Autoimmune and autoinflammatory conditions after COVID-19 vaccination. New case reports and updated literature review.

Autoimmunity linked to COVID-19 immunization has been recorded throughout the pandemic. Herein we present six new patients who experienced relapses of previous autoimmune disease (AD) or developed a new autoimmune or autoinflammatory condition following vaccination. In addition, we documented additional cases through a systematic review of the literature up to August 1st, 2022, in which 464 studies (928 cases) were included. The majority of patients (53.6%) were women, with a median age of 48 years (IQR: 34 to 66). The median period between immunization and the start of symptoms was eight days (IQR: 3 to 14). New-onset conditions were observed in 81.5% (n: 756) of the cases. The most common diseases associated with new-onset events following vaccination were immune thrombocytopenia, myocarditis, and Guillain-Barré syndrome. In contrast, immune thrombocytopenia, psoriasis, IgA nephropathy, and systemic lupus erythematosus were the most common illnesses associated with relapsing episodes (18.5%, n: 172). The first dosage was linked with new-onset events (69.8% vs. 59.3%, P = 0.0100), whereas the second dose was related to relapsing disease (29.5% vs. 59.3%, P = 0.0159). New-onset conditions and relapsing diseases were more common in women (51.5% and 62.9%, respectively; P = 0.0081). The groups were evenly balanced in age. No deaths were recorded after the disease relapsed, while 4.7% of patients with new-onset conditions died (P = 0.0013). In conclusion, there may be an association between COVID-19 vaccination and autoimmune and inflammatory diseases. Some ADs seem to be more common than others. Vaccines and SARS-CoV-2 may induce autoimmunity through similar mechanisms. Large, well-controlled studies are warranted to validate this relationship and assess additional variables such as genetic and other environmental factors.

Presentación inusual de compromiso metastásico cutáneo por carcinoma escamocelular de cuello uterino / Unusual presentation of metastatic skin involvement in a patient with squamous cell carcinoma of the cervix: Case report

Resumen El cáncer de cuello uterino ocupa el cuarto lugar dentro de las neoplasias de origen ginecológico a nivel global, representando un 85% de los casos en países en vías de desarrollo. Las metástasis cutáneas de origen ginecológico son altamente infrecuentes, observándose con mayor frecuencia en las neoplasias malignas de ovario, seguidas del adenocarcinoma endometrial y de cuello uterino y, menos frecuentemente, las de subtipo escamocelular. En la actualidad, existen alrededor de 80 reportes de casos citados en la literatura de metástasis cutáneas secundarias a un carcinoma de cuello uterino; sin embargo, ninguno con localización en la piel del cuello que se origine de un subtipo histológico escamocelular. En Colombia, no hay casos reportados hasta la fecha. Se presenta el caso de una paciente de 43 años que consulta por sangrado vaginal, dolor abdominal y una extensa placa tumoral exofítica de aspecto metastásico en la piel del cuello y del hombro izquierdo, encontrando al examen clínico inicial una masa tumoral en el cuello uterino con confirmación histológica de un carcinoma escamocelular como neoplasia primaria. Se hace diagnóstico de Carcinoma de cuello uterino estadio IVB y se inicia un tratamiento con intención paliativa con radioterapia y posterior quimioterapia sistémica. La enfermedad metastásica de origen ginecológico a nivel cutáneo confiere un mal pronóstico, con una supervivencia reportada de 1 a 37 meses después de su diagnóstico, por lo cual se deduce que la prevención y el diagnóstico temprano, particularmente en cáncer de cuello uterino, es de vital importancia en la población general.

Abstract Cervical cancer is the fourth most common cancer among gynecological neoplasms globally, representing 85% of cases in developing countries. Cutaneous metastases of gynecological origin are very rare, observed more frequently in ovarian malignancies, followed by endometrial and cervical adenocarcinoma and less frequently those of the squamous cell subtype. Currently there are about 80 case reports cited in the literature of cutaneous metastases secondary to cervical carcinoma, however, none with localization in the skin of the neck originated from a squamous cell histological subtype. In Colombia, there are no reported cases to date. We present the case of a 43-year-old patient who consulted for abdominal pain, vaginal bleeding and an extensive exophytic tumor plaque of metastatic appearance in the skin of the neck and left shoulder, finding a tumor mass in the cervix with histological confirmation of a squamous cell carcinoma as primary tumor. A diagnosis of stage IVB cervical carcinoma is made, and treatment is initiated with palliative intention with radiotherapy and subsequent systemic chemotherapy. Cutaneous metastatic disease of gynecological origin confers a poor prognosis, with a reported survival of 1 to 37 months after its diagnosis, for which prevention and early diagnosis, particularly in cervical cancer, is of vital importance in the general population.

Renal Amyloidosis and Crohn Disease.

Background: Secondary amyloidosis, a rare complication of Crohn disease (CD), is triggered by persistent systemic inflammation. Kidney involvement is the most frequent manifestation and is often characterized by nephrotic syndrome and kidney failure. This complication usually appears in patients with long-standing disease and is associated with increased morbidity and mortality risk. Diagnosis is by microscopic amyloid observation of tissue biopsy, and when the diagnosis is confirmed, the therapeutic objective is disease activity control. Response assessment is challenging because of a lack of reliable biomarkers. Case Report: A 56-year-old male with a long-standing history of CD treated with a tumor necrosis factor-α inhibitor presented with an acute elevation of creatinine in association with clinical and laboratory markers of nephrotic syndrome. Kidney biopsy revealed renal amyloidosis. After treatment adjustment, although a stable creatinine was achieved, the patient had persistent impaired glomerular filtration rate. Conclusion: As a systemic chronic inflammatory disorder, CD may present multisystemic morbidity, for which increased awareness among gastroenterologists is warranted. Renal amyloidosis is an infrequent extraintestinal complication of CD that may lead to chronic kidney impairment. Although evidence-based treatment is lacking, disease activity control is pivotal for management.

Effects of the Morphology, Surface Modification and Application Methods of ZnO-NPs on the Growth and Biomass of Tomato Plants.

Benefits of nanotechnology in agriculture include reduced fertilizer loss, improved seed germination rate and increased crops quality and yield. The objective of this research was to evaluate the effects of zinc oxide nanoparticles (ZnO-NPs), at 1500 ppm, on tomato (Solanum lycopersicum L.) growth. ZnO-NPs were synthetized to produce either spherical or hexagonal morphologies. In this research, we also studied two application methods (foliar and drench) and nanoparticles' (NPs) surface modification with maltodextrin. The results obtained indicate that ZnO-NP-treated tomato plants significantly increased plant height, stem diameter and plant organs (leaves, stem and root) dry weight compared to plants without NP treatment.

Linfoma linfoblástico cutáneo de células precursoras B: una presentación infrecuente de linfomas en niños / Cutaneous lymphoblastic lymphoma of precursor B cells: An infrequent presentation of lymphomas in children

Resumen Los linfomas linfoblásticos primarios cutáneos son una enfermedad infrecuente que ocurre predominantemente en la edad pediátrica y al momento del diagnóstico se presentan con lesiones cutáneas sin enfermedad sistèmica identificable. La enfermedad tiene un comportamiento agresivo y el tratamiento debe basarse en protocolos derivados de manejo de las leucemias linfoblásticas agudas con lo que se ha demostrado buenas tasas de supervivencia. Los autores presentan el caso de una niña con un linfoma linfoblástico de células precursoras B primario cutáneo localizado en cara manejado con protocolo basado en BFM para leucemias linfoblásticas con buena evolución.

Abstract Primary cutaneous lymphoblastic lymphomas are an infrequent disease that occurs predominantly in the pediatric age; and they present with cutaneous lesions without identifiable systemic disease at the time of diagnosis. The disease has an aggressive behavior and the treatment must be based on protocols derived from the management of acute lymphoblastic leukemia, which has shown good survival rates. The authors present the case of a girl with a lymphoblastic lymphoma of cutaneous primary precursor B cells localized on the face managed with a BFM-based protocol for lymphoblastic leukemia with good evolution.

Synthesis of stable TiO2 nanotubes: effect of hydrothermal treatment, acid washing and annealing temperature.

Effect of hydrothermal treatment, acid washing and annealing temperature on the structure and morphology of TiO2 nanotubes during the formation process was assessed. X-ray diffraction, scanning electron microscopy (SEM), transmission electron microscopy (TEM) and energy dispersive X-ray spectroscopy analysis were conducted to describe the formation and characterization of the structure and morphology of nanotubes. Hydrothermal treatment of TiO2 precursor nanoparticles and acid washing are fundamental to form and define the nanotubes structure. Hydrothermal treatment causes a change in the crystallinity of the precursor nanoparticles from anatase phase to a monoclinic phase, which characterizes the TiO2 nanosheets structure. The acid washing promotes the formation of high purity nanotubes due to Na+ is exchanged from the titanate structure to the hydrochloric acid (HCl) solution. The annealing temperature affects the dimensions, structure and the morphology of the nanotubes. Annealing temperatures in the range of 400 °C and 600 °C are optimum to maintain a highly stable tubular morphology of nanotubes. Additionally, nanotubes conserve the physicochemical properties of the precursor Degussa P25 nanoparticles. Temperatures greater than 600 °C alter the morphology of nanotubes from tubular to an irregular structure of nanoparticles, which are bigger than those of the precursor material, i.e., the crystallinity turn from anatase phase to rutile phase inducing the collapse of the nanotubes.

Proliferación linfoide indolente cutánea CD8 positiva a propósito de tres casos con compromiso facial / Indolent CD8-positive t-cell lymphoid proliferation: on purpose three cases of facial commitment

Resumen La proliferación linfoide indolente cutánea CD8 positiva es una variante recientemente descrita de linfoma T cutáneo que se caracteriza por un nódulo, pápula o placa eritematosa de crecimiento lento que puede afectar la región facial o extrafacial. En el estudio de patología se caracteriza por un infiltrado monomorfo de linfocitosTalo largo de la dermis con presencia de zona de Grenz y ausencia de epidermotropismo. El infiltrado es característicamente CD8+ así como CD3+, TIA-1+, CD4-, CD56- CD30-, PD-1-, Granzima B- y EBER negativo. El índice de proliferación Ki-67 es inferior al 10% y se observan reordenamientos clonales de los genes del receptor de antígeno de la célula T, TCR. El seguimiento clínico es favorable y no se ha observado compromiso sistémico. Se presentan tres casos con compromiso facial (dos casos en pabellón auricular y un caso con compromiso nasal), con presentación clínica y hallaz gos histopatológicos típicos (curiosamente un caso con cambio de célula clara), y además se realizaron estudios de clonalidad.

Abstract Primary cutaneous indolent CD8-positive lymphoid proliferation is a recent variant of cutaneous T lymphoma that is characterized by nodule, papule or plaque erythematous with slow growth that can affect the facial or extrafacial region. In the histopathology study it is characterized by an infiltration of monomorphic T lymphocytes throughout the dermis with presence of Grenz zone and absence of epidermotropism. The infiltrate is characteristically CD 8+ and CD3+ TIA-1+ CD4-, CD56- CD30, PD-1, Granzyme B- and negative EBER. Ki-67 Proliferación linfoide indolente cutánea CD8 positiva a propósito de tres casos proliferation index is less than 10% and clonal T-cell receptor gene rearrangements. Clinical follow-up is favorable and has not been observed systemic involvement. We present three cases with facial involvement (two cases in ear and one case with nasal commitment) with typical clinical presentation, histopathological findings (curiously a case with clear cell change) and clonality studies.

Metastatic Malignant Pilomatrixoma in an 8-Year-Old Girl Misdiagnosed as a Recurrent Pilomatrixoma.

Malignant pilomatrixoma or pilomatrix carcinoma is a rare, locally aggressive malignant neoplasm, derived from the hair follicle with a high propensity for local recurrence. Only a few cases of metastatic pilomatrixoma have been described in the literature. Till date, only 17 cases have been reported in the English-language medical literature, most commonly occurring associated with local recurrence in adults. We report the first case in children of a metastatic malignant pilomatrixoma in an 8-year-old girl presenting with a recurrent pilomatrix carcinoma of the forehead with metastases in cervical and parotid lymph nodes.

Diagnostic utility of epithelial and melanocitic markers with double sequential immunohistochemical staining in differentiating melanoma in situ from invasive melanoma.

Identification of melanoma in situ and its distinction from invasive melanoma is important because of its significant impact on morbidity and mortality. However, this interpretation can cause pitfalls in the diagnosis even with the use of immunohistochemistry. The aim of this study is to evaluate the diagnostic utility of epithelial makers (AE1/AE3, CK5/6, and p63) combined with melanocytic markers (HMB-45, S-100, or Melan-A) using dual-color immunohistochemical staining, performed on a single slide by sequentially applying the antibodies. In this study, we show 4 cases in which examination of routine hematoxylin and eosin slides did not allow for clear-cut distinction between in situ and invasive melanoma and highlight the utility of the double-staining method. Therefore, we recommend this double-staining method with melanocytic and epithelial markers as a helpful adjunct to the diagnosis of cases with a differential diagnosis between in situ and invasive melanoma.

Cutaneous Collision Tumor Associated With Porocarcinomatous and Angiosarcomatous Components: A Potential Diagnostic Pitfall.

Sarcomatoid eccrine porocarcinoma (SEP) is a very rare malignancy including epithelial and mesenchymal components exhibiting pleomorphic cells, nuclear hyperchromasia, and high mitotic activity in both elements. To date, only 6 cases of this uncommon neoplasm have been reported, corresponding to women over 70 years of age with ulcerated skin lesions. The authors describe the first sarcomatoid eccrine porocarcinoma in a 75-year-old male patient with a right hallux lesion, presenting a collision tumor with a mixed population of epithelial cells and a spindle cell angiosarcomatous mesenchymal component each expressing distinct and nonoverlapping morphologic and immunohistochemical features of epithelial and mesenchymal differentiation.

Carcinoma escamocelular de vesícula con infiltración al lecho hepático no diagnosticado prequirúrgicamente / Vesicle Scamocelular Carcinoma with Hepatic Bed Infiltration not diagnosed before Surgery

Los tumores malignos de la vesícula biliar son en su gran mayoría adenocarcinomas que, en una pequeña proporción, pueden presentar una diferenciación escamosa focal o extensa. Sin embargo, el carcinoma escamocelular primario como único componente se considera una neoplasia rara y surge en el terreno de un cambio metaplásico en el epitelio que reviste la vesícula biliar. El presente reporte de caso trata de una paciente de 69 años a quien se le practicó una colecistectomía por el diagnóstico prequirúrgico de colecistitis; durante el acto operatorio, se identificó una lesión tumoral de la vesícula biliar que infiltraba el quinto (V) segmento hepático, el cual se resecó en cuña. La histología correspondía a un carcinoma escamocelular de la vesícula biliar puro con infiltración al hígado. La paciente se recuperó satisfactoriamente del procedimiento practicado hace 5 meses.

Pseudoquiste pancreático en niño prematuro de 14 meses / Pancreatic Pseudocyst in a 14-month old Premature Baby

Se presenta el caso de un niño de 14 meses de edad a quien se le encontró una masa abdominal en el examen físico del control de crecimiento y desarrollo. El paciente fue el producto del tercer embarazo, complicado por corioamnionitis en la semana 32, por lo cual se practicó cesárea. Presentó neumonía intrauterina, que requirió hospitalización por un mes en la unidad neonatal, respiración mecánica durante una semana y múltiples transfusiones sanguíneas. Negaron antecedentes traumáticos u otros.

Infección del sitio de la operación en un hospital universitario de tercer nivel / Operating room infection in a third-level hospital

La infección del sitio de operación es una de las causas más importantes de morbimortalidad de infección hospitalaria y del incremento de los costos en salud. Es también un factor pronóstico de la calidad de la atención en salud. En los Estados Unidos, hacia la década de los noventa, se logró un sistema de estratificación del riesgo conocido como el índice de riesgo del National Nosocomial Infections Surveillance System (NNIS) que no sólo involucra el tipo de herida quirúrgica sino, además, las condiciones inherentes al paciente, que se han considerado puede ser factores de riesgo para el desarrollo de infección del sitio de la operación. En Colombia se han adelantado pocos estudios aplicando este índice. El presente corresponde a uno de los primeros y consiste en el análisis retrospectivo de los procedimientos quirúrgicos realizados en una institución hospitalaria universitaria de tercer nivel durante los meses de junio a agosto de 2002, basado en el NNIS y que evalúa el desenlace, es decir, la aparición de infección del sitio operatorio o su ausencia.