Ivermectin to prevent hospitalizations in patients with COVID-19 (IVERCOR-COVID19) a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has changed our lives. The scientific community has been investigating re-purposed treatments to prevent disease progression in coronavirus disease (COVID-19) patients. OBJECTIVE: To determine whether ivermectin treatment can prevent hospitalization in individuals with early COVID-19. DESIGN, SETTING AND PARTICIPANTS: A randomized, double-blind, placebo-controlled study was conducted in non-hospitalized individuals with COVID-19 in Corrientes, Argentina. Patients with SARS-CoV-2 positive nasal swabs were contacted within 48 h by telephone to invite them to participate. The trial randomized 501 patients between August 19th 2020 and February 22nd 2021. INTERVENTION: Patients were randomized to ivermectin (N = 250) or placebo (N = 251) arms in a staggered dose, according to the patient's weight, for 2 days. MAIN OUTCOMES AND MEASURES: The efficacy of ivermectin to prevent hospitalizations was evaluated as primary outcome. We evaluated secondary outcomes in relationship to safety and other efficacy end points. RESULTS: The mean age was 42 years (SD ± 15.5) and the median time since symptom onset to the inclusion was 4 days [interquartile range 3-6]. The primary outcome of hospitalization was met in 14/250 (5.6%) individuals in ivermectin group and 21/251 (8.4%) in placebo group (odds ratio 0.65; 95% confidence interval, 0.32-1.31; p = 0.227). Time to hospitalization was not statistically different between groups. The mean time from study enrollment to invasive mechanical ventilatory support (MVS) was 5.25 days (SD ± 1.71) in ivermectin group and 10 days (SD ± 2) in placebo group, (p = 0.019). There were no statistically significant differences in the other secondary outcomes including polymerase chain reaction test negativity and safety outcomes. LIMITATIONS: Low percentage of hospitalization events, dose of ivermectin and not including only high-risk population. CONCLUSION: Ivermectin had no significant effect on preventing hospitalization of patients with COVID-19. Patients who received ivermectin required invasive MVS earlier in their treatment. No significant differences were observed in any of the other secondary outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04529525 .

Maple syrup urine disease: Characteristics of diagnosis and treatment in 45 patients in Chile.

Maple urine syrup disease (MSUD) is an autosomal recessive disorder characterized by deficient activity of the branched-chain alpha ketoacid dehydrogenase (BCKAD) enzymatic complex due to biallelic variants in the alpha (BCKDHA) or beta (BCKDHB) subunits or the acyltransferase component (DBT). Treatment consists in leucine (LEU), isoleucine (ILE), and valine (VAL) (branched-chain amino acids) dietary restriction and strict metabolic control. to determine the characteristics of the Chilean cohort with MSUD currently in follow-up at Instituto de Nutrición y Tecnología de los Alimentos, during the 1990-2017 period Retrospective analytical study in 45 MSUD cases. Measured: biochemical parameters (LEU, ILE, and VAL), anthropometric evaluation, and neurocognitive development. In 18 cases undergoing genetic study were analyzed according to the gene and protein location, number of affected alleles, and type of posttranslational modification affected. Then, 45 patients with MSUD diagnosis were identified during the period: 37 were alive at the time of the study. Average diagnosis age was 71 ± 231 days. Average serum diagnosis LEU concentrations: 1.463 ± 854.1 µmol/L, VAL 550 ± 598 µmol/L and ILE 454 ± 458 µmol/L. BCKDHB variants explain 89% cases, while BCKDHA and DBT variants explain 5.5% of cases each. Variants p.Thr338Ile in BCKDHA, p.Pro240Thr and p.Ser342Asn in BCKDHB have not been previously reported in literature. Average serum follow-up LEU concentrations were 252.7 ± 16.9 µmol/L in the <5 years group and 299 ± 123.2 µmol/L in ≥5 years. Most cases presented some degree of developmental delay. Early diagnosis and treatment is essential to improve the long-term prognosis. Frequent blood LEU measurements are required to optimize metabolic control and to establish relationships between different aspects analyzed.

Preliminary testing by adults of a haptics-assisted robot platform designed for children with physical impairments to access play.

Development of children's cognitive and perceptual skills depends heavily on object exploration and experience in their physical world. For children who have severe physical impairments, one of the biggest concerns is the loss of opportunities for meaningful play with objects, including physical contact and manipulation. Assistive robots can enable children to perform object manipulation through the control of simple interfaces. Touch sensations conveyed through haptic interfaces in the form of force reflection or force assistance can help a child to sense the environment and to control a robot. A robotic system with forbidden region virtual fixtures (VFs) was tested in an object sorting task. Three sorting tasks-by color, by shape, and by both color and shape-were performed by 10 adults without disability and one adult with cerebral palsy. Tasks performed with VFs were accomplished faster than tasks performed without VFs, and deviations of the motion area were smaller with VFs than without VFs. For the participant with physical impairments, two out of three tasks were slower with the VFs. This implies that forbidden region VFs are not always able to improve user task performance. Alignment with an individual's unique motion characteristics can improve VF assistance.

[Determination of postoperative hemoglobin levels and their correlation with the weight of the transoperative textiles]. / Pérdida sanguínea por el peso de los textiles y su correlación con la hemoglobina posquirúrgica.

OBJECTIVE: To determine postsurgical hemoglobin levels and the correlation with trans-surgical textile weight. MATERIALS AND METHODS: A cross-sectional study, including 120 patients who underwent gynecological surgery, was performed in the HGR 1 in Cd. Obregon Sonora, from June to July 2015; the account of textile weight blood loss estimation was carried out and subsequently became an association of hemoglobin levels in the postoperative period, performing the conversion of a gram to one milliliter. There was expected to be an association between blood loss with low levels of hemoglobin; for each lost 500 ml, the hemoglobin decreased by 1 g. RESULTS: 120 patients were evaluated; the average age was 48.65 years. The surgical events were divided in abdominal in 76.67%, breast surgery 19.17%, and vaginal 9.17%. There was a decrease in hemoglobin of 0.74 mg/dl and hematocrit of 1.93%. We found significant association between blood loss and the decrease in hemoglobin with relative risk of 3.01 (95% CI: 1.69-5.36). CONCLUSIONS: The main conclusion of this study is to establish that a loss > 500 ml has a direct association with > 1.1 g postoperative hemoglobin decrease and hematocrit reduction > 6%.

[Abdominal and gastrointestinal symptoms of Dengue fever. Analysis of a cohort of 8559 patients]. / Síntomas abdominales y gastrointestinales del dengue. Análisis de una cohorte de 8.559 pacientes.

INTRODUCTION/AIM: Dengue fever is a common disease in tropical and subtropical regions and is characterized by fever, headache, and joint and muscle pain. Occasionally, patients develop abdominal and gastrointestinal symptoms but information about the real frequency of these manifestations is lacking. The aim of this study was to determine the frequency of abdominal and gastrointestinal symptoms in a cohort of patients with Dengue fever. PATIENTS AND METHODS: We performed a retrospective review of 8559 patients with a diagnosis of Dengue fever during the 2006 epidemic to determine the frequency of abdominal and gastrointestinal symptoms. RESULTS: Abdominal and gastrointestinal symptoms were present in 67% of patients. The most frequent symptom was nausea (n=4453, 52%), followed by abdominal pain (n=3058, 36%), vomiting (n=2477, 29%), diarrhea (n=1471, 17%), hepatomegaly, (n=144, 2%), gastrointestinal bleeding (n=34, 0.3%) and ascites (n=8, 0.1%). Hospitalization was required in 1640 patients (19%), of which 1210 (74%, p=0.0001) had some abdominal and gastrointestinal symptoms. In this group, the most frequent symptoms were nausea (n=972, 59%), abdominal pain (n=692, 42%), vomiting (n=668, 41%) and diarrhea (n=393, 24%). Among patients admitted to our hospital for Dengue, 70% showed alterations in liver function tests. CONCLUSIONS: Our findings suggest that close to 67% of patients with Dengue fever have abdominal and gastrointestinal symptoms or abnormalities in liver function tests. Abdominal and gastrointestinal symptoms were significantly more frequent in patients who were hospitalized. The differential diagnosis of an acute febrile syndrome with abdominal pain or gastrointestinal symptoms in patients living in endemic areas or who have recently travelled to certain regions should include Dengue fever.

Síntomas abdominales y gastrointestinales del dengue. Análisis de una cohorte de 8.559 pacientes / Abdominal and gastrointestinal symptoms of Dengue fever. Analysis of a cohort

Introducción/objetivo: El dengue es una enfermedad común en áreas tropicales y subtropicalesque se caracteriza por fiebre, cefalea, artralgia y mialgia. Ocasionalmente, los pacientesdesarrollan síntomas abdominales y gastrointestinales (SAGI), sin embargo, existe poca informaciónrespecto a la frecuencia real de estas manifestaciones. El objetivo de este estudio fuedeterminar la frecuencia de SAGI en una cohorte de pacientes con dengue.Pacientes y métodos: Se realizó una revisión retrospectiva de 8.559 pacientes con diagnósticode dengue durante la epidemia del a˜no 2006 para determinar la frecuencia de los SAGI.Resultados: El 67% de los pacientes presentaron SAGI. La náusea fue el síntoma más frecuente(n = 4.453, 52%) seguida del dolor abdominal (n = 3.058, 36%), vómito (n = 2.477, 29%), diarrea(n = 1.471, 17%), hepatomegalia (n = 144, 2%), esplenomegalia (n = 43, 0,5%), sangrado digestivo(n = 34, 0,3%) y ascitis (n = 8, 0,1%). Se hospitalizaron a 1.640 pacientes (19%) de los cuales1.210 (74%, p = 0,0001) presentaban algún SAGI. En este grupo los síntomas más frecuentesfueron náusea (n = 972, 59%), dolor abdominal (n = 692, 42%), vómito (n = 668, 41%) y diarrea(n = 393, 24%). En el grupo de los pacientes hospitalizados con dengue en el HRAEV el 70%presentó alteraciones en las pruebas de función hepática.Conclusión: Nuestros hallazgos indican que cerca del 67% de los pacientes con dengue presentanSAGI o alteraciones de pruebas de función hepática. La frecuencia de SAGI fue significativamentemayor en pacientes hospitalizados. El diagnóstico diferencial de un síndrome febrilagudo con síntomas gastrointestinales en pacientes en áreas endémicas o con historia de viajea ciertas regiones con antecedentes epidémicos debe incluir al dengue (AU)

Introduction/aim: Dengue fever is a common disease in tropical and subtropical regions andis characterized by fever, headache, and joint and muscle pain. Occasionally, patients developabdominal and gastrointestinal symptoms but information about the real frequency of thesemanifestations is lacking. The aim of this study was to determine the frequency of abdominaland gastrointestinal symptoms in a cohort of patients with Dengue fever.Patients and methods: We performed a retrospective review of 8559 patients with a diagnosisof Dengue fever during the 2006 epidemic to determine the frequency of abdominal andgastrointestinal symptoms.Results: Abdominal and gastrointestinal symptoms were present in 67% of patients. The mostfrequent symptom was nausea (n = 4453, 52%), followed by abdominal pain (n = 3058, 36%),vomiting (n = 2477, 29%), diarrhea (n = 1471, 17%), hepatomegaly, (n = 144, 2%), gastrointestinalbleeding (n = 34, 0.3%) and ascites (n = 8, 0.1%). Hospitalization was required in 1640 patients(19%), of which 1210 (74%, p = 0.0001) had some abdominal and gastrointestinal symptoms. Inthis group, the most frequent symptoms were nausea (n = 972, 59%), abdominal pain (n = 692,42%), vomiting (n = 668, 41%) and diarrhea (n = 393, 24%). Among patients admitted to ourhospital for Dengue, 70% showed alterations in liver function tests.Conclusions: Our findings suggest that close to 67% of patients with Dengue fever have abdominaland gastrointestinal symptoms or abnormalities in liver function tests. Abdominal andgastrointestinal symptoms were significantly more frequent in patients who were hospitalized.The differential diagnosis of an acute febrile syndrome with abdominal pain or gastrointestinalsymptoms in patients living in endemic areas or who have recently travelled to certain regionsshould include Dengue fever (AU)

[Urological complications following kidney transplantation using Lich-Gregoir technique: A 4-year experience in Mexico]. / Complicaciones urológicas postrasplante renal con técnica de Lich-Gregoir. Experiencia de cuatro años.

OBJECTIVE: We present a retrospective review of urological complications following kidney transplantation in two medical centers in the Mexican state of Veracruz using Lich-Gregoir extravesical ureteroneocystostomy during a 4-year period. METHODS: Records from 242 patients from January 2003 to November 2007 were reviewed. Standard technique for organ procurement, open nephrectomy and kidney transplant was performed. EVU was used in all patients. Urological complications and management are reported. RESULTS: There were 19 complications recorded in 18 patients (7.8%). Sixteen kidneys were obtained from living donors. Urinary leak was the most common complication (4.5%) followed by ureteral stenosis (1.6%), vesicoureteral reflux (1.2%) and ureteral necrosis (0.4%) Most patients were treated with Foley catheter (42%), Boary flap (26%) and nephrostomy (15%); 1.23% grafts were lost associated with urological complications. CONCLUSIONS: Renal transplantation should incur few urological complications. Attention to technical details should be paid to avoid major complications. Early evaluation to correct complications reduces sepsis, morbidity and the risk of losing graft function.

Complicaciones urológicas postrasplante renal con técnica de Lich-Gregoir: experiencia de cuatro años / Urological complications following kidney transplantation using Lich-Gregoir technique: a 4-year experience in Mexico

Objetivo: Revisión de las complicaciones urológicas posteriores al trasplante renal en dos centros hospitalarios utilizando la técnica de ureteroneocistostomía extravesical de Lich-Gregoir en un periodo de cuatro años. Material y métodos: Se revisaron los expedientes de 242 pacientes en quienes se llevó a cabo trasplante renal de enero de 2003 a noviembre de 2007. En todos los pacientes se realizó ureteroneocistostomía extravesical. Se informaron todas las complicaciones urológicas y su manejo. Resultados: Se registraron 19 complicaciones en 18 pacientes, con una incidencia de 7.8 %; 16 riñones se obtuvieron de donadores vivos. Las complicaciones más comunes fueron fuga de orina (4.5 %), estenosis urinaria (1.6 %), reflujo vesicoureteral (1.2 %) y necrosis ureteral (0.4 %). La mayoría de los pacientes fueron tratados con sonda de Foley (42 %), colgajo de Boary (26 %) y nefrostomía (15 %). La pérdida del injerto renal se asoció a complicaciones urológicas en 1.23 % Conclusiones: El trasplante renal debe incurrir en pocas complicaciones urológicas, por lo que debe cuidarse los detalles técnicos. La evaluación temprana para corregir las complicaciones reduce la sepsis, morbilidad y el riesgo de pérdida del injerto.

OBJECTIVE: We present a retrospective review of urological complications following kidney transplantation in two medical centers in the Mexican state of Veracruz using Lich-Gregoir extravesical ureteroneocystostomy during a 4-year period. METHODS: Records from 242 patients from January 2003 to November 2007 were reviewed. Standard technique for organ procurement, open nephrectomy and kidney transplant was performed. EVU was used in all patients. Urological complications and management are reported. RESULTS: There were 19 complications recorded in 18 patients (7.8%). Sixteen kidneys were obtained from living donors. Urinary leak was the most common complication (4.5%) followed by ureteral stenosis (1.6%), vesicoureteral reflux (1.2%) and ureteral necrosis (0.4%) Most patients were treated with Foley catheter (42%), Boary flap (26%) and nephrostomy (15%); 1.23% grafts were lost associated with urological complications. CONCLUSIONS: Renal transplantation should incur few urological complications. Attention to technical details should be paid to avoid major complications. Early evaluation to correct complications reduces sepsis, morbidity and the risk of losing graft function.