Global longitudinal strain in heart transplantation recipients using different vendors: reliability and validity in a tertiary hospital in Colombia.

Global Longitudinal Strain (GLS) is a useful tool to follow-up heart transplant (HT) recipients. Important inter-vendor variability of GLS measurements has been reported in healthy subjects and different conditions, but there is still limited evidence among HT patients. We assessed the reliability and validity of GLS using two vendors (General Electric and Philips) in a group of consecutive and stable adult HT recipients. Patients underwent two concurrent GLS analyses during their echocardiographic follow-up. We evaluated GLS inter-vendor reliability using Bland-Altman's limits of agreement (LOA) plots, computing its coverage probability (CP) and the intraclass correlation coefficient (ICC). Validity was assessed though receiver operating characteristics (ROC) curves, predictive values, sensitivity and specificity of GLS for each vendor to detect a normal left ventricle function. 78 pairs of GLS studies in 53 stable HT patients were analyzed. We observed a modest inter-vendor reliability with a broad LOA (less than 50% of values falling out our CP of 2% and an ICC of 0.49). ROC analyses (areas under the curve of 0.824 Vs. 0.631, p < 0.05) and diagnosis test indices (Sensitivity of 0.73 Vs. 0.64; and Specificity of 0.79 Vs. 0.50) favored GE over Philips. Inter-vendor variability for GLS analysis exceeded clinically acceptable limits in HT recipients. GLS from GE software seemed to show higher validity as compared to Philips'. The present study provides evidence to consider caution for the interpretation of GLS for clinical management in the follow-up of HT patients, especially when GLS is measured by different vendors.

Multidisciplinary Treatment of Deep Non-Carious Cervical Lesion With a CAD/CAM Chairside Restoration in Combination With Periodontal Surgery: A 60-Month Follow-Up Technique Report.

INTRODUCTION: Restoring function and esthetics are essential aspects of periodontology and restorative dentistry. Depending on their extension and the tissues involved, the treatment of non-carious cervical lesions (NCCLs) associated with gingival recessions may require a multidisciplinary approach, and different periodontal and restorative techniques have been described. CASE PRESENTATION: This case report presents an innovative approach to treat a deep NCCL combined with a gingival recession in a canine region of a female patient. A Computer Aided Design - Computer Aided Manufacturing (CAD/CAM) chairside ceramic restoration in combination with mucogingival surgery procedures is described. A comprehensive analysis of the selected approach and its clinical implications is presented based on a 60-month follow-up. Conclusions After 60-month follow-up, clinical condition maintained stable, and a successful esthetic outcome was accomplished. Complete root coverage was achieved and kept throughout the whole period of tracing.

Inpatient Neurology Consultations During the Onset of the SARS-CoV-2 New York City Pandemic: A Single Center Case Series.

Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily causes respiratory illness. However, neurological sequelae from novel coronavirus disease 2019 (COVID-19) can occur. Patients with neurological conditions may be at higher risk of developing worsening of their underlying problem. Here we document our initial experiences as neurologic consultants at a single center quaternary hospital at the epicenter of the COVID-19 pandemic. Methods: This was a retrospective case series of adult patients diagnosed with SARS-CoV-2 who required neurological evaluation in the form of a consultation or primary neurological care from March 13, 2020 to April 1, 2020. Results: Thirty-three patients (ages 17-88 years) with COVID-19 infection who required neurological or admission to a primary neurology team were included in this study. The encountered neurological problems associated with SARS-CoV-2 infection were encephalopathy (12 patients, 36.4%), seizure (9 patients, 27.2%), stroke (5 patients, 15.2%), recrudescence of prior neurological disease symptoms (4 patients, 12.1%), and neuromuscular (3 patients, 9.1%). The majority of patients who required evaluation by neurology had elevated inflammatory markers. Twenty-one (63.6%) patients were discharged from the hospital and 12 (36.4%) died from COVID-19 related complications. Conclusion: This small case series of our initial encounters with COVID-19 infection describes a range of neurological complications which are similar to presentations seen with other critical illnesses. COVID-19 infection did not change the overall management of neurological problems.

Dimensional Variations in the Soft Tissue Profile After Removal of Implant-Supported Fixed Interim Restorations: A Pilot Clinical Study.

PURPOSE: To measure dimensional changes of the periimplant soft tissue profile after removal of a single implant fixed interim restorations using digital impression procedures. MATERIALS AND METHODS: Ten participants presenting with single implant-supported fixed interim restorations (ISFIRs) on the maxillary esthetic zone. A 2-step silicone impression was made of the maxillary arch with the ISFIRs. The experimental procedure was obtained by making digital impressions of the gingival contours immediately after ISFIR removal. The control procedure was formed by fabricating definitive casts from the conventional impression using the ISFIRs as a customized impression transfer and making digital impressions of these definitive casts. Both images of paired groups were digitally overlapped on the computer, and their profiles were measured at the coronal, midlevel gingiva in the buccolingual and mesiodistal width. RESULTS: Statistically significant differences between the ISFIR emergence profile width and the unsupported soft tissue profile width were observed at the midlevel gingiva in the buccolingual dimension (1.35 mm) and at the coronal (0.51 mm) and midlevel gingiva (1.29 mm) in the mesiodistal dimension. CONCLUSIONS: A digital impression, as used in this pilot study, does not capture accurately the desired soft tissue dimensions immediately after removal of the ISFIR.

New diagnostic criteria for neurocysticercosis: Reliability and validity.

OBJECTIVE: The diagnosis of neurocysticercosis (NCC) remains problematic because of the heterogeneity of its clinical, immunological, and imaging characteristics. Our aim was to develop and assess a new set of diagnostic criteria for NCC, which might allow for the accurate detection of, and differentiation between, parenchymal and extraparenchymal disease. METHODS: A group of Latin American NCC experts developed by consensus a new set of diagnostic criteria for NCC. A multicenter, retrospective study was then conducted to validate it. The reference standard for diagnosis of active NCC was the disappearance or reduction of cysts after anthelmintic treatment. In total, three pairs of independent neurologists blinded to the diagnosis evaluated 93 cases (with NCC) and 93 controls (without NCC) using the new diagnostic criteria. Mixed-effects logistic regression models were used to estimate sensitivity and specificity. RESULTS: Inter-rater reliability (kappa) of diagnosis among evaluators was 0.60. For diagnosis of NCC versus no NCC, the new criteria had a sensitivity of 93.2% and specificity of 81.4%. For parenchymal NCC, the new criteria had a sensitivity of 89.8% and specificity of 80.7% and for extraparenchymal NCC, the new criteria had a sensitivity of 65.9% and specificity of 94.9%. INTERPRETATION: These criteria have acceptable reliability and validity and could be a new tool for clinicians and researchers. An advantage of the new criteria is that they consider parasite location (ie, parenchymal or extraparenchymal), which is an important factor determining the clinical, immunological, and radiological presentation of the disease, and importantly, its treatment and prognosis. Ann Neurol 2016;80:434-442.

Sindrome de embolismo graso con predominio de sintomas neurologicos / Fat embolism syndrome with predominance of neurological symptoms

El sindrome de embolismo graso hace referencia a un conjunto de signos y sintomas secundarios a la liberacion de lipidos dentro de la circulacion sanguinea. Ocurre en alrededor del 1% de los pacientes con fracturas de femur. La triada clasica de este sindrome incluye dificultad respiratoria con hipoxemia, alteracion neurologica y exantema petequial. Pese a las descripciones aisladas que documentan la mejoria de los sintomas despues de administrar corticoides, no existe clara evidencia de la utilidad de estos farmacos, por lo que el manejo actual consiste en soporte cardiovascular y respiratorio. Se presenta un paciente adulto joven con sindrome de embolismo graso y manifestaciones respiratorias minimas tras una fractura traumatica de femur.

Fat embolism syndrome refers to a set of signs and symptoms caused by the release of fat in the bloodstream. It occurs in about 1% of patients with femur fractures. The classic triad includes respiratory distress with hypoxemia, neurologic impairment and petechial rash. Isolated reports document symptom improvement after administration of corticosteroids, but solid evidence of the usefulness of these drugs is lacking; therefore current management includes cardiovascular and respiratory support. We present a young adult patient with fat embolism syndrome and minimal respiratory symptoms after traumatic femoral fracture.

Sex differences in glia reactivity after cortical brain injury.

Several brain disorders associated with neuroinflammation show sex differences in their incidence, onset, progression and/or outcome. The different regulation of the neuroinflammatory response in males and females could underlie these sex differences. In this study, we have explored whether reactive gliosis after a penetrating cortical injury exhibits sex differences. Males presented a higher density of Iba1 immunoreactive cells in the proximity of the wound (0-220 µm) than females. This sex difference was due to a higher number of Iba1 immunoreactive cells with nonreactive morphology. In addition microglia/macrophages in that region expressed arginase-1, marker of alternatively activated microglia, and the neuroprotective protein Neuroglobin, in a greater proportion in males than in females. No sex differences were found in the number of astrocytes around the lesion. However, the percentage of astrocytes expressing chemokine (C-C motif) ligand 2 (CCL2), involved in recruitment of immune cells and gliosis regulation, was higher in males. Males also presented a significantly higher density of neurons in the lesion edge than females. These findings indicate that male and female mice have different neuroinflammatory responses after a cortical stab wound injury and suggest that sex differences in reactive gliosis may contribute to sex differences in neuroinflammatory diseases. GLIA 2015;63:1966-1981.

Enfermedad quística de la vía biliar: diagnóstico por imagen / Imaging of cystic disease of the biliary tree

La enfermedad quística de la vía biliar también llamada quiste del colédoco, es una enfermedad rara en países occidentales, prevaleciendo en países orientales como Japón y China. Puede ser detectada por ultrasonido, tomografía computada y resonancia magnética, sin embargo, la colangiografía directa por vía percutánea o endoscópica es el método de elección para hacer el diagnóstico. En este trabajo, los autores describen los tipos anatómicos de enfermedad quística de la vía biliar con sus hallazgos de imagen y se propone añadir a la clasificación un sexto tipo que llamamos VI

Enfermedad de Chagas en una comunidad de pequeños mamíferos simpátricos de la reserva nacional de Las Chinchillas / Chagas disease in community of small sympatric mammals from Las Chinchillas national reserve, IV Region, Chile

En la Reserva Nacional Las Chinchillas y alrededores (Aucó, Illapel, IV Región de Chile), ubicada en el centro de una zona hiperendémica de la Enfermedad de Chagas en Chile, se realizó un muestreo dirigido de área, para estudiar los índices de infección por T. cruzi en la comunidad de micromamíferos simpátricos con Chinchilla lanígera. Este roedor hystricognato, ha sido considerado en peligro de extinción, debido a la caza indiscriminada a que fue sometido en el pasado, por el valor y la calidad de su piel. Con trampas para animales vivos se capturaron 126 ejemplares correspondientes a 6 géneros y 7 especies de roedores y una especie marsupial. En cada uno se investigó la presencia de infección por T. cruzi mediante xenodiagnóstico y/o serología. Para ésta, se empleó la Reacción de Hemoaglutinación Indirecta (RHAI) en suero total y en elución desde papel filtro. En total, 13,5% de los animales estudiados resultaron positivos. Se determinó un 20% de positividad de C. lanígera, considerando ambas pruebas diagnósticas, aunque subió a 31,6% en los sometidos sólo a RHAI. El 36,4% de Abrocoma bennetti resultaron positivos a RHAI y 11,1% al xenodiagnóstico, y el 10% de Phyllotis darwini fue positivo al xenodiagnóstico. Estas tres especies señaladas corresponden a las primeras publicaciones de positividad que se han hecho sobre ellas en Chile, aunque ya habíamos comunicado resultados preliminares en algunos eventos. Un 8,3% de ejemplares Octodon degus fueron positivos a RHAI y 12,9% al xenodiagnóstico, alcanzando los más altos índices de infección encontrados hasta ahora en Chile para esta especie. Se concluye que la endemoenzootía chagásica es un importante factor que afecta a estas comunidades. T. cruzi permanece circulando entre estos micromamíferos silvestres, vectorizado por Triatoma spinolai