Imágenes Doppler de arterias intrapulmonares dentro de la atelectasia y su impacto en la poscarga del ventrículo derecho con ecocardiografía transesofágica / Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography

La cirugía cardíaca por toracoscopia videoasistida (VATS) requiere ventilación unipulmonar (VUP) y monitorización con ecografía transesofágica (ETE). Utilizando Doppler color y espectral es posible estudiar el patrón de flujo sanguíneo en los vasos pulmonares dentro del pulmón atelectasiado. El objetivo de este reporte de casos es evidenciar la habilidad de la ETE para detectar el flujo sanguíneo dentro del pulmón atelectásico, así como también valorar la resistencia vascular pulmonar (RVP) y poscarga del ventrículo derecho, utilizando esta misma herramienta. Hallazgos: Tres adultos anestesiados y ventilados mecánicamente programados para cirugía cardíaca por VATS fueron escaneados con ETE cardiopulmonar. Una vez que se realizó la VUP quedando el pulmón derecho sin ventilar, la sonda se giró desde el corazón para lograr un escaneo pulmonar 2D y con Doppler color para detectar el flujo de sangre dentro del parénquima pulmonar consolidado. Se pudo identificar el patrón de flujo correspondiente a las ramas de la arteria intrapulmonar. La RVP fue registrada aplicando Doppler pulsado cardíaco, basal luego de la inducción de anestesia general, a los 20min de la VUP y al finalizar la VUP, luego de realizar una maniobra de reclutamiento alveolar (MRA) que condujo a la resolución completa de la consolidación mencionada. Conclusiones: La ETE cardiopulmonar es una herramienta de imagen semiinvasiva que permite no solo el diagnóstico y estudio de atelectasias inducidas por VUP, sino también el análisis del shunt dentro de esta consolidación y sus posibles consecuencias en la RVP.(AU)

Video-assisted thoracoscopy (VATS) cardiac surgery requires one-lung ventilation (OLV) and transoesophageal ultrasound (TOE) monitoring. Colour and spectral Doppler make it possible to study the pattern of blood flow in the pulmonary vessels within the atelectatic lung. In this case report we describe how TOE can be used to detect blood flow within the atelectatic lung and to assess pulmonary vascular resistance (PVR) and right ventricular afterload. Findings: Three anaesthetised, mechanically ventilated adults scheduled for VATS cardiac surgery were monitored using TOE. After left OLV, the transducer was rotated away from the heart to obtain 2D colour Doppler images of blood flow within the consolidated lung parenchyma. We were able to identify the flow pattern of the intrapulmonary branches of the pulmonary artery. PVR was recorded using pulsed cardiac Doppler at baseline, after induction of general anaesthesia, 20min after OLV and at the end of OLV, and after performing an alveolar recruitment manoeuvre (ARM) that led to complete resolution of the aforementioned consolidation. Conclusions: TOE is a semi-invasive imaging tool that can be used to diagnose and study PVR-induced atelectasis and to analyse the resulting pulmonary shunt and its possible effect on PVR.(AU)

Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom.

AIM: To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). METHODS: Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources. RESULTS: In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57-0.73) or BRACETD (RR = 0.46; 95% CI, 0.42-0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01-1.55) and BRACETD (HR = 1.46; 95% CI, 1.16-1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65-0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91-1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses. CONCLUSIONS: This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.

There are several medications used to treat people with relapsing remitting multiple sclerosis, such as interferon-based therapies (Betaferon/Betaseron (US), Rebif, Avonex, Extavia), glatiramer acetate (Copaxone), teriflunomide (Aubagio), and dimethyl fumarate (Tecfidera), collectively named BRACETD. Other treatments for multiple sclerosis (MS) have a narrower use, such as natalizumab (Tysabri) or fingolimod (Gilenya), among others.This study objective was to assess how well natalizumab and fingolimod helped treating MS (clinical effectiveness) and subsequently estimate what the cost of these treatments is in comparison to the benefit they bring to people with rapidly evolving severe MS that use them in the United Kingdom (UK) (cost-effectiveness).We used an international disease registry (MSBase), which collects clinical data from people with MS in various centers around the world to compare the effectiveness of natalizumab, fingolimod and BRACETD treatments. We used a technique called propensity score matching to obtain results from comparable patient groups. People treated with natalizumab had better disease control, namely with fewer relapses and higher improvement on their disability level, than patients on fingolimod or BRACETD. Conversely, there were no differences between each group of people on a measure called disability worsening.Based on these clinical results, we built an economic model that simulates the lifetime costs and consequences of treating people with MS with natalizumab in comparison with fingolimod. We found that using natalizumab was less costly and was more effective compared to using fingolimod in UK patients.

Doppler images of intrapulmonary arteries within atelectasis and its impact on right ventricular afterload with transesophageal echocardiography.

Video-assisted thoracoscopy (VATS) cardiac surgery requires one-lung ventilation (OLV) and transoesophageal ultrasound (TOE) monitoring. Colour and spectral Doppler make it possible to study the pattern of blood flow in the pulmonary vessels within the atelectatic lung. In this case report we describe how TOE can be used to detect blood flow within the atelectatic lung and to assess pulmonary vascular resistance (PVR) and right ventricular (RV) afterload. FINDINGS: Three anaesthetised, mechanically ventilated adults scheduled for cardiac surgery by VATS were scanned with TOE. After left OLV, the transducer was rotated away from the heart to obtain 2D colour Doppler images of blood flow within the consolidated lung parenchyma. We were able to identify the flow pattern of the intrapulmonary branches of the pulmonary artery. PVR was recorded using pulsed cardiac Doppler at baseline, after induction of general anaesthesia, 20 min after OLV and at the end of OLV, and after performing an alveolar recruitment manoeuvre (ARM) that led to complete resolution of the aforementioned consolidation. CONCLUSIONS: TOE is a semi-invasive imaging tool that can be used to diagnose and study PVR-induced atelectasis and to analyse the resulting pulmonary shunt and its possible effect on PVR.

Women are taking the hit: Examining the unique consequences of cannabis use across the female lifespan.

Cannabis use has risen dramatically in recent years due to global decriminalization and a resurgence in the interest of potential therapeutic benefits. While emerging research is shaping our understanding of the benefits and harms of cannabis, there remains a paucity of data specifically focused on how cannabis affects the female population. The female experience of cannabis use is unique, both in the societal context and because of the biological ramifications. This is increasingly important given the rise in cannabis potency, as well as the implications this has for the prevalence of Cannabis Use Disorder (CUD). Therefore, this scoping review aims to discuss the prevalence of cannabis use and CUD in women throughout their lifespan and provide a balanced prospective on the positive and negative consequences of cannabis use. In doing so, this review will highlight the necessity for continued research that goes beyond sex differences.

Análisis de la fotopletismografía para determinación de variaciones en el tono vascular y la presión arterial: Estudio basado en redes neuronales / Photoplethys mography waveform analysis for classification of vascular tone and arterial blood pressure: Study based on neural networks

Antecedentes y objetivo: El propósito del presente estudio fue evaluar si una red neuronal superficial (RN-S) puede detectar y clasificar los cambios en la presión arterial (PA), dependientes del tono vascular mediante un análisis del contorno de la onda de fotopletismografía (FPG). Material y métodos: Las señales de FPG y PA invasivas fueron simultáneamente registradas en 26 pacientes programados para cirugía general. Se estudió la aparición de episodios de hipertensión (presión arterial sistólica (PAS) > 140 mmHg), normotensión e hipotensión (PAS < 90 mmHg). El tono vascular fue clasificado según la FPG en dos formas: 1) Mediante inspección visual de los cambios en la amplitud de la onda de FPG y en la posición de la incisura dícrota; donde las clases I-II representan vasoconstricción (incisura dícrota ubicada a > 50% de la amplitud de FPG en ondas de pequeña amplitud), tono vascular normal de clase III (incisura dícrota ubicada entre 20-50% de la amplitud de FPG en ondas normales) y vasodilatación de clases IV-V-VI (incisura dícrota a < 20% de la amplitud FPG en ondas grandes). 2) Mediante un análisis automatizado basado en RN-S que combina siete parámetros derivados de la onda de FPG. Resultados: La evaluación visual fue precisa en la detección de hipotensión (sensibilidad 91%, especificidad 86% y precisión 88%) e hipertensión (sensibilidad 93%, especificidad 88% y precisión 90%). La normotensión se presentó como clase visual III (III-III) (mediana y 1°- 3° cuartiles), hipotensión como clase V (IV-VI) e hipertensión como clase II (I-III); todos con significancia estadística (p < 0,0001). La RN-S funcionó bien en la clasificación de las condiciones de PA. El porcentaje de datos con clasificación correcta por la RN-S fue del 83% para normotensión, 94% para hipotensión y 90% para hipertensión. Conclusiones: Los cambios en la PA inducidos por alteraciones en el tono vascular fueron clasificados correctamente de forma automática con una RN-S con base en...(AU)

Background: To test whether a Shallow Neural Network (S-NN) can detect and classify vascular tone dependent changes in arterial blood pressure (ABP) by advanced photopletysmographic (PPG) waveform analysis. Methods: PPG and invasive ABP signals were recorded in 26 patients undergoing scheduled general surgery. We studied the occurrence of episodes of hypertension (systolic arterial pressure (SAP) > 140 mmHg), normotension and hypotension (SAP < 90 mmHg). Vascular tone according to PPG was classified in two ways: 1) By visual inspection of changes in PPG waveform amplitude and dichrotic notch position; where Classes I-II represent vasoconstriction (notch placed > 50% of PPG amplitude in small amplitude waves), Class III normal vascular tone (notch placed between 20-50% of PPG amplitude in normal waves) and Classes IV-V-VI vasodilation (notch < 20% of PPG amplitude in large waves). 2) By an automated analysis, using S-NN trained and validated system that combines seven PPG derived parameters. Results: The visual assessment was precise in detecting hypotension (sensitivity 91%, specificity 86% and accuracy 88%) and hypertension (sensitivity 93%, specificity 88% and accuracy 90%). Normotension presented as a visual Class III (III-III) (median and 1st-3rd quartiles), hypotension as a Class V (IV-VI) and hypertension as a Class II (I-III); all p < 0.0001. The automated S-NN performed well in classifying ABP conditions. The percentage of data with correct classification by S-ANN was 83% for normotension, 94% for hypotension, and 90% for hypertension. Conclusions: Changes in ABP were correctly classified automatically by S-NN analysis of the PPG waveform contour.(AU)

Photoplethysmography waveform analysis for classification of vascular tone and arterial blood pressure: Study based on neural networks.

BACKGROUND: To test whether a Shallow Neural Network (S-NN) can detect and classify vascular tone dependent changes in arterial blood pressure (ABP) by advanced photopletysmographic (PPG) waveform analysis. METHODS: PPG and invasive ABP signals were recorded in 26 patients undergoing scheduled general surgery. We studied the occurrence of episodes of hypertension (systolic arterial pressure (SAP) >140 mmHg), normotension and hypotension (SAP < 90 mmHg). Vascular tone according to PPG was classified in two ways: 1) By visual inspection of changes in PPG waveform amplitude and dichrotic notch position; where Classes I-II represent vasoconstriction (notch placed >50% of PPG amplitude in small amplitude waves), Class III normal vascular tone (notch placed between 20-50% of PPG amplitude in normal waves) and Classes IV-V-VI vasodilation (notch <20% of PPG amplitude in large waves). 2) By an automated analysis, using S-NN trained and validated system that combines seven PPG derived parameters. RESULTS: The visual assessment was precise in detecting hypotension (sensitivity 91%, specificity 86% and accuracy 88%) and hypertension (sensitivity 93%, specificity 88% and accuracy 90%). Normotension presented as a visual Class III (III-III) (median and 1st-3rd quartiles), hypotension as a Class V (IV-VI) and hypertension as a Class II (I-III); all p < .0001. The automated S-NN performed well in classifying ABP conditions. The percentage of data with correct classification by S-ANN was 83% for normotension, 94% for hypotension, and 90% for hypertension. CONCLUSIONS: Changes in ABP were correctly classified automatically by S-NN analysis of the PPG waveform contour.

Prevalencia de lesiones por presión en pacientes del hospital Dr. José María Vargas 2021-2022. Estudio retrospectivo / Prevalence of pressure injuries in patients at Hospital Dr. Jose Maria Vargas 2021-2022. Retrospective study

Las lesiones por presión representan un problema de salud pública y de seguridad del paciente, debido a las elevadas tasas de prevalencia que condicionan y repercusiones en el ámbito sanitario y económico, tanto a nivel institucional como familiar y personal.Objetivo : analizar la prevalencia de las lesiones por presión en pacientes del Hospital Dr. José María Vargas, 2021-2022.Métodos : estudio retrospectivo, con enfoque cuantitativo, no experimental, descriptivo y de corte transversal, en el cual se efectuó revisión de historias clínicas. Con una población de 1838 pacientes que acudieron al Hospital José María Vargas de Cagua en el periodo de estudio, de los cuales se identificaron 25 casos con diagnóstico de lesión por presión; la muestra fue censal. Como instrumento de recolección de datos se empleó una ficha de registro. Resultados : las úlceras por presión tienen mayor prevalencia en pacientes con edad superior a 71 años, del sexo femenino, con antecedentes de diabetes mellitus, hipertensión arterial o accidente cerebrovascular. Con frecuencia se manifiesta clínicamente como una lesión única, grado II o III; mientras que las regiones anatómicas más afectadas son la región sacra, la región glútea y la cresta ilíaca. La prevalencia de la patología quedó asentada en 1,36%.Conclusión : las lesiones por presión tienen mayor prevalencia en pacientes de edad avanzada, sexo femenino y del entorno urbano, con antecedente de diabetes mellitus e hipertensión arterial. Se presentan como lesiones únicas, grado II-III, en la región sacra, habitualmente con evolución de hasta 7 días, y de origen comunitario(AU)

Pressure injuries represent a public health and patient safety problem, due to the high prevalence rates that condition and repercussions in the health and economic sphere, both at an institutional, family and personal level. Objective: to analyze the prevalence of pressure injuries in patients at the Dr. José María Vargas Hospital, 2021-2022. Methods: retrospective study, with a quantitative, non-experimental, descriptive and cross-sectional approach, in which medical records were reviewed. With a population of 1838 patients who attended the José María Vargas de Cagua Hospital in the study period, of which 25 cases diagnosed with pressure injury were identified; the sample was census. As a data collection instrument, a registration form was used. Results: pressure ulcers are more prevalent in patients older than 71 years, female, with a history of diabetes mellitus, arterial hypertension or stroke. It frequently manifests clinically as a single lesion, grade II or III; while the most affected anatomical regions are the sacral region, the gluteal region and the iliac crest. The prevalence of the pathology was established at 1.36%. Conclusion: pressure injuries are more prevalent in elderly, female and urban patients with a history of diabetes mellitus and arterial hypertension. They present as single lesions, grade II-III, in the sacral region, usually with evolution of up to 7 days, and of community origin(AU)

Factores predictivos de conversión de colecistectomía laparoscópica. Artículo de Revisión / Predictive factors of laparoscopic cholecystectomy conversion. Review Article

Objetivo: establecer los factores predictivos y causas de conversión de la colecistectomía laparoscópica. Métodos: se trata de un metaanálisis en el que se realizó revisión bibliográfica a través de 8 bases de datos, se incluyeron 14 publicaciones correspondientes al periodo 2019 ­ 2023.Resultados : se encontró que los factores predictivos de conversión de colecistectomía laparoscópica se dividen en: factores propios del paciente: edad, género, índice de masa corporal, comórbidos, antecedente de cirugía abdominal; factores de la enfermedad: forma de ingreso del paciente bien sea electiva o de urgencia, presencia de colecistitis aguda, incremento del grosor de la pared vesicular, presencia de adherencias en el lecho operatorio; y factores del cirujano: que incluyen tanto la experiencia de este como la percepción de colecistectomía difícil.Conclusión : se ha logrado establecer en el presente trabajo que el sexo masculino, la edad avanzada, el mayor grosor de la pared de la vesícula biliar y la presencia de colecistitis aguda, representan factores predictivos de conversión de colecistectomía laparoscópica. Las principales causas de conversión fueron adherencias, dificultad de disección o visualización de las estructuras que componen el triángulo de Calot y hemorragia no controlada(AU)

Objective: to establish the predictive factors and causes of conversion of laparoscopic cholecystectomy. Methods: this is a qualitative research in which a bibliographic review was carried out through 8 databases, 14 publications corresponding to the period 2019 - 2023 were included.Results : it was found that the predictive factors of laparoscopic cholecystectomy conversion were They are divided into: factors specific to the patient: age, gender, body mass index, comorbidities, history of abdominal surgery; disease factors: admission of the patient, whether elective or urgent, presence of acute cholecystitis, increased thickness of the gallbladder wall, presence of adhesions in the surgical bed; and surgeon factors: which include both the surgeon's experience and the perception of difficult cholecystectomy.Conclusion : it has been established in the present work that the male sex, advanced age, greater thickness of the gallbladder wall and the presence of acute cholecystitis represent predictive factors for laparoscopic cholecystectomy conversion. The main causes of conversion were adhesions, difficulty in dissection or visualization of the structures that make up Calot's triangle, and uncontrolled bleeding(AU)

Frailty Status as a Novel Risk Stratification Tool in Patients with Acute Pancreatitis.

BACKGROUND: Although frailty is a known predictor of mortality and complications across various disease states, it remains an understudied topic among patients with acute pancreatitis (AP). OBJECTIVES: Our aim was to assess the impact of frailty on outcomes in patients with AP. DESIGN: Retrospective cohort study. SETTING: Appended data was obtained from the 2016-2017 National Inpatient Sample (NIS) database. PARTICIPANTS: 574,895 adult patients with a primary discharge diagnosis of AP. MEASUREMENTS: We performed a nationwide cohort study utilizing International Classification of Diseases (ICD) diagnostic codes to identify adult patients with AP. The Hospital Frailty Risk Score (HFRS) was used to classify patients as frail or non-frail. The primary outcome was complications related to AP including all-cause mortality. Secondary outcomes were length of stay and total hospitalization costs. Multivariable logistic regression models were used to determine the association between frailty and complications. RESULTS: 574,895 patients were represented; 24.7% (141,999) characterized as frail and 75.3% (432,896) as non-frail. 26.7% of frail patients suffered composite complications related to AP versus 13.3% of non-frail patients (P < 0.001). Frail patients had more cardiovascular, pulmonary, gastrointestinal, and infectious adverse events compared to non-frail patients. Frail patients also had higher mortality rates (2.0% vs 0.1% P < 0.001), increased length of stay (6.5 days vs 3.6, P < 0.001) and total hospitalization charges ($60,136 vs $31,095, P < 0.001). On multivariable analysis, positive frailty status was associated with 2.33 times increased odds of having composite complications. CONCLUSIONS: Frailty assessments can be utilized as an adjunct to validated scoring systems to improve risk stratification and clinical management of patients with AP.

SARS-CoV-2 transmission dynamics in the urban-rural interface.

OBJECTIVES: As the world responds to the coronavirus outbreak, the role of public health in ensuring equitable health care that considers the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dynamics in rural communities is still a challenge. The same suppression and mitigation measures have been implemented homogeneously, ignoring the differences between urban and rural areas. We propose an epidemiological model and simulate the dynamics of SARS-CoV-2 in urban and rural areas considering the interaction between these regions. STUDY DESIGN: This was a population modeling study. METHODS: A compartmental epidemiological model was formulated to simulate the transmission of SARS-CoV-2 in urban and rural areas. We use the model to investigate the impact of control strategies focused on the urban-rural interface to contain the epidemic size of SARS-CoV-2 in rural areas. RESULTS: Considering five different levels for the exposition rate in urban areas and keeping intrarural and urban-rural exposition rates fixed, the preventive measures reduce the size and delay the peak for the urban infectives. The response of infected individuals and cumulative deaths in rural areas upon changes in the urban dynamics was small but not negligible. On the other hand, preventive measures focused on the urban-rural interface impact the number of infected individuals and deaths in rural areas. CONCLUSIONS: The maintenance of SARS-CoV-2 in rural areas depends on the interaction of individuals at the urban-rural interface. Thus, restrictive measures established by the governments would not be required within rural areas. We highlight the importance of focused preventive measures on the urban-rural interface to reduce the exposure and avoid the transmission of SARS-CoV-2 to rural communities.

Reflexión: Entretejiendo los cuidados enfermeros, la historia y la cultura en Uruguay / Reflection: interweaving nursing care, history and culture

En el curso de la evolución de la humanidad, las tradiciones culturales y el cuidado se han extendido desde la experiencia transmitida de generación en generación por las mujeres, atribuida gradualmente a los hombres; heredando un fuerte enlace conectado a la moral y a la religión. Para luego desarrollarlos como cuidados enfermeros en la construcción de la profesión de enfermería [Fragmento de texto] (AU)

Ultrasound-guided brachiocephalic vein access in neonates and pediatric patients.

Central venous accesses in neonates and pediatric patients represent a common and important procedure for both, intraoperative and postoperative care. Point-of-care ultrasound-guided technique has been proposed to increased success rate and efficiency, as well as to decrease the number of complications. Ultrasound-guided internal jugular vein cannulation is considering the "gold standard" in children. Another central venous cannulation option in neonates and children has been supraclavicular ultrasound-guided cannulation of the brachiocephalic vein using the in-plane approach. This article gives a review of the current evidence, the basic knowledge of the technique and the structured approach to follow for supraclavicular ultrasound-guided brachiocephalic vein access in children and neonates.

Linoleic and oleic acids enhance cell migration by altering the dynamics of microtubules and the remodeling of the actin cytoskeleton at the leading edge.

Fatty acids (FA) have a multitude of biological actions on living cells. A target of their action is cell motility, a process of critical importance during cancer cell dissemination. Here, we studied the effect of unsaturated FA on ovarian cancer cell migration in vitro and its role in regulating cytoskeleton structures that are essential for cell motility. Scratch wound assays on human ovary cancer SKOV-3 cell monolayers revealed that low doses (16 µM) of linoleic acid (LA, 18:2 ω6) and oleic acid (OA; 18:1 ω9) promoted migration, while α-linolenic acid (ALA, 18:3 ω3), showed a migration rate similar to that of the control group. Single cell tracking demonstrated that LA and OA-treated cells migrated faster and were more orientated towards the wound closure than control. In vitro addition of those FA resulted in an increased number, length and protrusion speed of filopodia and also in a prominent and dynamic lamellipodia at the cell leading edge. Using time-lapse video-microscopy and FRAP we observed an increase in both the speed and frequency of actin waves associated with more mobile actin and augmented Rac1 activity. We also observed that FA induced microtubule-organizing center (MTOC)-orientation towards the cell front and affected the dynamics of microtubules (MT) in the direction of cell migration. We propose that environmental cues such as OA and LA present in ascitic fluid, should be taken into account as key factors for the regulation of cell migration.

Ultrasound-guided brachiocephalic vein access in neonates and pediatric patients. / Accesos vasculares ecoguiados de la vena braquiocefálica en neonatos y pacientes pediátricos.

Central venous accesses in neonates and pediatric patients represent a common and important procedure for both, intraoperative and postoperative care. Point-of-care ultrasound-guided technique has been proposed to increased success rate and efficiency, as well as to decrease the number of complications. Ultrasound-guided internal jugular vein cannulation is considering the "gold standard" in children. Another central venous cannulation option in neonates and children has been supraclavicular ultrasound-guided cannulation of the brachiocephalic vein using the in-plane approach. This article gives a review of the current evidence, the basic knowledge of the technique and the structured approach to follow for supraclavicular ultrasound-guided brachiocephalic vein access in children and neonates.

FluoroType® MTB in pleural fluid for diagnosing tuberculosis.

OBJECTIVES: This work aims to investigate the diagnostic accuracy of a nucleic acid amplification test (FluoroType MTB®) in pleural fluid (PF) and sputum to diagnose tuberculous pleural effusion (TPE). We also analyzed the increase in diagnostic accuracy of a second FluoroType MTB® test on a second thoracentesis sample when the first was negative. METHODS: We conducted a prospective single-center study that included 207 patients with pleural effusion (31 tuberculous and 176 due to other causes). Of the 31 cases of TPE, 21 (68%) were confirmed histologically or microbiologically; the other cases were considered probable. RESULTS: The operational characteristics of FluoroType MTB® in PF for identifying tuberculosis were a sensitivity of 13%, a specificity of 99%, a positive likelihood ratio of 11, and a negative likelihood ratio of 0.9. The diagnostic efficacy data for sputum samples were 21%, 91%, 2.4, and 0.9, respectively. PF and sputum cultures in solid and liquid media had greater sensitivity (36% and 31%, respectively). A second FluoroType MTB® test in PF was negative for 24 patients who had TPE and for whom the first FluoroType MTB® test was also negative. Only two (6.5%) patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB® in PF. CONCLUSION: Due to its low sensitivity, the FluoroType MTB® test in PF has a limited role in diagnosing tuberculous pleurisy.

FluoroType® MTB en líquido pleural para el diagnóstico de tuberculosis / FluoroType® MTB in pleural fluid for diagnosing tuberculosis

Objetivos This work aims to investigate the diagnostic accuracy of a nucleic acid amplification test (FluoroType MTB®) in pleural fluid (PF) and sputum to diagnose tuberculous pleural effusion (TPE). We also analyzed the increase in diagnostic accuracy of a second FluoroType MTB® test on a second thoracentesis sample when the first was negative. Métodos We conducted a prospective single-center study that included 207 patients with pleural effusion (31 tuberculous and 176 due to other causes). Of the 31 cases of TPE, 21 (68%) were confirmed histologically or microbiologically; the other cases were considered probable. Resultados The operational characteristics of FluoroType MTB® in PF for identifying tuberculosis were a sensitivity of 13%, a specificity of 99%, a positive likelihood ratio of 11, and a negative likelihood ratio of 0.9. The diagnostic efficacy data for sputum samples were 21%, 91%, 2.4, and 0.9, respectively. PF and sputum cultures in solid and liquid media had greater sensitivity (36% and 31%, respectively). A second FluoroType MTB® test in PF was negative for 24 patients who had TPE and for whom the first FluoroType MTB® test was also negative. Only two (6.5%) patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB® in PF. Conclusión Due to its low sensitivity, the FluoroType MTB® test in PF has a limited role in diagnosing tuberculous pleurisy (AU)

Toward Community Empowerment: The Puerto Rican Ganchero.

People who inject drugs (PWID) who migrate from Puerto Rico (PR) to New York City (NYC) are at elevated risk for hepatitis C (HCV), HIV and drug overdose. There is an urgent need to identify a sustainable path toward improving the health outcomes of this population. Peer-driven HIV/HCV prevention interventions for PWID are effective in reducing risk behaviors. Additionally, the concept of intravention-naturally occurring disease prevention activities among PWID (Friedman, 2004)-is a suitable theoretical framework to cast and bolster PWID-indigenous risk reduction norms and practices to achieve positive health outcomes. From 2017-2019, we conducted an ethnographic study in the Bronx, NYC to identify the injection risks of migrant Puerto Rican PWID, institutional barriers to risk reduction and solutions to these barriers. Study components included a longitudinal ethnography with 40 migrant PWID (e.g., baseline and exit interviews and monthly face-to-face follow-ups for 12 months), two institutional ethnographies (IEs) with 10 migrants and six service providers, and three focus groups (FGs) with another 15 migrant PWID. Data were analyzed using a grounded theory approach. In this article, we present findings from the IEs and FGs, specifically regarding a promising intravention pathway to promote health empowerment among these migrants that leverages an existing social role within their networks: the PR-indigenous ganchero. A ganchero is a vein-finding expert who is paid with drugs or cash for providing injection services. Ethnographic evidence from this study suggests that gancheros can occupy harm reduction leadership roles among migrant Puerto Rican PWID, adapting standard overdose and HIV/HCV prevention education to the specific experiences of their community. We conclude by noting the culturally appropriate risk reduction service delivery improvements needed to mitigate the health vulnerabilities of migrants and provide a roadmap for improving service delivery and identifying future research avenues.

B cells from Patients with Rheumatoid Arthritis Show Conserved CD39-Mediated Regulatory Function and increased CD39 Expression After Positive Response to Therapy.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive joint destruction associated with increased pro-inflammatory mediators. In inflammatory microenvironments, exogenous ATP (eATP) is hydrolyzed to adenosine, which exerts immunosuppressive effects, by the consecutive action of the ectonucleotidases CD39 and CD73. Mature B cells constitutively express both ectonucleotidases, converting these cells to potential suppressors. Here, we assessed CD39 and CD73 expression on B cells from treated or untreated patients with RA. Neither the frequency of CD73+CD39+ and CD73-CD39+ B cell subsets nor the levels of CD73 and CD39 expression on B cells from untreated or treated RA patients showed significant changes in comparison to healthy controls (HC). CpG+IL-2-stimulated B cells from HC or untreated RA patients increased their CD39 expression, and suppressed CD4+ and CD8+ T cell proliferation and intracellular TNF-production. A CD39 inhibitor significantly restored proliferation and TNF-producing capacity in CD4+ T cells, but not in CD8+ T cells, from HC and untreated RA patients, indicating that B cells from untreated RA patients conserved CD39-mediated regulatory function. Good responder patients to therapy (R-RA) exhibited an increased CD39 but not CD73 expression on B cells after treatment, while most of the non-responder (NR) patients showed a reduction in ectoenzyme expression. The positive changes of CD39 expression on B cells exhibited a negative correlation with disease activity and rheumatoid factor levels. Our results suggest modulating the ectoenzymes/ADO pathway as a potential therapy target for improving the course of RA.

Enfermedad aneurismática coronaria / Coronary aneurysm disease

Resumen La enfermedad aneurismática coronaria se define como la dilatación de un segmento arterial coronario más 1,5 veces el diámetro de las arterias adyacentes de tamaño normal. Puede ser difusa, y afectar todo el trayecto de la arteria, o localizada y afectar sólo un segmento arterial específico. Puede encontrarse entre un 3 a un 8% de los estudios angiográficos y entre un 0,22% a un 1,4% de las necropsias clínicas. Se presenta 3 reportes de casos, donde la presentación clínica, los hallazgos angiográficos y el manejo farmacológico es diverso como corresponde a esta entidad.

Abstract Coronary aneurysm disease is defined as the dilation of a coronary artery segment more than 1.5 times the diameter of the adjacent arteries of normal size. It may be diffuse, and affect the whole trajectory of the artery, or localised and only affect a specific arterial segment. It can be found in between 3% and 8% of angiograph studies, with between 0.22% and 1.4% in clinical post-mortems. Three case reports are presented in which the clinical presentation, the angiographic findings, and the pharmacological management are shown to be as diverse as this condition itself.