Icteric Variant of Stauffer Syndrome as a Paraneoplastic Manifestation of Type 1 Papillary Renal Cell Carcinoma.

Intrahepatic cholestasis as a paraneoplastic manifestation was first described by Dr. Maurice H. Stauffer in 1961. This paraneoplastic manifestation was primarily associated with renal cell carcinoma characterized by abnormal liver enzymes without hepatic metastasis. Stauffer syndrome is classified into 2 types: classical and jaundice variants. Indeed, the jaundice variant is extremely rare and only described in 13 published cases. We report a case of intrahepatic cholestasis associated with a type 1 papillary renal cell carcinoma with complete resolution after surgical treatment.

A good death: non-negotiable personal conditions for clinicians, healthcare administrators and support staff.

OBJECTIVES: To ask all clinical, administrative and support staff affiliated with a large network of healthcare facilities to identify the conditions that they consider as non-negotiable for their own deaths to be regarded as good. METHODS: All 3495 staff of a healthcare network were asked to rank 10 conditions according to how non-negotiable they would be for themselves during their final 3 months or few hours for their own deaths to be considered as good. They were also asked about whether they had thought about their own death in the last 3 months, if they had a will, believed in God, and in the possibility of a good death, and the intensity of their fear of death. RESULTS: 2971 (85%) completed the survey. Most were female (79%) and clinical staff (65%). 93% believed in God, 60% had thought about their death recently, 33% had an intense fear of death, and 4% had a will. 64% considered a good death possible. Participants ranked dying at a preferred place, emotional support from family and friends and relief from physical symptoms as their top priorities. The lowest ranked conditions were (from the bottom) relief from psychological distress, performance of rituals and the right to terminate life. There were no statistically significant differences across genders or individual occupational groups. CONCLUSION: Most of conditions for a good death of interest to healthcare professionals could be provided without sophisticated medical infrastructure or specialised knowledge, opening the door for new support services to make it possible for everyone, anywhere.

Explanatory model of symptoms of stress, anxiety and depression in the general population: Cross-sectional study during the COVID-19 pandemic.

COVID-19 pandemic has had a great impact worldwide, specially affecting mental health and has undoubtedly taken part in human behaviour modification, increasing global health burden and with stress, anxiety and depression being the main contributors to this load. Because of the importance of this issue, the objective of this study was the creation of an explanatory model for the causal relationship of the main psychological variables: stress, anxiety and depression in the COVID-19 pandemic context. A cross-sectional study was carried out with a sample of 709 volunteers, sociodemographic variables and psychological symptoms were measured through a virtual DASS-21 questionnaire, during the COVID-19 pandemic, dated from November 2 to 6, 2020. A structural equation model using the weighted least squares means and the adjusted variance was employed for the creation and adjustment of the explanatory relational model. The results showed the presence of stress, anxiety and depression symptoms among the general population. The model showed an adequate fit (CFI = 0.94; TLI = 0.94; RMSEA = 0.06; P = 0.000) and was able to explain more than 80% of depressive symptoms (R2 = 0.86) and more than 70% of anxiety symptoms (R2 = 0.72), in addition to showing a unidirectional causal relationship of long-term stress on anxiety, and anxiety on depressive symptoms, showing a linked behaviour of the same, in the adjusted model. It was also outlined that this model was characterized by being expressed mainly in women, with lower quality of sleep and at a younger age.

Microglial depletion abolishes ischemic preconditioning in white matter.

Ischemic preconditioning (IPC) is a phenomenon whereby a brief, non-injurious ischemic exposure enhances tolerance to a subsequent ischemic challenge. The mechanism of IPC has mainly been studied in rodent stroke models where gray matter (GM) constitutes about 85% of the cerebrum. In humans, white matter (WM) is 50% of cerebral volume and is a critical component of stroke damage. We developed a novel CNS WM IPC model using the mouse optic nerve (MON) and identified the involved immune signaling pathways. Here we tested the hypothesis that microglia are necessary for WM IPC. Microglia were depleted by treatment with the colony stimulating factor 1 receptor (CSF1R) inhibitor PLX5622. MONs were exposed to transient ischemia in vivo, acutely isolated 72 h later, and subjected to oxygen-glucose deprivation (OGD) to simulate a severe ischemic injury (i.e., stroke). Functional and structural axonal recovery was assessed by recording compound action potentials (CAPs) and by microscopy using quantitative stereology. Microglia depletion eliminated IPC-mediated protection. In control mice, CAP recovery was improved in preconditioned MONs compared with non-preconditioned MONs, however, in PLX5622-treated mice, we observed no difference in CAP recovery between preconditioned and non-preconditioned MONs. Microgliadepletion also abolished IPC protective effects on axonal integrity and survival of mature (APC+ ) oligodendrocytes after OGD. IPC-mediated protection was independent of retinal injury suggesting it results from mechanistic processes intrinsic to ischemia-exposed WM. We conclude that preconditioned microglia are critical for IPC in WM. The "preconditioned microglia" phenotype might protect against other CNS pathologies and is a neurotherapeutic horizon worth exploring.

Comparison of different prognostic scores for patients with cirrhosis hospitalized with SARS-CoV-2 infection.

INTRODUCTION AND OBJECTIVES: Viral infections have been described to increase the risk of decompensation in patients with cirrhosis. We aimed to determine the effect of SARS-CoV-2 infection on outcome of hospitalized patients with cirrhosis and to compare the performance of different prognostic models for predicting mortality. PATIENTS: We performed a prospective cohort study including 2211 hospitalized patients with confirmed SARS-CoV-2 infection from April 15, 2020 through October 1, 2020 in 38 Hospitals from 11 Latin American countries. We registered clinical and laboratory parameters of patients with and without cirrhosis. All patients were followed until discharge or death. We evaluated the prognostic performance of different scoring systems to predict mortality in patients with cirrhosis using ROC curves. RESULTS: Overall, 4.6% (CI 3.7-5.6) subjects had cirrhosis (n = 96). Baseline Child-Turcotte-Pugh (CTP) class was assessed: CTP-A (23%), CTP-B (45%) and CTP-C (32%); median MELD-Na score was 19 (IQR 14-25). Mortality was 47% in patients with cirrhosis and 16% in patients without cirrhosis (P < .0001). Cirrhosis was independently associated with death [OR 3.1 (CI 1.9-4.8); P < .0001], adjusted by age, gender, and body mass index >30. The areas under the ROC curves for performance evaluation in predicting 28-days mortality for Chronic Liver Failure Consortium (CLIF-C), North American Consortium for the Study of End-Stage Liver Disease (NACSELD), CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < .0001). CONCLUSIONS: SARS-CoV-2 infection is associated with elevated mortality in patients with cirrhosis. CLIF-C had better performance in predicting mortality than NACSELD, CTP and MELD-Na in patients with cirrhosis and SARS-CoV-2 infection. Clinicaltrials.gov:NCT04358380.

Identification of Odor Blend Used by Caenorhabditis elegans for Pathogen Recognition.

Animals have evolved specialized pathways to detect appropriate food sources and avoid harmful ones. Caenorhabditis elegans can distinguish among the odors of various species of bacteria, its major food source, but little is known about what specific chemical cue or combination of chemical cues C. elegans uses to detect and recognize different microbes. Here, we examine the strong innate attraction of C. elegans for the odor of the pathogenic bacterium, Serratia marcescens. This initial attraction likely facilitates ingestion and infection of the C. elegans host. Using solid-phase microextraction and gas chromatography coupled with mass spectrometry, we identify 5 volatile odors released by S. marcescens and identify those that are attractive to C. elegans. We use genetic methods to show that the amphid chemosensory neuron, AWCON, senses both S. marcescens-released 2-butanone and acetone and drives attraction to S. marcescens. In C. elegans, pairing a single odorant with food deprivation results in a reduced attractive response for that specific odor. We find that pairing the natural odor of S. marcescens with food deprivation results in a reduced attraction for the natural odor of S. marcescens and a similar reduced attraction for the synthetic blend of acetone and 2-butanone. This result indicates that only 2 odorants represent the more complex odor bouquet of S. marcescens. Although bacterial-released volatiles have long been known to be attractive to C. elegans, this study defines for the first time specific volatile cues that represent a particular bacterium to C. elegans.

Propranolol en el tratamiento del hemangioma periocular: Presentación de un caso clínico / Propranolol in the treatment of periocular haemangioma: A clinical case

Los hemangiomas infantiles (HI) son los más comunes tumores vasculares benignos de la infancia. Más del 60% de HI ocurren en la cara, cabeza y cuello. Aunque son benignos, la localización en los párpados, punta nasal, labios y oídos pueden poner en peligro la respiración, la alimentación y la visión u ocasionar la desfiguración irreversible. El sangrado, la ulceración y la infección pueden ocurrir en hasta el 20% de los casos. Estudios anteriores han revelado que el propranolol, timolol y nadolol son eficaces en el tratamiento de los hemangiomas cutáneos, orbitales, hepáticos y subglóticos. La ambliopía es la preocupación principal por la deprivación del estímulo, produciendo anisometropía, estrabismo secundario o desplazamiento del globo ocular. Se presenta el caso de una paciente con diagnóstico de HI pericoular a quien se indicó tratamiento con Propranolol a 2mg/kg/día en los 6 primeros meses de vida.

Infantile haemangiomas (IH) are the most common benign vascular tumors of childhood. More than 60% of IH occur on the face, head and neck. Although they are benign, the location on the eyelids, tip of the nose, lips and ears can endanger breathing, feeding and vision or lead to irreversible disfigurement. Bleeding, ulceration and subsequent infection can occur in up to 20% of cases. Previous studies revealed that propranolol, nadolol and timolol are effective as treatment of cutaneous, orbital, subglottic and liver hemangiomas. Amblyopia is the primary concern due to the deprivation of the stimulus, producing anisometropia secondary strabismus or displacement of the eyeball. We present the case of a patient with the diagnosis of periocular IH, who was treated with propranolol, 2mg/kg/day during the 6 first months of life.

An education and motivation intervention to change clinical management of the third stage of labor - the GIRMMAHP Initiative.

BACKGROUND: Hemorrhage and hypertensive disorders are major contributors to death after delivery in developing countries. The GIRMMAHP Initiative was designed to describe the actual delivery care in five Latin American countries and to educate and motivate clinical staff at 17 hospitals with the purpose of implementing their own clinical practice guidelines to prevent postpartum hemorrhage. METHODS: A multicountry education intervention was developed in four consecutive stages, using two analyses: (a) an observational study of the clinical records in eight teaching and nine nonteaching hospitals and (b) a study of the long-term changes measured 12 months after completion of an education intervention and writing a local clinical guideline. RESULTS: Data from 2,247 pregnant women showed that only 23.3 percent had an active management of the third stage of labor and that 22.7 percent received no prenatal care visit. These data were used to prepare local clinical practice guidelines in each participant hospital. The proportion of active management increased to 72.6 percent of deliveries at 3 months and 58.7 percent 1 year later. Use of oxytocin during the third stage of labor increased to 85.9 percent of included deliveries. The proportion of women who had postpartum hemorrhage decreased from 12.7 percent at baseline to 5 percent at 1 year after the intervention. CONCLUSIONS: An education intervention and discussion of actual clinical practice problems with health professionals and their involvement in drafting clinical guidelines helped improve health care quality and practitioners' adherence to these guidelines.

Sintomas emocionales y accidentes en niños

Objetivo:determinar la asociación entre síntomas emocionales previos y la presentación de traumatismos moderados en niños. Metodología: se trata de un estudio piloto de corte, de casos y controles con 50 pacientes. Los pacientes consultaron por una fractura de miembros, el traumatismo de intensidad intermedia más frecuente, se aplicó una entrevista protocolo y un listado de síntomas que agrupa por síndromes los síntomas emocionales detectados. Resultados: se encontró una relación significativa entre las dos variables con una prevalencia del 36 por ciento, igualmente cada uno de los síntomas emocionales y del comportamiento pueden exponer a un niño a sufrir un traumatismo por accidente.

Intento de suicidio en el Hospital Pediátrico

Objetivo: describir algunas variables significativas en un grupo de 25 pacientes, cuya edad fue de 13 años en promedio, quienes consultaron al Servicio de Urgencias del Hospital Pediátrico Universitario de la Misericordia, por intento de suicidio, entre febrero de 1991 y febrero de 1993. Método: se incluyeron los datos de los pacientes en una encuesta especialmente diseñada para atenderlos, la cual se aplicó luego de las primeras 24 horas del intento. Conclusiones: la tristeza y los problemas familiares son los motivos que más alta frecuencia presentan en el grupo. Los conflictos que afrontan estos pacientes son crónicos y se comportan como multicausales del intento. No se encontró consumo de sustancias psicoactivas.

Tétanos Neónatal / Neonatal tetanus

El Dr.Hiroshi Nakajima,director general de la OMS dijo con motivo de la Cumbre Mundial de la Infancia: "Es preciso reconocer que la mayorparte de los grandes problemas de salud y de mortalidad prematura del mundo podrían prevenirse mediante algunos cambios el comportamiento humano a un bajo costo.Disponemos de los conocimientos y la tecnología necesarios, pero es preciso trnsformarlos en acciones eficaces a escala comunitaria. Los padres y las familias,debidamente respaldados, podrían salvar la vida de dos terceras partes de los 14millones de niños que mueren cada año, si dispusieran de una información adecuada.

Sindrome de Seckel y atresia intestinal múltiple / Seckel's syndrome and multiple intestinal atresia

Se describe una familia en la cual hijo e hija presentan las características clínicas consideradas como típicas del síndrome de Seckel, el propositus presentó además atresia intestinal múltiple de yeyuno. Se menciona la utilidad de realizar el perfil somatométrico para evaluar el crecimiento y desarrollo de estos pacientes; así mismo se analiza el diagnóstico diferencial con otros tipos de microcefalia tanto de origen genético como no genético y finalmente se discute la importancia de establecer un diagnóstico correcto, así como conocer la forma de transmisión hereditaria a fin de impartir un asesoramiento genético adecuado.

Correlación de los antecedentes obstétricos con la mortalidad neonatal / Correlation between obstetric antecedentes and neonatal mortality

Se presenta el análisis de 370 productos que fallecieron en la etapa neonatal en el Hospital de Ginecoobstetricia del Centro Médico "La Raza". Hubo antecedentes maternos patológicos en el 90%, entre los que se incluyen edad no óptima para procreación en 23%; baja escolaridad en 54% la primera gesta en 20% y gran multiparidad en 11%. Durante la gestación hubo toxemia en 15%, problemas placentarios en 23%, trabajo de parto prematuro en 12%, y ruptura prematura de membranas en 26%. Se consideró como causa primaria de la defunción la inmadurez en 38%, prematurez en 36%, con la mitad de los casos con síndrome de insuficiencia respiratoria idiopática; hemorragia intraventricular en 20%, hemorragia pulmonar 11%; infección en 17% y malformaciones mayores en 10.7%. Se subraya la conveniencia del conocimiento de estas características para una mejor planificación de la asistencia a la gestante y finalmente se hacen recomendaciones de manejo

Modelo de equilibrio químico para las aguas del lago Titicaca

El presente trabajo,se sugiere un modelo de equilibrio quimico, para calcular la distribucion de especies en las aguas del lago Titicaca, usando medidas de concentracion temperatura y pH.Con este objetivo, se utiliza el balance masico las especies de las especies analizadas en conjuncion con las constantes de equilibrio que involucran estas especies. Se recalca la importancia de los "pares ionicos" y su considerable influencia en la estabilidad ermodinamica de especies minerales en solucion acuosa. Finalmente, mediante un calculode iterecion, que puede ser acondicionado para un programa de computacion, se aplica el modelo,a un punto de muestreo del lago Titicaca obteniendose resultados bastante satisfactorios.

Separación de estaño de hojalata por eloctrolísis

La Termodinamica, eficaz instrumento de la Quimica experimental, ha sido frecuentemente limitada al estudio de reacciones en fase gaseosa y a la determnacion de la direccion y posibilidad de reacciones quimicas en general; sin embargo puede tambien ser usada en la solucion de problemas de otros campos, particularmente en algunas reacciones que ocurren en solucion acuosa y en las que los potenciales electricos entran en juego, por ej. reacciones de oxido-reduccion,fenomenos de electrolisis, corrosion, pasivacion, etc. Como una ayuda para interpretar los datos termodinamicos, Pourbaix ideo la representacion grafica potencial -pH, que consiste en graficar los potenciales reversibles de las ecuaciones que gobiernan los diversos equilibrios en un sistema acuoso contra el pH. En el presente trabajo se hace enfasis fundamentalmente en la construccion de diagrama Pourbaix para el sistema Estaño-Agua y su posterior aplicacion en la interpretacon del comportamiento electrolitico del estaño. Finalmente se realizala electrolisis de una solucion alcalina de hojalata (botes de deshecho) como proceso experimental para corroborar lo establecido teoricamente.