Interrater Reliability of the Spanish (Colombia) Version of the Post-COVID-19 Functional Status Scale.

Background: COVID-19 has been one of the most critical public health challenges of recent decades. This disease develops severely in one in five patients, and approximately 5% require admission to a critical care unit. Due to the impact of the sequelae, the Post-COVID-19 Functional Status Scale (PCFS) was developed. This study is aimed at determining the interrater reliability of the Spanish (Colombia) version of the PCFS in adult patients with post-COVID-19 infection. Methods: This is an observational study performed with patients diagnosed with COVID-19. Two evaluators repeated the test-retest of the PCFS scale with knowledge and clinical experience in the care of patients with COVID-19 and had previously applied the test. The PCFS assesses functional limitations at discharge and can be used at 4 and 8 weeks to evaluate practical consequences and determine the degree of disability these patients may have. For interrater reliability, Cronbach's alpha was applied with its respective confidence interval and the Bland-Altman method. A 95% confidence interval (CI) was taken as the basis for the interpretation of the Intraclass Correlation Coefficient (ICC). Results: A total of 112 adult patients participated in the study, aged 51.46 ± 15.94 years. It was evidenced that the survival, constant care, and activities of daily living questions have an ICC of one (1.000) with an ICC (1.000-1.000), demonstrating excellent reliability, while those close to one were instrumental activities, role participation, symptoms, and final score with an ICC 0.918 to 0.984 and an ICC (0.881-0.989). Thus, a homogeneous distribution of the interrater data was evident. Conclusions: Excellent interobserver reliability of the Spanish (Colombia) version of the PCFS in patients with different degrees of functional status was reported.

Emergent conversion from single-anastomosis gastric bypass to Roux-en-Y gastric bypass with subsequent obstruction of entero-enteric anastomosis by ascaris.

One anastomosis gastric bypass (OAGB), the third most commonly performed procedure worldwide, has shown excellent results in terms of weight loss and resolution of comorbidities compared with other bariatric surgeries. However, its use remains limited in various parts of the world due to postoperative complications. After the efficacy of this procedure was established, the focus of treatment shifted toward resolving postoperative complications. Protein-energy malnutrition after OAGB is one of the main issues that needs to be addressed. There are several operative options for patients who require revision surgery including reversal and conversion to Roux-en-Y gastric bypass (RYGB). The conversion from OAGB to RYGB is a feasible method that has shown excellent results when performed by experts in the field. Here, we present the case of a woman with symptoms of acute obstruction secondary to OAGB who underwent conversion to RYGB under emergent conditions.

Effects of changing reference values on the interpretation of spirometry for rubber workers.

Introduction: The National Health and Nutrition Assessment Survey (NHANES) is being adopted for interpreting spirometry in occupational examinations. Rubber workers have an elevated risk of respiratory health issues due to industrial exposure, and changes in the equations would affect spirometry monitoring programs. Objective: To determine the differences in the use of the Knudson and NHANES III equations in nonsmoking workers in the rubber industry. Method: A cross-sectional study was conducted with 75 nonsmoking workers with occupational exposure to rubber for at least two years. The factory had engineered protection controls and provided respiratory protection to the workers. Spirometry was conducted according to Spirometry Testing in Occupational Health Programs and Standardization of Spirometry: American Thoracic Society/European Respiratory Society. Result: Spirometric prediction differences were present in the restrictive pattern assessment based on forced vital capacity (FVC), in which three individuals (4%) classified as normal according to Knudson presented restrictive disease according to NHANES III; only in the record of one participant was there restrictive disease using both equations. There was an 8% discrepancy for small airway obstruction in which six workers classified as normal using NHANES III were classified as diseased (FEF 25-75 <50%) using the Knudson equation. Conclusion: In the respiratory examination of workers exposed to rubber, the NHANES III equation is better able to detect restrictive diseases than is the Knudson equation; however, the Knudson equation is more sensitive to obstructive patterns.

Colonic lipoma of the hepatic flexure causing invagination in an adult.

Intussusception is a rare condition in adults that can lead to intestinal obstruction due to malignant or benign lesions in the wall of the colon. Among the benign causes, lipomas are adipose tissue tumors that are most frequently located in the ascending colon. Invagination is characterized by nonspecific symptoms and normal laboratory test results. The exact point of invagination can be detected using advanced imaging studies such as abdominal computed tomography and colonoscopy. Invagination is treated surgically. Here, we presented the case of a female patient with colo-colonic invagination caused by a large lipoma diagnosed by computed tomography who underwent right hemicolectomy with primary ileocolonic anastomosis.

Photobiology of the giant kelp Macrocystis pyrifera in the land-terminating glacier fjord Yendegaia (Tierra del Fuego): A look into the future?

The channel and fjord region of southern Chilean Patagonia hosts giant kelp forests (Macrocystis pyrifera) that have little known site-specific responses to diverse physical gradients. In this study, the functionality of the bio-optical, morphological and biochemical features of the kelps, that determine their light trapping and acclimation, were studied along a gradient of varying turbidity and light conditions at the land-terminating glacier of fjord Yendegaia in the Beagle Channel. These habitats are marked by glacial retreat, and M. pyrifera has successfully colonized new areas due to the effects of warming. Results indicated that under a sharp gradient of turbidity and light availability, the kelps have adapted shading characteristics. The photobiological traits (e.g. light absorption, pigment concentration, photochemistry and blade optics) of algae from depths between 6 and 13 m varied in relation to the degree of turbidity along the fjord. However, these populations did not show obvious intra-thallus variation along the longitudinal profile e.g. blades located at different depths showed relatively similar acclimation potential to the prevailing light field. Only basal sporophylls showed general differences in comparison with the vegetative fronds. Otherwise, the high phenolic (phlorotannin) content, which was reflected in the massive presence of intracellular physodes, suggests that these organisms could be biochemically well-equipped to cope with changes in physical conditions or the presence of herbivore invertebrates (e.g. sea urchins).

Bioactive Polyphenols from Southern Chile Seaweed as Inhibitors of Enzymes for Starch Digestion.

The increment of non-communicable chronic diseases is a constant concern worldwide, with type-2 diabetes mellitus being one of the most common illnesses. A mechanism to avoid diabetes-related hyperglycemia is to reduce food digestion/absorption by using anti-enzymatic (functional) ingredients. This research explored the potential of six common Chilean seaweeds to obtain anti-hyperglycemic polyphenol extracts, based on their capacity to inhibit key enzymes related with starch digestion. Ethanol/water hot pressurized liquid extraction (HPLE), which is an environmentally friendly method, was studied and compared to conventional extraction with acetone. Total polyphenols (TP), antioxidant activity, cytotoxicity and inhibition capacity on α-glucosidase and α-amylase were analyzed. Results showed that the Durvillaea antarctica (cochayuyo) acetone extract had the highest TP content (6.7 ± 0.7 mg gallic acid equivalents (GAE)/g dry seaweed), while its HPLE ethanol/water extract showed the highest antioxidant activity (680.1 ± 11.6 µmol E Trolox/g dry seaweed). No extract affected cell viability significantly. Only cochayuyo produced extracts having relevant anti-enzymatic capacity on both studied enzymes, showing a much stronger inhibition to α-glucosidase (even almost 100% at 1000 µg/mL) than to α-amylase. In conclusion, from the Chilean seaweeds considered in this study, cochayuyo is the most suitable for developing functional ingredients to moderate postprandial glycemic response (starchy foods), since it showed a clear enzymatic inhibition capacity and selectivity.

Satellite-derived mapping of kelp distribution and water optics in the glacier impacted Yendegaia Fjord (Beagle Channel, Southern Chilean Patagonia).

Giant kelp Macrocystis pyrifera is a brown alga with extensive global distribution, however, recent evidence suggests that its dynamics presents high degree of regional variability. In southern Chilean fjord region, largely unexplored kelp forests are currently being threatened by global change and human impacts. High-resolution satellite (Sentinel-2) imagery was used to describe temporal and spatial distribution patterns of kelp beds in Yendegaia Fjord (Beagle Channel) using Spectral Mixture Analysis (SMA), and to characterize water optical gradients of this habitat strongly influenced by river runoff from a melting glacier. The suitability of SMA for kelp classification was contrasted with other vegetation indices (NDVI, EVI, FAI). Validation was made using drone aerial photographs of kelp canopies. Different analysis tools resulted in up to 35% difference in kelp coverage estimation. The overall accuracy (66-82%) of kelp classification followed an order FAI < EVI < NDVI < SMA. Omission error of SMA and lower coincidence with vegetation indices occurred in pixels with low kelp pixel abundance (<0.50). Based on SMA, the lowest kelp abundance was observed in the river mouth with high turbidity, increasing towards the Beagle Channel. The highest kelp abundance was observed in late summer, but otherwise no clear seasonal patterns could be observed. Water turbidity presented both spatial and seasonal variation. Strong particle sedimentation (leading to light attenuation, interference with remote detection of kelps, and even to their detachment due to substrate quality) and tidal fluctuations in glacier-impacted fjord-type environments can be identified as key features affecting both the kelp population dynamics as well as their remote sensing. Also, low sun elevation at high latitudes in mid winter produces uncertainties in image analyses. In all, the remote sensing approach used in the present study can be regarded as a useful tool to map and monitor kelps forests from a remote region.

Una nueva etapa de Publindex: dolores de crecimiento: [Editorial] / A new stage of Publindex: growth pains: [Editorial]

Los resultados de la convocatoria 768 de Publindex aplicando estándares internacionales, tales como el h5 y los cuartiles de Scimago (SJR), marcan una nueva etapa para las revistas colombianas, Un cambio doloroso, pero necesario. Para muchos autores colombianos de nuestras revistas puede ser no posible entender como Infectio pasa de clasificación A2 a B, cuando la revista ha aumentado sus índices de citación y es la única revista médica colombiana que logra ascender de cuartil SJR en 2016. Es decir que a pesar de mejorar sus índices bibliométricos internacionales esto no se ve reflejado en las categorías de revistas colombianas. De igual manera, Colombia Médica aumentó las citas de revistas indexadas en Scopus de los cuartiles 1 y 2; sin embargo, con los nuevos criterios de Publindex cambió su calificación de A1 a A2. Es de anotar que las revistas latinoamericanas en general han crecido de manera lenta y las revistas de Colombia siguen muy por debajo de Brasil y otros países de Latinoamérica, en los últimos años, como puede observarse al analizar los índices de Scopus (Figura 1). Los nuevos criterios de clasificación corrigen por lo menos situaciones caóticas, previamente analizadas1,2que permitían otorgar la misma clasificación de A1 a Nature o PNAS que a Biomédica (Revista del Instituto Nacional Salud de Colombia). El sistema de Publindex debió prever una transición por etapas, creando una clasificación intermedia, porque los efectos a corto y mediano plazo desestimulan las iniciativas editoriales nacionales, con mayor efecto en las revistas de mayor reconocimiento por su calidad. Es por eso que esta editorial busca ilustrar a nuestros lectores y autores (sobre todo los docentes universitarios estales colombianos), las razones e implicaciones de esta nueva clasificación.

The results of Publindex's call for papers 768 applying international standards, such as h5 and Scimago quartiles (SJR), mark a new stage for Colombian journals, a painful but necessary change. For many Colombian authors of our journals it may not be possible to understand how Infectio goes from A2 to B classification, when the journal has increased its citation rates and is the only Colombian medical journal that manages to move up from SJR quartile in 2016. That is to say that despite improving its international bibliometric indexes this is not reflected in the categories of Colombian journals. Similarly, Colombia Médica increased the citations of journals indexed in Scopus from quartiles 1 and 2; however, with the new Publindex criteria it changed its rating from A1 to A2. It should be noted that Latin American journals in general have grown slowly and Colombian journals continue to lag far behind Brazil and other Latin American countries in recent years, as can be seen when analyzing the Scopus indexes (Figure 1). The new classification criteria at least correct chaotic situations, previously analyzed1,2 that allowed granting the same A1 classification to Nature or PNAS as to Biomédica (Journal of the National Institute of Health of Colombia). The Publindex system should have foreseen a transition in stages, creating an intermediate classification, because the short and medium term effects discourage national editorial initiatives, with greater effect on journals with greater recognition for their quality. That is why this editorial seeks to illustrate to our readers and authors (especially Colombian state university professors), the reasons and implications of this new classification.

High-Dose Filgrastim Treatment of Nonregenerative Pancytopenia Associated With Chronic Canine Ehrlichiosis.

OBJECTIVE: To report the management and outcome of a dog with canine monocytic ehrlichiosis and nonregenerative pancytopenia, with high doses of filgrastim. CASE DESCRIPTION: An 8-year-old male, mixed-breed dog, weighing 5.6kg, presented with a 1-month history of hyporexia, adynamia, and a weight loss of approximately 1kg. The general condition of the dog was observed to be poor as follows: lethargy, tachycardia, marked pallor of the mucous membranes, petechiae on the abdomen, hepatosplenomegaly, and cervical lymphadenopathy. A complete blood count analysis revealed severe leukopenia, thrombocytopenia, and anemia. A direct immunofluorescence assay using anti-Ehrlichia canis-immunoglobin G (1:400) yielded positive result. The dog was diagnosed with nonregenerative pancytopenia associated with canine monocytic ehrlichiosis. The dog presented poor prognostic signs (neutropenia, thrombocytopenia, and severe anemia). The dog was treated with antibiotics and a short course of high-dose filgrastim (50µg/kg, SC, q 48h for 4 days) to stimulate bone marrow response, prednisone to decrease peripheral platelet destruction, and an iron supplement to compensate for the iron deficiency in the bone deposits. Although temporary side effects associated with filgrastim use, such as bone pain, bleeding, and the worsening of thrombocytopenia, were observed, the treatment improved the clinical course and the cell counts in less than a month. CLINICAL RELEVANCE: The treatment protocol used in this case might be an alternative for treating cases of severe myelosuppression. This treatment plan can substantially change the clinical course of the disease for the better, compared to conventional treatment.

To Use or Not to Use Metformin in Cerebral Ischemia: A Review of the Application of Metformin in Stroke Rodents.

Ischemic strokes are major causes of death and disability. Searching for potential therapeutic strategies to prevent and treat stroke is necessary, given the increase in overall life expectancy. Epidemiological reports indicate that metformin is an oral antidiabetic medication that can reduce the incidence of ischemic events in patients with diabetes mellitus. Its mechanism of action has not been elucidated, but metformin pleiotropic effects involve actions in addition to glycemic control. AMPK activation has been described as one of the pharmacological mechanisms that explain the action of metformin and that lead to neuroprotective effects. Most experiments done in the cerebral ischemia model, via middle cerebral artery occlusion in rodents (MCAO), had positive results favoring metformin's neuroprotective role and involve several cellular pathways like oxidative stress, endothelial nitric oxide synthase activation, activation of angiogenesis and neurogenesis, autophagia, and apoptosis. We will review the pharmacological properties of metformin and its possible mechanisms that lead to neuroprotection in cerebral ischemia.

Neurodegenerative diversity in human cortical contusion: histological analysis of tissue derived from decompressive craniectomy.

The principal aim in the management of patients with cerebral contusion (CC) following severe traumatic brain injury (TBI) is the prevention, amelioration, and treatment of secondary neuronal dysfunction and pathology. Distinguishing between irreversibly damaged and surviving tissue could have considerable therapeutic and prognostic implications for patients. To characterize structurally the neuronal compartment of the contused region in samples derived from patients who suffered severe TBI and were subjected to decompressive craniectomy, we used NeuN, a neuronal marker. We determined that NeuN "patches", sectors with loss of NeuN immunoreactivity (NeuN-IR), represented 25% of the area among the analyzed cases. We also found a 67% decrease in NeuN levels via Western blot. Tissue adjoining patches of NeuN-IR were considered "preserved" due to the apparent normal density of neurons and conservation of the six cortical layers. Nevertheless, these sectors retained only 39% of their neurons with the classical pattern described for normal NeuN-IR. Using Fluorojade we identified a 16-fold increase in density of moribund neurons in "preserved" sectors when compared to controls. Additionally these abnormalities were enhanced 5-fold in "patches" of NeuN-IR when compared to preserved regions. Therefore, NeuN/Fluorojade abnormalities are indicative of different cell fates characteristic of CC tissue. This analysis addressed exclusively the neuronal compartment and provides new insights into the degenerative state of neurons in the contused region that is likely to contribute to clinical outcome and differentiate TBI from ischemia.