Impacto de las Creencias Conspirativas en la Intención de Vacunación contra el COVID-19 en Adultos Mexicanos / Impact of Conspiracy beliefs on the Intention to Vaccinate against COVID-19 in Mexican Adults

Resumen Pese a los esfuerzos de las autoridades sanitarias, la presencia de información falsa o poco certera ha provocado que un porcentaje de la población mexicana se encuentra reticente a recibir la vacuna contra el COVID-19. De este modo el objetivo del presente estudio es determinar en adultos mexicanos el rol mediador de las creencias negativas sobre la vacuna y la percepción de riesgo en la relación de las creencias conspirativas y la intención de vacunación contra el COVID-19. Se realizó un estudio transversal en el que se aplicaron las escalas mediante una plataforma en línea. Las hipótesis fueron probadas mediante la técnica multivariada de análisis de senderos. Los resultados indican que las creencias conspirativas predijeron directamente menor intención de vacunación, asimismo, esta relación se encuentra parcialmente mediada por las creencias negativas sobre la vacuna y la percepción de riesgo. Los hallazgos sugieren que la adhesión a creencias conspirativas sobre el origen del CO-VID-19 favorecen el desarrollo de temor a los efectos secundarios de la vacuna y la reducción de la percepción de riesgo, convirtiéndose así, en la principal barrera de la intención de vacunación contra el COVID-19.

Abstract Despite the efforts of the health authorities, the presence of false or inaccurate information has caused a percentage of the Mexican population to be reluctant to receive the COVID-19 vaccine. Thus, the objective of the present study is to determine in Mexican adults the mediating role of negative beliefs about the vaccine and the perception of risk in the relationship between conspiracy beliefs and the intention to vaccinate against COVID-19. A cross-sectional study was carried out in which the scales were applied through an online platform. The hypotheses were tested using the multivariate trail analysis technique. The results indicate that conspiratorial beliefs directly predicted less vaccination intention, likewise, this relationship is partially mediated by negative beliefs about the vaccine and the perception of risk. The findings suggest that adherence to conspiracy beliefs about the origin of COVID-19 favor the development of fear of vaccine side effects and reduced risk perception, thus becoming the main barrier to vaccination intention against the COVID-19.

Loss of p53 enhances the tumor-initiating potential and drug resistance of clonogenic multiple myeloma cells.

Tumor relapse and drug resistance are major factors that limit the curability of multiple myeloma (MM). New regimens have improved overall MM survival rates, but patients with high-risk features continue to have inferior outcomes. Chromosome 17p13 deletion (del17p) that includes the loss of the TP53 gene is a high-risk cytogenetic abnormality and is associated with poor clinical outcomes owing to relatively short remissions and the development of pan-drug resistant disease. Increased relapse rates suggest that del17p enhances clonogenic growth, and we found that the loss of p53 increased both the frequency and drug resistance of tumor-initiating MM cells (TICs). Subsequent RNA sequencing (RNA-seq) studies demonstrated significant activation of the Notch signaling pathway and upregulation of inhibitor of DNA binding (ID1/ID2) genes in p53-knock out (p53-KO) cells. We found that the loss of ID1 or HES-1 expression or treatment with a gamma-secretase inhibitor (GSI) significantly decreased the clonogenic growth of p53-KO but not p53 wild-type cells. GSI treatment in a small set of MM specimens also reduced the clonogenic growth in del17p samples but not in non-del17p samples. This effect was specific as overexpression of the Notch intracellular domain (NICD) rescued the effects of GSI treatment. Our study demonstrates that the Notch signaling and ID1 expression are required for TIC expansion in p53-KO MM cells. These findings also suggest that GSI may be specifically active in patients with p53 mutant MM.

Abdominal Movements in Insect Flight Reshape the Role of Non-Aerodynamic Structures for Flight Maneuverability I: Model Predictive Control for Flower Tracking.

Research on insect flight control has focused primarily on the role of wings. Yet abdominal deflections during flight can potentially influence the dynamics of flight. This paper assesses the role of airframe deformations in flight, and asks to what extent the abdomen contributes to flight maneuverability. To address this, we use a combination of both a Model Predictive Control (MPC)-inspired computational inertial dynamics model, and free flight experiments in the hawkmoth, Manduca sexta. We explored both underactuated (i.e., number of outputs are greater than the number of inputs) and fully actuated (equal number of outputs and inputs) systems. Using metrics such as the non-dimensionalized tracking error and cost of transport to evaluate flight performance of the inertial dynamics model, we show that fully actuated simulations minimized the tracking error and cost of transport. Additionally, we tested the effect of restricted abdomen movement on free flight in live hawkmoths by fixing a carbon fiber rod over the thoracic-abdomen joint. Moths with a restricted abdomen performed worse than sham treatment moths. This study finds that abdominal motions contribute to flight control and maneuverability. Such motions of non-aerodynamic structures, found in all flying taxa, can inform the development of multi-actuated micro air vehicles.

Pruning deep neural networks generates a sparse, bio-inspired nonlinear controller for insect flight.

Insect flight is a strongly nonlinear and actuated dynamical system. As such, strategies for understanding its control have typically relied on either model-based methods or linearizations thereof. Here we develop a framework that combines model predictive control on an established flight dynamics model and deep neural networks (DNN) to create an efficient method for solving the inverse problem of flight control. We turn to natural systems for inspiration since they inherently demonstrate network pruning with the consequence of yielding more efficient networks for a specific set of tasks. This bio-inspired approach allows us to leverage network pruning to optimally sparsify a DNN architecture in order to perform flight tasks with as few neural connections as possible, however, there are limits to sparsification. Specifically, as the number of connections falls below a critical threshold, flight performance drops considerably. We develop sparsification paradigms and explore their limits for control tasks. Monte Carlo simulations also quantify the statistical distribution of network weights during pruning given initial random weights of the DNNs. We demonstrate that on average, the network can be pruned to retain a small amount of original network weights and still perform comparably to its fully-connected counterpart. The relative number of remaining weights, however, is highly dependent on the initial architecture and size of the network. Overall, this work shows that sparsely connected DNNs are capable of predicting the forces required to follow flight trajectories. Additionally, sparsification has sharp performance limits.

Covalent JNK Inhibitor, JNK-IN-8, Suppresses Tumor Growth in Triple-Negative Breast Cancer by Activating TFEB- and TFE3-Mediated Lysosome Biogenesis and Autophagy.

The heterogeneity and aggressiveness of triple-negative breast cancer (TNBC) contribute to its early recurrence and metastasis. Despite substantial research to identify effective therapeutic targets, TNBC remains elusive in terms of improving patient outcomes. Here, we report that a covalent JNK inhibitor, JNK-IN-8, suppresses TNBC growth both in vitro and in vivo. JNK-IN-8 reduced colony formation, cell viability, and organoid growth in vitro and slowed patient-derived xenograft and syngeneic tumor growth in vivo. Cells treated with JNK-IN-8 exhibited large, cytoplasmic vacuoles with lysosomal markers. To examine the molecular mechanism of this phenotype, we looked at the master regulators of lysosome biogenesis and autophagy transcription factor EB (TFEB) and TFE3. JNK-IN-8 inhibited TFEB phosphorylation and induced nuclear translocation of unphosphorylated TFEB and TFE3. This was accompanied by an upregulation of TFEB/TFE3 target genes associated with lysosome biogenesis and autophagy. Depletion of both TFEB and TFE3 diminished the JNK-IN-8-driven upregulation of lysosome biogenesis and/or autophagy markers. TFEB and TFE3 are phosphorylated by a number of kinases, including mTOR. JNK-IN-8 reduced phosphorylation of mTOR targets in a concentration-dependent manner. Knockout of JNK1 and/or JNK2 had no impact on TFEB/TFE3 activation or mTOR inhibition by JNK-IN-8 but inhibited colony formation. Similarly, reexpression of either wildtype or drug-nonbinding JNK (C116S) in JNK knockout cells did not reverse JNK-IN-8-induced TFEB dephosphorylation. In summary, JNK-IN-8 induced lysosome biogenesis and autophagy by activating TFEB/TFE3 via mTOR inhibition independently of JNK. Together, these findings demonstrate the efficacy of JNK-IN-8 as a targeted therapy for TNBC and reveal its novel lysosome- and autophagy-mediated mechanism of action.

Screening for parasites in migrant children.

BACKGROUND: Globalization has pushed population movements in the last decades, turning imported diseases into the focus. Due to behavioral habits, children are at higher risk of acquiring parasitosis. This study aims to investigate the prevalence of parasites in migrant children and factors associated with parasitic diseases. METHOD: Retrospective cross-sectional study (2014-2018) including children diagnosed with parasitosis. The diagnosis was based on serology and/or microscopic stool-sample evaluation. Epidemiological and clinical data were recorded. RESULTS: Out of 813 migrant children screened, 241 (29.6%) presented at least one parasite, and 89 (10.9%) more than one. The median age was 6.6 years (IQR: 3.1-11.9) and 58.9% were males. Most cases were referred for a health exam; only 52.3% of children were symptomatic, but 43.6% had eosinophilia. The most common diagnosis were giardiasis (35.3%), schistosomiasis (19.1%), toxocariasis (15.4%), and strongyloidiasis (9.1%). After the multivariate analysis, African origin and presenting with eosinophilia were the main risk factors for parasitism. CONCLUSIONS: parasitosis are frequent among migrant children. Children are often asymptomatic, and thus active screening for parasitosis should be considered among high-risk populations. Eosinophilia can be useful to guide complimentary tests, as well as geographical origin, but normal eosinophil count does not exclude parasitosis.

Eosinophilia in Migrant Children: How Should We Proceed?

BACKGROUND: The diagnostic approach to eosinophilia is complex, given the numerous reported etiologies. Intestinal parasites (especially helminths) are a concern in children from high-burden settings. We describe the diagnostic approach and clinical management of eosinophilia in a cohort of migrant children. METHODS: We conducted a retrospective observational study that included children diagnosed with eosinophilia at a reference center for pediatric tropical diseases from 2014 to 2018. All patients were screened according to a unified protocol, including direct microbiologic and serologic tests. RESULTS: A total of 163 children presented with eosinophilia during the study period [median age, 7.7 years (4.1-12.2); 57.1% boys], mostly from Asia (27.6%) and South America (22.1%). Most were internationally adopted children (43.6%) or migrants (26.4%). Only 34.4% of the children were symptomatic, and the main etiology for eosinophilia was helminths (56.4%). After a sequential diagnostic approach, no etiology was found for 40.5% of the patients. The independent risk factors for an unexplained etiology were younger age (≤2 years: odds ratio, 3.6; 95% CI, 1.3-10.2; P = 0.015), absence of symptoms (odds ratio, 4.8; 95% CI, 1.8-12.5; P = 0.001) and mild eosinophilia (<1000/µL: odds ratio, 4.2; 95% CI, 4.5-11.7; P = 0.005). Only 6 children were treated empirically. In those children with an identified cause and in those treated empirically, the eosinophilia resolved in 52% in a median of 7 months (5-9). CONCLUSIONS: Helminths are the main cause of eosinophilia in migrant children and need to be hunted, especially in older children with eosinophil counts >1000 eosinophils/µL.

Antropomorfismo, antropocentrismo y reduccionismo como obstáculos para la investigación de la cognición animal del siglo XXI / Anthropomorphism, anthropocentrism, and reductionism as obstacles to 21st-century animal cognition research

El objetivo de este artículo es argumentar la falta de validez del enfoque reduccionista para el estudio de la cognición animal y proponer su estudio desde un enfoque holista que tenga en cuenta toda la realidad de la cognición animal además de analizar el antropomorfismo y antropocentrismo relacionado con este tema. La metodología usada para esta investigación, fue una revisión de la literatura actual sobre el problema en cuestión y las conclusiones fueron que no se puede entender la mente de los sujetos no humanos sin un enfoque holista. Existen numerosos sesgos en la investigación científica, sea del observador, del sujeto experimental o respecto a los instrumentos de observación y medida. Entre todos los sesgos más conocidos, el muy conocido antropomorfismo, se ha visto como un sesgo inconsciente en donde el hombre se refleja en los elementos de su realidad exterior. La hipótesis de esta investigación es que el reduccionismo no toma en cuenta toda la riqueza y la verdadera realidad de la cognición animal no humana y ésta debe estudiarse mejor, desde un enfoque holista que tiene en cuenta la realidad entera de este fenómeno.

The objective paper is to argue the lack of validity of the reductionist approach to the study of animal cognition and to propose its study from a holistic approach that takes into account the entire reality of animal cognition in addition to analyzing anthropomorphism and anthropocentrism related to this topic. The methodology used for this research was a review of the current literature on the problem in question and the conclusions were that the mind of non-human subjects cannot be understood without a holistic approach. There are numerous biases in scientific research, be it from the observer, from the experimental subject or with respect to the instruments of observation and measurement. Among all the best-known biases, the well-known anthropomorphism has been seen as an unconscious bias where man is reflected in the elements of his external reality. The hypothesis of this research is that reductionism does not take into account all the richness and the true reality of non-human animal cognition and it should be studied better, from a holistic approach that takes into account the entire reality of this phenomenon.

Monosegment associating liver partition and portal vein ligation for staged hepatectomy: Preserving segment 1 as the only liver remnant after hepatocellular carcinoma recurrence.

Since the inception of the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) procedure, many centres have used this technique for patients who would otherwise be considered unresectable due to insufficient future liver remnant. In this report, we presented the case of a paediatric patient with recurrent hepatocellular carcinoma who underwent monosegment ALPPS (M-ALPPS) hepatectomy preserving segment 1 as the sole liver remnant using indocyanine green (ICG) as a fluorescence guide.

"Releyendo a"Sawamura Y, Abe H. Hypoglossal­facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique / "Rereading a..." Sawamura Y, Abe H. Hypoglossal­facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique

El artículo publicado por Sawamura Y. y Abe H. hace más de dos décadas representó una técnica revolucionaria para las cirugías contemporáneas de reanimación facial con axones del nervio hipogloso.1 Estos procedimientos se realizan cuando no es posible neurotizar al nervio facial con un cabo proximal del propio nervio. Esta situación se observa luego de la exéresis de tumores del ángulo pontocerebeloso, en la que se daña al VII par en su trayecto cisternal. La dificultad de realizar la neo anastomosis del hipogloso con el facial en su porción extracranal reside en la distancia anatómica en la que se encuentran

Non-domestic wastewater treatment with fungal/bacterial consortium followed by Chlorella sp., and thermal conversion of the generated sludge.

Liquid waste from biological stains is considered non-domestic wastewater difficult to treat, generating high environmental impact. Therefore, the objective of this work was to carry out secondary and tertiary treatment of these effluents at a pilot scale, using a fungal/bacterial consortium followed by Chorella sp., for 15 days. In addition, to obtain an adsorbent material for Malachite Green dye removal, sludge generated in the plant and pine bark co-pyrolysis was performed. For microalgae isolation and selection of the Chlorophyceae class, Chlorococcales order, and Chorella sp. genus Winogradsky columns were employed. After 15 days of pilot plant treatment, removal percentages of 91 ± 2%, 90 ± 4% and 17 ± 2% were obtained for Colour Units, Chemical Oxygen Demand and Nitrates, respectively. Two types of class II biochar (BC500 and BC700) and one of class III (BC300) were produced. The highest value for Fixed carbon (FC) was obtained at 300 °C (27.3 ± 3%), decreasing as the temperature increased by 25.9 ± 5% and 24.8 ± 2%, for BC500 and BC700, respectively. Biochar yield was 62.1 ± 3%, 46.3 ± 4% and 31.6 ± 3% for BC300, BC500 and BC700, respectively. Finally, BC500 and BC700 biochar efficiently adsorbed Malachite Green obtaining qe values of 0.290 ± 0.032, 0.281 ± 0.015, 0.186 ± 0.009 and 0.191 ± 0.012 mg g-1 at pH values of 4.0 and 8.0 ± 0.2, respectively. Pseudo-second order model demonstrated a chemical adsorption took place, which was influenced by pH. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13205-021-02780-1.

Is there autochthonous strongyloidiasis in Spanish children?

Strongyloidiasis, a neglected helminthiasis, is more prevalent in tropical/subtropical areas. However, sporadic autochthonous cases have been described around the Mediterranean coast. We performed a retrospective descriptive study in a referral Spanish Center for Pediatric Tropical diseases. All patients below 18 years of age diagnosed with probable strongyloidiasis between January 2014 and December 2019, born in Spain and with no history of travel abroad, were included. Epidemiological, clinical, and follow-up data were recorded, as well as all microbiology results. Five children met the inclusion criteria and were included in the study. Three males and two females, with a median age of 6.7 years (IQR: 5.8-9.1). All patients had previous medical conditions and used to spend holidays on the Mediterranean coast of Spain. All but one were mildly symptomatic at diagnosis but only four presented peripheral eosinophilia, which was the main reason for referral. First-line treatment was ivermectin in all but one, who was treated with albendazole. Reinfection was suspected in two during follow-up. At 12 months of follow-up 3/5 (60%) children presented negative serology.Conclusion: Although more prevalent in tropical areas, strongyloidiasis should be included among differential diagnosis in children presenting with eosinophilia. Screening for strongyloidiasis should be considered in all children candidate to immunosuppressive therapy. What is Known: • Strongyloidiasis is more prevalent in tropical/subtropical areas. • Strongyloidiasis can be life-threatening in immunosuppressed patients What is New: • Spanish children can be affected by autochthonous strongyloidiasis. • Screening for strongiloidiasis should be performed in all candidates to immunosuppresive therapies, including children.

Intra- and extradural anterior clinoidectomy: anatomy review and surgical technique step by step.

PURPOSE: The complex relations of the paraclinoid area make the surgical management of the pathology of this region a challenge. The anterior clinoid process (ACP) is an anatomical landmark that hinders the visualization and manipulation of the surrounding neurovascular structures, hence in certain surgical interventions might be necessary to remove it. We reviewed the anatomical relationships that involve the paraclinoid area and detailed the step-by-step techniques of intra and extradural clinoidectomy in cadaveric specimens. MATERIALS AND METHODS: A literature review was done describing the most relevant anatomic relationships regarding the anterior clinoid process. Extradural and intradural clinoidectomy techniques were performed in six dry bone heads and in ten previously injected cadaverous specimens with colored latex (Sanan et al. in Neurosurgery 45:1267-1274, 1999) and each step of the procedure was recorded using photographic material. Finally, an analysis of the anatomical exposure achieved in each of the techniques used was performed. RESULTS: The main advantage of the intradural clinoidectomy technique is the direct visualization of the neurovascular structures adjacent to the ACP when drilling, at the same time, opening the Sylvian fissure will allow the direct visualization of the ACP variants. The main advantage offered by the extradural technique is that the dura protects adjacent eloquent structures while drilling. Among the disadvantages, it is noted that the same dura that would protect the underlying structures also prevents the direct visualization of these neurovascular structures adjacent to the ACP. CONCLUSION: We reviewed the anatomy of the paraclinoid area and made a step-by-step description of the technique of the anterior clinoidectomy in its intra- and extradural variants in cadaveric preparations for a better understanding.

Biological therapy in refractory chronic nonbacterial osteomyelitis: A case series of 19 patients.

INTRODUCTION: Chronic non-bacterial osteomyelitis (CNO) represents an autoinflammatory bone disorder. Currently there are no standardized diagnostic or treatment guidelines. The objective of the study is to describe our experience with biological therapy in children with the disease. METHODS: Retrospective chart review of patients with CNO treated with biological therapy followed at two tertiary hospitals from January 2007 to April 2020. Biologicals were started in most patients due to persistent disease activity after receiving standard therapy with at least 2 drugs (NSAIDs and corticosteroids and/or pamidronate). RESULTS: Twenty-five patients were diagnosed with CNO. Out of those, 19 patients (15 females) failed conventional therapy. The mean age at diagnosis was 8.8±2.9 years and the mean diagnostic delay was 6.9±8.3 months. All patients presented with bone pain and 6/19 also had fever. The most frequently affected bones were femur (9 patients), followed by clavicle, tibia and vertebrae (6, 6 and 5 patients respectively). Nine children had skin lesions. C-reactive protein was elevated in 13/19 patients (mean 20.2mg/L±11.7) and ESR in 16/19 (mean 48mm/h±29). All patients received nonsteroidal anti-inflammatory drugs, 15/19 pamidronate, 10/19 corticosteroids and 19 anti-TNF-therapy. At the last follow-up visit, 10/19 patients were still on biological therapy (8 adalimumab, 2 infliximab) and 18 out of 19 remained asymptomatic. In regards to adverse effects, one patient receiving infliximab developed S. aureus osteomyelitis and another cutaneous leishmaniosis. CONCLUSIONS: This research emphasizes that anti-TNF-therapy represents an effective and safe alternative for patients with CNO refractory to conventional treatments.

Novel Simulation Model with Pulsatile Flow System for Microvascular Training, Research, and Improving Patient Surgical Outcomes.

BACKGROUND: Simulation allows surgical trainees to acquire surgical skills in a safe environment. With the aim of reducing the use of animal experimentation, different alternative nonliving models have been pursued. However, one of the main disadvantages of these nonliving models has been the absence of arterial flow, pulsation, and the ability to integrate both during a procedure on a blood vessel. In the present report, we have introduced a microvascular surgery simulation training model that uses a fiscally responsible and replicable pulsatile flow system. METHODS: We connected 30 human placentas to a pulsatile flow system and used them to simulate aneurysm clipping and vascular anastomosis. RESULTS: The presence of the pulsatile flow system allowed for the simulation of a hydrodynamic mechanism similar to that found in real life. In the aneurysm simulation, the arterial flow could be evaluated before and after clipping the aneurysm using a Doppler ultrasound system. When practicing anastomosis, the use of the pulsatile flow system allowed us to assess the vascular flow through the anastomosis, with verification using the Doppler ultrasound system. Leaks were manifested as "blood" pulsatile ejections and were more frequent at the beginning of the surgical practice, showing a learning curve. CONCLUSIONS: We have provided a step-by-step guide for the assembly of a replicable and inexpensive pulsatile flow system and its use in placentas for the simulation of, and training in, performing different types of anastomoses and intracranial aneurysms surgery.

Home Program for Acquisition and Maintenance of Microsurgical Skills During the Coronavirus Disease 2019 Outbreak.

BACKGROUND: During the current global crisis unleashed by the severe acute respiratory syndrome coronavirus 2 outbreak, surgical departments have considerably reduced the amount of elective surgeries. This decrease leads to less time in the surgical room to develop and improve the surgical skills of residents. In this study, we developed a training program to obtain and maintain microsurgical skills at home, using a smartphone camera and low-cost materials, affordable for everyone. METHODS: Using a smartphone camera as a magnification device, 6 participants performed 5 exercises (coloring grids, grouping colors, unraveling of a gauze, knots with suture threads, and tower of Hanoi), both with the dominant and with the nondominant hand, for 4 weeks. We compared performance at the beginning and at the end of the training process. Each participant filled out an anonymous survey. RESULTS: When we compared the performance at the beginning and at the end of the training process, we found significant improvements (P = 0.05) with the dominant as well as the nondominant hand in all the exercises. All participants were satisfied or very satisfied with the definition of the objectives of the training process, material availability, the exercises performed, the choice of the time to train, and general satisfaction with the training program. CONCLUSIONS: We developed a microsurgical skills training program to be performed at home, which can be easily reproduced. It allows residents to improve manual coordination skills and is regarded as a feasible adjunct for ongoing training for surgical residents.

Disfunción cardiaca subclínica en pacientes oncológicos: reporte de un caso / Subclinical cardiac dysfunction in cancer patients: a case report

RESUMEN La cardiotoxicidad es una entidad clínica relativamente nueva que, en caso de insuficiencia cardiaca, es un marcador de mal pronóstico en sobrevivientes de cáncer que han recibido, con mayor frecuencia, tratamiento con antraciclinas o trastuzumab. En estos pacientes, la detección de la disfunción cardiaca en estadio subclínico permite descubrir precozmente el compromiso miocárdico y evitar un mayor daño al corazón. El incremento de troponina I y los avances tecnológicos en imágenes como el Strain Longitudinal Global permiten detectar esta condición. Presentamos el caso de una paciente de 17 años diagnosticada de osteosarcoma en la pierna izquierda y que recibió antraciclinas. En la evaluación cardiovascular fue asintomática, con función ventricular izquierda normal (60 %), strain disminuido (-15 %) y troponina I elevada (115 ng/mL). Se diagnosticó disfunción cardiaca asintomática, y se indicó carvedilol 6,25 mg/día. Luego de 3 meses de tratamiento el strain se normalizó (-20 %) y la troponina I (19 ng/mL). Este caso es un ejemplo de la utilidad de las nuevas unidades de cardio-oncología que permiten evaluar, diagnosticar y tratar precozmente a los pacientes oncológicos, para evitar la cardiotoxicidad y su respectiva mortalidad.

ABSTRACT Cardiotoxicity is a relatively new clinical entity which, in the case of heart failure, is a marker of poor prognosis in cancer survivors who have received more frequent treatments with anthracyclines or trastuzumab. In these patients, detecting a cardiac dysfunction in the subclinical stage allows revealing early myocardial involvement and avoiding further damage to the heart. The increase in troponin I and the technological advances in imaging, such as the global longitudinal strain, enable the detection of this condition. This case report involves a 17-year-old female patient who was diagnosed with osteosarcoma in her left leg and received anthracyclines. In the cardiovascular evaluation, she was asymptomatic, and showed normal left ventricular function (60 %), decreased strain rate (-15 %) and elevated troponin I levels (115 ng/mL). Asymptomatic cardiac dysfunction was diagnosed and carvedilol 6.25 mg/day was prescribed. After 3 months of treatment, the strain rate (-20 %) and troponin I levels (19 ng/mL) returned to normal. This is an example of the usefulness of new cardio-oncology units that allow cancer patients to be evaluated, diagnosed and treated early in order to avoid cardiotoxicity and the resulting mortality.

Tumor de plexo braquial con extensión cervico torácica en paciente pediátrico / Brachial plexus tumor with cervical thoracic extension in a pediatric patient

Introducción: Los tumores de plexo braquial constituyen una entidad infrecuente. Cuando la lesión cumple con criterios quirúrgicos, el tratamiento ideal es la exéresis completa. Descripción del caso: Paciente pediátrica con antecedentes de neurofibromatosis que consulta por dolor leve y parestesias episódicas. Presenta masa palpable en región supraclavicular izquierda de consistencia duro elástica con signo de Tinel negativo. Se realiza una exéresis completa del neurofibroma mediante una cervicotomía anterior. Discusión: La indicación quirúrgica fue realizada en base al crecimiento tumoral y su efecto de masa sobre estructuras contiguas, los trastornos sensitivos y su antecedente de NF1, que predispone a variantes malignas. La clavícula suele ser el elemento anatómico que define las principales vías de abordaje al plexo braquial. Conclusión: Dejamos reportado un caso de neurofibroma de plexo braquial en una paciente pediátrica con neurofibromatosis. Describimos como la cervicotomía anterior fue una excelente vía a una masa extensión cervico torácica

Introduction: Brachial plexus tumors are an infrequent entity. When the lesion meets surgical criteria, the ideal treatment is its complete removal. Case report: A pediatric patient with a history of neurofibromatosis consults for mild pain and episodic paresthesias. The patient presented to the hospital for an elastic palpable mass in the left supraclavicular region testing negative for Tinel's sign. Complete removal of the neurofibroma was performed through an anterior cervicotomy. Discussion: The surgical indication was made based on the growth of the tumor and its mass effect on contiguous structures, the patient's sensory disorders and her neurofibromatosis history, which predisposes to malignant variants. The clavicle is usually the anatomical element defining the main approaches to the brachial plexus. Conclusion: The purpose of this article was to present a case of a of brachial plexus neurofibroma in a pediatric patient with neurofibromatosis. The anterior cervicotomy it would seem to be an excellent approach to a cervical thoracic extension mass