Case report: Uncommon gastric metastasis as a presentation of recurrent clear cell renal cell carcinoma.

Renal cell carcinoma (RCC) is a kidney neoplasm that accounts for 85% of cases and has complex genetic pathways that affect its development and progression. RCC metastasis can occur in 20%-50% of patients and usually affects distant organs. Gastric metastases (GM) from RCC are rare and present as polyp-like growths in the submucosal layer, accounting for 0.2%-0.7% of cases. This case report describes an 84-year-old female with Furhman grade II ccRCC who presented with an atherothrombotic ischemic stroke and gastrointestinal bleeding nine years post-radical nephrectomy. Gastroscopy revealed a 12mm pseudopedicled gastric lesion with ulceration and bleeding, diagnosed as metastatic ccRCC. The discussion focuses on the rarity, diagnostic challenges, and prognostic elements of gastric metastasis from RCC. The median survival after detecting digestive metastasis varies widely, and the mechanisms include direct invasion and dissemination through lymphatic, transcelomic, or hematogenous routes. Prognostic markers encompass patient history, symptoms, time since RCC diagnosis, overall health, and genetic factors. Surgical removal of gastric lesions and targeted therapy are treatment options that can improve survival. This case report highlights the need for further research to enhance diagnostic and treatment strategies for this rare aspect of RCC pathophysiology.

False diagnosis of recurrent thyroid carcinoma: the importance of testing for heterophile antibodies.

Thyroglobulin (Tg) levels are important to predict recurrence in differentiated thyroid cancer patients.However, false-positive results can hence the request of unnecessary tests and treatments. We reported two cases of interference in thyroglobulin measurement and the workup to investigate them. Both patients achieved an excellent response to therapy after total thyroidectomy and one patient had also received radioiodine treatment. During the follow-up, Tg levels increased and there was no evidence of recurrent disease in the imaging studies. The Tg levels by the Access platform were positive but the results by Elecsys platform and LC-MS/MS were undetectable, leading to the hypothesis of heterophile antibodies (HAbs) interference. The possibility of HAbs interference must be considered when the Tg levels do not fit in the clinical picture. The measurement of Tg by another immunoassay or by LC-MS/MS may be useful in these situations.

LC-MS/MS reduces interference by high levels of 25(OH)D and its metabolites on measured 1,25(OH)2D.

BACKGROUND: High-dose vitamin D supplementation has been recommended as treatment to several conditions; however, potential side effects such as hypercalcemia should be considered, plus the fact that high levels of 25(OH)D may interfere with potential 1,25(OH)2D measurements. Our study compared two methods of measuring 1,25-dihydroxyvitamin D [1,25(OH)2D] in samples with 25-hydroxyvitamin D [25(OH)D] levels above 150 ng/mL (375 nmol/L). METHODS: We studied serum samples referred to 25(OH)D and 1,25(OH)2D quantification. The concentrations of 25(OH)D and 1,25(OH)2D were measured using DiaSorin chemiluminescent assays (CLIA) in 213 samples (CLIA group), whereas in 357 samples 25(OH)D and 1,25(OH)2D were measured by DiaSorin CLIA and liquid chromatography-tandem mass spectrometry (LC-MS/MS), respectively (CLIA + MS group). RESULTS: Median concentrations of 25(OH)D and 1,25(OH)2D in the CLIA group were 371 ng/mL (928 nmol/L, range 154-856 ng/mL) and 350 pg/mL (875 pmol/L, range 41-1280 pg/mL), respectively, and correlated significantly (Spearman correlation coefficient rs = 0.8469, P < 0.001). In the CLIA + MS group, the median concentrations of 25(OH)D and 1,25(OH)2D were, respectively, 344 ng/mL (860 nmol/L, range 152-756 ng/mL) and 56 pg/mL (140 pmol/L, range 17-151 pg/mL), and were not correlated (rs = 0.0218, P = 0.6811). No significant difference was found in calcium, creatinine, and PTH serum values between the groups. CONCLUSION: Methods for measuring 1,25(OH)2D in patients with high levels of 25(OH)D may be susceptible to interference by 25(OH)D and its metabolites and should be validated carefully. In such cases, measurement of 1,25(OH)2D using LC-MS/MS is preferred.

No association between vitamin D status and COVID-19 infection in São Paulo, Brazil

ABSTRACT In recent years the immunomodulatory actions of vitamin D, a steroid hormone, have been extensively studied. In 2020, due to the COVID-19 pandemic, the question arose as to 25(OH)D status would be related to susceptibility to SARS-CoV-2 infection, since several studies pointed out a higher prevalence and severity of the disease in populations with low levels of 25(OH)D. Thus, we investigated the 25(OH)D levels in adults "Detected" positive for SARS CoV-2 by RT-PCR (reverse transcriptase polymerase chain reaction) test, and in negative controls, "not Detected", using the Fleury Group's examination database, in Sao Paulo, Brazil. Of a total of 14.692 people with recent assessments of 25(OH)D and RT-PCR tests for COVID-19, 2.345 were positive and 11.585 were negative for the infection. The groups did not differ in the percentage of men and women, or in the age distribution. There were no differences in the distribution of 25(OH)D between the two groups (p = 0.08); mean 25(OH)D of 28.8 ± 21.4 ng/mL and 29.6 ± 18.1 ng/mL, respectively. In the specific population studied, clinical, environmental, socioeconomic and cultural factors should have greater relevance than 25(OH)D in determining the susceptibility to COVID-19.

No association between vitamin D status and COVID-19 infection in São Paulo, Brazil.

In recent years the immunomodulatory actions of vitamin D, a steroid hormone, have been extensively studied. In 2020, due to the COVID-19 pandemic, the question arose as to 25(OH)D status would be related to susceptibility to SARS-CoV-2 infection, since several studies pointed out a higher prevalence and severity of the disease in populations with low levels of 25(OH)D. Thus, we investigated the 25(OH)D levels in adults "Detected" positive for SARS CoV-2 by RT-PCR (reverse transcriptase polymerase chain reaction) test, and in negative controls, "not Detected", using the Fleury Group's examination database, in Sao Paulo, Brazil. Of a total of 14.692 people with recent assessments of 25(OH)D and RT-PCR tests for COVID-19, 2.345 were positive and 11.585 were negative for the infection. The groups did not differ in the percentage of men and women, or in the age distribution. There were no differences in the distribution of 25(OH)D between the two groups (p = 0.08); mean 25(OH)D of 28.8 ± 21.4 ng/mL and 29.6 ± 18.1 ng/mL, respectively. In the specific population studied, clinical, environmental, socioeconomic and cultural factors should have greater relevance than 25(OH)D in determining the susceptibility to COVID-19.

Percepción de los adultos mayores acerca de sus vivencias en una casa de reposo / Perception of older adults about their experiences in a nursing home

Resumen

Introducción: la estancia de los adultos mayores en asilos o casas de reposo surge ante la necesidad, y de manera voluntaria, por razones de maltrato físico, emocional, psicológico y abandono por parte de la familia. La situación del anciano se complica, si requiere de cuidados prolongados y complejos por incapacidad o enfermedad propia de la vejez.

Objetivo: describir las vivencias de los adultos mayores institucionalizados (que viven en un asilo o casa de reposo) en un asilo del estado de Oaxaca.

Metodología: diseño cualitativo fenomenológico, mediante entrevista a profundidad a 21 adultos mayores entre 60 y 86 años de edad. La entrevista se inició con la pregunta: ¿Cuál es su percepción de vivir en este asilo? que guió el desarrollo de la misma. Los discursos fueron grabados, trascritos y analizados con la técnica de Klaus Krippendorff.

Resultados: en los adultos mayores se identificó un rango de edad entre 60 y 86 años, su estancia en el asilo va de 1 a 12 años, dos adultos mayores han intentado suicidarse y tres de ellos tienen una pierna amputada. Surgieron seis categorías que representan el significado de las vivencias del adulto mayor institucionalizado.

Conclusiones: en general, los discursos de los adultos mayores son similares, debido a los cambios en la dinámica familiar y social.

Abstract

Introduction: The stay of the elderly in asylum or nursing home arises from the need and voluntarily for reasons of physical, emotional, psychological and abandonment by the family. This gets complicated if the elder requires prolonged and complex care due to disability or illness typicals of old age.

Objective: To describe the experiences of institutionalized older adults (who live in a nursing home or nursing home) in a retirement home in Oaxaca, Mexico.

Methods: Qualitative phenomenological design, through in-depth interviews with 21 seniors between 60 and 86 years of age. The interview began with the question: What is your perception of living in this asylum? The speeches were recorded, transcribed and analyzed with the Klaus Krippendorff technique.

Results: In the elderly, an age range between 60 and 86 years was identified, their stay in the nursing home ranges from 1 to 12 years, two older adults have attempted suicide and three have an amputated leg. Six categories emerged that represent the meaning of the experiences of the institutionalized older adult.

Conclusions: In general, discourses of older adults are similar, due to changes in family and social dynamics.

Experience with a third-generation parathyroid hormone assay (BIO-PTH) in the diagnosis of primary hyperparathyroidism in a Brazilian population.

OBJECTIVE: To evaluate the usefulness of a third-generation PTH assay in the diagnosis of primary hyperparathyroidism (PHPT). SUBJECTS AND METHODS: Forty-one PHPT patients (4 men and 37 women) with 61.2 ± 10.9 (mean ± SD) years, were studied and had PTH levels measured with two different methods using the same immunochemiluminescent assay plataform (Elecsys 2010 System, Roche). We compared a second-generation assay (I-PTH) with a third-generation PTH assay (Bio-PTH). Two populations of 423 and 120 healthy adults with serum 25OHD levels above 25 ng/mL were used to define normal values in the I-PTH and Bio-PTH assays respectively. RESULTS: Normal PTH values based in the healthy adults population were 24.2-78.0 pg/mL for the I-PTH assay and 19.9-58.5 pg/mL for Bio-PTH assay. In PHPT patients, PTH values ranged from 67 to 553 pg/mL (median: 168 pg/mL) using the I-PTH assay and from 55 to 328 pg/mL (median: 111 pg/mL) using the Bio-PTH assay. Results obtained with the Bio-PTH assay were significantly lower (p < 0.0001, Wilcoxon). In general I-PTH and Bio-PTH showed highly significant correlation (r = 0.952, p < 0.0001). Passing-Bablok analysis gave a regression equation of Bio PTH = 13.44 + 0.59 x intact PTH. PHPT patients had 25OHD levels ranging from 4 to 36 ng/mL (mean 16.2 ng/mL); 35 subjects (85.3%) had values bellow 25 ng/mL. CONCLUSION: Our results demonstrate that both second and third generation PTH methods are strongly correlated in PHPT patients and control subjects. Lower results with Bio-PTH tests are expected in function of the assay specificity determined by the amino-terminal antibody used.

Experience with a third-generation parathyroid hormone assay (BIO-PTH) in the diagnosis of primary hyperparathyroidism in a Brazilian population

ABSTRACT Objective To evaluate the usefulness of a third-generation PTH assay in the diagnosis of primary hyperparathyroidism (PHPT). Subjects and methods Forty-one PHPT patients (4 men and 37 women) with 61.2 ± 10.9 (mean ± SD) years, were studied and had PTH levels measured with two different methods using the same immunochemiluminescent assay plataform (Elecsys 2010 System, Roche). We compared a second-generation assay (I-PTH) with a third-generation PTH assay (Bio-PTH). Two populations of 423 and 120 healthy adults with serum 25OHD levels above 25 ng/mL were used to define normal values in the I-PTH and Bio-PTH assays respectively. Results Normal PTH values based in the healthy adults population were 24.2-78.0 pg/mL for the I-PTH assay and 19.9-58.5 pg/mL for Bio-PTH assay. In PHPT patients, PTH values ranged from 67 to 553 pg/mL (median: 168 pg/mL) using the I-PTH assay and from 55 to 328 pg/mL (median: 111 pg/mL) using the Bio-PTH assay. Results obtained with the Bio-PTH assay were significantly lower (p < 0.0001, Wilcoxon). In general I-PTH and Bio-PTH showed highly significant correlation (r = 0.952, p < 0.0001). Passing–Bablok analysis gave a regression equation of Bio PTH = 13.44 + 0.59 x intact PTH. PHPT patients had 25OHD levels ranging from 4 to 36 ng/mL (mean 16.2 ng/mL); 35 subjects (85.3%) had values bellow 25 ng/mL. Conclusion Our results demonstrate that both second and third generation PTH methods are strongly correlated in PHPT patients and control subjects. Lower results with Bio-PTH tests are expected in function of the assay specificity determined by the amino-terminal antibody used.

Habilidades investigativas en estudiantes de medicina. Universidad de Ciencias Médicas de Sancti Spíritus. Curso 2013-2014 / Investigative abilities in medicine students. University of Medical Sciences of Sancti Spiritus. Academical year 2013-2014

La pertinencia y calidad de la educación superior es posible con actividad investigativa evidente e implícita, por ser consustancial con el proceso docente educativo. Objetivo: Identificar el nivel de desarrollo de las habilidades investigativas en estudiantes de Medicina de segundo año de la Universidad de Ciencias Médicas de Sancti Spiritus, durante el curso 2013-2014. Metodología: Se revisaron y analizaron 73 informes de trabajos científicos estudiantiles mediante una guía estructurada según el Estilo de Presentación de Investigaciones Científicas o indicaciones de comités organizadores de otros eventos, se observaron concurrentemente exposiciones y defensas de trabajos en la Jornada Científico estudiantil, Fórum de Historia y Jornada de Infecciones de Trasmision Sexual. El procesamiento de datos obtenidos incluyó distribución de frecuencia absoluta y relativa, con triangulación de métodos técnica y fuentes. Resultados: Predominó un escaso desarrollo de habilidades investigativas relacionadas con diseño teórico, fundamentalmente en problema científico y formulación de objetivos, errores ortográficos, de transcripción, redacción, en el apoyo digital de la exposición, expresión oral y argumentación en la defensa. Conclusiones: Existen necesidades de preparación científica estudiantil, desde asignaturas y disciplinas, rol de tutores, y protagonismo de organizaciones laborales y estudiantiles, con intencionalidad en el trabajo, que propicie la motivación y participación efectiva, lo que tributa a mejores modos de actuación y formación integral del futuro egresado(AU)

The relevancy and quality of the superior education is possible with evident and implicit investigative activity, to be consubstantial with the educational educational process. Objective: To identify the level of development of the investigative abilities in Medicine students of second year at the University of Medical Sciences of Sancti Spiritus, during the academical year 2013-2014. Methodology: 73 reports of student scientific works were checked and analyzed by means of a guide structured according to the Style of Presentation of Scientific Investigations or indications of organizing committees of other events, exhibitions and defenses of concurrently works in the Scientist student´s Day, Forum of History and Day of Sexual Transmission Infections were observed. The prosecution of obtained data included distribution of absolute and relative frequency, with technical triangulation of methods and sources. Results: A scarce development of investigative abilities related with theoretical design prevailed, fundamentally in scientific problem and formulation of objectives, spelling mistakes, of transcription, writing, in the digital support of the exhibition, oral expression and argument in the defense. Conclusions: Necessities of scientific student preparation exist, from subjects and disciplines, tutors' list, and protagonist of labor and student organizations, with premeditation in the work that propitiates the motivation and effective participation, what pays to better performance ways and integral formation of the future graduated(AU)

Habilidades investigativas en estudiantes de medicina. Universidad de Ciencias Médicas de Sancti Spíritus. Curso 2013-2014 / Investigative abilities in medicine students. University of Medical Sciences of Sancti Spiritus. Academical year 2013-2014

Fundamento: La pertinencia y calidad de la educación superior es posible con actividad investigativa evidente e implícita, por ser consustancial con el proceso docente educativo. Objetivo: Identificar el nivel de desarrollo de las habilidades investigativas en estudiantes de Medicina de segundo año de la Universidad de Ciencias Médicas de Sancti Spiritus, durante el curso 2013-2014. Metodología: Se revisaron y analizaron 73 informes de trabajos científicos estudiantiles mediante una guía estructurada según el Estilo de Presentación de Investigaciones Científicas o indicaciones de comités organizadores de otros eventos, se observaron concurrentemente exposiciones y defensas de trabajos en la Jornada Científico estudiantil, Fórum de Historia y Jornada de Infecciones de Trasmision Sexual. El procesamiento de datos obtenidos incluyó distribución de frecuencia absoluta y relativa, con triangulación de métodos técnica y fuentes. Resultados: Predominó un escaso desarrollo de habilidades investigativas relacionadas con diseño teórico, fundamentalmente en problema científico y formulación de objetivos, errores ortográficos, de transcripción, redacción, en el apoyo digital de la exposición, expresión oral y argumentación en la defensa. Conclusiones: Existen necesidades de preparación científica estudiantil, desde asignaturas y disciplinas, rol de tutores, y protagonismo de organizaciones laborales y estudiantiles, con intencionalidad en el trabajo, que propicie la motivación y participación efectiva, lo que tributa a mejores modos de actuación y formación integral del futuro egresado.

Background: The relevancy and quality of the superior education is possible with evident and implicit investigative activity, to be consubstantial with the educational educational process. Objective: To identify the level of development of the investigative abilities in Medicine students of second year at the University of Medical Sciences of Sancti Spiritus, during the academical year 2013-2014. Methodology: 73 reports of student scientific works were checked and analyzed by means of a guide structured according to the Style of Presentation of Scientific Investigations or indications of organizing committees of other events, exhibitions and defenses of concurrently works in the Scientist student´s Day, Forum of History and Day of Sexual Transmission Infections were observed. The prosecution of obtained data included distribution of absolute and relative frequency, with technical triangulation of methods and sources. Results: A scarce development of investigative abilities related with theoretical design prevailed, fundamentally in scientific problem and formulation of objectives, spelling mistakes, of transcription, writing, in the digital support of the exhibition, oral expression and argument in the defense. Conclusions: Necessities of scientific student preparation exist, from subjects and disciplines, tutors' list, and protagonist of labor and student organizations, with premeditation in the work that propitiates the motivation and effective participation, what pays to better performance ways and integral formation of the future graduated.

[The importance of methodology in serum testosterone measurement: comparison between a direct immunoassay and a method based on high performance liquid chromatography and tandem mass spectrometry (HPLC/MS-MS)]. / Importância da metodologia na dosagem de testosterona sérica: comparação entre um imunoensaio direto e um método fundamentado em cromatografia líquida de alta performance e espectrometria de massa em tandem (HPLC/MS-MS).

Serum testosterone in its total or free form, is a highly valuable diagnostic test and is available in the great majority of clinical laboratories. This reality was possible due to the development of simple and direct assays, adaptable to large automatic systems. Recent publications have called attention to the limitations of these simplified methodologies, mainly in samples with low concentration, as women and children. In this paper we present results obtained using a reference method based on high performance liquid chromatography and tandem mass spectrometry (HPLC/MS-MS) and its comparison with those obtained with a commercial routine immunoassay (electrochemiluminescent assay, ECLIA). Methods were compared in total testosterone measurement (n = 213), as well as in free testosterone evaluation based on calculation including sex hormone-binding protein (SHBG) levels (n = 135). Values obtained with ECLIA were significantly higher, with more marked dispersion in low concentration. This phenomenon is clearer when presented as a Bland-Altman plot. Difficulties in the implementation of reference methods as the one presented are discussed, as well as the necessity of caution in the interpretation of values obtained with routine assays, a matter of several publications in recent literature.

Importância da metodologia na dosagem de testosterona sérica: comparação entre um imunoensaio direto e um método fundamentado em cromatografia líquida de alta performance e espectrometria de massa em tandem (HPLC/MS-MS) / The importance of methodology in serum testosterone measurement: comparison between a direct immunoassay and a method based on high performance liquid chromatography and tandem mass spectrometry (HPLC/MS-MS)

A dosagem de testosterona sérica, total ou fração livre, é metodologia de alto valor diagnóstico e encontra-se disponível na maioria dos laboratórios clínicos. Esta disponibilidade foi possível pelo desenvolvimento de metodologias simples e diretas, adaptáveis a plataformas de dosagem automatizada. Uma série de publicações recentes tem alertado quanto às limitações destas metodologias, em especial em amostras com baixas concentrações, como mulheres e crianças. Neste trabalho serão apresentados os resultados do emprego de uma metodologia de referência, fundamentada em cromatografia líquida de alta performance e espectrometria de massa em tandem (HPLC/MS-MS), e sua comparação com uma dosagem de rotina (ensaio eletroquimioluminescente - ECLIA). Os métodos são comparados tanto na dosagem de testosterona total (n = 213) quanto na determinação de testosterona livre calculada com base na determinação da testosterona total e da proteína carregadora de hormônios sexuais (SHBG) (n = 135). Os valores obtidos com o ECLIA são significativamente mais elevados, sendo a dispersão mais nítida em soros com baixas concentrações. Tal fenômeno fica mais claro quando apresentado na forma de gráficos de Bland-Altman. Neste trabalho são discutidas as dificuldades de implementação de uma metodologia de referência, como a apresentada, e a convivência com as metodologias de rotina, bem como a literatura recente sobre o assunto.

Serum testosterone in its total or free form, is a highly valuable diagnostic test and is available in the great majority of clinical laboratories. This reality was possible due to the development of simple and direct assays, adaptable to large automatic systems. Recent publications have called attention to the limitations of these simplified methodologies, mainly in samples with low concentration, as women and children. In this paper we present results obtained using a reference method based on high performance liquid chromatography and tandem mass spectrometry (HPLC/MS-MS) and its comparison with those obtained with a commercial routine immunoassay (electrochemiluminescent assay, ECLIA). Methods were compared in total testosterone measurement (n = 213), as well as in free testosterone evaluation based on calculation inclu-ding sex hormone-binding protein (SHBG) levels (n = 135). Values obtained with ECLIA were significantly higher, with more marked dispersion in low concentration. This phenomenon is clearer when presented as a Bland-Altman plot. Difficulties in the implementation of reference methods as the one presented are discussed, as well as the necessity of caution in the interpretation of values obtained with routine assays, a matter of several publications in recent literature.