Precaución con el uso de dexametasona en pacientes con COVID-19 en sus fases iniciales / Caution with the use of dexamethasone in patients with COVID-19 in its initial phases

Introducción El efecto de la dexametasona en la fase inicial de la infección por SARS-CoV-2 y su influencia sobre la COVID-19 no está bien definido. Describimos las características clínico-radiológicas, los parámetros de tormenta de citoquinas y la evolución clínica de una serie de pacientes tratados con dexametasona en la fase inicial de la enfermedad. Método Estudio de 8 pacientes que recibieron dexametasona previo al desarrollo de la COVID-19. Evaluamos variables clínicas, pruebas de imagen, parámetros de liberación de citoquinas, tratamiento empleado y su evolución. Resultados Todos los pacientes recibieron una dosis de 6mg/día con una duración media de 4,5 días previos al ingreso. La mayoría de los pacientes presentaron una extensión grave en la tomografía computarizada de alta resolución (TCAR) y una elevación leve de los parámetros de liberación de citoquinas; 3 pacientes requirieron oxigenoterpia nasal de alto flujo (ONAF) por insuficiencia respiratoria, y ningún paciente requirió intubación orotraqueal ni falleció. Conclusión La dexametasona en las fases iniciales de la infección por SARS-CoV-2 parece asociarse con una COVID-19 grave (AU)

Introduction The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. Method A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. Results All patients received a 6mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. Conclusion Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19 (AU)

Caution with the use of dexamethasone in patients with COVID-19 in its initial phases.

INTRODUCTION: The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. METHOD: A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. RESULTS: All patients received a 6 mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. CONCLUSION: Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19.

[Caution with the use of dexamethasone in patients with COVID-19 in its initial phases]. / Precaución con el uso de dexametasona en pacientes con COVID-19 en sus fases iniciales.

INTRODUCTION: The effect of dexamethasone in the initial phase of infection by SARS-CoV-2 and its influence on COVID-19 is not well defined. We describe clinical-radiological characteristics, the cytokine storm parameters, and the clinical evolution of a series of patients treated with dexamethasone in the disease's initial phase. METHOD: A study of 8 patients who received dexamethasone before the development of COVID-19. We evaluate clinical variables, imaging tests, cytokine release parameters, treatment used and patient evolution. RESULTS: All patients received a 6 mg/day dose with a mean duration of 4.5 days before admission. High resolution computed tomography (HRCT) revealed that most of them presented a severe extension; most patients had a slightly elevated level of cytokine release parameters. Three patients required high-flow oxygen therapy due to respiratory failure; none required orotracheal intubation or died. CONCLUSION: Dexamethasone in the early stages of SARS-CoV-2 infection appears to be associated with severe COVID-19.

Evaluation of Thin Film Microextraction for trace elemental analysis of liquid samples using LIBS detection.

An analytical methodology based in the combination of Thin Film Microextraction with Laser-induced Breakdown Spectroscopy (TFME-LIBS) was investigated, for the first time, for detection of Cu, Cr, Ni and Pb in aqueous solutions. In this methodology, the analytes were extracted in a thin film of adsorbent material deposited on a solid support, which was introduced in the sample to analyse. After extraction, the analytes retained in the adsorbent were analysed by LIBS. In order to obtain adsorbent films useful for the microextraction step, two different experimental procedures for film generation, denoted as Drop Casting Deposition and Mould Deposition, were evaluated. In both cases, graphene oxide was used as adsorbent material. The mould deposition procedure was found to produce more homogeneous graphene oxide layers, leading to more uniform distribution of the adsorbed analytes on the graphene oxide surface. Experimental parameters affecting the TFME procedure, such as the adsorbent amount and extraction time, were studied. Under optimum microextraction conditions, the analytical figures of merit of the proposed TFME-LIBS method were evaluated, leading to limits of detection ranging from 41 µg kg-1 and 52 µg kg-1. Method trueness, evaluated from the analysis of a real sample of bottle water, led to recovery values about 70%, indicating the existence of strong matrix effects probably due to the presence of major cations in the bottle water. After 50% dilution of the sample with deionized water, recoveries values improved to 100%-108%.

Single cell genomics yields a wide diversity of small planktonic protists across major ocean ecosystems.

Marine planktonic protists are critical components of ocean ecosystems and are highly diverse. Molecular sequencing methods are being used to describe this diversity and reveal new associations and metabolisms that are important to how these ecosystems function. We describe here the use of the single cell genomics approach to sample and interrogate the diversity of the smaller (pico- and nano-sized) protists from a range of oceanic samples. We created over 900 single amplified genomes (SAGs) from 8 Tara Ocean samples across the Indian Ocean and the Mediterranean Sea. We show that flow cytometric sorting of single cells effectively distinguishes plastidic and aplastidic cell types that agree with our understanding of protist phylogeny. Yields of genomic DNA with PCR-identifiable 18S rRNA gene sequence from single cells was low (15% of aplastidic cell sorts, and 7% of plastidic sorts) and tests with alternate primers and comparisons to metabarcoding did not reveal phylogenetic bias in the major protist groups. There was little evidence of significant bias against or in favor of any phylogenetic group expected or known to be present. The four open ocean stations in the Indian Ocean had similar communities, despite ranging from 14°N to 20°S latitude, and they differed from the Mediterranean station. Single cell genomics of protists suggests that the taxonomic diversity of the dominant taxa found in only several hundreds of microliters of surface seawater is similar to that found in molecular surveys where liters of sample are filtered.

Dispersive micro solid-phase extraction (DµSPE) with graphene oxide as adsorbent for sensitive elemental analysis of aqueous samples by laser induced breakdown spectroscopy (LIBS).

In this work, the combination of dispersive micro solid-phase extraction (DµSPE) with laser-induced breakdown spectroscopy (LIBS) was evaluated for simultaneous preconcentration and detection of Zn, Cd, Mn, Ni, Cr and Pb in aqueous samples. Two adsorbent materials were tested in the microextraction step, namely graphene oxide and activated carbon. In both cases, the microextraction process consisted in the dispersion of a small quantity of adsorbent in the sample solution containing the analytes. However, while the use of activated carbon required a previous chelation of the metals, this step was avoided with the use of graphene oxide. After extraction, the analytes retained in the adsorbents were analysed by LIBS. Several experimental factors affecting the extraction of the metals (adsorbent amount, pH and extraction time) were optimized by means of the traditional univariate approach. Under optimum microextraction conditions, the analytical features of the proposed DµSPE-LIBS methods were assessed, leading to limits of detection below 100 µg kg-1 and 50 µg kg-1 with the use of activated carbon and graphene oxide, respectively, as adsorbents in the DµSPE process. Trueness evaluation of the most sensitive procedure was carried out by spike and recovery experiments in a real sample of tap water, leading to recovery values in the range 98-110%.

Reacción aguda de cuerpo extraño tras colocación de endoprótesis traqueobronquial en “Y” de Dumon / No disponible

No disponible

Teratoma congénito cervicofacial / Congenital cervicofacial teratoma

El teratoma congénito es el tumor más frecuente en el periodo neonatal. Su presentación habitual es en la zona sacrococcígea; sin embargo, puede mostrarse en otras localizaciones. Presentamos un caso de teratoma congénito cervicofacial gigante, en un recién nacido de 29 semanas de edad gestacional. La ecografía prenatal mostraba una tumoración con lesiones quísticas múltiples no identificadas. Se realizó cesárea electiva y falleció tras su ejecución. La anatomía patológica confirmó el diagnóstico. El pronóstico de este tipo de teratomas congénitos es malo; su diagnóstico prenatal y la práctica de una cesárea no mejoran la viabilidad del recién nacido (AU)

Molecular analysis of the fibrinogen gene cluster in 16 patients with congenital afibrinogenemia: novel truncating mutations in the FGA and FGG genes.

Congenital afibrinogenemia is an autosomal recessive disorder characterized by the complete absence of detectable fibrinogen. We previously identified the first causative mutations for this disease in a non-consanguineous Swiss family. These were homozygous deletions of approximately 11 kb of the fibrinogen alpha chain gene (FGA). Our subsequent study revealed that the majority of cases were attributable to truncating mutations in FGA, with the most common mutation affecting the donor splice site in FGA intron 4 (IVS4+1 G-->T). Here, we report 13 further unrelated patients with mutations in FGA, confirming the relative importance of this gene compared with FGG and FGB in the molecular aetiology of afibrinogenemia. Three other patients were homozygous for mutations in FGG. Eight novel mutations were identified: five in FGA and three in FGG. Sufficient mutation data is now available to permit an effective strategy for the genetic diagnosis of congenital afibrinogenemia.

[Vertical transmission of hepatitis C virus]. / Transmisión vertical del virus de la hepatitis C.

OBJECTIVES: Few studies have been published on vertical transmission of hepatitis C virus (HCV), although it is the most common cause of hepatitis C in children. We aimed to determine the rate of vertical transmission of HCV in at risk neonates and to assess the effect of possible risk factors. METHODS: A prospective follow-up study was conducted in 35 children of seropositive mothers during an 18-month period (July 1997-January 1999). Testing for anti-HCV antibodies was performed with third generation enzyme linked immunoadsorbent assay. HCV-RNA was qualitatively analyzed with reverse transcriptase polymerase chain reaction (RT-PCR) and hepatic enzyme studies. RESULTS: All the 35 children studied were positive for HCV antibodies at birth. The children became HCV negative at a mean age of 6 months. HCV infection was detected in two children (5.7%). The mother of one of these children had both HCV and human immunodeficiency virus (HIV) infection. Among the 35 seropositive mothers, a risk factor for percutaneous transmission of HCV (parenteral injection, drug addiction, or previous transfusions) was detected in 19(54%) and HIV coinfection was found in 9(26%). CONCLUSIONS: The present study is consistent with other studies that found a vertical HCV transmission rate of approximately 5%, with a greater risk if the mothers had HCV/HIV coinfection or parenteral risk factors. Studies with greater numbers of subjects are required to determine the prevalence of HCV in expectant mothers and the precise rate of vertical transmission. Infected children should be followed up to evaluate the repercussions of HCV infection.

Transmisión vertical del virus de la hepatitis C / Vertical transmission of hepatitis C virus infection

Los estudios sobre la transmisión vertical del virus de la hepatitis C (VHC) son escasos a pesar de ser la causa más frecuente de hepatitis C en niños. Se pretende fundamentalmente conocer la tasa de transmisión vertical del VHC en recién nacidos de riesgo y el efecto de los posibles factores de riesgo. MÉTODOS: Durante un período de 18 meses (de julio de 1997 a enero de 1999) se efectuó seguimiento prospectivo a 35 niños hijos de madres seropositivas mediante controles de anticuerpos anti VHC con ELISA de tercera generación, ARNVHC por RTPCR de forma cualitativa y enzimograma hepático. RESULTADOS: Del total de 35 niños objeto del estudio, el 100% tuvieron anticuerpos (Ac) VHC positivos al nacimiento. La edad media de negativización fue de 6 meses. En 2 niños (5,7%) se detectó infección por el virus C. Uno de ellos era hijo de una madre con coinfección VHC y VIH. De las 35 gestantes seropositivas se identificó un factor de riesgo de transmisión percutánea para el VHC (adicción a drogas por vía parenteral o transfusiones previas) en 19 (54 %) y 9 (26 %) tenían coinfección por VIH. CONCLUSIÓN: El presente estudio concuerda con otros que determinan una tasa de transmisión vertical del VHC alrededor de un 5%, con un mayor riesgo si las madres tienen coinfección VHC/VIH o factores de riesgo parenterales. Se requieren estudios extensos para determinar la prevalencia de la infección por virus de la hepatitis C en gestantes así como la tasa exacta de transmisión vertical. Es necesario el seguimiento de los niños infectados para valorar las repercusiones de la infección por VHC (AU)

[The role of thrombotic and hemostatic mechanisms in the initial phases of atherosclerosis]. / Participation des mécanismes de la thrombose et de l'hémostase aux étapes initiales de l'athérosclérose.

The factors of thrombosis (endothelium, haemostasis, coagulation, fibrinolysis) are implicated from the initiating phase of atherosclerotic lesions. Their participation is more established (and studied) in the later phases of intraluminal evolution of atherosclerosis, of thromboembolic complications of the lesions and interventional procedures. The traditional theory of response to physical lesions of the endothelium as an initiating factor of atherosclerotic lesions, which gave platelets an essential role, has been replaced by that linking an early functional lesion of the endothelium and a cellular response by monocytes infiltrating the vessel wall, becoming macrophages. The macrophages participate in changes of the LDL in the wall, ingest the lipids at the same time as the smooth muscle cells which have migrated and proliferated from the media to the intima. The lipid overload, especially with oxidised LDL, is intracellular at first in these foam cells, then extracellular as the cells die. During the early stages, all the tissue factors of activation and development of coagulation are present in the vessel wall and then within the lesion. This intra-cellular coagulation results in the production of thrombi in the tissues and the transformation of fibrinogen to fibrin. These stages precede and participate in cellular proliferation and extracellular lipid deposits. Factors of tissular thrombolysis (the uPA pathway) play a part in cellular immigration and proliferation. It is only at a later stage that the lesion activates intravascular coagulation and fibrinolysis which, in conditions of variable equilibrium, will result in the clinical complications of the atherosclerotic process. All these factors therefore participate firstly in the tissues and then within the lumen, in the progression and complications of atherosclerosis which for these reasons is often called atherothrombotic disease. The comprehension of these mechanisms is essential for the development and interpretation of tests and treatment applied to different stages of the disease, which is all the more complex given that in a given patient at a given time, lesions at different stages are present in the arterial network.