Skin manifestations in adults with gender dysphoria on hormone treatment in the outpatient clinic of Hospital de San José, Bogotá-Colombia.

BACKGROUND: Comprehensive healthcare for patients with gender dysphoria includes access to gender-affirming hormone therapy. It may cause cutaneous and adnexal side effects, which often affect quality of life, are underdiagnosed, and do not receive timely treatment. The literature on this subject is scarce. The main objective was to identify skin manifestations secondary to hormone treatment in adults with gender dysphoria. METHODS: Observational, descriptive, cross-sectional study. A search was performed in the database of patients with gender dysphoria older than 18 years treated at the dermatology and/or endocrinology outpatient clinic of the Hospital de San José de Bogotá in the period 2015-2021. Medical records of patients on hormone therapy with skin manifestations were selected, while patients using other medications as possible triggers were excluded. RESULTS: In total, 85 patients were included, with a predominance of young transgender men (average age was 27 ± 9 years) in whom the main manifestation was acne (87%), followed by androgenetic alopecia and acanthosis nigricans. Transgender women presented more acne, androgenetic alopecia, hypertrichosis, seborrheic dermatitis, and melasma. The majority received treatment, mainly topical therapies. More than half of the patients were treated by the endocrinology and dermatology services. CONCLUSIONS: Skin manifestations in patients with gender dysphoria on hormone therapy are frequent, so they should be known and taken into account in the multidisciplinary approach to these patients, which should involve dermatologists. This is the first Colombian and Latin American study focused on documenting skin manifestations in patients with gender dysphoria undergoing hormone therapy.

Prevention and Management of Chronic Postsurgical Pain and Persistent Opioid Use Following Solid Organ Transplantation: Experiences From the Toronto General Hospital Transitional Pain Service.

BACKGROUND: With >700 transplant surgeries performed each year, Toronto General Hospital (TGH) is currently one of the largest adult transplant centers in North America. There is a lack of literature regarding both the identification and management of chronic postsurgical pain (CPSP) after organ transplantation. Since 2014, the TGH Transitional Pain Service (TPS) has helped manage patients who developed CPSP after solid organ transplantation (SOT), including heart, lung, liver, and renal transplants. METHODS: In this retrospective cohort study, we describe the association between opioid consumption, psychological characteristics of pain, and demographic characteristics of 140 SOT patients who participated in the multidisciplinary treatment at the TGH TPS, incorporating psychology and physiotherapy as key parts of our multimodal pain management regimen. RESULTS: Treatment by the multidisciplinary TPS team was associated with significant improvement in pain severity and a reduction in opioid consumption. CONCLUSIONS: Given the risk of CPSP after SOT, robust follow-up and management by a multidisciplinary team should be considered to prevent CPSP, help guide opioid weaning, and provide psychological support to these patients to improve their recovery trajectory and quality of life postoperatively.

Partition Constant of Binary Mixtures for the Equilibrium between a Bulk and a Confined Phase.

It is well-known that the thermodynamic, kinetic and structural properties of fluids, and in particular of water and its solutions, can be drastically affected in nanospaces. A possible consequence of nanoscale confinement of a solution is the partial segregation of its components. Thereby, confinement in nanoporous materials (NPM) has been proposed as a means for the separation of mixtures. In fact, separation science can take great advantage of NPM due to the tunability of their properties as a function of nanostructure, morphology, pore size, and surface chemistry. Alcohol-water mixtures are in this context among the most relevant systems. However, a quantitative thermodynamic description allowing for the prediction of the segregation capabilities as a function of the material-solution characteristics is missing. In the present study we attempt to fill this vacancy, by contributing a thermodynamic treatment for the calculation of the partition coefficient in confinement. Combining the multilayer adsorption model for binary mixtures with the Young equation, we conclude that the liquid-vapor surface tension and the contact angle of the pure substances can be used to predict the separation ability of a particular material for a given mixture to a semiquantitative extent. Moreover, we develop a Kelvin-type equation that relates the partition coefficient to the radius of the pore, the contact angle, and the liquid-vapor surface tensions of the constituents. To assess the validity of our thermodynamic formulation, coarse grained molecular dynamics simulations were performed on models of alcohol-water mixtures confined in cylindrical pores. To this end, a coarse-grained amphiphilic molecule was parametrized to be used in conjunction with the mW potential for water. This amphiphilic model reproduces some of the properties of methanol such as enthalpy of vaporization and liquid-vapor surface tension, and the minimum of the excess enthalpy for the aqueous solution. The partition coefficient turns out to be highly dependent on the molar fraction, on the interaction between the components and the confining matrix, and on the radius of the pore. A remarkable agreement between the theory and the simulations is found for pores of radius larger than 15 Å.

On the interfacial lithium dynamics in Li7La3Zr2O12:poly(ethylene oxide) (LiTFSI) composite polymer-ceramic solid electrolytes under strong polymer phase confinement.

A better molecular-level understanding of Li+ diffusion through ceramic/polymer interfaces is key to design high-performance composite solid-state electrolytes for all-solid-state batteries. By considering as a case study a composite electrolyte constituted by Li+ conductive Ga3+ doped-Li7La3Zr2O12 (LLZO) garnet fillers embedded within a poly(ethylene oxide) and lithium bis(trifluoromethanesulfonyl) imide polymer matrix (PEO(LiTFSI)), we investigate Li+ interfacial dynamics at conditions of high polymer confinement, with large filler particles in a fully amorphous polymer phase. Such confinement scenario is aimed to capture the conditions near the percolation threshold, at which conductivity enhancement is often reported. Using molecular dynamics simulations combined with the generalized shadow hybrid Monte Carlo method and umbrella sampling calculations, we explain why the hopping towards the polymer phase of the Li+ sitting on the LLZO surface is thermodynamically hindered, while hopping of Li+ from the polymer to the LLZO is kinetically slowed-down by rigidified polymer near the interface. In addition, we demonstrate how the overlap of LLZO-bound polymer chains at high confinement leads to a decrease of Li+ diffusivity within the interstitial space. We put forward that these insights are relevant to interpret the variation of ionic conductivity as a function of volume fraction and filler particle sizes also below the glass transition temperature of the polymer, at the typical operating conditions of lithium ion batteries.

In-situ characterization of discharge products of lithium-oxygen battery using Flow Electrochemical Atomic Force Microscopy.

The increasing interest in lithium-oxygen batteries (LOB), having the highest theoretical energy densities among the advanced lithium batteries, has triggered the search for in-situ characterization techniques, including Electrochemical Atomic Force Microscopy (EC-AFM). In this work we addressed the characterization of the formation and decomposition of lithium peroxide (Li2O2) on a carbon cathode using a modified AFM technique, called Flow Electrochemical Atomic Force Microscopy (FE-AFM), where an oxygen-saturated solution of the non-aqueous lithium electrolyte is circulated through a liquid AFM cell. This novel technique does not require keeping the AFM equipment inside a glove-box, and it allows performing a number of experiments using the same substrate with different electrolytes without disassembling the cell. We study the morphology of Li2O2 on graphite carbon using lithium bis(trifluoromethane sulfonyl)imide (LiTFSI) in dimethyl sulphoxide (DMSO) as electrolyte under different operational conditions, in order to compare our results with those reported using other electrolytes and in-situ and ex-situ EC-AFM.

State of the science: cannabis and cannabinoids in palliative medicine-the potential.

Cannabinoids are chemicals derived naturally from the cannabis plant or are synthetically manufactured. They interact directly with cannabinoid receptors or share chemical similarity with endocannabinoids (or both). Within palliative medicine, cannabinoid receptors (CB1 and CB2) may modulate some cancer symptoms: appetite, chemotherapy-induced nausea and vomiting, and mood, pain and sleep disorders. Opioid and cannabinoid receptors have overlapping neuroanatomical receptor distribution, particularly at the dorsal horn, dorsal striatum and locus coeruleus. They have a favourable safety profile compared with opioids, and cannabis-based medicines help chronic pain. While cannabidiol (CBD) has anti-inflammatory properties, tetrahydrocannabinol (THC) is the psychoactive substance for issues such as mood and sleep. Nabiximols (Sativex), a CBD:THC combination, is Food and Drug Administration approved for some multiple sclerosis symptoms and epilepsy. There has been a swift societal evolution in attitudes about use of cannabis and cannabinoid medicines for chronic pain. In the USA, 33 states have now legalised prescription-based medical cannabis for several medical conditions; Canada has had legislation since 2001 authorising medical use. The European Union (EU) recently declared all EU citizens must have access to medical cannabis over the next 4 years. The integration into medicine and routine clinical use of cannabis is fraught with information gaps, regulatory issues and scarcity of research. Each patient should have a comprehensive assessment and risk-benefit discussion before any cannabis-based intervention to avoid possible complications such as hallucinations, psychosis and potential cardiac harm.

Pituitary gigantism: a case series from Hospital de San José (Bogotá, Colombia).

INTRODUCTION: Gigantism is a rare pediatric disease characterized by increased production of growth hormone (GH) before epiphyseal closure, that manifests clinically as tall stature, musculoskeletal abnormalities, and multiple comorbidities. MATERIALS AND METHODS: Case series of 6 male patients with gigantism evaluated at the Endocrinology Service of Hospital de San José (Bogotá, Colombia) between 2010 and 2016. RESULTS: All patients had macroadenomas and their mean final height was 2.01 m. The mean age at diagnosis was 16 years, and the most common symptoms were headache (66%) and hyperhidrosis (66%). All patients had acral changes, and one had visual impairment secondary to compression of the optic chiasm. All patients underwent surgery, and 5 (83%) required additional therapy for biochemical control, including radiotherapy (n = 4, 66%), somatostatin analogues (n = 5, 83%), cabergoline (n = 3, 50%), and pegvisomant (n = 2, 33%). Three patients (50%) achieved complete biochemical control, while 2 patients showed IGF-1 normalization with pegvisomant. Two patients were genetically related and presented a mutation in the aryl hydrocarbon receptor-interacting protein (AIP) gene (pathogenic variant, c.504G>A in exon 4, p.Trp168*), fulfilling the diagnostic criteria of familial isolated pituitary adenoma. CONCLUSIONS: This is the largest case series of patients with gigantism described to date in Colombia. Transsphenoidal surgery was the first-choice procedure, but additional pharmacological therapy was usually required. Mutations in the AIP gene should be considered in familial cases of GH-producing adenomas.

Pituitary gigantism: a case series from Hospital de San José (Bogotá, Colombia)

ABSTRACT Introduction Gigantism is a rare pediatric disease characterized by increased production of growth hormone (GH) before epiphyseal closure, that manifests clinically as tall stature, musculoskeletal abnormalities, and multiple comorbidities. Materials and methods Case series of 6 male patients with gigantism evaluated at the Endocrinology Service of Hospital de San José (Bogotá, Colombia) between 2010 and 2016. Results All patients had macroadenomas and their mean final height was 2.01 m. The mean age at diagnosis was 16 years, and the most common symptoms were headache (66%) and hyperhidrosis (66%). All patients had acral changes, and one had visual impairment secondary to compression of the optic chiasm. All patients underwent surgery, and 5 (83%) required additional therapy for biochemical control, including radiotherapy (n = 4, 66%), somatostatin analogues (n = 5, 83%), cabergoline (n = 3, 50%), and pegvisomant (n = 2, 33%). Three patients (50%) achieved complete biochemical control, while 2 patients showed IGF-1 normalization with pegvisomant. Two patients were genetically related and presented a mutation in the aryl hydrocarbon receptor-interacting protein (AIP) gene (pathogenic variant, c.504G>A in exon 4, p.Trp168*), fulfilling the diagnostic criteria of familial isolated pituitary adenoma. Conclusions This is the largest case series of patients with gigantism described to date in Colombia. Transsphenoidal surgery was the first-choice procedure, but additional pharmacological therapy was usually required. Mutations in the AIP gene should be considered in familial cases of GH-producing adenomas.

Platelet-rich plasma in treating peripheral neuropathic pain. Preliminary report / Plasma rico en plaquetas en el tratamiento del dolor neuropático periférico. Estudio preliminar

Background: Neuropathic pain (NP) is a chronic form of progressively incapacitating pain with a high impact on patients' quality of life. Often underdiagnosed and undertreated, NP has currently no effective treatment schemes, despite the many drugs and many techniques that have been proposed. This paper examines the effects of platelet-rich plasma (PRP) on relieving such form of pain applying it to the site where NP originates. Method: 45 patients with shooting, burning, electric, or lancinating pain and allodynia, with refractory multimodal-approach to pharmacologic management for more than 3 months were included in the study. All patients had a diagnosis of peripheral neuropathic pain. Patients received a sonographic-guided injection of PRP at the affected dermatome site. Results: At the end of three-month follow-up, the pain score was reduced up to 70 % in 39 out of the 45 patients, permitting the lowering of pain medication and improving their quality of life. Conclusion: These positive and promising results with PRP in treating peripheral neuropathic pain in the present study encourage us for further clinical investigations of this novel proposal

Antecedentes: El dolor neuropático (NP en sus siglas en inglés) es una forma de dolor crónico progresivamente incapacitante y con un alto impacto en la calidad de vida de los pacientes. A menudo subdiagnosticada y/o pobremente tratada, la NP no tiene actualmente ningún esquema de tratamiento efectivo, a pesar de los muchos fármacos y muchas técnicas que se han propuesto. Este artículo revisa la etiopatogenia del dolor neuropático y examina los efectos de la inyección del plasma rico en plaquetas (PRP) en el alivio del dolor neuropático periférico, cuando se aplica en el sitio donde se origina. Método: Se incluyeron en el estudio 45 pacientes con dolor tipo quemazón, calambre o dolor lancinante y alodinia, que venían siendo tratados en un esquema multimodal, pero refractario a dicho tratamiento farmacológico durante más de 3 meses. Todos los pacientes tenían un diagnóstico de dolor neuropático periférico. Los pacientes recibieron una inyección de PRP guiada por ecografía en el sitio del dermatoma afectado. Resultados: Al final de los tres meses de seguimiento, la puntuación del dolor se redujo hasta un 70 % en 39 de los 45 pacientes, permitiendo disminuir la medicación para el dolor y mejorar su calidad de vida. Conclusión: Estos resultados prometedores con PRP en el tratamiento de dolor neuropático periférico del presente estudio nos alientan a nuevas investigaciones clínicas con esta novedosa propuesta

Effect of halogen dopants on the properties of Li2O2: is chloride special?

There is consensus on the fact that one of the main limitations of Li air batteries (LABs) is the insulating character of Li2O2 and that it becomes crucial to explore new conduction paths. Recent studies indicate that doping with chloride increases the ion conductivity of Li2O2, although to a much lesser extent than expected if chloride is assumed to be a donor dopant [Gerbig et al., Adv. Mater., 2013, 25, 3129]. Subsequently, it has been shown that the addition of lithium chloride, LiCl, to the battery electrolyte increases its discharge capacity, while this effect is not observed with other halogens [Matsuda et al., J. Phys. Chem. C, 2016, 120, 13360]. This fact was attributed to an increase in the conductivity of Cl-doped Li2O2, but still the responsible mechanism is not clear. In this work, we have performed first principle calculations to study the effect of the different halogens (F, Cl, Br, I) as substitutional defects on the electronic and transport properties of Li2O2. We have calculated the formation energies of the different defects and impurities and we analysed how they affect the activation barriers and diffusion coefficients. We have demonstrated that the chloride does not behave like a donor dopant, thus explaining the meager increase of the ionic conductivity experimentally observed, and neither does it promote polaron formation and mobility. We have also found that chloride does not present any special behaviour among the halogen series. Our results reveal that all the studied configurations associated with the halogen defects do not derive metallic states nor extra polarons that would increase considerably the electronic conductivity. This is mainly due to the ionic characteristics of the Li2O2 crystal and the capability of the oxygen dimers to adapt its valence rather than to the nature of the dopant itself.

Prevalencia del síndrome metabólico en consulta de medicina interna Hospital de San José de Bogotá DC. septiembre 2009 - marzo 2010 / Prevalence of metabolic syndrome in patients attending the internal medicine outpatient clinic hospital de San José, Bogotá DC. September 2009 - March 2010

El síndrome metabólico es un complejo de factores de riesgo predictores de enfermedad cardiovascular y diabetes. Objetivo: describir su prevalencia en pacientes de la consulta de medicina interna del Hospital de San José de Bogotá, teniendo en cuenta los criterios ATP III, IDF 2005 e IDF-AHA/ NHLBI 2009. Métodos: estudio descriptivo de corte transversal de pacientes entre 30 y 70 años, excluyendo las gestantes, entre septiembre 2009 y marzo 2010. Resultados: se seleccionaron 315 pacientes, 30,5% hombres, con edad media de 52.4 (DE 9.6) años. La obesidad abdominal (81,2%) y el sedentarismo (68,2%) fueron los factores de riesgo más frecuentes. El 48,6% tenía hipertensión arterial, 45,1% CHDL bajo, 44,4% hipertrigliceridemia, 13,2% tabaquismo y 13% diabetes mellitus. La prevalencia entre hombres y mujeres fue mayor empleando los criterios diagnósticos IDF-AHA/NHLBI 2009: 56,2% (IC 95%:46.1-66.3) y 57,5% (IC 95% 51-64.1); y menor con ATP III: 41,7% (IC 95% 31.6-51.7) y 45,6%.(IC 95%: 39-52.3). Fue más común el diagnóstico en mayores de 50 años. Conclusiones: la modificación de las definiciones del SM aumenta la prevalencia facilitando la detección temprana de factores de riesgo. Es mayor que la reportada por tratarse de población que asiste a control en un hospital de tercer nivel.

Metabolic syndrome is a combination of factors that increase the risk of developing cardiovascular disease and diabetes. Objective: to describe its prevalence in patients seen at the Internal Medicine outpatient clinic at Hospital de San José, Bogotá, considering the ATP III, IDF 2005 and IDF?AHA/ NHLBI 2009 criteria. Methods: a descriptive cross sectional study including patients between 30 and 70 years of age, excluding pregnant women was conducted between September 2009 and March 2010. Results: 315 patients were selected, 30.5% males, mean age 52.4 (SD 9.6) years. The most frequent risk factors were central obesity (81.2%) and sedentary lifestyle (68.2%). 48.6% had arterial hypertension, 45.1% reduced HDL cholesterol, 44.4% hypertriglyceridemia, 13.2% smoked and 13% had diabetes mellitus. The prevalence between men and women was greater using the IDF-AHA/NHLBI 2009 diagnostic criteria: 56.2% (IC 95%:46.1?66.3) and 57.5% (IC 95% 51?64.1); and lower using the ATP III criteria: 41.7% (IC 95% 31.6?51.7) and 45.6% (IC 95%: 39- 52.3). Diagnosis of MS was more frequent in those older than 50. Conclusions: the modification of MS definitions increases the prevalence thus facilitating the early detection of risk factors. Prevalence rate is greater than that reported, for this population attends follow-up visits at a third level hospital.