Impact of intermediate to high doses of methylprednisolone on mortality rate in patients with COVID-19 pneumonia-induced severe systemic inflammation.

INTRODUCTION: In addition to respiratory support needs, patients' characteristics to guide indication or timing of corticosteroid treatment in COVID-19 patients are not completely established. This study aimed to evaluate the impact of methylprednisolone on mortality rate in patients with COVID-19 pneumonia-induced severe systemic inflammation (PI-SSI). METHODS: Between 9 March and 5 May 2020 (final follow-up on 2 July 2020), a retrospective cohort study was conducted in hospitalised patients with COVID-19 PI-SSI (≥2 inflammatory biomarkers [IBs]: temperature ≥38℃, lymphocyte ≤800 cell/µL, C-reactive protein ≥100 mg/L, lactate dehydrogenase ≥300 units/L, ferritin ≥1000 mcg/L, D-dimer ≥500 ng/mL). Patients received 0.5-1.0 mg/kg of methylprednisolone for 5-10 days or standard of care. The primary outcome was 28-day all-cause mortality. Secondary outcomes included ≥2 points improvement on a 7-item WHO-scale (Day 14), transfer to intensive care unit (ICU) (Day 28) and adverse effects. Kaplan-Meier method and Cox proportional hazard regression were implemented to analyse the time to event outcomes. RESULTS: A total of 142 patients (corticosteroid group n = 72, control group n = 70) were included. A significant reduction in 28-day all-cause mortality was shown with methylprednisolone in patients with respiratory support (HR: 0.15; 95% CI 0.03-0.71), with ≥3 (HR: 0.17; 95% CI 0.05-0.61) or ≥4 altered IB (HR: 0.15; 95% CI 0.04-0.54) and in patients with both respiratory support and ≥3 (HR: 0.11; 95% CI 0.02-0.53] or ≥4 altered IB (HR: 0.14; 95% CI 0.04-0.51). No significant differences were found in secondary outcomes. CONCLUSION: Intermediate to high doses of methylprednisolone, initiated between 5 and 12 days after symptom onset, was associated with a significant reduction in 28-day all-cause mortality in patients with COVID-19 pneumonia and ≥3 o ≥ 4 altered IB, independently of the need of respiratory support.

¿Pueden los biomarcadores inflamatorios ayudar al diagnóstico y predecir el pronóstico de la colecistitis aguda gangrenosa? Un estudio prospectivo / No disponible

INTRODUCCIÓN: el diagnóstico de la colecistitis aguda gangrenosa constituye un reto diagnóstico para el médico y en pocas ocasiones se realiza de manera preoperatoria. MATERIAL Y MÉTODOS: presentamos un estudio longitudinal prospectivo de 180 pacientes a los que se les realiza colecistectomía secundaria a colecistitis aguda. Se realiza curva ROC para determinar el punto de corte preoperatorio de diferentes biomarcadores (ratio neutrófilo-linfocito [RNL], proteína C reactiva [PCR], ratio plaqueta-linfocito [RPL], lactato y procalcitonina) y asociación con hallazgos perioperatorios y postoperatorios. RESULTADOS: el área bajo la curva para RNL, PCR, RPL, lactato y procalcitonina fue de 0,75, 0,8, 0,65 y 0,6, respectivamente. CONCLUSIÓN: RNL > 5 y PCR > 100 permanecen como factores independientes de gangrena (odds ratio [OR] ajustada de 2 y 2,1, respectivamente)

No disponible

Can inflammatory biomarkers help in the diagnosis and prognosis of gangrenous acute cholecystitis? A prospective study.

The diagnosis of gangrenous acute cholecystitis represents a diagnostic challenge for the physician and is rarely identified preoperatively. We report a longitudinal prospective study in 180 patients who underwent cholecystectomy for acute cholecystitis. A ROC curve was obtained to determine the preoperative cut-off for various biomarkers (neutrophil to lymphocyte ratio [NLR], C-reactive protein [CRP], platelet to lymphocyte ratio [PLR], lactate and procalcitonin) and their association with both preoperative and postoperative findings. The area under the curve (AUC) for NLR, CRP, PLR, lactate and procalcitonin was 0.75, 0.8, 0.65 and 0.6, respectively. NLR > 5 and CRP > 100 are still independent factors for gangrene (adjusted odds ratio [OR], 2 and 2.1, respectively).

Ganglioneuroblastoma nodular quístico: Presentación de un caso / Cystic Nodular Ganglioneuroblastoma: Case Report

Presentamos el caso de un niño de 9 años de edad, en quien como hallazgo incidental en una radiografía de tórax se observa una calcificación en el hipocondrio izquierdo sugestiva de masa. Se amplía el estudio mediante ecografía y resonancia magnética (RM) abdominal para mejor caracterización: se visualiza una masa suprarrenal izquierda, predominantemente quística, con un nódulo sólido. Finalmente, se le practica una resección quirúrgica, en la cual se llega al diagnóstico de ganglioneuroblastoma nodular quístico, tras el análisis histopatológico. El ganglioneuroblastoma quístico es un tumor poco frecuente, originado en las células ganglionares del sistema nervioso simpático. El sitio de origen más frecuente son las glándulas suprarrenales. A pesar de que el diagnóstico definitivo se suele realizar tras la resección quirúrgica del tumor, con la ecografía y la RM se debe incluir entre los diagnósticos diferenciales de incidentalomas suprarrenales en un niño o un paciente joven. Los hallazgos en tomografía computarizada son variables.

We present the case of a child patient aged 9 years, in whom, as an incidental finding in chest X-rays, a calcified lesion was observed in the left hypochondrium. The study is extended by ultrasound and then MRI was performed to better characterize it. These showed a left adrenal, predominantly cystic mass with a solid nodule. The surgical team decided to perform resection of the mass and submit it for histopathological examination. A definitive diagnosis of cystic nodular ganglioneuroblastoma was made. Ganglioneuroblastoma is a rare tumour, originating in ganglion cells of the sympathetic nervous system. The site of more frequent origin is in the adrenal glands. Although the majority are diagnosed based on the postoperative histological analysis, with ultrasound and MRI we should include it among the differentials diagnoses of adrenal incidentalomas in a child or young patient. The findings on CT are variables.

Utility of abdominal ultrasonography in the diagnosis and monitoring of inflammatory bowel disease.

Abdominal ultrasonography has been undervalued for years as technique used in examining the gastrointestinal tract. However, thanks to the technological advances that have been seen inultrasonography probes and the use of high frequency equipment, we are able to obtain high quality images of the intestinal wall.Moreover, due to the increased sensitivity of the colour Doppler, we can detect the parietal vascularization. Finally, in recent years, intravenous ultrasonography contrast agents have been used that allow not only the inflammatory activity to be quantified but also the presence of complications with a diagnostic accuracy similar to computed tomography (CT) and full magnetic resonance (full-RM), without the associated radiation risk and at a lower cost. This article reviews the utility of abdominal ultrasonography in inflammatory bowel disease, in particular Crohn´s disease, both during initial diagnosis and follow-up of the disease; the article also reviews the ability of the technique to be used in the detection of complications (stenosis, fistulas and abscesses).

Utilidad de la ecografía abdominal en el diagnóstico y seguimiento de la enfermedad inflamatoria intestinal / Utility of abdominal ultrasonography in the diagnosis and monitoring of inflammatory bowel disease

La ecografía abdominal ha sido una técnica infravalorada durante años para evaluar el tubo digestivo. Sin embargo, gracias al avance tecnológico que han experimentado los equipos ecográficos y al uso de sondas de alta frecuencia somos capaces de obtener imágenes de alta calidad de la pared intestinal. Por otra parte, debido al aumento de la sensibilidad del Doppler color podemos detectar la vascularización parietal. Finalmente, en los últimos años se están utilizando los contrastes ecográficos intravenosos que permiten no solo cuantificar la actividad inflamatoria, sino también detectar la presencia de complicaciones con una fiabilidad diagnóstica similar a la tomografía computarizada (TC) y la enterorresonancia magnética (entero-RM) sin riesgo de radiación y a un coste menor. En este artículo se hace una revisión de la utilidad de la ecografía abdominal en la enfermedad inflamatoria intestinal, especialmente en la enfermedad de Crohn, tanto en el diagnóstico inicial como durante el seguimiento de la enfermedad, así como de la capacidad de la técnica en la detección de complicaciones (estenosis, fístulas y abscesos) (AU)

Abdominal ultrasonography has been undervalued for years as technique used in examining the gastrointestinal tract. However, thanks to the technological advances that have been seen in ultrasonography probes and the use of high frequency equipment, we are able to obtain high quality images of the intestinal wall. Moreover, due to the increased sensitivity of the colour Doppler, we can detect the parietal vascularization. Finally, in recent years, intravenous ultrasonography contrast agents have been used that allow not only the inflammatory activity to be quantified but also the presence of complications with a diagnostic accuracy similar to computed tomography (CT) and full magnetic resonance (full-RM), without the associated radiation risk and at a lower cost. This article reviews the utility of abdominal ultrasonography in inflammatory bowel disease, in particular Crohn’s disease, both during initial diagnosis and follow-up of the disease; the article also reviews the ability of the technique to be used in the detection of complications (stenosis, fistulas and abscesses) (AU)

[Extraadrenal retroperitoneal myelolipoma]. / Mielolipoma extraadrenal retroperitoneal.

Extraadrenal myelolipomas are rare benign tumors and differentiating them from other soft tissue tumors containing fat can be difficult. A retroperitoneal myelolipoma adjacent to right renal helium is presented in this case-report. Initially oriented as liposarcoma, the final diagnosis was obtained after surgery. Computed tomography (CT), ultrasound (US) and magnetic resonance imaging (MRI) features may vary according to the major component of the tumor. MRI with fat suppression and opposed-phase imaging are the best imaging tools to demonstrate the adipose tissue. A histological confirmation may allow a better presurgical planification in most cases.

Mielolipoma extraadrenal retroperitoneal / Extraadrenal retroperitoneal myelolipoma

Los mielolipomas extra adrenales son tumores benignos raros cuya diferenciación de otros tumores de partes blandas que contienen grasa puede resultar difícil. Presentamos el caso de un mielolipoma retroperitoneal adyacente al hilio renal orientado inicialmente según hallazgos en imagen como liposarcoma obteniendo el diagnóstico definitivo tras la cirugía. Las características de estos tumores en TC, ecografía y RM pueden variar en función del componente mayoritario del mismo. La RM con supresión-grasa y en fase-opuesta supone la mejor herramienta diagnóstica para demostrar el componente graso. La confirmación histológica previa puede ayudar a una mejor planificación quirúrgica en la mayoría de los casos (AU)

Extraadrenal myelolipomas are rare benign tumors and differentiating them from other soft tissue tumors containing fat can be difficult. A retroperitoneal myelolipoma adjacent to right renal helium is presented in this case-report. Initially oriented as liposarcoma, the final diagnosis was obtained after surgery. Computed tomography (CT), ultrasound (US) and magnetic resonance imaging (MRI) features may vary according to the major component of the tumor. MRI with fat suppression and opposed-phase imaging are the best imaging tools to demonstrate the adipose tissue. A histological confirmation may allow a better presurgical planification in most cases (AU)