Pre-and post-surgical non-functional pituitary adenomas and their relationship with high levels of serum glucose.

OBJECTIVES: This clinical, analytical, retro-prospective, auto-controlled, not randomized, and not blinded study, aimed to investigate the association of changes in the serum glucose levels with the pre-and-post changes in the size tumor in mm3 in the Non-Functional pituitary adenomas. METHODS: Pre-and post-surgical MRI, as well as the measurements in the serum glucose levels and immunohistochemical techniques were performed in all the patients in the study, with a mean followed-up until 208.57 days. A comparison was made between the reductions in tumor size of hormonally active pituitary adenomas (HSPAs) vs NFPAs. RESULTS: Seventy-four patients were included in this study, of whom, 46 were NFPAs. The decrease in the NFPAs tumor size after surgery was statistically significant (P ≤ 0.0001). The Mean of the differences of both type of tumors in mm3 were -9552 ± 10287. Pre-surgery, the mean of the HSPAs were 8.923 ± 2.078; and the NFPAs were 14.161 ± 1.912. The differences in the tumor size were statistically significant (p = 0.039). Post-surgical, the mean of the HSPAs were 2.079 ± 971, with a (p = 0.14): and the NFPAs were 4.609 ± 1.205. After surgery of the NFPAs, most of the patients-maintained serum levels ≤ 100 mg/dL, with a statistical significance (P ≤ 0.0003). CONCLUSION: This study demonstrates for the first time the correlation between the presence of pre-and post- surgical changes in the NFPAs, with modifications in the levels of serum glucose, and the comparison, pre- and post-surgical between the tumor size of HSPAs and NFPAs.

Pre- and post-clinical-radiological and surgical evaluation of patients with pituitary adenoma and metabolic syndrome.

BACKGROUND: Pituitary adenomas are benign tumors located in the anterior hypophysis. Its appearance is associated with the development of parameters related to metabolic syndrome; therefore, surgical treatment could reduce associated morbimortality. METHODS: Pre- and post-surgical MRI, using the Hardy-Wilson and Knosp classification, and clinical data according to the American Association of Clinical Endocrinology (AACE) criteria for metabolic syndrome: all the patients were followed-up until 208.57 days were reviewed on 217 consecutive patients with pituitary surgery. RESULTS: Seventy-four patients were included in this study. There was a significant reduction in tumor size in mm3 [average pre- and post-surgery respectively: 12,362 mm3 (±12,397); 3,910 mm3 (±7,160)], (p < 0.0001). This was confirmed by the Hardy-Wilson and Knosp classification, where most patients went from grade IV C (33.7%) to grade 0 (12.1%), IA (20.2%), IIB (21.36%), and IIC (16.2%); as well as from grade 4 (24.3%) to grade 0 (45.9%), respectively. After surgery, there were statistically significant reductions in total serum levels of glucose [average pre- and post-surgery, respectively: 116 mg/dL (±26.9); 90 mg/dL (±10.2)], (p < 0.001), triglycerides [average pre- and post-surgery, 240 mg/dL (±102); 171 mg/dL (±60.5)], (p = 0.001); and HDL-c [average pre- and post-surgery, respectively: 39 mg/dL (±11.8); 44.6 mg/dL (±8.4)], (p = 0.029). The other parameters remained unchanged. CONCLUSION: This is the first study to demonstrate the relationship between the presence of pituitary adenoma and significative changes in serum glucose, triglycerides and c-HDL related to metabolic syndrome.

Mastitis granulomatosa idiopática complicada con absceso de mama producido por Gordonia sputi, caso clínico / Idiopathic granulomatous mastitis complicated with a breast abscess caused by Gornodia sputi, a case report

La mastitis granulomatosa idiopática es una entidad rara, benigna y crónica de causa desconocida que afecta a la mama. Es un diagnóstico de exclusión. Se deben descartar, entre otras etiologías, la tuberculosis, las infecciones, la sarcoidosis y otras enfermedades autoinmunes, como la arteritis de células gigantes. Los principales retos que plantea esta entidad son su diagnóstico diferencial con enfermedad maligna y su tratamiento. La afectación mamaria es anecdótica y ha sido solo reportada en relación con prótesis mamarias. Presentamos el caso de una paciente diagnosticada de mastitis granulomatosa idiopática complicada con un absceso de mama por Gordonia sputi.

Idiopathic granulomatous mastitis is a rare, benign, chronic entity of unknown cause affecting the breast. It is a diagnosis of exclusion. Among other aetiologies, tuberculosis, infections, sarcoidosis, and other autoimmune diseases such as giant cell arteritis must be ruled out. The main challenges posed by this entity are its differential diagnosis with malignant pathology and its treatment.Gordonia spp. are a group of emerging pathogens that are mainly associated with infections associated with medical devices, mainly catheters. Breast involvement is anecdotal and has only been reported in relation to breast prostheses.We present the case of a patient diagnosed with idiopathic granulomatous mastitis complicated with a breast abscess due to Gordonia sputi.

Carcinoma mucosecretor de mama HER2-positivo, un caso clínico / Pure mucinous breast cancer HER2-positive, a case report

El carcinoma mucosecretor de mama (CMS) es un tipo histológico poco frecuente de carcinoma infiltrante. Se considera un tipo histológico de mejor pronóstico que el carcinoma ductal infiltrante. Se caracteriza por la presencia de lagos de mucina. Generalmente el CMS ocurre en pacientes peri y posmenopáusicas, y la edad promedio es de 67años. Suelen ser tumores bien o moderadamente diferenciados. El tumor generalmente expresa receptores de estrógenos (RE) y progesterona positivos (RP) y no expresan Her2. La afectación axilar es rara. Presentamos un caso de una paciente con un cáncer de mama de tipo mucosecretor puro con expresión HER2.(AU)

Mucosecretory carcinoma of the breast (CMS) is a rare histological type of infiltrating carcinoma. It is considered a histological type with a better prognosis than infiltrating ductal carcinoma. It is characterised by the presence of mucin lakes. CMS usually occurs in peri- and post-menopausal patients with an average age of 67years. They are usually well or moderately differentiated tumours. The tumour usually expresses oestrogen receptor (OR) and progesterone receptor (PR) positive and does not express Her2. Axillary involvement is rare. We present a case of a patient with a pure mucosecretory type breast cancer with HER2 expression.(AU)

Tumor phyllodes de la mama: nuestra experiencia durante 11 años y revisión de la literatura / Phyllodes breast tumour: experience over 11 years and literature review

Objetivo: Analizar el perfil de las pacientes diagnosticadas de tumores phyllodes en nuestra área sanitaria. Material y métodos: Se presenta un estudio descriptivo retrospectivo de las pacientes diagnosticadas de tumor phyllodes en nuestro centro entre los años 2008 y 2019. Resultados: La edad media, el tamaño tumoral y la tasa de recidiva a 10 años fueron mayores en el grupo con tumores borderline-malignos. El tiempo medio de recidiva locorregional fue mayor en el grupo con tumores benignos que en el grupo borderline-maligno. El tipo histológico fue la única variable que demostró favorecer la recidiva local. El tamaño tumoral no se relacionó con el riesgo de recidiva locorregional. Conclusiones: El tipo histológico fue la única variable que demostró actuar como factor pronóstico de recidiva local. El tamaño tumoral no se relacionó con el riesgo de recidiva locorregional.(AU)

Objective: To analyse the profile of patients diagnosed with phyllodes tumours in a healthcare area. Material and methods: A retrospective descriptive study is presented on patients diagnosed with phyllodes tumour in a healthcare area between 2008 and 2019. Results: Mean age, tumour size, and recurrence rate at 10 years were higher in the group with borderline-malignant tumours. The mean time of locoregional recurrence was higher in the group with benign tumours than in the borderline-malignant group. The histological type was the only variable that showed to favour local recurrence. Tumour size was not related to the risk of locoregional recurrence. Conclusions: The histological type was the only variable that appeared to act as a prognostic factor for local recurrence. Tumour size was not related to the risk of locoregional recurrence.(AU)

Multi-element contamination in soils from major mining areas in Northeastern of Brazil.

Mining has become one of the main factors in the global biogeochemical cycle of potentially toxic elements. Therefore, it is considered one of the anthropogenic activities with the greatest negative impact on the environment. These impacts are maximized in semiarid regions, where mining activities can lead to soil degradation and decrease in land productivity. This study aimed to assess the level of contamination in natural, urban, and agricultural soils of three important mining areas, where approximately 80,000 people live, and pollution levels have never been determined before. For this purpose, soil samples were collected around iron, uranium, and vanadium mines, as well as in the main human settlements of the region. The concentrations of 34 elements were determined by instrumental neutron analysis activation (INAA) and inductively coupled plasma optical emission spectrometry (ICP OES) techniques. Pollution indices (CF, EF, mCd, PLI, and REEP) revealed that there is a moderate to heavy level of pollution for 89% of the analyzed elements. Additionally, an extreme contamination level was observed in 78% of the samples, for at least one element. Statistical analyses were performed to identify patterns in the distribution and common sources of pollution. The results suggest that the concentrations for Al, Ba, Hf, Na, Pb, Rb, REE, Ta, Th, U, Zn, and Zr are associated with geogenic causes. However, the influence of anthropogenic sources such as agriculture and mining on the accumulation of these elements in soils should not be disregarded. In contrast, the contents of As, Br, Cd, Co, Cr, Cs, Cu, Fe, K, Mn, Ni, Sc, Ti, and V reflect the direct impact of anthropogenic sources.

Implementación y evaluación de un protocolo de analgesia multimodal en el reemplazo total primario de rodilla que incluye bloqueo de canal de aductores guiado por ultrasonografía más infiltración de anestésico local periarticular / Implementation and evaluation of a multimodal analgesia protocol for total knee arthroplasty including ultrasound-guided adductor canal block and periarticular local anesthetic infiltration

Introducción: La anestesia regional guiada por ultrasonografía es una técnica segura y efectiva para el manejo del dolor postoperatorio. Este estudio evalúa la implementación de un protocolo analgésico para el reemplazo total primario de rodilla (RTPR). Métodos: Estudio observacional ambispectivo de cohortes no aleatorizado, realizado en un grupo de pacientes llevados a RTPR que recibieron infiltración de anestésico local periarticular más bloqueo del canal de aductores (IAL+BCA) como parte de un nuevo protocolo analgésico, frente a un grupo previo que recibió catéter perineural femoral más bloqueo del nervio ciático (CPF+BNC). La valoración de la intensidad del dolor se realizó utilizando la escala verbal numérica (EVN). El desenlace principal fue el dolor postoperatorio inmediato a las 24 y 48 horas. Se evaluó el cumplimiento de metas de rehabilitación física a las 48 horas como desenlace secundario. Resultados: Se analizaron 112 pacientes (67 en IAL + BCA y 45 en CPF + BNC). Ambas poblaciones fueron comparables en variables demográficas. La mediana del dolor en reposo en el primer y segundo día postoperatorios fue EVN 2/10 para ambos grupos. El promedio del dolor en movimiento en el segundo día postoperatorio fue EVN 5/10 para los pacientes con IAL + BCA y 4/10 para los pacientes con CPF + BNC, p = 0,073. El porcentaje de pacientes que cumplieron el 80 % o más de las metas de rehabilitación fue similar en ambos grupos (p = 0,201). Conclusiones: Ambas técnicas son equivalentes en el manejo analgésico postoperatorio del RTPR durante las primeras 48 horas. A pesar de que es conocido que la técnica de IAL + BCA genera menos compromiso motor del cuádriceps, esto no se reflejó en un mejor desempeño durante la rehabilitación física, posiblemente por un insuficiente control analgésico a las 48 horas.(AU)

Background: Ultrasound-guided regional anesthesia is a safe and effective technique in postoperative pain management. This study evaluates the implementation an analgesic protocol for total knee arthroplasty (TKA) including different nerve blocks. Methods: An observational ambispective non randomized cohort study was performed between a group of patients undergoing TKA who received local infiltration analgesia plus adductor canal block (LIA+ACB) as part of a new analgesic protocol against a previous group who received perineural femoral catheter plus sciatic nerve block (PFC+SNB). The measurement of pain intensity was made using the numerical rating scale (NRS). The main outcome was the immediate postoperative pain, at 24 and 48 hours. The fulfillment of physical rehabilitation goals was evaluated as a secondary outcome. Results: 112 patients were analyzed (67 in LIA+ACB and 45 in PFC+SNB). Both groups were comparable in demographic characteristics. The median pain at rest on the first and second postoperative days was NRS 2/10 for both groups. The average pain on movement on the second postoperative day was NRS 5/10 for patients with LIA+ACB and 4/10 for patients with PFC+SNB, p=0,073. The percentage of patients who fulfilled ≥80% of the rehabilitation goals was similar in both groups (p=0,201). Conclusions: In the TKA postoperative analgesic management, both techniques are equivalent during the first 48 hours. Although it is known that the LIA+ACB technique generates less motor impairment of the quadriceps muscle, this was not reflected on better performance during physical rehabilitation, possibly due to insufficient analgesic control at 48 hours.(AU)

Mastopatía diabética: un diagnóstico complicado. Revisión de la literatura a propósito de 2 casos / Diabetic mastopathy: A complicated diagnosis. Literature review and two cases

La mastopatía diabética es una entidad infrecuente. La presentación más común suele ser en forma de nódulo único o múltiple. Sus características clínicas y radiológicas pueden simular un cáncer de mama, por lo que debe tenerse en cuenta este diagnóstico diferencial en las pacientes jóvenes y con antecedentes de diabetes mellitus. Un correcto diagnóstico puede evitar tratamientos quirúrgicos innecesarios. Presentamos 2 casos que hemos diagnosticado en nuestra área sanitaria así como la revisión de la bibliografía al respecto

Diabetic mastopathy is an uncommon disorder, in which the most frequent presentation is as a single or multiple nodules. It can imitate breast cancer both clinically and radiologically. A differential diagnosis should be done in young patients with a personal history of diabetes, in order to avoid unnecessary surgical interventions. Two cases are presented that were diagnosed in our health area, as well as a review of the literature on this pathology

International league of associations for rheumatology recommendations for the management of psoriatic arthritis in resource-poor settings.

BACKGROUND: Psoriatic arthritis (PsA) is a challenging heterogeneous disease. The European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) last published their respective recommendations for the management of PsA in 2015. However, these guidelines are primarily based on studies conducted in resource replete countries and may not be applicable in countries in the Americas (except Canada and USA) and Africa. We sought to adapt the existing recommendations for these regions under the auspices of the International League of Associations for Rheumatology (ILAR). PROCESS: The ADAPTE Collaboration (2009) process for guideline adaptation was followed to adapt the EULAR and GRAPPA PsA treatment recommendations for the Americas and Africa. The process was conducted in three recommended phases: set-up phase; adaptation phase (defining health questions, assessing source recommendations, drafting report), and finalization phase (external review, aftercare planning, and final production). RESULT: ILAR recommendations have been derived principally by adapting the GRAPPA recommendations, additionally, EULAR recommendations where appropriate and supplemented by expert opinion and literature from these regions. A paucity of data relevant to resource-poor settings was found in PsA management literature. CONCLUSION: The ILAR Treatment Recommendations for PsA intends to serve as reference for the management of PsA in the Americas and Africa. This paper illustrates the experience of an international working group in adapting existing recommendations to a resource-poor setting. It highlights the need to conduct research on the management of PsA in these regions as data are currently lacking.Key Points• The paper presents adapted recommendations for the management of psoriatic arthritis in resource-poor settings.• The ADAPTE process was used to adapt existing GRAPPA and EULAR recommendations by collaboration with practicing clinicians from the Americas and Africa.• The evidence from resource-poor settings to answer clinically relevant questions was scant or non-existent; hence, a research agenda is proposed.

Sarcoidosis: una causa infrecuente de nódulo mamario / Sarcoidosis: An infrequent cause of a breast nodule

La sarcoidosis es una enfermedad granulomatosa sistémica de causa desconocida, caracterizada histológicamente por la presencia de granulomas no caseificantes. El tórax es la principal localización. La afectación mamaria es poco frecuente, menos del 1% de los casos, siendo necesario un diagnóstico diferencial adecuado para descartar enfermedad maligna. Presentamos el caso de una paciente diagnosticada de sarcoidosis sistémica grado II con aparición de sarcoidosis mamaria

Sarcoidosis is a systemic granulomatous disease of unknown cause. It is characterised by the presence of granulomas, mainly in the chest. Mammary involvement is rare, less than 1% of all cases, and an appropriate differential diagnosis is required in order to rule out malignant disease. The case is presented of a patient with a diagnosis of sarcoidosis that also presented with mammary sarcoidosis

Tratamiento quirúrgico de la enfermedad de Paget de la mama mediante técnica Grisotti. Descripción de un caso / Surgical management of Paget's disease of the breast using the Grisotti procedure. A case study

La afectación del complejo aréola-pezón (CAP) en la enfermedad de Paget está asociada en muchos casos a un carcinoma de mama subyacente. La rareza de la enfermedad hace que no se hayan establecido niveles de evidencia ni grados de recomendación concluyentes sobre el tipo de tratamiento quirúrgico de esta enfermedad. En la actualidad el tratamiento oncoplástico más radioterapia, en casos seleccionados, supone una alternativa a la indicación de mastectomía. Se presenta el caso de una paciente con enfermedad de Paget, y carcinoma intraductal subyacente, tratada con cirugía oncoplástica patrón de Grisotti seguida de radioterapia

The involvement of the nipple-areolar complex in Paget's disease is associated in many cases with an underlying breast cancer. The rarity of the disease means that no levels of evidence or conclusive grades of recommendation have been established concerning the type of surgical treatment of this disease. Nowadays, oncoplastic surgery plus radiotherapy, in selected cases, is an alternative to the indication of mastectomy. We present the case of a patient with Paget's disease, and underlying intraductal cancer treated with Grisotti's oncoplastic surgery procedure followed by radiotherapy

HHRISK: A code for assessment of human health risk due to environmental chemical pollution.

Chemical environmental pollution is currently one of the most concerning environmental problem on a global scale, due to the high risks posed to ecological systems and human health. Risk assessment methodologies are valuable tools for preventive management and the mitigation of human health risks. However, the application of these methodological tools involves several steps and the knowledge of many variables, which can hinder its correct implementation. The main objective of this work was the development of the computational code for human health risk assessment: HHRISK (Human Health Risk). This code allows for an agile and accurate risk assessment based on the methodology established by the U.S. Environmental Protection Agency (U.S. EPA). Different from other published methods, the HHRISK code includes a new spatiotemporal matrix for the analysis of the aggregated risk (for multiple exposure pathways) and the cumulative (for exposure to multiple chemicals). HHRISK was applied to two case studies published dealing with the assessment of risk to human health through exposure to toxic metals, obtaining satisfactory results. The concordance between the average results obtained with the HHRISK and those reported by the authors confirm the validity of the implemented model. The inclusion of a greater spatiotemporal detail of the risks allowed to carry out a more accurate analysis and to propose new subsidies for a more efficient risk mitigation management by affected place and period of time.

Bioaccumulation of nickel in tomato plants: risks to human health and agro-environmental impacts.

Anthropogenic activities such as agriculture, industry, and mining have contributed significantly to the accumulation of heavy metals in the soil, which in turn cause problems to human health and to the environment. The present work aims to study the effects of nickel (Ni) on the development of tomato plants, the risks to human health associated to the consumption of contaminated tomatoes, and the consequences to the environment. The experiment was carried out in greenhouse environment for a period of 120 days, and the plants were cultivated in soils with four different concentrations of Ni: 0, 35, 70, and 105 mg kg-1. The concentration of nickel in each part (root, stem, leaf, and fruit) of the tomato plant was measured at four different stages of the cycle: 30, 60, 90, and 120 days, by inductively coupled plasma optical emission spectrometer (ICP-OES). At the end of the cycle, the concentration of certain macro- and micronutrients was also determined and related to the corresponding Ni concentration in the soil. The distribution of Ni in the parts of the plant was analyzed from the bioaccumulation factor temporal behavior. Nickel concentrations found in the fruit were too low to pose a risk to human health. As a result of this research, it was verified that soils with nickel concentrations close to 70 mg kg-1, which is the limit established by the CONAMA resolution (420/2009), may actually represent an optimum concentration value for the development of tomato plants. It also increases productivity per plant and reduces the use of resources such as water and agricultural inputs.