A new genus and five new species of pseudoscorpions (Arachnida, Pseudoscorpiones, Withiidae) from Colombia.

The pseudoscorpion family Withiidae is widely distributed around the world, with most of its diversity in tropical areas. Five new species and a new genus from Colombia are described: Cystowithiusflorezisp. nov., Parawithiusbromelicolasp. nov., Oligowithiusachaguasp. nov., and the genus Paciwithiusgen. nov. with two species Paciwithiusvalduparensissp. nov. and Paciwithiuschimbilacussp. nov. A reassessment of the subgenus Dolichowithius (Oligowithius) Beier, 1936 allows the elevation to a full generic level, and the transfer of the only known species to Oligowithius, forming the new combination Oligowithiusabnormis (Beier, 1936), comb. nov.

Taking advantage of asynchronous digital feedback: development of an at-home basic suture skills training program for undergraduate medical students that facilitates skills retention.

Purpose: To date, there are no training programs for basic suturing that allow remote deliberate practice. This study seeks to evaluate the effectiveness of a basic suture skills training program and its 6-month skill retention applying unsupervised practice and remote digital feedback. Methods: Fourth-year medical-student trainees reviewed instructional videos from a digital platform and performed unsupervised practice as needed at their homes. When they felt competent, trainees uploaded a video of themselves practicing the skill. In < 72 h, they received expert asynchronous digital feedback. The course had two theoretical stages and five video-based assessments, where trainees performed different suturing exercises. For the assessment, a global (GRS) and specific rating scale (SRS) were used, with a passing score of 20 points (max:25) and 15 (max:20), respectively. Results were compared to previously published work with in-person expert feedback (EF) and video-guided learning without feedback (VGL). A subgroup of trainees underwent a 6-month skills retention assessment. Results: Two-hundred and forty-three trainees underwent the course between March and December 2021. A median GRS of 24 points was achieved in the final assessment, showing significantly higher scores (p < 0.001) than EF and VGL (20.5 and 15.5, respectively). Thirty-seven trainees underwent a 6-month skills retention assessment, improving in GRS (23.38 vs 24.03, p value = 0.06) and SRS (18.59 vs 19, p value = 0.07). Conclusion: It is feasible to teach basic suture skills to undergraduate medical students using an unsupervised training course with remote and asynchronous feedback through a digital platform. This methodology allows continuous training with the repetition of quality practice, personalized feedback, and skills retention at 6 months.

REMOTE ASYNCHRONOUS FEEDBACK FOR UNSUPERVISED LAPAROSCOPIC TRAINING: THE "LAPP" PLATFORM.

BACKGROUND: The advantages of laparoscopic surgery over traditional open surgery have changed the surgical education paradigm in the past 20 years. Among its benefits are an improvement in clinical outcomes and patient safety, becoming the standard in many surgical procedures. However, it encompasses an additional challenge due to the complexity to achieve the desired competency level. Simulation-based training has emerged as a solution to this problem. However, there is a relative scarcity of experts to provide personalized feedback. Technology-Enhanced Learning could be a valuable aid in personalizing the learning process and overcoming geographic and time-related barriers that otherwise would preclude the training to happen. Currently, various educational digital platforms are available, but none of them is able to successfully provide personalized feedback. AIMS: The aim of this study was to develop and test a proof of concept of a novel Technology-Enhanced Learning laparoscopic skills platform with personalized remote feedback. METHODS: The platform "Lapp," a web and mobile cloud-based solution, is proposed. It consists of a web and mobile application where teachers can evaluate remotely and asynchronously exercises performed by students, adding personalized feedback for trainees to achieve a learning curve wherever and whenever they train. To assess the effectiveness of this platform, two groups of students were compared: 130 participants received in-person feedback and 39 participants received remote asynchronous feedback throughout the application. RESULTS: The results showed no significant differences regarding competency levels among both groups. CONCLUSION: A novel Technology-Enhanced Learning strategy consisting of remote asynchronous feedback throughout Lapp facilitates and optimizes learning, solving traditional spatiotemporal limitations.

SARS-CoV-2 vaccine booster in solid organ transplant recipients previously immunised with inactivated versus mRNA vaccines: A prospective cohort study.

Background: Solid-organ transplant (SOT) recipients have worse COVID-19 outcomes than general population and effective immunisation in these patients is essential but more difficult to reach. We aimed to determine the immunogenicity of an mRNA SARS-CoV-2 vaccine booster in SOT recipients previously immunised with either inactivated or homologous SARS-CoV-2 mRNA vaccine. Methods: Prospective cohort study of SOT recipients under medical care at Red de Salud UC-CHRISTUS, Chile, previously vaccinated with either CoronaVac or BNT162b2. All participants received a BNT162b2 vaccine booster. The primary study end point was anti-SARS-CoV-2 total IgG antibodies (TAb) seropositivity at 8-12 weeks (56-84 days) post booster. Secondary end points included neutralising antibodies (NAb) and specific T-cell responses. Findings: A total of 140 (50% kidney, 38% liver, 6% heart) SOT recipients (mean age 54 [13.6] years; 64 [46%] women) were included. Of them, 62 had homologous (three doses of BNT162b2) and 78 heterologous vaccine schedules (two doses of CoronaVac followed by BNT162b2 booster). Boosters were received at a median of 21.3 weeks after primary vaccination. The proportion achieving TAb seropositivity (82.3% vs 65.4%, P = 0.035) and NAb positivity (77.4% vs 55.1%, P = 0.007) were higher for the homologous versus the heterologous group. On the other hand, the number of IFN-γ and IL-2 secreting SARS-CoV-2-specific T-cells did not differ significantly between groups. Interpretation: This cohort study shows that homologous mRNA vaccine priming plus boosting in SOT recipients, reaches a significantly higher humoral immune response than inactivated SARS-CoV-2 vaccine priming followed by heterologous mRNA booster. Funding: School of Medicine, UC-Chile and ANID.ClinicalTrials.gov ID: NCT05124509.

Reduced Immune Response to Inactivated Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine in a Cohort of Immunocompromised Patients in Chile.

BACKGROUND: Inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been widely implemented in low- and middle-income countries. However, immunogenicity in immunocompromised patients has not been established. Herein, we aimed to evaluate immune response to CoronaVac vaccine in these patients. METHODS: This prospective cohort study included 193 participants with 5 different immunocompromising conditions and 67 controls, receiving 2 doses of CoronaVac 8-12 weeks before enrollment. The study was conducted between May and August 2021, at Red de Salud UC-CHRISTUS, Santiago, Chile. Neutralizing antibody (NAb) positivity, total anti-SARS-CoV-2 immunoglobulin G antibody (TAb) concentrations, and T-cell responses were determined. RESULTS: NAb positivity and median neutralizing activity were 83.1% and 51.2% for the control group versus 20.6% and 5.7% (both P < .001) in the solid organ transplant group, 41.5% and 19.2% (both P < .0001) in the autoimmune rheumatic diseases group, 43.3% (P < .001) and 21.4% (P<.01 or P = .001) in the cancer with solid tumors group, 45.5% and 28.7% (both P < .001) in the human immunodeficiency virus (HIV) infection group, 64.3% and 56.6% (both differences not significant) in the hematopoietic stem cell transplant group, respectively. TAb seropositivity was also lower for the solid organ transplant (20.6%; P < .0001), rheumatic diseases (61%; P < .001), and HIV groups (70.9%; P = .003), compared with the control group (92.3%). On the other hand, the number of interferon γ spot-forming T cells specific for SARS-CoV-2 tended to be lower in all immunocompromising conditions but did not differ significantly between groups. CONCLUSIONS: Diverse immunocompromising conditions markedly reduce the humoral response to CoronaVac vaccine. These findings suggest that a boosting vaccination strategy should be considered in these vulnerable patients. CLINICAL TRIALS REGISTRATION: NCT04888793.

A new approach for the acquisition of trauma surgical skills: an OSCE type of simulation training program.

BACKGROUND: Worldwide, trauma-related deaths are one of the main causes of mortality. Appropriate surgical treatment is crucial to prevent mortality, however, in the past decade, general surgery residents' exposure to trauma cases has decreased, particularly since the COVID-19 pandemic. In this context, accessible simulation-based training scenarios are essential. METHODS: A low-cost, previously tested OSCE scenario for the evaluation of surgical skills in trauma was implemented as part of a short training boot camp for residents and recently graduated surgeons. The following stations were included bowel anastomosis, vascular anastomosis, penetrating lung injury, penetrating cardiac injury, and gastric perforation (laparoscopic suturing). A total of 75 participants from 15 different programs were recruited. Each station was videotaped in high definition and assessed in a remote and asynchronous manner. The level of competency was assessed through global and specific rating scales alongside procedural times. Self-confidence to perform the procedure as the leading surgeon was evaluated before and after training. RESULTS: Statistically significant differences were found in pre-training scores between groups for all stations. The lowest scores were obtained in the cardiac and lung injury stations. After training, participants significantly increased their level of competence in both grading systems. Procedural times for the pulmonary tractotomy, bowel anastomosis, and vascular anastomosis stations increased after training. A significant improvement in self-confidence was shown in all stations. CONCLUSION: An OSCE scenario for training surgical skills in trauma was effective in improving proficiency level and self-confidence. Low pre-training scores and level of confidence in the cardiac and lung injury stations represent a deficit in residency programs that should be addressed. The incorporation of simulation-based teaching tools at early stages in residency would be beneficial when future surgeons face extremely severe trauma scenarios.

Remote asynchronous feedback for unsupervised laparoscopic training: the "lapp" platform / Feedback assíncrono remoto para treinamento laparoscópico não supervisionado: a plataforma "lapp"

ABSTRACT BACKGROUND: The advantages of laparoscopic surgery over traditional open surgery have changed the surgical education paradigm in the past 20 years. Among its benefits are an improvement in clinical outcomes and patient safety, becoming the standard in many surgical procedures. However, it encompasses an additional challenge due to the complexity to achieve the desired competency level. Simulation-based training has emerged as a solution to this problem. However, there is a relative scarcity of experts to provide personalized feedback. Technology-Enhanced Learning could be a valuable aid in personalizing the learning process and overcoming geographic and time-related barriers that otherwise would preclude the training to happen. Currently, various educational digital platforms are available, but none of them is able to successfully provide personalized feedback. AIMS: The aim of this study was to develop and test a proof of concept of a novel Technology-Enhanced Learning laparoscopic skills platform with personalized remote feedback. METHODS: The platform "Lapp," a web and mobile cloud-based solution, is proposed. It consists of a web and mobile application where teachers can evaluate remotely and asynchronously exercises performed by students, adding personalized feedback for trainees to achieve a learning curve wherever and whenever they train. To assess the effectiveness of this platform, two groups of students were compared: 130 participants received in-person feedback and 39 participants received remote asynchronous feedback throughout the application. RESULTS: The results showed no significant differences regarding competency levels among both groups. CONCLUSION: A novel Technology-Enhanced Learning strategy consisting of remote asynchronous feedback throughout Lapp facilitates and optimizes learning, solving traditional spatiotemporal limitations.

RESUMO RACIONAL: As vantagens da cirurgia laparoscópica sobre a cirurgia aberta tradicional mudaram o paradigma da educação cirúrgica nos últimos 20 anos, tornando-se o padrão em muitos procedimentos cirúrgicos. No entanto, envolve um desafio adicional devido à complexidade para atingir o nível de competência desejado. O treinamento baseado em simulação surgiu como uma solução. No entanto, há uma relativa escassez de especialistas para fornecer feedback personalizado. A Technology Enhanced Learning pode ser uma ajuda valiosa na personalização do processo de aprendizagem e na superação de barreiras geográficas e temporais que impediriam o treinamento. Atualmente, várias plataformas educacionais estão disponíveis, mas nenhuma delas é capaz de fornecer feedback personalizado. OBJETIVOS: desenvolver e testar uma prova de conceito de uma nova plataforma de habilidades laparoscópicas da Technology Enhanced Learning com feedback remoto personalizado. MÉTODOS: É proposta a plataforma "Lapp", uma solução web e móvel baseada em nuvem. É composta por uma aplicação web em que os professores podem avaliar remotamente e de forma assíncrona exercícios realizados pelos alunos, adicionando feedback personalizado para os formandos alcançarem uma curva de aprendizagem onde e quando treinam. Para avaliar a eficácia desta plataforma, dois grupos de alunos foram comparados. 130 participantes receberam feedback pessoal e 39 participantes receberam feedback remoto assíncrono em todo o aplicativo. RESULTADOS: Os resultados não mostraram diferenças significativas em relação ao nível de competência entre os dois grupos. CONCLUSÕES: Uma nova estratégia Technology Enhanced Learning que consiste em feedback assíncrono remoto em toda a Lapp facilita e otimiza o aprendizado, resolvendo as limitações espaço-temporais tradicionais.

A new species and new records of Pachychernes Beier, 1932 from Colombia (Pseudoscorpiones, Chernetidae).

In Colombia, the status of the Neotropical genus Pachychernes Beier, 1932 is unknown. The only available data in literature to support the presence of this genus is an adult of P. aff. subrobustus, possibly female, from copal resin without specific locality data, and a record at generic level from Northern Colombia. In this study, we extend the distribution of Pachychernes by describing a new species, P. florezi sp. n. and several reporting individuals of P. zehorum Muchmore, 1997 from Montes de Mara and the Caribbean coast of the country. These species are clearly differentiated from one another by the sexual dimorphism in the latter species, with a depression on the tarsus I in males. We also present an updated key for all species of the genus.

[Ingestion of multiple magnets in pediatrics: endoscopic or surgical emergency?] / Ingestión de múltiples imanes en pediatría: ¿emergencia endoscópica o quirúrgica?

Ingestion of foreign bodies is common in the pediatric population. Most foreign bodies have a benign behavior and are usually eliminated without generating greater morbidity and mortality. In relation to the intake of magnets, its frequency has increased to the point that it currently represents a public health problem in the pediatric population. The ingestion of a single magnet does not generate any risk, but the ingestion of 2 or more of these, or even of magnets and metals in succession is considered an emergency since they can attract each other and can cause serious symptoms of intestinal obstruction, bleeding, fistulas, perforation and even intestinal necrosis. We present 2 pediatric patients, who ingested multiple magnets, in these cases we highlight the variety in the clinical presentation, as well as the complications presented in relation to a late diagnosis.

Validity Argument for a Simulation-Based Objective Structured Clinical Examination Scenario for Evaluation of Surgical Skills in Trauma.

BACKGROUND: Trauma is one of the main causes of death globally, and appropriate surgical care is crucial to impact mortality. However, resident-performed trauma cases have diminished in the last 10 years. Simulation-based tools have proven to be effective to evaluate practical skills in a variety of settings. However, there is a lack of evidence regarding proper validation of trauma surgery models. OBJECTIVE: The aim of this study was to evaluate under a contemporary validity framework, an objective structured clinical evaluation (OSCE) scenario for the assessment of basic and advanced surgical skills in trauma and emergency surgery. METHODS: An OSCE-type simulation assessment program was developed incorporating six stations representing basic and advanced surgical skills that are essential in trauma surgery. Each station was designed using ex-vivo animal tissue. The stations included basic knots and sutures, bowel resection and anastomosis, vascular end-to-end anastomosis, lung injury repair, cardiac injury repair, and laparoscopic suturing. Eight postgraduate year 2 (PY-2), eight recently graduated surgeons (RGS), and 3 experts were recruited, and their performance was blindly assessed by experts using the validated general rating scale OSATS (Objective Structured Assessment of Technical Skills) as well as the time taken to complete the procedure. RESULTS: Significant differences were identified among groups. The average OSATS score was 82 for the PY2 group, 113 for the RGS group, and 147 for the experts (P < 0.01). The average procedural time to complete all the stations was 98 minutes for the PY2 group, 68 minutes for the RGS group, and 35 minutes for the expert surgeons (P < 0.01). CONCLUSION: An OSCE scenario designed using ex-vivo tissue met 4 out of 5 criteria of the Messick validity framework: content, relation to other variables, response process and consequences of the test. The results show it is a valid strategy for the evaluation of practical skills in trauma surgery.

Elaboración de un simulador de trauma torácico a partir de un torso cadavérico utilizando tecnología de imágenes digitales e impresión 3D / Elaboration of a thoracic trauma surgery simulation model from a cadaveric human torso incorporating digital image technology and 3D printing

Resumen Objetivo: Presentar la elaboración de un simulador de trauma torácico de alta fidelidad elaborado mediante modelamiento e impresión 3D a partir de un torso humano cadavérico. Materiales y Método: Estudio descriptivo del desarrollo de un simulador de trauma torácico utilizando metodología centrada en el prototipado y la iteración basada en testeos. Resultados: Se elaboró un simulador reutilizable mediante la digitalización de un torso cadavérico utilizando tomografía computada. Se realizó una reconstrucción digital del torso diseñando los planos subcutáneos, muscular y óseo en base a las imágenes del paciente pre y postoracotomía anterolateral. Utilizando impresión 3D y materiales sintéticos, se elaboró la caja torácica para luego instalar un corazón y pulmón porcino ventilado y perfundido. Los parches de la toracotomía son reemplazables y de bajo costo. En conjunto, este simulador permite el entrenamiento en manejo de lesiones traumáticas cardiacas y pulmonares de alta fidelidad. Conclusión: La metodología presentada permite la creación de un modelo para el entrenamiento y evaluación de habilidades quirúrgicas en trauma torácico. Los elementos principales del simulador son reutilizables y permiten mantener bajos los costos del entrenamiento.

Aim: To describe the design and creation of a high-fidelity thoracic trauma surgery simulation model incorporating 3D printing technology using a cadaveric human torso as a model. Materials and Method: This is a descriptive study that aims to illustrate the creation process of a thoracic trauma surgery simulation model throughout the incorporation of prototypes and dynamic iteration technologies. Results: A high-fidelity reusable thoracic trauma surgery simulation model was created from the digitalization of a cadaveric torso using a computed tomography scan. Throughout digital reconstruction tools, the subcutaneous, muscular, and skeletal structures were modeled from images obtained before and after an anterolateral thoracotomy. Using 3D printing and synthetic materials, a high-fidelity thoracic cavity was built so that perfused and ventilated porcine heart and lungs could be placed. A thoracotomy patch for the anterolateral thoracotomy was designed in a reusable and low-cost fashion. This simulation model is suitable for high fidelity training in the surgical management of cardiopulmonary traumatic injuries. Conclusion: The described methodology allowed the creation of a simulation model for training and assessment of surgical skills in thoracic trauma. The main components of the simulation model are made from reusable materials, broadening access to low-cost, high fidelity training.

Ingestión de múltiples imanes en pediatría: ¿emergencia endoscópica o quirúrgica?

La ingesta de cuerpos extraños es común en población pediátrica. La mayoría de cuerpos extraños tienen un comportamiento benigno y suelen ser eliminados sin generar mayor morbimortalidad. En relación a la ingesta de imanes, se ha incrementado su frecuencia, a tal punto que en la actualidad representa un problema de salud pública en población pediátrica. La ingesta de un solo imán no genera ningún riesgo, pero la ingestión de 2 o más de estos, o incluso de imanes y metales de forma sucesiva se considera una emergencia ya que estos pueden atraerse entre sí pudiendo provocar cuadros graves de obstrucción intestinal, sangrado, fístulas, perforación e incluso necrosis intestinal. Presentamos 2 pacientes en edad pediátrica, que ingirieron múltiples imanes, en estos casos resaltamos la variedad en la presentación clínica, así como las complicaciones presentadas en relación a un diagnóstico tardío.

Ingestion of foreign bodies is common in the pediatric population. Most foreign bodies have a benign behavior and are usually eliminated without generating greater morbidity and mortality. In relation to the intake of magnets, its frequency has increased to the point that it currently represents a public health problem in the pediatric population. The ingestion of a single magnet does not generate any risk, but the ingestion of 2 or more of these, or even of magnets and metals in succession is considered an emergency since they can attract each other and can cause serious symptoms of intestinal obstruction, bleeding, fistulas, perforation and even intestinal necrosis. We present 2 pediatric patients, who ingested multiple magnets, in these cases we highlight the variety in the clinical presentation, as well as the complications presented in relation to a late diagnosis.

The pseudoscorpion genus Verrucachernes (Pseudoscorpiones: Chernetidae) in the Indian region.

The pseudoscorpion genus Verrucachernes Chamberlin, 1947 is widely distributed in the Old World tropics, with three named Australasian and West Pacific species and two from Africa. A review of some pseudoscorpions described from India has revealed that Withius parvus Beier, 1930 (currently in the genus Metawithius) and Pselaphochernes indicus Beier, 1974 are misplaced and actually belong to the genus Verrucachernes Chamberlin, 1947, forming the new combinations V. parvus (Beier, 1930) comb. nov. and V. indicus (Beier, 1974) comb. nov., respectively. Both species possess the single, large, rounded spermatheca and other features typical of Verrucachernes.

Checklist of the false scorpions (Arachnida: Pseudoscorpiones) of Colombia, with new records and a key to the identification of the families.

Colombia is a mega-biodiverse country and rich in ecosystems as different as the Amazon and the Andes. Much is known of the vertebrate fauna, however there is still an information-gap for many arthropod groups including the arachnids. Here, we compile all the information available for pseudoscorpions (Arachnida: Pseudoscorpiones) recorded from Colombia and include several new records and distribution extensions. For each described species, we present information on taxonomic history, type localities, global and local distributions, repository of Colombian specimens, and collection numbers when available. We document 12 families, 45 genera and 65 species of pseudoscorpions for Colombia and most species belong to the families Chernetidae (27 species) and Olpiidae (8 species). We record Beierolpium venezuelense Heurtault, 1982, Geogarypus amazonicus Mahnert, 1979, Sathrochthonius venezuelanus Muchmore, 1989, and Semeiochernes armiger (Balzan, 1892) for the first time for Colombia. We further extend the known ranges of Parachernes melonopygus Beier, 1959 and Paratemnoides nidificator (Balzan, 1888). The data suggest that the Caribbean region of Colombia has the highest number of records. Total numbers are not complete and many other new pseudoscorpion species are expected.

Flow Cytometric Characteristics of Extrathymic Thymocytes in Adenoid Tissue: A Case Report and Comparison to Normal Thymus and Thymoma.

BACKGROUND: Normal thymocyte precursors in secondary lymphoid organs have previously been described. It is important to recognize normal thymocyte precursors by flow cytometry to differentiate them from T-cell lymphoblastic leukemia. METHODS: A 3-year-old boy status 2 years postallogenic cardiac transplant underwent adenoidectomy to exclude post-transplant lymphoproliferative disorder. Microscopic, immunohistochemical, and flow cytometry analyses of the adenoid were performed. RESULTS: By flow cytometry, a population of CD45+(dim)/CD7+(bright)/CD3- cells were observed at 1.0% of lymphocytes. These cells expressed CD10, partial CD34 and exhibited acquisition of CD4 followed by CD8. Within the brighter CD45+ lymphocytes, a population of CD3-/CD4+/CD8+ thymocytes and a similarly sized population of CD4+/CD8+ cells exhibiting acquisition of low-density CD3 were identified. By immunostaining, clusters of TdT+/CD1a+/CD4+/CD8+ T-cells were identified in the interfollicular areas. Compared to normal thymus, thymocytes in the adenoid tissue lacked the classic CD4xCD8 winged differentiation profile but showed a normal early precursor pattern. CONCLUSIONS: Thymocytes in adenoid show a similar differentiation pattern to thymus and thymoma. However, the classic winged pattern of common thymocyte differentiation may not be readily apparent in thymocytes differentiating outside of the thymus. Recognition of the early thymocyte precursor antigen acquisition profile can be crucial to correct interpretation. © 2017 International Clinical Cytometry Society.

[Celiac disease, non celiac gluten sensitivity and wheat allergy: comparison of 3 different diseases triggered by the same food]. / Enfermedad celíaca, sensibilidad no celíaca al gluten y alergia al trigo: comparación de patologías diferentes gatilladas por un mismo alimento.

Gluten and other related proteins of the wheat, rye and barley, have antigenic properties that may trigger adverse reactions in susceptible individuals. Celiac disease was the first pathology with clear causal association related to the intake of these proteins. Recently, wheat allergy and non celiac gluten sensitivity have been described. Although, clinical presentation and its relation with protein ingestion may be similar and elicit confusion, their pathogenic mechanism, diagnosis and treatment are quite different. Since the prevalence of these diseases is relatively high as a whole, it is essential that these become familiar to primary care doctors and general pediatricians, thus they will know how to differentiate and face them. The aim of this review is to compare the main aspects of epidemiology, pathofisiology, diagnosis and treatment of these 3 conditions.

Enfermedad celíaca, sensibilidad no celíaca al gluten y alergia al trigo: comparación de patologías diferentes gatilladas por un mismo alimento / Celiac disease, non celiac gluten sensitivity and wheat allergy: comparison of 3 different diseases triggered by the same food

El gluten y otras proteínas relacionadas del trigo, centeno y cebada, tienen propiedades antigénicas que pueden desencadenar reacciones adversas en individuos susceptibles. La enfermedad celíaca fue la primera patología en que se estableció relación causal con estas proteínas alimentarias. Recientemente se han descrito la alergia al trigo y la sensibilidad no celíaca al gluten. Si bien sus formas de presentación clínica y su relación con la ingesta pueden ser similares, sus mecanismos patogénicos, forma de diagnóstico y tratamiento difieren. Dado que su prevalencia en conjunto es relativamente alta, resulta necesario que los médicos de atención primaria y pediatras se familiaricen con estas patologías, sepan cómo diferenciarlas y enfrentarlas. El objetivo de esta revisión es comparar los principales aspectos de epidemiología, fisiopatología, diagnóstico y tratamiento de estas 3 condiciones.

Gluten and other related proteins of the wheat, rye and barley, have antigenic properties that may trigger adverse reactions in susceptible individuals. Celiac disease was the first pathology with clear causal association related to the intake of these proteins. Recently, wheat allergy and non celiac gluten sensitivity have been described. Although, clinical presentation and its relation with protein ingestion may be similar and elicit confusion, their pathogenic mechanism, diagnosis and treatment are quite different. Since the prevalence of these diseases is relatively high as a whole, it is essential that these become familiar to primary care doctors and general pediatricians, thus they will know how to differentiate and face them. The aim of this review is to compare the main aspects of epidemiology, pathofisiology, diagnosis and treatment of these 3 conditions.

Flow cytometric characteristics of extrathymic thymocytes in adenoid tissue: A case report and comparison to normal thymus and thymoma.

BACKGROUND: Normal thymocyte precursors in secondary lymphoid organs have previously been described. It is important to recognize normal thymocyte precursors by flow cytometry to differentiate them from T-cell lymphoblastic leukemia. METHODS: A 3-year-old boy status 2 years post-allogenic cardiac transplant underwent adenoidectomy to exclude post-transplant lymphoproliferative disorder. Microscopic, immunohistochemical, and flow cytometry analyses of the adenoid were performed. RESULTS: By flow cytometry, a population of CD45+(dim)/CD7+(bright)/CD3- cells were observed at 1.0% of lymphocytes. These cells expressed CD10, partial CD34, and exhibited acquisition of CD4 followed by CD8. Within the brighter CD45+ lymphocytes, a population of CD3-/CD4+/CD8+ thymocytes and a similarly sized population of CD4+/CD8+ cells exhibiting acquisition of low-density CD3 were identified. By immunostaining, clusters of TdT+/CD1a+/CD4+/CD8+ T-cells were identified in the interfollicular areas. Compared to normal thymus, thymocytes in the adenoid tissue lacked the classic CD4xCD8 winged differentiation profile but showed a normal early precursor pattern. CONCLUSIONS: Thymocytes in adenoid show a similar differentiation pattern to thymus and thymoma. However, the classic winged pattern of common thymocyte differentiation may not be readily apparent in thymocytes differentiating outside of the thymus. Recognition of the early thymocyte precursor antigen acquisition profile can be crucial to correct interpretation. © 2017 International Clinical Cytometry Society.

Synchronous or Metachronous Hairy Cell Leukemia and Chronic Lymphocytic Leukemia: A Case Series and Literature Review.

INTRODUCTION: Concurrent hairy cell leukemia (HCL) and chronic lymphocytic leukemia (CLL) is rare; management is inadequately described in the literature. METHODS: Retrospective chart review and clinical follow-up. RESULTS: Five patients are described. The first patient developed synchronous HCL and CLL and was treated with rituximab for 13 months with HCL in remission and stable CLL. The second patient developed HCL and was treated with cladribine. His disease recurred 7 years later which was retreated with cladribine. Seven years later, he developed asymptomatic CLL. The third patient developed CLL, managed expectantly, then developed HCL 10 months later, and was treated with cladribine. Although his HCL went into remission, there was a slow redevelopment of CLL for which expectant management was done. The fourth patient developed concurrent CLL and HCL, received cladribine, with subsequent development of worsening abdominal lymphadenopathy and was lost to follow-up. The last patient developed concurrent HCL and CLL and was also diagnosed with lung adenocarcinoma; this patient was also lost to follow-up. CONCLUSION: The development of concurrent HCL and CLL may indicate a common origin. Patients with HCL may subsequently develop CLL, thus mimicking a relapse of HCL. Therapy requires individualized approach including watchful waiting in asymptomatic cases. Rituximab may be useful to treat both disorders simultaneously.