Pacientes con embarazo en cicatriz de cesárea tratadas con metotrexato. Serie de casos de terapia combinada sistémica y percutánea en un centro de tercer nivel de Colombia / Management of cesarean scar pregnancy with methotrexate. A case series of combined systemic and percutaneous therapy in a III level center in Colombia

Resumen OBJETIVO: Describir un esquema de atención no quirúrgica en pacientes con embarazo en cicatriz de cesárea en el contexto de un sistema de salud con bajos recursos. Además, describir la tolerancia, vigilancia, evolución y desenlace de cada una de las pacientes tratadas con el esquema propuesto. MATERIALES Y MÉTODOS: Estudio retrospectivo, descriptivo de serie de casos de pacientes que acudieron al servicio de Urgencias de una institución de tercer nivel de atención en Barranquilla, Colombia, entre los meses de mayo de 2020 a marzo 2023 debido a síntomas obstétricos o fueron remitidas a la institución con diagnóstico, confirmado por ultrasonografía, de embarazo en cicatriz de cesárea. Parámetros de estudio: medición de variables sociodemográficas, obstétricas, de evolución clínica y complicaciones maternas. Se efectuó el análisis descriptivo de los datos. RESULTADOS: Se documentaron 11 pacientes que dieron una incidencia de 1.85 casos por cada 5000 embarazos. El dolor pélvico y el sangrado fueron los síntomas más prevalentes. Cinco pacientes tuvieron dos o más cesáreas, el resto una sola previa y cinco antecedente de legrado obstétrico. Nueve de 11 pacientes se atendieron con menos de 8 semanas de embarazo. La tasa de éxito alcanzada fue en las 11 pacientes, con negativización de la beta hCG a los 38.7 días en promedio. No se registraron complicaciones severas ni requerimiento de atención quirúrgica. CONCLUSIONES: Se describió la implementación de un esquema combinado sistémico y local con metotrexato que resultó seguro y efectivo, con preservación de la fertilidad.

Abstract OBJECTIVE: To report a scheme of non-surgical care in patients with cesarean scar pregnancy in the context of a health system with low resources. In addition, to describe the tolerance, monitoring, evolution and outcome of each of the patients treated with the proposed scheme. MATERIALS AND METHODS: Descriptive study of a case series of patients who, between May 2020 and March 2023, attended the emergency room of a tertiary care institution in Barranquilla, Colombia, because of obstetric symptoms or were referred to the institution with a diagnosis of cesarean scar pregnancy confirmed by ultrasound. Study parameters: measurement of sociodemographic, obstetric, clinical evolution and maternal complication variables. Descriptive analysis of data was performed. Results: Eleven patients were documented, giving an incidence of 1.85 cases per 5000 pregnancies. Pelvic pain and bleeding were the most common symptoms. Five patients had two or more previous cesarean sections, the remainder had only one previous cesarean section, and five had a history of obstetric curettage. Nine of the 11 patients were treated at less than 8 weeks'; gestation. The success rate was 100%, with a mean beta-hCG negativity of 38.7 days. There were no major complications and no surgical intervention was required. CONCLUSIONS: We describe the implementation of a combined systemic and local regimen with methotrexate that was safe and effective, with preservation of fertility.

Manifestaciones bucales de pacientes con mucopolisacaridosis / Oral manifestations in patients with mucopolysaccharidosis

Objetivo: Describir las características bucales prevalentes de pacientes argentinos con mucopolisacaridosis (MPS) atendidos en el Servicio de Odontología del Hospital Nacional "Prof. Alejandro Posadas". Materiales y métodos: Se consideraron las historias clínicas de 19 pacientes con diagnóstico de MPS. Se registraron la edad, el sexo, el lugar de residencia, el tipo de MPS y la presencia de retraso madurativo. La muestra estuvo constituida por 13 niños (6,7±3 años) y 6 adultos (26±9 años): 2 eran mujeres (1 con MPS tipo I; 1 con MPS tipo IV A) y 17 eran hombres (15 con MPS tipo 2; 1 con MPS tipo 1; 1 con MPS tipo III); 13 de los pacientes presentaban discapacidad intelectual. Se evaluaron: tipo de dentición, oclusión, macroglosia, hipoplasias del esmalte, tipo de respiración predominante, clase molar y tratamiento realizado. Resultados: Ambos casos con MPS I presentaban mordida abierta anterior y giroversión dental, y solo uno de estos, diastemas, microdoncia, hipoplasias del esmalte, macroglosia y respiración bucal. De los 15 pacientes con MPS II, 11 presentaban mordida abierta anterior (73%), 3 mordida cruzada posterior (20%), 5 giroversión dental (33%), 11 diastemas (73%), 3 retraso en la erupción (20%), 4 hiperplasia gingival (26%), 13 macroglosia (87%), 7 hipoplasias del esmalte (47%), 2 microdoncia (13%), 9 respiración bucal (60%). Se registraron 5 pacientes con clase molar I (33%), 3 con clase molar II (20%), 3 con clase molar III (20%) y en 3 casos no se pudo evaluar (20%). En el paciente con MPS tipo III se halló mordida abierta anterior, diastemas, retraso en la erupción, macroglosia, respiración bucal y clase molar II; y en el caso de MPS tipo IV A, mordida abierta anterior, diastemas, hiperplasia gingival, macroglosia y clase molar II. El 90% de los pacientes requirió tratamiento odontológico (AU)

Aim: To identify the most prevalent oral manifestations of 19 Argentine patients with mucopolysaccharidos (MPS) attending the Dentistry Service of the National Posadas Hospital. Materials and methods: The medical records of 19 patients diagnosed with MPS were considered. Age, sex, place of residence, type of MPS, and presence of maturational delay were recorded. The sample consisted of 13 children (6.7 ± 3 years) and 6 adults (26 ± 9 years): 2 were women (1 with MPS type I; 1 with MPS type IV A) and 17 were men (15 with MPS type 2; 1 with MPS type 1; 1 with MPS type III); 13 of the patients had intellectual disabilities. The following were evaluated: type of dentition, occlusion, macroglossia, enamel hypoplasia, predominant type of respiration, molar class and treatment performed Results: Both cases with MPS I presented anterior open bite and dental gyroversion, and only one of these, diastemas, microdontia, enamel hypoplasia, macroglossia and mouth respiration. Of the 15 patients with MPS II, 11 presented anterior open bite (73%), 3 posterior crossbite (20%), 5 dental gyroversion (33%), 11 diastemas (73%), 3 delayed eruption (20%), 4 gingival hyperplasia (26%), 13 macroglossia (87%), 7 enamel hypoplasia (47%), 2 microdontia (13%), 9 mouth breathing (60%). 5 patients with molar class I (33%), 3 with molar class II (20%), 3 with molar class III (20%) and in 3 cases it could not be evaluated (20%). In the patient with type III MPS, anterior open bite, diastemas, delayed eruption, macroglossia, mouth breathing and molar class II were found; and in the case of type IV A MPS, anterior open bite, diastemas, gingival hyperplasia, macroglossia and molar class II. 90% of the patients required dental treatment. Conclusion: The most observed oral manifestations were macroglossia (84.2%) and anterior open bite (73%) (AU)

Dried blood spots to characterize mercury speciation and exposure in a Colombian artisanal and small-scale gold mining community.

The artisanal and small-scale gold mining (ASGM) sector uses the most mercury (Hg) worldwide. Despite health concerns associated with high Hg exposures in these communities, ASGM sites are often situated in resource limited and remote regions which challenge traditional human biomonitoring approaches. To help overcome such challenges, here we report on the development of a high-quality method to characterize chemical speciation of Hg in dried blood spots (DBS), and then apply this method to assess Hg exposures in people sampled from an ASGM community (Pueblito Mejia) and a nearby town (Barranco de Loba) in Colombia. We collected DBS and urine samples from 35 individuals in 2018, and used these to assess occupational (DBS inorganic Hg (InHg) and urine total Hg (THg) measures) and environmental (DBS methylmercury (MeHg) measures) exposure of participants to different forms of Hg. The accuracy and precision of the DBS-based measures generally met assay performance guideline. In study participants, the mean concentrations of DBS MeHg, InHg, and THg, and urine THg were 1.9, 4.1, 6.0, and 3.1 µg/L, respectively. For 37% of the participants, DBS THg values exceeded the 5 µg/L 'alert level' proposed by the German HBM Commission. About 60% of the blood Hg was in the InHg form thus exemplifying a need to speciate Hg in blood sampled from ASGM sites to better understand the contributions of environmental and occupational exposure sources. This study demonstrates the feasibility of using DBS for Hg speciation exposure assessments in remote and resource-limited areas such as ASGM communities.

Steroid-responsive pancreatitides.

Autoimmune pancreatitis has received considerable attention, especially due to the marked effect of corticosteroid therapy on its clinical course. Knowledge, especially regarding type 1 autoimmune pancreatitis, has significantly increased over the last decades, and despite significant differences in pathophysiology and outcomes, both type 1 and 2 autoimmune pancreatitis are still considered different types of the same disease. Some have proposed a different nomenclature reflecting these differences. Although the term steroid-responsive pancreatitides may be interpreted as synonymous to type 1 and 2 autoimmune pancreatitis, these are not the only pancreatic conditions that show a response to steroid therapy. Acute pancreatitis caused by vasculitis and connective tissue diseases and acute pancreatitis secondary to checkpoint inhibitors or programmed cell death receptor antibody-mediated blockage cancer therapy may also benefit from steroid treatment. This review presents current concepts on these disorders, aiming to increase awareness, analyze similarities and differences, and propose a new nomenclature that reflects their specific particularities, clustering them under the term "steroid-responsive pancreatitides".

Information and Communication Technology, Mobile Devices, and Medical Education.

Information and communication technologies (ICT) are practical and highly available tools. In medical education, ICTs allow physicians to update their knowledge and remember the necessary information within reach of current mobile devices. ICTs as preparation tools for medical education have not been reported for medical students in Mexico. To assess the use of mobile devices as ICTs with medical education purposes, we distributed a questionnaire through an online survey management system to all the medical students (n = 180) from a private university in Mexico City, 100% agreed to participate. We developed a questionnaire based on previous surveys and adapted it to our university. All participants reported possession of an electronic mobile device, and 95% used it regularly for learning purposes. Regardless of the school year, the most frequent usage given to these devices was the search and reading of medical articles, the use of medical calculators, and taking notes. As the levels in career advances, there was a reduction in the use of electronic devices. According to the students, the main barriers towards using mobile devices for learning purposes were both the lack of access to the Internet and permission from the professor to use them. Most medical students use mobile devices for learning purposes, but usage changes during their education. It is convenient to encourage the use of mobile devices and the development of ICT skills as tools for educational purposes rather than banning their use in schools and hospitals.

Edad de la primera consulta odontológica en un servicio hospitalario de la provincia de Buenos Aires / Age of the first dental visit among a hospital health clinic in Buenos Aires province

Objetivo: Identificar la edad de la primera consulta odontológica, los motivos de esta y el estado de salud/enfermedad de la población que concurre a atenderse en la Sección de Odontopediatría del Servicio de Odontología del Hospital Nacional "Prof. Alejandro Posadas". Materiales y métodos: Este es un estudio descriptivo retrospectivo, en el que se revisaron las historias odontológicas de los pacientes que concurrieron espontáneamente a la Sección de Odontopediatría del Hospital "Prof. A. Posadas" durante los meses de junio, julio y agosto de 2018. Se registraron las variables edad, motivo de la primera consulta, sexo, ceod y CPOD. Resultados: La muestra estuvo constituida por 337 historias clínicas de pacientes de 0 a 12 años; el 44,8% (n=151) llegó a la consulta por primera vez, del cual el 47% (n=71) fueron mujeres. La edad promedio de la primera consulta fue de 6,5 años (DS ±3), con una moda de 9 años. El 1,32% (n=2) tenía menos de 1 año; el 3,97% (n=6), 1 año; el 43,04% (n=65), entre 2 y 6 años; mientras que el 51,66% (n=78) tenía entre 7 y 12 años. Los motivos de consulta de los pacientes que concurrían por primera vez fueron presencia de caries, 51% (n=77); malposición dentaria, 11% (n=17); control, 15% (n=22); traumatismo, 10% (n=16); dolor, 10% (n=15), y problemas en tejidos blandos, 3% (n=4). El CPOD fue de 1,16 (DS ±1,45), y el ceod, de 4 (DS ±3,25). Conclusión: De la muestra estudiada de la población concurrente a un servicio de odontopediatría de la provincia de Buenos Aires, solo el 1,32% consultó dentro del primer año de vida, que es la edad considerada ideal para asesorar a los padres oportunamente sobre medidas preventivas y disminuir la incidencia de caries en la población infantil (AU)

Aim: To identify the age and reasons of the first dental visit and child's oral health, among attendees to the Pediatric Dentistry Section of the 'Prof. A. Posadas' Hospital. Materials and methods: This is a descriptive retrospective study, on dental clinical records selected from patients who went spontaneously to the Pediatric Dentistry Section of the 'Prof. A. Posadas' Hospital during June, July and August of 2018. Variables studied were: age, reported reasons for dental visit, gender, ceod, and CPOD. Results: The sample consisted of 337 clinical records of patients from 0 to 12 years old. 44.8% (n=151) came to the clinic for the first time (women: 47%; n=71). The average age of the first consultation was 6.5 years (SD ±3), mode 9 years. Of the sample, 1.32% (n=2) had less than 1 year, 3.97% (n=6) were 1 year old, between 2 and 6 years old 43.04% (n=65), while 51.66% (n=78) had between 7 and 12 years. The reasons for the first consultation were caries (51%; n=77), abnormal dental position (11%; n=17), control (15%; n=22), trauma (10%; n=16), pain (10%; n=15), and soft tissues consultations (3%; n=4). DMFT, 1.16 (DS ±1.45), and dmft, 4 (SD ±3.25). Conclusion: Of the sample studied from the population attending a pediatric dentistry service in the province of Buenos Aires, only 1.32% consulted within the year of life as it is considered ideal to advice parents timely on preventive measures and reduce the incidence of caries in the child population (AU)

Retroperitoneal fibrosis. Steroid treatment response seems to depend on its association to IgG4 related disease.

Retroperitoneal fibrosis (RF) is part of a rare fibrosclerotic disorder. Oral steroids are the initial treatment. Steroid combination with other immunosupressants is used in refractory cases. Steroids refractoriness has been observed in chronic cases. Some cases of RF represent a manifestation of the IgG4 related disease (IgG4-RD) that is associated to a dramatic response to steroid therapy. It is uncertain if RF́s treatment response differs according to its association with IgG4-RD. We hypothesize that RF́s treatment response to steroids depends on the association with IgG4-RD, thus, we collected and compared clinical data from 10 RF cases; 6 male, mean age 50.6 (±16.15 SD) years. Mean FU was 28 (±25.7 SD) months. According to IgG4 levels, patients were categorized as idiopathic RF (IRF n = 5) or RF-IgG4-RD (n = 5). Therapy response was categorized as complete, partial, stable disease, recurrence or non-response. Nine cases received initial therapy with prednisone; complete response was achieved in 4 RF-IgG4 RD. The remaining 5 cases (1 RF-IgG4RD and 4 IRF) underwent a 2nd line therapy; 4 prednisone + tamoxifen and 1 prednisone + azathioprine. Prednisone + tamoxifen combination achieved complete response in 1 case (RF-IgG4RD), partial response in 1 IRF; in 1 IRF case, disease remained stable and 1 did not respond. The prednisone + azathioprine treatment achieved complete response. At follow-up all patients remained stable and no recurrence was registered. These observations suggest and support the hypothesis that response to steroid monotherapy depends on the association of RF with IgG4, suggesting that IRF cases might benefit from initial combination therapies instead of steroid monotherapy.

Efecto de la centrifugación sobre la membrana plasmática y el ADN de espermatozoides bovinos / Efeito da centrifugação sobre a membrana plasmática e o DNA de espermatozóides bovinos / Effect of centrifugation on plasma membrane and DNA of bovine spermatozoa

El objetivo de este estudio fue determinar si la integridad de la membrana plasmática y el ADN de los espermatozoides pueden ser afectados por la centrifugación realizada en el proceso de lavado y selección. Los espermatozoides fueron sometidos a diferentes tiempos de centrifugación (10, 30 y 45 min); se utilizó un control negativo con espermatozoides no centrifugados y un control positivo con espermatozoides sometidos a estrés oxidativo con peroxido de hidrógeno (H2O2) (200 μM). Para evaluar la integridad de la membrana se utilizó la prueba hipoosmótica (HOST) y para evaluar la fragmentación del ADN se utilizó el ensayo cometa: El análisis estadístico se realizó mediante la prueba de Fisher. La centrifugación durante 10, 30 y 45 min, presentó un efecto estadísticamente significativo sobre el daño en el ADN, respecto de los espermatozoides no centrifugados (p<0.05). Además, se observó diferencia estadística significa (p<0.05) entre los espermatozoides centrifugados a diferentes tiempos con respecto al control positivo realizado con H2O2 (200 μM). La comparación de medias no indicó diferencia estadística significativa entre los espermatozoides no centrifugados y los centrifugados por un periodo de 10 y 30 min (p>0.05) en la reacción positiva a la prueba HOST, lo cual sí sucedió (p<0.05) al comparar los no centrifugados y los centrifugados por 45 min. El control positivo realizado con H2O2 presentó diferencia significativa (p<0.05) con el resto de los tratamientos. En conclusión, los resultados del presente trabajo sugieren que la centrifugación de los espermatozoides durante 10, 30 ó 45 min a 700 x g para la realización del gradiente diferencial de Percoll, tiene un efecto deletéreo sobre el ADN de los espermatozoides bovinos y que la centrifugación por 45 min además de causar daño en el ADN produce pérdida de la integridad de la membrana plasmática.

O objetivo de este estudo foi determinar se a integridade da membrana plasmática e o DNA dos espermatozóides podem ser afetados pela centrifugação realizada no processo de lavado e seleção. Os espermatozóides foram submetidos a diferentes tempos de centrifugação (10, 30 e 45 min); foi utilizado um controle negativo com espermatozóides não centrifugados e um controle positivo com espermatozóides submetidos a estresse oxidativo com peróxido de hidrogênio (H2O2) (200 μM). Para avaliar a integridade da membrana foi utilizado o teste hipoosmótica (HOST) e para avaliar a fragmentação do DNA Fo utilizado o ensaio cometa: A análise estatística se realizou mediante o teste de Fisher. A centrifugação durante 10, 30 e 45 min, apresentou um efeito estatisticamente significativo sobre o dano no DNA, em relação aos espermatozóides não centrifugados (p<0.05). Além disto, observou-se diferença estatisticamente significativa (p<0.05) entre os espermatozóides centrifugados a diferentes tempos em relação ao controle positivo realizado com H2O2 (200 μM). A comparação de medias não detectou diferença estatisticamente significativa entre os espermatozóides não centrifugados e os centrifugados por um período de 10 e 30 min (p>0.05) na reação positiva à prova HOST, o qual ocorreu ao comparar os não centrifugados e os centrifugados por 45 min (p<0,05). O controle positivo realizado com H2O2 apresentou diferença significativa (p<0.05) quando comparado contra os outros tratamentos. Em conclusão, os resultados do presente trabalho sugerem que a centrifugação dos espermatozóides durante 10, 30 ou 45 min a 700 x g para realização do gradiente diferencial de percoll, têm um efeito deletério sobre o DNA dos espermatozóides bovinos e que a centrifugação por 45 min além de causar dano no DNA produz perda da integridade da membrana plasmática.

The aim of this study was to evaluate the effects of different times of centrifugation on plasma membrane integrity and DNA of bovine sperm cells, by means of the hyposmotic test (HOST) and the comet assay, respectively. The sperm cells were centrifuged at 700 x g for 10, 30 or 45 min. No-centrifuged thawed semen served as negative control whereas hydrogen peroxide (H2O2) (200 mM) treated sperm cells were used as a positive control. The results indicate that while the integrity of the plasma membrane was not affected by centrifugation, bovine sperm DNA was damaged independently of centrifugation times. Significant differences between negative control and treatments were found (p<0.05) and in the same way, between treatments and positive control, where the damage for oxidative stress was greater. These results indicate that centrifugation could be detrimental for in vitro bovine embryo production. Additionally, some grade of DNA fragmentation in not centrifuged sperm cells (negative control) was registered, suggesting that DNA of bovine sperm cells could be affected by other factors, probably freezing procedure.