Serum Procalcitonin (PCT) - Is there a Role as an Early Biomarker in Infected Diabetic Foot Ulcer (IDFU) Patients?

@#Introduction: Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU). Materials and method: This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and Creactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification. Results: The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL. Conclusion: PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.

Tratamiento de la tuberculosis drogorresistente en adultos y niños. Revisión narrativa / Treatment of drug-resistant tuberculosis in adults and children. A narrative review

Resumen Desde 2018 han surgido a la luz de la evidencia importantes cambios en el tratamiento de la tuberculosis drogorresistente. El descubrimiento de nuevas drogas antituberculosis, como la bedaquilina y los derivados de nitroimidazopiranos, así como la utilización de drogas repropuestas, llevó a la recomendación de organismos internacionales de nuevos esquemas de tratamiento de la tuberculosis monorresistente y multidro gorresistente que son totalmente orales y así dejan de lado el uso prolongado de inyectables, con su inherente toxicidad e incomodidad. Algunas de las definiciones de tuberculosis drogorresistente han cambiado. También está en revisión el tiempo de su tratamiento y con algunos nuevos esquemas en estudio, como el BpaL (bedaquilina, pretomanid y linezolid), se ha logrado una duración similar a la del tratamiento de la tuberculosis pansensible. En esta revisión bibliográfica narrativa describimos las nuevas definiciones, algunos aspectos diagnósticos básicos, los aspectos farmacológicos y la nueva clasificación de las drogas a utilizar en el tratamiento de la tuberculosis drogorresistente, así como los esquemas actualmente propuestos para tratarla, contextualizados con la realidad nacional. Finalizamos con una breve reseña de los estudios clínicos en curso de nuevos esquemas acortados de tratamiento.

Abstract Since 2018, important changes in the treatment of drug-resistant tuberculosis have been produced in the light of new evidence. The discovery of new anti-tuberculosis drugs, such as bedaquiline and nitroimidazopirane derivatives, as well as the use of repurposed drugs, led to international organizations to recommend new, totally oral, treatment regimens for mono-resistant and multidrug-resistant tuberculosis, leaving aside the prolonged use of injectables, with their inherent toxicity and discomfort. Some definitions of drug-resistant tuberculosis have changed. The duration of treatment is also under review, leading some new regimens under study, such as BPaL (bedaquiline, pretomanid and linezolid), to a duration similar to that for treating susceptible tuberculosis. In this narrative review, we describe the new definitions, some basic diagnostic aspects, the pharmacological aspects, and the new classification of drugs to be used in the treatment of drug-resistant tuberculosis as well as the cur rently proposed schemes to treat it available within the Argentinean context. Finally, we include a brief review of ongoing clinical trials on new shortened treatments.

Asma: uso adecuado de dispositivos para inhalación / Asthma: correct use of inhalation drug-delivery devices

Resumen La terapia inhalada se considera la piedra angular del manejo del asma. Sin embargo, a pesar de ser la forma ideal de administración de estos medicamentos, solamente el 70% de los pacientes cumple el tratamiento adecuadamente y sólo del 39 al 67% de los médicos conocen y pueden explicar de forma adecuada las distintas técnicas de inhalación. La terapia inhalada tiene características muy particulares. El depósito pulmonar de un medicamento inhalado a través del tracto respiratorio es más complejo que cuando se administra por vía oral, y varía dependiendo de varios factores, tanto inherentes al medicamento como a la forma de administrarlo. Para que la terapia inhalada sea exitosa, se requiere que se generen partículas del medicamento de un tamaño apropiado que penetren más allá de la orofaringe y la laringe, y que puedan depositarse en los pulmones. Existen múltiples dispositivos para la administración de medicamentos en la vía respiratoria baja. Cada uno ha probado tener una eficacia similar, siempre y cuando se utilicen con la técnica correcta. La decisión para su uso se realiza con base en la edad del paciente, la capacidad de coordinar entre la inhalación y la activación del dispositivo y la presencia de síntomas agudos. La elección del dispositivo a utilizar siempre deberá hacerse de forma conjunta, evaluando pros y contras de cada uno de los dispositivos y siempre de forma individualizada.

Abstract Inhaled therapy is considered the cornerstone of asthma treatment. However, despite being the ideal form of drug delivery, it is recognized that only 70% of patients have an adequate attachment to their treatment and only 39-67% of physicians can explain the optimal inhaler technique. Inhaled therapy has very specific characteristics. Pulmonary deposit of an inhaled medication through the respiratory tract is more complex than when administered orally and depends on several factors inherent to both the medication and the administration. For successful inhaled therapy, the drug needs to be converted into particles of an appropriate size, which can enter beyond the oropharynx and larynx, and be deposited in the lungs. There are multiple devices for the administration of drugs in the lower respiratory tract, each one with a similar efficacy as long as it is used with the correct technique. The decision of which device should be used is made based on the age of the patient, the ability to coordinate between the inhalation and activation of the device, and the presence of acute symptoms. The choice of the device must be evaluated individually.

Uso de álcool e tabaco por gestantes em maternidade do sul de Santa Catarina / Alcohol and tobacco use by pregnant women in a maternity from the south Santa Satarina

Objetivo: Estimar perfil epidemiológico do consumo de álcool e tabaco durante a gravidez entre mulheres atendidas em maternidade de Santa Catarina. Métodos: Entrevistaram-se 157 mulheres, foram coletados dados sócio-demográficos e gestacionais, bem como informações sobre uso de álcool (incluindo questionário T-ACE) e tabaco (incluindo Questionário de Tolerância de Fagerström-QTF). Empregaram-se os testes qui-quadrado de Pearson ou Fisher (quando pertinente) e U de Mann-Whitney com nível de significância 95%, seguido de análise multivariada através de regressão logística. Resultados: O consumo alcoólico foi 36,9%. Na avaliação do T-ACE 22,9% foram positivas. A prática religiosa foi fator protetor para o álcool, as demais variáveis não. Não associaram-se fatores com resultado T-ACE. O hábito tabagístico foi de 14% e no QTF, 41,1% apresentaram dependência leve, 29,4% moderada ou grave. Menor escolaridade e ausência de prática religiosa associaram-se ao tabagismo. Houve consumo simultâneo das duas drogas. Conclusões: O consumo de álcool e tabaco no período gestacional não se caracterizou como evento incomum neste estudo. Praticar religião foi fator protetor para consumo de ambos, porém o tabagismo também esteve relacionado a menor escolaridade. Havendo, portanto indicativo de disseminação do álcool de forma mais homogênea e democrática nas diferentes classes sociais.

Objective: Estimate the epidemic profile of the consumption of alcohol and tobacco during the pregnancy period among women assisted at a maternity in Santa Catarina. Methods: Social-demographic and pregnancy data were collected from 157 women , as well as information on use of alcohol (including questionnaire T-ACE) and tobacco (including Questionary of Tolerance of Fagerström-QTF). The tests Qui-square of Pearson or Fisher were used (as pertinent) and U of Mann-Whitney with significance level of 95%, following by multi-sorted analysis through the regression logistics. Results: The alcoholic consumption was 36,9%. In T-ACE the evaluation of 22,9% was positive. The religious practice went protecting factor to alcohol, the other variables not. They didn't associate factors with resulted T-ACE. The habit of tabagism was of 14% and in QTF, 41,1% demonstrated light dependence, 29,4% moderate or serious. Low education level and absence of religious practicing were associated to the tabagism. There was simultaneous consumption of the two drugs. Conclusions: The consumption of the alcohol and the tobacco in the pregnancy period was not characterized as uncommon event in this study. To have a religion went protecting factor to consumption of both, however the tabagism was also related to the lowest education, therefore being an indicative of spread of the alcohol in a more homogeneous and democratic way in the different social classes.

Approaching Long Term Cardiac Rhythm Monitoring Using Advanced Arm Worn Sensors and ECG Recovery Techniques.

According to recent British Heart Foundation statistics, one in six men and more than one in ten women die from coronary heart disease (CHD) in the UK. This equates to almost 74,000 deaths per annum from CHD alone. More worryingly, every week, 12 apparently fit and healthy young people aged 35 and under, die from undiagnosed cardiac conditions. In both circumstances, monitoring is preformed only when triggered by an event. Unfortunately, this may be too late in the large majority of cases. For instance, there is evidence suggesting that most indiscernible cardiac abnormalities are made detectable by ECG through the act of suddenly standing upright. This infers that the condition would be detectable during the course of everyday ambulatory activity and highlights the need for a long term monitoring device. Current diagnostic equipment consists of the Holter monitor for extended periods up to 36 hours and the implantable loop recorder (ILR) for monitoring up to 3 years. The diagnostic yield of the ECG monitoring strategy is greatly increased as the monitoring period increases. Therefore, for subjects that exhibit symptoms of cardiac involvement that are transient in nature, the ILR offers the best opportunity for diagnosis. However, the ILR is inserted under the surface of the skin in the upper chest area and requires a surgical procedure, with associated risks, which makes ILR’s a costly and inconvenient option in many cases. The need for a non-invasive long term monitoring device, which is comfortable to wear along the arm and able to provide reliable ECG monitoring, has been addressed by many, in several lines of approach to a solution. This review details the current state of the art and any pending limitations. It then presents key multidisciplinary solutions on the different aspects of the problem, which will still require integration in order to realise such a device.

Molecular characterization of severe and mild cases of influenza A (H1N1) 2009 strain from Argentina / Caracterización molecular de cepas de influenza A (H1N1) 2009 de casos leves y graves de la Argentina

While worldwide pandemic influenza A(H1N1) pdm case fatality rate (CFR) was 0.4%, Argentina's was 4.5%. A total of 34 strains from mild and severe cases were analyzed. A full genome sequencing was carried out on 26 of these, and a partial sequencing on the remaining eight. We observed no evidence that the high CFR can be attributed to direct virus changes. No evidence of re-assortment, mutations associated with resistance to antiviral drugs, or genetic drift that might contribute to virulence was observed. Although the mutation D225G associated with severity in the latest reports from the Ukraine and Norway is not observed among the Argentine strains, an amino acid change in the area (S206T) surrounding the HA receptor binding domain was observed, the same previously established worldwide.

Mientras que la tasa de letalidad (CFR) para (H1N1)pdm en todo el mundo era del 0.4%, en la Argentina la mortalidad observada fue de 4.5%. La secuenciación del genoma completo de 26 cepas de virus argentinos de influenza A (H1N1)pdm de casos leves y graves y de 8 cepas secuenciadas parcialmente no mostró evidencia de que la elevada tasa de letalidad se pueda atribuir directamente a cambios en el virus. No se encontraron hallazgos de recombinación, de mutaciones asociadas con la resistencia a los medicamentos antivirales ni de variaciones genéticas que puedan contribuir a la virulencia observada. Si bien la mutación D225G asociada con la gravedad, comunicada en informes procedentes de Ucrania y Noruega, no se ha encontrado en las cepas argentinas estudiadas, se ha observado un cambio aminoacídico en la región (S206T) en torno al dominio del sitio de unión al receptor en la HA, el mismo hallado en cepas distribuidas alrededor del mundo.

Síndrome de activación macrofágica en enfermedad de Still del adulto / Adult-Onset Still's disease and macrophage activation syndrome

Se presenta un paciente de 27 años, portadora de enfermedad de Still del adulto, que desarrolló un síndrome de activación macrofágica de evolución fatal. Se revisan ambos cuadros, las manifestaciones clínicas y los resultados de los estudios complementarios

Cáncer de laringe en pacientes menores de 40 años / Laryngeal cancer in patients younger than 40 years

Objetivo: describir los datos demográficos de pacientes < 40 años de edad con diagnóstico de cáncer de laringe, y los resultados obtenidos después del tratamiento. Material y métodos: se revisaron los expedientes en forma retrolectiva, de una base de datos de 500 pacientes con cáncer de laringe atendidos entre 1989 y 2004; se incluyeron los pacientes < 40 años de edad al momento del diagnóstico, en quienes se corroboró el diagnóstico de carcinoma epidermoide. Resultados: fueron encontrados 15 pacientes (4.4 % de esta serie): nueve hombres (60 %) y seis mujeres (40 %), con una relación de 1.5:1, respectivamente. El promedio de edad para el grupo fue de 35 años. El tiempo promedio de evolución a la fecha del diagnóstico fue de 14.4 meses. El tabaquismo estuvo presente en 60 % y el alcoholismo en 40 %; la disfonía fue el síntoma cardinal en 87 %. La localización más frecuente fue la glotis (73 %). Los tumores bien diferenciados representaron 53 %. El tratamiento inicial fue cirugía en cuatro (27 %) pacientes y radioterapia en cinco (33 %), con un promedio de 63.44 Gy; un paciente (7 %) fue tratado con quimiorradioterapia concomitante con gemcitabine, cuatro (27 %) con quimioterapia neoadyuvante seguida de radioterapia, y un paciente no recibió tratamiento. El tiempo promedio de recurrencia después del primer tratamiento fue de 19.57 meses; cuatro pacientes fueron catalogados con persistencia. El tiempo promedio de supervivencia fue de 32 meses. La preservación de órgano al final fue de 28.5 %. Conclusiones: el cáncer epidermoide de laringe fue una patología rara en los pacientes < 40 años revisados. La relación de acuerdo con el sexo fue similar, con ligero predominio del masculino. Los factores de riesgo clásicos estuvieron presentes en 60 %. El pronóstico de los pacientes en esta serie estuvo determinado por el estadio clínico inicial.

BACKGROUND: We undertook this study to report demographic data of laryngeal cancer patients <40 years old and treatment results. METHODS: In a retrolective study we reviewed the clinical records of 500 patients with laryngeal cancer in the period from 1989 to 2004 and included those patients<40 years of age. RESULTS: We found 15 patients, representing 4.4% of the series. Nine (60%) were men and six (40%) were women, with a 1.5:1 ratio. Average group age was 35 years (range 21-40 and median of 37 months). Average time of evolution at the time of diagnosis was 14.4 months (range 0-36 and median of 12 months); 60% of the patients were smokers and 40% admitted to drinking alcohol; dysphonia was the main symptom found in 87% of the patients. The most frequent location was the glottis in 11 (73%) patients. Well-differentiated tumors represented 53% of the cases. Initial treatment was surgery in four (27%) patients; radiotherapy in five (33%) patients receiving an average of 63.44 Gy; concomitant chemoradiotherapy in one patient (7%) using gemcitabine; four (27%) patients were treated with neoadjuvant chemotherapy followed by radiotherapy; and one patient did not receive treatment. The average time in which the patients relapsed after the first treatment was 19.57 months (range 2-63) and four were classified as persistent. Survival time was 32 months (range 2-106 and median 27 months). Finally, organ preservation rate was obtained in 28.5%. CONCLUSIONS: Squamous cell carcinoma of the larynx is rare in patients<40 years old in our study. Gender relation seems to be equal, although a slight predominance of men does still exist. Classical risk factors were present in 60% of the cases. Prognosis for these patients was determined by the initial clinical stage.

Diagnóstico por imágenes en la fasciolosis hepática / Diagnostic imaging in liver fluke infection

La fasciolosis es una parasitosis hepática zoonótica. La enfermedad en los seres humanos transcurre en tres períodos: agudo o invasivo, latente y crónico u obstructivo. En la mayoría de los casos, el diagnóstico de fasciolosis es difícil por la sitomatología inespecífica y la eliminación intermitente de huevos del parásito con las heces. Los hallazgos radiológicos, las alteraciones bioquímicas y, en especial, la serología por el método de ELISA, contribuyen al diagnóstico, tanto en la etapa aguda como en la crónica. La tríada de fiebre prolongada, dolor en hipocondrio derecho y eosinofilia persistente, deben hacer sospechar la enfermedad. Se presenta el caso de un paciente con diagnóstico de fasciolosis hepática, haciendo especial mención de los hallazgos radiológicos (ecografía y tomografía computada). La paciente fue tratada con una dosis única de triclabendazol, con excelente respuesta clínica.

Maximizing profit and productivity at a multi-specialty private hopital using linear programming

Managers of health care organizations make financial decisions on a regular basis. An element of uncertainty exists in making budgetary decisions. Managers use mathematical models on financial information to minimize the uncertainty in forecasting future costs or profits. Linear programming with the aid of computer software package, is one such mathematical modeling technique that can be used by hospital managers to predict the behavior of financial variables. This paper demonstrates how Barnes hospital in Saint Louis Missouri, used linear programming to make budgetary allocation and maximize profit. 26 financial variables and 64 constraints were plugged in the linear equation, for a total budget amount of $28 million. Given the various limitations specified by the management, the mathematical equation of linear programming, after 76 iterations, yielded a maximum profit of $4.8 million for the Barnes hospital. Linear programming also suggested budgetary allocations for each of the 26 hospital departments and surgical procedures included in the model. Linear programming is a tool that hospital managers can use to help them in making financial decisions that may require complex calculations. As long as the managers understand the limitations and preferences of the hospital and can plant those as relationships in the linear programming equation, then they can make good use of this modeling technique in financial management

Infección recurrente por Staphylococcus aureus meticilino sensible en un paciente con marcapaso cardíaco definitivo (MCD) y obstrucción de la vena cava superior (VCS) / Relapsing infection by Staphylococcus aureus meticilino sensitive in a patient with the definitive cardiac pacemaker (DCP) and the obstruction of the superior vena cava

La infección es una complicación de frecuencia variable en pacientes con MCD, determinante del recambio del sitio del bolsillo y del catéter. Este, en oportunidades, no logra extraerse, empobreciendo el pronóstico. La obstrucción de la VCS limita la remoción de los mismos. El tratamiento antibiótico crónico controla la progresión de la infección

Biochemistry of the evolution of Triatoma infestans: XII. Biosynthesis and secretion of a Very High Density Lipoprotein

Biosynthetic processes related to the production of an insect hexamerin, very high density lipoprotein (VHDL), have been examined in the fat body of fifth-instar nymph and adult Triatoma infestans. Fat bodies were incubated in vitro with [3H] leucine and the incubation media were precipitated using a specific antiserum. The SDS-polyacrylamide gel electrophoresis followed by blotting on nitrocellulose showed that both larval and adult fat body secreted the VHDL subunit. Moreover, the radiolabel recovered in this subunit is indicative of the de novo synthesis. When the incubation medium was subjected to density gradient ultracentrifugation, a radiolabeled fraction was found at density 1.27 g/ml, value identical to the hemolymph circulating VHDL, indicating that the secreted apoprotein is combined with lipids. The SDS-polyacrylamide gel electrophoresis and immunoblotting of this fraction corroborated the presence of the VHDL-apoprotein. These results demonstrate that the fat body of T. infestans is able to synthesize the protein subunit which is associated to lipids as a lipoprotein particle that is released into the medium as VHDL.

Biochemistry of the evolution of Triatoma infestans: XI. Hemolymph lipophorin

Se aisló y purificó la lipoforina del T.infestans a partir de hemolinfa de machos adultos por ultracentrifugación en gradiente de densidad en dos etapas. Esta lipoproteína tiene una densidad de 1.10 g/ml y está constituida por 53% de proteínas y 47% de lípidos. El radio de Stokes (Rs) de la molécula, determinado por cromatografía de filtración en gel, es aproximadamente de 73A y e;l peso molecular (Mr) calculado por el método de Margolis, es de 743 000 daltons. La lipoforina contiene dos apoproteínas: apolipoforina I (apoLp-I) con Mr = 255 000 y apolipoforina II (apoLp-II) con Mr = 78 000, siendo ambas glicosiladas. La composición de aminoácidos de la apoLp-I y de la apoLp-II presenta un elevado contenido de aspartato, glutamato y leucina y muy pequeña cantidad de metionina y cisteína. Los lípidos de la lipoforina comprenden: diacilgliceroles (41.4% de los lípidos totales), fosfolípidos (31.5%), hidrocarburos (12.2%), ácidos grasos libres (6.1%), colesterol (4.7%) y triacilgliceroles (4.1%). La fosfatidiletanolamina es el fosfolípido predominante con cantidades menores de fosfatidilcolina. Al tratar la lipoforina con tripsina, la apoLp-I sufre ruptura proteolítica, mientras que la apoLp-II es resistente. La anisotropía de fluorescencia del difenilhexatrieno (DPH) incluido en la lipoforina señala una fuerte interacción lípido-apoproteína, la cual no se modifica después de una extensa proteólisis de la apoLp-I con tripsina. Durante la tripsinización de la lipoproteína no se detectó...