Androgen and Cortisol Cosecreting Adrenal Adenoma and Tuberculous Lymphadenitis.

The differential diagnosis between malignant and benign adrenal cortical tumors is challenging, and concurrent androgen and cortisol production should raise  suspicion of a malignant tumor. We present the case of a 36-year-old woman who exhibited pronounced hirsutism, clitoromegaly, and secondary amenorrhea. A contrast-enhanced computed tomography (CT) scan revealed a 35 × 27 mm right adrenal mass with unenhanced CT attenuation of 40 Hounsfield units (HUs). The mass exhibited absolute and relative washout rates of 50% and 28%, respectively, and was accompanied by a 25 × 20 mm adenopathy located in the hepatogastric space. Total testosterone was elevated by 247 ng/dL (8.56 nmol/L) (normal reference range, 10-75 ng/dL; 0.34-2.6 nmol/L). A 1-mg dexamethasone suppression test revealed an elevated serum morning cortisol concentration of 10.57 µg/dL (291.58 nmol/L) (reference range, <1.8 µg/dL; < 49.66 nmol/L). A fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan revealed increased uptake in both the adrenal mass and the adenopathy. Subsequently, the patient underwent an open right adrenalectomy and lymphadenectomy. Histological examination revealed the presence of an adrenal adenoma with myelolipomatous metaplasia, as well as a positive polymerase chain reaction (PCR) for Mycobacterium tuberculosis in the adenopathy.

Thermal, viscoelastic, and electrical properties of thermoplastic polyurethane films reinforced with multi-walled carbon nanotubes.

Thermoplastic polyurethane (TPU) doped with multi-walled carbon nanotubes (MWCNTs) at 1, 3, 5, and 7 wt% has been studied. The effect of MWCNTs on thermal, viscoelastic, and electric properties in the TPU matrix was characterized by differential scanning calorimetry (DSC), dynamic mechanical analysis (DMA), and by impedance spectroscopy. The results show that the thermal, electrical, and viscoelastic properties, such as the glass transition temperature, shifted towards high temperatures. The melting temperature decreased, and the conductivity and the storage modulus increased by 61.5 % and 58.3 %. The previously observed behavior on the films is due to the increase in the mass percentage of carbon nanotubes (CNTs) in the TPU matrix. Also, it can be said that the CNTs were homogeneously dispersed in the TPU matrix, preventing the movement of the polymer chains, and generating channels or connections that increase the conductivity and improve the thermal properties of the material.

Modified Bedside Index for severity in acute pancreatitis (BISAP) score validation in the national inpatient sample database.

PURPOSE: The aim of this study was to build and validate modified score to be used in the healthcare cost and utilization project databases for further classification of acute pancreatitis (AP). MATERIALS AND METHODS: The National Inpatient Sample database for the years 2016-2019 was queried for all primary adult discharge diagnoses of AP. An mBISAP score system was created utilizing the ICD-10CM codes for pleural effusion, encephalopathy, acute kidney injury, systemic inflammatory response, and age >60. Each was assigned a 1-point score. A multivariable regression analysis was built to test for mortality. Sensitivity and specificity analyses were performed for mortality. RESULTS: A total of 1,160,869 primary discharges for AP were identified between 2016 and 2019. The pooled mortality rate was: 0.1%, 0.5%, 2.9%, 12.7%, 30.9% and 17.8% (P â€‹< â€‹0.01), respectively for scores 0 to 5. Multivariable regression analysis showed increasing odds of mortality with each one-point increment: mBISAP score of 1 (adjusted odds ratio [aOR] 6.67; 95% confidence interval [CI] 4.69-9.48), score of 2 (aOR 37.87; 95% CI 26.05- 55.03), score of 3 (aOR 189.38; 95% CI 127.47-281.38), score of 4 (aOR 535.38; 95% CI 331.74-864.02), score of 5 (aOR 184.38; 95% CI 53.91-630.60). Using a cut-off of ≥3, sensitivity and specificity analyses reported 27.0% and 97.7%, respectively, with an area under the curve (AUC) of 0.811. CONCLUSION: In this 4-year retrospective study of a US representative database, an mBISAP score was constructed showing increasing odds of mortality with each 1-point increase and a specificity of 97.7% for a cut-off of ≥3.

Morphological Electrical and Hardness Characterization of Carbon Nanotube-Reinforced Thermoplastic Polyurethane (TPU) Nanocomposite Plates.

The impacts on the morphological, electrical and hardness properties of thermoplastic polyurethane (TPU) plates using multi-walled carbon nanotubes (MWCNTs) as reinforcing fillers have been investigated, using MWCNT loadings between 1 and 7 wt%. Plates of the TPU/MWCNT nanocomposites were fabricated by compression molding from extruded pellets. An X-ray diffraction analysis showed that the incorporation of MWCNTs into the TPU polymer matrix increases the ordered range of the soft and hard segments. SEM images revealed that the fabrication route used here helped to obtain TPU/MWCNT nanocomposites with a uniform dispersion of the nanotubes inside the TPU matrix and promoted the creation of a conductive network that favors the electronic conduction of the composite. The potential of the impedance spectroscopy technique has been used to determine that the TPU/MWCNT plates exhibited two conduction mechanisms, percolation and tunneling conduction of electrons, and their conductivity values increase as the MWCNT loading increases. Finally, although the fabrication route induced a hardness reduction with respect to the pure TPU, the addition of MWCNT increased the Shore A hardness behavior of the TPU plates.

Incidence, Burden, and Predictors of 11-Month Readmission in Patients Undergoing Bariatric Surgery.

BACKGROUND: Bariatric surgery (BSx) is one of the most common surgical procedures performed in the USA. Nonetheless, data regarding 11-month period after BSx remain limited. METHODS: A retrospective cohort study using the 2016 National Readmission Database. Adult patients admitted for BSx in January were included. The follow-up period was 11 months (February-December). The primary outcome was all-cause 11-month readmission. Secondary outcomes were index admission (IA) and readmission in-hospital mortality rate and healthcare resource use associated with readmission. Multivariate regression was performed to identify independent risk factors for readmission. RESULTS: A total of 13,278 IA were included. The 11-month readmission rate was 11.1%. The mortality rate of readmission was 1.4% and 0.1% for IA (P < 0.01). The most common cause of readmission was hematemesis. Independent predictors were Charlson comorbidity index (CCI) score ≥ 3 (adjusted hazard ratio [aHR] 1.34; P = 0.05), increasing length of stay (aHR 1.01; P < 0.01), transfer to rehabilitation facilities (aHR 5.02; P < 0.01), undergoing laparoscopic Roux-en-Y gastric bypass (aHR 1.71; P = 0.02), adjustable gastric band (aHR 14.09; P < 0.01), alcohol use disorder (2.10; P = 0.01), and cannabis use disorder (aHR 3.37; P = 0.01). Private insurance as primary payer (aHR 0.65; P < 0.01) and BMI 45-49 kg/m2 (aHR 0.72; P < 0.01) were associated with less odds of readmission. The cumulative total hospitalization charges of readmission were $69.9 million. CONCLUSIONS: The 11-month readmission rate after BSx is 11.1%. Targeting modifiable predictors of readmission may help reduce the burden of readmissions on our healthcare system.

Effect of fique fibers and its processing by-products on morphology, thermal and mechanical properties of epoxy based biocomposites.

This work examines the morphology, mechanical and thermal properties of biocomposites based on epoxy resin-EP and fique (Furcraea andina), a native crop of South America. The EP-fique biocomposites were prepared using fique powder-FP an industrial waste generated during fique processing, nonwoven fique fiber mats-NWF and unidirectional fique fiber mats-UF oriented at 0° and 90°. The addition of fique into EP matrix restricts EP macromolecule chains movement and enhance the thermal stability of EP. SEM images showed that fique form used (powder or fiber) and mat arrangement can generate changes in the biocomposites morphology. Mechanical characterization show that fique powder and fique fibers oriented at 90° acts as fillers for the epoxy matrix while the fique fibers oriented at 0° reinforce EP matrix increasing the tensile and flexural modulus up to 5700 and 1100% respectively and tensile and flexural strength up to 277% and 820% in comparison with neat EP. The obtained results can increase the interest in researching and developing products from fique Powders and other natural fibers processing byproducts thus reducing the abundance of waste in soil and landfills and environmental concerns and suggest that the EP-fique biocomposites are promising to be used in the automotive sector.

Characterization of 58 STRs and 94 SNPs with the ForenSeq™ DNA signature prep kit in Mexican-Mestizos from the Monterrey city (Northeast, Mexico).

BACKGROUND: STR allele frequency databases from populations are necessary to take full advantage of the increased power of discrimination offered by massively parallel sequencing (MPS) platforms. MATERIAL AND METHODS: For this reason, we sequenced 58 STRs (aSTRs, X-STRs, and Y-STRs) and 94 identity informative SNPs (iiSNPs) on 105 Mestizo (admixed) individuals from Monterrey City (Northeast, Mexico), with the Primer Set-A of the ForenSeq™ DNA Signature Prep Kit. RESULTS: Most of the STR markers were in Hardy Weinberg equilibrium, with a few exceptions. We found 346 different length-based alleles for these 58 STRs; nevertheless, they became 528 alleles when the sequence was assessed. The combined power of discrimination from autosomal STRs (aSTRs) was -virtually- 100% in both length and sequence-based alleles, while the power of exclusion was 99.9999999976065 and 99.9999999999494%, respectively. Haplotypes based on X-STRs and Y-STRs showed 100% of discriminatory capacity. CONCLUSIONS: These results provide -for the first time- forensic genomic population data from Mexico necessary for interpretation in kinship and criminal analyses.

Association between olfactory dysfunction and COVID-19 severity: A prospective study in a highly complex hospital in Peru.

INTRODUCTION: Olfactory dysfunction has been included among the early symptoms of coronavirus disease (COVID-19). Evidence suggests that a relationship exists between the duration of olfaction disorders and the probability of developing severe COVID-19. Given the scope of the COVID-19 pandemic, this study aimed to determine the frequency of smell alteration and its association with the severity of COVID-19 in a referral hospital in Peru, which is one of the most affected countries in the Latin American region. MATERIALS AND METHODS: This study was an observational, prospective cohort study that included patients with COVID-19 who were treated at the Hospital Nacional Edgardo Rebagliati Martins from August to November 2020. To assess the association, the chi-square test of independence or Fisher's exact test was performed. The outcome variable was COVID-19 severity, and the exposure variable was olfactory dysfunction. The first data collection was in the emergency department and the follow-up was via telephone. RESULTS: A total of 179 patients were included. The mean age was 61.6 ± 15.5 years, and 129 patients (72.1%) were male. Olfactory dysfunction was observed in 43 patients (24%). An inverse association was found between age and olfactory dysfunction (P = .002). No significant association was found between COVID-19 severity level and olfactory alteration (P = .056). However, a direct association was found between COVID-19 severity and age (P = .003), cough (P < .001), and respiratory distress (P = .003). CONCLUSION: This study did not find any association between the severity of COVID-19 and olfactory dysfunction. It showed a low incidence rate of smell alteration compared with studies from other regions. Moreover, smell alteration was associated with younger age.

Low Incidence and Mortality by SARS-CoV-2 Infection Among Healthcare Workers in a Health National Center in Mexico: Successful Establishment of an Occupational Medicine Program.

Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Healthcare workers (HCWs) constitute a population which is significantly affected by SARS-CoV-2 infection worldwide. In Mexico, the Instituto Nacional de Enfermedades Respiratorias (INER) is the principal national reference of respiratory diseases. Aim: To evaluate the efficiency of the INER-POL-TRAB-COVID19 program to mitigate the SARS-CoV-2 infection risk among the INER-healthcare workers (INER-HCW). Methods: Currently, the INER has 250 beds and 200 respiratory ventilators to support COVID-19 patients in critical condition. On March 1st, 2020, the INER-POL-TRAB-COVID19 program was launched to mitigate the SARS-CoV-2 infection risk among the INER-HCW. Findings: From March 1st to October 1st, 2020, 71.5% of INER-HCWs were tested for SARS-CoV-2 infection, and 77% of them were frontline workers. Among the tested INER-HCWs, 10.4% were positive for SARS-CoV-2 infection. Nonetheless, nosocomial infection represented only 3.8% of the cases and the mortality was null. Fifty-three of INER-HCWs positive to SARS-CoV-2 had a negative test 42-56 days post-diagnosis and were returned to service. Finally, although a change in the PPE implemented on May 11th, 2020, the incidence of SARS-CoV-2 infection was not affected. Conclusion: INER has a lower incidence of HCWs infected with SARS-CoV-2 as compared to the mean of the national report. The implementation of the INER-POL-TRAB-COVID19 program is efficient to decrease the risk of infection among the HCWs. Our findings suggest that the implementation of a similar program at a national level can be helpful to provide a safe environment to HCWs and to prevent the collapse of health institutions.

Effect of Extrusion Screw Speed and Plasticizer Proportions on the Rheological, Thermal, Mechanical, Morphological and Superficial Properties of PLA.

One of the critical processing parameters-the speed of the extrusion process for plasticized poly (lactic acid) (PLA)-was investigated in the presence of acetyl tributyl citrate (ATBC) as plasticizer. The mixtures were obtained by varying the content of plasticizer (ATBC, 10-30% by weight), using a twin screw extruder as a processing medium for which a temperature profile with peak was established that ended at 160 °C, two mixing zones and different screw rotation speeds (60 and 150 rpm). To evaluate the thermo-mechanical properties of the blend and hydrophilicity, the miscibility of the plasticizing and PLA matrix, Fourier transform infrared spectroscopy (FT-IR), thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC), oscillatory rheological analysis, Dynamic Mechanical Analysis (DMA), mechanical analysis, as well as the contact angle were tested. The results derived from the oscillatory rheological analysis had a viscous behavior in the PLA samples with the presence of ATBC; the lower process speed promotes the transitions from viscous to elastic as well as higher values of loss modulus, storage modulus and complex viscosity, which means less loss of molecular weight and lower residual energy in the transition from the viscous state to the elastic state. The mechanical and thermal performance was optimized considering a greater capacity in the energy absorption and integration of the components.

Injection Molding of Coir Coconut Fiber Reinforced Polyolefin Blends: Mechanical, Viscoelastic, Thermal Behavior and Three-Dimensional Microscopy Study.

In this study, the properties of a polyolefin blend matrix (PP-HDPE) were evaluated and modified through the addition of raw coir coconut fibers-(CCF). PP-HDPE-CCF biocomposites were prepared using melt blending processes with CCF loadings up to 30% (w/w). CCF addition generates an increase of the tensile and flexural modulus up to 78% and 99% compared to PP-HDPE blend. This stiffening effect is caused by a decrease in the polymeric chain mobility due to CCF, the higher mechanical properties of the CCF compared to the polymeric matrix and could be an advantage for some biocomposites applications. Thermal characterizations show that CCF incorporation increases the PP-HDPE thermal stability up to 63 °C, slightly affecting the melting behavior of the PP and HDPE matrix. DMA analysis shows that CCF improves the PP-HDPE blend capacity to absorb higher external loads while exhibiting elastic behavior maintaining its characteristics at higher temperatures. Also, the three-dimensional microscopy study showed that CCF particles enhance the dimensional stability of the PP-HDPE matrix and decrease manufacturing defects as shrinkage in injected specimens. This research opens a feasible opportunity for considering PP-HDPE-CCF biocomposites as alternative materials for the design and manufacturing of sustainable products by injection molding.

The Effects of Reprocessing and Fiber Treatments on the Properties of Polypropylene-Sugarcane Bagasse Biocomposites.

This study explores the reprocessing behavior of polypropylene-sugarcane bagasse biocomposites using neat and chemically treated bagasse fibers (20 wt.%). Biocomposites were reprocessed 5 times using the extrusion process followed by injection molding. The mechanical properties indicate that microfibers bagasse fibers addition and chemical treatments generate improvements in the mechanical properties, reaching the highest performance in the third cycle where the flexural modulus and flexural strength increase 57 and 12% in comparison with neat PP. differential scanning calorimetry (DSC) and TGA characterization show that bagasse fibers addition increases the crystallization temperature and thermal stability of the biocomposites 7 and 39 °C respectively, without disturbing the melting process of the PP phase for all extrusion cycles. The rheological test shows that viscosity values of PP and biocomposites decrease progressively with extrusion cycles; however, Cole-Cole plots, dynamic mechanical analysis (DMA), width at half maximum of tan delta peaks and SEM micrographs show that chemical treatments and reprocessing could improve fiber dispersion and fiber-matrix interaction. Based on these results, it can be concluded that recycling potential of polypropylene-sugarcane bagasse biocomposites is huge due to their mechanical, thermal and rheological performance resulting in advantages in terms of sustainability and life cycle impact of these materials.

Effect of Content and Surface Modification of Fique Fibers on the Properties of a Low-Density Polyethylene (LDPE)-Al/Fique Composite.

This work presents the physical-thermal and mechanical characterization of a low-density polyethylene (LDPE)-Al matrix composite material that was obtained from reinforcing recycled (post-consumer) long-life Tetra Pak packages with fique natural fibers from southwestern Colombia. The fique was subjected to three chemical treatments to modify its surface (alkalinization, silanization and pre-impregnation with polyethylene) to increase the quality of its interfaces. Additionally, panels with 10%, 20%, and 30% v/v of fiber were manufactured by the hot compression molding. The mechanical properties of the different composite materials showed that the pre-impregnation treatment promoted a significant increase in the tensile and flexural properties with respect to the fiber-reinforced composite without surface modification. Additionally, in materials with 30% fibers that were treated with pre-impregnation, there was a decrease in the water absorption capacity of 53.15% when compared to composites made with 30% native fibers. Finally, increases in the fiber content mainly caused better mechanical performances, which increased as a direct function of the amount of fique incorporated.

Lipomatous/Extensively Vacuolated Ependymoma with Signet-Ring Cell-Like Appearance: Analysis of a Case with Extensive Literature Review.

"Lipomatous" and "extensively vacuolated" are descriptive captions that have been used to portray a curious subset of ependymomas distinctively bearing cells with a large vacuole pushing the nucleus to the periphery and, thus, simulating a signet-ring cell appearance. Here, we would like to report the first ependymoma of this kind in a Latin American institution. A 16-year-old boy experienced cephalea during three months. Magnetic resonance imaging scans showed a left paraventricular tumour which corresponded to anaplastic ependymoma. Intriguingly, it was also composed of cells with single or multiple hollow cytoplasmic vacuoles sometimes giving a signet-ring cell-like configuration. Immunolabeling of these showed membrane positivity for GFAP, PS100, and CD99, while Ki-67 expression was null. Ultrastructural examination of retrieved paraffin-embedded tissue showed the presence of scarce microlumina filled with microvilli but failed to demonstrate any content in such optically empty vacuoles as only scant granulofibrillary debris was observed. A schism prevails at present regarding these unusual morphological variants, being either "lipomatous" or "vacuolated" based mainly on the EMA immunoprofile. This, however, is a misappropriate approaching. Could it be that perhaps we are dealing with the same histopathological entity or it may simply happen that fixation and artefacts cannot allow for their proper identification?

Complications of cochlear implant surgery: A ten-year experience in a referral hospital in Peru, 2006-2015.

OBJECTIVES: To describe the frequency and characteristics of complications of cochlear implant (CI) surgery at Edgardo Rebagliati Martins Hospital of social security in Lima-Peru between 2006 and 2015. METHODS: A retrospective descriptive study of patients that underwent CI surgery between August 2006 and December 2015. RESULTS: Among the 107 patients with CIs, the overall proportion of complications was 18.7% (20/107): 14.9% (16/107) of minor complications, and 3.7% (4/107) of major complications. Regarding the time of onset of complications, 2.8% (3/107) were intraoperative and 14% (15/107) postoperative. CONCLUSION: CI surgery in Peru is a safe procedure with a low frequency of major complications, representing an effective therapy for patients with sensorineural hearing loss who do not respond to hearing aids.

Intraventricular Neurilemmoma (Schwannoma): Shall GFAP Immunostaining Be Regarded as a Histogenetical Tag or as a Mere Histomimetical Trait?

Neurilemmomas are benign neoplasms presumedly derived from Schwann cells which rarely originate within the central nervous system. Moreover, their intraventricular location has been seldom noticed with less than 30 cases reported worldwide. Here, we add another case study to the record as well as the fifth one in Latin American population. A 16-year-old boy without significant past clinical data debuted with headache and progressive left eye blindness during six months. Neuroimaging scans showed a bulky, multiloculated, intraventricular tumour emerging from the posterior horn of the left lateral ventricle. Microscopically, the lesion put on view the classical schwannian histology: spindle cells arranged in both compact and loosely textured areas. Verocay bodies were not present but vessel hyalinisation, pericellular reticulin, and senescent atypia were observed. The immunoperoxidase reactions were also consistent with neurilemmal differentiation; however, glial fibrillary acidic protein expression was widespread and unexpectedly seen. Traditionally conceived as "nerve sheath tumours" the dual immunophenotype herein demonstrated points to a different histogenetical pathway other than sheer Schwann cell derivation. As previously advised by some authors, neoplastic transformation from a multipotent stem cell may explain the occasional finding of these tumours in unconventional intracranial compartments.

Short-Spindled Cell Haemangioblastoma with CD34 Expression: New Histopathological Variant or Just a Stochastic Cytological Singularity?

Haemangioblastomas are neoplasms of uncertain histogenesis with cellular and reticular variants advocated in current lore. Herein we describe an intriguing cerebellar specimen with unusual traits including spindle cell morphology and CD34 positivity. A thirty-nine-year old man had an infratentorial tumour discovered incidentally and resected three times. In all the instances, histopathological diagnosis was haemangioblastoma; nonetheless, he had neither physical stigmata nor family history of von Hippel-Lindau disease. By histology, the lesion was composed of areas of conventional stromal cells admixed with territories populated by short-spindled cells packed in lobules, sometimes giving the appearance of gomitoli. Immunoperoxidase-coupled reactions confirmed the expression of inhibin A, neuron-specific enolase (NSE), PS100, and CD57 but also revealed focal immunolabeling for CD34, CD99, and FXIIIa. This case highlights the potential phenotypical diversity that can be found within these neoplasms. Rather than uncertain histogenesis, it may in fact reflect multiple lines of differentiation-histomimesis-prone to adopt unusual morpho- and immunophenotypes in a subset of haemangioblastomas.