When is Sentinel Lymph Node Biopsy Useful in Ductal Carcinoma In Situ? The Experience at a Latin American Cancer Center.

Introduction Ductal carcinoma in situ (DCIS) accounts for 15% of breast cancers. Surgery is the main treatment, and the use of sentinel node biopsy (SLNB) is restricted to patients at risk of infiltration, which is estimated to be around 26%. Materials and methods Aimed at evaluating the benefit of SLNB in patients with DCIS at the Breast and Soft Tissue Functional Unit of the National Cancer Institute (INC for its initials in Spanish), a descriptive observational study of a retrospective cases series was conducted between August 1, 2013, and September 30, 2018. Results A total of 40 patients with a median age of 57 years were included in the study; 62.5% of them underwent mastectomy with SLNB, and the remaining 37.5% underwent conservative surgery with SLNB. 100% of sentinel nodes were identified, by using lymphoscintigraphy in 95%. Sentinel node was positive in four patients (10%), three of whom had infiltration in the surgical specimen reported. With a follow-up of 49 months, only one patient had a local relapse. None of the patients had axillary or distant recurrence. Conclusions SLNB in DCIS should be limited to patients with risk factors for infiltration (tumor size greater than 3 cm, comedo-type histology, and high-grade DCIS), and patients with an indication for mastectomy. Its percentage of complications is low, and a high identification percentage in surgical groups with adequate training.

Electrocardiograma en pacientes con SARS-CoV-2: guía rápida para interpretación / Electrocardiogram in patients with SARS-CoV-2: quick guide for interpretation

Conscientes de la emergencia sanitaria mundial desencadenada por el COVID-19 y la imperiosa necesidad de tomar decisiones tanto tempranas como efectivas, nuestro grupo desarrolló esta guía dirigida a la interpretación rápida y enfocada del electrocardiograma convencional de 12 derivaciones en pacientes con infección por SARS-CoV-2 en quienes se plantea inicio de tratamiento farmacológico. Dadas las alternativas terapéuticas que se están implementando de manera precoz para tener un impacto en la sobrevida de los pacientes, es imperioso limitar el número de efectos adversos que se pueden desencadenar en el desarrollo del tratamiento intrahospitalario como ambulatorio. Somos a su vez conscientes de que la coyuntura actual demanda toma de decisiones costo-efectivas y ágiles en el menor tiempo posible. Por lo anterior, gestamos esta guía rápida para facilitarle al personal médico involucrado en el manejo de estos pacientes (internistas, cardiólogos, intensivistas, infectologos, etc.) la interpretación y valoración de los tópicos más relevantes en electrocardiografía para limitar el número de posibles complicaciones en sus pacientes. El objetivo de dicha guía es acortar tiempos de atención, inicio temprano de terapia farmacológica basado en su juicio clínico y limitar al máximo posibles complicaciones y/o efectos adversos que retrasen el punto crítico terapéutico infeccioso. Esperamos facilitar a ustedes y su grupo de trabajo la toma de decisiones, basado en el uso costo-efectivo del electrocardiograma. No obstante, es importante recordar que toda decisión médica es un ejercicio riguroso, científico e integral basado en cada caso en particular. El electrocardiograma la ayudará a reforzar sus decisiones, así como a seguir a los pacientes que puedan presentar posibles complicaciones. Lo invitamos a que guarde esta guía rápida en sus dispositivos digitales y en cada momento que considere inicio de terapia farmacológica valore lo que en ella se indica.

Possible mechanisms for brain natriuretic peptide resistance in heart failure with a focus on interspecies differences and canine BNP biology.

B-type natriuretic peptide or brain natriuretic peptide (BNP) is a cardiac peptide hormone. The principal stimulus for BNP synthesis is myocyte stretch. BNP binds to the natriuretic peptide receptor-A causing increased intracellular cyclic guanosine monophosphate (cGMP) production and shows cardio- and renoprotective effects. However, high endogenous BNP levels are associated with a lack of effect in severe heart failure. Moreover, in experimental heart failure, the response to treatments targeting the natriuretic peptide system is attenuated. This article reviews potential mechanisms that may explain the 'BNP paradox' in heart failure with a focus on interspecies differences, on known and presumed specificities of canine BNP biology, and on experimental studies in dogs. Resistance to BNP is far from fully understood but may be due to post-translational modifications and alteration in proBNP processing, receptor downregulation and desensitization, blunted intracellular signalling and increased clearance of BNP(1-32.) Alternatively, resistance to BNP may be due to BNP(1-32) shortening into additional truncated forms that are less biologically effective. Future improvement in understanding of BNP biology may provide the rationale for innovative therapeutic strategies to maximize cardiovascular and renal cGMP bioavailability.

Method comparison of dipeptidyl peptidase IV activity assays and their application in biological samples containing reversible inhibitors.

BACKGROUND: Dipeptidyl peptidase IV (DPPIV, DPP4) is a serine protease that releases N-terminal dipeptides. It is a validated drug target for type 2 diabetes and DPPIV inhibitors are currently evaluated for other therapeutic applications. Various assays are used for DPPIV activity measurements in biological samples. Highly sensitive methods are needed to measure also very low activities in inhibited samples. METHODS: Here, the three most extensively used substrates to quantify DPPIV activity are compared using in-house methods. A luminescent kit was also included. In addition, one of the in-house fluorometric assays was elaborated for use in biological samples containing reversible DPPIV inhibitors to estimate residual DPPIV activity which is usually underestimated due to sample dilution. RESULTS: The in-house methods showed a good precision, linearity and specificity. Both fluorometric substrates had a 10-fold higher sensitivity compared to the colorimetric assay. The luminescent kit was found to be the most sensitive. CONCLUSIONS: All three in-house methods can be used to measure DPPIV activity in non-inhibited biological samples. The more sensitive fluorometric assays are recommended when sample volumes are limited or when using inhibited samples. The elaborated fluorometric method can be used to estimate the residual in vivo DPPIV activity in inhibitor treated subjects.

Dipeptidyl peptidase IV inhibition improves cardiorenal function in overpacing-induced heart failure.

AIMS: Recent studies indicate that brain natriuretic peptide (BNP(1-32)) may be truncated into BNP(3-32) by dipeptidyl peptidase IV (DPP4) and that BNP(3-32) has reduced biological activities compared with BNP(1-32). We investigated if DPP4 contributes to the cardiorenal alterations and to the attenuated response to BNP seen in heart failure. METHODS AND RESULTS: Haemodynamic and renal assessment was performed in 12 pigs at baseline, 4 weeks after pacing-induced heart failure, and during BNP infusion. They were randomized to either placebo or treatment with a DPP4 inhibitor, sitagliptin. After 4 weeks of pacing, heart rate was reduced compared with baseline in the sitagliptin group (60 ± 2 vs. 95 ± 16 b.p.m., P < 0.01), and an increase in stroke volume was observed in the sitagliptin group compared with placebo (+24 ± 6% vs. -17 ± 7%, P < 0.01). Glomerular filtration rate declined at week 4 compared with baseline in the placebo group (1.3 ± 0.4 vs. 2.3 ± 0.3 mL/kg/min, P < 0.01) but remained preserved in the sitagliptin group [1.8 ± 0.2 vs. 2.0 ± 0.3 mL/kg/min, P = NS (non-significant)]. In the sitagliptin group, BNP infusion improved end-systolic elastance (68 ± 5 vs. 31 ± 4 mmHg/kg/mL, P < 0.05), ventricular-arterial coupling, and mechanical efficiency. Compared with controls (n = 6), myocardial gene expression of BNP, interleukin-6, Na(+)-Ca(2+) exchanger, and calmodulin was up-regulated in the placebo group, but not in the sitagliptin group. CONCLUSION: In pacing-induced heart failure, DPP4 inhibition preserves the glomerular filtration rate, modulates stroke volume and heart rate, and potentiates the positive inotropic effect of exogenous BNP at no energy expense.

Caracterización etiológica y de sensibilidad a antimicrobianos en pacientes pediátricos con infección urinaria adquirida en la comunidad: Fundación Clínica Noel, Medellín, 2009 / Aetiological characterization and antibiotic sensitivity patterns in paediatric patients with community-acquired urinary tract infection: Fundación Clínica Noel, Medellín, 2009

Antecedentes: La infección del tracto urinario (ITU) es una patología sumamente importante en la práctica diaria del pediatra y del médico general que atiende niños. Regularmente en su manejo se requiere la aplicación empírica de un antibiótico 48 a 72 horas antes de contar el patrón de sensibilidad antimicrobiana de la bacteria implica-da. Así, es importante que el médico conozca la sensibilidad antimicrobiana de las cepas circundantes para administrar los medicamentos que maximicen el éxito en la atención de los pacientes. Metodología: Estudio descriptivo retrospectivo, a partir de registros de exámenes de orina y urocultivos realizados en el laboratorio clínico de la Fundación Clínica Noel, Medellín, para identificar los niños y niñas con ITU. Luego se analizó la información concerniente a patrones etiológicos y de sensibilidad antimicrobiana. Resultados: El microorganismo preponderante fue Escherichia coli (72.5% de los casos); otros agentes encontrados fueron Proteus mirabilis, Klebsiella pneumoniae y Enterococcus faecalis. Los medicamentos con mayor sensibilidad fueron ceftriaxona, gentamicina y amikacina. Conclusiones: Parece razonable que el manejo empírico de la ITU no complicada en los pacientes pediátricos sea con gentamicina, excepto en los lactantes, en los cuales podría usarse ésta o amikacina indistintamente. La ceftriaxona debería ser guardada para casos complicados o por cepas resistentes.

Background: Urinary tract infections (UTI) are a quite important disease process for paediatricians and for general physicians who attend children. On most cases, managing these infections includes prescribing an antibiotic agent 48 to 72 hours prior to having a urine culture result with antibiotic sensibility patters for the said strain. Therefore, it is of paramount importance for the physician to be aware of the general antibiotic resistance patterns of the strains most prevalent in his or her working place. Methods: This is a retrospective, descriptive study in which the institution's databases were reviewed in search for information concerning urine tests and cultures performed at the laboratory. The information was the processed and analysed focusing on information regarding aetiology and antibiotic sensitivity patterns. Results: The most common aetiologic agent was Escherichia coli (72.5%), followed by Proteus mirabilis, Klebsiella pneumonia and Enterococcus faecalis. Those antibiotics with greatest sensitivity rates were ceftriaxo-ne, gentamicin, and amikacin. Conclusions: It seems reasonable that empirical treatment for uncomplicated UTI in paediatric population should be started with gentamicin, except in those children under two years of age, in with both gentamicin and amikacin could be used without difference. Ceftriaxone should be saved for complicated or resistant strains.

Assessment of psychological functioning in adolescent earthquake victims in Colombia using the MMPI-A.

The earthquake that hit Armenia, Colombia, on January 25, 1999, dramatically impacted the lives of thousands of people, including children and adolescents. This study used the Hispanic MMPI-A to clinically assess for ongoing psychopathology in a group of 59 adolescent earthquake victims. Their scores on the basic, content, and supplementary scales of the instrument were compared to those of a control group of 62 Colombian adolescents with similar socioeconomic, educational, and ethnic backgrounds. The results showed no clinically significant elevations for the earthquake victims indicating that the disaster had not resulted in diagnosable psychopathology. When compared to controls, earthquake victims showed significant elevations on D, Pt, and Sc indicating that they were mildly affected (but within the normal range) by the earthquake. The results are discussed in the context of cultural factors and the contemporary disaster and resiliency literature.

The Hispanic MMPI-A across five countries.

The Hispanic MMPI-A was developed for use with Spanish-speaking adolescents living in the United States. In order to sample its potential usefulness in other countries, the test was administered to 385 Spanish-speaking adolescents in Colombia, Mexico, Peru, Spain, and the United States. The results showed a high degree of similarity across the five countries on the basic content and supplementary scales. Most scales were within 1/2 standard deviation of the U.S. Hispanic mean, and no scale elevations were greater than T = 65. Slight differences (T = 55-60) were obtained on scale F for males and scales F, Hs, Mf (Peru and Colombia), Pa, and Sc for females. This study would suggest that the Hispanic MMPI-A, with its established norms, is appropriate for adaptation in Spanish-speaking countries other than the United States. Further studies with the Hispanic MMPI-A are recommended to determine its effectiveness in clinical assessment in Spanish-speaking countries.

Ecografía transvaginal en el primer trimestre del embarazo / Transvaginal echography in the pregnancy firsth trimestre

Se realizó un estudio prospectivo con ecografía transvaginal en 150 embarazadas con menos de 13 semanas, utilizando frecuencias obsolutas y relativas para el análisis estadístico. El 68,69 por ciento de la población tenía 6-9 semanas de gestación. El motivo de consulta más frecuente fué el control prenatal (83,33 por ciento). Se logró identificar 27,28 por ciento de patologías, siendo el HMR lo más frecuente (9,33 por ciento). De 24 casos con actividad cardíaca negativa por ecosonograma transabdominal, en el 79,16 por ciento fué positiva con el transvaginal. así mismo, de 15 pacientes con embrión no transvaginal. La ecosonografía transvaginal es un método complementario útil en el diagnóstico y evaluación precoz del embarazo y sus complicaciones