Clinical manifestations and expression of CD18 to guide the diagnosis of leukocyte adhesion deficiency type 1: Mexico experience.

BACKGROUND: Leukocyte adhesion deficiency type 1 (LAD-1) is an inborn error of immunity characterized by a defect in leukocyte trafficking. METHODS: Patients with clinical suspicion of LAD-1 were referred to our institution. Complete blood count and flow cytometric analysis, to identify the expression of CD18, CD11b, and the lymphocyte population phenotyping, were performed, and statistical analysis was completed. RESULTS: We report clinical manifestations and immunological findings of six Mexican patients diagnosed with LAD-1. The diagnosis was based on typical clinical presentation, combined with laboratory demonstration of leukocytosis, and significant reduction or near absence of CD18 and its associated molecules CD11a, CD11b, and CD11c on leukocytes. We found atypical manifestations, not described in other countries, such as early-onset autoimmunity or infections caused by certain microorganisms. CONCLUSIONS: Patients with LAD-1 may present with atypical manifestations, making flow cytometry an indispensable tool to confirm the diagnosis. We present the first report of LAD-1 patients in a Latin American country.

Anaphylaxis in Cold Induced Urticaria: A Case Report and Review of The Literature.

Cold-induced urticaria is considered as a subtype of physical urticaria and also the second most common type of chronic inducible urticaria. Contact with cold surfaces or the environment may cause systemic reactions, especially during aquatic activities. A 22-year-old female patient with a history of sulfa drug allergy began her condition 2 years before the presence of generalized pruritic erythema with hives as well as 2 episodes that had been characterized by facial angioedema and syncope 3-5 minutes after being in contact with cold air or surfaces.  On both events, she had just been outdoors on a cold, winter day. She was suspected to have cold-induced urticaria; thereby she had a positive reaction to the ice cube test. Due to the previous episodes of anaphylaxis, the patient was trained to administer intramuscular epinephrine. After 4 weeks of starting the treatment with antihistamines, no new events or injuries had occurred. Cold-induced urticaria may cause life-threatening reactions. The rate of anaphylaxis in these patients is low however, this case is presented to inform the importance of identifying this type of systemic reaction and preventing strategies.

Knowledge of healthcare providers in the management of anaphylaxis.

INTRODUCTION: Anaphylaxis is defined as a severe, life-threatening systemic hypersensitivity reaction. Early diagnosis and treatment of a severe allergic reaction requires recognition of the signs and symptoms, as well as classification of severity. It is a clinical emergency, and healthcare providers should have the knowledge for recognition and management. The aim of the study is to evaluate the level of knowledge in the management of anaphylaxis in healthcare providers. METHODS: It is an observational, descriptive, cross-sectional study conducted among healthcare providers over 18 years old via a Google Forms link and shared through different social media platforms. A 12-item questionnaire was applied which included the evaluation of the management of anaphylaxis, from June 2020 to May 2021. RESULTS: A total of 1023 surveys were evaluated; 1013 met inclusion criteria and were included in the statistical analysis. A passing grade was considered with 8 or more correct answers out of 12; the overall approval percentage was 28.7%. The group with the highest percentage of approval in the questionnaire was health-care providers with more than 30 years of work experience. There was a significant difference between the proportions of approval between all specialty groups, and in a post-hoc analysis, allergy and immunology specialists showed greater proportions of approval compared to general medicine practitioners (62.9% vs 25%; p=<0.001). CONCLUSIONS: It is important that healthcare providers know how to recognize, diagnose, and treat anaphylaxis, and later refer them to specialists in Allergy and Clinical Immunology in order to make a personalized diagnosis and treatment.

Correlation between NT-proBNP levels and the maximun vasoactive-inotropic score in the first 24 hours post-intervention of cardiac surgery.

Introduction: The clinical utility of brain natriuretic peptide (NT-proBNP) as a prognostic marker in pediatric patients with heart failure is controversial. The maximum vasoactive inotropic score at 24 h after cardiac surgery in pediatric patients is an important predictor of morbidity and postoperative mortality. Objective: To determine if there is a correlation between the serum levels of NT-proBNP and the maximum vasoactive inotropic score at 24 hours after cardiac surgery in pediatric patients seen in the Intensive Care Unit. Material and methods: An analytical cross-sectional study. A Spearman correlation analysis (rs) was performed between the serum level of NT-proBNP and the maximum inotropic score both taken at 24 hours postoperatively. A value of p < 0.05 was considered statistically significant. Results: 40 patients were included, 52.5% to the male sex, 72.5% were older than 1 year of age at the time of surgery. A low correlation (rs = 0.26) was found between the serum levels of NT-proBNP and the maximum vasoactive inotropic score at 24 hours, this correlation was not statistically significant (p = 0.09). Conclusions: To our understanding, the present study is the first to investigate whether there is a correlation between these markers, so our results could set an important precedent that marks the beginning of multiple investigations in our critically ill patients in order to establish new diagnostic, prognostic and therapeutic approaches.

Introducción: La utilidad clínica del péptido natriurético cerebral (NT-proBNP) como marcador pronóstico en pacientes pediátricos con falla cardíaca es controversial. El puntaje inotrópico vasoactivo 24 horas después de la operación cardíaca en pacientes pediátricos es un importante predictor de morbilidad y mortalidad posoperatoria. Objetivo: Determinar si existe correlación entre los valores séricos de NT-proBNP y el puntaje inotrópico vasoactivo a las 24 horas posteriores a la intervención cardíaca en pacientes pediátricos atendidos en una unidad de terapia intensiva. Material y métodos: Estudio transversal analítico. Se realizó un análisis de correlación de Spearman (rs) entre la cifra sérica de NT-proBNP y el puntaje inotrópico máximo tomados ambos a las 24 horas del postoperatorio. Se consideró estadísticamente significativo un valor de p < 0.05. Resultados: Se incluyó a 40 pacientes, 52.5% del sexo masculino, 72.5% era mayor de un año de edad al momento de la operación. Se encontró una baja correlación (rs = 0.26) entre las concentraciones séricos de NT-proBNP y el puntaje inotrópico vasoactivo máximo a las 24 horas; dicha correlación no fue estadísticamente significativa (p = 0.09). Conclusiones: Este estudio es el primero en investigar la correlación entre estos marcadores y los resultados podrían sentar un antecedente que marque el inicio de múltiples investigaciones, con la finalidad de establecer nuevas herramientas diagnósticas, pronósticas y terapéuticas.

Correlación entre los valores séricos de NT-proBNP y el puntaje inotrópico vasoactivo máximo en las primeras 24 horas después de una intervención de cirugía cardíaca / Correlation between NT-proBNP levels and the maximun vasoactive-inotropic score in the first 24 hours post-intervention of cardiac surgery

Resumen Introducción: La utilidad clínica del péptido natriurético cerebral (NT-proBNP) como marcador pronóstico en pacientes pediátricos con falla cardíaca es controversial. El puntaje inotrópico vasoactivo 24 horas después de la operación cardíaca en pacientes pediátricos es un importante predictor de morbilidad y mortalidad posoperatoria. Objetivo: Determinar si existe correlación entre los valores séricos de NT-proBNP y el puntaje inotrópico vasoactivo a las 24 horas posteriores a la intervención cardíaca en pacientes pediátricos atendidos en una unidad de terapia intensiva. Material y métodos: Estudio transversal analítico. Se realizó un análisis de correlación de Spearman (rs) entre la cifra sérica de NT-proBNP y el puntaje inotrópico máximo tomados ambos a las 24 horas del postoperatorio. Se consideró estadísticamente significativo un valor de p menor que 0.05. Resultados: Se incluyó a 40 pacientes, 52.5% del sexo masculino, 72.5% era mayor de un año de edad al momento de la operación. Se encontró una baja correlación (rs = 0.26) entre las concentraciones séricos de NT-proBNP y el puntaje inotrópico vasoactivo máximo a las 24 horas; dicha correlación no fue estadísticamente significativa (p = 0.09). Conclusiones: Este estudio es el primero en investigar la correlación entre estos marcadores y los resultados podrían sentar un antecedente que marque el inicio de múltiples investigaciones, con la finalidad de establecer nuevas herramientas diagnósticas, pronósticas y terapéuticas.

Abstract Introduction: The clinical utility of brain natriuretic peptide (NT-proBNP) as a prognostic marker in pediatric patients with heart failure is controversial. The maximum vasoactive inotropic score at 24 h after cardiac surgery in pediatric patients is an important predictor of morbidity and postoperative mortality. Objective: To determine if there is a correlation between the serum levels of NT-proBNP and the maximum vasoactive inotropic score at 24 hours after cardiac surgery in pediatric patients seen in the Intensive Care Unit. Material and methods: An analytical cross-sectional study. A Spearman correlation analysis (rs) was performed between the serum level of NT-proBNP and the maximum inotropic score both taken at 24 hours postoperatively. A value of p less 0.05 was considered statistically significant. Results: 40 patients were included, 52.5% to the male sex, 72.5% were older than 1 year of age at the time of surgery. A low correlation (rs = 0.26) was found between the serum levels of NT-proBNP and the maximum vasoactive inotropic score at 24 hours, this correlation was not statistically significant (p = 0.09). Conclusions: To our understanding, the present study is the first to investigate whether there is a correlation between these markers, so our results could set an important precedent that marks the beginning of multiple investigations in our critically ill patients in order to establish new diagnostic, prognostic and therapeutic approaches.

From Elemental Sulfur to Hydrogen Sulfide in Agricultural Soils and Plants.

Sulfur is an essential element in determining the productivity and quality of agricultural products. It is also an element associated with tolerance to biotic and abiotic stress in plants. In agricultural practice, sulfur has broad use in the form of sulfate fertilizers and, to a lesser extent, as sulfite biostimulants. When used in the form of bulk elemental sulfur, or micro- or nano-sulfur, applied both to the soil and to the canopy, the element undergoes a series of changes in its oxidation state, produced by various intermediaries that apparently act as biostimulants and promoters of stress tolerance. The final result is sulfate S+6, which is the source of sulfur that all soil organisms assimilate and that plants absorb by their root cells. The changes in the oxidation states of sulfur S0 to S+6 depend on the action of specific groups of edaphic bacteria. In plant cells, S+6 sulfate is reduced to S-2 and incorporated into biological molecules. S-2 is also absorbed by stomata from H2S, COS, and other atmospheric sources. S-2 is the precursor of inorganic polysulfides, organic polysulfanes, and H2S, the action of which has been described in cell signaling and biostimulation in plants. S-2 is also the basis of essential biological molecules in signaling, metabolism, and stress tolerance, such as reactive sulfur species (RSS), SAM, glutathione, and phytochelatins. The present review describes the dynamics of sulfur in soil and plants, considering elemental sulfur as the starting point, and, as a final point, the sulfur accumulated as S-2 in biological structures. The factors that modify the behavior of the different components of the sulfur cycle in the soil-plant-atmosphere system, and how these influences the productivity, quality, and stress tolerance of crops, are described. The internal and external factors that influence the cellular production of S-2 and polysulfides vs. other S species are also described. The impact of elemental sulfur is compared with that of sulfates, in the context of proper soil management. The conclusion is that the use of elemental sulfur is recommended over that of sulfates, since it is beneficial for the soil microbiome, for productivity and nutritional quality of crops, and also allows the increased tolerance of plants to environmental stresses.

Effect of experimental spinal cord injury on salicylate bioavailability after oral aspirin administration.

The purpose of the present work was to study whether spinal cord injury (SCI) alters salicylate bioavailability after oral aspirin administration. Female Sprague-Dawley rats were subjected to SCI at the T8 level by two procedures, contusion by the weight-drop method and severance by knife, and received a single oral aspirin dose (15 mg/kg) 24 h after injury. Blood samples were drawn and aspirin (ASA) and salicylic acid (SA) concentrations in whole blood were determined at selected times over a period of 240 min. Both SCI procedures produced similar alterations on salicylate bioavailability. ASA bioavailability was not significantly changed by SCI. On the other hand, SA peak concentrations were significantly reduced in 20% to 30%, compared with sham-lesioned controls. The area under the SA concentration against time curve was decreased in 10% to 25%, although this difference did not reach statistical significance. Results suggest that SCI at the T8 level decreases the rate, but not the extent, of aspirin absorption from the gastrointestinal tract. SCI-induced alterations in aspirin absorption appeared to be modest compared with those previously reported for other analgesic agents, such as paracetamol (acetaminophen).