Shortage of perioperative supplies and drugs: Theory and practical implications / Desabastecimiento de insumos y medicamentos de uso perioperatorio: teoría e implicaciones prácticas

Abstract During the past three decades the world has been witness to an alarming increase in the shortage of drugs and biomedical products in the field of anesthesia and surgical care. This situation can be particularly challenging when there are no therapeutic alternatives available, as is the case with some supplies and drugs for perioperative use. Anesthesiologists, who play a crucial role in the preparation of the drugs they administer, are particularly aware of these shortages. The reasons for these shortages are diverse and involve problems in supply, demand and government regulation. Among the causes identified are the increase in demand, bidding systems and the sustainability challenges faced by pharmaceutical companies. It is essential to understand these causes in order to seek strategies to reduce the risk of shortages of medicines and supplies. Addressing this challenge requires improving supply chain management, fostering transparency in information on stock-outs, promoting local production of medicines, and strengthening procurement and distribution regulations and policies. The solution to this problem requires a comprehensive and collaborative approach, with multiple stakeholders working together to ensure adequate access to needed medications in the anesthesia and surgical care setting.

Resumen Durante las últimas tres décadas, en el mundo se ha observado un alarmante aumento en el desabastecimiento de medicamentos y productos biomédicos en el ámbito de la atención anestésica y quirúrgica. Esta situación puede resultar especialmente problemática cuando no existen alternativas terapéuticas disponibles, como ocurre en algunos casos de insumos y medicamentos de uso perioperatorio. Los anestesiólogos, quienes desempeñan un papel crucial en la preparación de los medicamentos que administran, son particularmente conscientes de estos fenómenos de desabastecimiento. Las causas de estos desabastecimientos son diversas e involucran problemas en la oferta, la demanda y la regulación estatal. Entre las causas identificadas se encuentran el aumento en la demanda, los sistemas de licitación y los desafíos de sostenibilidad que enfrentan las empresas farmacéuticas. Es fundamental comprender estas causas para buscar estrategias que reduzcan el riesgo de desabastecimiento de medicamentos e insumos. Para abordar este desafío se requiere mejorar la gestión de la cadena de suministro, fomentar la transparencia en la información sobre desabastecimientos, promover la producción local de medicamentos y fortalecer las regulaciones y políticas de adquisición y distribución. La solución a este problema exige un enfoque integral y colaborativo, en el que múltiples partes interesadas trabajen conjuntamente para garantizar un acceso adecuado a los medicamentos necesarios en el ámbito de la atención anestésica y quirúrgica.

Can India achieve UNAIDS’ target by 2030?

The world is embarking on a fast-track strategy to end the AIDS epidemic by 2030. UNAIDS is targeted towards achieving the 95-95-95 strategy by 2025. Scaling up prevention, testing and treatment services towards HIV/AIDS is paramount in achieving these targets. To understand the status of India in achieving these targets, review of trials registered in the CTRI registry was done and found that among the 155 included trials, most (n=45, 29%) of the trials were drug trails, few were vaccine trials (n=6, 3.8%). Out of 155 studies, forty-one (20%) were in line to reach UNAIDS’ targets. The primary focus of those studies was improving CD4 counts and suppression of viral load (third target of UNAIDS’) (n=12, 7.7%), and the minimal focus was on promoting treatment adherence (second target of UNAIDS’) (n=11, 7%) and promotion of HIV testing (first target of UNAIDS’) (n=4, 2.5%). As prevention is always better than care, research should be encouraged towards prevention of HIV, which in turn facilitates achieving UNAIDS’ 2025 and 2030 targets.

Estimation of risk posed by malignant polyps amongst colorectal surgeons in Australia and New Zealand

Purpose@#The estimation of the risk posed by malignant polyps for residual or lymphatic disease plays a central role. This study investigated colorectal surgeons’ assessment of these risks associated with malignant polyps. @*Methods@#A cross-sectional questionnaire was electronically administered to colorectal surgeons in Australia and New Zealand in October 2022. The questionnaire contained 17 questions on demographics, when surgeons consider colorectal resection appropriate, and the risk assessment for 5 hypothetical malignant polyps. @*Results@#The mean risk of residual or lymphatic disease that would prompt surgeons to recommend colonic resection was 5%. However, this increased to a mean risk of 10% if the malignant polyp was located in the rectum, and the only resection option was abdominoperineal resection with end-colostomy. There was high concordance between the estimated risk of residual or lymphatic disease by colorectal surgeons and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines for the 5 hypothetical malignant polyps, with the ACPGBI estimated risk lying within the 95% confidence interval for 4 of the 5 malignant polyps. Nonetheless, 96.6% of surgeons felt that an online risk calculator would improve clinical practice. @*Conclusion@#Colorectal surgeons in Australia and New Zealand accurately estimated the risk posed by malignant polyps. An online risk calculator may assist in better conveying risk to patients.

Obstructing colorectal cancer: a population-based review of colonic stenting in Queensland, Australia

Purpose@#Stenting is a useful treatment option for malignant colonic obstruction, but its role remains unclear. This study was designed to establish how stents have been used in Queensland, Australia, and to review outcomes. @*Methods@#Patients diagnosed with colorectal cancer in Queensland from January 1, 2008, to December 31, 2014, who underwent colonic stent insertion were reviewed. Primary outcomes of 5-year survival, 30-day mortality, and overall length of survival were calculated. The secondary outcomes included patient and tumor factors, and stoma rates. @*Results@#In total, 319 patients were included, and distant metastases were identified in 183 patients (57.4%). The 30-day mortality rate was 6.6% (n=21), and the 5-year survival was 11.9% (n=38). Median survival was 11 months (interquartile range, 4–27 months). A further operation (hazard ratio [HR], 0.19; P<0.001) and chemotherapy and/or radiotherapy (HR, 0.718; P=0.046) reduced the risk of 5-year mortality. The presence of distant metastases (HR, 2.052; P<0.001) and a comorbidity score of 3 or more (HR, 1.572; P=0.20) increased mortality. Surgery was associated with a reduced risk of mortality even in patients with metastatic disease (HR, 0.14; P<0.001). Twenty-two patients (6.9%) ended the study period with a stoma. @*Conclusion@#Colorectal stenting was used in Queensland in several diverse scenarios, in both localized and metastatic disease. Surgery had a survival advantage, even in patients with metastatic disease. There was no survival difference according to whether patients were socioeconomically disadvantaged, diagnosed in a major city or not, or treated at private or public hospitals. Stenting proved a valid treatment option with low stoma rates.

Estudio nacional sobre síndrome de burnout académico en residentes de urología en Colombia / National study on academic burnout syndrome in Colombian urology residents

Objetivo: El médico residente de urología está inmerso en situaciones académicas y extraacadémicas que pueden generar agotamiento, desinterés, autosabotaje frente a sus actividades y dudas acerca del valor del estudio, lo cual conduce al síndrome de burnout en un contexto académico. Este síndrome puede desencadenar deserción, bajo rendimiento académico, baja autoestima y frustración personal. El objetivo de este estudio es determinar la prevalencia del síndrome de burnout académico en los residentes de urología en Colombia y proponer estrategias que permitan evitar o disminuir el síndrome de burnout académico en el contexto colombiano. Método: Estudio de corte transversal, con muestreo por conveniencia en médicos residentes de urología de los diferentes programas académicos de posgrado en Colombia. El instrumento aplicado fue la escala de medición Maslach Burnout Inventory-Student Survey (MBI-SS). Resultados: La prevalencia de burnout académico en residentes de urología de Colombia es del 59,5% (IC95%: 59,4-59,6%). Se categorizan las áreas de posible intervención en cuatro dimensiones: a) administración de tiempo; b) estrategias de formación; c) actividades extracurriculares, y d) cuidados de salud mental. Conclusiones: El síndrome de burnout académico afecta al 59,5% de los residentes de urología de Colombia. Las actividades para prevenir y tratar el burnout académico se pueden enfocar en: organización del tiempo de las actividades académicas, tiempos reservados para investigación, actividades asistenciales y actividades extraacadémicas; desarrollo de rutas de apoyo emocionales/académicas; promoción sobre actividades de bienestar universitario.

Objective: The urology resident is involved in academic and extra-academic situations that can generate exhaustion, disinterest, self-sabotage, and doubts about the value of this own study methods; this context leads to burnout syndrome in an academic context. This syndrome can trigger dropout, low academic performance, low self-esteem, and personal frustration. The objective of this study is to determine the prevalence of academic burnout syndrome in urology residents in Colombia, and to propose strategies to avoid or reduce academic burnout syndrome in the Colombian context. Method: Cross-sectional study with convenience sampling in urology residents of all postgraduate academic programs of Colombia. The instrument applied was the Maslach Burnout Inventory-Student Survey (MBI-SS) measurement scale. Results: The prevalence of academic burnout in urology residents in Colombia is 59.5% (IC95%: 59.4-59.6%). The areas of possible intervention are categorized into four dimensions: a) time management; b) training strategies; c) extracurricular activities management, and d) mental health care. Conclusions: Academic burnout syndrome affects 59.5% of urology residents in Colombia. Activities to prevent and treat academic burnout can be focused on: organization of time for academic activities, time reserved for research and extracurricular activities, development of emotional and academical support routes, promotion of university wellness activities.

Prácticas clínicas para el manejo de la bacteriuria asintomática preoperatoria en cirugía endourológica de litiasis urinaria / Clinical practices for the management of preoperative asymptomatic bacteriuria in endourological surgery for urolithiasis

Objetivo: Describir las prácticas de médicos especialistas en urología e infectología con práctica clínica en Colombia para el manejo de la bacteriuria asintomática (BA) preoperatoria de pacientes candidatos a cirugía de cálculos urinarios. Método: Estudio de corte transversal, con recolección de datos por medio de instrumento tipo encuesta, diligenciada por especialistas en urología e infectología en Colombia. Se excluyeron las encuestas con respuestas incompletas o participantes con práctica clínica fuera de Colombia. El análisis estadístico se realizó en SPSS v25.0. Se consideró significativa una p < 0,05. Resultados: Se incluyeron 187 participantes, 85% urólogos y 15% infectólogos. La conducta prequirúrgica más frecuente en el manejo de la BA preoperatoria fue iniciar tratamiento antibiótico dirigido por urocultivo 72 horas antes del procedimiento quirúrgico y llevar al paciente a cirugía dentro de los siguientes tres días. Se evidenciaron diferencias en la práctica clínica (uso de antibiótico postoperatorio, tratamiento de la BA en pacientes con derivación urinaria, tiempo de validez del urocultivo preoperatorio, recomendación de diferir procedimiento hasta tener urocultivo negativo) según la especialidad y el volumen asistencial. Conclusiones: Se ha identificado heterogeneidad en el manejo de la BA previo a cirugía endourológica en Colombia. Se abre una oportunidad para desarrollar recomendaciones colombianas para el manejo de la BA preoperatoria en urolitiasis

Objective: To describe practices from Colombian specialists in urology and infectology for the handling of preoperative asymptomatic bacteriuria (AB) in patients that are candidates for endourological surgery of urolithiasis. Method: Cross-sectional study, with data collection through a survey-type instrument completed by specialists in urology and infectology in Colombia. Surveys with incomplete responses or participants with clinical practice outside of Colombia were excluded. Statistical analysis was performed in SPSS v25.0. A p < 0.05 was considered significant. Results: One hundred eighty-seven participants were included, of which 85% were urologists and 15% were infectologists. The most frequent presurgical behavior in the management of preoperative AB was to start targeted antibiotic treatment 72 hours before the procedure and take the patient to surgery within the next three days. Differences were evident in clinical practice (use of postoperative antibiotics, treatment of AB in patients with urinary diversion, validity period of the preoperative urine culture, recommendation to defer the procedure until a negative urine culture is obtained) depending on the specialty and surgical or clinical volume. Conclusions: The present study has identified heterogeneity in the management of AB prior to endourological surgery in Colombia. An opportunity opens up for the development of Colombian recommendations for the management of preoperative AB in urinary lithiasi

Evaluation of an automatized AMBU ESSI-1 INC designed at the Instituto Nacional de Cardiología Ignacio Chávez / Evaluación del AMBU automatizado ESSI-1 INC diseñado en el Instituto Nacional de Cardiología Ignacio Chávez

Abstract Objective: The objectives of this study were to evaluate an automated device for ventilatory support based on AMBU manufactured in March 2020. Methods: The ESSI-1 INC was evaluated through pulmonary mechanics and physiology parameters through compensatory spirometer tests (TISSOTs), and an artificial lung Model5600i Dual Adult PNEU VIEW SYSTEM; it was also compared to the anesthetic ventilatory support equipment (AEONMED 7500) in porcine models, measuring ventilatory, hemodynamic and gasometric parameters. Results: This equipment (ESSI-1 INC) was successfully tested by mechanical and biological models, such as pigs in which its performance was evaluated in terms of variability of tidal volume, ventilation frequency, and I/E relationship versus the manual performance of two medical interns. All the results turned out as expected and were satisfactory. Conclusions: It is safe and effective equipment and should be tested and used in diverse clinical conditions to standardize the ventilatory safety and care of patients who require it.

Resumen Objetivo: Evaluar un dispositivo automatizado para la asistencia ventilatoria basado en un AMBU manufacturado en Marzo del 2020. Métodos: El ESSI-1 INC fue evaluado por medio de parámetros fisiológicos y mecánica pulmonar a través de pruebas de espirómetro compensatorios (TISSOT); pulmón artificial (Modelo 5600i Dual Adult PNEU VIEW SYSTEM); así como su desempeño comparado a la máquina de anestesia (AEONMED 7500) en modelos porcinos, midiendo criterios ventilatorios, hemodinámicos y gasométricos. Resultados: Este equipo (ESSI-1 INC) fue exitosamente probado por modelos mecánicos y biológicos, tales como cerdos donde su desempeño fue evaluado en términos de la variabilidad del volumen tidal, frecuencia ventilatoria, y relación I/E versus el desempeño manual de dos médicos. Todos los resultados finalizaron como se esperaba de forma satisfactoria. Conclusiones: Es un equipo seguro y efectivo, el cual debería ser probado y usado en distintas condiciones clínicas para estandarizar la seguridad ventilatoria y cuidado de pacientes que lo requieran.

Desenlaces maternos y neonatales en gestantes con cardiopatía con evaluación única vs. evaluación semiestructurada por un equipo cardio-obstétrico / Maternal and neonatal outcomes in pregnant women with heart disease with single evaluation vs. semi-structured evaluation by a cardio-obstetric team

Resumen Introducción: Las enfermedades cardiovasculares en las gestantes son desafiantes, con alta morbimortalidad materna y perinatal, por lo que se recomienda un equipo cardio-obstétrico para su atención. Aun así, pocos datos evalúan el impacto de estos equipos. Por lo tanto, el presente estudio tiene como objetivo comparar los resultados obstétricos, maternos y neonatales del seguimiento semiestructurado (SSE) en una clínica cardio-obstétrica con respecto a un seguimiento usual o seguimiento no estructurado (SNE) en gestantes con enfermedad cardiaca. Métodos: Se realizó un registro prospectivo de gestantes con cardiopatías. Se compararon las pacientes con SSE por un equipo cardio-obstétrico, contra aquellas con evaluación única o SNE. Se calculó el riesgo de eventos según la clasificación de la Organización Mundial de la Salud modificado (OMSm) y la escala del Cardiac Disease in Pregnancy Study II (CARPREG-II) y se evaluaron los desenlaces cardiacos, obstétricos y neonatales. Resultados: Se evaluaron 168 pacientes, 37 con SSE y 131 con evaluación única (SNE). Los principales diagnósticos fueron cardiopatía congénita, arritmias y valvulopatías. La media del CARPREG-II en pacientes de SNE fue 2.48 (DE: 2.3) y en pacientes de SSE fue 3.37 (DE: 2.45; p = 0.041). La media de la OMSm en pacientes de SNE fue 2.1 (DE: 1.6) y con SSE fue 2.65 (DE: 0.95; p = 0.0052). No hubo diferencias significativas en los desenlaces cardiacos primarios (13.8% en SNE vs. 5.4% en SSE; p = 0.134), cardiacos secundarios (5.3 en SNE vs. 2.7 en SSE; p = 0.410), obstétricos (10% en SNE vs. 16.2% en SSE; p = 0.253) y neonatales (35.9% en SNE y 40.5% en SSE; p = 0.486) a pesar de que las pacientes con SSE tenían un riesgo mayor que las pacientes con SNE según las escalas de la OMSm y el CARPREG-II. Conclusiones: En gestantes con cardiopatía, un SSE comparado con un SNE por un equipo cardio-obstétrico no mostró diferencias estadísticamente significativas en los desenlaces cardiovasculares, obstétricos y neonatales, a pesar de que las pacientes con SSE tenían un riesgo significativamente más alto de desenlaces adversos por las escalas de la OMSm y el CARPREG-II. Esto sugiere que el SSE logra al menos equiparar los desenlaces a pesar del mayor riesgo de eventos adversos que tenían las pacientes de este grupo.

Abstract Introduction: Cardiovascular diseases in pregnant women are challenging, with high maternal and perinatal morbidity and mortality, so a cardio-obstetric team is recommended for their care. Even so, little data evaluates the impact of these teams. Therefore, the present study aims to compare the obstetric, maternal, and neonatal outcomes of semi-structured follow-up (SSF) in a Cardio-obstetric clinic concerning regular or unstructured follow-up (USF) in pregnant women with heart disease. Methods: A prospective registry of pregnant women with heart disease was carried out. Patients with SSF by a cardio-obstetric team were compared with those with single evaluation or USF. The risk of events was calculated according to the modified World Health Organization (mWHO) classification and the CARPREG-II scale, and cardiac, obstetric, and neonatal outcomes were evaluated. Results: One hundred sixty-eight patients were evaluated, 37 with SSF and 131 with single evaluation (USF). The primary diagnoses were congenital heart disease, arrhythmias, and valve disease. The average CARPREG-II in USF patients was 2.48 (SD 2.3); in SSF patients, it was 3.37 (SD 2.45; p = 0.041). The average of the mWHO in patients with USF was 2.1 (SD 1.6), and with SSF, it was 2.65 (SD 0.95; p = 0.0052). There were no significant differences in primary cardiac outcomes (13.8% in USF vs. 5.4% in SSF; p = 0.134), secondary cardiac (5.3% in USF vs. 2.7% in SSF; p = 0.410), obstetric (10% in USF vs. 16.2% in SSF; p = 0.253) and neonatal (35.9% in USF and 40.5% in SSF; p = 0.486) even though patients with SSF had a higher risk than patients with USF according to the mWHO and CARPREG-II scales. Conclusions: In pregnant women with heart disease, an SSF compared with a USF by a cardio-obstetric team did not show statistically significant differences in cardiovascular, obstetric, and neonatal outcomes. However, patients with SSF had a significantly higher risk of adverse outcomes due to the mWHO and CARPREG-II scales. This result suggests that the SSF achieves at least equal outcomes despite the higher risk of adverse events that patients in this group had.

Methylation analysis of Rb, P16, MGMT, and hMLH-1in mucoepidermoid carcinomas. A pilot study

Mucoepidermoid carcinoma (MC) is the most common malignant epithelial neoplasm in the salivary glands. This neoplasm has varying proportions of mucous, epidermoid, intermediate, columnar, and clear cells. MCs have been associated with CRTC1-MAML2 genes; however, their pathogenesis is uncertain. Recently, epigenetic changes have been considered a possible aetiologic factor. To identify the methylation state of RB, P16, MGMT, and hMLH genes in the three severity grades of MC were used five MCs and one healthy minor salivary gland as a control group (CG) obtained from the Pathology and Oral Medicine Laboratory and analyzed using MS-PCR to compare the presence or absence of methylation in promotor regions. The Kruskal- Wallis test was performed, with p≤0.05 considered significant. CG was employed as the normalizer of methylation levels. All assays were performed in triplicate. The mean age of our population was 52.6±18.6 years old; the total population was female and included 2 low grade, 2 intermediate grade, and 1 high grade levels of severity. When comparing the methylation status of the three histopathological grades of MC against the control, statistically significant differences were observed in Rb-M, MGMT-M, and hMLH-1-NM for high-grade severity, with p values of 0.03, 0.05, and 0.04, respectively. Methylation is a possible mechanism for pathogenesis processing of high-grade MC. However, a larger sample population is necessary to validate this finding.

El carcinoma mucoepidermoide (CM) es la neoplasia epitelial maligna más frecuente de glándulas salivales. Esta neoplasia tiene proporciones variables de células mucosas, epidermoides, intermedias, cilíndricas y claras. Los CM se han asociado con los genes CRTC1-MAML2; sin embargo, su patogenia es incierta. Recientemente, los cambios epigenéticos se han considerado un posible factor etiológico. Para identificar el estado de metilación de los genes RB, P16, MGMT y hMLH en los tres grados de severidad de CM se utilizaron cinco CM y una glándula salival menor sana como grupo control (GC) obtenidos del Laboratorio de Patología y Medicina Oral y analizados mediante MS-PCR para comparar la presencia o ausencia de metilación en regiones promotoras. Se realizó la prueba de Kruskal-Wallis, considerándose significativa una p≤0,05. Se empleó GC como normalizador de los niveles de metilación. Todos los ensayos se realizaron por triplicado. La edad media de nuestra población fue de 52,6 ± 18,6 años; la población total era femenina e incluía 2 niveles de severidad de grado bajo, 2 de grado intermedio y 1 de alto grado. Al comparar el estado de metilación de los tres grados histopatológicos de CM contra el GC, se observaron diferencias estadísticamente significativas en Rb-M, MGMT-M y hMLH-1-NM para severidad de alto grado, con valores de p de 0.03, 0.05, y 0,04, respectivamente. La metilación es un posible mecanismo para el procesamiento de patogénesis de CM de alto grado. Sin embargo, se necesita una población de muestra más grande para validar este hallazgo.

Presencia de mastocitoma en el pabellón auricular en un canino

RESUMEN Los mastocitos cutáneos y subcutáneos son neoplasias compuestas por mastocitos que forman parte de la piel en los caninos. Es un tumor muy común y el tratamiento va enfocado a la agresividad que pudiera presentar. Ocasionalmente se puede administrar un tratamiento local, sin embargo, este no debe considerarse en pacientes con metástasis. La estadificación del tumor es de gran importancia para dar un diagnóstico, tratamiento y pronóstico para aquellos pacientes afectados por esta patología. En este trabajo se presenta el caso clínico de un canino Pastor Alemán de 11 años con la presencia de una estructura ulcerada en el pabellón auricular derecho. Se realizó diagnóstico por citología e histopatológico de mastocitoma canino grado II y baja malignidad de acuerdo con la clasificación de Pakiel. Al paciente se le realizó una resección parcial del pabellón auricular con presencia de bordes limpios en los resultados del estudio histopatológico. El objetivo de este trabajo es reportar un caso clínico con la presencia de mastocitoma en el pabellón auricular en un perro doméstico.

ABSTRACT Cutaneous and subcutaneous mast cells tumor are neoplasms composed of mast cells that are part of the skin in canines. It is a very common tumor and the treatment is focused on the aggressiveness that it may present. Sometimes it can be limited to local treatment, but if there are metastases, the prognosis can be favorable. Tumor staging is of great importance to give a diagnosis, treatment and prognosis for those patients affected by this pathology. In this work, we present the clinical case of an 11-year-old German shepherd canine with the presence of an ulcerated mass in the right auricle. The diagnosis was made by cytology and histopathology of canine mastocytoma grade II and low malignancy according to Pakiel's classification. The patient underwent a partial resection of the auricle with the presence of clean borders in the histopathological results. This is the first report of the presence of canine mastocytoma in the pinna in a canine.

Nuevas perspectivas en el estudio y tratamiento de la sepsis

La sepsis es una disfunción orgánica potencialmente mortal debida a una respuesta desregulada del hospedero a la infección. No sólo contribuye con el 20 % de todas las causas de muerte de forma global, sino que los sobrevivientes de esta también pueden experimentar una significativa morbilidad a largo plazo. La sepsis y el shock séptico son emergencias médicas que requieren reconocimiento rápido, administración de antimicrobianos apropiados, soporte hemodinámico cuidadoso y control de la fuente infecciosa. El objetivo de esta revisión fue describir la definición y los criterios diagnósticos, la epidemiología, los factores de riesgo, la patogenia y la conducta inicial ante la sepsis.

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. It severely impacts global disease burden as it constates 20 % of all causes of death; its survivors may experience long-term morbidity. Sepsis and septic shock are medical emergencies that require rapid identification, administration of appropriate antimicrobials, careful hemodynamic support, and control of the infection source. This review aims to update the definition of sepsis and its diagnostic criteria, epidemiology, risk factors, pathogenesis, and baseline behavior.

Agave mapisaga aqueous extract shows in vitro and in vivo activity on murine prostate cancer cells / El extracto acuoso del Agave mapisaga presenta actividad in vitro e in vivo sobre células de cáncer de próstata murino

Plants are a source of multiple antineoplastic treatments. However, the effect of many species used in traditional medicine has yet to be demonstrated. In this work, the taxonomic identification of Agave mapisaga was made and a high-performance liquid chromatography-mass spectrometry (HPLC-MS) study suggested the presence of the aglycone hecogenin, which is part of compounds such as agavoside C and cantalasaponin 4. The antineoplastic activity of an aqueous extract was tested in vitro and in vivo on PEC-Src epithelial murine prostate cancer cells. In vitro study revelead a significant chemosensivity at 0.125 mg/100 µL (p=0.0001). Also, in in vivo, using an isotransplantation model with 1x106 cells subcutaneously, it was observed that the group treated with 50 mg/kg presented a lower tumor implantation compared with the control without treatment (p=0.04).

Las plantas son fuente de múltiples tratamientos antineoplásicos. Sin embargo, aún falta demostrar el efecto de muchas especies usadas en la medicina tradicional. En este trabajo se realizó la identificación taxonómica del Agave mapisaga y un estudio de cromatografía líquida de alta definición­masas (HPLC-MS) que sugirió la presencia de la aglicona hecogenina, que forma parte de compuestos como el agavósido C y la cantalasaponina 4. Se probó la actividad antineoplásica de un extracto acuoso in vitro e in vivo sobre células de cáncer de próstata murino epitelial PEC-Src. En el estudio in vitro se observó una actividad citotóxica significativa a partir de 0.125 mg/100 µL (p=0.0001). Mientras que, en los experimentos in vivo, se isotransplantaron 1x106 células por vía subcutánea, se observó que el grupo tratado con 50 mg/kg presentó una menor implantación tumoral con respecto del testigo sin tratamiento (p=0.04).

Top Ten Lessons Learned from Trials in Oligometastatic Cancers / Journal of the Korean Cancer Association, 대한암학회지

Recent evidence supports the role of aggressive local treatment in the oligometastatic setting. In this review, we discuss the top 10 lessons we have learned from trials in oligometastatic cancers. Major lessons learned pertain to definitions of oligometastatic disease, outcomes, toxicity, costs, and the combination of ablative therapies with systemic therapy, including immunotherapy. Barriers to accrual for trials and upcoming phase III trials are also reviewed. These lessons may help to inform clinical practice and may be the basis for future research in the oligometastatic space.

Litiasis urinaria en el donante cadavérico: respuestas a la penumbra urológica desde un análisis bibliométrico / Urolithiasis in the brain-dead donor: responses to the urological penumbra from a bibliometric analysis

La literatura disponible sobre las implicaciones de la urolitiasis en la donación y trasplante renal (TxR) con injertos de donante cadavérico es limitada; la información disponible tiene especial énfasis en el donante vivo. Objetivo: Exponer la producción bibliográfica y las implicaciones clínicas de la urolitiasis en el proceso de donación y TxR incluyendo la perspectiva con injertos de donante cadavérico. Métodos: Análisis bibliométrico ejecutado mediante una búsqueda sistemática de la literatura en Medline, Embase, SciELO, Cochrane Central, Google Académico y Web of Science utilizando combinaciones de los términos MesH "urolithiasis", "kidney calculi", "ureteral calculi", "tissue and organ procurement", "brain death", "living donors" y "kidney transplantation". Se limitó la búsqueda a artículos publicados entre los años 2000-2022. Resultados: Se analizaron 23 artículos. El 95.6% de ellos fueron publicados en inglés, el 26% se publicaron en revistas del cuartil 1, solo un tercio de ellos tienen relación con el donante cadavérico. La urolitiasis en el injerto renal no es una contraindicación absoluta para el trasplante, se puede ofrecer manejo quirúrgico activo ex vivo durante la cirugía de banco para cálculos > 4 mm y el trasplante con observación para injertos renales con cálculos < 4 mm. Conclusiones: La producción científica en términos de litiasis urinaria y donación/TxR es limitada. El hallazgo incidental de urolitiasis en el donante vivo o cadavérico de riñón no es una contraindic

The clinical literature about the implications of urolithiasis in the process of kidney donation/transplantation (KTx) from deceased donors is scarce. Objectives: To expose the current state of bibliographic production and the clinical implications of urolithiasis in the process of kidney donation/transplantation focus on cadaveric donor grafts. Methods: We performed a bibliometric analysis based on a systematic review of the literature in Medline, Embase, SciELO, Cochrane Central, Google Scholar and Web of Science using combinations (OR, AND) of MesH terms: "urolithiasis", "kidney calculi", "ureteral calculi", "tissue and organ procurement", "brain death", "living donors" and "kidney transplantation". The search was limited to primary articles, systematic reviews or meta-analyses performed in humans published between 2000-2022. Results: Twenty-three articles were included for analysis; 95.6% of the bibliographic production was published in English, 26% were published into quartile 1 journals. One third of the references were focused on cadaveric donors. The information obtained concludes that presence of urolithiasis in the kidney graft is not an absolute contraindication for KTx and proposes the ex vivo surgical management of urolithiasis during the bench surgery for stones > 4 mm and to proceed with KTx and then follow-up for kidney grafts with stones < 4 mm. Conclusions: The scientific production related to urolithiasis and kidney donation/transplantation is limited. The literature available concludes that incidental kidney stones in kidney grafts should not be considered an absolute contraindication for KTx. Ex vivo surgical management of urolithiasis is a feasible and safe prior to KTx

Mecanismos plasmídicos de resistencia a quinolonas, betalactámicos y colistina en Salmonella enterica. Paraguay 2020-2021

Las bacterias son capaces de desarrollar mecanismos de resistencia a los antimicrobianos, aquellos adquiridos y transmisibles son los más significativos debido al potencial de diseminación. La aparición de Salmonella enterica con resistencia a C3aG, quinolonas y a colistina representa una amenaza progresiva. El objetivo fue determinar la resistencia a los antimicrobianos y la presencia de los mecanismos de resistencia plasmídicos a quinolonas, ß-lactámicos y colistina en aislados de Salmonella provenientes de la vigilancia integrada de enteropatógenos. Fueron estudiadas 501 cepas de Salmonella spp. colectadas entre los años 2020 y 2021, por la red de enteropatógenos del Laboratorio Central de Salud Pública. Se investigó la resistencia a las C3aG, quinolonas y colistina, en aislamientos de humanos, alimentos, animales de consumo y ambiente. Las cepas estudiadas exhibieron resistencia a tetraciclina (32,5%), ácido nalidíxico (29%), ampicilina (13,2%), nitrofurantoína (11,6%), C3aG (7,2%), cotrimoxazol (5,8%), ciprofloxacina (2,2%). El 18% (90/501) presentaron resistencia trasferible por plásmidos, fueron detectados 111 genes (71 cepas con un gen, 17 cepas dos genes y 2 cepas tres genes diferentes). Qnr B: 41,1% (37/90), mcr-1: 38,9% (35/90), CMY: 23,3% (21/90), CTX-M: 16,7% (15/90) y Qnr S: 3,3% (3/90). Heidelberg fue el serovar predominante en muestras de pollo y el mayor portador de genes de resistencia de tipo CMY y mcr-1. La detección de genes en alimentos y animales de consumo, que pueden transmitirse fácilmente al ser humano es motivo de alerta y resalta la importancia de continuar fortaleciendo la vigilancia multisectorial y multidisciplinaria.

Bacteria can develop antimicrobial resistance mechanisms, those acquired and transmissible being the most significant due to the potential for dissemination. The emergence of Salmonella enterica with resistance to third-generation cephalosporins, quinolones, and colistin represents a progressive threat. The objective was to determine antimicrobial resistance and the presence of plasmid resistance mechanisms to quinolones, ß-lactams, and colistin in Salmonella isolates from integrated surveillance of enteropathogens. Five hundred and one strains of Salmonella spp. collected between 2020 and 2021 were studied by the enteropathogen network of the Laboratorio Central de Salud Publica (Central Public Health Laboratory). Research was conducted on the resistance to third-generation cephalosporins, quinolones, and colistin, isolated from humans, foodstuffs, animals for consumption, and the environment. The strains studied exhibited resistance to tetracycline (32.5%), nalidixic acid (29%), ampicillin (13.2%), nitrofurantoin (11.6%), third-generation cephalosporins (7.2%), cotrimoxazole (5.8%), and ciprofloxacin (2.2%). Eighteen percent (90/501) presented plasmid-transferable resistance, 111 genes were detected (71 strains with one gene, 17 strains with two genes, and 2 strains with three different genes). Qnr B: 41.1% (37/90), mcr-1: 38.9% (35/90), CMY: 23.3% (21/90), CTX-M: 16.7% (15/90), and Qnr S: 3.3% (3/90). Heidelberg was the predominant serovar in chicken samples and the largest carrier of CMY and mcr-1 resistance genes. The detection of genes in foodstuffs and animals for consumption, which can be easily transmitted to humans, is a cause for alarm and highlights the importance of continuing to strengthen multisectoral and multidisciplinary surveillance.

DNA methylation analysis identifies key transcription factors involved in mesenchymal stem cell osteogenic differentiation

BACKGROUND: Knowledge about regulating transcription factors (TFs) for osteoblastogenesis from mesenchymal stem cells (MSCs) is limited. Therefore, we investigated the relationship between genomic regions subject to DNA-methylation changes during osteoblastogenesis and the TFs known to directly interact with these regulatory regions. RESULTS: The genome-wide DNA-methylation signature of MSCs differentiated to osteoblasts and adipocytes was determined using the Illumina HumanMethylation450 BeadChip array. During adipogenesis no CpGs passed our test for significant methylation changes. Oppositely, during osteoblastogenesis we identified 2462 differently significantly methylated CpGs (adj. p < 0.05). These resided outside of CpGs islands and were significantly enriched in enhancer regions. We confirmed the correlation between DNA-methylation and gene expression. Accordingly, we developed a bioinformatic tool to analyse differentially methylated regions and the TFs interacting with them. By overlaying our osteoblastogenesis differentially methylated regions with ENCODE TF ChIP-seq data we obtained a set of candidate TFs associated to DNA-methylation changes. Among them, ZEB1 TF was highly related with DNA-methylation. Using RNA interference, we confirmed that ZEB1, and ZEB2, played a key role in adipogenesis and osteoblastogenesis processes. For clinical relevance, ZEB1 mRNA expression in human bone samples was evaluated. This expression positively correlated with weight, body mass index, and PPARγ expression. CONCLUSIONS: In this work we describe an osteoblastogenesis-associated DNA-methylation profile and, using these data, validate a novel computational tool to identify key TFs associated to age-related disease processes. By means of this tool we identified and confirmed ZEB TFs as mediators involved in the MSCs differentiation to osteoblasts and adipocytes, and obesity-related bone adiposity.

Adjunctive Middle Turbinectomy for Endoscopic Medial Orbital Wall - Thyroid Eye Disease Decompression

Abstract Introduction Middle turbinate resection (MTR) is commonly performed during endonasal endoscopic sinus and skull base surgery. Objective The purpose of this study was to characterize the additional orbital soft-tissue volume expansion during endoscopic medial orbital wall decompression with adjunctive MTR. Methods A retrospective review of patients who underwent endoscopic medial wall decompression with MTR was performed. The imaging software AW (GE Healthcare, Chicago, IL, USA) was used to overlay pre and postoperative orbital computed tomography (CT) images to visualize the preoperative position of the middle turbinate and the postoperative orbital soft tissue in the ethmoid bed. The imaging software Vitrea (Vital Images Inc., Minnetonka, MN, USA) was used to manually segment postoperative scans to determine the volume of orbital tissue which had filled the space previously occupied by the middle turbinate or medial to it. Results Nine orbits from 5 patients were included in this study; all patients were female with a history of hyperthyroidism. The average age was 55.6 years (range 32- 74). Of the 9 orbits, 7 (78%) had orbital soft tissue within the space of the resected middle turbinate postoperatively. The average volume of orbital tissue within or medial to this space was 0.83 +/- 0.67 cc. No patients had any postoperative complications. Conclusions In this patient cohort, adjunctive middle turbinate resection for endoscopic medial orbital wall decompression added ~ 0.83 cc of volume for orbital soft tissue after medial wall decompression. Middle turbinate resection is a useful adjunct to the orbital surgeon's armamentarium to augment the results of a medial orbital decompression for select patients.

Taquicardia ventricular asociada a mutación en el gen de ankirina B / Ventricular tachycardia associated to a mutation in the ankyrin B gen

Resumen Se presenta el caso de una mujer de 14 años, con taquicardiomiopatía secundaria a taquicardia ventricular. Se evidenció la presencia de una variante de significado incierto en el gen ANK2, por lo que se consideró un posible síndrome de ankirina B. La paciente fue tratada con éxito a través de ablación con radiofrecuencia. Tras dicho procedimiento, tuvo recuperación completa de su función ventricular izquierda y resolución de los complejos ventriculares prematuros y los episodios de taquicardia ventricular.

Abstract We report a case of a 14-year-old with tachycardiomyopathy due to ventricular tachycardia. A variant of uncertain significance of the ANK2 gene was identified, which is suggestive of a possible ankyrin-B syndrome. The patient underwent a successful radiofrequency ablation. After the procedure, the patient completely recovered her left ventricular function and there was resolution of the premature ventricular complexes and ventricular tachycardia.

Lactato como marcador temprano de hipoxia cerebral en pacientes neurológicos bajo anestesia general: una revisión sistemática / Lactate as an early marker of cerebral hypoxia in neurological patients under general anesthesia: a systematic review

Resumen: Las complicaciones neurológicas perioperatorias secundarias a hipoxia durante procedimientos de sedación y anestesia general son frecuentes en cirugía cardiovascular y en pacientes con comorbilidades. Sin embargo, hasta el momento no existe un consenso para el diagnóstico de estas posibles complicaciones. En pacientes con trauma encefálico severo y/o hemorragia subaracnoidea el lactato cerebral no fue útil para predicción de hipoxia cerebral; pese a ello, la relación de lactato/piruvato podría ser una herramienta para diagnóstico intraoperatorio de hipoxia cerebral aguda. Los estudios sugieren que éste debe asociarse a otros marcadores y/o a monitoreo multimodal. Es necesario realizar estudios que evalúen su valor predictivo para hipoxia cerebral.

Abstract: Perioperative neurological complications secondary to hypoxia during sedation and general anesthesia procedures are frequent in cardiovascular surgery, and in patients with comorbidities. However, so far there is no consensus for the diagnosis of these possible complications. In patients with head trauma severe and/or subarachnoid hemorrhage cerebral lactate was not useful for predicting cerebral hypoxia, however the lactate/pyruvate ratio could be a tool for intraoperative diagnosis of acute cerebral hypoxia. Studies suggest that it must be associated with other markers or multimodal monitoring. Further studies are needed to evaluate lactate predictive value for the diagnosis of cerebral hypoxia.