Enfermedad de Lhermitte-Duclos y síndrome de Cowden. Reporte de un caso / Lhermitte-Duclos Disease and Cowden Syndrome. A Case Report

Presentación del caso. Se trata de una paciente femenina de 45 años con antecedentes de hipertensión arterial y múltiples cirugías por cáncer, entre ellas, cáncer de tiroides, carcinoma de parótida, cáncer de mama y cáncer endometrial. De manera incidental se identificó una lesión en el hemisferio cerebeloso derecho en una tomografía de senos paranasales, que fue confirmada a través de una resonancia magnética cerebral. La lesión presentaba una apariencia estriada, característica de gangliocitoma displásico del cerebelo o enfermedad de Lhermitte-Duclos. Considerando los antecedentes de diversos tipos de cáncer y los criterios de diagnóstico propuestos por el Consorcio Internacional Cowden y la Red Nacional Integral del Cáncer, se estableció el diagnóstico de síndrome de Cowden que había pasado desapercibido hasta el momento. Intervención terapéutica. Posteriormente, la paciente fue hospitalizada debido al crecimiento de una masa metastásica en el hemicuello derecho con afectación del plexo braquial, adenopatías cervicales, infraclaviculares y axilares derechas. Evolución clínica. En la actualidad, se encuentra recibiendo tratamiento paliativo con el objetivo de controlar los síntomas y mejorar su calidad de vida, ya que expresó su negativa a someterse a una intervención quirúrgica de resección tumoral

Case presentation. The report is of a 45-year-old female patient with a history of high blood pressure and multiple surgeries for cancer, including thyroid cancer, parotid carcinoma, breast cancer, and endometrial cancer. Incidentally, a lesion in the right cerebellar hemisphere was identified in a tomography of the paranasal sinuses, which was later confirmed in a brain magnetic resonance. The lesion had a striated appearance, characteristic of dysplastic gangliocytoma of the cerebellum or Lhermitte-Duclos disease. Considering the history of various types of cancer and the diagnostic criteria proposed by the International Cowden Consortium and the National Comprehensive Cancer Network, the diagnosis of Cowden syndrome, which had gone unnoticed until now, was established. Treatment. Subsequently, the patient was hospitalized due to the growth of a metastatic mass in the right hemicollar with involvement of the brachial plexus, cervical, infraclavicular, and right axillary lymph nodes. Outcome. She is receiving palliative treatment to control the symptoms and improve her quality of life, since she expressed her refusal to undergo tumor resection surgery

Evaluation of short-term safety of COVID-19 vaccines in patients with multiple sclerosis from Latin America.

BACKGROUND: To date, there are no data available on the safety of COVID-19 vaccines in Latin American patients with Multiple Sclerosis (MS). OBJECTIVE: Characterize safety of COVID-19 vaccines in Latin American (LATAM) patients with Multiple Sclerosis (pwMS). METHODS: A cross-sectional study between February 1, 2021, and April 30, 2021. Individuals with MS from LATAM countries were invited to participate in a self-administered web-based survey, through MS patient organizations from the region. RESULTS: 393 vaccinated pwMS from 10 different Latin American countries were included. The vaccines administered were: inactivated virus vaccines (IVV) in 38.2% of patients, adenovirus vector vaccines (AdV) in 48.8% and mRNA vaccines 13%. All patients received at least one dose of any of the COVID-19 vaccines and 123 (31.3%) declared receiving a second dose. Mean (SD) age 41.5 (11.8) years, 82.4% female, MS disease duration: 8.4 (8.2) years. No serious adverse events were reported with any of the COVID-19 vaccines after either the first or second dose. A lower frequency of adverse events was found with IVV (22%) in comparison with AdV (46.4%) and mRNA (35.3%) (p < 0.01). Five participants reported having an MS relapse after IVV first dose. CONCLUSION: COVID-19 vaccines applied in LATAM proved safe for MS patients.

Changes on the health care of people with multiple sclerosis from Latin America during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in uncertain access to medical treatment for people with multiple sclerosis (pwMS) all over the world. However, there is no data regarding its impact on access to health care of pwMS from Latin America. OBJECTIVES: We investigated and described changes in health care delivery for pwMS from Latin America during the COVID-19 pandemic. METHODS: PwMS from 18 patient organizations of the region completed a web-based survey hosted from May to October 2020. RESULTS: A total of 602 pwMS completed the questionnaire. Changes in disease-modifying therapies (DMTs) use: 6.7% of pwMS on continuous DMTs claimed to stopped them; 14.1% of those on infusion therapies declared to postpone their dosing; 68.8% declared delaying the initiation of a DMT. Disruptions in accessing rehabilitation services were reported by 65.7%. Changes in laboratory and MRI monitoring were reported by 30% and 33%, respectively. In a multivariable-adjusted logistic regression model, changes in laboratory monitoring were significantly associated with increased odds of postponing MRI monitoring (OR 4.09 CI95% 2.79-6.00, p < 0.001). CONCLUSIONS: The COVID-19 pandemic has disrupted all aspects of the routine care for pwMS from Latin America. Consequences are yet to be determined.

Insect growth regulatory effects of linear diterpenoids and derivatives from Baccharis thymifolia.

Linear diterpenes isolated from aerial parts of Baccharis thymifolia ( 1- 3) were tested for insect growth inhibitory activity against Tenebrio molitor larvae. Compounds 4- 16 were prepared by various chemical transformations. The diterpenes 6,10-( E,E)-thymifodioic acid ( 1), the butenolide 3, and the derivatives 4, 11, and 14 produced developmental deficiencies in assays using topical application on fifth instar larvae of T. molitor. Compound 3 is a new natural product.

Antifeedant activity of neo-clerodane diterpenes from Baccharis flabellata Hook & Arn var. flabellata toward Tribolium castaneum Herbst: structure-activity relationships.

In order to establish structure-activity relationships, nine neo-clerodane diterpenes isolated from the acetone extract of aerial parts of Baccharis flabellata Hook & Arn var. fabellata were assayed for antifeedant activity against Tribolium castaneum (Coleoptera: Tenebrionidae). Compounds exhibiting maximal antifeedant activities showed an alpha,beta-unsaturated carbonyl group on the decalin portion and a furan ring at the side chain. Stereoelectronic studies indicate that the distance between the furan heteroatom and the more electrophilic carbon of the decaline moiety, as well as the electrostatic charge on that atom, were important features for antifeedant activity. Compounds possesing an alpha,beta,gamma,delta-unsaturated carbonyl group or an acetoxyl group at C-2, were inactive. Theoretical calculations were performed in order to find some structure-activity relationships.

Toxic and repellent effects of Baccharis salicifolia essential oil on Tribolium castaneum.

Allelochemical effects were observed when Tribolium castaneum (Herbst) adults were treated with Baccharis salicifolia (Ruiz & Pavon) Pers essential oil. The main biological activities were toxicity and repellence. Terpenes present in the essential oil were identified by GC-MS, and some authentic samples were tested to assess their activity individually. The most acutely toxic compounds after 3 days were beta-pinene and pulegone. Most of the monoterpenes elicited symptoms indicative of neurotoxicity. The most repellent compound was alpha-terpineol. Toxic and repellent effects of chemical derivatives of the major sesquiterpene present in B salicifolia essential oil, as well as a series of monoterpenes, were evaluated in order to investigate structure-activity relationships. The reduced derivatives of the monoterpenes and sesquiterpenes were more repellent that their carbonyl analogues. In addition, unsaturation in the germacrane skeleton enhanced repellent activity.

Antifeedant/insecticidal terpenes from asteraceae and labiatae species native to Argentinean semi-arid lands.

To validate the potential as added-value resources of Asteraceae and Labiatae species of Argentinean semi-arid lands, we have selected 13 of their major terpenoids belonging to several chemical classes and tested their insect antifeedant and toxic activity on the herbivorous insects Spodoptera littoralis and Leptinotarsa decemlineata. The antifeedant effects of the test compounds were structure- and species-dependent. The most active antifeedant to L. decemlineata was the eudesmane sesquiterpene gamma-costic acid (13), followed by the labdane diterpene 2alpha,3alpha-dihydroxycativic acid (8), the clerodane diterpenes 6-acetylteucjaponin B (5), bacchotricuneatin A (1), bartemidiolide (7), butanolide (4), and the sesquiterpenes ilicic acid (11) and tessaric acid (10) (eudesmane and eremophilane type, respectively). S. littoralis was only affected by the clerodanes and showed the strongest response to salviarin (3) and 5, followed by hawtriwaic acid (6) and 12-epi-bacchotricuneatin A (2). Orally injected S. littoralis larvae were negatively affected by 5. Most of the diterpenes had selective cytotoxic effects to insect-derived Sf9 cells with the clerodane 1 being the most active, followed by the eudesmane costic acid (12), the only cytotoxic sesquiterpene. None of these compounds was cytotoxic to mammalian CHO cells.

Iridoids as allelochemicals and DNA polymerase inhibitors.

Growth inhibitory activities and nutritional indices of catalpol (1), 8-O-acetylharpagide (2), and harpagide (3) were determinated in larvae and adults of Tribolium castaneum, respectively. Compound 1 produced a series of allelochemical effects probably related with the DNA synthesis. This iridoid possessed the highest inhibitory activity against DNA polymerase. Molecular orbital calculations suggest that a pi-pi charge transfer recognition model could explain the action of iridioids toward nucleic acid synthesis.

Allelochemical effects of eudesmane and eremophilane sesquiterpenes on Tribolium castaneum larvae.

Eight eudesmane and eremophilane sesquiterpenes administered to Tribolium castaneum larvae caused different allelochemical effects. Topical application of 3-oxo-gamma-costic acid produced the greatest lengthening in the duration of the pupal stage. Morphological deformities were found, specifically when ilicic, costic, and gamma-costic acids and costic aldehyde were used. Ilicic acid exhibited the major toxicity 72 hr following topical application. All compounds were significantly toxic at the end point of the experiment (60 days). Treated surface toxicity was lower than when topical assays were carried out. Responses to tessaric acid in choice bioassays had the highest attractive effect. Maximum repellency was caused by the 3-oxo-gamma-costic acid. However, experimental series carried out using gamma-costic acid, eremophilan-1(10),2,11(13)-trien-12-oic acid, costic aldehyde, and ilicic aldehyde showed no clear response.

Clerodane diterpenes from Baccharis sagittalis: insect antifeedant activity.

Two clerodane-type diterpene glycosides esters, which were studied as peracetyl derivatives, together with the known diterpene marrubiagenine, were isolated from the aerial part of Baccharis sagittalis (Less). Their structures were established by spectroscopic methods. Antifeedant activity toward Tenebrio molitor larvae of the isolated compounds along with six other diterpenes was evaluated and some structure-antifeedant bioactivity relationships are reported.

Patología quirúrgica del apéndice cecal: análisis de 8.950 casos / Surgical pathology of the cecal appendix: analysis of 8.950 cases

Se reclasificó la patologia quirúrgica del apéndice cecal. El diagnóstico clínico emitido con mayor frecuencia fue apendicitis aguda ( 80.5%). Los diagnósticos histopatológicos de revisión más frecuentes fueron apendicitis aguda (72%), apendicitis aguda con abscesos (36.2%), apéndice perforado (18.2%), apéndice cecal normal (11.2%), periapendicitis (4.1%), apendicitis crónica (2.5%), diverticulosis adquirida (1.7%), diverticulitis (1.2%), parasitosis (2.7%), apendicitis amibiana (1.1%) y neoplasias (1.2%). Se practicaron 558 apendicectomías profilácticas y en 158 casos (28.3%) se encontraron diferentes alteraciones patológicas. En 8.092 pacientes se emitión el diagnóstico clínico de apendicitis aguda o amibiana y en 2,067 (25.5%) no se apreciaron alteraciones que repercutieran clínicamente. De los 6,444 casos de apendicitis aguda, 5,559 (86.2%) el diagnóstico clínico coincidió con el histopatológico de revisión. En 12,788 diagnóstico histopatológicos se identificaron 4,877 discrepancias (38.1%) entre el diagnóstico intencionado de revisión y el de rutina