[Pheochromocytoma as a simulator of cardiac pathology]. / Feocromocitoma como simulador de patología cardiaca.

Pheochromocytomas are rare neuroendocrine tumors that can present as hypertensive crises or serious cardiac and cerebrovascular complications that endanger the patient's life. Two unusual cases of adrenergic crises induced by pheochromocytoma with cardiovascular manifestations are presented, one with multiple complications/multiorgan failure, fatal outcome and definitive diagnosis in the post mortem autopsy, and another with a satisfactory evolution after diagnosis and appropriate treatment.

Circumferential Inferior Vena Cavectomy Without Caval Replacement in the Management of Renal Cell Carcinoma with Tumor Thrombus.

PURPOSE OF REVIEW: Renal cell carcinoma presents a unique proclivity for vascular involvement giving rise to a peculiar form of locally advanced disease so-called tumor thrombus. To date, the only curative strategy for these cases remains surgery, which should aim to remove every vestige of macroscopic disease. Most of the preexisting literature advocates opening the vena cava to allow tumor thrombus removal and subsequent venous suture closure. However, inferior vena cava circumferential resection (cavectomy) without caval replacement is possible in the majority of cases since progressive occlusion facilitates the development of a collateral venous network aimed at maintaining cardiac preload. RECENT FINDINGS: Radical nephrectomy with tumor thrombectomy remains a surgical challenge not exempt of operative complications even in experienced hands. In opposition to what traditional cavotomy and thrombus withdrawal can offer, circumferential cavectomy without caval replacement would provide comparable or even better oncologic control, decrease the likelihood of operative bleeding, and prevent the development of perioperative pulmonary embolism. This review focuses on the rationale of circumferential IVC resection without caval replacement and the important technical aspects of this approach in cases of renal cell carcinoma with vascular involvement. We also include an initial report on the surgical outcomes of a contemporary series of patients managed under this approach at our center.

Effect of carbon source and metal toxicity for potential acid mine drainage (AMD) treatment with an anaerobic sludge using sulfate-reduction.

This study compares sulfate-reduction performance in an anaerobic sludge with different carbon sources (ethanol, acetate, and glucose). Also, the toxic effect of copper was evaluated to assess its feasibility for possible acid mine drainage (AMD) treatment. Serological bottles with 1.5 g VSS/L and 150 mL of basal medium (0.67 g COD/g SO42- at a 7-8 pH) were used to determine the percentage of electron equivalents, maximum specific methanogenic (SMA), and sulfide generation activities (SGA). The copper effect was evaluated in a previously activated sludge in batch bioassays containing different concentrations of copper (0-50 mg/L), 3 gVSS/L, and 150 mL of basal medium (0.67 g COD/g SO42-). Carbon source bioassays with glucose obtained the best results in terms of the SGA (1.73 ± 0.34 mg S2-/g VSS•d) and SMA (10.41 mg COD-CH4/g VSS•d). The electron flow in the presence of glucose also indicated that 21.29 ± 5.2% of the metabolic activity of the sludge was directed towards sulfidogenesis. Copper toxicity bioassays indicated that a considerable decline in metabolic activity occurs above 10 mg/L. The 20%IC, 50%IC, and 80%IC were 4.5, 14.94, and 35.31 mg Cu/L. Compared to the other carbon sources tested, glucose proved to be a suitable electron donor since it favors sulfidogenesis. Finally, copper concentrations above 15 mg/L inhibited metabolic activity in the toxicity bioassays.

Seropositivity and history of hospitalisation for dengue in relation to anthropometric indices among Colombian children and adults.

The role of anthropometric status on dengue is uncertain. We investigated the relations between anthropometric characteristics (height, body mass index and waist circumference (WC)) and two dengue outcomes, seropositivity and hospitalisation, in a cross-sectional study of 2038 children (aged 2-15 years) and 408 adults (aged 18-72 years) from Bucaramanga, Colombia. Anthropometric variables were standardised by age and sex in children. Seropositivity was determined through immunoglobulin G antibodies; past hospitalisation for dengue was self-reported. We modelled the prevalence of each outcome by levels of anthropometric exposures using generalised estimating equations with restricted cubic splines. In children, dengue seropositivity was 60.8%; 9.9% of seropositive children reported prior hospitalisation for dengue. WC was positively associated with seropositivity in girls (90th vs. 10th percentile adjusted prevalence ratio (APR) = 1.19; 95% confidence interval (CI) 1.03-1.36). Among adults, dengue seropositivity was 95.1%; 8.1% of seropositive adults reported past hospitalisation. Height was inversely associated with seropositivity (APR = 0.90; 95% CI 0.83-0.99) and with hospitalisation history (APR = 0.19; 95% CI 0.04-0.79). WC was inversely associated with seropositivity (APR = 0.89; 95% CI 0.81-0.98). We conclude that anthropometry correlates with a history of dengue, but could not determine causation. Prospective studies are warranted to enhance causal inference on these questions.

Discrimination of residents during neurosurgical training in Mexico: Results of a survey prior to SARS-CoV-2.

BACKGROUND: Recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an important negative impact on global training of neurosurgery residents. Even before the pandemic, discrimination is a challenge that neurosurgical residents have consistently faced. In the present study, we evaluated discriminatory conditions experienced by residents during their neurosurgical training in Mexico before the SARS-CoV-2 pandemic. METHODS: An electronic survey of 18 questions was sent among residents registered in the Mexican Society of Neurological Surgery (MSNS), between October 2019 and July 2020. Statistical analysis was made in IBM SPSS Statistics 25. The survey focused on demographic characteristics, discrimination, personal satisfaction, and expectations of residents. RESULTS: A response rate of 50% (132 of 264 residents' members of MSNS) was obtained and considered for analysis. Median age was 30.06 ± 2.48 years, 5.3% (n = 7) were female and 16.7% (n = 22) were foreigners undergoing neurosurgical training in Mexico. Approximately 27% of respondents suffered any form of discrimination, mainly by place of origin (9.1%), by gender (8.3%) or by physical appearance (6.1%). About 42.9% (n = 3) of female residents were discriminated by gender versus 6.4% (n = 8) of male residents (P = 0.001); while foreign residents mentioned having suffered 10 times more an event of discrimination by place of origin compared to native Mexican residents (36.4% vs. 3.6%, P < 0.001). CONCLUSION: This manuscript represents the first approximation to determine the impact of discrimination suffered by residents undergoing neurosurgical training in Mexico before the SARS-CoV-2 pandemic.

Clinical anatomy of the meniscus in animal models: pros and cons.

Nowadays, despite the possibility to use in vitro or computer models in research, animal models are still essential. Different animal models are available for meniscal repair investigation. Although a unique perfect model for the structure of the human's knee does not exist, the choice of the proper animal model is crucial for a correct research. The principal animal models in the meniscal repair are sheep, goats, pigs and dogs. Each of these has pros and cons for their utilization. Analysing each pro and con is essential for optimizing the choice of the animal model, which depends on the experimental question, avoiding unnecessary waste of resources and minimizing the animal suffering, according to the Russell and Burch's three "Rs" principles (Reduce, Refine and Recycle). In this concise review, we resume the meniscus anatomical features of the main large animals, to help choose the most suitable animal model for subsequent studies on meniscal repair.

Caracterización de materiales (pigmentos y cerámicas) para la conservación del patrimonio cultural y social en ciudad de La Habana / Characterization of materials (pigments and ceramics) for the conservation of cultural and social heritage in the city of Havana

RESUMEN Una de las direcciones de aplicación de la Ciencia de Materiales que realiza el Centro de Aplicaciones Tecnológicas y Desarrollo Nuclear CEADEN es el apoyo mediante un grupo de técnicas físicas a la restauración y el mantenimiento de estructuras y objetos de la ciudad de La Habana, entre otras localidades de Cuba, que poseen interés artístico y social . En el presente trabajo se abordan varias aplicaciones en la caracterización de materiales para contribuir a las actividades de conservación del patrimonio cultural e histórico cubano que se encuentra en La Habana. Se presentan dos ejemplos de análisis por las técnicas de Fluorescencia de Rayos X y Difracción de rayos X de los pigmentos de obras en lienzos y de la paleta de una reconocida artista de la plástica cubana; así como el de tejas cerámicas que fueron utilizadas en la restauración de los techos de la residencia conocida como Casa Verde de 5ta Avenida en el Municipio Playa.

ABSTRACT One of the applications in Materials Science carried out at the Center for Technological Applications and Nuclear Development (CEADEN) is the technical support through several methods used, based on applied Physics for the restoration and maintenance of structures and objects holding artistic and social relevance in Havana city. The aim of this paper is to present two examples of X -ray Fluorescence and Diffraction materials characterization, intended to support conservation and restoration activities of the Cuban cultural and historic heritage: analyzed objects were pottery roof tiles for the restoration of the mansion known as The Green House at 5th Avenue, Miramar, as well as pigments from a Cuban fine artist's canvas and palette.

Contribución a la restauración y el mantenimiento de obras de importancia histórica, cultural y social de la ciudad de La Habana / Contribution to the restoration and maintenance of works of historical, cultural and social importance of the city of Havana

RESUMEN Entre las aplicaciones de la Ciencia e Ingeniería de Materiales que realiza el Centro de Aplicaciones Tecnológicas y Desarrollo Nuclear CEADEN está el apoyo mediante varias técnicas físicas a la restauración y el mantenimiento de estructuras y objetos de la ciudad de La Habana que poseen interés histórico, cultural y social . En el presente trabajo es abordado el campo de la Defectoscopía, en lo cual los Ensayos no destructivos aplicados tributaron a la restauración del patrimonio cultural, a la mejora de instalaciones deportivas de la capital y, en mayor medida, a la seguridad de instalaciones de interés social como son los parques de diversión. En ese sentido se presentan la inspección de estructuras en el marco de la restauración de la Sala Cabildo del Museo de la Ciudad de La Habana en el Palacio de los Capitanes Generales en La Habana Vieja; el diagnóstico de uniones soldadas durante la restauración de la iluminación y la instalación de la pantalla gigante del Estadio Latinoamericano del Cerro y la Inspección realizada sistemáticamente en mantenimiento a elementos críticos de equipos de los parques de diversión.

ABSTRACT Among the applications of Materials Science and Engineering carried out by the Center for Technological Applications and Nuclear Development (CEADEN) / Centro de Aplicaciones Tecnológicas y Desarrollo Nuclear CEADEN is the use of various physical techniques to support the restoration and maintenance of buildings and other work objects of historical, cultural and social interest in Havana city. The field of Defectoscopy is addressed in this paper, where the applied Nondestructive testings also contributed to restore the cultural heritage, to upgrade the structural conditions at an important sport facility in Havana, and in a greater extent, to the safety of facilities of social significance, such as amusement parks. In this regard, three examples are presented: the inspection of structures during the restoration of the City Hall in the Museum of the Havana City at the Palace of Captains General; the welded joints testing during the restoration of the lighting system and the installation of the digital screen at the Latin American Stadium in Cerro municipality; and finally, the inspection systematically performed at maintenance works to critical elements and related devices at amusement parks.

Staphylococcus aureus intra-mammary infection affects the expression pattern of IL-R8 in goat.

IL-1R8 is a member of Interleukin-1 receptor family acting as a negative regulator of inflammation reliant on ILRs and TLRs activation. IL-1R8 role has never been evaluated in acute bacterial mastitis. We first investigated IL-1R8 sequence conservation among different species and its pattern of expression in a wide panel of organs from healthy goats. Then, modulation of IL-1R8 during natural and experimental mammary infection was evaluated and compared in blood, milk and mammary tissues from healthy and Staphylococcus aureus infected goats. IL-1R8 has a highly conserved sequence among vertebrates. Goat IL-1R8 was ubiquitously expressed in epithelial and lymphoid tissues with highest levels in pancreas. IL-1R8 was down-regulated in epithelial mammary cells following S. aureus infection. Interestingly it was up-regulated in leukocytes infiltrating the infected mammary tissues suggesting that it could represent a target of S. aureus immune evasion.

Vitamin D serostatus and dengue fever progression to dengue hemorrhagic fever/dengue shock syndrome.

Vitamin D could modulate pathways leading to dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). We examined the associations of serum total 25-hydroxy vitamin D [25(OH)D] and vitamin D binding protein (VDBP) concentrations in patients with uncomplicated dengue fever (DF) with risk of progression to DHF/DSS. In a case-control study nested in a cohort of DF patients who were followed during the acute episode in Bucaramanga, Colombia, we compared 25(OH)D and VDBP at onset of fever between 110 cases who progressed to DHF/DSS and 235 DF controls who did not progress. 25(OH)D concentrations were also compared between the acute sample and a sample collected >1 year post-convalescence in a subgroup. Compared with 25(OH)D ⩾75 nmol/l, adjusted odds ratios (95% CI) for progression were 0·44 (0·22-0·88) and 0·13 (0·02-1·05) for 50 to 75 nmol/l (vitamin D insufficiency) and <50 nmol/l (vitamin D deficiency), respectively (P, trend = 0·003). Mean 25(OH)D concentrations were much lower post-convalescence compared with the acute episode, regardless of case status. Compared with controls, mean VDBP was non-significantly lower in cases. We conclude that low serum 25(OH)D concentrations in DF patients predict decreased odds of progression to DHF/DSS.

Assessment of treatment patterns associated with injectable disease-modifying therapy among relapsing-remitting multiple sclerosis patients.

BACKGROUND: Availability of oral disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS) may affect injectable DMT (iDMT) treatment patterns. OBJECTIVE: The objective of this paper is to evaluate iDMT persistency, reasons for persistency lapses, and outcomes among newly diagnosed RRMS patients. METHODS: Medical records of 300 RRMS patients initiated on iDMT between 2008 and 2013 were abstracted from 18 US-based neurology clinics. Eligible patients had ≥3 visits: pre-iDMT initiation, iDMT initiation (index), and ≥1 visit within 24 months post-index. MS-related symptoms, relapses, iDMT treatment patterns (i.e. persistency, discontinuation, switching, and restart), and reasons for non-persistency were tracked for 24 months. RESULTS: At 24 months, iDMT persistency was 61.0%; 28.0% of patients switched to another DMT, 8.0% discontinued, and 3.0% stopped and restarted the same iDMT. The most commonly identified reasons for non-persistency were perceived lack of efficacy (22.2%), adverse events (18.8%), and fear of needles/self-injecting (9.4%). At 24 months, 38.0% of patients had experienced a relapse and 11.0% had changes in MRI lesion counts. Patients without MS-related symptoms at index reported increases in the incidence of these symptoms at 24 months. CONCLUSIONS: Non-persistency with iDMT remains an issue in the oral DMT age. Many patients still experienced relapses and disease progression, and should consider switching to more effective therapies.

Efecto inmediato de la crioterapia sobre la excitabilidad refleja en personas con espasticidad post-ECV / Immediate effect of cryotherapy on the spastic reflex excitability in people with spasticity post-stroke

Introducción: Existe controversia sobre los efectos terapéuticos de la crioterapia en el músculo espástico y las implicaciones clínicas que fundamentan su uso como coadyuvante en el proceso de rehabilitación. Objetivo: Evaluar el efecto inmediato de la aplicación del paquete de hielo sobre la excitabilidad refleja en la musculatura plantiflexora espástica en personas post-ECV. Métodolos: Estudio experimental de mediciones repetidas con asignación aleatoria a dos grupos de intervención: Grupo Experimental (n=10) y Grupo Control (n=5). Se registró latencia (ms), duración (ms) y amplitud (mV) de las ondas M y H y el índice de amplitud Hmáximo/Mmáximo (%) antes y después de la crioterapia o reposo. Los participantes fueron quince individuos de ambos géneros con hemiparesia espástica post-ECV, edad media de 60,7±10,7años, mediana tiempo de evolución 36 meses (RIC17-49). No hubo diferencias significativas en las características basales entre los grupos de intervención. Resultados: La crioterapia induce un aumento estadísticamente significativo en la latencia de la onda H (32,9±3,3 vs. 34,9±3,6ms, p<0,001) y M (8,0±1,9 vs. 9,4±2,4ms, p<0,05) y en la duración de la onda M (6,3±1,3 vs. 9,8±2,2ms, p<0,001) y H (7,2±1,6 vs. 9,9± 2,0ms, p<0,001). No se determinaron cambios significativos en la amplitud, ni en el índice Hmáx/Mmáx. Conclusiones: Nuestros hallazgos sugieren que el enfriamiento puede ser útil para el tratamiento de la espasticidad, pues retrasa la respuesta muscular evocada por estimulación eléctrica directa y refleja. A su vez, prolonga el período refractario del potencial de acción, por lo cual se requeriría más tiempo para activar las fibras musculares.

Introduction: There is controversy about the therapeutic effects of cryotherapy on spasticity and clinical implications underlying its use as an adjunct in the rehabilitation process. Objective: To evaluate the immediate effect of the application of ice pack on the H-reflex excitability in spastic muscles post-stroke people. Methods: A randomized experimental study of repeated measurements, with two intervention groups, was performed: Experimental group (n=10) and control group (n=5). Latency (ms) duration (ms) and amplitude (mV) of M and H waves and the amplitude index Hmáximo / Mmáximo (%) were recorded before and after cryotherapy or rest. The participants were fifteen subjects with spastic hemiparesis post-stroke were screened, mean age 60.7±10.7 years, median of injury duration 36 months (IQR17-49). There were no significant differences in baseline characteristics between the intervention groups. Results: Cryotherapy induces a statistically significant increase in the H wave latency (32.9±3.3 vs. 34.9± 3.6ms, p<0,001) and M wave (8.0±1.9 vs. 2.4ms±9.4, p<0.05); as well as, increase was observed in the duration of the M wave (6.3±1.3 vs. 9.8±2.2ms, p<0.001) and H (7.2±1.6 vs. 9.9±2.0ms, p<0.001). No significant changes in the amplitude or the Hmax/Mmax ratio were determined. There were no differences between the H-reflex or the M-wave variables recorded before and after in the control group. Conclusions: Our findings suggest that cooling may be useful for the treatment of spasticity, due to it delays muscle response evoked by direct and reflects electrical stimulation. Simultaneously, cooling prolongs the refractory period of the action potential, whereby more time is required to activate the muscle fibers.

Indicadores de calidad de Cuidados Intensivos Pediátricos en España (estudio QuaCIP) / Indicators of the quality of Pediatric Intensive Care in Spain (QuaCIP Study)

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Estado nutricional y funcionalidad en adultos mayores hospitalizados en unidad geriátrica de agudos del Hospital Naval Almirante Nef / Nutritional status and functionality in elderly hospitalized in an Acute Geriatric Unit of Hospital Naval Almirante Nef

Introducción: La desnutrición y la alteración en la funcionalidad son altamente prevalentes en adultos mayores hospitalizados y se asocia a resultados adversos. El objetivo principal de este trabajo fue evaluar la relación existente entre el estado nutricional y funcionalidad en adultos mayores hospitalizados en Unidad Geriátrica de Agudos (UGA) del Hospital Naval Almirante Nef. Pacientes y Métodos: Estudio descriptivo de corte transversal, que incluyó a adultos mayores (AM) hospitalizados en UGA entre 01 de Marzo 2014 y 01 de Mayo 2015. A los pacientes se les realizó valoración geriátrica integral y valoración nutricional con MNA SF y test para evaluar la presencia de anorexia. Se analizaron los datos con software STATA 10. Para evaluar significancia estadística se ocuparon las pruebas Chi2 y de Kruskal Wallis. Resultados: 97 pacientes ingresados, 1 excluido. Promedio de edad de 84,1 años, 52% mujeres. Índice de Barthel promedio de 74,02 puntos. Prevalencia de desnutrición de 20,83%. La asociación entre un peor estado nutricional y peor funcionalidad en ABVD resultó estadísticamente significativa (p: 0,005). Discusión: Aquellos pacientes que ingresaron a UGA con peor estado nutricional presentaban peor funcionalidad basal en las ABVD. La relación entre estado nutricional y funcionalidad es compleja y probablemente bidireccional. Conclusión: La alta prevalencia de desnutrición en AM recientemente hospitalizados se acompaña de peor funcionalidad basal en actividades básicas de la vida diaria.

Background: Malnutrition and functional impairment are highly prevalent in the hospitalized elderly and can lead to unfavorable outcomes. The purpose of this study was evaluate if there is a relation between nutritional status and functionality in elderly patients hospitalized in the Acute Geriatric Unit (AGU) of Hospital Naval Almirante Nef, Viña del Mar. Patients: Cross-sectional descriptive study wich included elderly patients hospitalized in the AGU between March 1, 2014 and May 1, 2015. Patients underwent a comprehensive geriatric assessment and nutritional assessment with MNA Short Form and an anorexy test. Data were analyzed with STATA 10 software. Chi2 and Kruskal Wallis tests were used to assess statistical significance. Results: A total of 97 patients, 1 excluded. Average age of 84,1 years, 52% female. Barthel index averaged 74,02 points. The prevalence of malnutrition was 20,83%. The association between poorer nutritional status and poorer functioning in basic activities of daily living was statistically significant (p: 0.005). Conclusions: Those patients who entered AGU with worse nutritional status presented worse baseline functionality in basic activities of daily living. The relationship between nutritional status and functionality is complex and probably bidirectional. The high prevalence of malnutrition in recently hospitalized elderly is accompanied by poorer baseline functionality in basic activities of daily living.

Hábitos alimentarios y condición física en estudiantes de pedagogía en educación física / Eating habits and physical condition of physical education students

Objective: To determinate dietary habits and physical condition of physical activity students from the Autonomous University of Chile, Temuco, relating these to their fitness level. Methods: An observational cross-sectional study was conducted among 239 students (76.5 % males). Assessment included a food questionnaire, anthropometric measurements and physical condition. Results: In a sample of 239 students, 35.6% of them were overweight or obese as well as having unhealthy dietary habits independent of the academic year at university. Only 4.7 % of the students used the national recommendations for fruit intake and only 30% ate breakfast daily. In men weight, waist circumference and BMI were negatively associated with the Nvette Course test (R = -0.203, R= -0.249 and R= -0.196, p<0.01 respectively). Conclusion: Physical activity education students have poor dietary habits throughout the university academic years while their fitness decreases irregularly as studies progress. This is a major concern since they will become healthy life style role models for their future students.

Objetivo: Determinar los hábitos alimentarios y condición física de los estudiantes de pedagogía en educación física de la Universidad Autónoma de Chile, sede Temuco y relacionarlos con el nivel de condición física. Sujetos y métodos: Estudio transversal observacional, se evaluaron 239 estudiantes de educación física, de los cuales 76,5% eran hombres, aplicándoles una encuesta alimentaria, antropometría y evaluación de la condición física. Resultados: El 35,6% de los estudiantes presentaba sobrepeso/obesidad, además tenían malos hábitos alimentarios independientes del año de ingreso. Sólo 4,7% consumía las recomendaciones de frutas y 30% tomaba desayuno todos los días. En hombres el peso, la circunferencia de la cintura e IMC correlacionan negativamente con la prueba de Course navette (R=-0,203; R=-0,249; R=-0,196, p<0,01 respectivamente). Conclusión: Los estudiantes universitarios presentan malos hábitos alimentarios durante toda la carrera universitaria, mientras que su condición física disminuye de manera irregular a medida que avanzan los estudios, situación preocupante ya que ellos se transformaran en modelos de estilos de vida saludable especialmente a nivel escolar.

Providing patients with pharmacogenetic test results affects adherence to statin therapy: results of the Additional KIF6 Risk Offers Better Adherence to Statins (AKROBATS) trial.

Despite the clinical benefit of statin therapy and the numerous strategies used to improve adherence, no strategy has used direct communication of genetic test results to the patient as an adherence and persistence motivator. We investigated in a real-world setting the effect of a process of providing KIF6 test results and risk information directly to 647 tested patients on 6-month statin adherence (proportion of days covered (PDC)) and persistence compared with concurrent non-tested matched controls. Adjusted 6-month statin PDC was significantly greater in tested patients: 0.77 (95% confidence interval (CI) 0.72-0.82) vs controls 0.68 (95% CI 0.63-0.73), P<0.0001. Significantly more tested patients were adherent (PDC⩾0.80) (63.4% (59.6-67.1%) vs 45.0% (41.1-48.8%), P<0.0001) and persisted on therapy (69.1% (65.4-72.5%) vs 53.3% (49.4-57.1%), P<0.0001). Similar results were observed in a secondary comparison with 779 unmatched patients who declined testing. The Additional KIF6 Risk Offers Better Adherence to Statins trial provides the first evidence that pharmacogenetic testing may modify patient adherence.