Ischaemic stroke and SARS-CoV-2 infection: A causal or incidental association? / Ictus isquémico e infección por SARS-CoV-2, ¿asociación casual o causal?

INTRODUCTION: Ischaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection. METHODS: We describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients. RESULTS: The association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental. CONCLUSIONS: Systemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.

Prevalence of Abdominal Aortic Aneurysm in Men Aged 65-74 Years in a Metropolitan Area in North-East Spain.

BACKGROUND: A declining prevalence of AAA and a shift in the distribution towards the older population have been observed during the last decade in Europe. The aim was to estimate the current screening prevalence of AAA in men aged 65-74 years in a metropolitan area in north-east Spain and to identify associated risk factors. METHODS: A cross sectional prevalence study in men registered in L'Hospitalet Primary Healthcare Services (Barcelona, Spain) was performed. There were 619 randomly selected subjects (expected prevalence of aneurysm, 5%; accuracy of estimation, ±2%; loss to follow up, 30%). Exclusion criteria were life expectancy <1 year, limited quality of life, previous diagnosis of AAA, prior aorto-femoral surgery, and non-Caucasian. The following were measured: internal diameter of the infrarenal abdominal aorta using ultrasound, cardiovascular risk factors, personal (heart disease, stroke, peripheral vascular disease) and family history (AAA), physical examination, and blood tests. We estimated the prevalence and 95% confidence interval of AAA, and used logistic regression analysis to identify risk factors for AAA. RESULTS: Among the 651 individuals included in the analysis the prevalence of aneurysm was 2.30% (95% CI, 1.30-3.77%). In the regression analysis, AAA was associated with smoking (0-10, 11-20, or >20 cigarettes/day), diagnosis of myocardial infarction, and being taller than the median (165 cm). CONCLUSIONS: The current screening prevalence of AAA among men aged 65-74 years in a metropolitan area in north-east Spain is similar to that in northern Europe. Smoking, myocardial infarction, and height were associated with the presence of AAA.

Successful Pancreas Transplantation From a Deceased Donor Intoxicated With Oral Antidiabetic Agent: A Case Report.

Simultaneous kidney pancreas transplantation (SKP) is a common procedure for the patient with long-term type 1 diabetes mellitus (DM) with terminal renal failure. It is unusual to consider the pancreas from a deceased donor who died after an acute intoxication with oral antidiabetic agent (OAA), which would suggest an abnormal functionality of the organ and preclude the potential use of the graft. We present a case of a successful pancreatic transplantation from a donor who died of acute cerebral edema secondary to severe hypoglycemia induced by OAA acute intoxication.

Pancreas oxygen persufflation increases ATP levels as shown by nuclear magnetic resonance.

BACKGROUND: Islet transplantation is a promising treatment for type 1 diabetes. Due to a shortage of suitable human pancreata, high cost, and the large dose of islets presently required for long-term diabetes reversal; it is important to maximize viable islet yield. Traditional methods of pancreas preservation have been identified as suboptimal due to insufficient oxygenation. Enhanced oxygen delivery is a key area of improvement. In this paper, we explored improved oxygen delivery by persufflation (PSF), ie, vascular gas perfusion. METHODS: Human pancreata were obtained from brain-dead donors. Porcine pancreata were procured by en bloc viscerectomy from heparinized donation after cardiac death donors and were either preserved by either two-layer method (TLM) or PSF. Following procurement, organs were transported to a 1.5-T magnetic resonance (MR) system for (31)P nuclear magnetic resonance spectroscopy to investigate their bioenergetic status by measuring the ratio of adenosine triphosphate to inorganic phosphate (ATP:P(i)) and for assessing PSF homogeneity by MRI. RESULTS: Human and porcine pancreata can be effectively preserved by PSF. MRI showed that pancreatic tissue was homogeneously filled with gas. TLM can effectively raise ATP:P(i) levels in rat pancreata but not in larger porcine pancreata. ATP:P(i) levels were almost undetectable in porcine organs preserved with TLM. When human or porcine organs were preserved by PSF, ATP:P(i) was elevated to levels similar to those observed in rat pancreata. CONCLUSION: The methods developed for human and porcine pancreas PSF homogeneously deliver oxygen throughout the organ. This elevates ATP levels during preservation and may improve islet isolation outcomes while enabling the use of marginal donors, thus expanding the usable donor pool.

Persufflation improves pancreas preservation when compared with the two-layer method.

Islet transplantation is emerging as a promising treatment for patients with type 1 diabetes. It is important to maximize viable islet yield for each organ due to scarcity of suitable human donor pancreata, high cost, and the large dose of islets required for insulin independence. However, organ transport for 8 hours using the two-layer method (TLM) frequently results in low islet yields. Since efficient oxygenation of the core of larger organs (eg, pig, human) in TLM has recently come under question, we investigated oxygen persufflation as an alternative way to supply the pancreas with oxygen during preservation. Porcine pancreata were procured from donors after cardiac death and preserved by either TLM or persufflation for 24 hours and subsequently fixed. Biopsies collected from several regions of the pancreas were sectioned, stained with hematoxylin and eosin, and evaluated by a histologist. Persufflated tissues exhibited distended capillaries and significantly less autolysis/cell death relative to regions not exposed to persufflation or to tissues preserved with TLM. The histology presented here suggests that after 24 hours of preservation, persufflation dramatically improves tissue health when compared with TLM. These results indicate the potential for persufflation to improve viable islet yields and extend the duration of preservation, allowing more donor organs to be utilized.

Continuous real-time viability assessment of kidneys based on oxygen consumption.

BACKGROUND: Current ex vivo quality assessment of donor kidneys is limited to vascular resistance measurements and histological analysis. New techniques for the assessment of organ quality before transplantation may further improve clinical outcomes while expanding the depleted deceased-donor pool. We propose the measurement of whole organ oxygen consumption rate (WOOCR) as a method to assess the quality of kidneys in real time before transplantation. METHODS: Five porcine kidneys were procured using a donation after cardiac death (DCD) model. The renal artery and renal vein were cannulated and the kidney connected to a custom-made hypothermic machine perfusion (HMP) system equipped with an inline oxygenator and fiber-optic oxygen sensors. Kidneys were perfused at 8 degrees C, and the perfusion parameters and partial oxygen pressures (pO(2)) were measured to calculate WOOCR. RESULTS: Without an inline oxygenator, the pO(2) of the perfusion solution at the arterial inlet and venous outlet diminished to near 0 within minutes. However, once adequate oxygenation was provided, a significant pO(2) difference was observed and used to calculate the WOOCR. The WOOCR was consistently measured from presumably healthy kidneys, and results suggest that it can be used to differentiate between healthy and purposely damaged organs. CONCLUSIONS: Custom-made HMP systems equipped with an oxygenator and inline oxygen sensors can be applied for WOOCR measurements. We suggest that WOOCR is a promising approach for the real-time quality assessment of kidneys and other organs during preservation before transplantation.

Usefulness of two new methods for diagnosing metapneumovirus infections in children.

Human metapneumovirus (hMPV) is associated with acute respiratory tract infections, mainly in paediatric patients. The aim of this study was to evaluate the usefulness of two new commercial techniques available for the detection of hMPV in clinical samples from children: an enzyme immunoassay, hMPV EIA (Biotrin International Ltd), and a molecular assay, real-time RT-PCR (Pro hMPV Real Time Assay Kit; Prodesse). A total of 184 nasopharyngeal aspirate specimens from 173 children aged less than 5 years who were hospitalized with acute wheezing were analysed. Respiratory syncytial virus was detected in 27% of the samples, followed by influenza A virus (6%), parainfluenza virus (PIV)3 (2.2%), adenovirus (2%), PIV1 (1.1%), PIV2 (1.1%), and influenza B virus (0.5%). The presence of hMPV was tested in all samples, using the real-time RT-PCR and EIA. Real-time RT-PCR detected 13 hMPV-positive samples (8%), and EIA detected 17 (9.3%). When the EIA results were compared with those of real-time RT-PCR for the detection of hMPV, a good correlation was found (94%). A relatively low co-infection rate (15%) was observed in our patients. RT-PCR and EIA provide robust methods for the diagnosis of hMPV infection in children.

Invasive pneumococcal disease among children in a health district of Barcelona: early impact of pneumococcal conjugate vaccine.

This study evaluated the impact of heptavalent pneumococcal conjugate vaccine (HPCV) on invasive pneumococcal disease (IPD) in children aged < or = 5 years in Barcelona, Spain. The incidence of IPD, vaccine uptake and prevalence of nasopharyngeal colonisation were analysed in two different periods: 1999-2001 (pre-licence period), and 2002-2004 (post-licence period). In total, 121 cases of IPD were identified. The overall incidence of IPD decreased from 96.9 cases/100,000 to 90.6 cases/100,000 (OR 0.93, 95% CI 0.69-1.26, p 0.71) between the two periods. The proportion of cases caused by non-vaccine-related serotypes (NVS) increased from 21% to 43.7% (OR 2.9, 95% CI 1.2-7, p 0.01). IPD was diagnosed in seven vaccinated children, six of whom were infected by NVS. There was a trend of diminishing prevalence of resistance to penicillin and macrolides in 2002-2004. The incidence of empyema increased from 1.7 to 8.5/100,000 (OR 4.5, 95% CI 0.91-18, p 0.06). The rate of vaccination ranged from 4.8% to 34%. It was concluded that the rates of IPD in this area did not decrease following the introduction of HPCV. The low uptake of vaccine and the greater proportion of colonisation/infection by NVS probably explain these findings. A trend of increasing empyema was also apparent. A decrease in the prevalence of penicillin and macrolide resistance paralleled the progressive uptake of vaccine.

Role of pH in partitioning and cation exchange of aromatic amines on water-saturated soils.

Predicting the reversible interactions between aromatic amines and soil is essential for assessing the mobility, bioavailability and exposure from contaminated sites. Reversible sorption mechanisms of aniline and alpha-naphthylamine were investigated by using single and binary solute sorption to five soils at several pH values, and by applying a distributed parameter (DP) model. The DP model assumes linear partitioning of the neutral species into soil organic matter domains and organic cation binding on negative-charged sites with the exchange coefficients represented by a Gaussian probability distribution. Sorption nonlinearity was attributed to cation exchange with varying site affinities, which was adequately simulated using the DP model. Greater uptake by hydrophobic partitioning and selectivity for cation exchange sites was observed for alpha-naphthylamine compared to aniline. Sorption of alpha-naphthylamine was not impacted quantitatively by aniline under those conditions examined; however, aniline sorption was reduced by alpha-naphthylamine with the largest reduction occurring in the soil with the lowest pH. DP model simulations showed that although hydrophobic partitioning increases with soil-solution pH, cation exchange still contributes significantly to the total sorption even at soil-solution pH values greater than pKa + 2.

Modeling competitive cation exchange of aromatic amines in water-saturated soils.

Competitive association to several components of soil through ion exchange processes influences the fate of organic cations in the environment. To examine these processes, the distributions of aniline and 1-aminonaphthalene between aqueous 5 mM CaCl2 solutions and three different Indiana soils were evaluated. Solute ratios (Sr) of aniline to 1-aminonaphthalene of 0.4-4.7 were employed, and the soil solutions ranged in pH from 2.7 to 7.5, with all measurements made 24 h after the introduction of the chemicals to the soils. Two previously proposed equilibrium models--the two-site (TS) and distributed parameter (DP) models--were modified to predict competition. These models assume instantaneous equilibrium of the following reversible processes: (i) acid dissociation of the protonated organic base (BHaq+) in the aqueous phase; (ii) ion exchange on the soil between the protonated organic base and inorganic divalent cations (Daq2+ = Caaq2+ + Mgaq2+); and (iii) partitioning of the nonionic species of aniline (Baq) to soil organic carbon. The TS model is a general mass action model that does not take into consideration cation exchange site heterogeneity, whereas the DP model considers association constants to these sites to be distributed in a log-normal fashion. To describe competition for cation exchange sites within the DP model, it was necessary to add a correlation coefficient (rho) that relates the ion-exchange association constant (KBH) probability density distribution functions of the two compounds. The value of rho is characteristic of each soil. Results indicate that competition has a greater effect at low pH values, where ion exchange is the predominant process. For all cases, these models capture the general trends in the soil-water distribution data of both amines. The DP model also captures the nonlinearity of the 1-aminonaphthalene isotherms at low pH while at the same time capturing the nearly linear isotherms of aniline as a competing organic base.

[The sentinel node: first cases in Panama]. / El ganglio centinela: los primeros casos en Panama.

Ideal treatment planning in cancer is primarily defined by proper staging. The presence of metastasis in the regional nodal basin must be determined. The best and least invasive manner to achieve this purpose in the nodal basin is by studying the sentinel node. We present the first series of patients treated in Panama with identification and evaluation of the sentinel node. Initially we used only the dye technique and our rate of identification was 77%. When the radioisotope technique was used combined with dye, the localization was successful in 100% of the cases. We recommend the combined technique for a higher yield and minimal false negatives.

In vitro and in vivo effects of an immunomodulator composed of Escherichia coli lipopolysaccharide and Propionibacterium granulosum-inactivated cells in pigs.

The in vitro cytokine profiles of porcine alveolar macrophages and peripheral blood mononuclear cells (PBMC) were examined by reverse transcription-polymerase chain reaction or enzyme-linked immunosorbent assay after stimulation with the immunomodulatory compound INMD [lipopolysaccharide (LPS) and Propionibacterium granulosum]. Expression of interleukin-1 (IL-1), IL-6, IL-12 and tumour necrosis factor-alpha (TNF-alpha), but not of IL-10, was detected in INMD-stimulated alveolar macrophages. Stimulated PBMC expressed IL-1, IL-2, IL-4, IL-6, IL-10 and IL-12 and secreted interferon-gamma (IFN-gamma). In all cases, the level of response was lower with INMD than with E. coli LPS alone, except for IFN-gamma, which was secreted in higher levels in INMD-stimulated cells. In a second experiment, the ex vivo effect of the administration of INMD was evaluated using the product as a coadjuvant of a live attenuated Aujeszky's disease virus (ADV) vaccine. For this purpose, 85 8-10-week-old crossbred pigs were assigned to two groups (group A = 43 and group B = 42) and vaccinated with ADV. Group B received, simultaneously with the first dose of vaccine, an intramuscular dose of INMD equivalent to 20 micrograms/ml LPS and 250 micrograms/ml P. granulosum, while group A was given sterile saline solution as a placebo. At the time of vaccination, 97.6% (42 of 43) and 95.2% (40 of 42) of animals of groups A and B, respectively, had anti-gB maternal antibodies. Of those animals, anti-gE ADV antibodies were detected in 11.6% of animals of group A (five of 43) and 19% of group B (eight of 42). All animals were boosted with ADV vaccine alone 4 weeks later. Pigs to which INMD was administered together with the vaccine showed higher primary humoral responses than the vaccine-alone animals (P < 0.005). However, after boosting significant differences disappeared (P > 0.05).

Prevalence of antibodies to spotted fever group rickettsiae in human beings and dogs from and endemic area of mediterranean spotted fever in Catalonia, Spain.

We assessed the prevalence of antibodies to spotted fever group rickettsiae in human beings and dogs by indirect immunofluorescence in the region of 'Vallés Occidental', Barcelona (Spain). In the group of 150 serum samples from patients without former history of Mediterranean spotted fever, 12 had antibodies to Rickettsia conori. The overall seroprevalence was 8% (95% confidence interval, 4.6% to 13.5%). There were no statistically significant differences between the mean ages of patients with positive and negative antibodies to R. conorii. However, seropositivity was significantly more common among patients living in semi-rural areas. In the group of 138 dog serum samples, 36 (26.1%) sera had antibodies to R. conorii. When the present results were compared with those obtained in a previous seroepidemiological survey carried out in the same geographical region in 1987, no significant differences were found. Therefore, although the epidemiological markers have dropped, this does not absolutely confirm the decrease of the presence of R. conorii in this area.

[Permanent venous access through a +portacath reservoir in patients receiving prolonged chemotherapy]. / Acceso venoso permanente mediante reservorio portacath en pacientes que reciben quimioterapia prolongada.

A significant number of oncology patients need intravenous chemotherapy. Peripheral venous access is generally difficult, frequently requiring central venous access. This study reviews the Author's experience with permanent venous portals. A total of 66 patients records, from January 1992 to April 1994, were reviewed. The central venous portals remained in place an average of 272 days. An average of 8 courses of chemotherapy were given through each port. There was no significant difference in the rate of complications secondary to the portal site. The Authors conclude that the placement of permanent venous portals is a safe and reliable chronic venous access in patients with cancer who require intravenous therapy. The rate of serious complication was 3% which is relatively low for these immunosuppressed patients. All venous portals, except one (98.5%) remained functional.

Acceso venoso permanente mediante reservorio portacath en pacientes que reciben quimioterapia prolongada / Permanent venous access through a +portacath reservoir in patients receiving prolonged chemotherapy

A significant number of oncology patients need intravenous chemotherapy. Peripheral venous access is generally difficult, frequently requiring central venous access. This study reviews the Author's experience with permanent venous portals. A total of 66 patients records, from January 1992 to April 1994, were reviewed. The central venous portals remained in place an average of 272 days. An average of 8 courses of chemotherapy were given through each port. There was no significant difference in the rate of complications secondary to the portal site. The Authors conclude that the placement of permanent venous portals is a safe and reliable chronic venous access in patients with cancer who require intravenous therapy. The rate of serious complication was 3% which is relatively low for these immunosuppressed patients. All venous portals, except one (98.5%) remained functional

[Prevalence of Helicobacter pylori in patients with gastric cancer in Panama]. / La prevalencia del Helicobacter pylori en pacientes con cáncer gástrico en Panama.

Cancer of the stomach is the second in incidence in Panama after the cancer of the prostata. It is studied now the incidence of infection due to Helicobacter pylori in patients with gastric carcinoma. It seems to be a significative relationship between the prevalence of gastric carcinoma and H. pylori infections. This observation is important because by the similar therapeutic implications in virus DNA hepatitis type B and hepatoma.

[Regional pancreatectomy in tumors invading the portal vein]. / Pancreatectomía regional en tumores con invasión a la vena porta.

The authors present the clinical history of a patient who underwent the first regional pancreatectomy performed in Panama. The patient had been operated on one year before and the tumor in the head of the pancreas had been considered unresectable at that time because it had invaded the portal vein. Since the patient was in excellent health and her diabetes and hypertension (diagnosed ten years before) were well controlled, the size of the tumor, as demonstrated in CAT scans, had not changed in one year and the biopsy of the tumor had characterized it as of neuroectodermic origin without regional lymph node involvement, it was decided to perform a regional pancreatectomy. The authors describe the different stages of the resection of the tumor and the anatomical reconstruction. They point out the recommendations of different schools of thought about the operation and report on the excellent results obtained in this patient.