The Value of Ultrasound for Detecting and Following Subclinical Interstitial Lung Disease in Systemic Sclerosis.

BACKGROUND: Interstitial lung disease (ILD) is a complication in patients with systemic sclerosis (SSc). Accurate strategies to identify its presence in early phases are essential. We conducted the study aiming to determine the validity of ultrasound (US) in detecting subclinical ILD in SSc, and to ascertain its potential in determining the disease progression. METHODS: 133 patients without respiratory symptoms and 133 healthy controls were included. Borg scale, Rodnan skin score (RSS), auscultation, chest radiographs, and respiratory function tests (RFT) were performed. A rheumatologist performed the lung US. High-resolution CT (HRCT) was also performed. The patients were followed every 12 weeks for 48 weeks. RESULTS: A total of 79 of 133 patients (59.4%) showed US signs of ILD in contrast to healthy controls (4.8%) (p = 0.0001). Anti-centromere antibodies (p = 0.005) and RSS (p = 0.004) showed an association with ILD. A positive correlation was demonstrated between the US and HRCT findings (p = 0.001). The sensitivity and specificity of US in detecting ILD were 91.2% and 88.6%, respectively. In the follow-up, a total of 30 patients out of 79 (37.9%) who demonstrated US signs of ILD at baseline, showed changes in the ILD score by US. CONCLUSIONS: US showed a high prevalence of subclinical ILD in SSc patients. It proved to be a valid, reliable, and feasible tool to detect ILD in SSc and to monitor disease progression.

The Impact of Insider Researcher Trainees in Recruiting and Retaining Latinx in an Outdoor Health Promotion Research Study.

Latinx represent the second largest ethnic group in the USA and remain significantly underrepresented in research studies. Efforts to better include Latinx make use of community-engaged research (CEnR) approaches, peer-navigators, and cultural humility training for research teams. While these efforts have led to slight increases in Latinx participation, studies to identify strategic practices for better inclusion of Latinx participants are needed. The objective of this study was to qualitatively examine factors leading to successful recruitment and retention of Latinx participants in the Promoting Activity and Stress Reduction in the Outdoors (PASITO) intervention. For this intervention, 99 low-income Latinx clients in a local community were contacted and 52 participants were recruited (53%). All were retained in the 3-month intervention. Of these, 12 were interviewed within 6 months of the close of PASITO by bi-cultural and bi-lingual non-research staff. They conducted one-on-one structured telephone interviews. Of the twelve participants, three (25%) were men, nine (75%) were women, and the mean age was 43.7 (SD = 8.7). Four critical themes for the recruitment and retention of Latinx populations emerged from the interviews: (1) importance of insider researchers; (2) sense of community and belonging; (3) responsive programming; and (4) health-promoting activities. These findings support the significant role insider researchers can play, and social identity theory provides a useful framework for understanding the role of insider researchers in recruiting and retaining Latinx, and likely other minoritized groups, in clinical studies. Insider researchers possess the skills, training, community cultural wealth, in-depth understanding of their communities, and structural competencies that position them to carry out more inclusive studies to address the needs of marginalized communities and advance science.

Analysis of IgG, IgA and IgM antibodies against SARS-CoV-2 spike protein S1 in convalescent and vaccinated patients with the Pfizer-BioNTech and CanSinoBio vaccines.

The SARS-CoV-2 virus was detected for the first time in December 2019 in Wuhan, China. Currently, this virus has spread around the world, and new variants have emerged. This new pandemic virus provoked the rapid development of diagnostic tools, therapies and vaccines to control this new disease called COVID-19. Antibody detection by ELISA has been broadly used to recognize the number of persons infected with this virus or to evaluate the response of vaccinated individuals. As the pandemic spread, new questions arose, such as the prevalence of antibodies after natural infection and the response induced by the different vaccines. In Mexico, as in other countries, mRNA and viral-vectored vaccines have been widely used among the population. In this work, we developed an indirect ELISA test to evaluate S1 antibodies in convalescent and vaccinated individuals. By using this test, we showed that IgG antibodies against the S1 protein of SARS-CoV-2 were detected up to 42 weeks after the onset of the symptoms, in contrast to IgA and IgM, which decreased 14 weeks after the onset of symptoms. The evaluation of the antibody response in individuals vaccinated with Pfizer-BioNTech and CanSinoBio vaccines showed no differences 2 weeks after vaccination. However, after completing the two doses of Pfizer-BioNTech and the one dose of CanSinoBio, a significantly higher response of IgG antibodies was observed in persons vaccinated with Pfizer-BioNTech than in those vaccinated with CanSinoBio. In conclusion, these results confirm that after natural infection with SARS-CoV-2, it is possible to detect antibodies for up to 10 months. Additionally, our results showed that one dose of the CanSinoBio vaccine induces a lower response of IgG antibodies than that induced by the complete scheme of the Pfizer-BioNTech vaccine.

Healthy Parks Healthy People as an Upstream Stress Reduction Strategy.

One of the primary goals of the Healthy Parks Healthy People (HPHP) program, located in the San Francisco Bay Area, is to offer group-based physical activities in natural settings. These activities arefor racially and ethnically diverse groups of individuals as an "upstream" strategy for improving health. This study investigated the health impact of selected two-hour HPHP Bay Area events that targeted low-income racial and ethnic minority groups using physiological and self-reported measures of stress and related variables. Study participants (N=52) in the selected HPHP Bay Area events donated saliva and filled out psychological measures of perceived stress (PSS-4; Cohen et al.) and mood state (I-PANAS-SF; Thompson, 2007) at the beginning and the end ofa two-hour guided walk in green spaces. Moreover, a measure of perceived restoration (SRRS; Han, 2007) was completed at the end ofthe walk. Study participants wore a physical activity self-monitoring device (Garmin Vivofit 2) to capture their step count and heart rate during the event. Stress, both measured by the analysis of salivary cortisol and self-reported perceived stress, significantly decreased over the course of the event (p<.0$) and there was a significant increase in positive mood (p<.05). The monitoring device also indicated that individuals were engaged in moderate levels of physical activity during the guided walks (x =8,990 steps, HR 95 bpm). The results encourage further development of nature-based health interventions to mitigate stress. Such interventions may be especially appropriate for low-income, urban, racial and ethnic minority groups that likely experience increased levels of stress due to social inequities and poor living conditions.

Tumores neuroendocrinos de páncreas debutando como ampuloma: reporte de un caso y revisión del abordaje diagnóstico actual / Neuroendocrine tumors of the pancreas appearing as ampulomas: report of one case and review of the current diagnostic approach

Objetivo: Demostrar un ejercicio clínico-quirúrgico del abordaje diagnóstico actual para el tratamiento de tumor neuroendocrino de páncreas con resultados satisfactorios en un paciente seleccionado. Sede: Centro Médico ISSEMYM (Tercer nivel de atención). Diseño: Reporte de caso. Descripción del caso: Mujer de 42 años con diagnóstico de pancreatitis aguda, las bilirrubinas mostraban patrón obstructivo. Se realizó colangiopancreatografía endoscópica retrógrada mostrando imagen sugestiva de ampuloma ulcerado; el reporte histopatológico refirió: adenocarcinoma pobremente diferenciado. En el curso de su evolución presentó colangitis, que requirió tratamiento con nueva realización de colangiopancreatografía endoscópica retrógrada con esfinterotomía, aseo coledocal con balón y colocación de endoprótesis plástica 10 French, con buena respuesta clínica. Se programó pancreatoduodenectomía, encontrando tumoración en proceso uncinado de páncreas y tumor en segunda porción de duodeno, cuyo reporte transoperatorio fue tumor neuroendocrino. Conclusión: Los tumores neuroendocrinos de páncreas son neoplasias poco comunes, cuya incidencia reportada en la literatura especializada es <1 por cada 100,000 personas por año. Provienen de células pluripotenciales dentro del páncreas exocrino y comprenden <2% de todos los tumores pancreáticos, son capaces de producir hormonas (insulina, gastrina, VIP, etcétera) y su tratamiento es primordialmente la resección quirúrgica. A pesar de tratarse de lesiones infrecuentes, los tumores neuroendocrinos de páncreas deben estar en la mente del cirujano general ante cuadros de colangitis de repetición o como probabilidad diagnóstica de patología biliar de corte maligno, sugerida por una evolución tórpida y apoyada con estudios de gabinete sensibles a su diagnóstico.

Objective: To demonstrate a clinical-surgical exercise of the current diagnostic approach for the treatment of a neuroendocrine tumor of the pancreas, with satisfactory results in a selected patient. Setting: Centro Médico ISSEMYM (Third level health care). Design: Case report. Description of the case: A 42-year-old woman with diagnosis of acute pancreatitis, bilirubins indicated an obstructive pattern, retrograde endoscopic cholangiopancreatography was performed that revealed an image suggestive of ulcerated ampuloma; the histopathological report referred: poorly differentiated adenocarcinoma. During evolution, the patient presented cholangitis, which required treatment and a new retrograde endoscopic cholangiopancreatography with esphyncterotomy, choledochus cleaning with balloon, and placement of a plastic French 10 endoprosthesis, with good clinical response. Pancreatoduodenectomy was programmed, finding a pancreatic uncinate process tumor and a tumor in the second portion of the duodenum, the transoperative report corresponded to a neuroendocrine tumor. Conclusion: Neuroendocrine tumors of the pancreas are rare neoplasms, with a literature reported incidence of less than 1 per 100,000 people per year. They originate from pluripotent cells within the exocrine pancreas and constitute <2% of all pancreatic tumors. They are able to produce hormones (insulin, gastrin, VIP, etc.) and their treatment is mainly surgical. Despite being infrequent tumors, neuroendocrine tumors of the pancreas must always be present in the mind of the general surgeon when faced with repeated cholangitis symptoms or as a diagnostic probability of malignant type biliary pathology as suggested by a torpid evolution and supported by imaging studies sensitive to the diagnosis.

Control de daños en trauma penetrante de cuello: Abordaje multidisciplinario / Damage control in penetrating trauma to the neck: Multidisciplinary approach

Objetivo: Demostrar el abordaje diagnóstico y terapéutico para el tratamiento de urgencia en las heridas penetrantes en el cuello por proyectil de arma de fuego. Sede: Centro Médico del Instituto de Seguridad Social del Estado de México. Diseño: Presentación de caso clínico. Descripción del caso: Varón de 46 años de edad, con antecedente de herida penetrante en el cuello por arma de fuego, presentando un orifico de entrada en el mentón sin orificio de salida, con compromiso de la vía aérea, siendo protocolizado de acuerdo con los criterios del Apoyo Vital Avanzado en Trauma (ATLS), con control temporal de la vía aérea, efectuando la intubación orotraqueal electiva apoyado por el Servicio de Anestesiología y realizando tratamiento quirúrgico inmediato. Se identificaron las lesiones, y la reparación de las mismas con control de daños se realizó de manera quirúrgica. Conclusión: El identificar de manera rápida y eficaz las lesiones que comprometan la vía aérea superior y, por ende, la vida, así como realizar control de daños en forma oportuna es importante en el ejercicio y quehacer diario del cirujano general. Por esto, es importante tener el conocimiento adecuado de la anatomía del cuello en sus tres zonas, así como de las técnicas quirúrgicas empleadas en este tipo de casos.

Objective: To demonstrate the diagnostic and therapeutic approach for the emergency treatment of neck penetrating injuries due to firearm bullets. Setting: Centro Médico del Instituto de Seguridad Social del Estado de México. Design: Case presentation. Case description: Man of 48 years of age with antecedents of penetrating injury to the neck by a firearm, entrance orifice in the chin without exit orifice, compromising the upper airway. The patient was, subjected to the advanced trauma life support (ATLS) protocol, with temporal control of the airway, performing an elective orotracheal intubation, with support from the anesthesia service and performing surgical treatment immediately. Injuries were identified and repaired with damage control exerted surgically. Conclusion: Identifying rapidly and efficiently the injuries that affect the upper airway and, hence, life itself, as well as performing timely damage control is important in the daily activities of the general surgeon, Therefore, it is necessary to have an adequate knowledge of the neck's anatomy in its three zones, as well as to master the surgical techniques used in these cases.