Triclabendazole efficacy, prevalence, and re-infection of Fasciola hepatica in bovine and ovine naturally infected in the Andes of Ecuador.

Fasciola spp., infections are distributed worldwide including the Andes region of Ecuador, affecting cattle, sheep, porcine, humans, and other herbivores. Triclabendazole (TCBZ) is commonly used to treat animal infections. However, prospective studies on TCBZ efficacy and fascioliosis prevalence have not been studied in the highlands of Ecuador. This study was performed in a rural community at central of the Ecuadorian Andes in freely roaming bovine and ovine aimed to 1) evaluate the efficacy of TCBZ by administering a single oral dose of 12 mg/kg body weight, 2) assess the prevalence of F. hepatica infection and 3) to monitor re-infections for a follow-up period of five months. In total, 122, 86, 111, 110, 89, and 90 and 49, 34, 47, 28, 27, and 31 stool samples were collected each month from bovines and ovine, respectively. Besides, 32 stool samples from porcine were also collected at the beginning of the study. Stools were microscopically analyzed by formalin-ether concentration method to detect F. hepatica ova. The prevalence of F. hepatica infections before treatment was 55,7% and 63,3% for bovine and ovine, respectively. The infection prevalence was of 22% in porcine. The efficacity of triclabendazole was 83% and 97% in bovines and ovine, respectively, at 30 days post-treatment. The re-infection reaches to 54,4% in bovines and 61,3% in ovine after five months. TCBZ had a high efficacy and could be used for bovines and ovine Fasciola infections in the study region; however, re-infections reach the initial prevalence after five months. Therefore, we recommend integrated control strategies, including chemotherapy with a single oral dose of TCBZ, vector control, and future drug resistance studies.

Kappa: Preliminary Results on a Novel Technique for Pelvic Fixation in Adult Spinal Deformity Correction.

Study Design: Retrospective cohort study. Objectives: Pelvic fixation in degenerative spinal deformation is as crucial as demanding. Several pelvic anchoring technics have been described, but loosening rates remain high for most solutions. Here is described the "Kappa" technic, combining ilio-sacral screws to S2A1 screws at 2 years of follow-up. Methods: Thirteen patients that underwent a spinal deformity correction with "Kappa" fixation to the pelvis and with more than 2 years of follow-up were prospectively included in this study. The surgical technic is described, and clinical and radiographic data have been collected for all patients. Results: The population exhibited an important pre-operative sagittal imbalance (mean SVA of 104,4 mm, mean PI-LL mismatch of 22,8°) that had improved significatively after surgery (mean SVA of 75,5 mm and mean PI-LL mismatch of 4,9°). No loosening of pull-out of the implants was to deplore at 2 years of follow-up. Conclusions: The association of ilio-sacral screw, resistant to pull-out because of the traction axis perpendicular to the construct, to S2A1 screws, known to be effective in sagittal balance restoration seems to be an effective and safe option to pelvic fixation for adult spinal deformity correction. Level of Evidence: IV.

Gravedad de los pacientes ingresados por EPOC agudizada en el ensayo clínico SLICE / Severity of patients admitted for acute COPDin the SLICE clinical trial

Introducción: Hay poca información actualizada sobre las características clínicas y la gravedad de los pacientes con EPOC que ingresan por una agudización. Nuestro objetivo fue caracterizar a los pacientes que ingresan por agudización de EPOC según la limitación al flujo aéreo: obstrucción leve (Volumen Espiratorio Forzado en el primer segundo [VEF1] ≥ 80%); moderada (VEF1 50 - 79%); grave (VEF1 30 - 49%); o muy grave (VEF1 <3 0%).Métodos: Realizamos un análisis post-hoc del ensayo clínico multicéntrico SLICE (Significance of Pulmonary Embolism in COPD Exacerbations), que reclutó pacientes consecutivos con agudización de EPOC que requirieron ingreso en 18 hospitales españoles en el periodo comprendido entre septiembre de 2014 y julio de 2020.Resultados: Incluimos 737 pacientes, con una edad media (DE) de 70,2 ± 9,9 años, y un predominio de hombres (73,5%). La espirometría clasificó a los pacientes con obstrucción leve, moderada, grave o muy grave en el 8%, 31,5%, 45% y el 15,5%, respectivamente. Al comparar a los pacientes de acuerdo al grado de obstrucción, observamos que los pacientes con mayor obstrucción al flujo aéreo eran más jóvenes (leve: 71,7 ± 8,8, moderada: 72,4 ± 10, grave: 70,2 ± 9,8, muy grave: 66,6 ± 9,2; p < 0,001), presentaban más insuficiencia respiratoria crónica (37,3% vs. 30,2% vs. 44,9% vs. 64,3%; p < 0,001), presentaban más cianosis (5,8% vs. 5,9% vs. 8,5% vs. 15,3%; p < 0,001), presentaron mayor porcentaje de agudizaciones y estaban más taquicárdicos a su llegada al centro hospitalario (92 ± 16 latidos por minuto [lpm] vs. 94 ± 18 vs. 96 ± 18 lpm vs. 99 ± 18 lpm; p < 0,001). Además, la gasometría arterial al ingreso mostraba un pH menor y una pCO2 mayor cuanto más grave era la obstrucción al flujo aéreo (p < 0,001). Conclusión: La gravedad de la obstrucción al flujo aéreo se asocia con la forma de presentación y el resultado de la gasometría arterial del paciente con agudización de EPOC que requiere ingreso hospitalario. (AU)

Introduction: There is little up-to-date information on the clinical characteristics and severity of COPD patients admitted for an exacerbation. Our objective was to characterize patients admitted due to COPD exacerbation according to airflow limitation: mild obstruction (Forced Expiratory Volume in 1 second [FEV1] ≥ 80%); moderate (FEV1 50 - 79%); severe (FEV1 30 - 49%); or very severe (FEV1 <3 0%).Methods: We performed a post-hoc analysis of the multicenter clinical trial SLICE (Significance of Pulmonary Embolism in COPD Exacerbations), which recruited consecutive patients with COPD exacerbation who required admission to 18 Spanish hospitals in the period between September 2014 and July 2020.Results: We included 737 patients, with a mean (SD) age of 70.2 ± 9.9 years, and a predominance of men (73.5%). Spirometry classified patients with mild, moderate, severe, or very severe obstruction in 8%, 31.5%, 45%, and 15.5%, respectively. When comparing the patients according to the degree of obstruction, we observed that the patients with greater airflow obstruction were younger (mild: 71.7 ± 8.8, moderate: 72.4 ± 10, severe: 70.2 ± 9.8, very severe: 66.6 ± 9.2; p < 0.001), had more chronic respiratory failure (37.3% vs. 30.2% vs. 44.9% vs. 64.3%; p < 0.001), had more cyanosis (5.8% vs. 5.9% vs. 8.5% vs. 15.3%; p < 0.001), had a higher percentage of exacerbations and were more tachycardic on arrival at the center hospital (92 ± 16 beats per minute [bpm] vs. 94 ± 18 vs. 96 ± 18 bpm vs. 99 ± 18 bpm; p < 0.001). In addition, arterial blood gases on admission showed a lower pH and a higher pCO2 the more severe the airflow obstruction was (p < 0.001).Conclusion: The severity of the airflow obstruction is associated with the form of presentation and the result of the arterial blood gases of the patient with COPD exacerbation who requires hospital admission. (AU)

Melanoma nodular amelanótico: a propósito de un caso / Amelanotic nodular melanoma: a case report

RESUMEN Introducción: El melanoma es un tumor maligno de estirpe melanocítica que constituye el sexto cáncer más frecuente en la población general y tiene una alta capacidad para producir metástasis. Aproximadamente el 95% de los melanomas primarios pertenecen a cuatro tipos clínico-patológicos: extensivo superficial, nodular, lentigo maligno y lentiginoso acral. El 5% restante corresponde a variantes menos frecuentes entre las que se encuentra el melanoma amelanótico, que representa entre el 0.4-27.5% de los casos de este subgrupo. Objetivo: Presentar un caso de un melanoma amelanótico, como una variante que puede acompañar a cualquier otro tipo clínico de melanoma, en este caso a uno de tipo nodular,lesión que, debido a su disminución o ausencia de pigmento, puede conducir a errores diagnósticos que inciden en la demora en el tratamiento y reducen la sobrevida de los pacientes que lo padecen. Caso Clínico: Se presenta el caso de un paciente de sexo masculino de 75 años que acude por presentar una lesión tumoral exofítica en la frente, de aproximadamente un año de evolución. Al examen físico se observa la lesión tumoral cupuliforme, eritematosa y brillante, que bajo dermatoscopio de luz polarizada muestra un patrón vascular polimorfo a predominio de vasos lineales gruesos. Se plantean varios diagnósticos diferenciales entre los que se destacan: carcinoma basocelular, granuloma piógeno, linfoma y metástasis cutáneas; se realiza una toma de muestra para biopsia y técnicas de tinción con inmunohistoquímica, que confirman el diagnóstico de melanoma, se decide exéresis de la tumoración con márgenes y seguimiento multidisciplinario del caso. Conclusiones: Las variantes hipo/amelanóticas del melanoma son poco frecuentes y su diagnóstico presenta dificultades que suelen generar demoras que influyen en el tratamiento y pronóstico de la enfermedad. La dermatoscopía se presenta como una herramienta sumamente útil que puede aumentar la sospecha diagnóstica de estos tumores, aunque el estudio histopatológico continúa siendo el patrón de referencia para el diagnóstico, así como para el abordaje terapéutico y seguimiento ulteriores.

ABSTRACT Introduction: Melanoma is a malignant melanocytic tumor that constitutes the sixth most frequent cancer in the general population and has a high capacity to produce metastasis. Approximately 95% of primary melanomas belong to four clinicopathological types: extensive superficial, nodular, lentigo maligna, and acral lentiginous. The remaining 5% correspond to less frequent variants, among which is amelanotic melanoma, that represents between 0.4-27.5% of the cases in this subgroup. Objective: To present a case of an amelanotic melanoma, as a variant that can accompany any other clinical type of melanoma, in this case a nodular type, a lesion that, due to its decrease or absence of pigment, can lead to diagnostic errors that affect the delay in treatment and reduce the survival of patients who suffer from it. Clinical Case: The case of a 75-year-old male patient who presents with an exophytic tumor lesion on the forehead of approximately one year of evolution. Physical examination reveals a bright, erythematous, dome-shaped tumor which shows a polymorphous vascular pattern with a predominance of thick linear vessels under a polarized light dermatoscope. Several differential diagnoses are proposed, among which the following stand out: basal cell carcinoma, pyogenic granuloma, lymphoma, and skin metastases; a sample is taken for biopsy and staining techniques with immunohistochemistry, which confirm the diagnosis of melanoma, it is decided to excise the tumor with margins and multidisciplinary follow-up of the case. Conclusions: The hypo / amelanotic variants of melanoma are rare and their diagnosis presents difficulties that usually generate delays that influence the treatment and prognosis of the disease. Dermoscopy is presented as an extremely useful tool that can increase the diagnostic suspicion of these tumors, although the histopathological study continues being the gold standard for diagnosis, as well as for the therapeutic approach and subsequent follow-up.

Extraocular Muscle Enlargement in Growth Hormone-Secreting Pituitary Adenomas.

BACKGROUND AND PURPOSE: While Graves disease is the most common cause of extraocular muscle enlargement, case reports have also associated growth hormone-secretory pituitary adenomas with this same phenomenon. We investigated the prevalence and response to treatment of extraocular muscle enlargement in patients with growth hormone-secretory pituitary adenomas. MATERIALS AND METHODS: We retrospectively reviewed extraocular muscle sizes using MR imaging in patients with growth hormone-secretory pituitary adenomas who underwent a transsphenoidal surgical resection compared with a matched control group with nonsecretory pituitary adenomas. Descriptive and comparative statistics were used to evaluate patient characteristics and extraocular muscle sizes between the 2 groups. RESULTS: We identified 16 patients who presented with growth hormone-secreting pituitary adenomas and underwent transsphenoidal surgical resection from 2010 to 2019. The average diameter of the extraocular muscle at the time of diagnosis for the group with growth hormone-secretory pituitary adenomas was larger than that in the control group (4.7 versus 3.8 mm, P < .001). Nine patients achieved insulin-like growth factor 1 level normalization at a median of 11.5 months before their most recent MR imaging evaluation. The average size of the extraocular muscles of patients who achieved a normalized insulin-like growth factor 1 was smaller compared with those that did not (difference, 0.7 mm; 95% CI, 0.3-1.2 mm; P < .001), approaching the size of extraocular muscle in the control group. CONCLUSIONS: We describe a high prevalence of extraocular muscle enlargement in patients with growth hormone-secreting pituitary adenomas. Additionally, we note that the size of extraocular muscles decreased with associated improvement in the biochemical control of acromegaly.

A WC/WO star exploding within an expanding carbon-oxygen-neon nebula.

The final fate of massive stars, and the nature of the compact remnants they leave behind (black holes and neutron stars), are open questions in astrophysics. Many massive stars are stripped of their outer hydrogen envelopes as they evolve. Such Wolf-Rayet stars1 emit strong and rapidly expanding winds with speeds greater than 1,000 kilometres per second. A fraction of this population is also helium-depleted, with spectra dominated by highly ionized emission lines of carbon and oxygen (types WC/WO). Evidence indicates that the most commonly observed supernova explosions that lack hydrogen and helium (types Ib/Ic) cannot result from massive WC/WO stars2,3, leading some to suggest that most such stars collapse directly into black holes without a visible supernova explosion4. Here we report observations of SN 2019hgp, beginning about a day after the explosion. Its short rise time and rapid decline place it among an emerging population of rapidly evolving transients5-8. Spectroscopy reveals a rich set of emission lines indicating that the explosion occurred within a nebula composed of carbon, oxygen and neon. Narrow absorption features show that this material is expanding at high velocities (greater than 1,500 kilometres per second), requiring a compact progenitor. Our observations are consistent with an explosion of a massive WC/WO star, and suggest that massive Wolf-Rayet stars may be the progenitors of some rapidly evolving transients.

Significado pronóstico de las anormalidades pulmonares intersticiales / Prognostic significance of interstitial lung abnormalities

Se desconoce el significado pronóstico de las anormalidades pulmonares intersticiales (API) observadas en tomografíacomputarizadas realizadas a pacientes sin sospecha de enfermedad pulmonar intersticial. Por ello, presentamos una revisión de la literatura actual para estudiar su evolución y su manejo.(AU)

The prognostic significance of interstitial lung abnormalities (ILAs) observed on computed tomography performed in pa-tients without suspected interstitial lung disease is unknown. Therefore, we present a review of the current literature to study its evolution and management.(AU)

Uninformative and unuseful: why it is necessary to actively challenge COVID-19 antibody testing postvaccination.

OBJECTIVES: We aimed to assess the evidence on the usefulness of postvaccination testing of COVID-19 antibodies. STUDY DESIGN: We used a descriptive analytical approach. METHODS: We synthesized insights of studies on the immunological responses to SARS-CoV-2 after natural infection or vaccination and recommendations by regulatory institutions, such as the Food and Drug Administration and the Centers for Disease Control and Prevention in the United States. RESULTS: Based on the multiple humoral and cellular responses elicited by either the virus or the vaccines, the high variability of antibodies in blood, and the lack of correlation between the presence of antibodies and active cellular immunity against SARS-CoV-2, there has been explicit advice against assessing immunological status postvaccination. CONCLUSIONS: Postvaccination antibody testing is not warranted to assess immunity status for COVID-19. Patients may misinterpret results, leading to the spread of misinformation regarding vaccine efficacy or the need to continue self-protection or the protection of others. Therefore, public health authorities should actively challenge the promotion and commercialization of this type of tests.

Knowledge acquired from Clinical Guidelines on the Diagnosis and Treatment of Acute Pancreatitis by attending physicians and residents in hospitals in Veracruz. / Conocimiento de las Guías Clínicas de Diagnóstico y Tratamiento de la Pancreatitis Aguda en médicos adscritos y residentes de los hospitales de Veracruz.

INTRODUCTION: Clinical practice guidelines on the diagnosis and treatment of acute pancreatitis (CPGDTAP) have been designed in an effort to reduce the morbidity and mortality of that severe disease. AIM: To identify the knowledge acquired from CPGDTAP in hospitals in Veracruz. MATERIALS AND METHODS: A descriptive, observational, multicenter study was conducted at four hospitals in Veracruz, through the application of a survey to evaluate the knowledge of attending physicians and residents that treat patients with acute pancreatitis. Descriptive statistics were employed to analyze the results. RESULTS: A total of 74 physicians were surveyed: 55.41% of whom were attending physicians and 44.59% of whom were resident physicians. The majority of physicians (67.57%) were familiar with CPGDTAP from the Asociación Mexicana de Gastroenterología (AMG), followed by those of the General Health Council of the Mexican Department of Health (CENETEC, the Spanish acronym) (54.05%) and the American College of Gastroenterology (ACG) (48.65%). A total of 97.30% of the physicians routinely use a nasogastric tube, 79.73% considered early enteral nutrition to be very important, as did 98.65% regarding generous fluid replacement, 85.14% did not routinely use antimicrobials, 63.51% ordered a CAT scan at 72h or later, and 87.84% answered that infected necrosis was the indication for surgery, preferably after the third week. DISCUSSION AND CONCLUSIONS: In our hospital environment, the CPGDTAP issued by the AMG and CENETEC were the most well-known, but their recommended measures were given importance by under 85% of the physicians surveyed. Therefore, the diffusion of the knowledge they contain is advisable to guarantee optimal results in acute pancreatitis management.

Associations of changes in fat free mass with risk for type 2 diabetes: Hispanic Community Health Study/Study of Latinos.

AIMS: To determine whether loss of muscle mass (approximated using fat free mass [FFM]) is associated with risk for type 2 diabetes mellitus (T2DM) in Hispanic/Latino adults in the United States. METHODS: Participants were Hispanic/Latino adults (18-74-year-olds) who completed Visit 2 of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; multi-site, prospective cohort study; 6.1-year follow-up) and did not have T2DM at baseline (n = 6264). At baseline and Visit 2, FFM was measured using bioelectrical impedance analysis and fasting glucose, HbA1c, and fasting insulin were measured by examiners. Diabetes was defined according to American Diabetes Association criteria. Survey-weighted Poisson regression models examined the association of percent change in relative FFM (%ΔFFM) with incident prediabetes and T2DM. Survey-weighted multivariable regression models examined associations of %ΔFFM with changes in glucose and insulin measures. RESULTS: Relative FFM declined by 2.1% between visits. %ΔFFM was inversely associated with incident prediabetes (p-for-trend = 0.001) and with changes in glucose and insulin measures (p-for-trend <0.0001). Findings were null, except for HOMA-IR, after adjustment for changes in adiposity measures. Associations were generally stronger for individuals with baseline overweight/obesity. CONCLUSIONS: Reducing loss of FFM during adulthood may reduce prediabetes risk (primarily insulin resistance), particularly among individuals with overweight/obesity.

Family function and eating behaviours among Hispanic/Latino youth: results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth).

OBJECTIVE: To elucidate mechanisms across family function, home environment and eating behaviours within sociocultural context among Hispanic youth. DESIGN: Two models tested via path analysis (youth fruit and vegetable (FV) consumption; empty energy consumption) using data from the Study of Latino Youth (2011-2013). SETTING: Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA. PARTICIPANTS: Youth (8-16-year-olds), n 1466. RESULTS: Youth ate 2·4 servings of FV per d and received 27 % of total energy from empty energies. Perceiving higher acculturative stress was indirectly associated with lower FV consumption via a pathway of low family function and family support for FV (ß = -0·013, P < 0·001) and via lower family closeness and family support (ß = -0·004, P = 0·004). Being >12-year-olds was indirectly associated with lower FV consumption via lower family closeness and family support (ß = -0·006, P < 0·001). Household food security was indirectly associated with greater FV consumption via family closeness and family support (ß = 0·005, P = 0·003). In contrast, perceiving higher acculturative stress was indirectly associated with higher empty energy consumption (via family closeness and family support: ß = 0·003, P = 0·028 and via low family function and low family support: ß = 0·008, P = 0·05). Being older was associated with higher consumption of empty energies via family closeness (related to family support: ß = 0·04, P = 0·016; parenting strategies for eating: ß = 0·002, P = 0·049). CONCLUSIONS: Findings suggest pathways of influence across demographic and sociocultural context, family dynamics and home environment. The directionality of these associations needs confirmation using longitudinal data.

Experimental transmission of Caligus rogercresseyi between two different fish species.

Caligus rogercresseyi is the dominant sea louse parasite affecting the salmon and trout industry in southern Chile. This parasite has a wide range of native and endemic fish hosts. The Patagonian blenny Eleginops maclovinus, which is parasitized mostly by the caligid species Lepeophtheirus spp. and C. rogercresseyi, is presumably responsible for the transmission of C. rogercresseyi to salmonids. The aim of this study was to characterize the transmission of parasites between different fish species and parasite cohort development under laboratory conditions. Parasite abundances and intensities were quantified. Transmission of parasites from Patagonian blenny to Atlantic salmon Salmo salar was lower (~9%, mainly corresponding to C. rogercresseyi) than from salmon to Patagonian blenny (14.7-26.9%, where only C. rogercresseyi were observed). This suggests that the transmission of C. rogercresseyi from salmon individuals is higher than the transmission from a native fish. Parasite cohorts developed successfully on both fish species, but apparently under different developmental rates. Water temperature, oxygen, and juvenile abundances were the variables that better explained cohort development success and variation in C. rogercresseyi adult abundances over time.