Immune-mediated hepatitis: Basic concepts and treatment.

Immunotherapy with immune checkpoint inhibitors (ICIs) has revolutionized advanced cancer management. Nevertheless, the generalized use of these medications has led to an increase in the incidence of adverse immune-mediated events and the liver is one of the most frequently affected organs. Liver involvement associated with the administration of immunotherapy is known as immune-mediated hepatitis (IMH), whose incidence and clinical characteristics have been described by different authors. It often presents as mild elevations of amino transferase levels, seen in routine blood tests, that spontaneously return to normal, but it can also manifest as severe transaminitis, possibly leading to the permanent discontinuation of treatment. The aim of the following review was to describe the most up-to-date concepts regarding the epidemiology, diagnosis, risk factors, and progression of IMH, as well as its incidence in different types of common cancers, including hepatocellular carcinoma. Treatment recommendations according to the most current guidelines are also provided.

Sunflower (Helianthus annuus) Seed Allergy.

BACKGROUND AND OBJECTIVE: Sunflower seed is one of the most common edible seeds and its consumption is growing. Case reports of sunflower seed allergy have been described since the 1970s. However, there are few data on the prevalence and clinical manifestations of sunflower seed allergy. To improve understanding of sunflower seed allergy. METHODS: We evaluated the clinical and immunological features of patients with sunflower seed allergy diagnosed in the Allergy Department of a tertiary hospital in Madrid over a 5-years period. RESULTS: Forty-seven patients reported adverse reactions after ingestion of sunflower seed and had specific sensitization to sunflower seed determined by skin prick test (median 8 mm) or specific IgE (median 1.10 kUA/L). Most had an adult-onset reaction to sunflower seed preceded by a history of atopy and other food allergies, predominantly to peach, peanut and nuts. Clinical presentation of sunflower seed allergy ranged from mild to severe, with a high proportion of patients suffering severe reactions, often undertreated. A variability in the severity of symptoms was seen on repeated exposures to sunflower seed on a same patient. Levels of sunflower seed IgE were strongly correlated with levels of IgE to non-specific lipid transfer proteins, while no significant differences were found in the severity of the reactions according to sensitization to those proteins. CONCLUSION: Our findings reveal a variability of clinical presentations of sunflower seed allergy on repeated exposures and an underuse of epinephrine in anaphylaxis. We highlight the importance of strict avoidance of sunflower seed and accurate prescription and administration of epinephrine in allergic patients.

Informal waste pickers in guayaquil: Recycling rates, environmental benefits, main barriers, and troubles.

Systems for managing municipal solid waste are typically ineffective in developing nations because of governments' deficient financial and administrative frameworks, poor rules, and a lack of suitable infrastructure and human resources. The informal sector plays an essential role in these systems by reprocessing waste into secondary raw materials, reducing collection and disposal costs, and, most importantly, benefiting the environment by avoiding incineration and landfilling. However, their actual contributions remain unknown. The present paper aims to understand the role of informal waste pickers (IWPs) in the waste management system of Guayaquil City and their environmental impact through the calculations of the carbon footprint (CF) avoided due to their aid. The survey design gathered information on their personal profiles, types, and rates of collected recyclables, market conditions, their main barriers, and troubles regarding their formalization. The results of the survey demonstrate that waste picking is mostly a male-driven activity, the average daily mass collected per IWP is 13 kg, the most collected recyclable waste is polyethylene terephthalate, their average monthly income is $179, and the total avoided CF of the entire informal waste picking process is almost 14 thousand tons of CO2 eq yearly. Further, IWPs prefer to operate alone, and only 16% of them would join a cooperative, despite their numerous financial, logistical, and personal challenges.

Sensitivity of PM10 oxidative potential to aerosol chemical composition at a Mediterranean urban site: ascorbic acid versus dithiothreitol measurements.

The oxidative potential (OP) of PM10 daily samples collected at a traffic site in southeastern Spain during summer and winter was assessed by two acellular assays: the ascorbic acid (AA) and dithiothreitol (DTT) methods. Although PM10 levels were similar during both periods, OP values (expressed in nmol min-1 m-3) showed a defined seasonal trend. The AA activity was higher in summer than in winter, whereas the DTT reactivity exhibited an opposite seasonal pattern. Both assays were sensitive to different PM10 components, as shown by the results of the linear correlation analysis. Moreover, the relationship between OP values and PM10 chemical species was not the same during summer and winter, indicating that particle toxicity is associated with different sources during the warm and cold seasons. When OP values were expressed on a mass basis (nmol min-1 µg-1), lower correlation coefficients with PM10 chemical species were generally obtained compared to volume-normalized activities. These outcomes suggest that only some specific components have a significant intrinsic oxidative potential. Supplementary Information: The online version contains supplementary material available at 10.1007/s11869-023-01332-1.

Abordaje común del paciente con psoriasis y riesgo de esteatosis hepática metabólica: recomendaciones de un grupo de expertos multidisciplinar / Common Approach to Metabolic-Associated Fatty Liver Disease in Patients With Psoriasis: Consensus-Based Recommendations From a Multidisciplinary Group of Experts

En los últimos años se están haciendo notables esfuerzos para entender la relación existente entre la psoriasis y la esteatosis hepática metabólica (EHmet). No solo se presenta este trastorno en pacientes psoriásicos con una mayor prevalencia, sino que además se acompaña de una mayor gravedad. Con este precedente, se evidencia la necesidad de establecer un protocolo de abordaje precoz de la enfermedad hepática en los pacientes con psoriasis. Asimismo, es de especial relevancia la evaluación de riesgo y beneficio en referencia al uso de tratamientos con potencial hepatotóxico. En el presente manuscrito se exponen las recomendaciones de un panel de expertos en dermatología y hepatología para el cribado, diagnóstico, monitorización y criterios de derivación en pacientes con psoriasis, en caso de sospecha de esteatosis hepática metabólica (AU)

Recent years have seen concerted efforts to understand the relation between psoriasis and metabolic-associated fatty liver disease (MAFLD). Not only is MALFD diagnosed more often in patients with psoriasis, but its clinical course is also more aggressive. A common approach is therefore needed to enable early detection of liver disease coincident with psoriasis. Especially important is an analysis of risks and benefits of potentially hepatotoxic treatments. This consensus paper presents the recommendations of a group of experts in dermatology and hepatology regarding screening for MALFD as well as criteria for monitoring patients and referring them to hepatologists when liver disease is suspected (AU)

[Translated article] Common Approach to Metabolic-Associated Fatty Liver Disease in Patients With Psoriasis: Consensus-Based Recommendations From a Multidisciplinary Group of Experts / Abordaje común del paciente con psoriasis y riesgo de esteatosis hepática metabólica: recomendaciones de un grupo de expertos multidisciplinar

Recent years have seen concerted efforts to understand the relation between psoriasis and metabolic-associated fatty liver disease (MAFLD). Not only is MALFD diagnosed more often in patients with psoriasis, but its clinical course is also more aggressive. A common approach is therefore needed to enable early detection of liver disease coincident with psoriasis. Especially important is an analysis of risks and benefits of potentially hepatotoxic treatments. This consensus paper presents the recommendations of a group of experts in dermatology and hepatology regarding screening for MALFD as well as criteria for monitoring patients and referring them to hepatologists when liver disease is suspected (AU)

En los últimos años se están haciendo notables esfuerzos para entender la relación existente entre la psoriasis y la esteatosis hepática metabólica (EHmet). No solo se presenta este trastorno en pacientes psoriásicos con una mayor prevalencia, sino que además se acompaña de una mayor gravedad. Con este precedente, se evidencia la necesidad de establecer un protocolo de abordaje precoz de la enfermedad hepática en los pacientes con psoriasis. Asimismo, es de especial relevancia la evaluación de riesgo y beneficio en referencia al uso de tratamientos con potencial hepatotóxico. En el presente manuscrito se exponen las recomendaciones de un panel de expertos en dermatología y hepatología para el cribado, diagnóstico, monitorización y criterios de derivación en pacientes con psoriasis, en caso de sospecha de esteatosis hepática metabólica (AU)

Lithium levels and lifestyle in patients with bipolar disorder: a new tool for self-management.

BACKGROUND: Patients should get actively involved in the management of their illness. The aim of this study was to assess the influence of lifestyle factors, including sleep, diet, and physical activity, on lithium levels in patients with bipolar disorder. METHODS: A multicenter study was performed. In total, 157 lithium measurements were done biweekly in a sample of 65 patients (35 women) over 6 weeks. Lifestyle, based on total sleep hours and physical activity, was assessed by actigraphy. Diet was evaluated using the Mediterranean Lifestyle Index (Medlife). RESULTS: 35.4% of patients had a normal weight. The mean Medlife score was 14.5 (± 2.5) (moderate-good adherence to Mediterranean diet). BMI, daily dose of lithium and intensity of physical activity had a combined effect on lithium levels, after adjustment for other variables. Patients who practiced intense physical exercise, who took lower doses and had a higher BMI exhibited lower levels of lithium. CONCLUSIONS: Higher physical activity and BMI contribute to lower lithium levels. Patients should be made aware of these relationships to improve their perception of control and self-management. Lifestyle-based interventions contribute to establishing a more personalized medicine.

Common Approach to Metabolic-Associated Fatty Liver Disease in Patients With Psoriasis: Consensus-Based Recommendations From a Multidisciplinary Group of Experts. / Abordaje común del paciente con psoriasis y riesgo de esteatosis hepática metabólica: recomendaciones de un grupo de expertos multidisciplinar.

Recent years have seen concerted efforts to understand the relation between psoriasis and metabolic-associated fatty liver disease (MAFLD). Not only is MALFD diagnosed more often in patients with psoriasis, but its clinical course is also more aggressive. A common approach is therefore needed to enable early detection of liver disease coincident with psoriasis. Especially important is an analysis of risks and benefits of potentially hepatotoxic treatments. This consensus paper presents the recommendations of a group of experts in dermatology and hepatology regarding screening for MALFD as well as criteria for monitoring patients and referring them to hepatologists when liver disease is suspected.

Risk factors associated with sarcopenia in elderly persons in military Hospital Central de la Defensa «Gómez Ulla»

Antecedents and objectives: Sarcopenia is a syndrome characterized by the progressive and generalized decrease in skeletal muscle mass, strength and decreased physical performance. Associated factors are age, diet, sedentary lifestyle and chronic diseases. Very few studies have been conducted on the epidemiology of sarcopenia in hospitalized elderly. The objective of the study was to describe the prevalence of sarcopenia and identify the associated factors among elderly patients hospitalized in Madrid, Spain.Material y Methods:A cross-sectional study was conducted at the Hospital Central de la Defensa “Gómez Ulla” during the period from March to September 2018. 295 patients with ages greater than or equal to 65 participated. Sarcopenia was defined according to the EWGSOP2 criterion measuring muscle mass, muscle strength and functionality.Results:The prevalence of sarcopenia was 28.5% (95% CI 23.3-33.7), without significant differences between men and women. The Body Mass Index, hospital stay, alcohol consumption, smoke, physical activity, frequency of physical activity and strength of muscle mass, muscle strenght and funcionality presented an association with the sarcopenia.Conclusions:The prevalence was higher than other studies. The body mass index was significantly higher in subjects with sarcopenia. A higher proportion of smoking was found in subjects without sarcopenia. Likewise, an association was found between physical exercise and a lower prevalence of sarcopenia. (AU)

Antecedentes y objetivos: La sarcopenia es un síndrome caracterizado por la disminución progresiva y generalizada de la masa muscular esquelética, la fuerza y ​​la disminución del rendimiento físico. Los factores asociados son la edad, la dieta, el sedentarismo y las enfermedades crónicas. Se han realizado muy pocos estudios sobre la epidemiología de la sarcopenia en ancianos hospitalizados. El objetivo del estudio fue describir la prevalencia de sarcopenia e identificar los factores asociados entre pacientes ancianos hospitalizados en Madrid, España.Material y Métodos:Se realizó un estudio transversal en el Hospital Central de la Defensa «Gómez Ulla» durante el periodo de marzo a septiembre de 2018. Participaron 295 pacientes con edades mayores o iguales a 65 años. La sarcopenia se definió según el criterio EWGSOP2 que mide la masa muscular, la fuerza muscular y la funcionalidad.Resultados:La prevalencia de sarcopenia fue del 28,5 % (IC 95 % 23,3-33,7), sin diferencias significativas entre hombres y mujeres. El índice de masa corporal, estancia hospitalaria, consumo de alcohol, tabaquismo, actividad física, frecuencia de actividad física y fuerza de masa muscular, fuerza muscular y funcionalidad presentaron asociación con sarcopenia.Conclusiones:La prevalencia fue superior a otros estudios. El índice de masa corporal fue significativamente mayor en sujetos con sarcopenia. Se encontró una mayor proporción de fumadores en sujetos sin sarcopenia. Asimismo, se encontró asociación entre el ejercicio físico y una menor prevalencia de sarcopenia. (AU)

Anestesia libre de opioides para cistectomía radical laparotómica en obesidad mórbida / Opioid-free anesthesia for open radical cystectomy in morbid obesity

El estudio de la técnica anestésica libre de opioides aporta evidencias de su efectividad y seguridad. Sin embargo, aún no están bien definidos todos sus riesgos y beneficios, ni en qué pacientes o intervenciones puede ser superior a la técnica anestésica convencional basada en opioides. Las cirugías intensivas y/o duraderas plantean dudas para la utilización de esta técnica por la respuesta a cambios hemodinámicos bruscos, al no producir la simpaticolisis a través de la actuación sobre el receptor μ y haber poca experiencia de uso. Una paciente con obesidad mórbida fue sometida a cistectomía radical con derivación urinaria tipo Bricker mediante laparotomía infraumbilical, consiguiéndose una adecuada estabilidad hemodinámica y una analgesia óptima en el postoperatorio sin emplear opioides intraoperatorios. La anestesia libre de opioides está en expansión con una evidencia creciente. No obstante, es necesario seguir investigando sobre sus posibilidades de utilización, las distintas combinaciones de fármacos que se puedan emplear y la resolución de complicaciones que puedan ocurrir.(AU)

Opioid-free anaesthesia shows evidence about its efectivity and security, even though its risks and benefits are not well defined. Neither are the patient profile or sort of surgery where it could be superior to the conventional opioid-based anaesthetic technique. Aggressive and/or long-lasting surgeries set out several queries on this technique regarding sudden hemodynamic changes, as it does not produce sympatholysis through μ receptor and there is modest experience in this technique. A morbidly obese patient received open radical cystectomy with Bricker-type urinary diversion using infraumbilical incision under OFA protocol, maintaining an adequate hemodynamic stability and excellent analgesia in postoperatory care without using any intraoperative opioids. Opioid-free anaesthesia technique is developing its evidence. However, it is necessary to keep on researching its clinical applications, different drug combinations and solutions to its expected complications.(AU)

Opioid-free anesthesia for open radical cystectomy in morbid obesity.

Opioid-free anaesthesia shows evidence about its efectivity and security, even though its risks and benefits are not well defined. Neither are the patient profile or sort of surgery where it could be superior to the conventional opioid-based anaesthetic technique. Aggressive and/or long-lasting surgeries set out several queries on this technique regarding sudden hemodynamic changes, as it does not produce sympatholysis through µ receptor and there is modest experience in this technique. A morbidly obese patient received open radical cystectomy with Bricker-type urinary diversion using infraumbilical incision under OFA protocol, maintaining an adequate hemodynamic stability and excellent analgesia in postoperatory care without using any intraoperative opioids. Opioid-free anaesthesia technique is developing its evidence. However, it is necessary to keep on researching its clinical applications, different drug combinations and solutions to its expected complications.

Patient-centered Outcomes in Breast Cancer: Description of EQ-5D-5L and EORTC-QLQ-BR23 Measurements in Real-world Data and Their Association With Survival.

AIMS: In recent years, major improvements in breast cancer treatments have led to a significant increase in survival. Despite that, this population's quality of life (QoL) information is lacking, especially real-world data. MATERIALS AND METHODS: This was a prospective, multicentre, observational study of female breast cancer patients, without prior systemic treatment, treated between 2012 and 2019 in private health care in Brazil. QoL was assessed by two questionnaires, the EQ-5D-5L and the EORTC-QLQ-BR23. Additional data were retrospectively collected. RESULTS: The study comprised 1372 patients, most with early-stage disease (80.2% stages 0-II). At a median follow-up of 25.6 months, the estimated 3-year overall survival was 93.6%. Patients with locally advanced and metastatic breast cancer had the lowest visual analogue scale scores and the highest symptom burden in all dimensions of EQ-5D-5L, but with the most significant improvement after treatment. With the EORTC-QLQ-BR23 questionnaire, patients undergoing lumpectomy had a better perception of body image. Axillary dissection led to greater arm symptoms after 12 months, radiotherapy enhanced breast symptoms and patients treated with chemotherapy had significant worsening in the effects of systemic therapy compared with endocrine or HER2 therapy. Staging and immunohistochemical subtype correlated with survival and with several QoL parameters, but overall survival was not independently affected by patient-reported outcomes in this cohort. CONCLUSION: Our results show that early diagnosis and access to treatments with fewer side-effects, such as endocrine or targeted therapy, and less aggressive surgeries are the best strategies to achieve a better QoL for breast cancer patients.

Bilateral facial palsy with paresthesias, variant of Guillain-Barré syndrome following COVID-19 vaccine: A case series of 9 patients.

Several cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 vaccination have been reported, including the rare subtype known as Bilateral Facial Palsy with paresthesias (BFP). To date, it is not known whether a causal relationship may exist between the two. We report 9 cases of BFP in patients vaccinated against COVID-19 in the previous month. Nerve conduction studies revealed demyelinating polyneuropathy in 4 patients, and 5 presented bilateral, focal facial nerve involvement, exclusively. Ganglioside antibody panel was positive in 4 patients (anti-GM1=2, anti-GD1a=1 and anti-sulfatide=1). Seven patients received intravenous immunoglobulin treatment, one plasma exchange, and one patient died from sudden cardiac arrest following arrhythmia before treatment could be administered. Rates of BFP following COVID-19 vaccination, did not differ from those reported in previous series. Epidemiological studies are essential to determine whether a causal relationship may exist between this rare form of GBS and COVID-19 vaccination.

Condición psicofisiológica en el desempeño de tareas sanitario-militares con mascarilla quirúrgica / Psychophysiological Condition in the Performance of Sanitary-Military Tasks with Surgical Mask

Se ha analizado, mediante un diseño cuasi-experimental con 19 sanitarios (33.7 ± 5.1 años), la importancia de la condición física, cognitiva y el rendimiento al portar un equipo de protección con mascarilla quirúrgica durante situaciones de entrenamiento en contextos significativos de intervención militar. Se midieron la frecuencia cardíaca y su variabilidad, los niveles de glucosa, la termorregulación, la fuerza explosiva y el esfuerzo percibido en tareas de rendimiento motor específicas (tapping test, torniquete, municionamiento), y de rendimiento cognitivo y decisional (triaje). Los resultados indican diferencias significativas (p < 05) en función de la condición física (glucemia y fuerza explosiva), del género (fuerza explosiva y torniquete), del hábito tabáquico (esfuerzo percibido) y del cuerpo de pertenencia (nivel de glucemia) en el grupo de estudio. Como conclusión, se destaca la importancia del entrenamiento físico y psicológico para la mejora de la respuesta operativa en situaciones sanitario-militares que requieren el uso de mascarilla quirúrgica. (AU)

Using a quasi-experimental design with 19 health workers (33.7 ± 5.1 years), the importance of physical and cognitive condition and performance when wearing protective equipment with a surgical mask during training situations in significant contexts of military intervention has been analysed. Heart rate and its variability, glucose levels, thermoregulation, explosive strength and perceived effort in specific motor performance tasks (tapping test, tourniquet, ammunition), and cognitive and decisional performance (triage) were measured. The results indicate significant differences (p < 05) depending on the physical condition (blood glucose and explosive strength), gender (explosive strength and tourniquet), smoking habit (perceived effort) and specialty (glucose level) in the study group. In conclusion, the importance of physical and psychological training is highlighted to improve the operational response in health-military situations that require the use of a surgical mask. (AU)

Size segregated ionic species collected in a harbour area.

Water-soluble ions were analysed in size segregated aerosol samples collected in the port of Alicante (Southeastern Spain) during summer and winter using a multistage cascade impactor. Seasonal variations in the size distributions of the analysed components and the influence of bulk materials handling (loading/unloading and stockpiling) at the docks were investigated. The size distributions of SO42-, NH4+ and K+ were characterized by prominent peaks in the condensation and droplet modes, both in summer and winter, while those of Ca2+, Na+, Mg2+ and Cl- had a main peak centred at ∼4 µm. Although oxalate size distributions were similar during both seasons, the fraction of coarse-mode oxalate increased in summer most likely as a result of volatilization and repartition processes or reactions of oxalic acid with coarse alkaline particles. Nitrate size distributions were dominated by a coarse mode; however, during winter, modal peaks in the submicron size range were also observed due to favourable conditions for the formation of fine-mode NH4NO3. Harbour activities had a significant impact only on the concentrations of calcium, particularly in the coarse fraction, during both summer and winter.

Preparation and characterization of polysulfone-polyurethane membranes for recovery of simulated wastewater from industrial textile processes.

Techniques using membranes for the treatment of wastewaters usually promote higher quality of treated water when compared to other processes. Among them, pervaporation has advantages in terms of selectivity in addition to low working pressure, which can prevent clogging problems. Polysulfone and polyurethane have complementary characteristics and are interesting in the context of membranes for industrial applications. In this sense, the aim of this work was to prepare and characterize polysulfone/polyurethane-based membranes and tested them with a simulated wastewater containing the reactive black dye and sodium chloride by pervaporation. In their manufacture, thermal treatment (at 60°C) and photo-radiation treatment (using ultraviolet light) were also applied. The characterizations were performed using different analytical tools. In general, it was possible to verify that all membranes have a dense layer. The thermal analysis allowed to define that the indicated working temperature is below 50°C. With respect to the simulated wastewater treatment, all membranes reached 100% selectivity. Concerning the saline solution, the mean selectivity was around 98.5%. Moreover, the permeate flow values were within the range presented by commercial membranes ranging from 1.6 to 2.4 kg m-2 h-1. Although for the photoirradiated membranes the photo-graft reaction has occurred, among all membranes, the blend without any treatment stood out from the others, presenting the highest permeate flow of the simulated wastewater. Finally, the results reveal that these membranes are capable of recovering wastewater from textile processes, in addition to having the potential to remove salts from water through the pervaporation process.Highlights Polysulfone/polyurethane-based membranes were not yet evaluated for wastewater recovery.Modifications in the membrane characteristics promoted variations in the permeate flow.Changes in physical-chemical properties of membrane as a result of a photoinitiation reaction.Removal efficiency achieved was 100% for reactive black dye and 98.5% for sodium chloride.A new way of performing pervaporation on the recovery of aqueous solutions.