The Prediction and Treatment of Bleeding Esophageal Varices in the Artificial Intelligence Era: A Review.

Esophageal varices (EVs), a significant complication of cirrhosis, present a considerable challenge in clinical practice due to their high risk of bleeding and associated morbidity and mortality. This manuscript explores the transformative role of artificial intelligence (AI) in the management of EV, particularly in enhancing diagnostic accuracy and predicting bleeding risks. It underscores the potential of AI in offering noninvasive, efficient alternatives to traditional diagnostic methods such as esophagogastroduodenoscopy (EGD). The complexity of EV management is highlighted, necessitating a multidisciplinary approach that includes pharmacological therapy, endoscopic interventions, and, in some cases, surgical options tailored to individual patient profiles. Additionally, the paper emphasizes the importance of integrating AI into medical education and practice, preparing healthcare professionals for the evolving landscape of medical technology. It projects a future where AI significantly influences the management of gastrointestinal bleeding, improving clinical decision-making, patient outcomes, and overall healthcare efficiency. The study advocates for a patient-centered approach in healthcare, balancing the incorporation of innovative technologies with ethical principles and the diverse needs of patients to optimize treatment efficacy and enhance healthcare accessibility.

Bone metabolism and inflammatory biomarkers in radiographic and non-radiographic axial spondyloarthritis patients: a comprehensive evaluation.

Introduction: Axial spondyloarthritis (axSpA) is a heterogeneous disease that can be represented by radiographic axSpA (r-axSpA) and non-radiographic axSpA (nr-axSpA). This study aimed to evaluate the relationship between the markers of inflammation and bone turnover in r-axSpA patients and nr-axSpA patients. Methods: A cross-sectional study included 29 r-axSpA patients, 10 nr-axSpA patients, and 20 controls matched for age and sex. Plasma markers related to bone remodeling such as human procollagen type 1 N-terminal propeptide (P1NP), sclerostin, tartrate-resistant acid phosphatase 5b (TRACP5b), receptor activator of nuclear factor kappa B ligand (RANKL), and osteoprotegerin (OPG) were measured by an ELISA kit. A panel of 92 inflammatory molecules was analyzed by proximity extension assay. Results: R-axSpA patients had decreased plasma levels of P1NP, a marker of bone formation, compared to controls. In addition, r-axSpA patients exhibited decreased plasma levels of sclerostin, an anti-anabolic bone hormone, which would not explain the co-existence of decreased plasma P1NP concentration; however, sclerostin levels could also be influenced by inflammatory processes. Plasma markers of osteoclast activity were similar in all groups. Regarding inflammation-related molecules, nr-axSpA patients showed increased levels of serum interleukin 13 (IL13) as compared with both r-axSpA patients and controls, which may participate in the prevention of inflammation. On the other hand, r-axSpA patients had higher levels of pro-inflammatory molecules compared to controls (i.e., IL6, Oncostatin M, and TNF receptor superfamily member 9). Correlation analysis showed that sclerostin was inversely associated with IL6 and Oncostatin M among others. Conclusion: Altogether, different inflammatory profiles may play a role in the development of the skeletal features in axSpA patients particularly related to decreased bone formation. The relationship between sclerostin and inflammation and the protective actions of IL13 could be of relevance in the axSpA pathology, which is a topic for further investigation.

Dermatological Manifestations in Patients With Chronic Kidney Disease: A Review.

Chronic kidney disease (CKD) is a progressive disease and has multiple clinical manifestations; when CKD reaches the end stage, at least one cutaneous manifestation appears due to some increased toxin levels or a constant proinflammatory state. Nonspecific manifestations include pruritus, xerosis, pigmentation disorders, acquired ichthyosis, purpuric spots, and nail disorders. Some specific manifestations are bullous dermatoses, acquired perforating dermatoses (APD), eruptive xanthoma, access site infections, calcifying disorders, and nephrogenic systemic fibrosis (NSF). All these cutaneous changes negatively impact patients; early recognition and diagnosis of these dermatoses will make a difference in their quality of treatment. Exploring a patient's skin is fundamental to suspect some diseases and increased toxin levels; pruritus occurs when uremic toxins are raised, and nail disorders are associated with hypoalbuminemia. This review provides the clinician with information on the clinical manifestations that occur in CKD, including epidemiology, pathophysiology, clinical manifestations, diagnosis, histopathology, treatment, and life impact of the dermatoses in CKD.

Lhermitte-Duclos Disease: A Case Series.

Lhermitte-Duclos disease (LDD), or dysplastic cerebellar gangliocytoma, is a rare benign tumor characterized by unilateral hemispheric cerebellar expansion. It is linked to mutations in the phosphatase and tensin homolog (PTEN) gene, which inhibit the phosphatidylinositol-3'-kinase pathway, leading to increased cell division and defective neuronal migration. This study aims to compare the clinical, radiological, histopathological, surgical resolution, and follow-up characteristics of reported cases of this rare condition. An in-depth search of LDD patients' clinical records at our institute between 2003 and 2023 was conducted, in addition to a systematic literature review on PubMed. Three patients with a diagnosis of LDD were found. Cerebellar abnormalities, varying headaches, and visual impairment were all present clinically. On T2 in the posterior fossa, all three MRI scans displayed the typical hyperintense parallel streak appearance. The histopathological report showed that large ganglion cells had replaced the granular layer, Purkinje cells had degenerated, the molecular layer had become hyper-myelinated, and synaptophysin and chromogranin were positive. Partial tumor resection and avoiding intracranial hypertension were the main goals of treatment. Genetic follow-up was conducted for all three patients. Neurosurgeons must be aware of LDD to provide close genetic monitoring despite the benign nature of the tumor because of its link to Cowden syndrome and elevated risk of cancer in other organs.

First report of Aedes albopictus (Diptera: Culicidae) in the North of Colombia.

Aedes albopictus is considered a potential vector of arboviruses in Colombia. Females and males naturally infected with dengue, Zika and chikungunya viruses have already been found in this country. We document the first record of Ae. albopictus in the Cordoba department, in North of Colombia. The finding was carried out during Ae. aegypti collection activities in the Ayapel, Montelibano, Planeta Rica, Pueblo Nuevo and Puerto Libertador municipalities. The entomological material was collected in water containers such as cement water tanks, tanks, bottles, tires, abandoned toilets, and plastic lids with natural water located in the intradomicile, peridomicile, and extra-domicile spaces of the homes. We collected 658 Ae. albopictus samples in the larva and pupa stages, and once these reached adulthood, we determined that 389 were female and 269 were male. This is the first record of the presence of Ae. albopictus in the Cordoba department.

Cytomegalovirus (CMV)-Driven Transformation: An Uncommon Cause of a Central Nervous System Pseudotumor.

Cytomegalovirus (CMV) is an opportunistic virus that can cause life-threatening neurological diseases in immunocompromised individuals, particularly those with HIV/AIDS. In this case report, a patient presenting with left gait lateralization was found to have a ring-enhancing cerebral mass lesion that was attributed to CMV. To date, only eight similar cases have been documented. When evaluating patients with HIV/AIDS who have cerebral mass lesions, clinicians should keep CMV as a possible cause because prompt antiviral therapy may improve clinical outcomes.

Frecuencia de malnutrición y su relación con complicaciones en mujeres embarazadas y sus recién nacidos

En el embarazo el requerimiento energético y de nutrientes aumentan, el déficit o el exceso puede afectar el estado nutricional de la madre y del neonato. Con el objetivo de determinar la frecuencia de malnutrición y su relación con complicaciones en mujeres embarazadas y sus recién nacidos que acuden al Hospital Distrital de Capiatá del Ministerio de Salud Pública y Bienestar Social, en el mes de febrero a agosto de 2022, se realizó un estudio observacional descriptivo de corte transverso retrospectivo que incluyó a 140 gestantes, de las cuales 64 presentaron complicaciones por malnutrición y 76 no presentaron ninguna complicación. La edad media fue de 26,9±6,6 años con un rango de edad de 15 a 40 años. Los resultados muestran que el 45.7% (n=64) de las gestantes presentaron complicaciones por malnutrición, el 51,6% presentó diabetes gestacional, anemia en el 29,7%, el 7,8% presentó anemia y diabetes gestacional, el otro 7,8% hipertensión arterial, el 1,6% manifestó hipertensión arterial y diabetes gestacional y el otro 1,6% presentó anemia, hipertensión arterial y diabetes gestacional. En relación a la evaluación nutricional al inicio y al final de la gestación en las gestantes con complicaciones hubo una leve disminución en los porcentajes de obesidad de 43,7% a 37,5% y un aumento del bajo peso de 11% a 20,3%. En cuanto al tipo de parto en las gestantes con complicaciones el 51,6% fue por cesárea (n=33), las cuales presentaron diabetes gestacional en el 54,5%, seguido de anemia en el 21,2%. Se comprobó un mayor porcentaje de sobrepeso y obesidad (29,7%) en los recién nacidos de madres con complicaciones. Se pudo evidenciar la frecuencia de malnutrición y complicaciones en casi la mitad de las gestantes, es preciso generar mayores estrategias en salud pública para prevenir la malnutrición y complicaciones en gestantes.

In pregnancy the energy and nutrient requirement increases, the deficit or excess can affect the nutritional status of the mother and the neonate. In order to determine the frequency of malnutrition and their relationship with complications in pregnant women and their newborns who go to the Capiata District Hospital of the Ministry of Public Health and Social Welfare, in the month of February to August 2022, a Descriptive observational study of retrospective cross -section that included 140 pregnant women, of which 64 presented complications for malnutrition and 76 did not present any complication. The Middle Ages was 26.9 ± 6.6 years with an age range of 15 to 40 years. The results show that 45.7% (n = 64) of pregnant women presented complications for malnutrition, 51.6% presented gestational diabetes, anemia in 29.7%, 7.8% presented anemia and gestational diabetes, the other 7.8% arterial hypertension, 1.6% expressed arterial hypertension and gestational diabetes and the other 1.6% presented anemia, arterial hypertension and gestational diabetes. In relation to nutritional evaluation at the beginning and at the end of pregnancy in pregnant women with complications there was a slight decrease in obesity percentages of 43.7% to 37.5% and an increase in low weight of 11% to 20, 3%. As for the type of childbirth in pregnant women with complications, 51.6%was due to caesarean section (n = 33), which presented gestational diabetes in 54.5%, followed by anemia in 21.2%. A higher percentage of overweight and obesity (29.7%) was proven in mother's newborns with complications. The frequency of malnutrition and complications could be evidenced in almost half of the pregnant women, it is necessary to generate greater public health strategies to prevent malnutrition and complications in pregnant women.

Frecuencia de malnutrición y su relación con complicaciones en mujeres embarazadas y sus recién nacidos / Frequency of malnutrition and their relationship with complications in pregnant women and their newborns

En el embarazo el requerimiento energético y de nutrientes aumentan, el déficit o el exceso puede afectar el estado nutricional de la madre y del neonato. Con el objetivo de determinar la frecuencia de malnutrición y su relación con complicaciones en mujeres embarazadas y sus recién nacidos que acuden al Hospital Distrital de Capiatá del Ministerio de Salud Pública y Bienestar Social, en el mes de febrero a agosto de 2022, se realizó un estudio observacional descriptivo de corte transverso retrospectivo que incluyó a 140 gestantes, de las cuales 64 presentaron complicaciones por malnutrición y 76 no presentaron ninguna complicación. La edad media fue de 26,9±6,6 años con un rango de edad de 15 a 40 años. Los resultados muestran que el 45.7% (n=64) de las gestantes presentaron complicaciones por malnutrición, el 51,6% presentó diabetes gestacional, anemia en el 29,7%, el 7,8% presentó anemia y diabetes gestacional, el otro 7,8% hipertensión arterial, el 1,6% manifestó hipertensión arterial y diabetes gestacional y el otro 1,6% presentó anemia, hipertensión arterial y diabetes gestacional. En relación a la evaluación nutricional al inicio y al final de la gestación en las gestantes con complicaciones hubo una leve disminución en los porcentajes de obesidad de 43,7% a 37,5% y un aumento del bajo peso de 11% a 20,3%. En cuanto al tipo de parto en las gestantes con complicaciones el 51,6% fue por cesárea (n=33), las cuales presentaron diabetes gestacional en el 54,5%, seguido de anemia en el 21,2%. Se comprobó un mayor porcentaje de sobrepeso y obesidad (29,7%) en los recién nacidos de madres con complicaciones. Se pudo evidenciar la frecuencia de malnutrición y complicaciones en casi la mitad de las gestantes, es preciso generar mayores estrategias en salud pública para prevenir la malnutrición y complicaciones en gestantes.

In pregnancy the energy and nutrient requirement increases, the deficit or excess can affect the nutritional status of the mother and the neonate. In order to determine the frequency of malnutrition and their relationship with complications in pregnant women and their newborns who go to the Capiata District Hospital of the Ministry of Public Health and Social Welfare, in the month of February to August 2022, a Descriptive observational study of retrospective cross -section that included 140 pregnant women, of which 64 presented complications for malnutrition and 76 did not present any complication. The Middle Ages was 26.9 ± 6.6 years with an age range of 15 to 40 years. The results show that 45.7% (n = 64) of pregnant women presented complications for malnutrition, 51.6% presented gestational diabetes, anemia in 29.7%, 7.8% presented anemia and gestational diabetes, the other 7.8% arterial hypertension, 1.6% expressed arterial hypertension and gestational diabetes and the other 1.6% presented anemia, arterial hypertension and gestational diabetes. In relation to nutritional evaluation at the beginning and at the end of pregnancy in pregnant women with complications there was a slight decrease in obesity percentages of 43.7% to 37.5% and an increase in low weight of 11% to 20, 3%. As for the type of childbirth in pregnant women with complications, 51.6%was due to caesarean section (n = 33), which presented gestational diabetes in 54.5%, followed by anemia in 21.2%. A higher percentage of overweight and obesity (29.7%) was proven in mother's newborns with complications. The frequency of malnutrition and complications could be evidenced in almost half of the pregnant women, it is necessary to generate greater public health strategies to prevent malnutrition and complications in pregnant women.

Characterization of the inflammatory proteome of synovial fluid from patients with psoriatic arthritis: Potential treatment targets.

Objectives: 1) To characterize the inflammatory proteome of synovial fluid (SF) from patients with Psoriatic Arthritis (PsA) using a high-quality throughput proteomic platform, and 2) to evaluate its potential to stratify patients according to clinical features. Methods: Inflammatory proteome profile of SF from thirteen PsA patients with active knee arthritis were analyzed using proximity extension assay (PEA) technology (Olink Target 96 Inflammation panel). Four patients with OA were included as control group. Results: Seventy-nine inflammation-related proteins were detected in SF from PsA patients (SF-PsA). Unsupervised analyzes of the molecular proteome profile in SF-PsA identified two specific phenotypes characterized by higher or lower levels of inflammation-related proteins. Clinically, SF-PsA with higher levels of inflammatory proteins also showed increased systemic inflammation and altered glucose and lipid metabolisms. Besides, SF from PsA patients showed 39 out of 79 proteins significantly altered compared to SF-OA specifically related to cell migration and inflammatory response. Among these, molecules such as TNFα, IL-17A, IL-6, IL-10, IL-8, ENRAGE, CCL20, TNFSF-14, OSM, IFNγ, MCP-3, CXCL-11, MCP4, CASP-8, CXCL-6, CD-6, ADA, CXCL-10, TNFß and IL-7 showed the most significantly change. Conclusion: This is the first study that characterizes the inflammatory landscape of synovial fluid of PsA patients by analyzing a panel of 92 inflammatory proteins using PEA technology. Novel SF proteins have been described as potential pathogenic molecules involved in the pathogenesis of PsA. Despite the flare, inflammatory proteome could distinguish two different phenotypes related to systemic inflammation and lipid and glucose alterations.

Adaptogens on Depression-Related Outcomes: A Systematic Integrative Review and Rationale of Synergism with Physical Activity.

Depression is considered the most important disorder affecting mental health. The aim of this systematic integrative review was: (i) to describe the effects of supplementation with adaptogens on variables related to depression in adults; and (ii) to discuss the potential combination with physical exercise to aid planning and commissioning future clinical research. An integrative review was developed complementing the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PROSPERO registration: CRD42021249682). A total of 41 articles met the inclusion criteria. With a Price index of 46.4%, we found that: (i) Hypericum perforatum (St. John's Wort) is the most studied and supported adaptogen (17/41 [41.46%], three systematic reviews with meta-analysis) followed by Crocus sativus L. or saffron (6/41 [14.63%], three systematic reviews with meta-analysis and two systematic reviews); (ii) it is possible that the significantly better performance of adaptogens over placebo is due to the reduction of allostatic load via the action of secondary metabolites on BDNF regulation; and, (iii) the number of studies reporting physical activity levels is limited or null for those that combine an exercise program with the consumption of adaptogens. Aware of the need for a multidisciplinary approach for depression treatment, this systematic integrative review provides an up-to-date view for supporting the use of St. John's Wort and saffron as non-pharmacological strategies while also help commissioning future research on the efficacy of other adaptogens. It also contributes to the design of future clinical research studies that evaluate the consumption of herbal extracts plus physical exercise, mainly resistance training, as a potentially safe and powerful strategy to treat depression.

Transgastric laparoscopic polypectomy in giant gastric polyps not susceptible of endoscopic management: novel surgical technique and case series.

BACKGROUND: The identification of gastric polyps incidentally in endoscopies of the upper digestive tract has increased its incidence, varying between 0.5% and 23%. 10% of these polyps have symptoms, 40% are hyperplastic. We allow ourselves to propose a laparoscopic technique for the management of giant hyperplastic polyps associated with a pyloric syndrome, not susceptible to endoscopic resection. METHOD: A series of patients approached by laparoscopic transgastric polypectomy due to the giant gastric polyps associated with pyloric syndrome, in Bogotá, Colombia, from January 2015 to December 2018. RESULTS: Seven patients, 85% female, with an average age of 51 years, who were admitted for pyloric syndrome and were taken to laparoscopic management, with an average surgical time of 42 min, intraoperative bleeding 7-8 cc, tolerance to the oral route 24 hours, no conversion, without mortality. CONCLUSIONS: Transgastric polypectomy for the management of benign giant gastric polyps that cannot be resected endoscopically turns out to be a feasible method, with a low rate of complications and without mortality.

ANTECEDENTES: La identificación de pólipos gástricos de manera incidental en endoscopias de vías digestivas altas ha aumentado su incidencia, que varía entre el 0.5% y el 23%. El 10% de estos pólipos presentan síntomas y el 40% son hiperplásicos. Nos permitimos proponer una técnica laparoscópica para el manejo de los pólipos hiperplásicos gigantes asociados a síndrome pilórico no susceptibles de resección endoscópica. MÉTODO: Serie de pacientes llevados a polipectomía transgástrica laparoscópica por hallazgo de pólipos gástricos gigantes asociados a síndrome pilórico, en Bogotá, Colombia, de enero de 2015 a diciembre de 2018. RESULTADOS: Un total de siete pacientes, el 85% de sexo femenino, con edad promedio de 51 años, ingresaron por síndrome pilórico y fueron llevados a manejo laparoscópico, con un tiempo quirúrgico promedio de 42 minutos, sangrado intraoperatorio de 7-8 cc, tolerancia a la vía oral a las 24 horas, no conversión, sin mortalidad. CONCLUSIONES: La polipectomía transgástrica para el manejo de pólipos gástricos gigantes benignos que no pueden ser resecados por vía endoscópica resulta ser un método factible, con una baja tasa de complicaciones y sin mortalidad.

Sex differences in cardiovascular and disease-related features in axial spondyloarthritis. A multicenter study of 912 patients.

OBJECTIVES: To determine the potential impact of sex-specific disease-related characteristics on cardiovascular (CV) disease in axial spondyloarthritis (axSpA). METHODS: Cross-sectional study of the Spanish AtheSpAin cohort to study CV disease in axSpA. Data on carotid ultrasound and CV disease and disease-related features were collected. RESULTS: 611 men and 301 women were recruited. Classic CV risk factors were significantly less prevalent in women, who also showed a lower frequency of carotid plaques (p = 0.001), lower carotid intima-media thickness (IMT) values ​​(p<0.001) and CV events (p = 0.008). However, after adjustment for classic CV risk factors, only the differences with respect to carotid IMT remained statistically significant. Women showed higher ESR at diagnosis (p = 0.038), and more active disease (ASDAS, p = 0.012, and BASDAI, p<0.001). They had shorter disease duration (p<0.001), lower prevalence of psoriasis (p = 0.008), less structural damage (mSASSS, p<0.001), and less mobility limitation (BASMI, p = 0.033). To establish whether these findings could lead to sex differences in CV disease burden, we compared the prevalence of carotid plaques in men and women with the same level of CV risk stratified according to the Systematic Coronary Risk Evaluation (SCORE). Men included in the low-moderate CV risk SCORE category had more carotid plaques (p = 0.050), along with longer disease duration (p = 0.004), higher mSASSS (p = 0.001) and psoriasis (p = 0.023). In contrast, in the high-very high-risk SCORE category, carotid plaques were observed more frequently in women (p = 0.028), who were characterized as having worse BASFI (p = 0.011), BASDAI (p<0.001) and ASDAS (p = 0.027). CONCLUSION: Disease-related features may influence the expression of atherosclerosis in patients with axSpA. This may be especially applicable to women at high CV risk, characterized by greater disease severity and more severe subclinical atherosclerosis than men, suggesting a stronger interaction between disease activity and atherosclerosis in women with axSpA.

Exploring the potential of eco-friendly silver nanoparticles to inhibit azole-resistant clinical isolates of Candida spp.

The antimicrobial activity and biological efficiency of silver nanoparticles (AgNps) have been widely described and can be modeled through stabilizing and reducing agents, especially if they exhibit biocidal properties, which can enhance bioactivity against pathogens. The selective action of AgNps remains a major concern. In this regard, the use of plant extracts for the green synthesis of nanoparticles offers advantages because it improves the toxicity of Nps for microorganisms and is harmless to normal cells. However, biological evaluations of the activity of AgNps synthesized using different reducing agents are determined independently, and comparisons are frequently overlooked. Thus, we investigated and compared the antifungal and cytotoxic effects of two ecological AgNps synthesized from Moringa oleifera aqueous leaf extract (AgNp-M) and glucose (AgNp-G) against azole-resistant clinical isolates of Candida spp. and nontumor mammalian cells. Synthesized AgNps exhibited an antifungal effect on planktonic cells of drug-resistant C. albicans and C. tropicalis (MIC 0.21-52.6 µg/mL). The toxicity was influenced by size. However, the use of M. oleifera extracts allows us to obtain AgNps that are highly selective and nongenotoxic to Vero cells due to modifications of the shape and surface. Therefore, these results suggest that AgNp-M has antimicrobial potential and deserves further investigation for biomedical applications.

Smoking and alcohol consumption are associated with peripheral musculoskeletal involvement in patients with spondyloarthritis (including psoriatic arthritis). Results from the ASAS-PerSpA study.

BACKGROUND: An inverse association between alcohol consumption and disease activity and functional impairment has been observed in patients with spondyloarthritis (SpA). However, neither this association nor the influence of smoking has been investigated in peripheral manifestations of SpA. OBJECTIVES: The objective of this study was to analyze the association between smoking and alcohol consumption and the presence of peripheral musculoskeletal manifestations (arthritis, enthesitis or dactylitis) and to determine the specific location of these manifestations. METHODS: Patients from the worldwide cross-sectional ASAS-PerSpA study with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or psoriatic arthritis (PsA) according to their rheumatologist were included. Generalised linear mixed models used peripheral manifestation (or location) as a dependent variable, smoking status and alcohol consumption as fixed effects and country as a random effect. The interaction between smoking and alcohol was tested. Analyses were performed for each diagnosis (axSpA, pSpA and PsA). RESULTS: A total of 4181 patients were included. In axSpA patients, smoking was associated with a lower prevalence of any peripheral manifestation, and current alcohol consumption was associated with a lower prevalence of both current arthritis and current enthesitis. In pSpA patients, current alcohol consumption was associated with a lower prevalence of current arthritis or enthesitis. In PsA patients, a significant association was found for arthritis with smoking and for enthesitis with alcohol consumption, and current alcohol consumption was associated with a lower prevalence of current arthritis or enthesitis. CONCLUSION: Taking into account the country, smoking and alcohol are associated with a lower prevalence of peripheral manifestations.

First report of Aedes albopictus (Diptera: Culicidae) in the North of Colombia

ABSTRACT Aedes albopictus is considered a potential vector of arboviruses in Colombia. Females and males naturally infected with dengue, Zika and chikungunya viruses have already been found in this country. We document the first record of Ae. albopictus in the Cordoba department, in North of Colombia. The finding was carried out during Ae. aegypti collection activities in the Ayapel, Montelibano, Planeta Rica, Pueblo Nuevo and Puerto Libertador municipalities. The entomological material was collected in water containers such as cement water tanks, tanks, bottles, tires, abandoned toilets, and plastic lids with natural water located in the intradomicile, peridomicile, and extra-domicile spaces of the homes. We collected 658 Ae. albopictus samples in the larva and pupa stages, and once these reached adulthood, we determined that 389 were female and 269 were male. This is the first record of the presence of Ae. albopictus in the Cordoba department.

Modifications in self-care, quality of life and therapeutic adherence in patients with rheumatoid arthritis during the SARS-CoV-2 pandemic treated by telehealth

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation, causing pain and stiffness in the joints. SARS-CoV-2 increases the clinical vulnerability of the population with RA and has led to the implementation and/or development of telemedicine. Objective: To describe changes in level of therapeutic adherence, quality of life and capacity for self-care agency, during the follow-up period of a group of patients linked to a non-face-to-face multidisciplinary consultation model during the SARS-CoV-2 pandemic. Methodology: Descriptive cohort study (July to October 2020). Description of the level of therapeutic adherence (Morisky Green Test), quality of life (EuroQOL-5-Dimensions-3-Level-version) and self-care capacity (ASA-R Scale) in the context of a telehealth model. A univariate and bivariate analysis was performed (Stata Software, Considered p-value <0.05). Results: Of 71 patients treated under the telehealth model, 85.9% were women, the age range was between 33 and 86 years with a median of 63. The most prevalent comorbidity was arterial hypertension (35.2%). Quality of life did not change during follow-up nor did adherence to treatment, apart from in one item [the patients did not stop taking the medication when they were well (p = 0.029)]. In self-care capacity, there were significant improvements in five dimensions (p < 0.05), without significant differences in the global score. Conclusion: Patients with RA evaluated in the context of telehealth in a period of pandemic did not present significant changes in quality of life, adherence to treatment, or capacity for self-care, and remained close to baseline values when they attended a traditional face-to-face assessment.

INTRODUCCIÓN: La artritis reumatoide (AR) es una enfermedad autoinmune caracterizada por una inflamación crónica que produce dolor y rigidez articular. El SARS-CoV-2 aumenta la vulnerabilidad clínica en pacientes con AR, lo que ha conllevado la implementación o el desarrollo de la telesalud. OBJETIVO: Describir los cambios en el nivel de adherencia terapéutica, la calidad de vida y la capacidad de autocuidado durante el periodo de seguimiento, en un grupo de pacientes con AR vinculados con un modelo de consulta multidisciplinar no presencial, en el curso de la pandemia por SARS-CoV-2. METODOLOGÍA: Estudio de cohorte descriptiva (julio a octubre del 2020). Descripción del nivel de adherencia terapéutica (TEST MORISKY GREEN), calidad de vida (EUROQOL-5-DIMENSIONS-3-LEVEL-VERSION) y capacidad de autocuidado (Escala ASA-R) en el contexto de un modelo de telesalud. Se realizó análisis univariado y bivariado (SOFTWARE Stata®, valor de p considerado <0,05). RESULTADOS: De 71 pacientes atendidos en modalidad de telesalud, el 85,9% fueron mujeres, la mediana de la edad fue de 63 (33-86) anos. La comorbilidad más prevalente fue la hipertensión (35,2%). La calidad de vida no tuvo cambios durante el seguimiento, al igual que la adherencia al tratamiento, excepto en uno de los ítems (los pacientes no dejaron de tomar la medicación cuando se encontraban bien; p = 0,029). En la capacidad de autocuidado hubo mejoras significativas en 5 dimensiones (p < 0,05), sin diferencias significativas en el puntaje global. CONCLUSIÓN: Los pacientes con AR evaluados en el contexto de la telesalud, en un periodo de pandemia, no presentaron cambios significativos en la calidad de vida, la adherencia al tratamiento y la capacidad de autocuidado; se mantuvieron en niveles similares a los valores basales cuando asistían a valoración tradicional presencial.

Hypoglossal nerve injury with C1 lateral mass screw placement: A case report and review of the literature.

We report the case of a 62-year-old man who presented with a progressive myelopathy secondary to spinal cord compression from an odontoid process fracture and subaxial central canal stenosis. The patient underwent a C1-T2 posterior decompression and instrumented fusion (PCDF) and did well immediately postoperatively. However, on POD1, he developed a right hypoglossal nerve (HN) palsy attributed to direct mechanical compression or injury from the C1 lateral mass screw (LMS), which improved following a revision and screw replacement. While HN injury is a known complication of high anterior and anterolateral cervical spine approaches as well as transcondylar screw fixation, this case aims to expand on the limited reports available regarding hypoglossal nerve injury following placement of bicortical C1 LMS. Furthermore, the use of fluoroscopic guidance in addition to anatomic landmarks and triggered electromyography of the tongue are offered as potential solutions to prevent HN injury intraoperatively.

Gastric perforation from a migrating ventriculoperitoneal shunt: A case report and review of literature.

Ventriculoperitoneal (VP) shunts represent a surgical option for patients affected by increased intracranial hypertension when medical management fails or is contraindicated. Complications following implantation include shunt obstruction, infection, over and under drainage, migration or disconnection of the tube, formation of a pseudocyst, and allergy to the silicone tube. We report the case of a 31-year-old woman who presented to the emergency room with nausea and generalized malaise, found to have the distal segment of the VP catheter perforating her gastric wall into the stomach lumen which required surgical intervention. In this report, we describe a rare complication associated with the implantation of ventriculoperitoneal shunt (VPS) catheters and the subsequent management plan.

Cardiovascular and disease-related features associated with extra-articular manifestations in axial spondyloarthritis. A multicenter study of 888 patients.

OBJECTIVES: To determine the potential impact of extra-articular manifestations (EAMs) on disease characteristics and cardiovascular (CV) risk in patients with axial spondylarthritis (axSpA). METHODS: This is a cross-sectional study from the AtheSpAin cohort, a Spanish multicenter cohort to study atherosclerosis in axSpA. Data on the history of CV events, subclinical carotid atherosclerosis, and disease-related features, including EAMs, were collected. RESULTS: 888 axSpA patients were recruited. Concomitant acute anterior uveitis (AAU), psoriasis (PSO), and inflammatory bowel disease (IBD) were present in 177 (19.9%), 96 (10.8%), and 57 (6.4%) patients, respectively. When compared with axSpA patients without EAMs, a significant increase in past CV events was observed in patients with PSO (9% versus 4%, p = 0.048) and in those with at least one EAM (7% versus 4%, p = 0.032) or with more than one EAM (11% versus 4%, p = 0.022). The frequency of carotid plaques and the values of cIMT were higher in patients with EAMs than in those without EAMs, although only the univariable analysis for carotid plaques in patients with PSO (39% versus 30%, p = 0.038) and for cIMT in patients with AAU (665 ± 156 µm versus 637 ± 139 µm, p = 0.042) and those with at least one EAM (661 ± 155 µm versus 637 ± 139 µm, p = 0.024) showed significant results. In addition, patients with PSO or IBD were found to have specific disease-related features, such as higher ESR at diagnosis, and more frequent use of glucocorticoids and TNF inhibitors than those without EAMs. Also, PSO patients had more commonly peripheral involvement and those with AAU more severe radiographic damage than those without EAMs. The frequency of HLA B27 was higher in patients with AAU and lower in those with PSO or IBD compared to those without EAMs. CONCLUSION: Patients with axSpA and EAMs, in addition to displaying their own disease-related features, are likely to have an increased CV risk that appears proportional to the number of EAMs and could be related to proatherogenic factors other than traditional CV risk factors, such as the inflammatory load and the use of glucocorticoids.

Making Visible HTLV Infection in a Non-endemic Area of Argentina.

In Argentina, the human T-cell lymphotropic virus type 1 (HTLV-1) infection has been documented mainly among blood banks with a prevalence of ~0.02-0.046% for Buenos Aires city, 0.8% for the northeast, and 1% for the northwest; both areas are considered endemic for HTLV-2 and 1, respectively. Policies and specific guidelines for testing blood donors for HTLV are included since 2005. Screening for antibodies is performed at blood banks and confirmatory testing is performed at reference laboratories. There are no specific recommendations for the assistance of communities and individuals affected, nor referral to specialized clinics on the HTLV infection. In 2016, as a strategy of intervention, we opened a specialized clinical attendance in a referral infectious diseases public hospital for the comprehensive approach to patients with HTLV, offering follow-up and counseling for patients and their families for the early diagnosis of HTLV-1/2 and related diseases. During the study, 124 patients with presumptive HTLV positive diagnosis from blood bank, symptomatic patients (SPs), relatives, and descendants visited the unit. A total of 46 patients were HTLV positive (38 HTLV-1 and 8 HTLV-2). There were nine SPs (2 adult T-cell leukemia/lymphoma [ATL] and 7 HTLV-1-associated myelopathy/tropical spastic paraparesis [HAM/TSP]). All patients with HTLV-1 and-2 were offered to study their relatives. Two out of 37 (5.4%) descendants tested were positive for HTLV-1. Sexual partners were studied; among 6 out of 11 couples (54.5%) were found positive (5 HTLV-1 and 1 HTLV-2). Other relatives, such as mothers (1/2) and siblings (1/6), were positive for HTLV-1. According to the place of birth among HTLV-1 carriers, 58% were born in an endemic area or in countries where HTLV infection is considered endemic while for HTLV-2 carriers, 12.5% were born in an endemic area of Argentina. The proviral load (pVL) was measured in all, patients with HTLV-1 being higher in symptomatic compared with asymptomatic carriers. In addition, two pregnant women were early diagnosed during their puerperium and breastmilk replacement by formula was indicated. Inhibition of lactation was also indicated. Our study provides tools for a multidisciplinary approach to the infection and reinforces the importance of having specialized clinical units in neglected diseases, such as HTLV for counseling, clinical and laboratory follow-up, and providing useful information for patients for self-care and that of their families.