Cross-sectional characteristics of pediatric-onset discoid lupus erythematosus: Results of a multicenter, retrospective cohort study.

BACKGROUND: The incidence of systemic lupus in children with discoid lupus is unknown. OBJECTIVE: This study assessed the baseline characteristics of patients with pediatric discoid lupus erythematosus (pDLE). METHODS: Medical records at 17 sites were reviewed for pediatric dermatology and rheumatology patients with discoid lupus erythematosus. The inclusion criteria were clinical and/or histopathologic diagnosis of discoid lupus erythematosus with an age at onset of <18 years. Baseline data were collected at the first documented visit. Outcomes included diagnosis of systemic lupus erythematosus (SLE) at the baseline visit using the 1997 American College of Rheumatology (primary) and the 2012 Systemic Lupus International Collaborating Clinics (secondary) criteria. RESULTS: Of the >1500 charts reviewed, 438 patients met the inclusion criteria. The cohort was predominantly female (72%) and racially/ethnically diverse. A diagnosis of SLE at the baseline visit (pDLE + SLE) was rendered in 162 (37%) patients using the American College of Rheumatology and in 181 (41%) patients using the Systemic Lupus International Collaborating Clinics criteria. Patients with pDLE + SLE were older at the time of rash onset (median, 12.9 vs 8.9 years; P < .001), with shorter time from discoid lupus erythematosus onset to diagnosis, compared with patients with pDLE-only (median, 2 vs 7 months; P < .001). Patients with pDLE + SLE were more likely to be female (P = .004), with generalized discoid lupus erythematosus and clinically aggressive disease, including end-organ involvement, positive serologies, and higher- titer levels of antinuclear antibodies (P < .001). LIMITATIONS: Retrospective study. CONCLUSION: A diagnosis of discoid lupus erythematosus in adolescence should prompt thorough screening for SLE.

Clinical characteristics of vulnerable populations hospitalized and diagnosed with COVID-19 in Buenos Aires, Argentina.

There is not in Argentina publications regarding the presentation of patients with COVID-19 requiring hospitalized and emergency care in vulnerable populations (lower incomes and less education tend at greater risk for poor health status and healthcare access), and it has few reports in developing countries. The objective is to determine whether in the care of vulnerable patients, to succeed against COVID-19, multiple public health tools and interventions will be needed to minimize morbidity and mortality. The study is a prospective cohort investigation of patients with lab-confirmed COVID-19, who required to any of the Health Centers response from April 8, 2020, to August 18, 2020. In Buenos Aires Metropolitan Area (AMBA), April 8, 2020 the virus was identified in patients hospitalized in the "Southeast Network" (SN), AMBA. SN covering an area of 661 square kilometers, with 1.8 million inhabitants residing in urban, and rural areas. A total of 14 health centers with different levels of care complexity provide care to patients in the region. The information of each patient with COVID-19 evaluated by SN, was incorporated in an Epidemiological Dashboard. The investigation was designed and reported with consideration of observational studies in epidemiology. We describe the hospitals presentation and care of persons who required SN response and were ultimately diagnosed with COVID-19. From April 8, 2020, to August 18, 2020, were included 1495 patients with lab-confirmed COVID-19 in SN. A total of 58% patients were men, and the mean age (SD) was 48.9 (15.59) years. Eighty one percent patients with pre-existing diseases, most frequent hypertension and diabetes, but hypertension, chronic lung disease, and cardiovascular disease presented higher risk. A total of 13% were hospitalized in Intensive Therapy Unit. The mortality of the cohort was 9.77%. Mortality was higher for patients aged 65 or more (OR 5.09), and for those had some pre-existing disease (OR 2.61). Our observations are consistent with reports demonstrating older persons, and those with comorbidities have the highest risk of mortality related to COVID-19. However, unlike other reports from developed or some developing countries, the mortality in our study is lower. This finding may be related to age of our cohort is younger than other published. Also, the health system was able to respond to the demand.

Platelet Rich Plasma for Chronic Synovitis Treatment in Patients with Haemophilia.

INTRODUCTION: Haemophilic synovitis is caused by chronic accumulation of blood in the joint. Conservative treatment is insufficient to solve this pathology. Platelet-rich plasma (PRP) has a high concentration of growth factors (GFs) that play a key role in regulation and stimulation of healing processes. The aim of this study was to describe the effect of PRP injection in chronic synovitis of the joints in patients with haemophilia (PWH). PATIENTS AND METHODS: Nineteen patients with 28 joints were treated at our centre in Buenos Aires, Argentina between December 2014 and December 2015. Eighteen were Haemophilia type A (17 severe, one mild) and one was type B severe. Mean age was 26 years old. Chronic synovitis was present in two ankles, seven elbows and 19 knee joints. All affected joints were evaluated for range of motion (ROM), perimeter, Haemophilia Joint Health Score (HJHS), number of bleedings episodes and Visual Analogue Scale (VAS). Evaluations were before treatment and 3 and 6 months after treatment. RESULTS: A mean volume of 4 mL of PRP was injected into the joint cavity. The statistical analysis before and after treatments revealed a statistically significant (P < 0.001) decrease in the HJHS score. Decrease in joint bleeding episodes was also statistically significant (P < 0.001). All patients reported pain relief and VAS scores were statistically significant (P < 0.001). Joint perimeter also showed a statistically significant difference (P < 0.001). No complications were observed in any of the patients, either during blood collection or during PRP injection, even for inhibitor patients. CONCLUSION: Platelet-rich plasma is a useful, safe, and inexpensive treatment for chronic haemophilic synovitis.

Revised diagnostic criteria for neurocysticercosis.

BACKGROUND: A unified set of criteria for neurocysticercosis (NCC) has helped to standardize its diagnosis in different settings. METHODS: Cysticercosis experts were convened to update current diagnostic criteria for NCC according to two principles: neuroimaging studies are essential for diagnosis, and all other information provides indirect evidence favoring the diagnosis. Recent diagnostic advances were incorporated to this revised set. RESULTS: This revised set is structured in absolute, neuroimaging and clinical/exposure criteria. Absolute criteria include: histological confirmation of parasites, evidence of subretinal cysts, and demonstration of the scolex within a cyst. Neuroimaging criteria are categorized as major (cystic lesions without scolex, enhancing lesions, multilobulated cysts, and calcifications), confirmative (resolution of cysts after cysticidal drug therapy, spontaneous resolution of single enhancing lesions, and migrating ventricular cysts on sequential neuroimaging studies) and minor (hydrocephalus and leptomeningeal enhancement). Clinical/exposure criteria include: detection of anticysticercal antibodies or cysticercal antigens by well-standardized tests, systemic cysticercosis, evidence of a household Taenia carrier, suggestive clinical manifestations, and residency in endemic areas. Besides patients having absolute criteria, definitive diagnosis can be made in those having two major neuroimaging criteria (or one major plus one confirmative criteria) plus exposure. For patients presenting with one major and one minor neuroimaging criteria plus exposure, definitive diagnosis of NCC requires the exclusion of confounding pathologies. Probable diagnosis is reserved for individuals presenting with one neuroimaging criteria plus strong evidence of exposure. CONCLUSIONS: This revised set of diagnostic criteria provides simpler definitions and may facilitate its more uniform and widespread applicability in different scenarios.

Bases para establecer un sistema de vigilancia activa y respuesta rápida para el manejo de la morbilidad materna severa / Basis for establishing an active surveillance and rapid response system for the management of severe maternal morbity

La razón de mortalidad materna (RMM) se ha utilizado como indicador de salud sinconsiderar los eventos precedentes. La morbilidad materna severa (MMS) incluye amujeres con morbilidad asociada a un embarazo, que amenaza sus vidas pero quefinalmente permite la sobrevida.ObjetivosInvestigar la situación de la mortalidad materna (MM) y la MMS en Misiones, Jujuy yLa Rioja. Establecer bases para un sistema de vigilancia y manejo de casos.MétodosSe realizó un estudio multicéntrico de prevalencia con un componente de implementación.Mujeres embarazadas, tratadas en el subsector público entre el 1 de octubrede 2013 y el 31 de marzo de 2014, fueron tamizadas para detectar condicionespotencialmente fatales (CPF) y notificar MMS y MM.ResultadosSe analizaron 9 921 nacimientos. Ingresaron 294 mujeres, y hubo 219 (74,5%) casosde CPF, 67 (22,8%) de MMS y 8 (2,7%) de MM. Criterios de identificación por tamizaje:clínicos 78,1% de CPF, basados en enfermedad 94% de MMS, y 100% de MM presentóalgún criterio clínico. Las principales causas de MMS fueron hipertensión (35,8%),hemorragias (29,9%) y complicaciones de abortos (13,4%). La incidencia global deCPF fue 2,21%, la de MMS 0,68% y la de MM 0,08%. El índice de morbimortalidadglobal fue de 8,4 (4,0-7,4), la tasa de letalidad global fue del 10,7%, y el uso global deintervenciones beneficiosas para el manejo de MMS fue del 54,8%.ConclusionesEl estudio permitió conocer la MM y la MMS en las tresprovincias y sentar las bases para implementar un sistemade vigilancia activa y respuesta rápida para el manejode la MMS, consistente con el Plan Operativo Nacional

[Resistant gram-negative bacteria. Therapeutic approach and risk factors]. / Aproximación terapéutica empírica a la infección por gramnegativos resistentes. Valor de los factores de riesgo.

The rapid spread of multidrug-resistant bacteria has become a serious threat, especially in critical care units, thereby prolonging the hospital stay. Enterobacteriaceae have a high capacity to adapt to any environment. Plasmids are the reason behind their expansion. The choice of empiric therapy for intra-abdominal or urinary infections requires knowledge of the intrinsic microbiological variability of each hospital or critical care unit, as well as the source of infection, safety or antibiotic toxicity, interaction with other drugs, the dosage regimen and the presence of risk factors. Carbapenems are the drug of choice in the case of suspected infection by ESBL-producing Enterobacteriaceae. The new ceftazidime/avibactam and ceftolozane/tazobactam drugs are opening up promising new horizons in the treatment of multidrug-resistant Enterobacteriaceae.

Determination of 3-mercaptopropionic acid by HPLC: A sensitive method for environmental applications.

The organic sulfur compound 3-mercaptopropionic acid (3-MPA) is an important thiol intermediate in organic sulfur metabolism in natural environments. It is generated during degradation of sulfur-containing amino acids (e.g. methionine) and from demethylation of dimethylsulfoniopropionate (DMSP). This pathway is an alternative enzymatic process in the DMSP catabolism that routes sulfur away from the climatically-active dimethyl sulfide (DMS). 3-MPA detection and subsequent quantification in different matrices is difficult due to its extreme reactivity. We therefore developed a sensitive method for determination of 3-MPA based on pre-column derivatization with monobromobimane and analysis by high-performance liquid chromatography (HPLC) with fluorescence detection. This methodology was first tested with 3-MPA standards under low (0.005-0.2µmolL(-1)) and high (1-25µmolL(-1)) concentrations. For the optimization of the reaction, CHES and, alternatively, Tris-HCl buffers were evaluated in the derivatization step, with Tris-HCl showing more effective separation of thiol derivatives and a better 3-MPA peak shape. The detection limit was 4.3nmolL(-1) with a 10µL sample injection, and mean recoveries of 3-MPA ranged from 97 to 105% in estuarine waters with different salinities (0.17 and 35.9ppt). The linearity (r>0.99) and repeatability of detector response, with intra- and inter-day precision (% CV) of 2.68-7.01% and 4.86-12.5%, respectively, confirmed the reliability of the method. Previous 3-MPA analytical methods required immediate analysis due to unstable derivatives, but in this method we achieved high stability of the derivatized samples when stored at 4°C, with only a 3-5% loss after more than one year of storage. This method was successfully applied to measure 3-MPA concentrations and rates of 3-MPA production in a variety of intertidal estuarine sediment slurries. Dissolved 3-MPA concentrations in these sediment slurries varied between 2 and 237µmolL(-1) and, 3-MPA net fluxes ranged in wet sediments between -3.6±1.7 and 30±5µmolL(-1)g(-1)h(-1). Thus, the application of this optimized methodology showed an efficient performance for measuring 3-MPA in environmental samples, with a straightforward sample derivatization and a simple analysis of stable 3-MPA derivatives.

Shock séptico debido a la infección por Clostridium difficile adquirida en la comunidad. Estudio de un caso y revisión de la literatura / Septic shock due to a community acquired Clostridium difficile infection. A case study and a review of the literature

La epidemiología de la infección por Clostridium difficile ha cambiado en la última década, aumentando la incidencia de los casos adquiridos en la comunidad en pacientes sin factores de riesgo clásicos. Presentamos el caso de un varón con infección por Clostridium difficile adquirida en la comunidad que ingresó en nuestro centro por dolor abdominal agudo, y desarrolló un cuadro de insuficiencia renal aguda y shock séptico. Se describe el diagnóstico, tratamiento y evolución y se realiza una breve revisión de la bibliografía (AU)

The epidemiology of Clostridium difficile infection has changed in the past decade. The incidence rate of community acquired cases has increased in patients with no typical risk factors. We present a patient who was diagnosed with community-acquired Clostridium difficile infection who presented with acute abdominal pain, and subsequently developed acute renal failure and septic shock. We describe the diagnosis, treatment and outcome and brief review of the literature (AU)

[Septic shock due to a community acquired Clostridium difficile infection. A case study and a review of the literature]. / Shock séptico debido a la infección por Clostridium difficile adquirida en la comunidad. Estudio de un caso y revisión de la literatura.

The epidemiology of Clostridium difficile infection has changed in the past decade. The incidence rate of community acquired cases has increased in patients with no typical risk factors. We present a patient who was diagnosed with community-acquired Clostridium difficile infection who presented with acute abdominal pain, and subsequently developed acute renal failure and septic shock. We describe the diagnosis, treatment and outcome and brief review of the literature.

Effect of bariatric surgery on weight loss, inflammation, iron metabolism, and lipid profile.

BACKGROUND AND AIMS: Accumulating evidence indicates that a state of chronic inflammation has a crucial role in the pathogenesis of obesity-related metabolic dysfunction. This study aims to evaluate changes in inflammatory process, iron metabolism, erythropoiesis, and lipid profile associated with weight loss after gastric banding surgery. MATERIAL AND METHODS: A total of 46 patients were evaluated before and 3 months after gastric banding surgery. A survey was conducted to record demographic data, body mass index, and presence of comorbidities. Moreover, complete blood cell counts and serum levels of iron, ferritin, transferrin, high-sensitivity C-reactive protein, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides were performed. RESULTS: At a follow-up 3 months after surgery, our patients presented a significant decrease in weight and body mass index, associated with a decreased inflammatory process (decreased high-sensitivity C-reactive protein, neutrophil counts, and neutrophil:lymphocyte ratio), increased iron availability (increased transferrin saturation and a trend to higher iron serum levels), and significant decreased triglycerides and triglycerides:high-density lipoprotein-cholesterol ratio. CONCLUSIONS: Our results showed a significant decrease in the inflammation process 3 months after gastric banding surgery, associated with adipose tissue loss. This decrease in the inflammatory process is associated with more efficient iron absorption and increased iron availability for erythropoiesis. Moreover, we also found decreased triglyceride serum levels. These changes suggest benefits of weight loss, including decreased risk of cardiovascular disease.

Validación de udna estrategia destinada a la homologación de criterios para evaluación de caries / Validation of a strategy aimed to homologate criteria for caries assessment

Objetivo: validar la efectividad de una estrategia destinada a la homologación de criterios para la detección y evaluación del proceso de caries dental. Métodos: la estrategia implementada desarrolla un protocolo consistente en: a) clase expositiva (4 hs.) con apoyo visual, destinada al reconocimiento de las categorías etablecidas en el ICDAS II (Pitts, 2005) y los puntos de corte entre las diferentes categorías; b) taller para el diagnóstico sobre piezas dentarias ex vivo, y discusión de los resultados con un investigador de referencia (Kappa >0,75), empleando los recursos instrumentales planteados por el sistema; y c) práctica clínica (20 hs) realizada sobre pacientes voluntarios que incluyó las siguientes fases: 1) asignación a cada operador de 6 personas que proporcionarán un número equilibrado de superficies dentarias con códigos ICDAS de 1 a 6; II) observación y registro en planilla ad hoc de los hallazgos a cargo de cada operador independiente; III) reevaluación de cada paciente a cargo del investigador de referencia; y IV) contrastación de los resultados entre el operador de referencia y cada operador independiente mediante el cálculo del coeficiente Kappa. Resultados: la actividad fue desarrollada por 26 odontólogos. Se analizaron 33100 superficies dentarias. Se determinó un Kappa global 0,77 (p<0,002), teniendo en cuenta los códigos de lesión 0 y un valor de 0,73 (p<0,002), sin tener en cuenta las superficies sanas. Un 57,69 por ciento de los operadores en entrenamiento obtuvieron valores de Kappa >0,7. Conclusión: la estrategia de entrenamiento teoría-práctica desarrollada resultó efectiva para la homologación de criterios destinados a la detección y evaluación del proceso de caries dental (ICDAS II)

Necesidad de tratamiento ortodóncico en escolares residentes en una comunidad rural: estudio preliminar / Orthodontic treatment need in a shoolchildren population from a rural community: a preliminary study

Los problemas de maloclusión se asocian con discriminación por apariencia, problemas oclusales, trastornos témporomandibulares, problemas de deglución, fonación, dificultad para la higiene bucal

Validación de udna estrategia destinada a la homologación de criterios para evaluación de caries / Validation of a strategy aimed to homologate criteria for caries assessment

Objetivo: validar la efectividad de una estrategia destinada a la homologación de criterios para la detección y evaluación del proceso de caries dental. Métodos: la estrategia implementada desarrolla un protocolo consistente en: a) clase expositiva (4 hs.) con apoyo visual, destinada al reconocimiento de las categorías etablecidas en el ICDAS II (Pitts, 2005) y los puntos de corte entre las diferentes categorías; b) taller para el diagnóstico sobre piezas dentarias ex vivo, y discusión de los resultados con un investigador de referencia (Kappa >0,75), empleando los recursos instrumentales planteados por el sistema; y c) práctica clínica (20 hs) realizada sobre pacientes voluntarios que incluyó las siguientes fases: 1) asignación a cada operador de 6 personas que proporcionarán un número equilibrado de superficies dentarias con códigos ICDAS de 1 a 6; II) observación y registro en planilla ad hoc de los hallazgos a cargo de cada operador independiente; III) reevaluación de cada paciente a cargo del investigador de referencia; y IV) contrastación de los resultados entre el operador de referencia y cada operador independiente mediante el cálculo del coeficiente Kappa. Resultados: la actividad fue desarrollada por 26 odontólogos. Se analizaron 33100 superficies dentarias. Se determinó un Kappa global 0,77 (p<0,002), teniendo en cuenta los códigos de lesión 0 y un valor de 0,73 (p<0,002), sin tener en cuenta las superficies sanas. Un 57,69 por ciento de los operadores en entrenamiento obtuvieron valores de Kappa >0,7. Conclusión: la estrategia de entrenamiento teoría-práctica desarrollada resultó efectiva para la homologación de criterios destinados a la detección y evaluación del proceso de caries dental (ICDAS II)(AU)

Necesidad de tratamiento ortodóncico en escolares residentes en una comunidad rural: estudio preliminar / Orthodontic treatment need in a shoolchildren population from a rural community: a preliminary study

Los problemas de maloclusión se asocian con discriminación por apariencia, problemas oclusales, trastornos témporomandibulares, problemas de deglución, fonación, dificultad para la higiene bucal(AU)

Concurrent Koro and Cotard syndromes in a Spanish male patient with a psychotic depression and cerebrovascular disease.

Koro and Cotard syndromes are uncommon conditions described in a variety of psychiatric and medical disorders. The authors report the third case of a simultaneous presentation of both syndromes, in a 62-year-old inpatient Spanish male with major depressive disorder with psychotic features, parkinsonism and cognitive impairment. A discussion of the literature and the possible relationship between both syndromes and other neuropsychiatric disorders are presented.

The Brazilian database on pregnancy in multiple sclerosis.

OBJECTIVES: To report the results from the Brazilian database on multiple sclerosis (MS) and pregnancy. METHODS: Retrospective data from MS patients who became pregnant at any time of their disease were sent to a Brazilian database, using a specific file for this purpose. RESULTS: Data on 128 women (142 pregnancies) from 30 neurologists working in 21 cities in Brazil were collected. Patients' average age at pregnancy was 29.8 years (range 16-42). EDSS at start of pregnancy was 1.5±1.4; and the relapse rate in the year preceding pregnancy was 1.2±1.5. Exposure to medication at any time during pregnancy was high (69.7%): 48.6% to interferon beta; 14.1% to glatiramer acetate; and 7% to other immunomodulatory and immunosuppressive drugs. There was a significant decrease in relapse rate during pregnancy. The prevalence of complications was relatively low, with 4.9% of obstetric and 1.4% neonatal unfavorable outcomes. CONCLUSIONS: Our patients had low degrees of disability, short histories of disease, high drug exposure, and relatively high relapse rate in the year previous to pregnancy. Obstetric and neonatal outcomes were successful in over 90% of our patients.

Gray matter volume deficits and correlation with insight and negative symptoms in first-psychotic-episode subjects.

OBJECTIVE: To determine brain areas reduced in first episode of psychotic subjects and its association with lack of insight and negative symptoms. METHOD: Twenty-one drug naive first-episode subjects and 20 controls underwent a structural MRI scan and were clinically assessed. Optimized voxel-based-morphometry analysis (VBM) was implemented to find between-group differences and correlations between GM volume and: (i) lack of insight and (ii) negative symptoms. RESULTS: Patients showed GM reduction in prefrontal and left temporal areas. A significant correlation was found between insight and GM volume in the cerebellum (corrected P = 0.01), inferior temporal gyrus (corrected P = 0.022), medial superior frontal gyrus (corrected P < 0.001), and inferior frontal gyrus (corrected P = 0.012), as the insight decreased, the volume decreased. Negative symptoms correlated with decreased GM volume at cerebellum (corrected P = 0.037) and frontal inferior regions (corrected P < 0.001), the more negative symptoms, the less volume. CONCLUSION: Our findings support an association between prefrontal, temporal, and cerebellar deficits and lack of insight in schizophrenia and confirm previous findings of GM deficits in patients since the first episode of psychosis.

"Global" and "local" predictions of dairy diet nutritional quality using near infrared reflectance spectroscopy.

The objective of the study was to evaluate performance of classic (global) and innovative (local) calibration techniques to monitor cattle diet, based on fecal near infrared reflectance spectroscopy (NIRS). A 3-yr on-farm survey (2005-2008) was carried out in Vietnam and La Reunion Island to collect animal, feed intake, and feces excretion data. Feed and feces were scanned by a Foss NIRsystem 5000 monochromator (Foss, Hillerød, Denmark) to estimate diet characteristics and nutrient digestibility. A data set including 1,322 diet-fecal pairs was built and used to perform global and local calibrations. Global equations gave satisfactory accuracy [coefficient of determination (R(2)) >0.8, 10% ≤ relative standard error of prediction (RSEP) ≤20%], whereas local equations gave good accuracy (R(2) >0.8, RSEP <10%) or excellent accuracy (R(2) >0.9, RSEP <10%) for the prediction of diet intake, quality, and digestibility. When validating the equations using the external individual data, both techniques were robust, with similar RSEP (8%) and R(2) (0.82) values. The predictive performance of global and local equations was improved (RSEP = 5% and R(2)=0.90) when averaged animal data from farm, visit, and similar milk production were used. In particular, local equations reduced RSEP by 43% and increased R(2) by 15%, on average, compared with those obtained from individual data. The low RSEP (4%), high R(2) (0.96), and good ratio performance deviation (RPD=5) illustrated the excellent accuracy and robustness of the local equations. Findings suggest the ability of fecal NIRS to successfully and more accurately predict diet properties (intake, quality, and digestibility) with local calibration techniques compared with classic global techniques, especially on an averaged data set. Local calibration techniques represent an alternative promising method and potentially a decision support tool to decide whether diets meet dairy cattle requirements or need to be modified.