Feasibility and Safety of Percutaneous Kidney Biopsy in Small Kidneys: Breaking the Paradigm.

INTRODUCTION: The percutaneous kidney biopsy (PKB) is an essential tool in nephrology, small kidney size has been a relative contraindication to PKB and there is limited data on the safety and utility of performing PKB in this setting. Our aim was to describe the complications of PKB in small kidneys and to assess if kidney biopsy results have an impact on medical decisions and outcomes. METHODS: This was a retrospective, descriptive, and observational study. Patients older than 16 years of age with a decreased kidney size (≤ 8 cm), and undergoing PKB of native kidneys from July 2019 to December 2022 were included. RESULTS: Twenty-five patients were included, 19 women and 6 men. The mean age was 42.3 ± 18.04. The mean kidney length was 7.56 ±0.33 and the mean width was 4.2 cm. All patients received only one puncture, obtaining an average of 12 glomeruli. The mean BUN and serum creatinine were 36 mg/dl and 1.94 mg/dl, respectively and the mean Hgb (hemoglobin) was 12.87 ±2.81g/dL. Minor complications occurred in 5 patients, perirenal hematoma in 3 patients, hematuria in 1 patient, and hematoma plus hematuria in 1 patient. Histological examination showed FSGS, lupus nephritis, other Glomerular disease (GD), crescentic glomerulonephritis (GN), and tubulointerstitial nephritis in 36%, 20%, 16%, 16%, and 12% of the cases, respectively. Biopsy resulted in management modification in 64% of cases. In a bivariate analysis, kidney size was not associated with higher complication rates. CONCLUSIONS: Percutaneous kidney biopsy in small kidneys is a feasible and safe procedure when properly planned, providing an adequate sample in all cases, with an insignificant number of minor complications, and that is clinically relevant.

Pan American League of Associations for Rheumatology Recommendations for the Treatment of Psoriatic Arthritis.

OBJECTIVE: Psoriatic arthritis (PsA) is chronic disease that compromises multiple domains and might be associated with progressive joint damage, increased mortality, functional limitation, and considerably impaired quality of life. Our objective was to generate evidence-based recommendations on the management of PsA in Pan American League of Associations for Rheumatology (PANLAR) countries. METHODS: We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to adapt the 2019 recommendations of the European Alliance of Associations for Rheumatology. A working group consisting of rheumatologists from various countries in Latin America identified relevant topics for the treatment of PsA in the region. The methodology team updated the evidence and synthesized the information used to generate the final recommendations. These were then discussed and defined by a panel of 31 rheumatologists from 15 countries. RESULTS: Theses guidelines report 15 recommendations addressing therapeutic targets, use of antiinflammatory agents and corticosteroids, treatment with disease-modifying antirheumatic drugs (conventional synthetic, biologic, and targeted synthetic), therapeutic failure, optimization of biologic therapy, nonpharmacological interventions, assessment tools, and follow-up of patients with PsA. CONCLUSION: Here we present a set of recommendations to guide decision making in the treatment of PsA in Latin America, based on the best evidence available, considering resources, medical expertise, and the patient's values and preferences. The successful implementation of these recommendations should be based on clinical practice conditions, healthcare settings in each country, and a tailored evaluation of patients.

Oxidative stress in the bivalve Diplodon chilensis under direct and dietary glyphosate-based formulation exposure.

The aim of this study was to evaluate and compare the effects on biochemical parameters and organosomatic indices in the freshwater bivalve Diplodon chilensis exposed to a glyphosate-based formulation under direct and dietary exposures (4 mg a.p./L). After 1, 7, and 14 days of exposure, reduced glutathione (GSH) and thiobarbituric acid reactive substances (TBARS) levels and the activities of glutathione-S- transferase (GST), superoxide dismutase (SOD), and catalase (CAT) were evaluated in the gills and digestive gland. The hepatosomatic (HSI) and branchiosomatic (BSI) indices were also analyzed. Direct and dietary glyphosate-based formulation exposure altered the redox homeostasis in the gills and digestive gland throughout the experimental time, inducing the detoxification response (GST), the antioxidant defenses (SOD, CAT, GSH), and causing lipid peroxidation. After 14 days of exposure, the HSI and BSI increased significantly (43% and 157%, respectively) only in the bivalves under direct exposure. Greater changes in the biochemical parameters were induced by the dietary exposure than by the direct exposure. Furthermore, the gills presented an earlier response compared to the digestive gland. These results suggested that direct and dietary exposure to a glyphosate-based formulation induced oxidative stress in the gills and digestive glands of D. chilensis. Thus, the presence of glyphosate-based formulations in aquatic ecosystems could represent a risk for filter-feeding organisms like bivalves.

Visualization and Identification of Silicone Oil Emulsification Using Dynamic Infrared Confocal Scanning Laser Ophthalmoscopy.

Introduction: Silicone oil (SO) is a crucial agent used as an intraocular tamponade in the treatment of complex vitreoretinal diseases. Despite its effectiveness, SO is prone to emulsification, which can lead to significant and sometimes irreversible complications in both the anterior and posterior segments of the eye. The detection and monitoring of SO emulsification are therefore of paramount importance. Traditional imaging modalities have limitations in visualizing SO, leading to the exploration of more advanced imaging techniques. This study introduces the application of dynamic infrared confocal scanning laser ophthalmoscopy (IRcSLO) for this purpose and evaluates its effectiveness. Case Presentation: We report on 2 patients who underwent pars plana vitrectomy with subsequent SO injection for the management of retinal detachment. Postsurgery, both patients were imaged using the Heidelberg Retina Tomography Spectralis IRcSLO. The focus was on the visualization of the SO status, including the presence and distribution of emulsified SO droplets. The IRcSLO imaging technique demonstrated its capability to effectively visualize emulsified SO droplets. Interestingly, this was also true for cases where the SO had been removed. The emulsified droplets were observed as micron-sized, spherical entities with a nonuniform distribution throughout the vitreous cavity. Conclusion: Dynamic IRcSLO has proven to be an effective imaging modality for visualizing the emulsification of SO, offering a novel perspective into the characterization of SO droplets. It facilitates the analysis of droplet count, motility, and precise localization within the vitreous cavity. The findings from the case presentations underscore the variability of SO emulsification patterns and the sensitivity of IRcSLO in detecting even minuscule emulsified droplets. This imaging technique has significant potential for future research, particularly in understanding the timing of emulsification, the factors contributing to it, and the development of possible preventive strategies. Additionally, it allows for a more in-depth analysis of the behavior of emulsified SO droplets across different SO viscosities, which could be instrumental in optimizing patient outcomes.

Treat-to-target recommendations in giant cell arteritis and polymyalgia rheumatica.

OBJECTIVES: To develop treat-to-target (T2T) recommendations in giant cell arteritis (GCA) and polymyalgia rheumatica (PMR). METHODS: A systematic literature review was conducted to retrieve data on treatment targets and outcomes in GCA/PMR as well as to identify the evidence for the effectiveness of a T2T-based management approach in these diseases. Based on evidence and expert opinion, the task force (29 participants from 10 countries consisting of physicians, a healthcare professional and a patient) developed recommendations, with consensus obtained through voting. The final level of agreement was provided anonymously. RESULTS: Five overarching principles and six-specific recommendations were formulated. Management of GCA and PMR should be based on shared decisions between patient and physician recognising the need for urgent treatment of GCA to avoid ischaemic complications, and it should aim at maximising health-related quality of life in both diseases. The treatment targets are achievement and maintenance of remission, as well as prevention of tissue ischaemia and vascular damage. Comorbidities need to be considered when assessing disease activity and selecting treatment. CONCLUSION: These are the first T2T recommendations for GCA and PMR. Treatment targets, as well as strategies to assess, achieve and maintain these targets have been defined. The research agenda highlights the gaps in evidence and the need for future research.

Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group.

OBJECTIVE: To develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR). METHODS: A task force including 29 rheumatologists/internists, 4 general practitioners, 4 patients and a healthcare professional emerged from the international giant cell arteritis and PMR study group. The task force supplied clinical questions, subsequently transformed into Population, Intervention, Comparator, Outcome format. A systematic literature review was conducted followed by online meetings to formulate and vote on final recommendations. Levels of evidence (LOE) (1-5 scale) and agreement (LOA) (0-10 scale) were evaluated. RESULTS: Two overarching principles and five recommendations were developed. LOE was 4-5 and LOA ranged between 8.5 and 9.7. The recommendations suggest that (1) each individual with suspected or recently diagnosed PMR should be considered for specialist evaluation, (2) before referring an individual with suspected PMR to specialist care, a thorough history and clinical examination should be performed and preferably complemented with urgent basic laboratory investigations, (3) individuals with suspected PMR with severe symptoms should be referred for specialist evaluation using rapid access strategies, (4) in individuals with suspected PMR who are referred via rapid access, the commencement of glucocorticoid therapy should be deferred until after specialist evaluation and (5) individuals diagnosed with PMR in specialist care with a good initial response to glucocorticoids and a low risk of glucocorticoid related adverse events can be managed in primary care. CONCLUSIONS: These are the first international recommendations for referral of individuals with suspected PMR, which complement the European Alliance of Associations for Rheumatology/American College of Rheumatology management guidelines for established PMR.

Pan American League of Associations for Rheumatology recommendations for the management of axial spondyloarthritis.

Axial spondyloarthritis (axSpA) comprises a spectrum of chronic inflammatory manifestations affecting the axial skeleton and represents a challenge for diagnosis and treatment. Our objective was to generate a set of evidence-based recommendations for the management of axSpA for physicians, health professionals, rheumatologists and policy decision makers in Pan American League of Associations for Rheumatology (PANLAR) countries. Grading of Recommendations, Assessment, Development and Evaluation-ADOLOPMENT methodology was used to adapt existing recommendations after performing an independent systematic search and synthesis of the literature to update the evidence. A working group consisting of rheumatologists, epidemiologists and patient representatives from countries within the Americas prioritized 13 topics relevant to the context of these countries for the management of axSpA. This Evidence-Based Guideline article reports 13 recommendations addressing therapeutic targets, the use of NSAIDs and glucocorticoids, treatment with DMARDs (including conventional synthetic, biologic and targeted synthetic DMARDs), therapeutic failure, optimization of the use of biologic DMARDs, the use of drugs for extra-musculoskeletal manifestations of axSpA, non-pharmacological interventions and the follow-up of patients with axSpA.

Association of patient copayment and medication adherence in systemic lupus erythematosus.

OBJECTIVE: To investigate the association of medication copayment and treatment adherence to hydroxychloroquine and immunosuppressants for SLE. METHODS: We conducted a retrospective analysis of health claims data using Optum's de-identified Clinformatics Data Mart Database. Individuals with SLE continuously enrolled for 180 days from 1 July 2010 to 31 December 2019 were included. Adherence was defined as the proportion of days covered ≥80%. Copayment for a 30-day supply of medication was dichotomised as high (≥$10) or low (<$10). We examined the association between copayment and odds of adherence in multivariable-adjusted logistic regression models, including age, sex, race or ethnicity, comorbidities, educational attainment and household income. RESULTS: We identified 12 510 individuals (age 54.2±15.5 years; 88.2% female sex), of whom 9510 (76%) were prescribed hydroxychloroquine and 1880 (15%) prescribed hydroxychloroquine and an additional immunosuppressant (azathioprine, methotrexate or mycophenolate mofetil). Median (IQR) 30-day copayments were $8 (4-10) for hydroxychloroquine, $7 (2-10) for azathioprine, $8 (3-11) for methotrexate and $10 (5-20) for mycophenolate mofetil. High copayments were associated with OR of adherence of 0.61 (95% CI 0.55 to 0.68) for hydroxychloroquine, OR 0.44 (95% CI 0.30 to 0.66) for azathioprine and OR 0.69 (95% CI 0.49 to 0.96) for mycophenolate mofetil. For methotrexate, the association was not significant. CONCLUSION: In a large, administrative health claims database, we identified that high copayments were associated with reduced adherence to commonly prescribed medications for SLE. Incorporating awareness of the burden of copayments and its consequences into healthcare is essential to promote optimal medication adherence.

Risk Factors Associated with COVID-19 Mortality in the State of Durango, Mexico.

The coronavirus disease 2019 (COVID-19) has caused over six million deaths worldwide since its emergence in Wuhan China, factors associated with COVID-19 mortality, such as comorbidities, age, and observed symptomatology still remain a major subject of study. In the present work, a total of 16,345 SARS-CoV-2 positive cases from Durango Mexico diagnosed from May 2020 to December 2021 were analyzed to establish an association of COVID-19 mortality with clinical and demographic variables in a case-control study. Selected variables include patient age, smoking status, sex, presence of comorbidities such as hypertension, diabetes and obesity, as well as patient symptomatology such as fever, dyspnea, abdominal pain and diarrhea. Results indicate that among analyzed data, the median age was 43 years; 54% were female, with a mortality rate of 5.66%. Multivariate regression analysis indicated that the comorbidities associated with the highest risk factor were advanced age (>60) with an odds ratio of 4.127 (IC 95%, 3.37-5.05), hypertension with 1.961 (IC 95%, 1.57-2.45), diabetes with 1.753 (IC 95%, 1.39-2.20) and obesity with 1.413 (IC 95%, 1.11-1.78) respectively. On the other hand, the symptom associated with the highest risk factor was dyspnea with an odds ratio of 18.369 (IC 95%, 14.42-23.39). Our data suggests an association between hypertension and old age with COVID-19 mortality. Other findings include the prevalence of dyspnea, polypnea and cyanosis as a major predictor for COVID-19 mortality, as well as lower mortality risks among health workers.

Clinical and microbiological characteristics of bacterial infections in patients with cirrhosis. A prospective cohort study from Argentina and Uruguay.

INTRODUCTION AND OBJECTIVES: there is insufficient data regarding bacterial infections in patients with cirrhosis to support recommendations for empiric antibiotic treatments, particularly in Latin America. This study aimed to evaluate bacterial infection's clinical impact and microbiological characteristics, intending to serve as a platform to revise current practices. MATERIALS AND METHODS: multicenter prospective cohort study of patients with cirrhosis and bacterial infections from Argentina and Uruguay. Patient and infection-related information were collected, focusing on microbiology, antibiotic susceptibility patterns, and outcomes. RESULTS: 472 patients were included. Spontaneous bacterial infections and urinary tract infections (UTIs) were registered in 187 (39.6%) and 116 (24.6%) patients, respectively, representing the most common infections. Of the 256 culture-positive infections, 103 (40.2%) were caused by multidrug-resistant organisms (reaching 50% for UTI), and 181 (70.7%) received adequate initial antibiotic treatment. The coverage of cefepime and ceftriaxone was over 70% for the empirical treatment of community-acquired spontaneous infections, but ceftazidime´s coverage was only 40%. For all UTI cases and for healthcare-associated or nosocomial spontaneous bacterial infections, the lower-spectrum antibiotics that covered at least 70% of the isolations were imipenem and meropenem. During hospitalization, a second bacterial infection was diagnosed in 9.8% of patients, 23.9% required at least one organ support, and 19.5% died. CONCLUSIONS: short-term mortality of bacterial infections in patients with cirrhosis is very high, and a high percentage were caused by multidrug-resistant organisms, particularly in UTIs. The information provided might serve to adapt recommendations, particularly related to empirical antibiotic treatment in Argentina and Uruguay. The study was registered in Clinical Trials (NCT03919032).

Faricimab in neovascular AMD: first report of real-world outcomes in an independent retina clinic.

PURPOSE: Assess short-term real-world outcomes in neovascular aged-related macular degeneration (nAMD) treated with novel faricimab. METHODS: Retrospective case series of nine patients with nAMD (11 eyes) treated with faricimab between May and November 2022. Treatment-naïve patients and non-naïve patients underwent logMAR best corrected visual acuity (BCVA), optical coherence tomography (OCT) DRI OCT-1 Triton (Topcon Corp, Tokyo, Japan), ultra-widefield (UWF) and fundus autofluorescence (FAF) (California Optomap, Optos plc, Dunfermline, Scotland, UK). Previous treatment intervals, number of intravitreal injections, sub/intra retinal fluid (SRF/IRF), central retinal thickness (CRT) and presence/changes in pigment epithelial detachments (PEDs) were recorded. RESULTS: Mean baseline BCVA and CRT values of patients who switched from other agents were 0.612 ± 0.75 logMAR and 256.16 ± 12.98 µm respectively, with a mean 36-day previous treatment interval. The median number of other previous anti-VEGF intravitreal injections was 8. Mean BCVA at one month significantly improved to 0.387 ± 0.54 logMAR, as well as CRT values which decreased to 245.43 ± 15.34 µm. In the 3 naïve patients, mean baseline BVCA and CRT values were 0.33 ± 0.29 and 874.67 ± 510.86 µm, respectively. At one month follow-up, mean BCVA improved to 0.30 ± 0.29 logMAR and mean CRT was 536.04 ± 36.15 µm. Overall, a significant improvement in BCVA of 0.21 ± 41 logMAR and 238.44 ± 114.9 µm was achieved at one month after the first faricimab intravitreal injection. In addition, a complete resolution of SRF was observed in 6 out of 8 eyes (75%) and of IRF in 2 out of 3 eyes (66.67%), respectively. Drusenoid PED morphology changes were observed in all patients and no drug-related adverse events were observed. CONCLUSION: Real-world outcomes showed improvement in BCVA and anatomic parameters at an early timepoint, demonstrating the efficacy and durability of faricimab in nAMD patients. Larger numbers of patients and longer follow-up are needed to determine whether the loading dose is required in all, what percentage of patients experience an improvement, and whether improvement it is maintained.

The dynamic atmospheric and aeolian environment of Jezero crater, Mars.

Despite the importance of sand and dust to Mars geomorphology, weather, and exploration, the processes that move sand and that raise dust to maintain Mars' ubiquitous dust haze and to produce dust storms have not been well quantified in situ, with missions lacking either the necessary sensors or a sufficiently active aeolian environment. Perseverance rover's novel environmental sensors and Jezero crater's dusty environment remedy this. In Perseverance's first 216 sols, four convective vortices raised dust locally, while, on average, four passed the rover daily, over 25% of which were significantly dusty ("dust devils"). More rarely, dust lifting by nonvortex wind gusts was produced by daytime convection cells advected over the crater by strong regional daytime upslope winds, which also control aeolian surface features. One such event covered 10 times more area than the largest dust devil, suggesting that dust devils and wind gusts could raise equal amounts of dust under nonstorm conditions.

Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey.

BACKGROUND: We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. METHODS: From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination. RESULTS: We analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%. CONCLUSION: Among adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring.

Laparoscopic gastrostomy in critical polytrauma patients / [Gastrostomía laparoscópica en pacientes politraumatizados críticos]

Introduction: In critical ill patients, a hypermetabolic state develops in response to the aggression received, which leads to a rapid process of malnutrition, and has been associated with increased morbidity and mortality. The preferred enteral feeding way is through an endoscopic gastrostomy, an alternative procedure is the laparoscopic approach. Methods: Data was collected Between January 2016 and March 2019, of patients admitted to the Intensive Care Unit of the Hospital de Urgencias de Córdoba. Patients had an indication of enteral nutrition, and underwent laparoscopic feeding gastrostomy. Demographic data, as well as preoperative assessment according to the American Society of Anesthesiologists (ASA) classification, operative and postoperative complications, beginning and feasibility of feeding were recorded. Results: 12 patients full fill the inclusion criteria. Age average was 39 years. The total average surgical time was 39 minutes, not recording perioperative complications regarding the procedure. All the patients were fed after 24 hours. Conclusion: In our institution, the indication of percutaneous endoscopic gastrostomy is the elected choice; laparoscopic gastrostomy is a low-complexity technique, which can be done immediately after the indication in selected patients.

Introducción: En los pacientes críticos se instala un estado hipermetabólico como respuesta a la agresión recibida, lo que conduce a un rápido proceso de desnutrición, el cual se ha asociado a mayor morbilidad y mortalidad. La vía de alimentación enteral de elección es a través de una gastrostomía endoscópica, y una alternativa es la vía laparoscópica. Métodos: Entre enero de 2016 y marzo de 2019, se colectaron los datos de los pacientes internados en la Unidad de Terapia Intensiva del Hospital de Urgencias de Córdoba con indicación de nutrición enteral y sometidos a gastrostomía laparoscópica de alimentación. Se obtuvieron datos demográficos, valoración preoperatoria según la clasificación de American Society of Anesthesiologists (ASA), complicaciones trans y postoperatorias, comienzo y factibilidad de la alimentación. Resultados: Cumplieron los criterios de inclusión 12 pacientes, edad promedio de 39 años. El tiempo quirúrgico promedio total fue de 39 minutos, no registrando complicaciones perioperatorias Todos pudieron ser alimentados a partir de las 24 hs. Conclusión: En nuestro Hospital la gastrostomía endoscópica percutánea es de elección, utilizando la gastrostomía laparoscópica en casos seleccionados. Es una técnica de escasa complejidad y al alcance del cirujano, pudiendo ser programada en forma inmediata a la indicación.

Evidence and the Main Adverse Effects Regarding Drug Therapies in the War Against COVID-19.

BACKGROUND: Nowadays, the breakthrough of COVID-19 pandemic around the world is the biggest health challenge for the clinicians, and it represents an unexpected effort to identify an effective treatment for those patients. No proven definitive therapies for this infection currently exist. Unfortunately, the infected patients increased in an alarming way every day, faster than medical evidence. At present, the expanding knowledge regarding SARS-COV-2 virology provides several potential drug targets. OBJECTIVE: Therefore, clinicians need a rapid review and guideline about the main adverse effects regarding the most prescribed drugs and, specifically, the efficacy and potential risk of each pharmacological therapy, during hospital care. METHODS: The articles review was performed using PubMed to identify relevant papers in English language reported through July 20th, 2020; a second review was performed using Web of Science until August 28th, 2020. Due to the lack of randomized clinical trials, we included case reports, case series and reviews. We found a total of 1606 related articles. The authors independently reviewed the titles and abstracts for inclusion. CONCLUSION: At present, despite the enormous medical effort for publishing several trials or case reports, we have not yet discovered a definitive therapy against the COVID-19 infection. This brief review aims to prompt identification of risk factors and main adverse effects in a systematic view related to therapy with partial evidence proposed to date.

Comunicación Buco Sinusal a causa de un Quiste Odontogénico Residual / Oroantral fistula caused by a residual odontogenic cyst

Los quistes odontogénicos se dividen en dos grupos principales de acuerdo a la patogénesis de la entidad. Uno de esos grupos incluye a los quistes radiculares de origen inflamatorio. Nuestra situación es una paciente de sexo femenino que a causa de un molar superior con tratamiento endodóntico la patología quística invadió la cavidad sinusal comprometiendo las estructuras vecinas y al realizar la exodoncia se generó una comunicación bucosinusal con infección de esa entidad patológica. El diagnostico de certeza se confirmó a través de la biopsia previa, y se la intervino bajo anestesia general para la extirpación total de la patología quística (AU)

Carcinoma del conducto salival: presentación de un caso / Salivary duct carcinoma: report of a case

El carcinoma de conductos salivales (CCS) es una neoplasia maligna primaria clínica y patológicamente distinta de las glándulas salivales. Debido a su rareza existe una falta de documentación exhaustiva en la literatura con respecto a sus características, manejo y resultados clínicos. En la presente publicación se presenta un caso de un paciente de sexo masculino de 74 años, que acudió al servicio de odontología del Hospital Interzonal General de Agudos Presidente Perón de Avellaneda. El resultado ecográfico arrojó a nivel submaxilar derecho una imagen nodular de aspecto solido que mide 25 x 24 mm Se le realizó la intervención quirúrgica y el resultado anatomopatológico confirmó el diagnóstico de carcinoma de conductos salivales, una de las neoplasias salivales más agresivas. En la actualidad, la muerte ocurre en 60 a 80% de los pacientes, por lo general dentro de los 5 años; alrededor del 33% desarrolla recidiva local y más del 50% metástasis a distancia, en sitios que incluyen pulmones, huesos, hígado, cerebro y piel (AU)

Salivary duct carcinoma (SDC) is a clinically and pathologically distinct primary malignant neoplasm of the salivary glands. Due to its rarity, there is a lack of exhaustive documentation in the literature regarding its characteristics, management, and clinical results. This publication presents a case of a 74-year-old male patient who attended the dentistry service of the Interzonal General Acute Hospital President Perón by Avellaneda. The ultrasound result revealed a nodular image at the right submaxillary level solid aspect measuring 25 x 24 mm. Surgical intervention was performed, and the pathological result confirmed the diagnosis of salivary duct carcinoma, one of the most aggressive salivary neoplasms. Currently, death occurs in 60% to 80% of patients, usually within 5 years; about 33% develop local recurrence and more than 50% distant metastases, at sites including the lungs, bones, liver, brain, and skin (AU)

El camino hacia una nueva antropología clínica: afectividad y corporalidad en la obra de erwin straus / The way towards a new clinical anthropology: affectivity and corporality in erwin straus's work / O caminho até uma nova antropologia clínica: afetividade e corporalidade na obra de erwin straus

A partir de uma leitura hermenêutica da fenomenologia antropológica de Erwin Straus, procura-se elucidar o sentido original da afetividade e a corporalidade, como modalidades essenciais que constituem a relação da existência humana com seu mundo. Primeiro, por meio duma reconsideração histórico-critica de certas proposições da psicologia científica, e de seus fundamentos filosóficos, é preciso retornar ao origem da condição humana, deformada pelas interpretações fundadas nos supostos a priori, para desvenda-la. Precisamente, frente à psicologia naturalista atual e invisibiliza a diferença ontológica entre o homem e as coisas, duma perspectiva strausiana pretende-se propor como objeto primário de estudo da ciência psicológica a subjetividade encarnada, que sente-se a sim mesma quando sente outra coisa, e sua própria ação está continuamente exposta a outras influências, daí sua vulnerabilidade intrínseca. As presentes análises permitem estabelecer um novo marco, tanto para as investigações experimentais futuras quanto para a compreensão da experiência do homem alienado. Por um lado, a antropologia fenomenológica de Straus permite cortar com os três dualismos que sustentam as investigações contemporâneas da corporalidade e a afetividade: sujeito-objeto, receptividade-atividade e interior-exterior. Em segundo lugar, agora, as patologias psico(pato)logias são entendidas como modos diversos de relações do eu-mundo, plenamente significativas, nas quais prevalece a impossibilidade da existência de decidir sobre o curso de sua biografia.

From a hermeneutic reading of the phenomenological anthropology of Erwin Straus, current work seeks to explain the original meaning of affectivity and corporality, as constituting modalities of the relation between human existence and its world. On the first term, through a critical-historical reconsideration of certain propositions of scientific psychology and their philosophical foundations, the aim is to go back to the origin of human condition, deformed by interpretations founded on suppositions a priori, uncovering it. Precisely, opposite to current naturalistic psychology, fades off the ontological difference between man and things, from a perspective as Straus', the incarnated subjectivity, which feels itself when it feels something else, is proposed as the primary object of study of psychological science; its own action is exposed continuously to other influences, therefore, its intrinsic vulnerability. The present analysis allows us to establish a new frame, both for the future experimental investigations and for the comprehension of the experience of the alienated man. Indeed, Straus' phenomenological anthropology allows us to break off the three dualisms that support contemporary investigations of corporality and affectivity: subject-object, receptivity-activity, interior-exterior. Secondly, psychopathologies are understood as different modalities of I-world relations, fully significative in which the impossibility of existence to decide on the course of his biography prevails.

Desde una lectura hermenéutica de la antropología fenomenológica de Erwin Straus, se busca dilucidar el sentido originario de la afectividad y la corporalidad, en tanto modalidades esenciales que constituyen la relación de la existencia humana con su mundo. En primer término, mediante una reconsideración histórico-critica de los fundamentos filosóficos de la psicología científica, se busca retornar al origen, para des-encubrir la condición humana deformada por interpretaciones fundadas en supuestos a-priori. Frente a la psicología naturalista actual, que invisibiliza la diferencia ontológica entre el hombre y las cosas, desde una perspectiva strausiana se propone como objeto estudio de la ciencia psicológica la subjetividad encarnada, que se siente a sí misma cuando siente otra cosa, y su acción propia está expuesta sin cesar a otras influencias, por ello su intrínseca vulnerabilidad. Los presentes análisis permiten establecer un nuevo marco, tanto para las futuras investigaciones experimentales como para la comprensión de la experiencia del hombre alienado. Por una parte, la antropología fenomenológica de Straus permite romper con los tres dualismos que sustentan las investigaciones contemporáneas de la corporalidad y la afectividad: sujeto-objeto, receptividad-actividad e interior-exterior. En segundo lugar, ahora, las psico(pato)patologías se comprenden como diversos modos de relaciones yo-mundo, plenamente significativos, en los que priman la imposibilidad de la existencia de decidir sobre el curso de su biografía.

Approach to the Patient with Axial Spondyloarthritis and Suspected Inflammatory Bowel Disease.

To adequately and efficiently evaluate patients with gastrointestinal symptoms in the context of axial spondyloarthritis can be difficult, considering that many of these patients suffer from chronic pain, present high inflammatory parameters, and use drugs with possible gastrointestinal adverse effects. In addition, the immunosuppressive treatments that these patients can receive make it necessary to always consider infections within the differential diagnoses of inflammatory bowel disease. In this article, we propose a practical approach to patients diagnosed with axial spondyloarthritis and suspected inflammatory bowel disease.

Biochemical responses of the golden mussel Limnoperna fortunei under dietary glyphosate exposure.

The aim of this study was to analyze the biochemical alterations in the golden mussel Limnoperna fortunei under dietary glyphosate exposure. Mussels were fed during 4 weeks with the green algae Scenedesmus vacuolatus previously exposed to a commercial formulation of glyphosate (6 mg L-1 active principle) with the addition of alkyl aryl polyglycol ether surfactant. After 1, 7, 14, 21 and 28 days of dietary exposure, glutathione-S-transferase (GST), catalase (CAT), superoxide dismutase (SOD), acetylcholinesterase (AChE), carboxylesterases (CES) and alkaline phosphatase (ALP) activities, glutathione (GSH) content and damage to lipids and proteins levels were analyzed. A significant increase (72%) in the GST activity and a significant decrease (26%) in the CES activity in the mussels fed on glyphosate exposed algae for 28 days were observed. The ALP activity was significantly increased at 21 and 28 days of dietary exposure (48% and 72%, respectively). GSH content and CAT, SOD and AchE activities did not show any differences between the exposed and non exposed bivalves. No oxidative damage to lipids and proteins, measured as TBARS and carbonyl content respectively, was observed in response to glyphosate dietary exposure. The decrease in the CES activity and the increases in GST and ALP activities observed in L. fortunei indicate that dietary exposure to glyphosate provokes metabolic alterations, related with detoxification mechanisms.