A Case of Wild-type Cardiac Transthyretin Amyloidosis Diagnosed by Non-invasive Methods.

INTRODUCTION: Transthyretin amyloid cardiomyopathy was considered a rare pathology. However, recent studies show a significant prevalence in patients with degenerative aortic stenosis and heart failure with preserved ejection fraction. CASE PRESENTATION: An 85-year-old woman presented with a four-month history of pain in the rib cage with a history of diffuse large B-cell lymphoma of the oral cavity, essential thrombocytosis and dyslipidemia. She had no significant family history. A transthoracic echocardiogram showed degenerative aortic stenosis and normal systolic function with preserved left ventricular ejection fraction of 70%. Bone-avid tracer cardiac scintigraphy with technetium-99m-labeled hydroxymethylene diphosphonate with SPECT-CT documented grade two myocardial uptake according to the Perugini scale. MRI evidenced late patchy enhancement in the myocardium associated with diffuse subendocardial enhancement. Laboratory tests showed the absence of mutation in the transthyretin (TTR) gene, serum and urine immunofixation electrophoresis (IFE) negative for monoclonal protein and serum-free light chain (sFLC) assay with a normal kappa/lambda (K/L) ratio. All these findings were compatible with a non-invasive diagnosis of wild-type cardiac amyloidosis. CONCLUSION: The accepted criteria for the definitive non-invasive diagnosis of amyloid cardiomyopathy are based on myocardial uptake by scintigraphy (with SPECT), serum and urine immunofixation electrophoresis, serum-free light chain assay and suggestive findings on echocardiography and/or MRI. Genetic testing should differentiate between ATTRv (v for variant) and ATTRwt (wt for wild type) forms.

Teranóstico en medicina nuclear: ¿qué es y qué experiencia tenemos en Colombia? / Teranóstico en medicina nuclear: ¿qué es y qué experiencia tenemos en Colombia?

En la era de la medicina personalizada y de precisión, enfocada en mejorar la atención en salud aprovechando al máximo las oportunidades que ofrecen los desarrollos biomédicos, tecnológicos, sociales y económicos de la actualidad, han aparecido nuevos términos como el de teranóstico. Este término nace de la fusión de los conceptos de terapia y diagnóstico y, aunque fue propuesto en años recientes, hace referencia a un abordaje que se ha utilizado desde hace mucho tiempo (1). El teranóstico consiste en una metodología donde el abordaje diagnóstico se hace enfocado hacia la intervención terapéutica individualizada, buscando proporcionar los mejores desenlaces para el paciente. El área de la medicina nuclear ha sido pionera en el teranóstico, pues el primer tratamiento basado en este concepto se realizó con yodo radiactivo (131I) en pacientes con patología tiroidea. Actualmente, con los avances en imagen molecular e imágenes con genes reporteros (2), cada vez se encuentran disponibles más agentes teranósticos para proporcionar terapias individualizadas o "lesionalizadas", como se han empezado a llamar más recientemente (3). En la presente revisión se expone el abordaje teranóstico en medicina nuclear, enfatizando en el funcionamiento, las aplicaciones más frecuentes y la experiencia que se tiene en Colombia.

In the era of personalized and precision medicine, focused on improving health care by making the most of the opportunities offered by current biomedical, technological, social and economic developments, new terms such as theranostic have appeared. This term was born from the fusion of the concepts of therapy and diagnosis and, although it was proposed in recent years, it refers to an approach that has been used for a long time (1). Theranostic consists of a methodology where the diagnostic approach is focused on individualized therapeutic intervention, seeking to provide the best outcomes for the patient. The area of nuclear medicine has been a pioneer in theranostic, since the first treatment based on this concept was performed with radioactive iodine (131I) in patients with thyroid disease. Currently, with advances in molecular imaging and reporter gene imaging (2), more and more theranostic agents are available to provide individualized or "lesionalized" therapies, as they more recently have come to be called (3). In this review, the theranostic approach in nuclear medicine is exposed, emphasizing how it works, what are the most frequent applications and what experience we have in Colombia

Ganglios linfáticos axilares hipermetabólicos en PET-FDG posvacunación contra COVID-19, en pacientes con cánce / Hypermetabolic axillary lymph nodes in PET-FDG post-vaccination against COVID-19, in cancer patients

Al igual que las células malignas, las células inflamatorias pueden captar intensamente 18F-fluorodesoxiglucosa (FDG). La reacción inflamatoria ganglionar axilar se ha descrito en forma creciente y globalmente luego de la vacunación contra COVID-19 con las vacunas de Pfizer, Moderna y AstraZeneca, en pacientes con cáncer. Se presentan dos casos con diagnóstico de cáncer de ovario y mama, respectivamente, con antecedente de vacunación reciente contra COVID-19, en quienes el estudio de PET/TC muestra ganglios linfáticos axilares hipermetabólicos con FDG. A continuación, se describen los hallazgos clave para interpretar el realce aumentado de los ganglios linfáticos axilares en pacientes con cáncer que han sido vacunados contra este virus.

Like malignant cells, inflammatory cells can intensely take upF18-fluorodeoxyglucose (FDG). The axillary lymph node inflammatory reaction has been increasingly and globally described after vaccination against COVID-19 with the Pfizer, Moderna and AstraZeneca vaccines, in cancer patients. We present two cases with a diagnosis of ovarian and breast cancer respectively, with a history of recent vaccination against COVID-19, in whom the PET/CT study present hypermetabolic axillary lymph nodes with FDG. Key findings for interpreting increased axillary lymph node uptake in cancer patients who have been vaccinated against this virus are described below

Optimizing the treatment of metastatic castration-resistant prostate cancer: a Latin America perspective.

Prostate cancer is a significant burden and cause of mortality in Latin America. This article reviews the treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC) and provides consensus recommendations to assist Latin American prostate cancer specialists with clinical decision making. A multidisciplinary expert panel from Latin America reviewed the available data and their individual experience to develop clinical consensus opinions for the use of life-prolonging agents in mCRPC, with consideration given to factors influencing patient selection and treatment monitoring. There is a lack of level 1 evidence for the best treatment sequence or combinations in mCRPC. In this context, consensus recommendations were provided for the use of taxane-based chemotherapies, androgen receptor axis-targeted agents and targeted alpha therapy, for patients in Latin America. Prostate-specific antigen (PSA) changes alone, during treatment, should be treated with caution; PSA may not be a suitable biomarker for radium-223. Bone scans and computed tomography are the standard imaging modalities in Latin America. Imaging should be prompted during treatment where symptomatic decline and/or significant worsening of laboratory evaluations are reported, or where a course of therapy has been completed and another antineoplastic agent is under consideration. Recommendations and guidance for treatment options in Latin America are provided in the context of country-level variable access to approved agents and technologies for treatment monitoring. Patients should be treated with the purpose of prolonging overall survival and preserving quality of life through increasing the opportunity to administer all available life-prolonging therapies when appropriate.

Manejo estético de los tejidos en implantes postextracción en el sector anterior. A propósito de un caso clínico / Aesthetic management of tissues in postextraction implants in the anterior sector. A clinical case report

La excelencia estética en los implantes del sector anterior sigue siendo un reto para los profesionales, además de una exigencia de nuestros pacientes. Para ello, un correcto diagnóstico y la utilización de técnicas para la preservación de los tejidos duros y blandos, una extracción meticulosa, el mantenimiento de los perfiles de emergencia mediante el uso de injertos de tejido conectivo y provisionales inmediatos, son fundamentales para conseguir una estética adecuada y la armonía de los tejidos periimplantarios. Se presenta el caso de una mujer de 57 años que refiere haber sufrido un traumatismo en el incisivo central superior izquierdo. El examen clínico y radiológico reveló una fractura horizontal a nivel del tercio coronal de la raíz sin pérdida ósea. Por lo que se planificó la colocación de un implante postextracción. Para la preservación de los tejidos se realizó un relleno con un sustituto óseo, un injerto de tejido conectivo del paladar tunelizado por vestibular y para el mantenimiento de la arquitectura gingival se llevó a cabo una provisionalización inmediata con su propia corona (AU)

Aesthetics excellency outcomes in anterior sector implants still is a challenge for professionals and is also the patient requirement. To ensure this, a correct diagnostic, the use of techniques to preserve the soft and hard tissues, a meticulous extraction, the use of connective tissues graft to maintain the emergence profiles and use immediate provisionalization are essential to keep the esthetics armory of periimplant tissues. In a presented case of a 57 year old woman, with an upper central incisor injury, the clinical and radiological examinations show a horizontal fracture in the upper third without any bone lost. An immediate implant was planned, bone substitute was used to tissue preservation, and a tunneling technique with a connective tissue graft taken from palatal. her own crown was use to keep the gingival architecture as an immediate restoration (AU)

The consumption of Hibiscus sabdariffa dried calyx ethanolic extract reduced lipid profile in rats.

The scientific basis for the statement that plants and their active constituents play an important role in the prevention of chronic and degenerative diseases is continously advancing. The object of the present study was to evaluate the effect of Hibiscus sabdariffa L. dried calyx ethanolic extract on the serum lipid profile of Sprague-Dawley rats. The rats were fed during 4 weeks with either a basal diet, containing high cholesterol (1%), cholic acid (0.25%), lard oil (10%), or a supplemental diet with H. sabdariffa extract at 5%, 10%, and 15% levels (SD(5), SD(10), SD(15)). Weight gain and faeces dry weight were both very significantly less (p

Levels of organochlorine pesticides in soils and rye plant tissues in a field study.

The organochlorine pesticides are lipophilic and persistent and tend to accumulate in soils and growing plants. The contamination of growing plants occurs by adhesion of volatile substances from the air to the plant surface and by the migration of contaminants through xylem in inner ascendant transport. Persistent organochlorine pesticides (HCB, alpha,gamma-HCH, pp'DDE, op'DDT, pp'DDT) levels were determined in soils and rye plants. The aims of the study were the monitoring of organochlorine pesticide concentrations and the comparison of these levels among soil, rye straw, and rye grains. Fifty soil samples and 50 rye plant (50 straw and 50 grains) samples were taken. The GLC-ECD chromatographic results indicated the following contamination levels distributed among soil, straw, and grains: HCB (0.7-1.2-0.7 microg.kg(-1)), alpha-HCH (0.6-3.4-1.2 microg.kg(-1)), gamma-HCH (1.8-27.3-4.4 microg.kg(-1)), Sigma-HCH (2.5-30.7-5.6 microg.kg(-1)), pp'DDE (1.0-7.8-5.5 microg.kg(-1)), op'DDT (16.1-20.4-17.0 microg.kg(-1)), pp'DDT (38.0-41.7-49.6 microg.kg(-1)), and Sigma-DDT (54.2-63.2-72.1 microg.kg(-1)). The study verified the presence of organochlorine pesticides in the Mexican agricultural environment and their migration from soil to the growing rye plants. However, DDT has been banned since 1999 for sanitary reasons, and Lindane is applied only in some cases as a seed dresser. The determined organochlorine pesticide levels in rye plants are low, at residual levels that are below Codex Alimentarius Commission maximum residue limits.

Tratamiento de lesiones hepáticas tumorales con RENIO188- LIPIODOL. Experiencia en Colombia / Treatment of liver cancer injuries with RENIO188- LIPIODOL. Experience in Colombia

Objetivo: Evaluar pacientes con lesiones tumorales hepáticas, no quirúrgicas, a quienes se les administro Renio 188 -Lipiodol vía transarterial, como alternativa terapéutica.Método: Once pacientes con cáncer de hígado no operable se trataron con dosis entre 170 y 4181 MBq de Renio 188 Lipiodol a través de la arteria hepática. Los pacientes fueron evaluados clínicamente, con test hematológicos, de función hepática y TAC hepático periódicamente.Resultados: El tratamiento con Renio 188 Lipiodol fue bien tolerado . Tres pacientes desarrollaron fiebre leve y un paciente Neumonitis Intersticial que resolvió completamente. En el TAC de control siete pacientes evidenciaron reducción significativa del tamaño de la lesión , 1 sin cambios, 1 progresión y 2 no se han evaluado.Conclusiones: Renio 188 Lipiodol es un tratamiento seguro, la técnica de preparación fácilmente reproducible y se constituye en una alternativa terapéutica para este tipo de pacientes.

Organochlorine pesticide levels in blood serum samples taken at autopsy from auto accident victims in Veracruz, Mexico.

Samples of human blood sera (N = 118) for the determination of organochlorine pesticide levels were obtained at autopsy from auto accident victims in Veracruz, Mexico, during the years 2000 and 2001. The presence of hexachlorobenzene (HCH), beta-hexachlorocyclohexane (beta-HCH), 2,2-bis(p-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE), 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (p,p'-DDT), and o,p'-DDT was confirmed by gas-liquid-electron-capture detection chromatography. During the years 2000 and 2001, the respective mean levels of (a) HCB, (b) beta-HCH, (c) p,p'-DDE, (d) o,p'-DDT, (e) p,p'-DDT, and (f) total DDT were (a) 2.1 ng/ml and 1.4 ng/ml, (b) 3.0 ng/ml and 3.6 ng/ml, (c) 21.1 ng/ml and 23.8 ng/ml, (d) 1.2 ng/ml and 0.8 ng/ml, (e) 3.3 ng/ml and 2.5 ng/ml, and, finally, (f) 25.4 ng/ml and 27.1 ng/ml, respectively. High levels of persistent organochlorine pesticides were--and continue to be--present in the blood of individuals who live in Mexico. Levels of insecticide metabolites (e.g., beta-HCH, p,p'-DDE) in blood have increased during recent years (1997-2001), but levels of p,p'-DDT decreased in 2001 because the use of DDT for the control of malaria in Mexico was restricted.