Facilitating safe discharge through predicting disease progression in moderate COVID-19: a prospective cohort study to develop and validate a clinical prediction model in resource-limited settings

BackgroundIn locations where few people have received COVID-19 vaccines, health systems remain vulnerable to surges in SARS-CoV-2 infections. Tools to identify patients suitable for community-based management are urgently needed. MethodsWe prospectively recruited adults presenting to two hospitals in India with moderate symptoms of laboratory-confirmed COVID-19 in order to develop and validate a clinical prediction model to rule-out progression to supplemental oxygen requirement. The primary outcome was defined as any of the following: SpO2 < 94%; respiratory rate > 30 bpm; SpO2/FiO2 < 400; or death. We specified a priori that each model would contain three clinical parameters (age, sex and SpO2) and one of seven shortlisted biochemical biomarkers measurable using near-patient tests (CRP, D-dimer, IL-6, NLR, PCT, sTREM-1 or suPAR), to ensure the models would be suitable for resource-limited settings. We evaluated discrimination, calibration and clinical utility of the models in a temporal external validation cohort. Findings426 participants were recruited, of whom 89 (21{middle dot}0%) met the primary outcome. 257 participants comprised the development cohort and 166 comprised the validation cohort. The three models containing NLR, suPAR or IL-6 demonstrated promising discrimination (c-statistics: 0{middle dot}72 to 0{middle dot}74) and calibration (calibration slopes: 1{middle dot}01 to 1{middle dot}05) in the validation cohort, and provided greater utility than a model containing the clinical parameters alone. InterpretationWe present three clinical prediction models that could help clinicians identify patients with moderate COVID-19 suitable for community-based management. The models are readily implementable and of particular relevance for locations with limited resources. FundingMedecins Sans Frontieres, India. RESEARCH IN CONTEXTO_ST_ABSEvidence before this studyC_ST_ABSA living systematic review by Wynants et al. identified 137 COVID-19 prediction models, 47 of which were derived to predict whether patients with COVID-19 will have an adverse outcome. Most lacked external validation, relied on retrospective data, did not focus on patients with moderate disease, were at high risk of bias, and were not practical for use in resource-limited settings. To identify promising biochemical biomarkers which may have been evaluated independently of a prediction model and therefore not captured by this review, we searched PubMed on 1 June 2020 using synonyms of "SARS-CoV-2" AND ["biomarker" OR "prognosis"]. We identified 1,214 studies evaluating biochemical biomarkers of potential value in the prognostication of COVID-19 illness. In consultation with FIND (Geneva, Switzerland) we shortlisted seven candidates for evaluation in this study, all of which are measurable using near-patient tests which are either currently available or in late-stage development. Added value of this studyWe followed the TRIPOD guidelines to develop and validate three promising clinical prediction models to help clinicians identify which patients presenting with moderate COVID-19 can be safely managed in the community. Each model contains three easily ascertained clinical parameters (age, sex, and SpO2) and one biochemical biomarker (NLR, suPAR or IL-6), and would be practical for implementation in high-patient-throughput low resource settings. The models showed promising discrimination and calibration in the validation cohort. The inclusion of a biomarker test improved prognostication compared to a model containing the clinical parameters alone, and extended the range of contexts in which such a tool might provide utility to include situations when bed pressures are less critical, for example at earlier points in a COVID-19 surge. Implications of all the available evidencePrognostic models should be developed for clearly-defined clinical use-cases. We report the development and temporal validation of three clinical prediction models to rule-out progression to supplemental oxygen requirement amongst patients presenting with moderate COVID-19. The models are readily implementable and should prove useful in triage and resource allocation. We provide our full models to enable independent validation.

Lisencefalia, hipoplasia cerebelar y atresia de vías biliares extrahepáticas: una asociación inusual / Lissencephaly, cerebellar hypoplasia, and extrahepatic biliary atresia: An unusual association

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El papel de la mujer a lo largo de la historia de la Nefrología / The role of women throughout the history of Nephrology

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Presentación de dos casos de vasa previa, ¿se podría haber evitado el desenlace? / Presentation of two cases of vasa previa. Could the outcome have been avoided?

Introducción: La vasa previa (VP) es una rara condición obstétrica en la cual los vasos sanguíneos fetales, libres de tejido placentario y no protegidos por gelatina de Wharton, pasan a nivel del segmento uterino inferior entre la presentación fetal y el cérvix, recubiertos solo por membranas amnióticas. Esta condición conlleva un elevado riesgo de mortalidad perinatal (2,4-56,4%), debido al riesgo de la-ceración de los vasos fetales durante el parto o la ruptura de membranas amnióticas, y consecuentemente la exanguinación fetal. Casos clínicos: Presentamos dos casos clínicos de gestaciones con VP sin diagnóstico prenatal, que presentaron hemorragia fetal durante el parto, requiriendo maniobras de reanimación avanzada y transfusión urgente de concentrado de hematíes, con una adecuada evolución. Conclusión: Resaltar la importancia del diagnóstico prenatal de VP, mediante estudio ecográfico según protocolo, que puede mejorar significativamente los resultados perinatales

Introduction. The vasa previa (VP) is a rare obstetric condition in which the fetal blood vessels, free of placental tissue and not protected by Wharton's gelatin, pass at the level of the lower uterine segment between the fetal presentation and the cervix, coated only by amniotic membranes. This condition carries a high risk of perinatal mortality (2.4-56.4%), due to the risk of laceration of the fetal vessels during delivery or the rupture of amniotic membranes, and consequently fetal exanguination. Cases report: We present two clinical cases of pregnancies with VP without prenatal diagnosis, which presented fetal hemorrhage during labor, requiring advanced resuscitation maneuvers and urgent transfusion of packed red blood cells, with an adequate evolution. Conclusion: Highlight the importance of prenatal diag-nosis of VP, by means of an echographic study according to protocol, which can significantly improve perinatal results

Is the prognosis of occult N2 disease similar to that of positive positron emission tomography-computed tomography (PET/CT) scan single-station N2 disease in patients with non-small cell lung cancer treated by surgical resection? / ¿Es el pronóstico de la enfermedad N2 oculta mediastínica similar al de la enfermedad N2 estación única por tomografía de emisión de positrones-tomografía computarizada (PET-TC) en pacientes con cáncer de pulmón no célula pequeña tratados con resección quirúrgica?

Objective. A retrospective study, using a prospective database, was conducted on patients treated with surgery in order to analyze the prognosis between two groups: NSCLC (non-small cell lung cancer) patients with occult N2 disease and patients with single station N2 disease observed on pre-operative integrated PET/CT scan. Methods. A total of 772 patients underwent surgical treatment for lung cancer from January 2007 to December 2014. All of them had an integrated PET/CT scan in the pre-operative work-up and a pulmonary resection plus mediastinal lymphadenectomy were performed in all cases. In the selected cases, no one received induction treatment. All patients from both groups had N2 disease after examination of the histopathology specimen. Clinical and pathological characteristics, disease free survival, and overall survival, were analyzed in both groups. Results. A total of 34 cases presented occult N2 disease, whereas 11 cases showed single station N2 disease on pre-operative PET/CT scan. Mean disease free survival and mean overall survival for occult N2 disease compared to single-station N2 disease on PET/CT scan was 36.0 months (95% CI: 24.9-47.1) and 38.9 months (95% CI: 20.6-57.1), p=.586; and 52.3 months (95% CI: 38.9-65.7) and 38.2 months (95% CI: 21.9-54.5), p=.349, respectively. Conclusion. The prognosis of patients with single-station N2 disease on PET/CT scan treated by surgical resection and mediastinal lymphadenectomy as first line treatment was similar to those with occult N2 disease. More studies are needed to support our findings (AU)

Objetivo. Estudio retrospectivo de una base de datos prospectiva sobre pacientes tratados con cirugía para analizar el pronóstico entre dos grupos: pacientes con cáncer de pulmón no células pequeñas con enfermedad N2 oculta y pacientes con enfermedad N2 estación única observados en el estudio preoperatorio con PET/TC integrado. Métodos. Desde enero de 2007 hasta diciembre de 2014 un total de 772 pacientes fueron operados por cáncer de pulmón. Todos los pacientes tuvieron una PET/TC en el estudio preoperatorio y se les realizó la resección pulmonar más linfadenectomía mediastínica. En los casos seleccionados no hubo tratamiento de inducción. Todos los pacientes de ambos grupos fueron N2 después del examen anatomopatológico. Se analizaron las características clinicopatológicas, la supervivencia libre de enfermedad y la supervivencia global de ambos grupos. Resultados. Un total de 34 casos fueron enfermedad N2 oculta, mientras que 11 casos mostraron enfermedad N2 con estación única en el estudio preoperatorio con PET/TC. La supervivencia libre de enfermedad y la supervivencia media global para la enfermedad N2 oculta comparada con la enfermedad N2 con estación ganglionar mediastínica única fue de 36,0 meses (IC 95%: 24,9-47,1) y 38,9 meses (IC 95%: 20,6-57,1) p=0,586 y de 52,3 meses (IC 95%: 38,9-65,7) y 38,2 meses (IC 95%: 21,9-54,5) p=0,349, respectivamente. Conclusión. El pronóstico de los pacientes con enfermedad N2 de estación única en PET/TC tratados con cirugía y linfadenectomía mediastínica como primera línea de tratamiento fue similar a aquellos con enfermedad N2 oculta. Más estudios son necesarios para apoyar nuestros resultados (AU)

Miocardiopatía no compactada asociada a síndrome 1P36 / Non-compaction cardiomyopathy associated to 1P36 syndrome

La miocardiopatía no compa da (MNC) es una enf medad congénita caracterizada por la ausencia de compaqctación del miocardio ventricular. Tiene una gran variabilidad genética, clinica, evolutiva y pronóstica. Presentamos a una recién nacida pretérmino (34 semanas) con restrición del crecimiento intrauterino, fenotipo peculiar, hipotonia generalizada y distrés respiratono. La ecocardiografía objetiva ausencia de compactación del ventrículo izquierdo y disfunción sistólica leve, que se trata con captopril y ácido acetilsalicílico. Desarrolla crisis convulsivas parciales resistentes al tratamiento y se evidencia ausencia de respuesta en potenciales auditivo-visuales del tronco del encéfalo. El cariotipo convencional es normal pero el estudio de microarrays revela deleción 1p36.33-p36.23. El estudio carddiológico y genético de los progenitores es normal. El conocimiento de esta cardiopatía permite un diagnóstico precoz. Debe realizarse despistaje a familiares de primer grado. Dada la frecuente asociación entre MNC y síndrome 1p36 recomendamos incluir estudio genético mediante microarrays en pacientes con sospecha de asociación sindrómica y normalidad en el cariotipo convencional, como en el caso que presentamos (AU)

The non-compaction cardiomypathy (MNC) is a congenital disorder characterized by the absence of the compaction ventricular myocardium. It presents a high variability, genetic, clinical, evolutionary and prognostic. We report a preterm newborn (34 weeks) with intrauterine growth restriction particular phenotype, generalized hypotonia and respiratory distress. Echocardiography objective absence of compaction left ventricular myocardium and mild sistolic dysfunction, treated with captopril and acetylsalicylic acid. Develops resistant treatment partial seizurcs and lack response evident in visual-auditory evoked potentials brainstem. The conventional kariotype is normal but the microarray study revealed 1p.36-p36.23 deletion. Cardiological and genetic study of the parents are normal. Thebest knowledge of the MNC allows earlier diagnosis. Have to perform screening for first-degree relatives. Given the frequent association between MNC and lp36 syndrome, we recommend using microarray genetic study in patients with suspected syndromic association and normality in the conventional as in the case presented (AU)

Omentoplastia y packing intratorácico simple para cerrar una fístula broncopleural derecha postneumonectomía y evitar la toracostomía / Omentoplasty and simple thoracic packing to close a right post-pneumonectomy bronchopleural fistula and to avoid thoracostomy

Un varón de 77 años con múltiples factores de riesgo desarrolló 13 días después de una neumonectomía derecha una fístula broncopleural de 8mm. Fue reoperado utilizando un colgajo de epiplon para cubrir el muñón bronquial y el mediastino sin suturarlo al muñon bronquial. El colgajo de epiplon simplemente se colocó sobre el mediastino cubriendo ampliamente el muñón. Permaneció sujeto en su posición con varios puntos sobre el orificio transdiafragmático y pericardio y con múltiples compresas empaquetadas ocupando toda la cavidad pleural para comprimir el epiplon desplegado sobre el mediastino. El drenaje torácico se conectó a aspiración para evitar acúmulo de derrame pleural infectado y la toracotomía se cerró. Las compresas que formaban el packing intratorácico se cambiaron cada dos días. El colgajo de epiplon quedó agarrado firmemente al mediastino y la fístula del bronquio derecho cerró completamente. El paciente fue dado de alta 14 días después de la omentoplastia y en el seguimiento no aparecieron signos de recidiva de la fístula broncopleural

A 77-year-old male patient with high risks factors developed 13 days after pneumonectomy a 8mm-size bronchopleural fistula. He was reoperated on using an omentum flap to cover the bronchial stump and the mediastinum without suturing the bronchial stump. The omentum flap was just laid on the right mediastinal site to cover widely the stump, and was kept in place by applying some stiches to the diaphragm and to the pericardium, and also several dressings inside the postpneumonectomy thoracic cavity to completely pack the omentum against the mediastinum. A chest tube was connected to suction to avoid accumulation of infected pleural effusion, and thoracostomy was closed. The packing of intrathoracic dressings were changed every 2 days. The omentum flap got intensely attached to the mediastinum and the right main bronchial fistula completely healed. Patient was discharged 14 days after omentoplasty, and no signs of fistula relapse appeared in the follow-up

Omentoplastia y packing intratorácico simple para cerrar una fístula broncopleural derecha postneumonectomía y evitar la toracostomía / Omentoplasty and simple thoracic acking to close a right postp-neumonectomy bronchopleural fistula and to avoid thoracostomy

Un varón de 77 años con múltiples factores de riesgo desarrolló 13 días después de una neumonectomía derecha una fístula broncopleural de 8 mm. Fue reoperado utilizando un colgajo de epiplon para cubrir el muñón bronquial y el mediastino sin suturarlo al muñon bronquial. El colgajo de epiplon simplemente se colocó sobre el mediastino cubriendo ampliamente el muñón. Permaneció sujeto en su posición con varios puntos sobre el orificio transdiafragmático y pericardio y con múltiples compresas empaquetadas ocupando toda la cavidad pleural para comprimir el epiplon desplegado sobre el mediastino. El drenaje torácico se conectó a aspiración para evitar acúmulo de derrame pleural infectado y la toracotomía se cerró. Las compresas que formaban el packing intratorácico se cambiaron cada dos días. El colgajo de epiplon quedó agarrado firmemente al mediastino y la fístula del bronquio derecho cerró completamente. El paciente fue dado de alta 14 días después de la omentoplastia y en el seguimiento no aparecieron signos de recidiva de la fístula broncopleural

A 77-year-old male patient with high risks factors developed 13 days after pneumonectomy a 8 mm-size bronchopleural fistula. He was reoperated on using an omentum flap to cover the bronchial stump and the mediastinum without suturing the bronchial stump. The omentum flap was just laid on the right mediastinal site to cover widely the stump, and was kept in place by applying some stiches to the diaphragm and to the pericardium, and also several dressings inside the postpneumonectomy thoracic cavity to completely pack the omentum against the mediastinum. A chest tube was connected to suction to avoid accumulation of infected pleural effusion, and thoracostomy was closed. The packing of intrathoracic dressings were changed every 2 days. The omentum flap got intensely attached to the mediastinum and the right main bronchial fistula completely healed. Patient was discharged 14 days after omentoplasty, and no signs of fistula relapse appeared in the follow-up

Análisis de las tendencias en la mortalidad por enfermedades cerebrovasculares en España 1980-2011 / Analysis of cerebrovascular mortality trends in Spain from 1980 to 2011

Introducción: En las últimas décadas las tasas de mortalidad por enfermedades cerebrovasculares (ECV) han descendido de forma importante en muchos países. En este estudio se analizan los cambios recientes en la evolución de la mortalidad por ECV en España (1980-2011) para verificar si las tendencias observadas previamente continúan. Pacientes y métodos: Los datos de mortalidad por ECV y las poblaciones necesarias para el cálculo de los indicadores fueron facilitados por el Instituto Nacional de Estadística. Se calcularon las tasas específicas por grupos de edad y estandarizadas globales y truncadas (35-64 años) mediante el método directo (población estándar europea). Mediante análisis de regresión «joinpoint» estimamos el porcentaje de cambio anual de las tasas e identificamos puntos de cambio significativos en la tendencia. Resultados: La mortalidad por ECV se ha reducido de forma contundente y sostenida en los últimos 32 en todos los grupos de edad y sexo en España. En ambos sexos el análisis joinpoint identifica un periodo final de mayor descenso (2005-2011 [-6,3%] en mujeres y 2007-2011 en varones [-7,2%]). Conclusiones: Existe un marcado y continuo descenso en la mortalidad por ECV en España (1980-2011). Teniendo en cuenta el proceso de envejecimiento de la población, es esperable un incremento de la prevalencia y, por ello, de la magnitud de las ECV medida en términos de discapacidad y costes de salud, lo que representará un gran reto para nuestro sistema sanitario

Introduction: In recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. Patients and methods: Data on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. Results: CVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (−6.3%) and 2007-2011 in men (−7.2%). Conclusions: CVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system

Ratio between maximum standardized uptake value of N1 lymph nodes and tumor predicts N2 disease in patients with non-small cell lung cancer in 18F-FDG PET-CT scan / La relación entre el SUV (standardized uptake value) de los ganglios linfáticos N1 y el tumor predice la enfermedad N2 en pacientes con cáncer de pulmón no célula pequeña mediante PET-TC 18F-FDG (AU)

Objective. F-18 fluorodeoxyglucose integrated PET-CT scan is commonly used in the work-up of lung cancer to improve preoperative disease stage. The aim of the study was to analyze the ratio between SUVmax of N1 lymph nodes and primary lung cancer to establish prediction of mediastinal disease (N2) in patients operated on non-small cell lung cancer. Material and method. This is a retrospective study of a prospective database. Patients operated on non-small cell lung cancer (NSCLC) with N1 disease by PET-CT scan were included. None of them had previous induction treatment, but they underwent standard surgical resection plus systematic lymphadenectomy. Results. There were 51 patients with FDG-PET-CT scan N1 disease. 44 (86.3%) patients were male with a mean age of 64.1 ± 10.8 years. Type of resection: pneumonectomy = 4 (7.9%), lobectomy/bilobectomy = 44 (86.2%), segmentectomy = 3 (5.9%). Histology: adenocarcinoma = 26 (51.0%), squamous = 23 (45.1%), adenosquamous = 2 (3.9%). Lymph nodes after surgical resection: N0 = 21 (41.2%), N1 = 12 (23.5%), N2 = 18 (35.3%). Mean ratio of the SUVmax of N1 lymph node to the SUVmax of the primary lung tumor (SUVmax N1/T ratio) was 0.60 (range 0.08-2.80). ROC curve analysis to obtain the optimal cut-off value of SUVmax N1/T ratio to predict N2 disease was performed. At multivariate analysis, we found that a ratio of 0.46 or greater was an independent predictor factor of N2 mediastinal lymph node metastases with a sensitivity and specificity of 77.8% and 69.7%, respectively. Conclusions. SUVmax N1/T ratio in NSCLC patients correlates with mediastinal lymph node metastasis (N2 disease) after surgical resection. When SUVmax N1/T ratio on integrated PET-CT scan is equal or superior to 0.46, special attention should be paid on higher probability of N2 disease (AU)

Objetivo. La PET-TC integrada con F-18 fluorodeoxiglucosa es utilizada frecuentemente en la estadificación preoperatoria del cáncer de pulmón(CP). El objetivo del estudio fue analizar la relación entre SUVmax de los ganglios linfáticos N1 con el tumor pulmonar para establecer un factor predictivo de enfermedad metastásica ganglionar en el mediastino(N2) en pacientes operados de cáncer de pulmón no microcítico. Material y método. Estudio retrospectivo de una base de datos prospectiva. Se incluyeron pacientes operados de CP con enfermedad N1 por PET-TC. Ninguno tuvo tratamiento previo. Se realizó una resección pulmonar estándar y linfadenectomía. Resultados. Hubo un total de 51 pacientes con N1 por PET-TC. 44(86,3%) fueron varones, edad media = 64,1 ± 10,8 años. Tipo de resección: neumonectomía = 4(7,9%), lobectomía/bilobectomía = 44(86,2%), segmentectomía = 3(5,9%). Histología: adenocarcinoma = 26(51,0), epidermoide = 23(45,1%), adenoescamoso = 2(3,9%). Ganglios linfáticos tras la resección: N0 = 21(41,2%), N1 = 12(23,5%), N2 = 18(35,3%). La relación media entre el SUVmax de los ganglios N1 con el SUVmax del tumor pulmonar (relación SUVmax N1/T) fue 0,60 (rango 0,08–2,80). El análisis de la curva ROC se realizó para determinar el punto de corte óptimo para predecir N2 (metástasis mediastínica). En el análisis multivariante encontramos que una relación de 0,46 o mayor fue un factor pronóstico independiente para N2, con una sensibilidad y especificidad de 77,8% y 69,7%, respectivamente. Conclusiones. La relación SUVmax N1/T en pacientes con CP no microcítico se correlaciona con la metástasis ganglionar mediastínica (N2) después de la resección quirúrgica. Cuando la relación SUVmax N1/T en la PET-TC es igual o mayor de 0,46 se debería prestar atención especial por la alta probabilidad de enfermedad mediastínica N2 (AU)

Golpe de calor relacionado con el uso de topiramato. La importancia de la prevención / Heat stroke related to the use of topiramate. The importance of prevention

Entre las entidades patológicas relacionadas con el calor, el golpe de calor es el más grave. Se define como una elevación de la temperatura corporal central acompañada de signos de disfunción neurológica, presentando una elevada tasa de mortalidad si no se establece un tratamiento precoz. El topiramato es uno de los fármacos más utilizados en el tratamiento de la epilepsia y en la prevención de las migrañas. Entre sus efectos secundarios, se ha descrito la hipohidrosis, produciendo riesgo de hipertermia y favoreciendo la aparición del golpe de calor. Presentamos el caso de una paciente que presentó un golpe de calor por ejercicio potenciado por el uso de topiramato

Heat stroke is the most severe pathology related to heat. It is defined as an increase in core body temperature accompanied by signs of neurological dysfunction. In the absence of an early treatment, it has a very high mortality rate. Topiramate is a well known drug widely used in epilepsy treatment and migraine prevention. Oligohydrosis has been described amongst topiramate side effects, favouring the risk of hyperthermia and heatstroke. We present the case of a patient who developed heat stroke due to physical exercise while under topiramate treatment

Tumor fibroso solutario pleural maligno, a propósito de tres casos / Malignant solitary fibrous tumour of the pleura. Report of three cases

Los tumores fibrosis solitarios pleurales son lesiones infrecuentes con origen en el tejido conectivo submesotelial. Se diferencian de los mesoteliomas por sus características clínicas, anatomo-patológicas y pronóstico. Solo (..) (AU)

Pleural solitary fibrosis tumors are infrequent lessions. They are originated from submesothelial connective tissue. Difference to mesotheliomas is based (..) (AU)

Hipouricemia tubular renal / Renal tubular hypouricemia

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Duplicación gástrica como causa de masa abdominal en el recién nacido / Gastric duplication as the origin of abdominal mass in the newborn

La duplicación gástrica es una malformación poco frecuente que representa el 8% de las duplicaciones digestivas. Se atribuye a un fallo, durante el periodo embrionario, en la recanalización del tubo digestivo primitivo. La mayoría se localizan en la región antropilórica, en el borde mesentérico, y usualmente no se comunican con el estómago. Por lo general, son asintomáticas, y constituyen un hallazgo por técnicas de imagen. Estas malformaciones se presentan comúnmente como una masa abdominal y con dolor. En algunos pacientes puede dar sintomatología secundaria a una complicación, como infección, sangrado, obstrucción intestinal, masa palpable y perforación. El diagnóstico viene determinado por la ecografía abdominal y la tomografía computarizada, lo que permite definir la localización de la masa y las relaciones con las estructuras vecinas. Debemos considerar entre los diagnósticos diferenciales principalmente los quistes de la vía biliar, los linfangiomas mesentéricos y otras duplicaciones intestinales. El tratamiento es siempre quirúrgico. El objetivo de este trabajo fue presentar una causa poco frecuente de masa palpable, que debería tenerse en cuenta en los pacientes pediátricos con esta sintomatología y una imagen quística en la ecografía(AU)

Gastric duplication is an uncommon malformation that represents 8% of the digestive duplications. It is attributed to a failure in the recanalization of the primitive alimentary tract during the embryonic period. The most frequent location is the antropiloric region, on the mesenteric edge and usually they do not communicate with the stomach. These malformations are generally asymptomatic, and they are detected by imaging techniques. The most frequent presentation form of these malformations is an abdominal mass and pain. In some patients symptoms secondary to a complication such as infection, bleeding, intestinal obstruction, palpable mass and perforation, are observed. Diagnosis is determined by abdominal ultrasound and computed tomography (CT), allowing to establish the mass location and its involvement with nearby structures. In differential diagnosis we must mainly consider cysts of the biliary tract, mesenteric lymphangiomas and other intestinal duplications. The treatment is always surgical. The objective of this paper was to report an uncommon cause of abdominal pain and palpable mass in children that should be considered in patients with these symptoms and showing acystic image in abdominal ultrasonography(AU)

Respuesta a carta sobre indicadores de calidad / No disponible

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Prevención secundaria del ictus en pacientes muy ancianos / Secondary stroke prevention in very elderly patients

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The parahippocampal gyrus in the baboon: anatomical, cytoarchitectonic and magnetic resonance imaging (MRI) studies.

The parahippocampal gyrus, located at the medial temporal lobe, is a key structure in declarative memory processing. We have analyzed the general organization of the parahippocampal gyrus in the baboon, a nonhuman primate species relatively close to human. This region is rostrocaudally made up of the temporopolar, perirhinal, entorhinal (divided into seven subfields) and posterior parahippocampal (areas TH and TF) cortices. The basic analysis has been performed in three brains, serially sectioned and stained with thionin, myelin stain, acetylcholinesterase and parvalbumin, to determine cytoarchitectonic boundaries. Borders of all subfields were charted onto camera lucida drawings, and two-dimensional maps of the surface and topography of the parahippocampal gyrus were made. Finally, the limits of each parahippocampal area were then transposed on corresponding MR images (commonly used for in vivo PET or functional MRI activation studies) of two animals for precise identification. The general cytoarchitectonic features of the baboon parahippocampal gyrus are similar to macaques, but the size of temporopolar cortex and the laminar organization of perirhinal and posterior parahippocampal cortices resemble humans more than macaque species. In conclusion, the size and structure of the baboon parahippocampal cortex makes this species very appropriate for experimental studies on memory function.

Chemical characterization of the lectin from Amaranthus leucocarpus syn. hypocondriacus by 2-D proteome analysis.

In this work, we characterized chemically the N-acetyl-D-galactosamine specific lectin from Amaranthus leucocarpus syn hypocondriacus lectin (ALL). It is a dimeric glycoprotein composed by three isoforms with pl at 4.8, 4.9, and 5.2. Circular dichroism analysis indicated that the secondary structure of ALL contains 45% of \bibeta-sheet and 5% of \bialpha-helix. Amino acid sequence of the purified lectin and its isoforms was determined from peptides obtained after trypsin digestion by MALDI-TOF (Matrix assisted laser desorption ionization-time of flight). The tryptic peptides prepared from the purified lectin and the three isoforms showed different degrees (80 to 83%) of identity with the amino acid sequence belonging to a previously described high nutritional value protein from A. hypocondriacus not shown at the time to be a lectin. Furthermore, analysis of tryptic peptides obtained from ALL previously treated with peptide N-glycosidase, revealed a 93% identity with the aforementioned protein. Presence of N-glycosidically linked glycans of the oligomannosidic type and, in minor proportion, of the N-acetyllactosaminic type glycans was determined by affinity chromatography on immobilized Con A.