retirada. En este artículo se presenta la experiencia de una de ellas: el uso de trefinas. CASOS CLÍNICOS: Se describen tres instancias de clavos intramedulares tipo Küntscher detallando los pasos a seguir en una extracción, tras revisar y organizar las técnicas publicadas y las distintas herramientas que se precisan en su realización, de forma que el cirujano pueda planificar mejor la remoción y disponga de los recursos necesarios para poder realizarlas progresivamente si van fracasando durante la cirugía. CONCLUSIÓN: El uso de trefinas como sistema de extirpación es una modalidad poco utilizada, reproducible como alternativa cuando fallan los métodos habituales. No requiere nuevos abordajes y no precisa de la integridad del extremo proximal del elemento, pudiendo ser utilizada en la mayoría de los diseños.

Aneurysmal bone cyst and osteoblastoma: an extremely rare combination in the pediatric spine.

STUDY DESIGN: Case report. OBJECTIVE: To report the clinical and imaging findings of a patient with the extremely rare association of aneurysmal bone cyst and osteoblastoma in the cervical spine. To our knowledge, only three cases have been reported in the published literature in children under 16 years of age with this condition in the cervical spine. METHODS: The patient's history, physical examination, imaging findings, and management with a complete 4-year medical history, surgical intervention and radiological follow-up are reported. RESULTS: A 4-year 11-month-old boy was diagnosed with aneurysmal bone cyst in association of osteoblastoma and was treated with CT-guided intralesional injection calcitonin and methylprednisolone. During the course of intralesional therapy, a pathological fracture of C2 was produced. Subsequently, a widened intralesional excision and instrumented fusion from occiput to cervical spine (C0-C4) was performed. CONCLUSION: The association of aneurysmal bone cyst and osteoblastoma in spine is extremely rare. Although both are benign lesions, in the cervical location, complete removal of the tumors is challenging. Wide resection with reconstruction of the segments for stability associated with adjuvant treatment with calcitonin and corticosteroids provides a good option.

Galactomannan in bronchoalveolar lavage fluid for diagnosis of invasive aspergillosis in non-hematological patients.

BACKGROUND: The role of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BALF) for the diagnosis of invasive pulmonary aspergillosis (IPA) has been extensively evaluated in hematological patients, however its performance in non-hematological patients is not well established. METHODS: We performed a multicenter retrospective study in 3 university hospitals in Madrid, Spain between 2010 and 2014. The study population comprised patients with chronic obstructive pulmonary disease (COPD) and patients with immunosuppressive conditions in whom IPA was suspected and for whom BALF GM was available. Patients with hematological disorders were excluded. RESULTS: A total of 188 patients (35 with COPD and 153 with immunosuppressive conditions) were analyzed, and 31 cases of IPA (proven or probable) were identified. The global sensitivity of BALF GM (optical density index [ODI] ≥ 1.0) was 77.4%; sensitivity was higher in patients with immunosuppressive conditions than in patients with COPD (81.8% vs 66.7%; p: 0.38). In COPD patients, the best performance was obtained for BALF GM (ODI ≥ 0.5), although sensitivity (88.9%) was similar to that of BALF fungal culture (88.9%). The sensitivity of GM in serum was very poor in both populations (36.4% and 11.6%, respectively). CONCLUSIONS: In the present series, the diagnostic performance of BALF GM was good for IPA in non-hematological patients, especially in patients with immunosuppressive conditions.

Charge separation and charge recombination photophysical studies in a series of perylene-C60 linear and cyclic dyads.

A new donor­acceptor doubly bridged perylenediimide­fullerene dyad (PDI­C60, DB-3), where the perylenediimide (PDI) acts as a donor, has been synthesized and studied by time-resolved absorption spectroscopy. The DB-3 undergoes an electron transfer (ET) in both polar and non-polar media under photo-excitation. Structurally the DB-3 dyad resembles four other recently studied dyads (R. K. Dubey et al., Chem. Eur. J., 2013, 19, 6791­6806). Analysis of the ET reactions in this series of dyads was carried out in frame of both classic and semi-quantum ET theories. The result of the analysis for DB-3 suggests that the electronic coupling for the ET reaction is roughly 0.005 eV, internal reorganization energy is 0.16 eV, and outer sphere or solvent reorganization energy is 0.5 and 0.3 eV in benzonitrile and toluene, respectively.

Nódulos frontales asociados a adenopatías generalizadas / Nodules on the Forehead Associated With Generalized Lymphadenopathy

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Computer assisted surgery. Its usefulness in different levels of pre-operative deformities.

OBJECTIVE: To compare the results obtained with computer assisted surgery with conventional techniques and evaluate the influence of navigation at different levels of preoperative deformity. MATERIAL AL METHOD: A retrospective study was conducted on 100 cases with primary total knee arthroplasty performed with conventional or computer assisted surgery. A comparison was made of the post-operative mechanical axis of the lower limb between both groups and in terms of pre-operative deformity. RESULTS: Optimal alignment is most often obtained by using the navigation system (62%) than by a conventional technique (36%). Patients with deformities under 10° varus showed a mean post-operative alignment within the optimal range (0±3° deviation from the neutral mechanical axis), while those with more than 15° of varus show an alignment out of range, regardless of the technique used (p=.002). In those with a deformity of between 10 and 15° of pre-operative varus alignment, values were found closer to the neutral axis in the navigation group (178.7°) than in the conventional technique (175.5°), although these differences are not statistically significant (p=.127). CONCLUSION: Post-operative alignment obtained with navigation is better than with the conventional technique, with a smaller percentage of cases out of range, and greater accuracy in placing implants. A potential benefit was observed in navigation for cases with deformities of between 10 and 15° of varus.

Prospects for magnetic nanoparticles in systemic administration: synthesis and quantitative detection.

Methods for the quantitative determination of magnetic nanoparticles in biological matrices, in the frame of biomedical applications, are required to evaluate the particles biodistribution after systemic administration. AC magnetic susceptibility measurements are an alternative method to quantify magnetic nanoparticles in tissues, being able to provide also information on the particle transformations over time and allowing the distinction of the particles from other endogenous species such as the ferritin iron cores. The protocol for particle quantification using AC magnetic susceptibility measurements is described in detail in this article. A summary of synthesis routes towards magnetic nanoparticles is also provided.

A major gene effect controls resistance to caries.

Despite recent advances revealing genetic factors influencing caries susceptibility, questions regarding the model of inheritance involved are yet to be addressed. We conducted a Complex Segregation Analysis on decayed teeth in a sample of homogenous, isolated families recruited from the Brazilian Amazon. A dominant, major gene effect controlling resistance to phenotype was detected. The frequency of the resistance allele "A" was 0.63; mean numbers of decayed teeth were 1.53 and 9.53 for genotypes AA/AB and BB, respectively. These results represent a step toward a description of the exact nature of the genetic risk factors controlling human susceptibility to caries.

[Hypertransaminasemia as a manifestation of Shwachman-Diamond syndrome]. / Hipertransaminasemia como manifestación del síndrome de Shwachman-Diamond.

Shwachman-Diamond syndrome (SDS) is the second most common cause of congenital exocrine pancreatic insufficiency after cystic fibrosis. SDS is an autosomal recessive multisystemic disorder, with wide heterogenicity in its clinical characteristics. The central features of this syndrome are pancreatic exocrine and bone marrow dysfunction (mainly neutropenia). Other features are skeletal abnormalities, hepatomegaly, elevation of serum aminotransferase levels, short stature and frequent infections. We present two patients who were referred to us because of persistent hypertransaminasemia. In both patients, liver function returned to normal and pancreatic function improved. Both patients showed several neutropenic episodes but no bone disorders, which does not exclude the diagnosis.

Hipertransaminasemia como manifestación del síndrome de Shwachman-Diamond / Hypertransaminasemia as a manifestation of Shwachman-Diamond syndrome

El síndrome de Shwachman-Diamond es la segunda causa más frecuente de insuficiencia pancreática exocrina congénita, después de la fibrosis quística. Se trata de un trastorno multisistémico de herencia autosómica recesiva con una gran heterogeneidad en las manifestaciones clínicas. Los rasgos centrales del síndrome son la disfunción pancreática exocrina y la disfunción de la médula ósea (sobre todo neutropenia). Otros rasgos que apoyan el diagnóstico son las anormalidades esqueléticas, hepatomegalia, elevación de transaminasas en suero, corta estatura e infecciones frecuentes. Presentamos 2 casos clínicos cuyo motivo de remisión a nuestra consulta fue la hipertransaminasemia persistente. Nuestras 2 pacientes evolucionaron hacia la normalidad de la función hepática y mejoría de la función pancreática. Presentaron varios episodios de neutropenia pero no mostraron alteraciones óseas, lo cual no excluye el diagnóstico

Shwachman-Diamond syndrome (SDS) is the second most common cause of congenital exocrine pancreatic insufficiency after cystic fibrosis. SDS is an autosomal recessive multisystemic disorder, with wide heterogenicity in its clinical characteristics. The central features of this syndrome are pancreatic exocrine and bone marrow dysfunction (mainly neutropenia). Other features are skeletal abnormalities, hepatomegaly, elevation of serum aminotransferase levels, short stature and frequent infections. We present two patients who were referred to us because of persistent hypertransaminasemia. In both patients, liver function returned to normal and pancreatic function improved. Both patients showed several neutropenic episodes but no bone disorders, which does not exclude the diagnosis

Magnetic and structural study of the state of iron in the oral haematinic ferrimannitol ovoalbumin.

From magnetic and structural analyses performed on ferrimannitol ovalbumin, iron in this drug is observed to be present as two-line ferrihydrite nanoparticles, of around 4 nm in diameter, which are superparamagnetic above approximately 20 K. Among other parameters, the temperature dependence of the magnetic out-of-phase susceptibility of this compound has been fully characterised and yields results clearly different from that of ferritin. This characterisation, performed for the first time for an oral haematinic, is of interest in the context of future pharmacological studies of this compound.

Magnetic characterisation of rat muscle tissues after subcutaneous iron dextran injection.

Ex vivo freeze-dried rat muscle tissues, collected at different times t after a single dose of subcutaneously injected iron dextran, have been magnetically characterised. The AC susceptibility of the tissues shows an overall superparamagnetic behaviour and the dependence on t of, especially, the out-of-phase component is remarkably systematic despite the fact that each tissue originates in a different rat individual. The experiments show that the akaganéite (beta-FeOOH) nanoparticles contained in the injected drug are progressively degraded in the living tissue and, at times of the order of 1 month and for all the analysed rat individuals, converge to a magnetically well-defined species with much narrower magnetic activation energy distribution than iron dextran. Thorough transmission electron microscopy experiments of the same tissues indicate the presence of oxyhydroxide particles, whose size decreases for increasing t in agreement with the interpretation of the magnetic susceptibility. The conclusions drawn from the magnetic study do well correspond to the properties of the whole tissue since no biochemical extraction work has been done. The AC susceptibility appears to be a valuable and complementary tool in pharmacological studies of iron-containing drugs.

Pleurotomías en cuidados intermedios quirúrgicos / Pleurotomies in intermediate surgical cares

Se presentan los resultados obtenidos de la caracterización de la indicación de pleurotomía a los pacientes ingresados en la Unidad de Cuidados Intermedios Quirúrgicos del Instituto Superior de Medicina Militar: “Dr. Luis Díaz Soto” con el diagnóstico de Traumatismo Torácico en el período comprendido entre Enero del 2002 a Noviembre del 2003. Es un estudio descriptivo, exploratorio, cuantitativo, cualitativo y prospectivo. Se evaluó el procedimiento y la influencia de las técnicas de drenaje y aspiración en la evolución de los pacientes. El grupo de edades más afectado fue el de 18 a 37 años (58 por ciento). El 93 por ciento correspondió al sexo masculino. La pleurotomía mínima (indiferente) se realizó en el 77.4 por ciento. Los traumas cerrados (accidentes de tránsito y caídas de altura) representaron el 70.9 por ciento. Las complicaciones asociadas al drenaje con la aspiración atmosférica y sello de agua se presentaron en el 66.6 por ciento. La no reexpansión pulmonar se presentó en el 12.9 por ciento. A las 72 horas de realizado el procedimiento el 40 por ciento necesitó de una nueva intervención. La permanencia de la sonda pleural osciló entre 6 a 10 días en el 67.7 por ciento de los pacientes. No hubo fallecidos porque el mayor número de politraumatizados (82.2 por ciento) se encontró en el Grupo III. La pleurotomía mínima con drenaje y aspiración central continua fue el procedimiento utilizados con mejores resultados. La videotoracoscopía es otro procedimiento útil para los casos de hemoneumotórax(AU)

Linfadenitis histiocítica necrotizante de Kikuchi / Kikuchi's histiocytic necrotizing lymphadenitis

La linfadenitis histiocítica necrotizante (LHN) o enfermedad de Kikuchi-Fujimoto es una entidad anatomoclínica poco frecuente; afecta preferentemente a mujeres jóvenes e individuos de razas orientales y se caracteriza por fiebre, adenopatías preferentemente cervicales, afectación sistémica y, ocasionalmente, extraganglionar.Se presentan dos casos de LHN en mujeres jóvenes con afectación cutánea y en uno de los casos con meningitis linfocitaria.Se discuten los aspectos etiológicos, la relación de la LHN con las enfermedades colágeno-vasculares (fundamentalmente el lupus eritematoso sistémico [LES]), los problemas del diagnóstico anatomopatológico y las posibilidades terapéuticas (AU)

[Kikuchi's histiocytic necrotizing lymphadenitis]. / Linfadenitis histiocítica necrotizante de Kikuchi.

Necrotizing histiocytic lymphadenitis (NHL) or Kikuchi-Fujimoto disease is an infrequent seen clinicopathologic entity that affects most frequently young women and individuals of eastern races, and that is characterized by fever and adenopathies (basically cervical) and systemic disease even though occasional patients present extranodal disease. We present two young women with NHL and cutaneous affectation, and with lymphocytic meningitis in one of the patients. We discuss the etiology of NHL, the relation of NHL with collagen-vascular diseases (basically systemic erythematous lupus) the problem of the pathologic diagnosis, and the therapeutic possibilities in these patients.

Triplet repeat polymorphism in the transmembrane region of the MICA gene in celiac disease.

Celiac disease (CD) is characterized by a striking expansion of gamma delta T cells in the intestine. These cells interact with MICA, a cell surface protein encoded by a major histocompatibility complex gene. We investigated whether MICA gene polymorphism could contribute to susceptibility to CD. DNA typing for HLA-DR, DQA1, DQB1, TNF-308, TNFa, TNFb and a triplet repeat polymorphism in the transmembrane region of the MICA gene were carried out. We performed case-control stratified association studies and transmission disequilibrium tests. Our results indicate that although there is no primary association between MICA polymorphism and CD, there is, in addition to HLA-DQ, a second susceptibility locus on the 8.1 ancestral haplotype in strong linkage disequilibrium with MICA A5.1 allele.

Anatomía patológica del adenocarcinoma endometrial y de lesiones relacionadas (hiperplasia y metaplasia) / Pathologic features of endometrial adenocarcinoma and related lesions (hyperplasia and metaplasia)

Los autores revisan los criterios microscópicos del adenocarcinoma endometrial y de las lesiones relacionadas (hiperplasia y metaplasia) y analizan los factores patológicos de significado pronóstico del carcinoma endometrial (AU)

Artrodesis de rodilla con clavo intramedular / Arthrodesis of the knee with intramedullary nailing

Se revisan 21 artrodesis de rodilla realizadas en 20 pacientes mediante enclavado intramedular, a lo largo de diez años, con un seguimiento medio mayor de 3 años. La causa más frecuente, en 18 casos, fue el fracaso de la artroplastia de rodilla tanto séptico como aséptico. La consolidación primaria de la artrodesis se obtuvo en 16 casos (76 por ciento), en un tiempo medio de 8,1 meses (AU)