Significant improvement of a nevus spilus-type congenital melanocytic nevus with oral selumetinib.

Giant congenital melanocytic nevi (GCMN) can be cosmetically significant and can lead to melanoma. There is no standard pharmacologic treatment for GCMN. We present the case of an 8-year-old female with kaposiform lymphangiomatosis caused by an NRAS mutation whose nevus spilus-type GCMN improved on oral selumetinib.

Human leukocyte antigen class-I variation is associated with atopic dermatitis: A case-control study.

Atopic dermatitis (AD) is a common immune-medicated skin disease. Previous studies have explored the relationship between Human Leukocyte Antigen (HLA) allelic variation and AD with conflicting results. The aim was to examine HLA Class I genetic variation, specifically peptide binding groove variation, and associations with AD. A case-control study was designed to evaluate HLA class I allelic variation and binding pocket polymorphisms, using next generation sequencing on 464 subjects with AD and 388 without AD. Logistic regression was used to evaluate associations with AD by estimating odds ratios (95% confidence intervals). Significant associations were noted with susceptibility to AD (B*53:01) and protection from AD (A*01:01, A*02:01, B*07:02 and C*07:02). Evaluation of polymorphic residues in Class I binding pockets revealed six amino acid residues conferring protection against AD: A9F (HLA-A, position 9, phenylalanine) [pocket B/C], A97I [pocket C/E], A152V [pocket E], A156R [pocket D/E], B163E [pocket A] and C116S [pocket F]. These findings demonstrate that specific HLA class I components are associated with susceptibility or protection from AD. Individual amino acid residues are relevant to protection from AD and set the foundation for evaluating potential HLA Class I molecules in complex with peptides/antigens that may initiate or interfere with T-cell responses.

Estados emocionais de idosos em isolamento social durante COVID-19

Introducción:La alta contagiosidad de la COVID-19, el crecimiento de casos confirmados, las muertes y el aislamiento social han ocasionado que las emociones y pensamientos negativos se extiendan, con amenaza a la salud mental de la población adulta mayor.Objetivo:Identificar los estados emocionales de adultos mayores en aislamiento social durante la COVID-19.Método:Se realizó un estudio descriptivo, transversal, entre mayo y junio de 2020, en el área de salud perteneciente al Policlínico Universitario “Dr. Rudesindo Antonio García del Rijo”, Sancti Spíritus. La población de estudio fue de 100 adultos mayores. Se evaluaron las variables: edad, sexo, estado civil, convivencia, ocupación, comorbilidad, ansiedad, depresión, irritabilidad, estrés. La información se obtuvo mediante la entrevista semiestructurada, la observación y test psicológicos.Resultados:El 61,0Porciento correspondió al sexo femenino; el 57,0 Porciento pertenecía al grupo de 70-79 años; la mayoría de los ancianos vivía acompañado con su pareja, un menor de edad o un discapacitado (64,0 Porciento), solo el 36,0 Porciento vivía efectivamente solo. El 65,0 Porciento no tenía vínculo laboral. El 89,0 Porciento presentaba patologías consideradas de riesgo para la COVID-19. Predominó un nivel de irritabilidad normal, tanto externa (68,0 Porciento) como interna (70,0 Porciento), un nivel leve de ansiedad (73,0 Porciento) y un nivel leve de depresión (50,0 Porciento). El 47,0 Porciento mostró alteración en los niveles de estrés.Conclusiones:El aislamiento social como medida para evitar el contagio por COVID-19 ha repercutido en la salud mental de los adultos mayores.[AU]

Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis.

INTRODUCTION: Hip fracture usually occurs in older patients. These patients remain at risk for developing new medical complications even after discharge from the hospital. The objective of this study was to identify risk factors for hospital readmission 30 days after hip fracture and the prognosis of the readmitted patients. MATERIALS METHODS: A prospective, observational cohort study of 732 consecutive patients over 65 years surgically treated for hip fracture and discharged alive in 2010-2014 was conducted. The measurements were patient demographic characteristics, residential and discharge status, Katz Index, Merle D'aubigné Hip Score, Mini-Mental Test, comorbid conditions, Charlson Index, ASA group, type of fracture and repair, and postoperative complications. Patient characteristics were tested by bivariate and multivariate analyses. RESULTS: 8.3 % of patients were readmitted within 30 days (56.0 % of these within 2 weeks). Medical reasons were 13 times more frequent than surgical reasons. Diagnoses more prevalent for readmission were pulmonary disease, deep vein thrombosis, heart failure, and renal failure. Predictors of readmission were female gender (HR 1.9, 95 % CI 1.1-3.4), grade III-IV ASA (HR 2.1, 95 % CI 1.1-4.2), and pre-existing pulmonary disease (HR 5.3, 95 % CI 3.4-9.6). In-hospital mortality among readmitted patients was 22.9 %. In bivariate analyses, male gender, ASA III-IV, cognitive impairment, and more than two comorbidities were potential predictive factors for readmission, and in multivariate analysis only male gender and ASA III-IV. Mortality risk among readmitted patients was significantly higher compared to the in-hospital mortality in the overall cohort (OR 1.8, 95 % CI 1.5-2.3). CONCLUSIONS: Hospital readmissions after hip fracture were mainly due to medical complications and a fraction of these may be preventable. Readmission was associated with increased morbidity and mortality.

Componente acetabular no cementado en coxartrosis por fractura de cotilo / Cementless acetabular component in coxarthrosis due to a acetabular fracture

Objetivo. Valoración del componente acetabular no cementado en prótesis total de cadera por artrosis secundaria a fractura de cotilo. Material y método. Estudio prospectivo de 24 pacientes con edad media de 56 años (rango: 28-77) y seguimiento medio de 8,4 años (rango: 5-15), que fueron tratados con acetábulo no cementado atornillado. El tiempo medio entre la fractura y la prótesis fue de tres años (rango: 5 meses-14 años). La fractura había sido tratada conservadoramente en 15 casos y con fijación interna en 9 casos. Se realizó valoración clínica con la escala de Harris y radiográfica, con especial interés en el acetábulo. Resultados. La escala de Harris media se incrementó de 35 puntos (rango: 22-52) a 77 (rango: 45-94). Hubo tres aflojamientos de cotilo, dos con osteólisis que fueron revisados y uno con radiolucencia continua. El vástago femoral precisó revisión quirúrgica en un caso. Hubo un caso de infección profunda y una luxación tardía postraumática. La función de supervivencia de la artroplastia por cualquier causa a 12 años fue del 78,4%. Discusión y conclusiones. Son escasos los estudios al respecto y todos con pequeño número de casos. La tasa de fallos acetabulares es superior que la tasa en los casos no traumáticos. La prótesis no cementada es un tratamiento adecuado para las secuelas de fractura de cotilo (AU)

Objective. To evaluate the outcomes of cementless acetabular component for post-traumatic arthritis after acetabular fracture. Material and method. A prospective study of twenty-four patients with a mean age of 56years (range: 28-77) and a follow-up 8.4years (range: 5-15) treated with cementless total hip arthroplasty. The time from fracture to total hip arthroplasty was 3years (range: 5 months-14years). The fracture had been treated conservatively in 15 cases and with internal fixation in 9 cases. A clinical assessment was made using with Harris hip score, along with radiology with special interest in the socket. Results. Harris hip score increased from 35 points (range: 22-52) to 77 (range: 45-94). Unstable acetabular fixation was seen in 3 cases, 2 with osteolysis that required revision and 1 with a complete radiolucent line. The stem required revision in 1 case. There was 1 case of deep infection and 1 post-traumatic late dislocation. Survival for any cause at 12years was 78.4%. Discussion and conclusions. There are few studies on this topic, and all with a small number of cases. Acetabular failure rate is higher than routine total hip arthroplasty for non-traumatic osteoarthritis. Cementless total hip arthroplasty is a suitable treatment for post-traumatic arthritis after acetabular fracture (AU)

Toxicokinetic analysis of losartan during gestation and lactation in the rat.

Previous developmental and reproductive toxicity studies in rats with losartan, a potent AT1-selective angiotensin II (AII) receptor antagonist, correlated maternal treatment during gestation day (GD) 15-20 with irreversible renal abnormalities in the F1 generation (Spence et al., '95a,b). Continued treatment through lactation was also associated with increases in pup mortality and decreases in pup body weights that persisted through weaning. The studies presented here were undertaken to quantify fetal and neonatal exposure to losartan when administered to the dam by oral gavage during early gestation, late gestation, and lactation. Following daily oral dosing of 135 mg/kg/day on GD6-15, fetal drug levels were negligible. However, losartan and its active metabolite, EXP3174 (L-158,641) were readily detectable in fetal plasma on GD 20 (estimated AUC values, 50.70 and 167.70 micrograms/hr/ml, respectively) and maternal milk during lactation (1.61 and 1.67 micrograms/ml, respectively). These studies suggest that the relative increased sensitivity of the fetus as compared to the neonate for losartan-induced renal lesions is related to the degree of exposure which is dependent on the time of administration (early gestation vs. late gestation/lactation) and the route of exposure (transplacental or through the milk). Furthermore, the maximum exposure to losartan and EXP3174 correlates with the ontogeny of the renin angiotensin system on approximately GD 17 and the critical period for losartan-induced renal lesions (GD15-20). The data support the hypothesis that the observed adverse fetal and neonatal effects are pharmacologically mediated, presumably through the lack of AT1 receptor stimulation.

High-performance liquid chromatographic method for the determination of a novel leukotriene D4 antagonist (MK-0571) in biological specimens.

A rapid, sensitive and selective liquid chromatographic procedure was developed to quantitate the levels of a novel leukotriene D4 antagonist, MK-0571 (I), in biological samples. The method involves the addition of an internal standard, an analogue of I, and methanol to the biological matrix. Following centrifugation the supernatant is chromatographed isocratically on a C18 reversed-phase column and the acids are detected with an ultraviolet detector. The sensitivity of the method is such that 50 ng of drug can be quantitated per aliquot of sample. Assays were linear over a 0.06-40.0 micrograms range and exhibited a recovery of 100.5 +/- 7.0% (mean +/- S.D.) over this range. This procedure was utilized to monitor plasma, liver and urinary levels of I in chronic and acute toxicity studies in several animal species.

[Cystic lymphangiomas of the mediastinum. Apropos of 2 cases and a review of the literature]. / Lymphangiomes kystiques du médiastin. A propos de 2 cas, revue de la littérature.

Two cases of patients suffering from a cystic lymphangioma of the mediastinum are presented. The literature is reviewed and the surgical and pathological findings are commented.