Detection of SARS-CoV-2 in aerosols in long term care facilities and other indoor spaces with known COVID-19 outbreaks.

Coronavirus outbreaks are likely to occur in crowded and congregate indoor spaces, and their effects are most severe in vulnerable long term care facilities (LTCFs) residents. Public health officers benefit from tools that allow them to control COVID-19 outbreaks in vulnerable settings such as LTCFs, but which could be translated in the future to control other known and future virus outbreaks. This study aims to develop and test a methodology based on detection of SARS-CoV-2 in aerosol samples collected with personal pumps that could be easily implemented by public health officers. The proposed methodology was used to investigate the levels of SARS-CoV-2 in aerosol in indoor settings, mainly focusing on LTCFs, suffering COVID-19 outbreaks, or in the presence of known COVID-19 cases, and targeting the initial days after diagnosis. Aerosol samples (N = 18) were collected between November 2020 and March 2022 in Castelló (Spain) from LTCFs, merchant ships and a private home with recently infected COVID-19 cases. Sampling was performed for 24-h, onto 47 mm polytetrafluoroethylene (PTFE) and quartz filters, connected to personal pumps at 2 and 4 L/min respectively. RNA from filters was extracted and SARS-CoV-2 was determined by detection of regions N1 and N2 of the nucleocapsid gene alongside the E gene using RT-PCR technique. SARS-CoV-2 genetic material was detected in 87.5% samples. Concentrations ranged ND-19,525 gc/m3 (gene E). No genetic traces were detected in rooms from contacts that were isolated as a preventative measure. Very high levels were also measured at locations with poor ventilation. Aerosol measurement conducted with the proposed methodology provided useful information to public health officers and contributed to manage and control 12 different COVID-19 outbreaks. SARS-CoV-2 was detected in aerosol samples collected during outbreaks in congregate spaces. Indoor aerosol sampling is a useful tool in the early detection and management of COVID-19 outbreaks and supports epidemiological investigations.

Clinical factors predictive for histological aggressiveness of basal cell carcinoma: A prospective study of 2274 cases.

INTRODUCTION: Since surgery is the first-line treatment for basal cell carcinomas (BCC), the histological aggressiveness of the disease must be clinically predicted in order to apply optimal safety margins that ensure a high rate of complete resection while minimising the risk of recurrence. OBJECTIVES: To evaluate clinical predictive factors of histological aggressiveness of BCC, we conducted a national prospective multi-centre study. METHODS: All consecutive patients presenting for BCC surgery were included, and standardised clinical data collected, and slides were submitted for review. Trabecular, micronodular and morpheaform BCCs were classified as aggressive. RESULTS: Of the 2710 cases included, 2274 were histologically confirmed. Clinical subtyping was correct in 49.9% of superficial BCCs, 86.2% of nodular BCCs and only 22% of aggressive BCCs. By multivariate analysis, aggressive BCCs were more frequently ulcerated (45%), indurated (70%), showed adherence (8.6%), and were associated with high-risk anatomical zones (50.3%, P<0.0001). These predictive clinical features may be helpful for decision making.

Valor pronóstico del recuento de leucocitos y plaquetas, en tumores testiculares de células germinales / Leukocyte and platelet counts as prognostic values of testicular germ cell tumors

Introduction: The immune system plays an essential role in the organism's response to cancer. Several hematological markers can influence prognosis and survival of patients. The objective of this study is to determine their prognostic value in testicular germ cell tumors. Material and methods: Retrospective cohort study on 164 patients with germ cell tumors. Clinical, analytical, histological and evolutionary data were collected. The absolute neutrophil and absolute platelet counts, neutrophil-lymphocyte (NLR), platelet-lymphocyte and lymphocyte-monocyte ratios were estimated at diagnosis. The association that these markers can have with the classic prognostic factors, as well as their effect on prognosis and survival, have been analyzed. Results: 17.7% had NLR > 4 and 14.6% ANC > 8000/μL. These patients presented higher percentages of residual disease and stage II-III tumors. Patients with elevated absolute neutrophil showed also higher percentages of progression and exitus. 7.3% presented absolute platelet > 400,000/μL. These patients obtained higher rates of residual disease, nonseminomatous and stage III tumors. 28.4% showed platelet-lymphocyte values > 150. This data was associated to higher percentages of residual disease, progression, stage II and III tumors and seminomatous tumors. 83.3% had a lymphocyte-monocyte > 3. These patients presented: higher tumor markers in normal range, decreased residual disease rates and higher percentages of stage I and II tumors. The mean survival time was shorter in patients with NLR > 4 and absolute neutrophil > 8000/μL. The ROC curves showed significance in the prediction of progression and values of lymphocyte-monocyte >3, and prediction of survival and values NLR > 4. Conclusion: Our results indicate that the analyzed hematological markers are associated with poor prognoses at diagnosis. Therefore, their use in daily clinical practice can be a valuable tool in the diagnosis and prognosis of patients with testicular germ cell tumors

Introducción: El sistema inmune ejerce un papel clave en la respuesta del organismo frente al cáncer. Existen diversos marcadores hematológicos que pueden influir en el pronóstico y supervivencia de los pacientes. El objetivo de este estudio es determinar su valor pronóstico en tumores testiculares de células germinales. Material y métodos: Estudio de cohortes retrospectivo sobre 164 pacientes con tumores testiculares de células germinales. Se recogieron datos clínicos, analíticos, histológicos y evolutivos. Se estimaron, al diagnóstico, el recuento total de neutrófilos y plaquetas, la ratio neutrófilo-linfocito (RN/L), plaqueta-linfocito(RP/L) y linfocito-monocito (RL/M). Se analizó la relación que estos marcadores pueden tener sobre los factores pronósticos clásicos, así como sobre el pronóstico y supervivencia. Resultados: Un 17,7% tuvieron una RN/L > 4 y un 14,6% un RNT > 8000/μL. Estos enfermos, presentaron mayor porcentaje de enfermedad residual y tumores en estadios II y III. Los enfermos con recuento total de neutrófilos elevado también tuvieron mayor porcentaje de progresión y éxitus. Un 7,3%, tenían un recuento total de plaquetas > 400000/μL. Estos enfermos tuvieron un mayor porcentaje de tumores no seminomatosos, de enfermedad residual y tumores en estadio III. El 28,4% mostraron valores RP/L>150, asociándose este dato a mayor porcentaje de tumores seminomatosos, enfermedad residual, estadios II y III y progresión. El 83,3% tuvieron una RL/M > 3. Estos enfermos presentaron: mayor porcentaje de marcadores tumorales en rango normal, menor porcentaje de enfermedad residual y mayor porcentaje de pacientes en estadio I y II. El tiempo medio de supervivencia fue menor en pacientes con RN/L > 4 y con recuento total de neutrófilos > 8.000/μL. Las curvas ROC mostraron significación en la predicción de progresión y valores de RL/M > 3, y predicción de supervivencia y valores RN/L > 4. Conclusión: Nuestros resultados indican que los marcadores hematológicos analizados se asocian situaciones de mal pronóstico en el momento del diagnóstico. Por tanto, su utilización en la práctica clínica diaria puede ser considerada como una herramienta más en el diagnóstico y pronóstico de pacientes con tumores testiculares de células germinales de testículo

Leukocyte and platelet counts as prognostic values of testicular germ cell tumours. / Valor pronóstico del recuento de leucocitos y plaquetas, en tumores testiculares de células germinales.

INTRODUCTION: The immune system plays an essential role in the organism's response to cancer. Several haematological markers can influence prognosis and survival of patients. The objective of this study is to determine their prognostic value in testicular germ cell tumours. MATERIAL AND METHODS: Retrospective cohort study on 164 patients with germ cell tumours. Clinical, analytical, histological and evolutionary data were collected. The absolute neutrophil and absolute platelet counts, neutrophil-lymphocyte (NLR), platelet-lymphocyte and lymphocyte-monocyte ratios were estimated at diagnosis. The association that these markers can have with the classic prognostic factors, as well as their effect on prognosis and survival, have been analysed. RESULTS: 17.7% had NLR>4 and 14.6% ANC>8000/µL. These patients presented higher percentages of residual disease and stage II-III tumours. Patients with elevated absolute neutrophil showed also higher percentages of progression and exitus. 7.3% presented absolute platelet >400000/µL. These patients obtained higher rates of residual disease, nonseminomatous and stage III tumours. 28.4% showed platelet-lymphocyte values>150. This data was associated to higher percentages of residual disease, progression, stage II and III tumours and seminomatous tumours. 83.3% had an lymphocyte-monocyte >3. These patients presented: higher tumour markers in normal range, decreased residual disease rates and higher percentages of stage I and II tumours. The mean survival time was shorter in patients with NLR>4 and absolute neutrophil >8,000/µL. The ROC curves showed significance in the prediction of progression and values of lymphocyte-monocyte >3, and prediction of survival and values NLR>4. CONCLUSION: Our results indicate that the analysed haematological markers are associated with poor prognoses at diagnosis. Therefore, their use in daily clinical practice can be a valuable tool in the diagnosis and prognosis of patients with testicular germ cell tumours.

Combined immunotherapy encompassing intratumoral poly-ICLC, dendritic-cell vaccination and radiotherapy in advanced cancer patients.

Background: Combination immunotherapy has the potential to achieve additive or synergistic effects. Combined local injections of dsRNA analogues (mimicking viral RNA) and repeated vaccinations with tumor-lysate loaded dendritic cells shows efficacy against colon cancer mouse models. In the context of immunotherapy, radiotherapy can exert beneficial abscopal effects. Patients and methods: In this two-cohort pilot phase I study, 15 advanced cancer patients received two 4-week cycles of four intradermal daily doses of monocyte-derived dendritic cells preloaded with autologous tumor lysate and matured for 24 h with poly-ICLC (Hiltonol), TNF-α and IFN-α. On days +8 and +10 of each cycle, patients received intratumoral image-guided 0.25 mg injections of the dsRNA-analogue Hiltonol. Cyclophosphamide 600 mg/m2 was administered 1 week before. Six patients received stereotactic ablative radiotherapy (SABR) on selected tumor lesions, including those injected with Hiltonol. Expression of 25 immune-relevant genes was sequentially monitored by RT-PCR on circulating peripheral blood mononuclear cell (PBMCs) and serum concentrations of a cytokine panel were sequentially determined before and during treatment. Pre- and post-treatment PBMC from patients achieving durable stable disease (SD) were studied by IFNγ ELISPOT-assays responding to tumor-lysate loaded DC and by TCRß sequencing. Results: Combined treatment was, safe and well tolerated. One heavily pretreated castration-resistant prostate cancer patient experienced a remarkable mixed abscopal response to SABR+ immunotherapy. No objective responses were observed, while nine patients presented SD (five of them in the six-patient radiotherapy cohort). Intratumoral Hiltonol increased IFN-ß and IFN-α mRNA in circulating PBMC. DC vaccination increased serum IL-12 and IL-1ß concentrations, especially in patients presenting SD. IFNγ-ELISPOT reactivity to tumor lysates was observed in two patients experiencing durable SD. Conclusions: This radio-immunotherapy combination strategy, aimed at resembling viral infection in tumor tissue in combination with a dendritic-cell vaccine and SABR, is safe and shows immune-associated activity and signs of preliminary clinical efficacy.

Changes in serum interleukin-8 (IL-8) levels reflect and predict response to anti-PD-1 treatment in melanoma and non-small-cell lung cancer patients.

BACKGROUND: Surrogate biomarkers of efficacy are needed for anti-PD1/PD-L1 therapy, given the existence of delayed responses and pseudo-progressions. We evaluated changes in serum IL-8 levels as a biomarker of response to anti-PD-1 blockade in melanoma and non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Metastatic melanoma and NSCLC patients treated with nivolumab or pembrolizumab alone or nivolumab plus ipilimumab were studied. Serum was collected at baseline; at 2-4 weeks after the first dose; and at the time-points of response evaluation. Serum IL-8 levels were determined by sandwich ELISA. Changes in serum IL-8 levels were compared with the Wilcoxon test and their strength of association with response was assessed with the Mann-Whitney test. Accuracy of changes in IL-8 levels to predict response was estimated using receiver operation characteristics curves. RESULTS: Twenty-nine melanoma patients treated with nivolumab or pembrolizumab were studied. In responding patients, serum IL-8 levels significantly decreased between baseline and best response (P <0.001), and significantly increased upon progression (P =  0.004). In non-responders, IL-8 levels significantly increased between baseline and progression (P =  0.013). Early changes in serum IL-8 levels (2-4 weeks after treatment initiation) were strongly associated with response (P <0.001). These observations were validated in 19 NSCLC patients treated with nivolumab or pembrolizumab (P =  0.001), and in 15 melanoma patients treated with nivolumab plus ipilimumab (P <0.001). Early decreases in serum IL-8 levels were associated with longer overall survival in melanoma (P =  0.001) and NSCLC (P =  0.015) patients. Serum IL-8 levels also correctly reflected true response in three cancer patients presenting pseudoprogression. CONCLUSIONS: Changes in serum IL-8 levels could be used to monitor and predict clinical benefit from immune checkpoint blockade in melanoma and NSCLC patients.

Utility of neurological smears for intrasurgical brain cancer diagnostics and tumour cell percentage by DESI-MS.

Analysis of neurological smears by desorption electrospray ionization mass spectrometry (DESI-MS) is an emerging diagnostic strategy for intraoperative consultation in brain tumor resection. DESI-MS allows rapid sampling while providing accurate diagnostic information. We assess the chemical homogeneity of neurological smears using DESI-MS imaging and the quality of rapid DESI-MS diagnosis.

Fine tuning of magnetite nanoparticle size distribution using dissymmetric potential pulses in the presence of biocompatible surfactants and the electrochemical characterization of the nanoparticles.

The effects of varying the surfactant concentration and the anodic pulse potential on the properties and electrochemical behaviors of magnetite nanoparticles were investigated. The nanoparticles were synthesized with an electrochemical method based on applying dissymmetric potential pulses, which offers the advantage that can be used to tune the particle size distribution very precisely in the range of 10 to 50 nm. Under the conditions studied, the surfactant concentration directly affects the size distribution, with higher concentrations producing narrower distributions. Linear voltammetry was used to characterize the electrochemical behavior of the synthesized nanoparticles in both the anodic and cathodic regions, which are attributed to the oxidation of Fe(2+) and the reduction of Fe(3+); these species are part of the spinel structure of magnetite. Electrochemical impedance spectroscopy data indicated that the reduction and oxidation reactions of the nanoparticles are not controlled by the mass transport step, but by the charge transfer step. The sample with the highest saturation magnetization was that synthesized in the presence of polyethylene glycol.

Uso de toxina botulínica tipo A en el manejo de dolor crónico refractario a tratamiento. Reporte de una serie de casos. / Use of botulinum toxin type A in the management of chronic pain refractory to treatment. Report a series cases

Botulinum toxin type A (BTA) has analgesic effect independent of its action in muscle tone, inhibiting the release of neurotransmitters (substance P-glutamate) and neuropeptides of nociceptors. Objective: To characterize infiltration procedures with Botox® in patients with chronic pain refractory to treatment. Method: Observational-cross-retrospective study. Infiltrations with botox procedures performed in Hospital Clínico Mutual de Seguridad, between 01.01.2014 and 30.04.2015 were analyzed. Medical record data were extracted. Information analyzed with Excel2013® using Chi-square test (p <0.05). Results: 31 patients treated, 83.9 percent male. Average age 51 years (SD ± 11.9yo). Diagnostics causes of pain: post-traumatic pain and myofascial syndrome (25.8 percent); complex regional pain syndrome (16.1 percent) and partial hand amputation (12.9 percent). Predominant type of pain: neuropathic pain (64.5 percent). Common procedures: median nerve blockade (21.2 percent) and infiltration of lumbar back trigger points (15.4 percent). 77.4 percent reported good pain control, crisis decreased 74.2 percent and 71 percent decreases opioid use. Return work was effective in 64.5 percent of patients. 93.6 percent satisfactorily tolerated the procedure, 9.7 percent showed fewer adverse effects. The subgroup neuropathic pain had significantly worse results regarding mixed pain subgroup (p <0.05). Discussion: In this study, the use of BTA in chronic pain proved to be a safe and effective procedure for the management of chronic musculoskeletal pain...

Testicular and epididymal ltrasonography in Santa Inês lambs raised in Brazil

The objective of this work was to study, through ultrasonographic evaluation, changes in testes and epididymides of clinically healthy, peripubertal and pubertal Santa Inês lambs raised in Brazil. Periodic e valuations of weight, biometric characteristics (scrotal circumference, width and length) and ultrasound examinatio ns of the testes and epididymides of 20 lambs were performed between 84 and 280 days old at intervals of 28 days. Scans were performed in the sagittal, transverse, frontal and oblique planes to evaluate the echotexture of the testicular parenchyma and mediastinum and the tail epididymis as well as the thickness and width of the mediastinum testis. The testicular parenchyma demonstrated a homogeneous echogenicity patter n ranging from low to moderate. The echogenicity of testicular parenchyma increased in direct proportion to animal age, being higher in pubertal lambs when compared to prepubertal at the same age. The mediastinum testis was observed in 100% of the evaluated animals, regardless of the scan plane used, and was classified as diffuse or moderately or highly echogenic. Echogenicity and the thickness of the mediastinum testis increased in direct proportion to animal age. The epididymal tail was presented in hypoechoic relation to the testicular parenchyma. Based on these results, it was concluded that ultrasound is useful tool for selection and morphophysiological evaluation of Santa Inês lambs on peripubertal and pubertal phases, when used in combination with other methods such as semen evaluation.

Células dendríticas especializadas en presentación de antígenos exógenos a linfocitos T citotóxicos / Specialized dendritic cells in cross-presentation of exogenous antigens to cytotoxic T lymphocytes

Las células dendríticas son células de origen hematopoiético, que expresan constitutivamente moléculas presentadoras de antígeno MHC de clase I y II, y son funcionalmente las inductoras más potentes de la activación y proliferación de linfocitos Ta los que presentan antígenos. Los linfocitos T CD8+ proliferan y adquieren capacidad citotóxica cuando reconocen su antígeno específico presentado en la superficie de una o varias células dendríticas con las que interactúan. Sin embargo, solamente algunas subpoblaciones de células dendríticas pueden presentar antígenos internalizados desde el exterior celular a través de procesos de pinocitosis y fagocitosis a precursores de linfocitos T citotóxicos. Esta función se denomina presentación cruzada o presentación subrogada (en inglés, cross presentation) y requiere mecanismos de translocación de los antígenos que se encuentran internalizados en fagosomas al citosol para su procesamiento. Se ha establecido que la diferenciación de subpoblaciones de células dendríticas con capacidad de efectuar este tipo de presentación cruzada a linfocitos T CD8+ son dependientes del factor de crecimiento FLT-3L y del factor de transcripción BATF3. Presentan peculiaridades tanto funcionales como de marcadores de membrana que nos permiten identificarlas. En ratones se distinguen por la expresión de CD8α y en humanos por la de CD141 (BDCA-3). Esta población en ambas especies es capaz de internalizar selectivamente restos de células necróticas mediante su receptorCLEC9A que se une a actina polimerizada extracelular. Disponen del receptor de quimioquinas XCR1 que asegura su encuentro con linfocitos T CD8+. La vacunación terapéutica con antígenos tumorales utilizando células dendríticas es una estrategia en desarrollo para el tratamiento del cáncer. La utilización de subpoblaciones de células dendríticas con mayor capacidad de realizar presentación cruzada o subrogada remeda los mecanismos naturales de inmunización para inducir linfocitos T citotóxicos. La dianización in vivo de antígenos a estas subpoblaciones celulares mediante anticuerpos monoclonales anti-DEC-205 o anti-CLEC9A consigue respuestas inmunitarias muy intensas y se están probando en ensayos clínicos frente a viriasis crónicas y enfermedades malignas (AU)

Dendritic cells (DC) are cells of hematopoietic origin, which constitutively express MHC class I and II, and are functionally the most potent inducers of T-lymphocyte activation and proliferation. CD8+ T lymphocytes proliferate and acquire cytotoxic functions upon recognition of their cognate antigen on the surface of one or various dendritic cells with which they interact. However, only some DC subsets are able to present antigen to cytotoxic T cell precursors as taken up from extracellular sources. This function is termed cross-presentation (in Spanish, presentacion cruzada or presentacion subrogada) and requires shuttle mechanisms from phagosomes to the cytosol for antigen processing. It has been demonstrated that the differentiation of DC with these capabilities is dependent on FLT-3Land the transcription factor BATF3. They express peculiar functions and differentiation markers. These cells are distinguished in mice by surface CD8 α features, while CD141 (BDCA-3) marks these cells in the human. These subpopulations are capable of selective internalization of necrotic cell debris by means of their CLEC9A lectin which is a receptor for extracellular polymerized actin. Expression of the chemokine receptor XCR1 favours contact with CD8+ T cells. Therapeutic vaccination with tumour antigens using DC is a strategy under development for the treatment of cancer. The use of DC subsets with more prominent capabilities for cross-presentation would mimic the natural mechanisms of immunization to induce cytolitic T lymphocytes. In vivo targeting of antigens with monoclonal antibodies against DEC-205 or CLEC9A attains very robust immune responses and is a strategy undergoing clinical trials for chronic viral diseases and malignancies (AU)

[Specialized dendritic cells in cross-presentation of exogenous antigens to cytotoxic T lymphocytes]. / Células dendríticas especializadas en presentación de antígenos exógenos a linfocitos T citotóxicos.

Dendritic cells (DC) are cells of hematopoietic origin, which constitutively express MHC class I and II, and are functionally the most potent inducers of T-lymphocyte activation and proliferation. CD8+ T lymphocytes proliferate and acquire cytotoxic functions upon recognition of their cognate antigen on the surface of one or various dendritic cells with which they interact. However, only some DC subsets are able to present antigen to cytotoxic T cell precursors as taken up from extracellular sources. This function is termed cross-presentation (in Spanish, presentación cruzada or presentación subrogada) and requires shuttle mechanisms from phagosomes to the cytosol for antigen processing. It has been demonstrated that the differentiation of DC with these capabilities is dependent on FLT-3L and the transcription factor BATF3. They express peculiar functions and differentiation markers. These cells are distinguished in mice by surface CD8 features, while CD141 (BDCA-3) marks these cells in the human. These subpopulations are capable of selective internalization of necrotic cell debris by means of their CLEC9A lectin which is a receptor for extracellular polymerized actin. Expression of the chemokine receptor XCR1 favours contact with CD8+ T cells. Therapeutic vaccination with tumour antigens using DC is a strategy under development for the treatment of cancer. The use of DC subsets with more prominent capabilities for cross-presentation would mimic the natural mechanisms of immunization to induce cytolitic T lymphocytes. In vivo targeting of antigens with monoclonal antibodies against DEC-205 or CLEC9A attains very robust immune responses and is a strategy undergoing clinical trials for chronic viral diseases and malignancies.

Ultrasonografía doppler transcraneal urgente: utilidad predictiva del vasoespasmo sintomático en la hemorragia subaracnoidea espontánea en pacientes con buena situación neurológica / Emergency transcranial doppler ultrasound: predictive value for the development of symptomatic vasospasm in spontaneous subarachnoid hemorrhage in patients in good neurological condition

Objetivo: Establecer el valor predictivo, para desarrollar deterioro neurológico tardío de origen isquémico (DNI), de un estudio doppler transcraneal (DTC) en pacientes con hemorragia subaracnoidea espontánea (HSA) en buena situación neurológica. Diseño: Estudio descriptivo-observacional desarrollado durante 3 años. Ámbito: Cuidados Críticos y Urgencias. Pacientes: Se incluyeron de forma consecutiva aquellos pacientes con HSA en buena situación neurológica (Hunt-Hess I-III). Variables de Interés: DNI (disminución en 2 puntos del GCS o déficit focal), velocidad media (VM) en arterias cerebrales medias, índice de Lindegaard (IL). Se consideró patrón sonográfico de vasoespasmo (PSV) cuando la VM fue>120cm/s y existía un IL>3. Resultados: La media de edad de los 122 pacientes fue de 54,1±13,7 años. El 57,3% eran mujeres. Se detectaron 24 pacientes con PSV (19,7%) encontrándose VM elevadas en 38 pacientes (31,1%). 21 pacientes desarrollaron DNI (VM 183+/-49cm/s), todos presentaron PSV. En los pacientes con DNI se detectó un aumento de VM de 22+/-5cm/s/24h durante los 3 primeros días. Al comparar aquellos pacientes que no presentaron VM elevadas (85 pacientes/VM 67+/-16,6cm/s) con respecto a los que desarrollaron DNI encontramos diferencias en las VM (p<0,001) y en el ΔVM/24h (8,30+/-4,5cm/s Vs 22+/-5cm/s) durante los 3 primeros días (p=0,009). Mediante curvas ROC, se fijó que el ΔVM/día de 21cm/s (p<0,001), era el que mejor predecía el DNI. Conclusión: Durante los 3 primeros días un incremento en la VM de 21cm/s/24h se asoció con el desarrollo de vasoespamo sintomático. El DTC es una herramienta útil para la detección de aquellos pacientes con HSA en riesgo de desarrollar DNI (AU)

Purpose: To examine the predictive value of an early transcranial Doppler ultrasound (TCD) study performed in the emergency department in patients with spontaneous subarachoniod hemorrhage (SAH) in good neurological condition, in order to know which patients are at high risk of developing delayed cerebral ischemia (DCI). Design: A descriptive observational study was carried out involving a period of 3 years. Setting: Critical Care and Emergency Department. Patients: The study consecutively included patients with SAH of grade I-III on the Hunt and Hess scale. Variables of Interest: DCI (decrease of 2 points in GCS or focal deficit), Mean Velocity (MV) of middle cerebral arteries (MCA), Lindegaard Index (IL). Sonographic vasospasm pattern (SVP) was considered if MCA-MV>120cm/sc and IL>3. Results: The mean age of the 122 patients was 54.1±13.7 years; 57.3% were women. SVP was detected in 24 patients (19.7%), although high velocities patterns (HVP) were present in 38 patients (31.1%). DCI developed in 21 patients (MV183+/-49cm/sc), all with previous SVP. In this group MV increased 22+/-5cm/sc/day during the first 3 days. The group without HVP (84 patients/MV of 67+/-16.6cm/sc), compared with DCI group, showed differences in highest MV (p<0.001), and also ΔMV/day (8.30+/-4,5cm/sc Vs 22+/-5cm/sc) during the first 3 days (p=0.009). In our series, ROC analysis selected the best cut-off value for ΔMV/day as 21cm/sc (p<0.001). Conclusion: During the first 3 days, an increase of 21cm/s/24h in MCA-MV was associated with the development of symptomatic vasospasm. TCD is a useful tool for the early detection of patients at risk of DCI after SAH (AU=

Impacto de la intervención farmacéutica en la adherencia al tratamiento antirretroviral en pacientes de un hospital de Lima (Perú) / Pharmacist intervention in the improvement of adherence in HIV/AIDS patients with antiretroviral treatment in Lima (Peru)

Introducción: La atención farmacéutica mejora la adherencia del paciente al tratamiento, por lo que es necesario que el farmacéutico cuente con instrumentos para evaluarla y mejorarla mediante su intervención en el seguimiento farmacoterapéutico (SFT). Objetivos: Evaluar el impacto de la intervención farmacéutica en la mejora de la adherencia de los pacientes con virus de la inmunodeficiencia humana (VIH) y sida, e identificar los factores que influyen en ella y que pueden ser modificados por la intervención farmacéutica en el SFT. Métodos: Se realizó SFT durante 23 meses a 52 pacientes mayores de 18 años de edad, con tratamiento antirretroviral durante más de 3 meses, que dieron su consentimiento informado. La adherencia se evaluó con el CEAT-VIH (cuestionario para evaluar la adhesión al tratamiento antirretroviral) al inicio y al final de 6 meses de SFT. Resultados: La puntuación total del CEAT-VIH (p <0,05; intervalo de confianza del 95%), el cumplimiento del tratamiento (p <0,001) y la percepción del paciente respecto a su enfermedad y tratamiento antirretroviral (p <0,001) incrementaron significativamente su valor. La educación al paciente para incrementar la adherencia al tratamiento (46%) fue la intervención farmacéutica más frecuente. Conclusiones: Se demuestra que la intervención del farmacéutico, mediante el SFT, mejora la adherencia al tratamiento antirretroviral. El farmacéutico mejoró los aspectos de cumplimiento y percepción del paciente sobre su tratamiento y enfermedad. Los farmacéuticos pueden utilizar el CEAT-VIH como instrumento para evaluar la adherencia en la práctica del SFT (AU)

Introduction: Pharmaceutical care improves medication adherence that is why is important that the pharmacist uses instruments to evaluate and improves it through pharmaceutical intervention at pharmaceutical care. Objective: To evaluate the impact of the pharmaceutical intervention in the improvement of the medication adherence of the patients with HIV and AIDS, and to identify the factors that influence on medication adherence and which one could be modified by the pharmaceutical intervention during pharmaceutical care. Methods: Pharmacotherapeutic follow-up was realized for 23 months to 52 patients, older than 18 years, with antiretroviral treatment for up to three months, consent informed was obtained from patients. Medication adherence was evaluated with CEAT-HIV (questionnaire to evaluate the adhesion to the antiretroviral treatment) at the beginning and at the end of the study (6 months). Results: The final score from CEAT-HIV (p <0.05; 95% IC), treatment compliance (p <0.001) and patient’s beliefs to the disease and antiretroviral treatment (p <0.001) improved significantly with the pharmaceutical intervention. The more frequent pharmaceutical intervention was education to the patient to increment the adherence to the treatment (46%). Conclusion: These results demonstrate that the pharmacists’ intervention through pharmacotherapeutic follow-up improves the adherence to the antiretroviral treatment. The pharmacist was able to improve aspects of compliance and patient’s beliefs about the treatment and disease. The pharmacist could utilize CEAT-VIH as an instrument to evaluate the adherence in HIV/AIDS patients (AU)

[Hyperammonemic encephalopathy: nutritional assessment and management of a case]. / Encefalopatía hiperamoniémica: valoración y manejo nutricional a propósito de un caso.

OTC deficiency is a disorder of the urea cycle X-linked. It is manifested in men as severe hyperammonemia in the first days of life. In women the disease is milder severity. Various conditions cause decompensation with hyperammonemia. It could be fatal or cause permanent neurological damage. We report a 36 years old woman admitted for surgery, she suffered a decompensation in conjunction with surgical wound infection. Hyperammonemia caused neurological deterioration with decreased level of consciousness, tetraparesis and neurogenic dysphagia. The treatment consisting of low-protein diet, ammonium chelating drugs and dialytic measures, was effective in controlling hyperammonaemia and improving neurological status. This case illustrates the importance of nutritional support of patients with disorders of the urea cycle in the hospital because the descompensations are more frecuent here.

Achados ultrassonográficos nos testículos e epidídimos de carneiros deslanados jovens e clinicamente sadios / Ultrasonographic findings in the testis and epididymis of clinically healthy young hair sheep

Objetivou-se descrever os achados ultrassonográficos nos testículos e epidídimos de carneiros jovens. Análises de desenvolvimento ponderal, mensurações das características biométricas testiculares e exames ultrassonográficos foram realizados dos 140 aos 280 dias de idade, a cada 28 dias. O parênquima testicular apresentou ecogenicidade homogênea (baixa a moderada) que aumentou com a idade. A ecogenicidade e a espessura do mediastino aumentaram com a idade, e a cauda do epidídimo apresentou aspecto hipoecoico em relação ao parênquima testicular. Foram observadas calcificações de grau leve nos testículos de cinco cordeiros. Conclui-se que o exame ultrassonográfico contribui para o monitoramento dos testículos e epidídimos de carneiros.

This study aimed to describe ultrasonographic findings in the testis and epididymis of young sheep. Evaluations of the development of weight, measurements of biometric characteristics of the tests and ultrasound examinations of the tests and epididymis were performed from 140 to 280 days of age, each 28 days. The testicular parenchyma showed homogeneous echogenicity (low to moderate) and increased with the age. The mediastinum echogenicity and thickness increased with age and the epididymis tail showed hypoechoic appearance in relation to the testicular parenchyma. Mild calcification was observed in the testis parenchyma of five lambs. In conclusion, ultrasonographic exams help to monitor testes and epididymis of young hair rams.

[Emergency transcranial doppler ultrasound: predictive value for the development of symptomatic vasospasm in spontaneous subarachnoid hemorrhage in patients in good neurological condition]. / Ultrasonografía doppler transcraneal urgente: utilidad predictiva del vasoespasmo sintomático en la hemorragia subaracnoidea espontánea en pacientes con buena situación neurológica.

PURPOSE: To examine the predictive value of an early transcranial Doppler ultrasound (TCD) study performed in the emergency department in patients with spontaneous subarachoniod hemorrhage (SAH) in good neurological condition, in order to know which patients are at high risk of developing delayed cerebral ischemia (DCI). DESIGN: A descriptive observational study was carried out involving a period of 3 years. SETTING: Critical Care and Emergency Department. PATIENTS: The study consecutively included patients with SAH of grade I-III on the Hunt and Hess scale. VARIABLES OF INTEREST: DCI (decrease of 2 points in GCS or focal deficit), Mean Velocity (MV) of middle cerebral arteries (MCA), Lindegaard Index (IL). Sonographic vasospasm pattern (SVP) was considered if MCA-MV>120cm/sc and IL>3. RESULTS: The mean age of the 122 patients was 54.1±13.7 years; 57.3% were women. SVP was detected in 24 patients (19.7%), although high velocities patterns (HVP) were present in 38 patients (31.1%). DCI developed in 21 patients (MV183+/-49cm/sc), all with previous SVP. In this group MV increased 22+/-5cm/sc/day during the first 3 days. The group without HVP (84 patients/MV of 67+/-16.6cm/sc), compared with DCI group, showed differences in highest MV (p<0.001), and also ΔMV/day (8.30+/-4,5cm/sc Vs 22+/-5cm/sc) during the first 3 days (p=0.009). In our series, ROC analysis selected the best cut-off value for ΔMV/day as 21cm/sc (p<0.001). CONCLUSION: During the first 3 days, an increase of 21cm/s/24h in MCA-MV was associated with the development of symptomatic vasospasm. TCD is a useful tool for the early detection of patients at risk of DCI after SAH.

Encefalopatía hiperamoniémica; valoración y manejo nutricional a propósito de un caso / Hyperammonemic encephalopathy; nutritional assessment and management of a case

El déficit de Ornitintranscarbamilasa (OTC) es un trastorno del ciclo de la urea ligado al cromosoma X. Se manifiesta en el varón como hiperamoniemia severa en los primeros días de vida. En la mujer la enfermedad esmás leve. Diversas situaciones pueden provocar una descompensación con hiperamoniemia que puede ser letal o provocar daños neurológicos permanentes. Presentamos una mujer de 36 años que ingresó para cirugía y que sufrió una descompensación coincidiendo con infección de la herida quirúrgica. La hiperamoniemia provocó un deterioro neurológico con disminución del nivel de conciencia, tetraparesia y disfagia neurógena. Con tratamiento, que consistió en dieta hipoproteica, quelantes de amonio y medidas dialíticas, se consiguió controlar la hiperamoniemia y mejorar el estado neurológico. Este caso ilustra la importancia del soporte nutricional especializado de los pacientes con trastornos del ciclo de laurea en el ámbito hospitalario por darse frecuentemente situaciones que favorecen las descompensaciones (AU)

OTC deficiency is a disorder of the urea cycle X-linked. It is manifested in men as severe hyperammonemia in the first days of life. In women the disease is milder severity. Various conditions cause de compensation with hyperammonemia. It could be fatal or cause permanent neurological damage. We report a 36 years old woman admitted forsurgery, she suffered a de compensation in conjunction with surgical wound infection. Hyperammonemia caused neurological deterioration with decreased level of consciousness, tetraparesis and neurogenic dysphagia. The treatment consisting of low-protein diet, ammonium chelating drugs and dialytic measures, was effective incontrolling hyperammonaemia and improving neurological status. This case illustrates the importance of nutritional support of patients with disorders of the urea cyclein the hospital because the descompensations are more frecuent here (AU)