Age-period-cohort effects on incidence trends of childhood leukemia from four population-based cancer registries in Colombia.

BACKGROUND: Childhood leukemia (CL) is the most prevalent form of pediatric cancer on a global scale. However, there is a limited understanding of the dynamics of CL incidence in South America, with a specific knowledge gap in Colombia. This study aimed to identify trends in CL incidence and to analyze the effects of age, period, and birth cohort on the risk of leukemia incidence in this population. METHODS: Information on all newly diagnosed leukemia cases (in general and by subtype) among residents aged 0-18 years and living in the serving areas of population-based cancer registries of Cali (2008-2017), Bucaramanga (2000-2017), Manizales (2003-2017), and Pasto (1998-2018). Estimated annual percent changes (EAPC) in incidence over time and potential changes in the slope of these EAPCs were calculated using joinpoint regression models. The effects of age, period, and cohort in CL incidence trends were evaluated using age-period-cohort models addressing the identifiability issue through the application of double differences. RESULTS: A total of 966 childhood leukemia cases were identified. The average standardized incidence rate (ASIR) of leukemia was calculated and expressed per 100,000 person-years - observing ASIR of 4.46 in Cali, 7.27 in Bucaramanga, 3.89 in Manizales and 4.06 in Pasto. Concerning CL trends there were no statistically significant changes in EAPC throughout the different periods, however, when analyzed by leukemia subtype, statistically significant changes were observed in the EAPC for both ALL and AML. Analysis of age-period-cohort models revealed that age-related factors significantly underpin the incidence trends of childhood leukemia in these four Colombian cities. CONCLUSIONS: This study offers valuable insights into the incidence trends of childhood leukemia in four major Colombian cities. The analysis revealed stable overall CL incidence rates across varying periods, predominantly influenced by age-related factors and the absence of cohort and period effects. This information is useful for surveillance and planning purposes for CL diagnosis and treatment in Colombia.

Assessment of mercury and lead contamination using the bivalve Anadara tuberculosa (Arcidae) in an estuary of the Colombian Pacific.

Buenaventura Bay is considered the main estuary on the Pacific coast of Colombia, because of port and industrial activities. Mining and agriculture are major sources of contamination in the estuary. This study used the bivalve Anadara tuberculosa to evaluate the presence of mercury and lead in the Dagua River estuary (Colombia), one of the main tributaries coming into the bay. Five samplings for sediments and six for tissues of A. tuberculosa were carried out between 2016 and 2017. Additionally, a series of bioassays were conducted to determine its ability to bioaccumulate metals. A mean mercury concentration of 0.57 ± 0.74 mg*kg-1 and lead concentration of 0.87 ± 0.68 mg*kg-1 in sediment were found. Bioassays allowed us to conclude that at low mercury exposure concentrations (0.25 mg*kg-1), lesions are generated in animal tissue, mainly in sexual cells. The high concentrations of mercury found in organisms exceed the maximum permitted concentration established in Colombia. In addition, the contamination factors for mercury and lead were considered very high. This research aims at contributing to the use of Anadara tuberculosa, as prospective bioindicator for pollution biomonitoring in mangrove coastal ecosystems.

Design and analysis of a mechanical ventilation system based on cams.

Low-cost mechanical ventilators have been developed in order to deal with the shortage of traditional ventilators whose quantity is not sufficient in an emergency context in Perú. Protofy, a company from Spain, designed one of the first low-cost mechanical ventilation systems OxyGEN which was approved by a medicine agency in its country in special context of COVID 19. Therefore, as main of this article, a redesign of this system named OxygenIP.PE was carried out according to local requirements and available technology, but maintaining its working concept based on compression mechanism by cams. Sensors were added and a control algorithm of the respiratory rate was developed. Ventilation curves monitoring over time was implemented; in this sense, a mathematical model of the whole system was developed. OxygenIP.PE was redesigned, fabricated, and tested measuring its ventilation curves over time. Results indicate that this redesign provides a sturdy equipment able to work during a longer lifetime than the original. The replicability of the ventilation curves behavior is ensured, while the mechanism dimensions are adapted for a particular airbag resuscitator. The mathematical model of the whole system can satisfactorily determine the ventilation curves over time and is used to show the air pressure, volume, and flow as a function of the compression arm's angular position and differential pressure through the breathing circuit measurement, furthermore the algorithms designed as a consequence of the mathematical model were implemented for Raspberry and ARDUINO microcontrollers. There were obtained parameters of pressure 10-65 cmH2O, airflow 50-65 l/m, volume 0-0.5 l, at two values of beat per minute (BPM) 15 and 25.

Phylogenomic Evidence of Reinfection and Persistence of SARS-CoV-2: First Report from Colombia.

The continuing evolution of SARS-CoV-2 and the emergence of novel variants have raised concerns about possible reinfection events and potential changes in the coronavirus disease 2019 (COVID-19) transmission dynamics. Utilizing Oxford Nanopore technologies, we sequenced paired samples of three patients with positive RT-PCR results in a 1-2-month window period, and subsequent phylogenetics and genetic polymorphism analysis of these genomes was performed. Herein, we report, for the first time, genomic evidence of one case of reinfection in Colombia, exhibiting different SARS-CoV-2 lineage classifications between samples (B.1 and B.1.1.269). Furthermore, we report two cases of possible viral persistence, highlighting the importance of deepening our understanding on the evolutionary intra-host traits of this virus throughout different timeframes of disease progression. These results emphasize the relevance of genomic surveillance as a tool for understanding SARS-CoV-2 infection dynamics, and how this may translate effectively to future control and mitigations efforts, such as the national vaccination program.

Diagnóstico microbiológico en lavado broncoalveolar. Revisión de la literatura / Microbiological diagnosis in bronchoalveolar lavage. Literature review

El lavado broncoalveolar (LBA) se describió hace aproximadamente 50 años, y desde ese momento se ha venido empleando cada vez con más frecuencia, llegando a ser uno de los métodos de elección para hacer el diagnóstico microbiológico de las infecciones respiratorias bajas, pues facilita la identificación de patógenos oportunistas y no oportunistas. Su uso se incrementó paralelamente con el número de pacientes inmunocomprometidos, sobre todo a causa del SIDA y los trasplantes, situaciones en las que con frecuencia los pacientes padecen infecciones pulmonares por gérmenes oportunistas. El LBA es un procedimiento seguro que permite obtener muestras que aportan información amplia de las características celulares y microbiológicas del tracto respiratorio inferior. Para garantizar su utilidad es fundamental que la recolección, transporte, almacenamiento y procesamiento de las muestras sean óptimos. El análisis de las muestras se hace por técnicas convencionales para identificación de microorganismos, como son las tinciones y el aislamiento en medios de cultivo, y por otros métodos tales como la inmunofluorescencia, pruebas inmunológicas para la detección de antígenos y anticuerpos, y pruebas de biología molecular. En la presente revisión, se hace una actualización sobre el procedimiento de obtención, almacenamiento y transporte de las muestras de LBA, así como de las técnicas de diagnóstico microbiológico más utilizadas para identificar los principales agentes infecciosos asociados con enfermedades del tracto respiratorio inferior

Bronchoalveolar lavage (BAL) was described approximately 50 years ago and since then it has been used with increasing frequency, becoming one of the methods of choice for making the microbiological diagnosis of lower respiratory infections, as it facilitates the identification of opportunistic and non-opportunistic pathogens. Its use increased in parallel with the number of immunocompromised patients, especially due to AIDS and transplantation, situations in which patients frequently suffer from lung infections due to opportunistic germs. BAL is a safe procedure that allows obtaining samples that provide comprehensive information on the cellular and microbiological characteristics of the lower respiratory tract. Optimal collection, transport, storage and processing of samples is essential to guarantee its usefulness. Analysis of the samples is done both by conventional techniques for the identification of microorganisms, such as staining and isolation in culture media, as well as by other methods such as immunofluorescence, immunological tests for the detection of antigens and antibodies, and molecular biology assays. In this review, an update in presented on the procedure for obtaining, storing and transporting BAL samples, as well as on the most widely used microbiological diagnostic techniques to identify the main infectious agents associated with lower respiratory tract diseases

Case of neuromyelitis optica: bilateral sensorineural hearing loss and transverse myelopathy following intrathecal chemotherapy.

Neurotoxicity from intrathecally administered chemotherapeutic drugs is frequent, particularly with some agents like methotrexate, which are more prone to developing adverse effects. Myelopathy ranks among the most frequently reported neurological entities; with the diagnosis being straightforward, after ruling out infectious, metabolic, autoimmune or paraneoplastic causes. Scarcity of cases precludes evidence-based recommendations for the management of these complications. The most common therapeutic approach consists of the suspension of chemotherapy, exclusion of infectious and neoplastic causes, with prompt administration of high-dose steroids. We report a 21-year-old patient with acute lymphoblastic leukaemia, who developed acute transverse myelitis and bilateral sensorineural hearing loss, after five rounds of intrathecal methotrexate and cytarabine. Although neurotoxicity from both agents has been documented, this combination has not been previously reported.

Prognostic Factors Associated with Clinical and Economic Outcomes of Appendectomies in Children: A Multilevel Analysis in a National Retrospective Cohort Study.

BACKGROUND: Acute appendicitis is the most common acute surgical abdominal pathology in children, and it has a large impact on morbidity and the costs incurred by health care systems. In low- and median-income countries, national information on the clinical and economic outcomes associated with this surgery does not exist. This study aimed to identify and describe the clinical and economic outcomes for children undergoing appendectomy in Colombia's contributory system and to determine the prognostic factors associated with these outcomes. METHODS: A retrospective cohort study was conducted using administrative data from patients under 18 years of age who underwent an appendectomy between July 1, 2013, and September 30, 2015, in Colombia's contributory health system. Thirty-day mortality rates, intensive care unit (ICU) admission rates, length of stay (LOS), readmission rates and median costs were estimated for the entire country by geographic region and insurer. The prognostic factors associated with these outcomes were identified using generalized multilevel mixed models. RESULTS: A total of 21,674 children were included. The 30-day postoperative mortality rate was 0.06% [95% CI 0.02-0.9], the ICU admission rate was 8.00% [95% CI 7.63-8.36], the mean LOS was 2.48 days (SD 5.24), the readmission rate was 1.5% [95% CI 1.33-1.66] and the median cost for Colombia was 394 USD [p25-p75: 256-555]. The prognostic factors that were associated with the 30-day ICU admission rate, LOS and readmission rate were the insurer, geographic region, age, occurrence of an appendectomy with peritoneal drainage, and certain comorbidities, such as cancer and neurological, respiratory and gastrointestinal illnesses. The prognostic factors associated with costs were those previously mentioned as well as the occurrence of a laparoscopic appendectomy. CONCLUSIONS: In Colombia's contributory health system, large differences in clinical outcomes and the costs incurred by the system exist, and these differences are associated with the geographic region, the insurer, and some of the clinical characteristics of the children undergoing appendectomy.

Resultados polisomnográficos de pacientes adultos con parálisis de cuerdas vocales y diagnóstico de síndrome de apnea hipopnea obstructiva del sueño llevados a cordectomía posterior: estudio antes-después / Polisomnographic results of adult patients with bilateral vocal cord paralysis and diagnosis of hypopnea sleep apnea syndrome managed with posterior cordectomy: study before-after

Introducción: la parálisis bilateral de cuerdas vocales (PBCV) y el síndrome de apnea hipoapnea obstructiva del sueño (SAHOS) son patologías que generan limitación respiratoria. Por tratarse de patologías obstructivas, es razonable considerar una posible relación. Materiales y métodos: se realizó un estudio antes y después en dos centros universitarios de Bogotá. Se describieron frecuencias y medidas de tendencia central. Se utilizaron las pruebas de McNemar BoWker y T pareada o Wilcoxon, considerándose significativo un p <0,05. Resultados: se incluyeron 14 pacientes con PBCV manejados con cordectomía posterior transversa. 100 % fueron del género femenino y la media de edad de 51,2±10,73 años. El promedio de índice de masa corporal (IMC) fue 25,42±5,4, 50 % tuvieron IMC normal. La severidad del SAHOS fue leve (42,9 %), moderada (28,6 %) y severa (28,6 %). La intervención fue exitosa en un 64,28 %, lo que evidencia una reducción del 54 % del índice apnea/hipopnea (IAH) prequirúrgico comparado con el posquirúrgico (p = 0,029), 85,6 % reducción en el índice de apneas obstructivas (p = 0,017), en el índice de hipopneas en 52 % (p = 0,028) y la latencia del sueño en 33,3 % (p = 0,025). Otras variables no mostraron diferencias significativas (p >0,05). Conclusiones e importancia clínica: los resultados descritos evidencian una relación estadísticamente significativa del SAHOS y la PBCV. Los pacientes con PBCV se beneficiaron del uso de la cordectomía posterior como intervención terapéutica ya que disminuye los índices de severidad del SAHOS y, por ende, mejora la calidad de vida de los pacientes.

Background: bilateral vocal cord paralysis (BVFP) and obstructive sleep apnea-hypopnea syndrome (OSAHS) are pathologies that generate respiratory limitation. As they are obstructive airway diseases, it is reasonable to consider a possible relationship. Materials and methods: a before and after study was performed, in two university centers in Bogotá, frequencies and measures of central tendency were described. The McNemar BoWker and paired T or Wilcoxon tests were used, considering p <0.05 significant. Results: 14 patients were managed with transverse posterior cordectomy. 100 % were female and the mean age of 51.2±10.73 years. The average BMI was 25.42±5.4, 50 % had normal BMI. OSAHS severity was mild 42.9 %, moderate 28.6 % and severe 28.6 % disease classification. The intervention was successful in 64.28 %, there was a 54 % reduction in presurgical Apnea Hypopnea Index compared to the post-surgical one (p = 0.029), 85.6 % reduction in the index of obstructive apneas (p = 0.017), in the index of hypopneas in 52 % (p = 0.028) and sleep latency in 33.3 % (p = 0.025). Other variables showed no significant differences (p >0.05). Conclusions: the results described show a statistically significant relationship between OSAHS and BVFP. Patients with BVFP benefited from the use of posterior cordectomy as a therapeutic intervention reducing the severity rates of OSAHS and thus improving the quality of life of patients.

The poor insane Ophelia: reconsidering Ophelia syndrome.

INTRODUCTION: The association between memory loss and Hodgkin's lymphoma has been given the eponym of Ophelia syndrome, in memory of Shakespeare's character in The Tragedy of Hamlet, Prince of Denmark. Nevertheless, there are differences between the disease and the character. OBJECTIVE: To review the origins and uses of the eponym through an original article by pathologist Ian Carr, its relation to the character Ophelia, and the related autoantibodies. METHODS: Historical narrative review. RESULTS: Besides an eloquent description in the original article, Carr presaged the presence of autoantibodies, before they had been thoroughly researched. Since then, five different autoantibodies (mGluR5, Hu, NMDAR, SOX, PCA2) have been associated with Hodgkin's disease. It is interesting to note the divergent outcomes of Shakespeare's character and the patient in the original description by Carr, the latter recovering to lead a normal life, and the former deceased. CONCLUSIONS: Although there is little relationship between the fictional character and the syndrome, both imply the unintentional trigger of self-harm (suicide in one case, autoimmunity in the other), thus remaining associated.

"Los libros y la noche", perspectiva neurológica de la ceguera de Jorge Luis Borges.

The works of Argentinian scholar Jorge Luis Borges (1899-1986) have captivated physicians. An assiduous reader, he was given, with magnificent irony, "books and the night". Borges suffered from chronic and irreversible blindness, which influenced much of his work and has been the subject of different literary and diagnostic analyses from the ophthalmological point of view. However, the characteristics of his visual impairment have escaped the neurological approach, which is why we reviewed his work looking for data suggesting a concomitant brain injury. On his autobiography, he recounts how, during an episode of septicemia, he suffered hallucinations and loss of speech; in addition, in some poems and essays he describes data that suggest "phantom chromatopsia", a lesion of cortical origin. After that accident, Borges survived with a radical change in literary style. Although a precise diagnosis is impossible, his literary work allows recognizing some elements in favor of concomitant brain involvement.

La obra del erudito argentino Jorge Luis Borges (1899-1986) ha cautivado a los médicos. Asiduo lector con magnífica ironía, le fueron dados "los libros y la noche". Borges padeció una ceguera crónica e irreversible que impulsó gran parte de su obra y ha sido objeto de distintos análisis literarios y diagnósticos desde el punto de vista oftalmológico. Sin embargo, las características de su ceguera han escapado al abordaje neurológico, por lo cual revisamos su obra en busca de datos que sugieran una lesión cerebral concomitante. En su autobiografía relata cómo durante un episodio de septicemia padeció alucinaciones y pérdida del habla; además, en algunos poemas y ensayos describe datos que sugieren "cromatopsia fantasma", lesión de origen cortical. Tras dicho accidente, Borges sobrevivió con un cambio radical en su estilo literario. Aunque un diagnóstico preciso es imposible, su obra literaria nos permite reconocer algunos elementos que sugieren involucramiento cerebral concomitante.

The poor insane Ophelia: reconsidering Ophelia syndrome / La pobre e insensata Ofelia: reconsiderando el síndrome de Ofelia

ABSTRACT The association between memory loss and Hodgkin's lymphoma has been given the eponym of Ophelia syndrome, in memory of Shakespeare's character in The Tragedy of Hamlet, Prince of Denmark. Nevertheless, there are differences between the disease and the character. Objective: To review the origins and uses of the eponym through an original article by pathologist Ian Carr, its relation to the character Ophelia, and the related autoantibodies. Methods: Historical narrative review. Results: Besides an eloquent description in the original article, Carr presaged the presence of autoantibodies, before they had been thoroughly researched. Since then, five different autoantibodies (mGluR5, Hu, NMDAR, SOX, PCA2) have been associated with Hodgkin's disease. It is interesting to note the divergent outcomes of Shakespeare's character and the patient in the original description by Carr, the latter recovering to lead a normal life, and the former deceased. Conclusions: Although there is little relationship between the fictional character and the syndrome, both imply the unintentional trigger of self-harm (suicide in one case, autoimmunity in the other), thus remaining associated.

RESUMO El síndrome de Ofelia describe la asociación entre pérdida de memoria y enfermedad de Hodgkin, en memoria del personaje de La Tragedia de Hamlet, Príncipe de Dinamarca, de William Shakespeare. Sin embargo, existen diferencias entre ambos. Objetivo: Revisar los orígenes y usos del epónimo a través del artículo original, su relación con el personaje y los autoanticuerpos relacionados. Métodos: Revisión narrativa histórica. Resultados: Además de una descripción elocuente, el artículo original prefigura los autoanticuerpos, cuando no se buscaban de rutina. Desde entonces, cinco distintos (mGluR5, Hu, NMDAR, SOX, PCA2) han sido asociados. Cabe destacar, que el desenlace del personaje y del paciente fueron diametralmente opuestos, el primero falleció y el segundo se recuperó, llevando una vida normal. Conclusiones: A pesar de la poca relación entre el personaje y el síndrome, ambos implican el desencadenamiento no intencional de daño auto-inflingido (suicidio en un caso, autoinmunidad en el otro), manteniendo así la adecuacía.

Supercritical fluid chromatography coupled to mass spectrometry for lipidomics.

Supercritical fluid chromatography (SFC) has experienced a particular revival in recent years thanks to the development of robust and efficient commercial systems. Because of its physico-chemical properties, supercritical carbon dioxide (CO2 ) mixed with cosolvents and additives is particularly suitable for SFC to allow the elution of compounds of different polarities and more particularly complex lipids. Hyphenation with mass spectrometry (MS) is increasingly described in the literature but still requires many further developments in order to be as user-friendly as coupling with liquid chromatography. The basic concepts of SFC and MS hyphenation will be first considered. Then a representative example of method development in lipidomics will be introduced. In conclusion, the challenges and future needs in this field of research will be discussed.

"The books and the night", neurological perspective on Jorge Luis Borges' blindness

The works of Argentinian scholar Jorge Luis Borges (1899-1986) have captivated physicians. An assiduous reader, he was given, with magnificent irony, "books and the night". Borges suffered from chronic and irreversible blindness, which influenced much of his work and has been the subject of different literary and diagnostic analyses from the ophthalmological point of view. However, the characteristics of his visual impairment have escaped the neurological approach, which is why we reviewed his work looking for data suggesting a concomitant brain injury. On his autobiography, he recounts how, during an episode of septicemia, he suffered hallucinations and loss of speech; in addition, in some poems and essays he describes data that suggest "phantom chromatopsia", a lesion of cortical origin. After that accident, Borges survived with a radical change in literary style. Although a precise diagnosis is impossible, his literary work allows recognizing some elements in favor of concomitant brain involvement.

Odor generation patterns during different operational composting stages of anaerobically digested sewage sludge.

This study aimed to evaluate the global patterns of odor generation and odorant composition for different operational stages of anaerobically digested sewage sludge (ADS) composting at pilot scale. To this end, gas emissions were sampled and analyzed during storage, forced aeration treatment (active phase), turning process and curing. For each operational stage, odors were monitored by measuring the odor emission rates (OER in OUE h-1 kg-1ADS) through dynamic olfactometry and computing the odor activity values (OAVs) of compounds quantified by analytical methods (i.e., GC/MS). Ammonia and volatile sulfur compounds (VSCs) were the most abundant air pollutants, representing 55.5% and 20.6% of the cumulative mass emitted, respectively. The first eight days of aerobic treatment and the first turning of the compostable mixture were the critical steps for odor generation with OER ranging from 30 to 317 OUE h-1 kg-1ADS. Particularly, the first turning process was responsible for strong odor episodes that were emitted in a short process time (295 OUE h-1 kg-1ADS). Based on the OAVs approach, dimethyl disulfide, dimethyl sulfide, and methanethiol were the predominant odorants along these early operational stages. Odor potential and composition shifted for the middle and later active phase, second turning, and curing stage where OER fluctuated from 0.18 to 12.6 OUE h-1 kg-1ADS, and hydrogen sulfide showed the most substantial odor contribution. A principal component analysis explaining 77% of the variability in odor concentration and OAVs datasets eased the recognition of these odor patterns.

Síndrome comisural de Wernekink secundario a un ictus de la unión mesencéfalo-protuberancial / Wernekinks commissural syndrome due to a stroke of the midbrain-pons union

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