Prevalencia de hipertirotropinemia neonatal comoindicador de deficiencia de yodo en la provincia de La Pampa: un análisis epidemiológico / Prevalence of high neonatal thyroid stimulating hormone levels as an indicator of iodine deficiency in the province of La Pampa: An epidemiological analysis

Introducción. El yodo desempeña un rol fundamental en el metabolismo, el crecimiento y el desarrollo humano. Durante el embarazo y la infancia, la demanda de este micronutriente aumenta considerablemente. La tirotropinemia neonatal (TSHn) aumentada, definida como TSHn ≥5 mUI/l, es un marcador que señala la deficiencia de yodo en una población cuando su prevalencia supera el 3 %. Objetivo. Determinar la prevalencia de TSHn ≥ 5 en La Pampa durante el período 2021-2022, analizar su correlación con diferentes variables y compararla con datos de una cohorte histórica. Población y métodos. Estudio transversal, de diseño descriptivo-analítico, sobre una población de neonatos nacidos en las cinco zonas sanitarias de la provincia de La Pampa durante los años 2021 y 2022. Resultados. De los 5778 neonatos evaluados, el 9,6 % presentó niveles de TSHn ≥5 mUI/l. El 70,4 % de estas mediciones fueron realizadas después del tercer día de vida. No se observaron diferencias significativas en la frecuencia de niveles elevados de TSHn según el año de nacimiento, peso al nacer o días hasta la extracción. Se registró una mayor prevalencia en el sexo masculino (10,6 % versus 8,5 %; p = 0,007) y entre los neonatos nacidos a término (9,8 % versus 6,6 %; p = 0,02). La prevalencia de hipertirotropinemia fue superior a la observada en una cohorte de 2001-2002. Conclusiones. La prevalencia de hipertirotropinemia neonatal en La Pampa durante los años 2021 y 2022 fue del 9,6 %, lo que indica un estado de deficiencia leve de yodo en la provincia, superior al reportado hace dos décadas.

Introduction. Iodine plays a key role in human metabolism, growth, and development. During pregnancy and childhood, the demand for this micronutrient increases notably. Increased neonatal thyroid stimulating hormone (nTSH) levels, defined as nTSH ≥ 5 mIUL, are a marker of iodine deficiency in a population if its prevalence is higher than 3%.Objective. To establish the prevalence of nTSH ≥ 5 in La Pampa in the 2021­2022 period, analyze its correlation with different variables, and compare it with data from a historical cohort.Population and methods. Cross-sectional, descriptive-analytical study in a population of newborn infants born in the 5 health regions of the province of La Pampa in 2021 and 2022. Results. Of  the  5778  assessed  newborn  infants,  9.6%  had  nTSH  levels  ≥  5  mIU/L. It was reported that 70.4% of these measurements were done after the third day of life. No significant differences were observed in the frequency of high nTSH levels by year of birth, birth weight, or days until samplecollection.A higher prevalence was observed among male infants (10.6% versus 8.5%; p = 0.007) and term infants (9.8% versus 6.6%; p = 0.02). The prevalence of high TSH levels was superior to that observed in the 2001­2002 cohort. Conclusions. The  prevalence of high nTSH levels in La Pampa during 2021 and 2022 was 9.6%, suggesting the presence of mild iodine deficiency in the population of this province, higher that what  had been reported 2 decades ago.

Efectos histológicos hepático y renal relacionados con la hiperglicemia producida por el extracto de Angostura trifoliata (Willd) T.S. Elías. Rutaceae / Hepatic and renal histological effects related to hyperglycemia produced by the extract of Angostura trifoliata (Willd) T.S. Elías. Rutaceae

Angostura trifoliata (Willd) T.S. Elías (Rutaceae) es una planta, cuya corteza es empleada en Venezuela para el tratamiento de la diabetes mellitus, la malaria y la disminución de peso. Sin embargo, se ha demostrado que altas dosis de su extracto administrados en forma aguda producen hiperglicemia y alteraciones neurológicas. El objetivo de este estudio fue correlacionar los efectos histológicos a nivel hepático y renal en ratones sanos con la hiperglicemia aguda producida por el extracto de la corteza de esta planta. Métodos: Se realizó un estudio experimental in vivo utilizando el extracto diluido en agua y administrado vía ip a dosis de 452 y 700 mg/kg; se determinó la glicemia utilizando un glucómetro comercial; los efectos histológicos con hematoxilina eosina previa fijación de los órganos con formaldehído al 10%. En todos los casos, se comparó con el grupo control. Resultados: el extracto produjo hiperglicemia significativamente P<0,05. En el tejido hepático causó: pérdida parcial de su arquitectura, binucleación, vasos congestivos con elementos inflamatorios, núcleos hipercromáticos, espacios de Disse dilatados con hematíes y áreas de necrosis. En el riñón originó congestión vascular en los tubos contorneados proximales y distales, concomitante con ruptura y necrosis de la membrana basal. Conclusión: el extracto produce toxicidad hepática y renal que se correlacionan con hiperglicemia, por lo que podría ser considerado como un agente hepatotóxico y nefrotóxico. (AU)

Angostura trifoliata (Willd) T.S. Elías (Rutaceae) is a plant, whose bark is used in Venezuela for the treatment of diabetes mellitus, malaria and weight loss. However, it has been shown that high doses of its extract administered acutely produce hyperglycemia and neurological alterations. The objective of this study was to correlate the histological effects at the liver and kidney level in healthy mice with the acute hyperglycemia produced by the bark extract of this plant. Methods: An in vivo experimental study was carried out using the extract diluted in water and administered ip at doses of 452 and 700 mg/kg; blood glucose was determined using a commercial glucometer; the histological effects with hematoxylin eosin after fixation of the organs with 10% formaldehyde. In all cases, it was compared with the control group. Results: the extract produced hyperglycemia significantly P<0.05. In the liver tissue it caused: partial loss of its architecture, binucleation, congested vessels with inflammatory elements, hyperchromatic nuclei, dilated spaces of Disse with red blood cells and areas of necrosis. In the kidney, it caused vascular congestion in the proximal and distal convoluted tubes, concomitant with rupture and necrosis of the basement membrane. Conclusion: the extract produces liver and kidney toxicity that correlates with hyperglycemia, so it could be considered a hepatotoxic and nephrotoxic agent. (AU)

Association of IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with COPD: a cross-sectional study / Asociación de los genotipos de IGF-1 e IGF-2 con la fuerza muscular respiratoria en individuos con EPOC: estudio transversal

INTRODUCTION: Chronic obstructive pulmonary disease is a systemic disease characterized not only by respiratory symptoms but also by physical deconditioning and muscle weakness. One prominent manifestation of this disease is the decline in respiratory muscle strength. Previous studies have linked the genotypes of insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) to muscle weakness in other populations without this disease. However, there is a notable knowledge gap regarding the biological mechanisms underlying respiratory muscle weakness, particularly the role of IGF-1 and IGF-2 genotypes in this pulmonary disease. Therefore, this study aimed to investigate, for the first time, the association between IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with chronic obstructive pulmonary disease. In addition, we analyzed the relationship between oxidative stress, chronic inflammation, and vitamin D with respiratory muscle strength. METHODS: A cross sectional study with 61 individuals with chronic obstructive pulmonary disease. Polymerase chain reaction of gene polymorphisms IGF-1 (rs35767) and IGF-2 (rs3213221) was analyzed. Other variables, related to oxidative stress, inflammation and Vitamin D were dosed from peripheral blood. Maximal inspiratory and expiratory pressure were measured. RESULTS: The genetic polymorphisms were associated with respiratory muscle strength ( 3.0 and 3.5; = 0.57). Specific genotypes of IGF-1 and IGF-2 presented lower maximal inspiratory and expiratory pressure (<0.05 for all). Oxidative stress, inflammatory biomarkers, and vitamin D were not associated with respiratory muscle strength. CONCLUSION: The polymorphisms of IGF-1 and IGF-2 displayed stronger correlations with respiratory muscle strength compared to blood biomarkers in patients with chronic obstructive pulmonary disease. Specific genotypes of IGF-1 and IGF-2 were associated with reduced respiratory muscle strength in this population.

INTRODUCCIÓN: La enfermedad pulmonar obstructiva crónica es una enfermedad sistémica caracterizada no solo por síntomas respiratorios, sino también por el deterioro físico y la debilidad muscular. Una manifestación destacada de esta enfermedad es el declive en la fuerza de los músculos respiratorios. Estudios previos han vinculado los genotipos de factor de crecimiento insulínico 1 y 2 (IGF-1 e IGF-2) con la debilidad muscular en poblaciones sin esta enfermedad. Sin embargo, existe un vacío de conocimiento con respecto a los mecanismos biológicos subyacentes a la debilidad de los músculos respiratorios, en particular el papel de los genotipos IGF-1 e IGF-2 en esta enfermedad pulmonar. Por lo tanto, este estudio tuvo como objetivo investigar, por primera vez, la asociación de los genotipos IGF-1 e IGF-2 con la fuerza de los músculos respiratorios en individuos con enfermedad pulmonar obstructiva crónica. Además, analizamos la relación entre el estrés oxidativo, la inflamación crónica y la vitamina D con la fuerza de los músculos respiratorios. MÉTODOS: Un estudio transversal con 61 individuos con enfermedad pulmonar obstructiva crónica. Se analizó la reacción en cadena de la polimerasa de los polimorfismos genéticos IGF-1 (rs35767) e IGF-2 (rs3213221). Otras variables relacionadas con el estrés oxidativo, la inflamación y la vitamina D se dosificaron a partir de muestras de sangre periférica. Se midieron las presiones inspiratorias y espiratorias máximas. RESULTADOS: Los polimorfismos genéticos están asociados con la fuerza de los músculos respiratorios (F: 3.0 y 3.5; R2= 0.57). Genotipos específicos de IGF-1 e IGF-2 presentaron bajos valores en las presiones inspiratorias y espiratorias (p<0.05 en todos los casos). El estrés oxidativo, los biomarcadores inflamatorios y la vitamina D no se asociaron con la fuerza de los músculos respiratorios. CONCLUSIÓN: Los polimorfismos de IGF-1 e IGF-2 mostraron correlaciones más sólidas con la fuerza de los músculos respiratorios en pacientes con enfermedad pulmonar obstructiva crónica en comparación con los biomarcadores sanguíneos. Genotipos específicos de IGF-1 e IGF-2 se asociaron con una disminución de la fuerza de los músculos respiratorios en esta población.

The Effects of Acute Binge Alcohol Consumption on the Trabecular Morphometry and Tensile Strength of Adolescent Sprague Dawley Rat Femora

SUMMARY: Excessive alcohol consumption adversely affects bone metabolism, thus resulting in reduced bone length, density, and strength. Moreover, these deficits in bone density and strength are likely to increase the risk of fragility fractures and the early onset of osteoporosis. While excessive alcohol consumption is an established risk factor for osteoporotic fractures, there remains a dearth of information in literature about bone effects of binge alcohol consumption in adolescents. Therefore, our study aimed to examine the effects of acute binge alcohol consumption on the adolescent bone micro-architecture and tensile strength. Twelve male Sprague Dawley rats aged 7 weeks were randomly placed in 2 groups: alcohol (n =6), receiving alcohol (3g/kg) and pair-fed control (n = 6), receiving an isocaloric equivalent of maltose dextrin via oral gavage for 3 days in one week (on alternative days). The femora were dissected and scanned using a Micro-Focus X-ray Computed Tomography (3D-µCT). Following reconstruction, trabecular morphometry was assessed in both the proximal and distal epiphysis, using a Volume Graphics Studio® software. A three-point bending test was employed to examine the effect of alcohol on the tensile strength of the bone. Results showed trabeculae parameters to be affected in the distal epiphysis of the femur, while in the proximal epiphysis it remained unaffected. Tensile strength parameters were also not affected by the consumption of alcohol. These findings may suggest that acute binge alcohol consumption has detrimental effects on the bone micro-architecture specific to the distal epiphysis.

El consumo excesivo de alcohol afecta negativamente al metabolismo óseo, lo que resulta en una reducción de la longitud, densidad y resistencia de los huesos. Además, es probable que estos déficits en la densidad y la fuerza ósea aumenten el riesgo de fracturas por fragilidad y la aparición temprana de osteoporosis. Si bien el consumo excesivo de alcohol es un factor de riesgo establecido para las fracturas osteoporóticas, existe escasa información en la literatura sobre los efectos óseos del consumo excesivo de alcohol en adolescentes. Por lo tanto, nuestro estudio tuvo como objetivo examinar los efectos del consumo excesivo de alcohol en la microarquitectura ósea y la resistencia a la tracción e n ratas adolescentes. Doce ratas macho Sprague Dawley de 7 semanas de edad se colocaron aleatoriamente en 2 grupos: alcohol (n = 6), que recibieron alcohol (3 g/kg) y control (n = 6), que recibieron un equivalente isocalórico de maltosa dextrina mediante sonda oral, durante 3 días en una semana (en días alternos). Los fémures se diseccionaron y escanearon mediante una tomografía computarizada de rayos X con microenfoque (3D-mCT). Después de la reconstrucción, se evaluó la morfometría trabecular tanto en la epífisis proximal como en la distal, utilizando un software Volume Graphics Studio®. Se empleó una prueba de flexión de tres puntos para examinar el efecto del alcohol sobre la resistencia a la tracción del hueso. Los resultados mostraron que los parámetros de las trabéculas se vieron afectados en la epífisis distal del fémur, mientras que en la epífisis proximal no se observaron afectados. Los parámetros de resistencia a la tracción tampoco se vieron afectados por el consumo de alcohol. Estos hallazgos pueden sugerir que el consumo excesivo de alcohol tiene efectos perjudiciales sobre la microarquitectura ósea específica de la epífisis distal del hueso.

Asociación del resultado auditivo final, en pacientes con hipoacusia súbita, a la respuesta a glucocorticoides in vitro / Association of the final hearing result, in patients with sudden hearing loss, to the response to glucocorticoids in vitro

Introducción: La hipoacusia súbita (HS) es poco frecuente y su etiopatogenia no está definida. La terapia con corticoides es de elección en base a recomendaciones de expertos por sus efectos teóricos y no en base a utilidad clínica demostrada. Objetivo: Evaluar si existe correlación entre el resultado auditivo final, de pacientes con HS tratados con corticoides, y la respuesta in vitro de sus leucocitos a corticoides, medida como diferencias en la expresión relativa de genes blanco del receptor de glucocorticoides. Material y Método: Estudio de casos (recuperación total) y controles (no recuperados) de pacientes con HS tratados con corticoides en el Hospital Clínico de la Universidad de Chile, durante 2017-2019. Se obtuvo DNA que fue almacenado en el Biobanco de Tejidos y Fluidos de la Universidad de Chile (BTUCH). Se purificaron y cultivaron leucocitos mononucleares de sangre periférica, expuestos in vitro a hidrocortisona. Se determinó la diferencia en la expresión relativa de genes blanco (IGFBP1, CAT, HSD17B12, APOA2), por Q-RTPCR, entre ambos grupos. Resultados: Se reclutaron 35 pacientes; se incluyeron para análisis 23: 11 casos y 12 controles, con edad promedio de 54,9 y 50,8 años respectivamente, distribución homogénea de sexo. No hubo diferencia estadísticamente significativa en la expresión relativa de los genes blanco, a la exposición in vitro a corticoides, entre ambos grupos. Conclusión: En nuestro estudio, modelo, y sistema de evaluación no se evidenciaron efectos de los corticoides. No podemos descartar que, con un número mayor de pacientes, otros genes blanco u otros protocolos de estudio podrían detectarse diferencias.

Introduction: Sudden hearing loss (SHL) is rare and its etiopathogenesis is still not clear. Corticosteroid therapy is of choice based on expert recommendations due to its theoretical effects and no based on proved clinical efficacy. Objectives: To assess whether there is a correlation between the final auditory outcome of patients with SHL treated with corticosteroids and the in vitro response of their leukocytes to corticosteroids, measured as differences in the relative expression of glucocorticoid receptor target genes. Material and Method: Case-control (total recovery and not recovered respectively) study of patients with SHL treated with corticosteroids at Clinical Hospital Universidad de Chile between 2017 and 2019. DNA was obtained and stored in the Biobanco de Tejidos y Fluidos de la Universidad de Chile (BTUCH). Peripheral blood mononuclear leukocytes were purified and cultured and then exposed to hydrocortisone. The difference in the relative expression of target genes (GFBP1, CAT, HSD17B12, APOA2), by Q-RTPCR was determined. Results: Thirty-five patients were recruited, 24 were included for the analysis: 11 cases and 12 controls, with and average age of 54.9 and 50.,8 years respectively, homogeneous sex distribution. There was no statistically significant difference in the relative expression of the target genes, upon in vitro exposure to corticosteroids, between both groups. Conclusion: In our study, model and evaluation system, no effects of corticosteroids were evidenced. With a larger number of patients, other target genes or other study protocols, we cannot rule out that differences could be detected.

Consensus on clinical application of immunoglobulin G4 / 中华内科杂志

IgG4 is a subclass of IgG. Elevated serum IgG4 levels are an important serological feature of IgG4 related diseases and serve as a serological marker for assessing disease activity and severity. The harmonization of IgG4 detection is crucial for its clinical application. National Clinical Research Center for Dermatologic and Immunologic Diseases (Peking Union Medical College Hospital), Experimental Diagnosis Research Committee, Rheumatology and Immunology Physicians Committee of Chinese Medical Doctor Association, Autoantibodies Detection Committee, and Chinese Rheumatism Data Center have organized clinical and laboratory experts to draft this consensus, aiming to standardize IgG4 detection and provide guideline for clinician and laboratory experts to appropriate utility and interpret IgG4 results in China.

Ocular manifestations in patients diagnosed with dengue in a reference hospital in the city of Manaus, Brazil / Alterações oculares em pacientes diagnosticados com dengue em um hospital de referência na cidade de Manaus

ABSTRACT Objective: To determine the prevalence of ocular alterations in patients diagnosed with dengue, admitted to a reference center for infectious and parasitic diseases in Manaus (AM), Brazil. Methods: This was an observational, analytical, and prospective case series study with 33 patients admitted to the hospital with positive clinical pathology tests during a 90-day period of a dengue epidemic in 2011. The investigations included measurement of visual acuity, macular assessment with Amsler grid test, fundus biomicroscopy, retinography and optical coherence tomography. Results: The average age of the patients was 35.48 years (minimum age 17 years and maximum 69 years). The main symptoms reported were blurred vision, followed by retro-ocular pain, photopsia, halos, foreign bodies, scotoma, double vision, and floaters. Visual acuity ranged from 20/20 to 20/40 (median 20/30). Macular assessment with Amsler Grid Test was unsatisfactory in three patients. The most common retinal findings were perimacular edema, macular edema, retinal hemorrhage, vasculitis, and changes in the retinal pigment epithelium. Optical coherence tomography showed retinal edema in 16 patients (51.51%). Conclusions: In all cases, the disease was self-limiting and resolved spontaneously without treatment. Therefore, this study confirms that ocular manifestations in dengue fever are varied and frequent.

RESUMO Objetivo: Determinar a prevalência de alterações oculares em pacientes com diagnóstico de dengue, internados em um centro de referência para doenças infecciosas e parasitárias em Manaus (AM), Brasil. Métodos: Estudo observacional, analítico e prospectivo de série de casos de 33 pacientes admitidos no hospital com exames de patologia clínica positivos durante um período de 90 dias de uma epidemia de dengue em 2011. As investigações incluíram medida da acuidade visual, avaliação macular com tela de Amsler, biomicroscopia de fundo de olho, retinografia e tomografia de coerência ótica. Resultados: A idade média dos pacientes foi de 35,48 anos (idade mínima de 17 anos e máxima de 69 anos). Os principais sintomas relatados foram visão turva, seguida de dor retro-ocular, fotopsia, halos, corpos estranhos, escotoma, visão dupla e moscas volantes. A acuidade visual variou entre 20/20 e 20/40 (mediana 20/30). A avaliação macular com a tela de Amsler foi insatisfatória em três doentes. Os achados retinianos mais comuns foram edema perimacular, edema macular, hemorragia retiniana, vasculite e alterações no epitélio pigmentar da retina. A tomografia de coerência óptica mostrou edema da retina em 16 doentes (51,51%). Conclusões: Em todos os casos, a doença foi autolimitada e resolveu-se espontaneamente sem tratamento. Este estudo confirma, portanto, que as manifestações oculares da dengue são variadas e frequentes.

Hospitalizaciones por diarrea con sangre en un centro pediátrico de referencia en Uruguay / Hospitalizations due to bloody diarrhea in a pediatric reference center in Uruguay / Internações por diarreia sanguinolenta em um centro de referência pediátrica no Uruguai

Introducción: La diarrea con sangre es un motivo frecuente de admisión hospitalaria en niños, con gastroenteritis aguda; en la mayoría de los casos se tratan de infecciones leves y autolimitadas, pero pueden producirse complicaciones graves. Objetivos: Describir la etiología y características clínico- evolutivas de los niños menores de 15 años hospitalizados por diarrea con sangre en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell entre los años 2012- 2023. Materiales y métodos: Estudio retrospectivo mediante revisión de historias y registros de laboratorio. Variables: demográficas, estado nutricional, hidratación, motivos de hospitalización, ingreso unidades de cuidados intensivos (UCI), enteropatógenos, tratamientos, evolución. Resultados: Se incluyeron 229 niños, mediana de edad de 8 meses; sexo masculino 61%; eutróficos 88%, bien hidratados 55%, con comorbilidades 11%, prematurez 6,5%. El motivo de hospitalización fue diarrea con sangre/disentería sin otro síntoma 45%. Se solicitó coprovirológico/coprocultivo en 98% y detección por técnicas de ácidos nucleicos en materia fecal 5,2%. Se identificó al menos un agente patógeno en 34,3%: Shigella sp. 38%; Salmonella sp. 19,5%; coinfecciones en 12%. Se indicaron antibióticos a 86%; ceftriaxona 62%, azitromicina 35%. Ingresaron a UCI 6,5% (15), presentaron complicaciones 10/14, fallo renal agudo 5 y alteraciones del medio interno 3. La mayoría presentó buena evolución. Conclusiones: La diarrea con sangre/disentería continúa siendo una causa importante de hospitalización afectando en su mayoría a niños sanos menores de 5 años. Los patógenos detectados con mayor frecuencia fueron bacterias principalmente Shigella sp., Salmonella sp. y E coli diarreogénicas. Se reportó alta prescripción de antibióticos, cumpliendo en la mayoría de los casos con las recomendaciones.

Introduction: Bloody diarrhea is a common reason for hospital admission in children with acute gastroenteritis; In most cases these are mild and self-limiting infections, but serious complications can occur. Goals: To describe the etiology and clinical-evolutionary characteristics of children under 15 years of age hospitalized for bloody diarrhea at the Pediatric Hospital, Centro Hospitalario Pereira Rossell between the years 2012-2023. Materials and methods: Retrospective study through review of histories and laboratory records. Variables: demographics, nutritional status, hydration, reason for hospitalization, intensive care unit (ICU) admission, enteropathogens, treatments, evolution. Results: 229 children were included, median age 8 months; male sex 61%; eutrophic 88%, well hydrated 55%, with comorbidities 11%, prematurity 6.5%. The reason for hospitalization was bloody diarrhea/dysentery without other symptoms 45%. Coprovirological/coproculture was requested in 98% and detection by nucleic acid techniques in fecal matter was requested in 5,2%. At least one pathogenic agent was identified in 34,3%: Shigella sp. 38%; Salmonella sp 19,5%; coinfections in 12%. Antibiotics were indicated for 86%; ceftriaxone 62%, azithromycin 35%. Were admitted to the ICU 6,5% (15), 10/14 had complications, 5 had acute kidney failure and 3 had alterations in the internal environment. The majority had a good evolution. Conclusions: Bloody diarrhea/dysentery continues to be an important cause of hospitalization, affecting mostly healthy children under 5 years of age. The most frequently detected pathogens were bacteria, mainly Shigella sp., Salmonella sp. and diarrheagenic E coli. High prescription of antibiotics was reported, complying in most cases with the recommendations.

Introdução: A diarreia com sangue é um motivo comum de internação hospitalar em crianças com gastroenterite aguda; Na maioria dos casos, estas são infecções leves e autolimitadas, mas podem ocorrer complicações graves. Metas: Descrever a etiologia e as características clínico-evolutivas de crianças menores de 15 anos internadas por diarreia sanguinolenta no Hospital Pediátrico Centro Hospitalario Pereira Rossell entre os anos de 2012-2023. Materiais e métodos: Estudo retrospectivo por meio de revisão de histórias e registros laboratoriais. Variáveis: dados demográficos, estado nutricional, hidratação, motivo da internação, internação em unidade de terapia intensiva (UTI), enteropatógenos, tratamentos, evolução. Resultados: foram incluídas 229 crianças, mediana de idade 8 meses; sexo masculino 61%; eutrófico 88%, bem hidratado 55%, com comorbidades 11%, prematuridade 6,5%. O motivo da internação foi diarreia sanguinolenta/disenteria sem outros sintomas 45%. O estudo coprovirologico/coprocultivo foi solicitado em 98% e a detecção por técnicas de ácidos nucleicos em matéria fecal foi solicitada em 5,2%. Pelo menos um agente patogênico foi identificado em 34,3%: Shigella sp. 38%; Salmonella sp. 19,5%; coinfecções em 12%. Os antibióticos foram indicados para 86%; ceftriaxona 62%, azitromicina 35%. Foram internados em UTI 6,5% (15), 10/14 apresentaram complicações, 5 tiveram insuficiência renal aguda e 3 apresentaram alterações no meio interno, a maioria teve boa evolução. Conclusões: A diarreia/disenteria com sangue continua a ser uma causa importante de hospitalização, afetando sobretudo crianças saudáveis ​​com menos de 5 anos de idade. Os patógenos mais frequentemente detectados foram bactérias, principalmente Shigella sp., Salmonella sp. e E. coli diarreiogênica. Foi relatada elevada prescrição de antibióticos, cumprindo na maioria dos casos as recomendações.

Beneficial effects of coconut oil (Cocos nucifera) on hematobiochemicl and histopathological markers in CCL4-intoxicated rabbits / Efeitos benéficos do óleo de coco (Cocos nucifera) em marcadores hematobioquímicos e histopatológicos em coelhos intoxicados com CCL4

The study was designed to investigate the effect of Coconut Oil on the levels of some liver and hematological parameters in carbon tetrachloride intoxicated rabbits. Also the antioxidant capacity of Coconut Oil for various concentrations was assessed on the basis of percent scavenging of (DPPH) free radical. Experimental animals were divided into five groups, eight rabbits in each group. These were: group A (Normal control), group B (Toxic control), group C (Standard control), group D (Treated with Coconut Oil 50 mL/kg body weight after CCl4 intoxication), group E (Treated with Coconut Oil 200 mL/kg body weight after CCl4 intoxication). The effects observed were compared with a standard hepatoprotective drug silymarine (50 mL/kg body weight). The Coconut Oil (200 mL/kg body weight) significantly (P<0.05) reduced the elevated serum levels of alanine transaminase (ALT), aspartate transaminase (AST) and alkaline phosphatase (ALP) when compared to a toxic control rabbits. The results of extract treated rabbits were similar to silymarine administered rabbits group. Treatment with Coconut Oil root and silymarine caused no significant changes in RBC, Platelets, (Hb), (MCH) concentration and (HCT) values. However, significant (P<0.05) increase was observed in the total WBC count. The present study suggested that Coconut Oil can be used as an herbal alternative (need further exploration i.e to detect its bioactive compound and its efficacy) for hepatoprotective activit.

O estudo foi desenhado para investigar o efeito do óleo de coco nos níveis de alguns parâmetros hepáticos e hematológicos em coelhos intoxicados com tetracloreto de carbono. Também a capacidade antioxidante do óleo de coco para várias concentrações foi avaliada com base na porcentagem de eliminação de radicais livres (DPPH). Os animais experimentais foram divididos em cinco grupos, oito coelhos em cada grupo. Estes foram: grupo A (controle normal), grupo B (controle tóxico), grupo C (controle padrão), grupo D (tratado com óleo de coco 50 mL/kg de peso corporal após intoxicação por CCl4), grupo E (tratado com óleo de coco 200 mL/kg de peso corporal após intoxicação por CCl4). Os efeitos observados foram comparados com um fármaco hepatoprotetor padrão silimarina (50 mL/kg de peso corporal). O óleo de coco (200 mL/kg de peso corporal) reduziu significativamente (P<0,05) os níveis séricos elevados de alanina transaminase (ALT), aspartato transaminase (AST) e fosfatase alcalina (ALP), quando comparado a um coelho controle tóxico. Os resultados dos coelhos tratados com extrato foram semelhantes aos do grupo de coelhos administrados com silimarina. O tratamento com raiz de óleo de coco e silimarina não causou alterações significativas nos valores de RBC, Plaquetas, (Hb), (MCH) e (HCT). No entanto, observou-se aumento significativo (P<0,05) na contagem total de leucócitos. O presente estudo sugeriu que o óleo de coco pode ser usado como uma alternativa fitoterápica (precisa de mais exploração, ou seja, para detectar seu composto bioativo e sua eficácia) para atividade hepatoprotetora.

Effects of Pasturella Multocida B: 2 and its immunogens (LPS and OMP) on reproductive hormones in Nili-Ravi Buffaloes / Efeitos de Pasteurella multocida B: 2 e seus imunógenos (LPS e OMP) em hormônios reprodutivos em búfalos Nili-Ravi

Abstract Livestock is a fundamental part of the agriculture industry in Pakistan and contributes more than 11.53% to GDP. Among livestock species, the buffaloes are regarded as the black gold of Pakistan. Being the highest milk producers globally, Nili-Ravi buffaloes are the most famous ones. Buffaloes are affected by many endemic diseases, and "Hemorrhagic septicemia" (HS) is one of them. This study was designed to ascertain the effects of experimental exposure ofP. multocida B:2 (oral) and its immunogens, i.e., LPS (oral and intravenous) and OMP (oral and subcutaneous) on reproductive hormonal profiles in Nili-Ravi buffaloes. Repeated serum samples were collected from the jugular vein of experimental animals for 21 days (0, 02, 04, 08, 12, 16, 20, 24, 36, 48, 72, 120, 168, 216, 264, 360, 456 and 504 hours). Hormonal assays to determine the serum concentrations of Gonadotropin-releasing hormone (GnRH), Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Estrogen (E2) and progesterone (P4) were performed using (MyBioSource) commercial Elisa kits. The hormonal profile of all treatment groups of the buffalo heifers exhibited significant (P<0.05) variations as compared to the control group (G-1). These results indicate suppression in Nili-Ravi buffaloes' reproductive hormonal profile on exposure to P. multocida B:2 and its immunogens. This influence warrants that exposure to H.S may be a possible reason for delayed puberty and poor reproduction performance in Nili-Ravi buffaloes.

Resumo A pecuária é uma parte fundamental da indústria agrícola no Paquistão e contribui com 11,53% do PIB nacional. Entre as espécies de gado, os búfalos são considerados o ouro negro do Paquistão. Sendo os maiores produtores de leite em todo o mundo, os búfalos Nili-Ravi são os mais famosos. Os búfalos são afetados por muitas doenças endêmicas, entre as quais a "septicemia hemorrágica" (SH). Este estudo busca verificar os efeitos da exposição experimental de P. multocida B:2 (oral) e seus imunógenos, ou seja, LPS (oral e intravenoso) e OMP (oral e subcutâneo), nos perfis hormonais reprodutivos em búfalos Nili-Ravi. Amostras de soro repetidas foram coletadas da veia jugular de animais experimentais por 21 dias (0, 2, 4, 8, 12, 16, 20, 24, 36, 48, 72, 120, 168, 216, 264, 360, 456 e 504 horas). Os ensaios hormonais para determinar as concentrações séricas do hormônio liberador de gonadotrofina (GnRH), hormônio foliculoestimulante (FSH), hormônio luteinizante (LH), estrogênio (E2) e progesterona (P4) foram realizados usando kits comerciais Elisa (MyBioSource). O perfil hormonal de todos os grupos de tratamento das novilhas bubalinas apresentou variações significativas (P < 0,05) em relação ao grupo controle (G-1). Esses resultados indicam supressão no perfil hormonal reprodutivo de búfalos Nili-Ravi na exposição a P. multocida B:2 e seus imunógenos. Essa influência garante que a exposição à SH possa ser uma possível razão para o atraso da puberdade e o baixo desempenho reprodutivo em búfalos Nili-Ravi.

Avaliação morfológica dos glóbulos periféricos nos nevos melanocíticos e no melanoma através da dermatoscopia / Melanoma and melanocytic nevi with peripheral globules: Clinical and dermoscopic features

Introdução: A morfologia e biologia do nevo melanocítico (NM) com glóbulos periféricos (GP) é descrita como parte do processo natural de evolução do nevo melanocítico sendo caracterizada como fase de crescimento. Por outro lado, os melanomas cutâneos (MC) com glóbulos periféricos ainda permanecem indefinidos. Objetivos: avaliar e descrever as características dos melanomas com glóbulos periféricos à dermatoscopia e, com isso, criar um algoritmo de conduta para facilitar o manejo das lesões melanocíticas em crescimento. Como objetivo secundário, foi realizado análise prospectiva de lesões melanocíticas com glóbulos periféricos à dermatoscopia através da utilização do algoritmo proposto previamente buscando comprovar sua aplicabilidade clínica. Materiais e métodos: Fase 1, estudo retrospectivo, foram avaliadas lesões melanocíticas com GP de 2006 a 2020. As imagens dermatoscópicas destas lesões foram avaliadas por dermatoscopista experiente, através da análise estatística foi possível desenvolver um algoritmo de conduta. Fase 2, na amostra inicial foram incluídas lesões melanocíticas com GP entre 2020 e 2023. Com esta nova amostra, foi realizada a validação do algoritmo de conduta através da aplicação estatística de um modelo preditivo. Em um segundo momento, 04 observadores avaliaram as imagens dermatoscópicas através do algoritmo proposto sendo possível estimar seu desempenho. Resultados: Fase 1, das 401 lesões, 179 foram excisadas sendo 41 melanomas. Os melanomas foram mais comuns quando localizados nos membros inferiores (p<0,1) e se apresentavam com padrão dermatoscópico desorganizado. Enquanto os nevos melanocíticos foram mais comuns no tronco e com padrão organizado. Além disso, a presença de uma das seguintes estruturas: pontos e glóbulos atípicos, estruturas vasculares atípicas ou área de borrão apresentaram associação com melanoma. Fase 2, as 55 lesões coletadas foram excisadas e adicionadas ao banco de dados final (n= 456), a partir dos valores preditos deste banco de dados, foi possível estabelecer uma curva ROC cuja área sob a curva foi de 0,834 e acurácia de 71,21%. A análise dermatoscópica de quatro observadores demonstrou área sob a curva ROC de 0,627 a 0,765. Conclusão: Lesões melanocíticas com glóbulos periféricos apresentam maior risco para melanoma quando em indivíduos acima de 30 anos de idade, se localizadas nos membros inferior e com a presença de uma ou mais das seguintes estruturas: pontos e glóbulos atípicos e/ou estruturas vasculares atípicas e/ou área de borrão. Estas características encontradas foram validadas por modelo preditivo demonstrando um bom desempenho através da análise da curva ROC e índice de acurácia dentro do esperado

Introduction: The morphology and biology of melanocytic nevus (MN) with peripheral globules (PG) is described as part of the natural process of evolution of melanocytic nevus and is characterized as a growth phase. On the other hand, cutaneous melanomas (CM) with peripheral globules remain unclear. Objectives: To evaluate and describe in detail the characteristics of melanocytic lesions with peripheral globules at dermoscopy, therefore, create an algorithm of management of growing melanocytic lesions. As a secondary objective, a prospective analysis of melanocytic lesions with peripheral globules was carried out using the previously proposed algorithm, seeking to prove its clinical applicability. Materials and methods: Phase 1, retrospective study, melanocytic lesions with PG were evaluated from 2006 to 2020. The dermoscopic images of these lesions were evaluated by an experienced dermatoscopist, through statistical analysis it was possible to develop a management algorithm. Phase 2, melanocytic lesions with peripheral globules were included between 2020 and 2023. In this phase, a predictive model was fitted to the dataset to evaluate the algorithm accuracy and ROC curve. In a second moment, 04 observers evaluated the dermoscopic images using the proposed algorithm, making it possible to estimate its performance. Results: Phase 1, of the 401 lesions, 179 were excised, 41 of which were melanomas. Melanomas were more common when located on the lower limbs (p<0.1) and presented a disorganized dermoscopic pattern. While melanocytic nevi were more common on the trunk and with an organized pattern. In addition, the presence of one of the following structures: atypical dots and globules, atypical vessels or blotch was associated with melanoma. Phase 2, the 55 lesions collected were excised and added to the final database (n= 456), based on the predicted values from this database, it was possible to establish a ROC curve whose area under the curve was 0.834 and accuracy was 71 .21%. Dermoscopic analysis by four observers demonstrated an area under the ROC curve of 0.627 to 0.765. Conclusion: Melanocytic lesions with peripheral globules are the greatest risk of melanoma in individuals older than 30 years if located on the lower limbs and if lesions reveal one or more of the following structures: atypical dots and globules, atypical vessels, or blotch. These characteristics found were validated by a predictive model demonstrating an excellent performance index through ROC curve analysis and an accuracy index within expectations

Development of blood transfusion external quality assessment program at national scale / Desarrollo de un programa de evaluación externa de calidad de la transfusión sanguínea a nivel nacional

Introduction: External quality assessment is a crucial component in ensuring the quality of blood transfusion testing laboratories. Objectives: To develop a procedure for generating external quality assessment items for blood transfusion testing to evaluate participants' performance. Methods: Experimental research was conducted at Quality Control Center for Medical laboratory- University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam. Three items, including red blood cell, serum, and atypical antibody serum samples, were assessed for homogeneity and stability; 5 assessment areas, including ABO grouping, Rh grouping, compatible cross matches, Coombs test, and screening of atypical antibodies, were utilized to evaluate the performance of 38 participants in the 2020-2021 period. Results: Red blood cell and serum samples maintained quality for a specific period at controlled temperatures, while serum samples with atypical antibodies showed stability at different temperatures. The participants demonstrated high satisfactory performance in ABO grouping, Rh grouping, Coombs test, and screening for atypical antibodies. However, the most unsatisfactory performance was reported in crossmatching, with 15 percent of participants unsatisfactory results. Conclusion: The procedure of production of proficiency testing items has been successfully developed, and its application at the national level is suggested to improve the quality of blood transfusion laboratories(AU)

Introducción: La evaluación externa de calidad es esencial para asegurar la calidad de los laboratorios de pruebas de transfusión sanguínea. Objetivos: Desarrollar un procedimiento para generar elementos de evaluación externa de calidad y evaluar el rendimiento de los participantes en pruebas de transfusión sanguínea. Métodos: Estudio experimental realizado en el Centro de Control de Calidad para Laboratorios Médicos de la Universidad de Medicina y Farmacia en la Ciudad de Ho Chi Minh, Vietnam. Se evaluaron muestras de glóbulos rojos, suero y suero con anticuerpos atípicos para homogeneidad y estabilidad. Se utilizaron 5 áreas de evaluación, incluida la agrupación ABO, la agrupación Rh, las coincidencias cruzadas compatibles, la prueba de Coombs y la detección de anticuerpos atípicos, para evaluar el desempeño de 38 participantes, en el período 2020-2021. Resultados: Las muestras de glóbulos rojos y suero mantuvieron la calidad durante un período específico a temperaturas controladas, mientras que las muestras de suero con anticuerpos atípicos mostraron estabilidad a diferentes temperaturas. Los participantes obtuvieron un alto rendimiento en algunas áreas, como la agrupación ABO y Rh, la prueba de Coombs y la detección de anticuerpos atípicos. Sin embargo, las pruebas de compatibilidad reportaron un rendimiento insatisfactorio en un 15 por cientode los participantes. Conclusión: El procedimiento desarrollado cumple con los criterios de calidad, y se sugiere su aplicación a nivel nacional para mejorar la calidad de los laboratorios de transfusión sanguínea(AU)

Abordagem da anemia em situações específicas na mulher: importância e evidências para a tomada de decisão / Specific Anemia Management in Women: Significance and Evidence-Based Decision-Making

A Organização Mundial de Saúde estima que aproximadamente 30% das mulheres na menacme apresentam anemia ferropriva, com implicações significativas para a saúde e a qualidade de vida delas. A anemia é definida com base nos níveis de hemoglobina e pode variar em gravidade. Essa condição resulta em comprometimento da capacidade de transporte de oxigênio, exigindo mecanismos compensatórios do organismo. Além disso, pacientes que enfrentam perda sanguínea aguda e crônica e distúrbios hemorrágicos estão em risco elevado de desenvolver anemia. O Programa Patient Blood Management (PBM) surge como uma abordagem centrada no paciente, enfocando deficiência de ferro, anemia, coagulopatia e perda de sangue. O Patient Blood Management propõe a otimização da gestão do sangue do paciente, evitando transfusões desnecessárias e promovendo uma abordagem mais conservadora. Este artigo aborda a relevância da deficiência de ferro durante a gestação e a menacme, bem como as estratégias de tratamento no período pré-operatório. A suplementação de ferro, seja por via oral ou endovenosa, é fundamental para tratar a anemia ferropriva, enquanto as hemotransfusões são reservadas para casos mais graves. A abordagem sistemática da anemia é crucial para garantir melhores desfechos em cirurgias ginecológicas e no período gestacional. A suplementação de ferro, principalmente via intravenosa, surge como uma opção terapêutica eficaz e rápida, enquanto a hemotransfusão, apesar de útil em situações específicas, apresenta riscos associados que devem ser cautelosamente avaliados.

Miocardio salvado en infarto agudo de miocardio con supradesnivel del ST post reperfusión: Análisis mediante resonancia magnética cardiaca / Saved myocardium in acute ST-segment elevation myocardial infarction post-reperfusion: Analysis by cardiac magnetic resonance

OBJETIVO: Cuantificar el miocardio salvado mediante resonancia magnética cardiaca, en miocardio irrigado por la arteria relacionada con el infarto en pacientes con IAM con SDST reperfundidos y no reperfundidos. PACIENTES Y MÉTODOS: A 25 pacientes con un primer infarto de miocardio con elevación del ST (no reperfundidos, 10 pacientes; trombólisis, 10 pacientes; angioplastía Miocardio salvado post reperfusión en infarto agudo de miocardio -R. Díaz-Navarro et al primaria, 5 pacientes) se les realizó resonancia magnética cardíaca 3 a 6 días después de la coronariografía. Se cuantificó el miocardio salvado y el índice de miocardio salvado. RESULTADOS: Los valores máximos de troponina fueron más bajos en los pacientes con angioplastía primaria que en los pacientes trombolizados y no reperfundidos (14,1 ng/mL versus 515,4 ng/mL y 123,1 ng/mL, respectivamente; p < 0,007) y el tamaño del infarto menor (14,1 gr versus 31,2 gr y 31,5 gr, respectivamente; p < 0,003). La masa de miocardio salvado y el índice de miocardio salvado fue mayor en los pacientes con angioplastía primaria que en los pacientes trombolizados y no reperfundidos (27,4 gr versus 4,7 gr y 2,1 gr, respectivamente; p < 0,003) y (65,2 % versus 14,9 % y 6,6 %, respectivamente; p < 0,0001). Conclusiones: Este estudio propone la necesidad de reevaluar la realización de angioplastía coronaria e implantación de stents, en pacientes con un primer IAM con SDST, trombolizados y no trombolizados, sin la realización de estudios de viabilidad previos. La resonancia magnética cardiaca permite cuantificar el miocardio salvado y podría ser considerada una aplicación clínica emergente, para la evaluación precoz de viabilidad miocárdica.

OBJECTIVE: To quantify by cardiovascular magnetic resonance the salvaged myocardium in the myocardium supplied by the infarct-related artery in reperfused and non-reperfused patients with a first ST-segment elevation myocardial infarction (STEMI). PATIENTS AND METHOD: Twenty-five patients with a first STEMI (non-reperfused, ten patients; thrombolysis, ten patients; primary angioplasty, five patients) underwent cardiac magnetic resonance imaging 3 to 6 days after coronary angiography. Myocardial salvage and myocardial salvage index were quantified. RESULTS: Peak troponin values were lower in patients with primary angioplasty than in thrombolysis and non-reperfused patients (14,1 ng/ mL versus 515,4 ng/mL and 123,1 ng/mL, respectively; p < 0,007) and smaller infarct size (14,1 g versus 31,2 g and 31,5 g, respectively; p < 0,003). Myocardial salvage mass and myocardial salvage index were higher in patients with primary angioplasty than in thrombolysis and non-reperfused patients (27,4 g versus 4,7 g and 2,1 g, respectively; p < 0,003) and (65,2% versus 14,9% and 6,6%, respectively; p < 0,0001). Conclusions: The results of this study indicate the need to reassess the performance of coronary angioplasty and stent implantation in patients with a first STEMI, thrombolysis, and non-thrombolysis without prior myocardial viability studies. Cardiac magnetic resonance allows the quantification of salvaged myocardium and could be considered an emerging clinical application for the early evaluation of myocardial viability.

Vitamina D y embarazo: una experiencia piloto / Vitamin D and pregnancy: a pilot experience

La insuficiencia de vitamina D (VD) en el embarazo se relaciona con una mayor incidencia de cesáreas, preeclampsia y partos prematuros. Objetivo: evaluar si el grado de insuficiencia de VD se asocia a mayor número de cesáreas y evaluar la correlación entre la 25 hidroxivitamina D (25OHD) materna y en sangre del cordón del recién nacido. Las mujeres (n=127) se dividieron según sus niveles de 25OHD (ng/mL):G1:<20 (deficiencia), G2:20-30 (insuficiencia), G3:>30 (suficiencia). Se registraron edad; edad gestacional (EG); índice de masa corporal (IMC); tensión arterial sistólica y diastólica; tipo de parto y la estación del año en que se tomó la muestra. Se determinaron calcemia (ng/mL); 25OHD; parathormona intacta (pg/mL); fosfatasa alcalina ósea (UI/L) y crosslaps (pg/mL). La edad media fue de 26±6 años y la EG de 35,8±2,7 semanas, sin diferencias entre grupos. El porcentaje de cesáreas fue mayor en G1 que en G2 y G3 (31,3%, 21,4% y 25%, respectivamente; p<0,05). El mayor porcentaje de muestras se tomó en primavera (p<0,05). No se observaron diferencias en las demás variables maternas estudiadas. La 25OHD materna correlacionó positivamente con los valores de la sangre de cordón de sus respectivos recién nacidos (r= 0,67; p<0,0001). Independientemente de la época del año y del IMC, se observó que un porcentaje significativo de las mujeres embarazadas estudiadas tenía niveles de 25OHD inferiores a 30 ng/mL. Conclusión: evidenciamos que la deficiencia de VD materna se asoció al número de cesáreas. Asimismo, los niveles séricos de 25OHD en sangre de cordón umbilical correlacionaron significativamente con los maternos. (AU)

Vitamin D (VD) insufficiency in pregnancy is associated with a higher incidence of cesarean section, preeclampsia, and preterm delivery. Objective: to evaluate if the degree of VD insufficiency is associated with the incidence of cesarean section and to determine the correlation between maternal and newborn cord blood 25-hydroxy VS (25OHD). Women (n=127) were divided according to their 25OHD levels (ng/mL): G1:<20 (deficiency), G2:20-30 (insufficiency), G3:>30 (sufficiency). Age; gestational age (GA); body mass index (BMI); systolic and diastolic blood pressure (mmHg); type of delivery and the season of the year in which the sample was taken were recorded. Calcemia (ng/mL); 25OHD; intact parathormone (pg/mL); bone alkaline phosphatase (IU/L) and Crosslaps (pg/mL) levels were determined. Mean age was 26±6 years and GA was 35.8±2.7 weeks with no differences among groups. The % of cesarean sections was higher in G1 than in G2 and G3 (31.3%, 21.4% and 25%; p<0.05). The highest % of samples were taken in spring (p<0.05). No differences were observed in the other maternal variables studied. Maternal serum 25OHD levels correlated positively with those of cord blood from their respective newborns (r=0.67; p<0.0001). Regardless the season of the year and BMI, a high % of the studied pregnant women presented 25OHD levels lower than 30 ng/ml. Conclusion: we found that maternal VD deficiency is associated with the number of cesarean sections. In addition, 25OHD levels in the newborn significantly correlate with maternal serum levels. (AU)

Pancreatitis aguda en el escenario de hipercalcemia por hiperparatiroidismo primario / Acute pancreatitis in the setting of hypercalcemia due to primary hyperparathyroidism

Introducción: describir el caso de un paciente con pancreatitis aguda secundaria a hipercalcemia por hiperparatiroidismo prImario. Esta es una causa poco frecuente de pancreatitis, asociada a morbimortalidad significativa en caso de no ser diagnosticada oportunamente Caso clínico: un hombre de 44 años, con antecedente de pancreatitis de presunto origen biliar que había requerido previamente colecistectomía, consultó por dolor abdominal y náuseas. Los estudios complementarios fueron compatibles con un nuevo episodio de pancreatitis aguda. Presentaba hipercalcemia y hormona paratiroidea (PTH) elevada, configurando hiperparatiroidismo primario. La gammagrafía informó hallazgos compatibles con adenoma paratiroideo. Se inició tratamiento con reanimación hídrica y analgesia con adecuada disminución de calcio sérico y resolución de dolor abdominal. Después de la paratiroidectomía se logró normalizar los niveles de calcio y PTH. Discusión: la pancreatitis aguda es una condición potencialmente fatal, por lo que la sospecha de causas poco frecuentes como la hipercalcemia debe tenerse en cuenta. El tratamiento de la hipercalcemia por adenoma paratiroideo se basa en reanimación hídrica adecuada y manejo quirúrgico del adenoma, con el fin de evitar recurrencia de pancreatitis y mortalidad. (AU)

Introduction: we describe the case of a patient with acute pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism. This is a rare cause of pancreatitis associated with significant morbidity and mortality if not diagnosed in time. Clinical case: a 44-year-old man with a history of pancreatitis of presumed biliary origin, which had previously required cholecystectomy, consulted for abdominal pain and nausea. The laboratory findings were compatible with a new episode of acute pancreatitis. He presented hypercalcemia and an elevated parathyroid hormone (PTH), configuring primary hyperparathyroidism. Scintigraphy was performed, yielding findings compatible with parathyroid adenoma. Treatment with fluid resuscitation and analgesia was started, resulting in an adequate decrease in serum calcium and resolution of abdominal pain. After parathyroidectomy, calcium and PTH levels were normalized. Discussion: acute pancreatitis is a potentially fatal condition; therefore the suspicion of rare causes, such as hypercalcemia, should be considered. The treatment of hypercalcemia due to parathyroid adenoma is based on adequate fluid resuscitation and surgical management of the adenoma, to avoid recurrence of pancreatitis and death. (AU)

Incidencia de Hipocalcemia Post Tiroidectomía. Factores predictores (PTH, Fósforo, Magnesio) y protocolo de manejo con alta precoz / Post-Thyroidectomy Hypocalcemia: Incidence, Prediction, and Outpatient Management Strategies Based on PTH and Calcium Levels

Se ha propuesto la medición de PTH como predictor de hipocalcemia postoperatoria transitoria y permanente. No hay un estándar de punto de corte o tiempo de toma de muestra. El OBJETIVO es reportar la incidencia de hipocalcemia post tiroidectomía en un grupo quirúrgico de alto volumen y proponer un protocolo de manejo ambulatorio (esquemas de I a V) según niveles postoperatorios (PO) de calcemia, PTHi (normal, baja o indetectable) y síntomas. Y determinar valores de PTH postoperatoria como predictores de hipocalcemia. En 106 pacientes con tiroidectomía total entre 2019 y 2021 se realiza medición de niveles pre y postoperatorios de calcio, magnesio, fosforo y PTHi. Se observó 29% y 1% de hipocalcemia transitoria ( 12 meses). Los puntos de corte para predecir hipocalcemia fueron PTH < 8,8 pg/ml y < 80% de descenso de % de PTH (d % PTH) al día siguiente. Con el manejo propuesto se indica el alta precoz (promedio 1.05 días) y el costo de la prescripción es acotado. No hay asociación significativa de hipomagnesemia e hiperfosfemia PO con la hipocalcemia PO. El tratamiento más utilizado es de carbonato de calcio exclusivo (esquemas I y II). Los pacientes se mantienen con síntomas leves a las 2 semanas PO en 5% y logran suspender el tratamiento vía oral en 93% en este mismo período. Los protocolos de medición de PTH como predictor de hipocalcemia son muy variados. Cada centro debe conocer y establecer sus propios protocolos de manejo. Con esta experiencia demostramos la utilidad y seguridad de un esquema de manejo basado en calcemia, PTH (normal, baja o indetectable) y síntomas, con indicación de tratamiento profiláctico para todos los pacientes y ajuste ambulatorio seguro y de menor costo que una hospitalización prolongada.

INTRODUCTION: PTH measurement has been proposed to predict transient and permanent postoperative hypocalcemia. There is no standard cut-off point or time for sampling. Aim: To report the incidence of post-thyroidectomy hypocalcemia in a high-volume surgical group and propose an outpatient management protocol according to postoperative (PO) calcium levels, iPTH (normal, low, or undetectable), and symptoms. Furthermore, determine postoperative PTH values as predictors of hypocalcemia. Methods: In 106 patients with total thyroidectomy between 2019 and 2021, pre-and postoperative levels of calcium, magnesium, phosphorus, and iPTH were measured. Results: Transient ( 12 months) hypocalcemia was observed in 29% and 1%. Cut-off points to predict hypocalcemia were PTH < 8.8 pg/mL and < 80% decrease in % PTH (d% PTH) the day after surgery. With the proposed management, early discharge is indicated (an average of 1.05 days), and the prescription cost is limited. There is no significant association between PO hypomagnesemia and hyperphosphatemia with PO hypocalcemia. The most widely used treatment is exclusive calcium carbonate (schemes I and II). Patients remain with mild symptoms at two weeks PO in 5% and discontinue oral treatment in 93% in this period. Conclusions: Protocols for measuring PTH as a hypocalcemia predictor vary. Each center must know and establish its management protocols. With this experience, we demonstrate the usefulness and safety of a management scheme based on calcium, PTH (normal, low, or undetectable), and symptoms with an indication of prophylactic treatment for all patients and a safe outpatient setting at a lower cost than prolonged hospitalization.

Beyond the Recommendations of the Clinical Guidelines for Medullary Thyroid Cancer - A Case Report / Más allá de las recomendaciones de las guías clínicas de cáncer medular de tiroides - a propósito de un caso

Medullary thyroid cancer (MTC) is a rare disease from parafollicular C cells. Calcitonin has been suggested as a screening; its levels are proportional to the tumor size and predictive of metastatic disease. We present a case where an early action was taken with lower cut-off points. Male patient, 49 years old. Thyroid ultrasound (US) with a suspicious nodule. Fine Needle Aspiration Biopsy (FNAB) suggests MTC, with pre-operative serum calcitonin (CTN) of 591 pg/mL. Total thyroidectomy with central and bilateral dissection was performed. Biopsy: MTC in left nodule of 26 mm without lymph nodes (LN) metastases. Follow-up with undetectable CTN for six years. After that, CT was 4.7 pg/mL, and carcinoembryonic antigen (CEA) was 1.2 ng/mL. Neck US showed bilateral LN. FNAB of LN does not show recurrence. A progressive rise of markers with doubling time of CTN and CEA was 16 and 51.3 months, respectively. CTN raised until 112 pg/mL. Given the lack of cervical compromise, a neck and lung CT, liver MRI, and bone scintigraphy were ordered despite CTN levels < 150 pg/mL. MRI showed hypervascular hepatic lesions, contrasted with gadoxetic acid. PET Ga68-DOTATATE showed lesions with overexpression of somatostatin receptors in the liver. Surgery was done, and a biopsy confirmed metastases. Conclusions: The clinical guidelines may allow the management of cases; however, they should be used considering each case context. In our patient, if the guidelines had been strictly followed, it would not have been possible to detect liver metastases to achieve a surgical resection with curative intent.

Paciente masculino, 49 años. Ecografía tiroidea con nódulo sospechoso. Biopsia por aspiración con aguja fina (PAAF) sugiere cáncer medular de tiroides (CMT), calcitonina sérica preoperatoria (CTN) de 591 pg/mL. Se realizó tiroidectomía total con disección central y bilateral. Biopsia: CMT en nódulo tiroideo izquierdo de 2,6 cm sin metástasis en 29 ganglios linfáticos (GL). En el seguimiento, CTN sérica indetectable durante 6 años. Posteriormente CTN sérica de 4,7 pg/mL y antígeno carcinoembrionario (CEA) de 1,2 ng/mL. Ecografía cervical de control mostró GL subcentimétricos bilaterales en grupo IV. PAAF de GL sin evidencia de malignidad, con niveles de CTN indetectables en la muestra. El doblaje de CTN y CEA fue 16 y 51,3 meses respectivamente. Dado ausencia de compromiso cervical, se solicitó TC de cuello y tórax, RM hepática y gammagrafía ósea, a pesar de no presentar niveles de CTN > 150 pg/mL. La RM mostró 3 lesiones hepáticas hipervasculares; se complementa con un PET Ga-DOTATATE que mostró 2 lesiones focales con sobreexposición de receptores de somatostatina en el parénquima hepático, con SUVmáx de 6,8 y 7,3. Se realiza cirugía extirpando 5 lesiones; la biopsia confirmó metástasis de CMT. Conclusiones: Las guías clínicas pueden dar orientaciones generales y permitir el manejo de casos basados en la evidencia; sin embargo, siempre deben usarse considerando el contexto de cada caso en particular. Si se hubieran seguido estrictamente las pautas, no habría sido posible detectar las metástasis hepáticas dentro de la ventana de oportunidad para lograr una resección quirúrgica con intención curativa.

Método indirecto para la verificación del intervalo de referencia del perfil lipídico / Indirect method for the verification of the lipid profile reference range

Introducción: La dislipidemia es uno de los problemas más frecuentes en los niños y adolescentes y su estudio es importante debido a su fuerte correlación con la enfermedad cardiovascular aterosclerótica en adultos. Muchos países desarrollaron valores de referencia nacionales investigando los lípidos séricos utilizando datos basados en la población nacional propia. Nuestro objetivo fue verificar el intervalo de referencia del perfil lipídico calculando las curvas de percentiles a través del método indirecto en nuestra población pediátrica. Materiales y métodos: Se analizaron los resultados de nuestra base de datos utilizando el método indirecto. Luego de aplicar filtros y criterios de exclusión se calcularon los percentiles 25, 50, 75, 95 y 99 para colesterol total (CT), colesterol HDL (C-HDL), colesterol no HDL (C-no-HDL), triglicéridos (TG) y colesterol LDL (C-LDL) y para el C-HDL además se calculó el percentil 10. El valor de referencia para el cambio (RCV) se utilizó para determinar si existía diferencia clínicamente significativa entre los valores de percentiles obtenidos y los utilizados en el consenso de la SAP. Resultados: No se evidenció diferencia clínicamente significativa contra los valores propuesto por la SAP, excepto para los TG para las edades 1,5,7 años en el percentil 95 y para la edad de 8 años en el percentil 75 y 95; para el C-HDL en el percentil 10 para las edades 1,16 y 17 años. Discusión: Se obtuvieron los percentiles de los lípidos y se compararon con los valores de referencia utilizados por el consenso en el que están basados las guías (AU)

Introduction: Dyslipidemia is one of the most common problems in children and adolescents and its study is important because of its strong correlation with atherosclerotic cardiovascular disease in adulthood. Many countries have developed national reference values investigating serum lipids using data based on their own national population. Our aim was to verify the lipid profile reference range by calculating percentile curves through the indirect method in our pediatric population. Materials and methods: The results of our database were analyzed using the indirect method. After applying filters and exclusion criteria, the 25th, 50th, 75th, 95th, and 99th percentiles were calculated for total cholesterol (TC), HDL cholesterol (HDL-C), non-HDL cholesterol (non-HDL-C), triglycerides (TG), and LDL cholesterol (LDL-C); for HDL-C, the 10th percentile was also calculated. The reference change values (RCV) were used to determine whether there was a clinically significant difference between the percentile values obtained and those used in the consensus of the Argentine Association of Pediatrics (SAP). Results: There was no clinically significant difference with the values proposed by the SAP, except for TG for ages 1, 5, and 7 years at the 95th percentile and for age 8 years at the 75th and 95th percentile; and for HDL-C at the 10th percentile for ages 1, 16, and 17 years. Discussion: Lipid percentiles were obtained and compared with the reference values used by the consensus on which the guidelines are based (AU)

Presencia de autoanticuerpos anti islotes pancreáticos en diabetes tipo 1 durante la edad pediátrica / Presence of anti-pancreatic islet autoantibodies in type 1 diabetes in children

En la Diabetes tipo 1 (DM1) la pérdida de células ß pancreáticas es consecuencia de un proceso de autoinmunidad que cursa con la presencia de autoanticuerpos anti-islotes pancreáticos (AAPs). Estos AAPs son marcadores útiles para la clasificación de la enfermedad. En un centro pediátrico de tercer nivel se analizó la frecuencia de presentación de GADA, IA-2A, ZnT8A e IAA en un grupo con reciente debut entre enero 2018 y agosto 2021 (n= 90). Además, se investigó la frecuencia de presentación y relación de los AAPs con la edad, sexo y tiempo de evolución en pacientes en seguimiento (n= 240). En el grupo de debut se obtuvo positividad de GADA, IA-2A, ZnT8A y IAA en 77,8; 60; 62 y 47,8% de los pacientes respectivamente, un 4% no presentó AAPs. El 95,6% de los pacientes presentaron al menos un AAPs positivo. La frecuencia de IAA en el grupo en debut fue mayor en menores de 5 años. En el grupo en seguimiento el 75,2% resultaron GADA positivo (85,7% en mujeres y 62,8% en varones) p<0,05. IA-2A y ZnT8A fueron positivos en 45 y 51.7% respectivamente. El 91% presentaron al menos un AAP positivo. En este grupo se evidenció una menor positividad en función del tiempo de evolución. Se pudo determinar la frecuencia de presentación de los AAPs en un grupo en debut y la relación con la edad, sexo y tiempo de evolución en pacientes en seguimiento. La determinación de APPs facilita la correcta clasificación y elección de la terapia adecuada (AU)

In type 1 diabetes (DM1) the loss of pancreatic ß-cells is a consequence of an autoimmune process that results in the presence of pancreatic anti-islet autoantibodies (PAAs). PAAs are useful markers for the classification of the disease. The frequency of presentation of GADA, IA-2A, ZnT8A, and IAA in a group with recent debut seen between January 2018 and August 2021 (n= 90) was analyzed in a tertiary pediatric center. In addition, we investigated the frequency of presentation and association of PAAs with age, sex, and time of evolution in patients in follow-up (n= 240). In the debut group, GADA, IA2A, ZnT8A, and IAA positivity was found in 77.8, 60, 62, and 47.8% of patients, respectively; no PAAs were observed in 4% of the patients. Overall, 95.6% presented at least one positive PAA. The frequency of IAA in the debut group was higher in children younger than 5 years. In the follow-up group, 75.2% were GADA positive (85.7% of females and 62.8% of males) p<0.05. IA-2A and ZnT8A were positive in 45 and 51.7% respectively. Ninety-one percent presented with at least one positive PAA. In this group, a lower positivity was evidenced as a function of the time of evolution. The frequency of presentation of PAAs in a debut group and the relationship with age, sex, and time of evolution in patients in follow-up was demonstrated. The assessment of PAAs facilitates the correct classification and choice of adequate therapy (AU)