Attending pediatric acutely ill patients at home: families' socioeconomic characterization, expectations, and experiences.

BACKGROUND: SJD a Casa is an acute pediatric hospital-at-home program that was initiated in 2019. For a thorough understanding of acute pediatric homecare programs, an analysis of all related factors, including the medical, social, and economic aspects as well as the family's experience, is essential. However, no previous study has attempted a comprehensive evaluation of this topic in relation to a complex program such as ours (in terms of the diseases and treatments offered). In this study, we aimed to finely characterize the population that opts for pediatric homecare programs and obtain a thorough understanding of the families' needs, which will improve our understanding of the program and potentially reveal possible deficiencies. METHODS: This prospective quantitative and qualitative study involved collection of ordinal data as well as statements made by the caregivers of patients undergoing homecare. A total of 372/532 families were asked to answer two independent questionnaires (preadmission and postadmission) that evaluated their socioeconomic characteristics; expectations and experiences; and factors influencing the preference for homecare. The results were presented as frequencies and comparisons (Fisher's exact test). RESULTS: The families had an adequate social network and a less-than-expected workload, and most families responded that they would have repeated the experience despite the workload. The expectations regarding the caregiver's well-being at home were better than the actual situation, since some caregivers experienced anxiety or fear. The rating for homecare was better than that for the inpatient care offered before the homecare transfer. CONCLUSIONS: Families included in the program were content with the homecare program and mostly responded that they would repeat the experience if needed. Although the duration of the program was short-term, some caregivers may experience symptoms of burnout like anxiety, which should be taken into consideration. Despite its limitations, this study offers the possibility of improving our service portfolio by focusing on vulnerable families' access to the program and the caregiver's risk of burnout.

An engineered SARS-CoV-2 receptor-binding domain produced in Pichia pastoris as a candidate vaccine antigen.

Developing affordable and easily manufactured SARS-CoV-2 vaccines will be essential to achieve worldwide vaccine coverage and long-term control of the COVID-19 pandemic. Here the development is reported of a vaccine based on the SARS-CoV-2 receptor-binding domain (RBD), produced in the yeast Pichia pastoris. The RBD was modified by adding flexible N- and C-terminal amino acid extensions that modulate protein/protein interactions and facilitate protein purification. A fed-batch methanol fermentation with a yeast extract-based culture medium in a 50 L fermenter and an immobilized metal ion affinity chromatography-based downstream purification process yielded 30-40 mg/L of RBD. Correct folding of the purified protein was demonstrated by mass spectrometry, circular dichroism, and determinations of binding affinity to the angiotensin-converting enzyme 2 (ACE2) receptor. The RBD antigen also exhibited high reactivity with sera from convalescent individuals and Pfizer-BioNTech or Sputnik V vaccinees. Immunization of mice and non-human primates with 50 µg of the recombinant RBD adjuvanted with alum induced high levels of binding antibodies as assessed by ELISA with RBD produced in HEK293T cells, and which inhibited RBD binding to ACE2 and neutralized infection of VeroE6 cells by SARS-CoV-2. Additionally, the RBD protein stimulated IFNγ, IL-2, IL-6, IL-4 and TNFα secretion in splenocytes and lung CD3+-enriched cells of immunized mice. The data suggest that the RBD recombinant protein produced in yeast P. pastoris is suitable as a vaccine candidate against COVID-19.

Potential Development of Vitrified Immature Human Oocytes: Influence of the Culture Medium and the Timing of Vitrification.

How does the in vitro maturation (IVM) medium and the vitrification procedure affect the survival of germinal vesicle (GV) oocytes obtained from stimulated cycles and their development to the blastocyst stage? In total, 1085 GV human oocytes were obtained after women underwent a cycle of controlled ovarian stimulation, and these oocytes were subjected to IVM before or after their vitrification. IVM was carried out in two commercial culture media not specifically designed for maturation. MII oocytes were then activated and embryo development until day 6 was evaluated. According to the results, a higher percentage of oocytes reach the MII stage if they are vitrified before they undergo IVM. Nevertheless, the medium used and the sample size determine whether these differences become significant or not. Similar survival rates and development to blastocysts were observed in all the conditions studied.

Anakinra versus Baricitinib: Different Strategies for Patients Hospitalized with COVID-19.

BACKGROUND: Immunomodulatory drugs have been used in patients with severe COVID-19. The objective of this study was to evaluate the effects of two different strategies, based either on an interleukin-1 inhibitor, anakinra, or on a JAK inhibitor, such as baricitinib, on the survival of patients hospitalized with COVID-19 pneumonia. METHODS: Individuals admitted to two hospitals because of COVID-19 were included if they fulfilled the clinical, radiological, and laboratory criteria for moderate-to-severe disease. Patients were classified according to the first immunomodulatory drug prescribed: anakinra or baricitinib. All subjects were concomitantly treated with corticosteroids, in addition to standard care. The main outcomes were the need for invasive mechanical ventilation (IMV) and in-hospital death. Statistical analysis included propensity score matching and Cox regression model. RESULTS: The study subjects included 125 and 217 individuals in the anakinra and baricitinib groups, respectively. IMV was required in 13 (10.4%) and 10 (4.6%) patients, respectively (p = 0.039). During this period, 22 (17.6%) and 36 (16.6%) individuals died in both groups (p = 0.811). Older age, low functional status, high comorbidity, need for IMV, elevated lactate dehydrogenase, and use of a high flow of oxygen at initially were found to be associated with worse clinical outcomes. No differences according to the immunomodulatory therapy used were observed. For most of the deceased individuals, early interruption of anakinra or baricitinib had occurred at the time of their admission to the intensive care unit. CONCLUSIONS: Similar mortality is observed in patients treated with anakinra or baricitinib plus corticosteroids.

Impact of Maturation and Vitrification Time of Human GV Oocytes on the Metaphase Plate Configuration.

The combination of in vitro maturation (IVM) techniques and oocyte vitrification (OV) could increase the number of useful oocytes in different types of patients. IVM and subsequent OV is the most widely used clinical strategy. Would the results improve if we reverse the order of the techniques? Here, we evaluated survival, in vitro maturation, time to extrude the first polar body (PB), and the metaphase plate configuration of human prophase I (GV) oocytes before or after their vitrification. Specific, 195 GV oocytes from 104 patients subjected to controlled ovarian stimulation cycles were included. We stablished three experimental groups: GV oocytes vitrified and IVM (Group GV-Vit), GV oocytes IVM and vitrified at MII stage (Group MII-Vit), and GV oocytes IVM (Group not-Vit). All of them were in vitro matured for a maximum of 48 h and fixed to study the metaphase plate by confocal microscopy. According to our results, the vitrification of immature oocytes and their subsequent maturation presented similar survival, maturation, and metaphase plate conformation rates, but a significantly higher percentage of normal spindle than the standard strategy. Additionally, the extension of IVM time to 48 h did not seem to negatively affect the oocyte metaphase plate configuration.

Xantogranuloma necrobiótico asociado a gammapatía monoclonal IgG kappa de significado incierto / Necrobiotic xanthogranuloma associated with monoclonal gammopathy of unknown significance

No disponible

Species undersampling in tropical bat surveys: effects on emerging biodiversity patterns.

Undersampling is commonplace in biodiversity surveys of species-rich tropical assemblages in which rare taxa abound, with possible repercussions for our ability to implement surveys and monitoring programmes in a cost-effective way. We investigated the consequences of information loss due to species undersampling (missing subsets of species from the full species pool) in tropical bat surveys for the emerging patterns of species richness (SR) and compositional variation across sites. For 27 bat assemblage data sets from across the tropics, we used correlations between original data sets and subsets with different numbers of species deleted either at random, or according to their rarity in the assemblage, to assess to what extent patterns in SR and composition in data subsets are congruent with those in the initial data set. We then examined to what degree high sample representativeness (r ≥ 0·8) was influenced by biogeographic region, sampling method, sampling effort or structural assemblage characteristics. For SR, correlations between random subsets and original data sets were strong (r ≥ 0·8) with moderate (ca. 20%) species loss. Bias associated with information loss was greater for species composition; on average ca. 90% of species in random subsets had to be retained to adequately capture among-site variation. For nonrandom subsets, removing only the rarest species (on average c. 10% of the full data set) yielded strong correlations (r > 0·95) for both SR and composition. Eliminating greater proportions of rare species resulted in weaker correlations and large variation in the magnitude of observed correlations among data sets. Species subsets that comprised ca. 85% of the original set can be considered reliable surrogates, capable of adequately revealing patterns of SR and temporal or spatial turnover in many tropical bat assemblages. Our analyses thus demonstrate the potential as well as limitations for reducing survey effort and streamlining sampling protocols, and consequently for increasing the cost-effectiveness in tropical bat surveys or monitoring programmes. The dependence of the performance of species subsets on structural assemblage characteristics (total assemblage abundance, proportion of rare species), however, underscores the importance of adaptive monitoring schemes and of establishing surrogate performance on a site by site basis based on pilot surveys.

Prevalence of mental disorders in children and adolescents from a Spanish slum.

This paper reports rates of psychopathology in a population of 9- and 13-yr olds from a Spanish slum. Two cohorts of all the children born in 1989 and in 1993 and registered in the census of a municipality in 2001 were assessed over a 3-yr period with structured diagnostic interviews and functional measures. In the first year of the study 79 (53.7%) children of the adolescent 13-yr-old population and 72 (59.5%) of the pre-adolescent 9-yr-old population participated. Between 30% and 60% of preadolescents and between 30% and 50% of adolescents presented some mental disorder. Anxiety and disruptive behavior disorders were the most frequent disorders in both cohorts. For both genders, the highest risk for any psychopathology was at 10 yr. We found that, psychopathology and functional impairment decreased with age, and that the psychopathology of children in a peripheral slum of a big city is 3 times higher than the median of the general population. This information should be useful for administrators providing services for children from the most disadvantaged segment of the population.

Tratamiento mínimamente invasivo de la neoplasia oclusiva del colon izquierdo: prótesis endoluminal autoexpandible y colectomía laparoscópica. Resultados preliminares / Minimally invasive treatment of malignant obstruction of the left colon: self-expandable endoluminal stent and laparoscopic colectomy. Preliminary results

Introducción. El tratamiento de la oclusión por cáncer más ampliamente utilizado consiste en la resección del segmento cólico y la realización de una colostomía terminal (operación de Hartmann). Las alternativas técnicas para evitar la realización de un estoma son la colectomía subtotal o colectomía segmentaria con lavado intraoperatorio pero, aunque existen muchos argumentos a favor de la cirugía en un tiempo, ésta es posible en menos del 70 por ciento de los casos. Otra opción técnica a esta intervención consiste en la colocación de una endoprótesis autoexpandible, con finalidad paliativa definitiva, o como paso previo a la colectomía electiva convencional. Ello permite obviar la realización de una colostomía. Por otra parte, la posibilidad de efectuar la colectomía laparoscópica permite asociar un abordaje mínimamente invasivo, con las consecuentes ventajas de bienestar para el paciente. Pacientes y método. De la base de datos prospectiva de 250 pacientes con patología colorrectal intervenidos por laparoscopia en nuestro servicio, hemos revisado los resultados obtenidos en los 5 pacientes a los que previamente se les había colocado una endoprótesis para solucionar una obstrucción completa por cáncer de colon izquierdo. Se han recogido los datos demográficos, las características del tumor, los datos referentes a la colocación de la endoprótesis y a la cirugía laparoscópica, así como la evolución postoperatoria. Resultados. Las lesiones se localizaron en el rectosigma (un caso), en el sigma (2 casos) y en el colon descendente (2 casos). La endoprótesis solucionó el cuadro oclusivo en los 5 pacientes con tolerancia a la dieta oral a las 24 h de su colocación. Un paciente presentó un episodio de rectorragia leve que se autolimitó sin necesidad de transfusión. Los 5 pacientes fueron intervenidos a los 8 días (rango, 6-14 días) tras la colocación de la prótesis. En un paciente fue necesaria la conversión a cirugía abierta y en otro a cirugía laparoscópica asistida con la mano. La causa de conversión en ningún caso se debió a dificultades relacionadas con la endoprótesis. Conclusiones. Los resultados preliminares de la combinación stent-cirugía electiva refuerzan las ventajas de esta opción, especialmente si se lleva a cabo la utilización secuencial de dos técnicas mínimamente invasivas (stent y colectomía laparoscópica), que permite obviar la necesidad de un estoma y ofrece las ventajas clínicas del abordaje laparoscópico (AU)

Tratamiento laparoscópico de la intususcepcióndel intestino delgado en el adulto / Laparoscopic treatment of small intestine intussusception in adults

Intususcepción e invaginación son los términos que se utilizan para describir la introducción en forma telescópica espontánea de una porción del intestino en otra asa intestinal. Su incidencia es más frecuente en niños, y en adultos representa el 1-5 por ciento de las oclusiones intestinales. El diagnóstico de intususcepción en adultos es difícil, y la intervención quirúrgica es necesaria en todos los casos. Hasta en el 90 por ciento de los casos dentro de la invaginación se encuentra una lesión orgánica. El abordaje laparoscópico ofrece una opción diagnóstica y terapéutica. Objetivo. Se presentan 2 casos de intususcepción en el adulto tratados de forma satisfactoria por vía laparoscópica. Caso 1: varón de 51 años que ingresa por presentar melenas, en el que la enteroscopia evidencia un tumor ulcerado en el yeyuno. Se interviene por laparoscopia, observando el intestino delgado invaginado en la zona del tumor. El diagnóstico es de tumor del estroma gastrointestinal con bajo riesgo de malignidad. Caso 2: mujer de 72 años, que ingresa por suboclusión intestinal. Mediante tomografía axial computarizada se evidencia una masa pélvica en relación con un asa intestinal, compatible con invaginación de la masa en un asa ileal. Se efectúa la resección del tumor invaginado por laparoscopia, que corresponde a un tumor de estirpe mesenquimal y con bajo grado nuclear. Conclusión. El abordaje laparoscópico puede ser de utilidad con finalidad diagnóstica o terapéutica en la intususcepción del adulto (AU)

Cirugía laparoscópica y situs inversus.Revisión de la literatura y presentación de uncaso de sigmoidectomía por diverticulitis / Laparoscopic surgery and situs inversus. Review of the literature and presentation of a case of sigmoidectomy due to diverticulitis

El situs inversus es un defecto congénito de herencia autosómica recesiva, poco frecuente, que se caracteriza por la localización de los órganos abdominales o torácicos en el lado opuesto, en sentido sagital. En el 25 por ciento de los casos se presenta formando parte del síndrome de Kartagener, caracterizado por la presencia de situs inversus, bronquiectasias y sinusitis de repetición. Presentamos el caso de una paciente con síndrome de Kartagener y situs inversus completo que desarrolló una diverticulitis aguda recidivante y a la que se le realizó una sigmoidectomía laparoscópica. En la revisión de la literatura se encuentra otro único caso de sigmoidectomía por laparoscopia en pacientes con situs inversus, así como 27 casos intervenidos por otras enfermedades, que incluyen técnicas laparoscópicas tanto básicas (laparoscopia exploradora, colecistectomía) como avanzadas (gastrectomía y bypass gástrico).El abordaje laparoscópico es factible en casos de situs inversus, a pesar del incremento en la dificultad técnica que significa la disposición anatómica visceral especular (AU)

Laparoscopic treatment for intussusception of the small intestine in the adult.

The term intussusception refers to a spontaneous invagination of a portion of the intestine into another bowel loop. Its incidence is higher in children, but in adults it causes 1% to 5% of intestinal obstructions. The diagnosis of intussusception in the adult is difficult due to the variability of the symptoms. The condition may be chronic, intermittent, or acute. Surgical intervention is necessary in all cases and in up to 90% of cases an organic lesion inside the invaginated part of the bowel is found to be the lead point. The laparoscopic approach offers both a diagnostic and therapeutic option. Laparoscopy may be used as the final diagnostic or therapeutic tool for intussusception in the adult.

Etiología bacteriana y parasitaria de las enfermedades diarreicas agudas: estudio de 192 pacientes / Bacterial and parasitic etiology of acute diarrheal diseases: study of 192 pacientes

Se estudiaron 192 pacientes menores de 3 años, procedentes de los municipios de la Ciudad de La Habana y de provincia La Habana, los cuales egresaron del Servicio de Enfermedades Diarreicas Agudas del Hospital Pediátrico Docente "Centro Habana", en el período de octubre a diciembre de 1986. El 46,8

de los pacientes lo constituían menores de 6 meses y de ellos el 16,1 tenían menos de 3 meses de edad. La positividad de bacterias y parásitos fue de 73,4

de los cuales el 40,6

estaba representado por parásitos y el 32,8

por bacterias. El parásito que se identificó más comúnmente fue la Entamoeba histolytica con el 20,5

. La positividad por Giardia lamblia en heces fue muy baja (3,1

), lo cual contrasta con 58 pacientes en los que no obstante ser negativas sus heces, se aisló Giardia lamblia por intubación duodenal en el 51,7

. Los agentes bacterianos identificados en los coprocultivos fueron ECEP, 12,7

; ECEI, 1,6

; Salmonella, 34,9

; Shigella, 28,6

; Campylobacter fetus jejuni, 11,1

y Plesiomona shigelloide, 4,8

. En el 28,4

de los pacientes estudiados se constató la asociación de bacterias con parásitos y con otras bacterias. Se destaca la asociación de E.histolytica a Shigella en el 40

y a Salmonella en el 10

. Se realiza comparación con la literatura médica mundial y se destaca la importancia de no confundir los quistes de Entamoeba histolytica con los leucocitos polimorfonucleares, levaduras o Blastocystis hominis que con frecuencia se observan en los resultados de las heces. (AU)

Etiología bacteriana y parasitaria de las enfermedades diarreicas agudas: estudio de 192 pacientes / Bacterial and parasitic etiology of acute diarrheal diseases: study of 192 pacientes

Se estudiaron 192 pacientes menores de 3 años, procedentes de los municipios de la Ciudad de La Habana y de provincia La Habana, los cuales egresaron del Servicio de Enfermedades Diarreicas Agudas del Hospital Pediátrico Docente "Centro Habana", en el período de octubre a diciembre de 1986. El 46,8% de los pacientes lo constituían menores de 6 meses y de ellos el 16,1 tenían menos de 3 meses de edad. La positividad de bacterias y parásitos fue de 73,4% de los cuales el 40,6% estaba representado por parásitos y el 32,8% por bacterias. El parásito que se identificó más comúnmente fue la Entamoeba histolytica con el 20,5%. La positividad por Giardia lamblia en heces fue muy baja (3,1%), lo cual contrasta con 58 pacientes en los que no obstante ser negativas sus heces, se aisló Giardia lamblia por intubación duodenal en el 51,7%. Los agentes bacterianos identificados en los coprocultivos fueron ECEP, 12,7%; ECEI, 1,6%; Salmonella, 34,9%; Shigella, 28,6%; Campylobacter fetus jejuni, 11,1% y Plesiomona shigelloide, 4,8%. En el 28,4% de los pacientes estudiados se constató la asociación de bacterias con parásitos y con otras bacterias. Se destaca la asociación de E.histolytica a Shigella en el 40% y a Salmonella en el 10%. Se realiza comparación con la literatura médica mundial y se destaca la importancia de no confundir los quistes de Entamoeba histolytica con los leucocitos polimorfonucleares, levaduras o Blastocystis hominis que con frecuencia se observan en los resultados de las heces.