Description of mpox reinfection by whole genome sequencing.

Several possible mpox reinfections have been reported, however, the debate on whether these are confirmed reinfections remains open. A 30-year-old male living with HIV and a history of single-dose mpox vaccination, first diagnosed with mpox in September 2022, presented with genital ulcers in March 2023, testing positive for mpox virus. Real-time polymerase chain reaction revealed the presence of viral DNA with cycle threshold values of 24 and 25, respectively. Whole genome sequencing and phylogenetic approach allowed us to classify these viruses as Clade IIb lineage B.1 and Clade IIb lineage B.1.4, respectively. Twelve nucleotide differences were identified. The observed difference was higher than the estimate of mutations/genome/year described. These data confirm that mpox reinfection is possible and reinforces current vaccination campaigns.

First confirmation of importation and transmission in Spain of the newly identified SARS-CoV-2 B.1.1.7 variant.

INTRODUCTION: A newly identified SARS-CoV-2 variant, VOC202012/01 originating lineage B.1.1.7, recently emerged in the United Kingdom. The rapid spread in the UK of this new variant has caused other countries to be vigilant. MATERIAL AND METHODS: We based our initial screening of B.1.1.7 on the dropout of the S gene signal in the TaqPath assay, caused by the 69/70 deletion. Subsequently, we confirmed the B.1.1.7 candidates by whole genome sequencing. RESULTS: We describe the first three imported cases of this variant from London to Madrid, subsequent post-arrival household transmission to three relatives, and the two first cases without epidemiological links to UK. One case required hospitalization. In all cases, drop-out of gene S was correctly associated to the B.1.1.7 variant, as all the corresponding sequences carried the 17 lineage-marker mutations. CONCLUSION: The first identifications of the SARS-CoV-2 B.1.1.7 variant in Spain indicate the role of independent introductions from the UK coexisting with post-arrival transmission in the community, since the early steps of this new variant in our country.

A Pilot Study on the Use of Low Doses of CBD to Control Seizures in Rare and Severe Forms of Drug-Resistant Epilepsy.

Due to its anticonvulsant properties, cannabidiol can be supportive as an adjuvant therapy in the management of drug resistant epilepsy. This retrospective observational study evaluates the intensity and frequency of the seizures of patients with drug-resistant epilepsy that have been treated with antiepileptic medication associated with CBD in low doses for at least 12 months. Thirty-four patients were included in the study. The most frequent diagnosis of epilepsy was focal symptomatic epilepsy and Lennox−Gastaut syndrome (35.2%). During the follow-up, there was a statistically significant decrease in the seizure frequency (t student p < 0.001). A high proportion of patients, 16, concluded the study with a total control of the seizures reaching a 100% improvement, 12 reported ≥ 75% improvement, 3 ≥ 50%, and 2 ≥ 25%; only 1 patient had an improvement of less than 25%. This is the first Latin American study that demonstrates that long-term CBD added to the usual drugs significantly reduces the frequency, duration, and type of seizures in the different etiologies of epilepsy, being especially effective on the seizures that are the most incapacitating, improving the quality of life of the individual and their family.

First confirmation of importation and transmission in Spain of the newly identified SARS-CoV-2 B.1.1.7 variant / Primera confirmación de importación y transmisión en España de la variante B.1.1.7 del SARS-CoV-2 recientemente identificada

Introduction: A newly identified SARS-CoV-2 variant, VOC202012/01 originating lineage B.1.1.7, recently emerged in the United Kingdom. The rapid spread in the UK of this new variant has caused other countries to be vigilant. Material and methods: We based our initial screening of B.1.1.7 on the dropout of the S gene signal in the TaqPath assay, caused by the 69/70 deletion. Subsequently, we confirmed the B.1.1.7 candidates by whole genome sequencing. Results: We describe the first three imported cases of this variant from London to Madrid, subsequent post-arrival household transmission to three relatives, and the two first cases without epidemiological links to UK. One case required hospitalization. In all cases, drop-out of gene S was correctly associated to the B.1.1.7 variant, as all the corresponding sequences carried the 17 lineage-marker mutations. Conclusion: The first identifications of the SARS-CoV-2 B.1.1.7 variant in Spain indicate the role of independent introductions from the UK coexisting with post-arrival transmission in the community, since the early steps of this new variant in our country.(AU)

Introducción: Recientemente, ha surgido en Reino Unido una nueva variante de SARS-CoV-2, VOC202012/01, que origina el linaje B.1.1.7. Su rápida distribución en Reino Unido ha alertado a otros países a vigilar su presencia. Material y métodos: El rastreo inicial de la variante B.1.1.7 se basó en la ausencia de amplificación del gen S en el ensayo TaqPath, causado por la deleción 69/70. Todos los casos candidatos de corresponder a la variante B.1.1.7 con este criterio fueron posteriormente confirmados por secuenciación de genoma completo. Resultados: Describimos los primeros 3 casos importados de esta variante, desde Londres hasta Madrid, con la posterior transmisión domiciliaria de uno de estos casos a 3 familiares y, adicionalmente, los 2 primeros casos con la variante sin vínculo epidemiológico con Reino Unido. Uno de los casos requirió hospitalización. En todos los casos el criterio de no amplificación del gen S identificó con precisión la variante B.1.1.7, como demostró posteriormente la presencia de las 17 mutaciones marcadoras de este linaje. Conclusión: Las primeras identificaciones de la variante B.1.1.7 de SARS-CoV-2 indican un papel solapante de las introducciones independientes desde Reino Unido, con eventos de transmisión comunitaria, incluso desde los primeros momentos de la presencia de esta variante en nuestro país.(AU)

Systematic Genomic and Clinical Analysis of Severe Acute Respiratory Syndrome Coronavirus 2 Reinfections and Recurrences Involving the Same Strain.

Estimates of the burden of severe acute respiratory syndrome coronavirus 2 reinfections are limited by the scarcity of population-level studies incorporating genomic support. We conducted a systematic study of reinfections in Madrid, Spain, supported by genomic viral analysis and host genetic analysis, to cleanse laboratory errors and to discriminate between reinfections and recurrences involving the same strain. Among the 41,195 cases diagnosed (March 2020-March 2021), 93 (0.23%) had 2 positive reverse transcription PCR tests (55-346 days apart). After eliminating cases with specimens not stored, of suboptimal sequence quality, or belonging to different persons, we obtained valid data from 22 cases. Of those, 4 (0.01%) cases were recurrences involving the same strain; case-patients were 39-93 years of age, and 3 were immunosuppressed. Eighteen (0.04%) cases were reinfections; patients were 19-84 years of age, and most had no relevant clinical history. The second episode was more severe in 8 cases.

First confirmation of importation and transmission in Spain of the newly identified SARS-CoV-2 B.1.1.7 variant.

INTRODUCTION: A newly identified SARS-CoV-2 variant, VOC202012/01 originating lineage B.1.1.7, recently emerged in the United Kingdom. The rapid spread in the UK of this new variant has caused other countries to be vigilant. MATERIAL AND METHODS: We based our initial screening of B.1.1.7 on the dropout of the S gene signal in the TaqPath assay, caused by the 69/70 deletion. Subsequently, we confirmed the B.1.1.7 candidates by whole genome sequencing. RESULTS: We describe the first three imported cases of this variant from London to Madrid, subsequent post-arrival household transmission to three relatives, and the two first cases without epidemiological links to UK. One case required hospitalization. In all cases, drop-out of gene S was correctly associated to the B.1.1.7 variant, as all the corresponding sequences carried the 17 lineage-marker mutations. CONCLUSION: The first identifications of the SARS-CoV-2 B.1.1.7 variant in Spain indicate the role of independent introductions from the UK coexisting with post-arrival transmission in the community, since the early steps of this new variant in our country.

Colangiocarcinoma en tercio medio de la vía biliar principal tratado con cirugía radical en el Hospital Nacional Guillermo Almenara, Lima, Perú / Cholangiocarcinoma in the middle third of the bile duct treated with radical surgery in Guillermo Almenara Hospital, Lima, Peru

Reportamos el caso de una paciente en quien se hizo el diagnóstico inicial de tumoración en vía biliar principal en su tercio medio. Paciente se presentó con baja ponderal de 10 kilogramos en 2 meses y dolor moderado en epigastrio, no ictericia. El paciente fue sometido a cirugía radical de la vía biliar con biopsia por congelación múltiple de bordes quirúrgicos, coledocoscopía intraoperatoria, colangiografía intraoperatoria y reconstrucción con anastomosis bilio-digestiva en Y de Roux transmesocólica, tuvo una recuperación sin complicaciones y alta precoz. El resultado anátomo-patológico evidenció adenocarcinoma tubular moderadamente diferenciado sobre la base de un adenoma. Carcinoma in situ sobre la base del adenoma. Ganglios retroperitoneales, retropancreáticos, pericoledocianos, curvatura menor y arteria hepática negativos. Bordes quirúrgicos y ampliación de bordes proximal y distal libres de neoplasia. Cirugía R0. pT1N0Mx. Estadio 1. Después de los resultados quirúrgicos óptimos es manejado por cirugía de hígado y vías biliares y oncología médica para seguimiento y controles periódicos. Presentamos aquí la secuencia de hechos y una revisión de la literatura...

We report the case of a patient who had the initial diagnosis of tumor in the bile duct in the middle third. Patient presented with lost weight of 10 kilograms in two months and moderate epigastric pain, no jaundice. The patient underwent radical surgery of the bile duct with multiple freeze biopsy surgical margins, intraoperative choledochoscopy, intraoperative cholangiography and reconstruction bilioenteric anastomosis Y Roux transmesocolic, he had a great recovery and early discharge. The pathological results showed moderately differentiated tubular adenocarcinoma on the basis of an adenoma. Negatives retroperitoneal, retropancreatic, pericholedochal, lesser curvature and negative hepatic artery nodes, and extension of surgical margins free of neoplasia proximal and distal edges. R0 surgery. pT1N0Mx. Stage 1. After the optimal surgical outcomes, is managed by liver and biliary tract surgery service and medical oncology service for regular monitoring and controls. We present here the sequence of events and a review of the literature...

[Cholangiocarcinoma in the middle third of the bile duct treated with radical surgery in Guillermo Almenara Hospital, Lima, Peru]. / Colangiocarcinoma en tercio medio de la vía biliar principal tratado con cirugía radical en el Hospital Nacional Guillermo Almenara, Lima, Perú.

We report the case of a patient who had the initial diagnosis of tumor in the bile duct in the middle third. Patient presented with lost weight of 10 kilograms in two months and moderate epigastric pain, no jaundice. The patient underwent radical surgery of the bile duct with multiple freeze biopsy surgical margins, intraoperative choledochoscopy, intraoperative cholangiography and reconstruction bilioenteric anastomosis Y Roux transmesocolic, he had a great recovery and early discharge. The pathological results showed moderately differentiated tubular adenocarcinoma on the basis of an adenoma. Negatives retroperitoneal, retropancreatic, pericholedochal, lesser curvature and negative hepatic artery nodes, and extension of surgical margins free of neoplasia proximal and distal edges. R0 surgery. pT1N0Mx. Stage 1. After the optimal surgical outcomes, is managed by liver and biliary tract surgery service and medical oncology service for regular monitoring and controls. We present here the sequence of events and a review of the literature.

Trasplante hepático en el Perú experiencia nacional. Hospital Nacional Guillermo Almenara Irigoyen- EsSalud / Liver transplantation in Peru national experience. Guillermo Almenara Irigoyen National Hospital-EsSalud

Se presentan los resultados de los 15 primeros pacientes trasplantados de hígado en el Servicio de Trasplante y Cirugía de Hígado del Hospital Nacional Guillermo Almenara Irigoyen - EsSALUD desde Marzo 2000 a Abril 2002 (13 pacientes adultos y 2 pacientes en edad pediátrica), 9 varones y 6 mujeres, Edad: de 3 a 60 años, Etiología: Adultos: Cirrosis biliar primaria: 5 pctes, cirrosis alcohólica 3 pctes, Cirrosis Criptogenética: 2 pctes, Esteatohepatitis no alcohólica: 1 pcte, cirrasis autoinmune 1 pcte y Déficit de alfa 1 antitripsina: 1 pcte. Niños: Fístulas arterioportales intrahepáticas: 1 pcte,atresia de vias biliares: 1 pcte Tiempo en Lista Espera: de 5 a 420 días. Tiempo operatorio: 9 a 15 horas (promedio 11.8horas), tiempos de isquemia fría (CIT): 7 a 10 horas, isquemia caliente (WIT): 60 a 120 minutos. Banco de sangre(promedio):GR: 10 unidades, PFC: 18 unidades, Plaquetas: 13 unidades y Crioprecipitado: 8 unidades. Estancia en DCI: 7 a 25 días. Post DCI: 5 a 70 días. Estancia Hospitalaria Total: 12 a 87 días. Inmunosupresión: Esquema doble: Tacrolimus más Corticoides: 9 pacientes, esquema triple: Ciclosporinamicroemulsión, Corticoides más Micofenolato mofetilo: 6 pacientes. Rechazo celular leve: 3 pacientes. Complicaciones médicas: Sepsis: 4 pctes, Sangrado gastrointestinal: 2 pctes, Disfunción primaria del injerto: 2 pacientes, Neurotoxicidad Severa: 4 pctes. Nefratoxicidad por inhibidor de calcineurina: 3 pctes. Neumonía nosocomial: 3 pctes, Atelectasia 6 pctes.Dolor costal persistente 1 paciente, Síndrome de Raynaud severo: 1 paciente. Complicaciones quirúrgicas: Trombosis de la arteria hepática 2 pacientes, Infección de herida operatoria: 2 pctes, Sangrado postoperatorio: 1 pcte. Mortalidad Operatoria: 0 por ciento. Retrasplante: 0 por ciento. Conclusión: Nuestra experiencia inicial muestra resultadossimilares a los publicados por grandes series en los diferentes centros de trasplante en el mundo.

We present the results our first 15 transplanted patients at the Liver transplantation Service of our hospital between March 2000 to April 2002 (13 adults and 2 children), 9 males y 6 females, ages: 3 to 60 years old, Ethiology: Adults: PBC: 5 patients, Alcoholic Cirrhosis 3 patients, cryptogenic Cirrhosis:2 patients, NASH: 1 patient and alfa 1 antitrypsin deficiency: 1 patient. Children: Arterio-portal intrahepahic fistulas 1 patient and biliary atresia 1 patient. Waiting list time: 5 to 140days. Operating time: 9 to 15 hours (average 11.8 hours), Cold ischemia time (CIT) 7 to 10 hours and warm ischemia time (WIT) 60 to 120 mino Blood products (average): RBC: 10 u,FFP: 18 u, PLT: 13 u y Crioprecipitate: 8 u. ICU staying: 7 to 25 days. ICU postop 5 to 70 days. Inhospital: 12 to 87 days.Immunosupression: Tacrolimus plus Steroids: 9 ptes and Cyclosporin, steoids plus MMF: 6 ptes. Cellular rejection : 2patients. Medical complications: Sepsis: 4 patients, GI bleeding: 2 ptes, Primary disfunction: 2 patiens. Severe neurotoxicity: 4 patients. Nefrotoxicity: 3 patients. Nosocomial Pneumonia: 3 ptes, Athelectasia 6 patients. Severe rib pain 1 pte. Surgical complications: Hepatic artery thrombosis 1 patient, wound infection: 2 patients, inmediatly postop bleeding: 1 patient . Mortality: 0 per cent. Retrasplant: per cent. Conclusions: The results of our initial experience show similar results as published in other series fram differents centersaround the world.

Síndrome de Mirizzi: diagnóstico pre-operatorio / Mirizzi syndrome: pre-operatory diagnosis

A propósito de un caso diagnosticado pre-operatoriamente, se revisan retrospectivamente 4 casos de Síndrome de Mirizzi; que si bien es una complicación rara de la colelitiasis, en nuestra casuística en el período de dos años (1989-1990) de un total de 212 colecistectomías realizadas en el Servicio de Cirugía General No. 6 del Hospital Nacional Guillermo Almenara Irigoyen, encontramos 4 casos de este síndrome lo cual representa el 1.88 por ciento del total. De estos 4 casos, un caso fué diagnosticado en pre-operatorio y tres casos en el intraoperatorio; también señalamos que según la clasificación de Mc Sherry uno fué Mirizzi tipo I, y tres Mirizzi tipo II, anotando que en dos de estos casos la operación que se realizó fué una Derivación Biliodigestiva Hepático-yeyuno en Y de Roux. La mortalidad fué cero

Síndrome de Mirizzi - diagnóstico pre-operatorio / Mirizzi syndrome - pre-operative diagnosis

A propósito de un caso diagnosticado en el pre-operatorio; se revisan 4 casos de Síndrome de Mirizzi; que si bien es una complicación rara de la colelitiasis; en nuestra casuística en el periodo de dos años (1989-1990) de un total de 212 colecistectomías realizadas en el Servicio de Cirugía General N§ 6 del Hospital Nacional Guillermo Almenara Irigoyen; encontramos 4 casos de este sídrome, que representa el 1.88 por ciento del total. De estos 4 casos 1 caso fue diagnosticado en pre-operatorio y 3 casos en el intraoperatorio; también señalamos que según la clasificación de Mc Sherry 1 fue Mirizzi tipo I y 3 Mirizzi tipo II; anotando que en dos de estos casos la operación que se realizó fue una Derivación Biliodigestiva Hepática-yeyuno en Y de Roux. La mortalidad fue cero.