Sex hormones and the total testosterone:estradiol ratio as predictors of severe acute respiratory syndrome coronavirus 2 infection in hospitalized men.

BACKGROUND: The predictive ability of the early determination of sex steroids and the total testosterone:estradiol ratio for the risk of severe coronavirus disease 2019 or the potential existence of a biological gradient in this relationship has not been evaluated. OBJECTIVES: To assess the relationship of sex steroid levels and the total testosterone:estradiol ratio with the risk of severe acute respiratory syndrome coronavirus 2 infection in men, defined as the need for intensive care unit admission or death, and the predictive ability of each biomarker. MATERIALS AND METHODS: This was a prospective observational study. We included all consecutive adult men with severe acute respiratory syndrome coronavirus 2 infections in a single center admitted to a general hospital ward or to the intensive care unit. Sex steroids were evaluated at the centralized laboratory of our hospital. RESULTS: We recruited 98 patients, 54 (55.1%) of whom developed severe coronavirus disease in 2019. Compared to patients with nonsevere coronavirus disease 2019, patients with severe coronavirus disease 2019 had significantly lower serum levels of total testosterone (111 ± 89 vs. 191 ± 143 ng/dL; p < 0.001), dehydroepiandrosterone (1.69 ± 1.26 vs. 2.96 ± 2.64 ng/mL; p < 0.001), and dehydroepiandrosterone sulfate (91.72 ± 76.20 vs. 134.28 ± 98.261 µg/dL; p = 0.009), significantly higher levels of estradiol (64.61 ± 59.35 vs. 33.78 ± 13.78 pg/mL; p = 0.001), and significantly lower total testosterone:estradiol ratio (0.28 ± 0.31 vs. 0.70 ± 0.75; p < 0.001). The lower the serum level of androgen and the lower the total testosterone:estradiol ratio values, the higher the likelihood of developing severe coronavirus disease 2019, with the linear trend in the adjusted analyses being statistically significant for all parameters except for androstenedione (p = 0.064). In the receiver operating characteristic analysis, better predictive performance was shown by the total testosterone:estradiol ratio, with an area under the curve of 0.77 (95% confidence interval 0.68-0.87; p < 0.001). DISCUSSION AND CONCLUSION: Our results suggest that men with severe acute respiratory syndrome coronavirus 2 infection, decreased androgen levels and increased estradiol levels have a higher likelihood of developing an unfavorable outcome. The total testosterone:estradiol ratio showed the best predictive ability.

Dasatinib-Induced Chylothorax: A Clinical Laboratory's Perspective.

Dasatinib is a tyrosine kinase inhibitor drug used for chronic myeloid leukaemia (CML) treatment. Chylothorax has been rarely reported as a secondary effect of dasatinib occurring especially in long-term treated patients, although its pathophysiology is not yet fully understood. Laboratory analysis of the pleural effusion is crucial for chylothorax diagnosis. We report a case of a 53-year-old male patient presenting a chylothorax after 14 years of dasatinib therapy where the clinical laboratory was key in the diagnosis.

TNF Inhibitors Exert a "Hidden" Beneficial Effect in the Cardiovascular Lipoprotein Profile of RA Patients.

Purpose: A high cardiovascular risk has been described in patients with rheumatoid arthritis (RA); the effects of different biological agents have also been described in these patients. The aim of the present study is to examine the effects of tumor necrosis factor inhibitors (TNFi) in the lipoprotein profile of RA patients using a broad laboratory assessment including a large number of non-routine tests. Patients and Methods: RA patients treated with and without TNFi (70 patients in each group) were cross-sectionally compared regarding a broad spectrum of lipoprotein parameters including serum levels of total and HDL, LDL and VLDL cholesterol triglycerides, lipoprotein A (LpA), apolipoprotein A1 (Apo A), B100 (Apo B) and paroxonase. For each lipoprotein subfraction (HDL, LDL and VLDL), we assess specific concentrations of cholesterol, triglycerides, phospholipids and proteins and total mass of each one. Additionally, HDL Apo A, LDL and VLDL Apo B concentrations and number of particles of LDL and VLDL were also determined. Exploratory univariate and multivariate analyses of the different variables were performed. Results: Seventy patients in each subset were enrolled. Patients on treatment with TNFi showed a trend to be younger and to have a longer disease duration. Regarding the lipoprotein analyses, borderline significant higher levels of serum Apo A were detected and an independent association with lower HDL mass, LDL triglyceride, VLDL cholesterol, VLDL Apo B, VLDL mass, number of VLDL cholesterol molecules and number of particles of VLDL was clearly observed. Conclusion: TNFi treatment was associated with beneficial atherogenic effects at the lipoprotein level especially centered in the VLDL-related parameters consistent with a reduction of the atherogenic risk.

Measurement and clinical usefulness of bilirubin in liver disease.

Elevated plasma bilirubin levels are a frequent clinical finding. It can be secondary to alterations in any stage of its metabolism: (a) excess bilirubin production (i.e., pathologic hemolysis); (b) impaired liver uptake, with elevation of indirect bilirubin; (c) impaired conjugation, prompted by a defect in the UDP-glucuronosyltransferase; and (d) bile clearance defect, with elevation of direct bilirubin secondary to defects in clearance proteins, or inability of the bile to reach the small bowel through bile ducts. A liver lesion of any cause reduces hepatocyte cell number and may impair the uptake of indirect bilirubin from plasma and diminish direct bilirubin transport and clearance through the bile ducts. Various analytical methods are currently available for measuring bilirubin and its metabolites in serum, urine and feces. Serum bilirubin is determined by (1) diazo transfer reaction, currently, the gold-standard; (2) high-performance liquid chromatography (HPLC); (3) oxidative, enzymatic, and chemical methods; (4) direct spectrophotometry; and (5) transcutaneous methods. Although bilirubin is a well-established marker of liver function, it does not always identify a lesion in this organ. Therefore, for accurate diagnosis, alterations in bilirubin concentrations should be assessed in relation to patient anamnesis, the degree of the alteration, and the pattern of concurrent biochemical alterations.

The Ratio Serum Creatinine/Serum Cystatin C (a Surrogate Marker of Muscle Mass) as a Predictor of Hospitalization in Chronic Obstructive Pulmonary Disease Outpatients.

BACKGROUND: In chronic obstructive pulmonary disease (COPD), low muscle mass has been associated with several clinical outcomes such as low exercise capacity, hospital admission, and mortality. The Sarcopenia Index (SI) is a novel way to estimate muscle mass based on the ratio of serum creatinine (produced exclusively by muscle)/cystatin C (produced by all nucleated body cells). OBJECTIVES: This study aims to assess the SI in stable COPD outpatients, as compared with a healthy control group, to quantify its relationship with several important clinical features in COPD, and to study its potential usefulness to predict COPD exacerbations and hospital admissions. METHODS: The SI was calculated in 18 healthy control subjects and 65 stable COPD outpatients were included in the study. Patients were prospectively followed for 1 year after being enrolled in the study. RESULTS: COPD patients had a lower SI than controls, that is lower muscle mass. Furthermore, patients with a modified Medical Research Council dyspnea score ≥2, patients with a COPD Assessment Test score ≥10, and patients with a high risk of exacerbation had lower levels of SI compared with patients without these characteristics. SI correlated with FEV1 (r = 0.491, p < 0.001), the 6-min walking test (r = 0.560, p = 0.001), and the Fat-Free Mass Index (r = 0.431, p = 0.017). Univariate and multivariate Cox proportional risk analysis showed that a low SI is an independent predictor of hospital admission in COPD outpatients followed for 1 year (HR 5.16, p = 0.025). CONCLUSIONS: The ratio serum creatinine/serum cystatin C correlates with several COPD characteristics, and it can be used to predict COPD hospitalization.

Conocimiento y actitudes de los padres sobre los signos de alarma y deshidratación en Enfermedad Diarreica Aguda / Knowledge and attitudes of the parents on the signs of alarm and dehydration in Disease Diarreica Aguda

Objetivo: Describir el nivel de conocimientos sobre los signos de alarma y deshidratación e identificar cuáles son las actitudes tomadas por los padres de niños de 5 años o menos que presentaron diarreas agudas y que acudieron a la Unidad de Rehidratación Oral del Instituto Nacional de Salud del Niño. Materiales y métodos: Estudio observacional, descriptivo y trasversal; se realizó una entrevista previo consentimiento informado a los padres de niños de 5 años o menos que acudieron a la Unidad de Rehidratación Oral del Instituto Nacional de Salud del Niño por presentar cuadro de diarreas agudas, para medir su conocimiento y actitudes en deshidratación. Los resultados se presentaron en forma descriptiva. Resultados: Al preguntar sobre los signos de alarma, se obtuvo que 69 padres (67.6 por ciento) conocían al menos un signo. Los signos más conocidos por los padres fueron: vomita todo lo que ingiere y convulsiones...

Objective: To describe the level of knowledge about the warning signs and dehydration and identify what are the attitudes taken by parents of children 5 years or less who had acute diarrhea box and went to the Oral Rehydration Unit of the National Institute Child Health. Materials and methods: Observational, descriptive and cross, was interviewed prior informed consent for parents of children 5 years or less who attended the Oral Rehydration Unit of the National Institute of Child Health for acute diarrhea present box, to measure their knowledge and attitudes in dehydration. The results were presented descriptively. Results: When asked about the warning signs, we obtained that 69 parents (67.6 per cent) knew at least one sign. The most familiar signs parents were vomiting all feeds and seizures...

Organismos tipo campylobacter en el esofago de Barrett / Organisms type campylobacter in Barrett esofhagus

Esta claro que el CP está presente en mayor o menor grado en diversa patología gastroduodenal, fundamentalmente en gastritis crónica superficial activa, úlcera gástrica y úlcera duodenal con metaplasia gástrica. Tambien se lo encuentra en gastritis crónica atrófica y en menor porcentaje si ésta tiene metaplasia intestinal, así como en algunos estómagos normales. No se lo halla en duodeno histológicamente normal ni en esófago. Como nos llamó la atención que no se hubiera realizado ninguna publicación en EB, nos dispusimos a realizar retrospectivamente, la búsqueda del CP en la metaplasia columnar del esófago distal. Su incidencia resultó elevada, 88.88% aún en aquellos casos con metaplasia intestinal, y con úlcera de Barret. Utilizamos coloración de Gram y Warthin-Starry con Alcian-Blue, y clasificándolos dentro de los Grados establecidos por Marshall y Warren. Elaboramos asimismo la discusión sobre algunos hechos fisiopatológicos, como la presencia de infiltrado PMN en todos los casos, y su importancia en el mantenimiento de la metaplasia, de las úlceras de Barrett y su posible papel en el desarrolo del adenocarcinoma (AU)

Organismos tipo campylobacter en el esofago de Barrett / Organisms type campylobacter in Barrett esofhagus

Esta claro que el CP está presente en mayor o menor grado en diversa patología gastroduodenal, fundamentalmente en gastritis crónica superficial activa, úlcera gástrica y úlcera duodenal con metaplasia gástrica. Tambien se lo encuentra en gastritis crónica atrófica y en menor porcentaje si ésta tiene metaplasia intestinal, así como en algunos estómagos normales. No se lo halla en duodeno histológicamente normal ni en esófago. Como nos llamó la atención que no se hubiera realizado ninguna publicación en EB, nos dispusimos a realizar retrospectivamente, la búsqueda del CP en la metaplasia columnar del esófago distal. Su incidencia resultó elevada, 88.88% aún en aquellos casos con metaplasia intestinal, y con úlcera de Barret. Utilizamos coloración de Gram y Warthin-Starry con Alcian-Blue, y clasificándolos dentro de los Grados establecidos por Marshall y Warren. Elaboramos asimismo la discusión sobre algunos hechos fisiopatológicos, como la presencia de infiltrado PMN en todos los casos, y su importancia en el mantenimiento de la metaplasia, de las úlceras de Barrett y su posible papel en el desarrolo del adenocarcinoma

Diagnóstico y etiología del esófago de Barrett: presencia de células secretoras de gastrina (G) / Diagnosis and etiology of Barrett esophagus: presence of gastrin secreting cells (6 cells)

Presentamos las pautas diagnósticas, revisando los datos clínicos, radiológicos, endoscópicos e histológicos de 35 pacientes con Esófago de Barrett (EB) (metaplasia columnar en esófago distal). Las características clínicas son las de una esofagitis severa de larga evolución, aunque la metaplasia por sí misma, es asintomática y su clínica depende del grado de inflamación. La radiología nos revela algunos datos como reflujo GE, hernia hiatal, úlceras o estenosis, y tal vez el doble contraste haga sospechar el endobraquiesófago (EBE). La endoscopía nos proporciona datos precisos sobre la altura del EBE, úlceras, estenosis e inflamacion. La histología nos aclara el tipo de metaplasia columnar (cardial o transicional, gástrica fúndica, intestinal o especializada, ó mixta). La etiología congénita o adquirida, sujeta a controversia, puede ser aclarada con un método inmuno histoquímico, le de la Peroxidasa anti-Peroxidasa (PAP) revelándonos la presencia de células secretoras de Gastrina (G) en los casos congénitos

Diagnóstico y etiología del esófago de Barrett: presencia de células secretoras de gastrina (G) / Diagnosis and etiology of Barrett esophagus: presence of gastrin secreting cells (6 cells)

Presentamos las pautas diagnósticas, revisando los datos clínicos, radiológicos, endoscópicos e histológicos de 35 pacientes con Esófago de Barrett (EB) (metaplasia columnar en esófago distal). Las características clínicas son las de una esofagitis severa de larga evolución, aunque la metaplasia por sí misma, es asintomática y su clínica depende del grado de inflamación. La radiología nos revela algunos datos como reflujo GE, hernia hiatal, úlceras o estenosis, y tal vez el doble contraste haga sospechar el endobraquiesófago (EBE). La endoscopía nos proporciona datos precisos sobre la altura del EBE, úlceras, estenosis e inflamacion. La histología nos aclara el tipo de metaplasia columnar (cardial o transicional, gástrica fúndica, intestinal o especializada, ó mixta). La etiología congénita o adquirida, sujeta a controversia, puede ser aclarada con un método inmuno histoquímico, le de la Peroxidasa anti-Peroxidasa (PAP) revelándonos la presencia de células secretoras de Gastrina (G) en los casos congénitos (AU)