Adaptation and validation of a TB stigma scale for adolescents in Lima, Peru.

BACKGROUND: TB-related stigma contributes to poor clinical outcomes and reduced wellbeing for affected individuals. Adolescents may be particularly susceptible to TB-related stigma due to their heightened sensitivity to peer acceptance, yet few studies have evaluated TB-related stigma in this group. Without a validated scale, it remains challenging to measure TB-related stigma in adolescents.METHODS: We adapted and validated the Van Rie TB Stigma Scale (VTSS) for adolescents on treatment for rifampicin-susceptible TB in Lima, Peru. The modified stigma scale was administered within a larger survey, which measured other psychosocial factors, including depression, adverse childhood experiences (ACEs), and social support. Data analysis included factor analysis, internal consistency, and convergent validity.RESULTS: From October 2020 to September 2021, 249 adolescents (individuals aged 10-19 years) completed the survey. Preliminary confirmatory factor analysis led to removal of two items. The final 10-item scale demonstrated good internal consistency (Cronbach's α = 0.82) and adequate model fit (χ²/df = 2.0; root mean square error of approximation: 0.06; comparative fit index: 0.94; Tucker-Lewis Index: 0.92: standardized root mean square residual: 0.05). Stigma was positively correlated with ACEs (γ = 0.13), depression (γ = 0.39), and suicidal ideation (γ = 0.27), and negatively correlated with social support (γ = -0.19).CONCLUSION: This adolescent TB stigma scale may serve as a practical tool to measure TB-related stigma and evaluate the impact of stigma-reduction interventions in adolescents.

Leiomiosarcomas de grandes vasos en las extremidades inferiores / Leiomyosarcomas affecting main vessels in the lower extremities

Objetivos: Evaluar los resultados de la resección en bloque y la reconstrucción vascular de leiomiosarcomas con afectación de vasos principales en las extremidades inferiores. Material y métodos: Desde enero de 1983 a diciembre 2016 se diagnosticaron 42 pacientes con leiomiosarcomas, de los que 6 afectaban a vasos principales de las extremidades inferiores (denominados vasculares). Se registraron retrospectivamente datos epidemiológicos, estudios de imagen, cirugía realizada, tratamientos adyuvantes, complicaciones, así como las recidivas y mortalidad. Resultados: Todos los pacientes fueron afectos de leiomiosarcomas de alto grado(II-III FNCLCC), con un diámetro mayor tumoral de 9,1cm de media (6-15) y un seguimiento medio de 23 meses (7-36). La edad media fue de 64 años (29-84). El primer síntoma fue una tumoración palpable en 4 de ellos. Los otros 2 casos comenzaron con fenómenos tromboembólicos. En 5 casos el origen fueron los vasos femorales, mientras que un caso fue a nivel poplíteo. A pesar de que todos los casos preservaban la extremidad, 3 (50%) presentaron diseminación pulmonar, 2 (33%) hepática y un caso presentó recidiva local. Dos casos fueron exitus al finalizar el estudio y hubo un caso de pérdida de seguimiento. Discusión y conclusiones: Los leiomiosarcomas vasculares son tumores altamente agresivos con baja tasa de supervivencia a los 5 años. En nuestro estudio, el 50% de los pacientes se mantienen en remisión completa con un seguimiento medio de 23 meses. Es frecuente que su inicio asocie la presencia de una masa tumoral con fenómenos trombóticos (33% de nuestros casos). La cirugía de resección tumoral habitualmente compromete las estructuras vasculares principales, hecho que implica una resección y técnicas reconstructivas vasculares para el salvamento de la extremidad

Objective: To evaluate the results of bloc resection and vascular reconstruction of leiomyosarcomas with involvement of main vessels in the lower extremities. Material and methods: From January 1983 to December 2016, 42 patients with leiomyosarcomas were diagnosed. Six of these leiomyosarcomas affected main vessels of the lower extremities (called vascular). Epidemiological data, imaging studies, surgery performed, adjuvant treatments, complications, as well as recurrences and mortality were retrospectively recorded. Results: All the patients were affected by high-grade leiomyosarcomas (II-III FNCLCC classification), with a larger tumour average diameter of 9.1cm(6-15) and a mean follow-up of 23 months (7-36). The average age was 64 years (29-84). The first symptom was a palpable tumour in 4 of them. The other 2 cases debuted with thromboembolic phenomena. In 5 cases the origin was the femoral vessels, while one case was at the popliteal level. Although all cases preserved the limb, in 3 cases (50%) they presented pulmonary dissemination,2 cases (33%) hepatic dissemination and one case had local recurrence. Two cases died at the end of the study and there was one case of loss to follow-up. Discussion and conclusions: Vascular leiomyosarcomas are highly aggressive tumours with a low survival rate at 5 years. In our study, 50% of the patients remain in complete remission with a mean follow-up of 23 months. Their onset frequently associates the presence of tumour mass with thrombotic phenomena (33% of our cases). Tumour resection surgery usually compromises the main vascular structures, which implies resection and vascular reconstructive techniques to salvage the limb

Leiomyosarcomas affecting main vessels in the lower extremities. / Leiomiosarcomas de grandes vasos en las extremidades inferiores.

OBJECTIVE: To evaluate the results of bloc resection and vascular reconstruction of leiomyosarcomas with involvement of main vessels in the lower extremities. MATERIAL AND METHODS: From January 1983 to December 2016, 42 patients with leiomyosarcomas were diagnosed. Six of these leiomyosarcomas affected main vessels of the lower extremities (called vascular). Epidemiological data, imaging studies, surgery performed, adjuvant treatments, complications, as well as recurrences and mortality were retrospectively recorded. RESULTS: All the patients were affected by high-grade leiomyosarcomas (ii-iii FNCLCC classification), with a larger tumour average diameter of 9.1cm(6-15) and a mean follow-up of 23 months (7-36). The average age was 64 years (29-84). The first symptom was a palpable tumour in 4 of them. The other 2 cases debuted with thromboembolic phenomena. In 5 cases the origin was the femoral vessels, while one case was at the popliteal level. Although all cases preserved the limb, in 3 cases (50%) they presented pulmonary dissemination,2 cases (33%) hepatic dissemination and one case had local recurrence. Two cases died at the end of the study and there was one case of loss to follow-up. DISCUSSION AND CONCLUSIONS: Vascular leiomyosarcomas are highly aggressive tumours with a low survival rate at 5 years. In our study, 50% of the patients remain in complete remission with a mean follow-up of 23 months. Their onset frequently associates the presence of tumour mass with thrombotic phenomena (33% of our cases). Tumour resection surgery usually compromises the main vascular structures, which implies resection and vascular reconstructive techniques to salvage the limb.

Omeprazole-associated changes in the gastric mucosa of children.

AIMS: To describe histological findings in gastric mucosa biopsy specimens of children treated with proton-pump inhibitors (PPIs) for different periods of time. METHODS: Biopsy specimens from 12 children (aged 8 months to 15 years) treated with PPIs and 8 controls were processed for paraffin embedding and stained with H&E as well as inmmunohistochemically for sialyl-Tn antigen. RESULTS: The main changes were related to parietal cells which showed brisk cytoplasmic eosinophilia, apical cytoplasmic protrusions to dilated glands, cytoplasmic and nuclear hypertrophy, dilated intracytoplasmic canaliculi, binucleation and multinucleation. The intracellular canaliculi surface showed strong immunohistochemical reaction for sialyl-Tn antigen, apparently a marker for this structure. Some of the patients were biopsied after a short period of oral or intravenously administered omeprazole; the changes may therefore occur rapidly. CONCLUSIONS: PPIs induce the same changes in the gastric mucosa of children as in adults, but the number of nuclei is increased. These effects have not been reported previously in this age group. It is suggested that the changes result from a combination of effects of PPIs and gastrin release.

Small bowel gastric metaplasia: a report of three cases in children.

AIMS: To report three children displaying gastric metaplasia antral pyloric type of the small bowel mucosa. METHODS: Analysis of clinical, histopathological and immunohistochemical data. RESULTS: The first patient was a 14-year-old girl with history of chronic intestinal pseudo-obstruction and chronic jejunitis; the second patient was a 6-year-old girl with a long-lasting jejunostomy; and the third patient was a 5-year-old girl with ileal-rectal anastomosis. The foci of gastric metaplasia were obvious with H&E-stained sections. The cells at the gastric metaplasia mucosa proved to be MUC-1 and sialyl-Tn positive by immunohistochemistry and they were in a pattern that was different from that of the adjacent mucosa; the cells were autofluorescent in H&E-stained sections. CONCLUSIONS: Gastric metaplasia of the small bowel mucosa in these cases seems to have resulted from chronic inflammation and persistent regenerative activity. This has rarely been reported outside Crohn disease, and if ever in children.

Extrahepatic biliary atresia with cartilaginous metaplasia in the gallbladder remnants.

Extrahepatic biliary atresia (EBA) is a chronic inflammatory process leading to fibrous obliteration of the biliary tree. Cartilaginous metaplasia within the remaining walls of the biliary main ducts in EBA has been reported once, although as cartilage heterotopia. A similar finding is presented here, but in the gallbladder of an infant with the full-blown manifestations of EBA; it is proposed that the alteration results from metaplasia of local connective tissue. Also of note is the complete disappearance of smooth muscle cells in the walls of the biliary tree in EBA, a fact which seems to be missing in the description of the pathology in these cases.

Seguimiento de niños con Síndrome de Down: Grupo Atención Interdisciplinaria en niños Down: estudio preliminar / Follow-up of children with Down Syndrome: Group Interdisciplinary care in Down children: preliminary study

Se presenta un estudio preliminar, descriptivo y longitudinal, con los resultados del Programa de Seguimiento de Niños con Síndrome de Down nacidos en el Hospital Materno Infantil Ramón Sardá Grupo At.i.e.n.do (Atención integral en niños Down), sus características y la incidencia de las patologías más frecuentes.

Programa de seguimiento de niños con Síndrome de Down: Grupo At.i.e.n.do / Follow-up program of childrens with Down's Syndrome (Interdisciplinary care in Down childrens)

Se presenta el programa de seguimiento para niños con síndrome de Down (Atención integral en niños Down: At.i.en.Do.) del Hospital "Ramón Sardá" (HMIRS).

Seguimiento de niños con Síndrome de Down: Grupo Atención Interdisciplinaria en niños Down: estudio preliminar / Follow-up of children with Down Syndrome: Group Interdisciplinary care in Down children: preliminary study

Se presenta un estudio preliminar, descriptivo y longitudinal, con los resultados del Programa de Seguimiento de Niños con Síndrome de Down nacidos en el Hospital Materno Infantil Ramón Sardá Grupo At.i.e.n.do (Atención integral en niños Down), sus características y la incidencia de las patologías más frecuentes. (AU)

Programa de seguimiento de niños con Síndrome de Down: Grupo At.i.e.n.do / Follow-up program of childrens with Downs Syndrome (Interdisciplinary care in Down childrens)

Se presenta el programa de seguimiento para niños con síndrome de Down (Atención integral en niños Down: At.i.en.Do.) del Hospital "Ramón Sardá" (HMIRS). (AU)

High frequency of iron bone deposits in a Mexican population with renal osteodystrophy.

Renal osteodystrophy (ROD) is a multifactorial disease. Aluminium deposits have been implicated in its physiopathology but iron deposits have seldom been described. The purpose of this study was to investigate the presence of iron on the mineralization front, in 70 patients with ROD. Their mean age was 48+/-16 years, 36 were female, 34 male, 55 were admitted on peritoneal dialysis (78.5%) and 15 to haemodialysis (21.5%), for a period of 28+/-22 months. A bone biopsy was obtained from each patient after double tetracycline labelling. Blood samples were also obtained at the time of bone biopsy. The histomophometric analysis was performed following the criteria of Sherrard et al., with slight modifications; beside the usual stains, aluminium, iron and amyloid stainings were done on all bone specimens. Biochemical findings were: Ca 8.8+/-0.9 mg/dl, P 6.1+/-1.5 mg/dl; total alkaline phosphatase 197+/-258; PTHm 4.9+/-4.05ng/ml (normal 0.4-0.7 ng/ml), calcitonin 11+/-6 pg/ml (normal 1-26 pg/ml). Osteitis fibrosa was found in 31 patients (44.28%), mixed bone disease in two patients (2.28%); mild bone disease in 20 subjects (28.57%), adynamic bone lesion in 15 cases (21.42%) and osteomalacia in two patients (2.28%). Iron deposits were found on the mineralization front in 43 patients (61.4%); in 17, the percentage was <25 and, in 26, >25%. The iron deposits in the osteitis fibrosa group were highly significant (25/31). The aluminium deposit at the mineralization front was observed in eight patients (11.4%); in all but one, the percentage of this metal was <10%. Amyloid deposits were negative in all cases. The results show: (i) a Mexican population with ROD, present a highly significant incidence of siderosis on the bone mineralization front; (ii) in contrast, the aluminium deposits in this group of patients is lower than that reported in other series, and (iii) the spectrum of RO in this Mexican population is similar to that reported in other studies.