Acute Liver Infarct with a Superimposed Liver Abscess as a Consequence of Hypercoagulable State in a Patient with COVID-19 without Respiratory Manifestations.

COVID-19 infection has been associated, particularly in severely ill patients requiring hospitalization, with a hypercoagulable state. The case presented herein was a 66-year-old man with SARS-CoV-2 infection who did not have any respiratory symptoms. He presented with the following clinical manifestations: portal vein and hepatic artery thrombosis, liver infarction, and a superimposed abscess of the liver. In this case, early detection and the administration of anticoagulants and antibiotics led to a significant improvement within weeks of the diagnosis. We encourage physicians to be aware of COVID-19-associated hypercoagulable state and its potential complications, regardless of the acuity of the presentation or the absence of respiratory symptoms.

Combination of explainable machine learning and conceptual density functional theory: applications for the study of key solvation mechanisms.

We present explainable machine learning approaches for the accurate prediction and understanding of solvation free energies, enthalpies, and entropies for different salts in various protic and aprotic solvents. As key input features, we use fundamental contributions from the conceptual density functional theory (DFT) of solutions. The most accurate models with the highest prediction accuracy for the experimental validation data set are decision tree-based approaches such as extreme gradient boosting and extra trees, which highlight the non-linear influence of feature values on target predictions. The detailed assessment of the importance of features in terms of Gini importance criteria as well as Shapley Additive Explanations (SHAP) and permutation and reduction approaches underlines the prominent role of anion and cation solvation effects in combination with fundamental electronic properties of the solvents. These results are reasonably consistent with previous assumptions and provide a solid rationale for more recent theoretical approaches.

Generic and specific recurrent neural network models: Applications for large and small scale biopharmaceutical upstream processes.

The calculation of temporally varying upstream process outcomes is a challenging task. Over the last years, several parametric, semi-parametric as well as non-parametric approaches were developed to provide reliable estimates for key process parameters. We present generic and product-specific recurrent neural network (RNN) models for the computation and study of growth and metabolite-related upstream process parameters as well as their temporal evolution. Our approach can be used for the control and study of single product-specific large-scale manufacturing runs as well as generic small-scale evaluations for combined processes and products at development stage. The computational results for the product titer as well as various major upstream outcomes in addition to relevant process parameters show a high degree of accuracy when compared to experimental data and, accordingly, a reasonable predictive capability of the RNN models. The calculated values for the root-mean squared errors of prediction are significantly smaller than the experimental standard deviation for the considered process run ensembles, which highlights the broad applicability of our approach. As a specific benefit for platform processes, the generic RNN model is also used to simulate process outcomes for different temperatures in good agreement with experimental results. The high level of accuracy and the straightforward usage of the approach without sophisticated parameterization and recalibration procedures highlight the benefits of the RNN models, which can be regarded as promising alternatives to existing parametric and semi-parametric methods.

Successful Treatment of Radial Artery Pseudoaneurysm After Transradial Cardiac Catheterization With Continuous Compression Therapy by a TR Band® Radial Compression Device.

Arterial pseudoaneurysm formation after transradial cardiac catheterization is a rare post-procedural complication occurring in less than 0.1% of radial arterial access. While the data on the management of femoral pseudoaneurysms is extensive, few studies have evaluated how these techniques apply for small vessel arterial pseudoaneurysms. We present the case of an octogenarian man with a radial artery pseudoaneurysm after transradial coronary intervention that failed initial compression therapy, and surgical intervention was avoided by applying continuous compression therapy with a TR Band® radial compression device.

The Evolution of Polymer Composition during PHA Accumulation: The Significance of Reducing Equivalents.

This paper presents a systematic investigation into monomer development during mixed culture Polyhydroxyalkanoates (PHA) accumulation involving concurrent active biomass growth and polymer storage. A series of mixed culture PHA accumulation experiments, using several different substrate-feeding strategies, was carried out. The feedstock comprised volatile fatty acids, which were applied as single carbon sources, as mixtures, or in series, using a fed-batch feed-on-demand controlled bioprocess. A dynamic trend in active biomass growth as well as polymer composition was observed. The observations were consistent over replicate accumulations. Metabolic flux analysis (MFA) was used to investigate metabolic activity through time. It was concluded that carbon flux, and consequently copolymer composition, could be linked with how reducing equivalents are generated.

[Behavior of predictive variables of exacerbations of the COPD in the neumological hospital of Cuba.] / Comportamiento de variables predictivas de exacerbaciones de la EPOC en el hospital neumológico de Cuba.

The use of predictive variables of exacerbations of the COPD is not a practice generalized in our environment, for what we cannot characterize the exacerbating patient neither to design strategies for its integral handling. There was carried out a prospective descriptive study to correlate in patient with diagnosis of COPD from the Neumologic Hospital of Cuba, with the objective of determining the association between clinical, functional variables and imagenological and the exacerbations frequency a year. The population was constituted for patients with clinical diagnosis of COPD and the sample for those patients with confirmed diagnosis that they completed the inclusion approaches. The correlation among the variables was carried out by means of the Coefficient of Correlation of Pearson with an interval of Trust of 95% and the test t student with a significance level (p) smaller than 0.05. 81.82% of the very serious patients are exacerbating with emphysema. 75% of the patients with index of the lung artery / aorta have more than two exacerbations a year. 84.61% of the patient exacerbating presented degree four of the dyspnea. The half pressure of the lung artery next to the VEF1 constituted the best exacerbations predictors in the group of studied patients.

Síndrome de Lady Windermere como causa de tos crónica. A propósito de un caso / Lady Windermere Syndrome as a cause of chronic cough. Report of a case

Resumen Las mycobacterias no tuberculosas son poco reconocidas en la actualidad, pero su prevalencia se incrementa al sospechar su presencia en inmunodeprimidos o en enfermedades crónicas como la fibrosis quística. Se presenta el caso de una paciente con diagnóstico de síndrome de Lady Windermere con tos crónica. Se realizó tomografía computarizada donde se observaron bronquiectasias en el segmento lingular del pulmón izquierdo y en los lóbulos medio e inferior del derecho. En la broncoscopia se aisló complejo Mycobacterium avium-intracellulare. El no considerar en el diagnóstico de pacientes con tos crónica y sin factores predisponentes a las mycobacterias atrasa el diagnóstico y se acelera el deterioro clínico del paciente.

Abstract The nontuberculous mycobacteria are rarely recognized today in the world, being increased their prevalence about to departure of their suspicion in chronic illnesses such as inmunocompromised patients and cystic fibrosis. We present a case with diagnosis of syndrome of Lady Windermere about to departure of a square of chronic cough. Computed tomography was performed where bilateral bronchiectasis is observed in the left lingual segment and right upper lobe. In the Bronchoscopy was isolated complex Mycobacterium avium-intracellulare. The lack of suspicion of nontuberculous mycobacteria in patient without risk factors, with a square of chronic cough leads to the delay in the diagnosis and the patient's clinical deterioration.

Fluxes in PHA-storing microbial communities during enrichment and biopolymer accumulation processes.

The use of mixed microbial cultures for the production of polyhydroxyalkanoates (PHAs) is emerging as a viable technology. In this study, 16S rRNA gene amplicon pyrosequencing was used to analyse fluctuations in populations over a 63-day period within a PHA-storing mixed microbial community enriched on fermented whey permeate. This community was dominated by the genera Flavisolibacter and Zoogloea as well as an unidentified organism belonging to the phylum Bacteroidetes. The population was observed to cycle through an increase in Zoogloea followed by a return to a community composition similar to the initial one (highly enriched in Flavisolibacter). It was found that the PHA accumulation capacity of the community was robust to population flux during enrichment and even PHA accumulation, with final polymer composition dependent on the overall proportion of acetic to propionic acids in the feed. This community adaptation suggests that mixed culture PHA production is a robust process.

Vólvulo gástrico como causa de disnea. A propósito de un caso / The gastric volvulus as a cause of dyspnea. A case report

El vólvulo gástrico es una entidad poco frecuente que puede presentarse de forma aguda o crónica. El vólvulo agudo puede presentarse con la triada de Borchardt, el crónico puede ser asintomático y su diagnóstico es usualmente incidental. Se presenta el caso de un piloto de avión que presenta falta de aire a los medianos esfuerzos con tos relacionada con episodios de acidez gástrica sobre todo después de comidas profusas. La confirmación diagnóstica se realizó mediante estudios radiológicos simples y contrastados. Se realizó intervención quirúrgica y los síntomas desaparecieron sin otras alteraciones en un período de seguimiento de un año...

The gastric volvulus is a not very frequent entity that can show up in acute form or chronic. The acute volvulus can show up with the triad of Borchardt, the chronic one can be asymptomatic and its diagnosis is usually incidental. We present shows a case of an airplane pilot that presents dyspnea to the medium efforts with cough related with episodes of gastric acidity mainly after profuse foods. The diagnostic confirmation was carried out by means of radiological simple and contrasted studies. A surgical intervention was performed and the symptoms disappeared without other alterations in a period of pursuit of one year...

Síndrome de Lady Windermere como causa de tos crónica. A propósito de un caso / Lady Windemere syndrome as the cause of chronic cough. A propos of one case

Las micobacterias no tuberculosas son poco reconocidas hoy en el mundo, incrementándose su prevalencia a punto de partida de su sospecha en inmunodeprimidos o en enfermedades crónicas, como la fibrosis quística. Se presenta el caso de una paciente con diagnóstico de síndrome de Lady Windermere a punto de partida de un cuadro de tos crónica. Se realizó tomografía computarizada donde se evidenciaron bronquiectasias en el segmento lingular del pulmón izquierdo y en los lóbulos medio e inferior del derecho. Mediante la broncoscopia se aisló el complejo Mycobacterium avium-intracellulare. La falta de sospecha de micobacterias atípicas en pacientes sin factores predisponentes, con un cuadro de tos crónica, conduce al retraso en el diagnóstico y el deterioro clínico del paciente...

Nontuberculous mycobacteria are rarely recognized in the world today; their prevalence is increasing due to suspicion in immunocompromised patients or in those suffering from chronic illnesses such as cystic fibrosis. A case with of Lady Windermere Syndrome diagnosis that originally started with chronic cough is presented. Tomography showed bilateral bronchiectasis in the left lingual segment and in the middle and lower right lobe. Mycobacterium avium-intracellulare complex was isolated using bronchoscopy. The lack of suspicion of nontuberculous mycobacteria in patients without risk factors and chronic cough leads to diagnosis delay and clinical deterioration of the patient...

[The gastric volvulus as a cause of dyspnea. A case report]. / Vólvulo gástrico como causa de disnea. A propósito de un caso.

The gastric volvulus is a not very frequent entity that can show up in acute form or chronic. The acute volvulus can show up with the triad of Borchardt, the chronic one can be asymptomatic and its diagnosis is usually incidental. We present shows a case of an airplane pilot that presents dyspnea to the medium efforts with cough related with episodes of gastric acidity mainly after profuse foods. The diagnostic confirmation was carried out by means of radiological simple and contrasted studies. A surgical intervention was performed and the symptoms disappeared without other alterations in a period of pursuit of one year.

In-line monitoring of thermal degradation of PHA during melt-processing by Near-Infrared spectroscopy.

Polyhydroxyalkanoate (PHA) biopolymer processing is often challenged by low thermal stability, meaning that the temperatures and time for which these polymers can be processed is restrictive. Considering the sensitivity of PHA to processing conditions, there is a demand for in-line monitoring of the material behaviour in the melt. This paper investigates the application of Near-Infrared (NIR) spectroscopy for monitoring the thermal degradation of PHAs during melt-processing. Two types of materials were tested: two mixed culture PHAs extracted from biomass produced in laboratory and pilot scale after an acidic pre-treatment, and two commercially available materials derived from pure culture production systems. Thermal degradation studies were carried out in a laboratory scale extruder with conical twin screws connected to a NIR spectrometer by a fibre optic to allow in situ monitoring. Multivariate data analysis methods were applied for assessing thermal degradation kinetics and predicted the degree of degradation as measured by (1)H NMR (proton nuclear magnetic resonance spectroscopy). The pre-treated mixed culture PHAs were found to be more thermally stable when compared with the commercial pure culture PHAs as demonstrated by NIR, (1)H NMR and GPC (gel permeation chromatography).

Calcifilaxis cooo complicación cutánea en paciete con insuficiencia renal crónnica en diálisis / Calciphylaxis skin as a complication in patients with chronic renal dallysis / Calciilaxia comoo complicação cutâneaem paciente com insuficiência rrenal crônica em diálsee

La calcifilaxis generalmente hace referencia a una enfermedad caracterizada por lesiones violáceas reticuladas dolorosas que progresan a necrosis, de predominio en miembros inferiores, en pacientes con falla renal especialmente que se encuentran en manejo con hemodiálisis, tiene una mortalidad que en algunos estudios alcanza hasta el 80%. Hay una mayor incidencia de eventos cardiovasculares en estos pacientes. Presentamos el caso de una paciente con calcifilaxis secundaria a insuficiencia renal crónica, en la que se resalta el alto grado de mortalidad de la enfermedad.

Calciphylaxis usually refers to a disease characterized by reticulated violet lesions painful to touch which progress to necrosis and predominate in lower extremities in patients diagnosed with renal failure and who are being managed with hemodialysis. This disease has a high mortality rate that in some studies reaches up to 80%. There is an increase in cardiovascular events in these patients. We present the case of a patient who is diagnosed with calciphylaxis secondary to chronic renal failure, in which we highlight the elevated rate of mortality secondary to this disease.

Calciphylaxis.

renal failure.

metastatic calcification.

A calcifilaxia geralmente faz referência a uma doença caracterizada por lesões violáceas reticuladas dolorosas que progridem a necrose, de predomínio em membros inferiores, em pacientes com falha renal especialmente que se encontram em manejo com hemodiálise, tem uma mortalidade que em alguns estudos atinge até o 80%. Há uma maior incidência de eventos cardiovasculares em estes pacientes. Apresentamos o caso de uma paciente com calcifilaxia secundaria a insuficiência renal crônica, na que se resalta a alta série de mortalidade da doença.

Cirugía de Mohs variedad en parafina en el Hospital Militar Central: una excelente elección / Mohs micrographic surgery modified by the use of tangential, formalin-fixed, paraffin- embedded histologic specimens (Slow Mohs): an excelent opcion

Introducción: La cirugía micrográfica de Mohs (CMM) es la técnica para la resección secuencial del cáncer de piel que permite el mejor control histológico y la conservación de tejido sano, dejando defectos quirúrgicos menores, reconstrucciones menos complejas y un buen resultado funcional y estético. La adaptación de la técnica clásica de Mohs en congelación a la variedad en parafina se ajusta al uso de los recursos, humanos, técnicos y físicos en los servicios de dermatología y patología del Hospital Militar Central, dispuestos para el manejo quirúrgico de los pacientes con tumores de piel de alto riesgo, disminuyendo costos, optimizando recursos y logrando resultados excelentes y reproducibles. Objetivos: Demostrar la efectividad de la CMM variedad en parafina en el tratamiento de los tumores malignos de piel de alto riesgo en el servicio de Dermatología del Hospital Militar Central. Materiales y Métodos: Estudio descriptivo, de serie de casos, donde se incluyeron los pacientes manejados con CMM variedad en parafina en el HOSMIC desde julio de 2005 hasta julio de 2008. Resultados: Se incluyó un total de 114 tumores, en 104 pacientes (primarios: 107, recurrentes: 7), con una evolución promedio de 20.5 meses. Se intervinieron 102 (89.4%) carcinomas basocelulares (CBC), 7 (6%) carcinomas escamocelulares (CEC), 1 (0,9%) léntigo maligno, 1 (0,9%) melanoma léntigo maligno, y 3 (2.6%) correspondientes a otro tipo de tumores. Se requirió un promedio de 1.3 estados de Mohs, erradicando el tumor en un solo tiempo en el 72% de los casos. El ahorro de tejido en CBC fue de 35,1% y 18,6% en CEC, al compararlo con los márgenes convencionales. La corrección quirúrgica fue realizada por el cirujano de Mohs en 78 casos (68.42%). Se comparó el informe final de patología con el de la biopsia inicial hallando una concordancia del 70%, en los restantes, 15%, correspondían a un patrón más agresivo que el inicial, generándose un riesgo adicional para estos pacientes en cirugía convencional. Se ha podido realizar seguimiento al 94%, (98), de los pacientes, sin presencia de recidivas en tres años del programa. Conclusiones: En el Hospital Militar Central los pacientes con cáncer de piel de alto riesgo se benefician de la técnica CMM variedad en parafina, la cual se ajusta a los recursos disponibles y brinda una alta tasa de curación con la posibilidad de ahorro de tejido sano, dejando defectos menores y permitiendo correcciones quirúrgicas por parte del servicio. Esta técnica puede ser reproducible con los recursos convencionales de histología en parafina bajo un entrenamiento previo en otras instituciones.

Experiencia en una unidad de cuidados intensivos pediátricos / Our experience in a pediatric intensive care unit

Al cumplirse los 5 primeros años de funcionamiento de la Unidad de Cuidados Intensivos de Pediatria del Hospital Central de Sanidad de la Policia Nacional, la experiencia obtenida es la siguiente: De un total de 5964 egresos del Departamento de Pediatría 1,102 casos (18.4 por ciento), fueron hospitalizados en la unidad. Del total de egresos 683 casos (62 por ciento) fueron del sexo masculino y 414 (38 por ciento) del sexo femenino. La incidencia por edades: Menores de 2 años, 749 casos (68 por ciento), de los cuales 209 correspondieron a neonatos. A mayores de 2 años, correspondieron 353 casos (32 por ciento). Entre las patologías más frecuentes encontramos: Patología respiratoria (34.2 por ciento), patología neurológica (21.9 por ciento), patología digestiva y trastornos hidroelectrolíticos (20.5 por ciento). La mortalidad global fue de 92 casos (8.3 por ciento), correspondiendo la mayor mortalidad al sexo masculino con 55 (59.8 por ciento). En cuanto a la mortalidad por grupo etáreo, es mayor en los menores de 2 años, con 58 defunciones (63 por ciento). La causa más frecuentes de mortalidad, la sepsis con 35 casos (38.2 por ciento), seguida de la patología neurológica, con 25 (27.2 por ciento) y la patología respiratoria con 20 (21.8 por ciento)

Grados de asma infantil / Infant asthma grades of

Se hace una revisión de historias clínicas de pacientes asmáticos hospitalizados durante el año 1989 a los que se clasifica por grados. De un total de 1146 hospitalizados, 202 correspondieron a casos de asma; encontrándose un mortalidad de 2 (0.9 por ciento). De los pacientes asmáticos 51 casos fueron asma leve (25 por ciento), 140 de asma moderada (69.5 por ciento), 8 de asma severa (4 por ciento) y 3 de status asmáticos (1.5 por ciento). Se encontró que 129 casos correspondieron al sexo masculino (63.8 por ciento) y 73 (36.2 por ciento) fueron del sexo femenino. En cuanto a incidencia por edades, 43 casos correspondieron a niños menores de 2 años (21.2 po ciento) y 159 (78.8 por ciento) a mayores de 2 años. La mayor incidencia de hospitalización se encontró entre los meses de setiembre y diciembre. Se identificaron infecciomes intercurrentes en 36 casos, observándose que en su mayoría, correspondieron a cuadros de bronconeumonía