SARS-CoV-2 variants are associated with different clinical courses in children with MIS-C.

BACKGROUND: Recent infection with SARS­CoV­2 in children has been associated with multisystem inflammatory syndrome in children (MIS-C). SARS­CoV­2 has undergone different mutations. Few publications exist about specific variants and their correlation with the severity of MIS-C. METHODS: This was a single-center, retrospective study including all patients admitted with MIS-C at Rady Children's Hospital-San Diego between May 2020 and March 2022. Local epidemiologic data, including viral genomic information, were obtained from public records. Demographics, clinical presentation, laboratory values, and outcomes were obtained from electronic medical records. RESULTS: The analysis included 104 pediatric patients. Four MIS-C waves were identified. Circulating variants in San Diego during the first wave included clades 20A to C. During the second wave, there were variants from clades 20A to C, 20G, 21C (Epsilon), 20I (Alpha), and 20J (Gamma). The third wave had Delta strains (clades 21A, 21I, and 21J), and the fourth had Omicron variants (clades 21K, 21L, and 22C). MIS-C presented with similar symptoms and laboratory findings across all waves. More patients were admitted to the pediatric intensive care unit (PICU) (74%) and required inotropic support (63%) during the second wave. None of the patients required mechanical circulatory support, and only two required invasive ventilatory support. There was no mortality. CONCLUSIONS: The various strains of SARS-CoV-2 triggered MIS-C with differing severities, with the second wave having a more severe clinical course. Whether the differences in disease severity across variants were due to changes in the virus or other factors remains unknown.

El reto de crear un equipo de investigación efectivo / The challenge of creating an effective research team

En el mundo actual, donde el acceso a la información y los últimos avances de la ciencia están a tan solo un clic, la academia y la investigación en la práctica diaria juegan un papel clave. Conforme las instituciones trabajan para subir su ranking académico, en un ámbito tan competitivo, aumenta la presión sobre los investigadores y profesionales para la creación de nuevas publicaciones y proyectos de investigación con alto impacto científico1. Esto, sumado al poco apoyo a la investigación en la región, la necesidad de cumplir labores asistenciales y las trabas administrativas, dificulta el adecuado desarrollo para llevar a cabo estos proyectos y disminuyen la motivación del equipo clínico. Es por esto, y en búsqueda de la optimización de recursos, que la creación de un equipo de investigación es imperiosa para poder cumplir las necesidades de producción científica y complementar efectivamente el trabajo en conjunto. Pero esto, a su vez, también presenta un gran reto, pues aunque las habilidades necesarias para el trabajo en equipo parecen intuitivas, no suelen ser materia de educación en la formación actua

Urología de precisión: conceptualización desde el cáncer de próstata / Precision urology: a view from prostate cancer

No hay duda de que la práctica diaria de la urología es un constante ejercicio de ajustar factores, variables o determinantes demográficos, clínicos, paraclínicos, histopatológicos e imagenológicos para lograr clasificar a un paciente en determinado grupo de partida para definir su ruta o plan de manejo. Es en ese punto donde la semántica de los términos medicina o cuidado personalizado y medicina de precisión de encuentran y a su vez divergen. Hemos adoptado el término de la medicina de precisión desde la perspectiva de la aplicación clínica de la farmacogenómica, entendida como el desarrollo de moléculas a dianas o alteraciones de las denominadas «ómicas¼ (genómica, transcriptómica y proteómica, entre otras). La medicina de precisión abarca o agrupa los determinantes del cuidado personalizado que corresponde a la adaptación metódica y meticulosa de los resultados de los estudios de investigación (medicina basa en evidencia) actuales a las condiciones clínicas, circunstancias de la atención médica, tecnología disponible, acceso a servicios y habilidades clínicas, sumado al perfilamiento biológico del tumor por medio de la información obtenida de diferentes plataformas, incluidas nuevas tecnologías en diagnostico por imágenes (por ejemplo), por lo que podríamos definirlo como una aproximación o integración de datos obtenidos de una forma más precisa con el fin de ajustar el tratamiento1. El término también abarca un control del «daño colateral¼, entendido como la disminución de los efectos secundarios o no deseados por una intervención, una denominación ampliamente usada en la terapia antibiótica o citotóxica en cáncer2,3. Este daño puede ocurrir por acciones como una identificación errónea o subóptima de la severidad o significancia de una lesión, emplear estrategias de tratamiento inadecuadas por ser insuficientes o exageradas para una enfermedad determinada.

There is no doubt that the daily practice of urology is a constant exercise of adjusting demographic, clinical, paraclinical, histopathological and imaging factors, variables or determinants in order to classify a patient in a certain starting group to define his or her management plan. It is at this point where the semantics of the terms personalized medicine or personalized care and precision medicine meet and diverge. We have adopted the term precision medicine from the perspective of the clinical application of pharmacogenomics, understood as the development of molecules to targets or alterations of the so-called "omics" (genomics, transcriptomics and proteomics, among others). Precision medicine encompasses or groups together the determinants of personalized care that corresponds to the methodical and meticulous adaptation of the results of current research studies (evidence-based medicine) to clinical conditions, circumstances of medical care, available technology, access to services and clinical skills, added to the biological profiling of the tumor by means of information obtained from different platforms, including new technologies in diagnostic imaging (for example), so we could define it as an approximation or integration of data obtained in a more precise way in order to adjust the treatment1. The term also encompasses a control of "collateral damage", understood as the reduction of side effects or unwanted effects of an intervention, a term widely used in antibiotic or cytotoxic therapy in cancer2,3. This harm can occur by actions such as misidentification or suboptimal identification of the severity or significance of a lesion, employing treatment strategies that are inadequate because they are insufficient or exaggerated for a given disease.

Bimetallic Ruthenium Nitrosyl Complexes with Enhanced Two-Photon Absorption Properties for Nitric Oxide Delivery.

One monometallic and three bimetallic ruthenium nitrosyl (RuNO) complexes are presented and fully characterized in reference to a parent monometallic complex of formula [FTRu(bpy)(NO)]3+ , where FT is a fluorenyl-substituted terpyridine ligand, and bpy the 2,2'-bipyridine. These new complexes are built with the new ligands FFT, TFT, TFFT, and TF-CC-TF (where an alkyne C≡C group is inserted between two fluorenes). The crystal structures of the bis-RuNO2 and bis-RuNO complexes built from the TFT ligand are presented. The evolution of the spectroscopic features (intensities and energies) along the series, at one-photon absorption (OPA) correlates well with the TD-DFT computations. A spectacular effect is observed at two-photon absorption (TPA) with a large enhancement of the molecular cross-section (σTPA ), in the bimetallic species. In the best case, σTPA is equal to 1523±98 GM at 700 nm, in the therapeutic window of transparency of biological tissues. All compounds are capable of releasing NO⋅ under irradiation, which leads to promising applications in TPA-based drug delivery.

Early clinical and radiological outcomes after double osteotomy in patients with late presentation Legg-Calvé-Perthes disease.

PURPOSE: Legg-Calvé-Perthes disease is an idiopathic avascular necrosis of the femoral head. Although many surgical approaches to treat the late presentation of this pathology have been proposed, there are few reports about the early results of the double osteotomy procedure (femoral varus osteotomy combined with Salter innominate osteotomy). The purpose of this study was to describe the early results obtained with the double osteotomy in patients with late presentation of Legg-Calvé-Perthes disease. METHODS: Cross-sectional evaluation of ten patients intervened with double osteotomy. There were seven males and three females with a mean age of 9.2 +/- 1.7 years [standard deviation (SD)]. The average post-surgical time of evaluation was of 46.5 +/- 26.2 months. RESULTS: Of the ten evaluated patients, four had a Catterall III and six had a Catterall IV disease. According to Herring classification, three patients were Herring B and seven were Herring C. The epiphyseal extrusion average before and after the surgical procedure was 19.3 +/- 12.4 and 12.1 +/- 14.9%, respectively. In accordance with the Ratliff classification and Lloyd Roberts radiological results, the following were the postoperative clinical results: four good, five fair and one poor. Based on the Stulberg classification, there was one patient in class I, five in class II, three in class III and one in class IV. CONCLUSION: The surgical treatment for late Perthes disease with the best expected outcome is still a challenge. According to the resultsreported here, the double osteotomy could be considered as an alternative to treat this entity.