Assessing EUS-guided radiofrequency ablation in unresectable pancreatic ductal adenocarcinoma: a single-center historic cohort study.

BACKGROUND AND AIMS: EUS-guided radiofrequency ablation (EUS-RFA) has emerged as an alternative for the local treatment of unresectable pancreatic ductal adenocarcinoma (PDAC). We assessed the feasibility and safety of EUS-RFA in patients with unresectable PDAC. METHODS: This study followed an historic cohort compounded by locally advanced (LA-) and metastatic (m)PDAC-naïve patients who underwent EUS-RFA between October 2019 and March 2022. EUS-RFA was performed with a 19-gauge needle electrode with a 10-mm active tip for energy delivery. Study primary endpoints were feasibility, safety, and clinical follow-up, whereas secondary endpoints were performance status (PS), local control, and overall survival (OS). RESULTS: Twenty-six patients were selected: 15 with locally advanced pancreatic duct adenocarcinoma (LA-PDAC) and 11 with metastatic pancreatic duct adenocarcinoma (mPDAC). Technical success was achieved in all patients with no major adverse events. Six months after EUS-RFA, OS was seen in 11 of 26 patients (42.3%), with significant PS improvement (P = .03). Local control was achieved, with tumor reduction from 39.5 mm to 26 mm (P = .04). A post-treatment hypodense necrotic area was observed at the 6-month follow-up in 11 of 11 patients who were still alive. Metastatic disease was a significant factor for worsening OS (hazard ratio, 5.021; 95% confidence interval, 1.589-15.87; P = .004). CONCLUSIONS: EUS-RFA for the treatment of pancreatic adenocarcinoma is a minimally invasive and safe technique that may have an important role as targeted therapy for local treatment of unresectable cases and as an alternative for poor surgical candidates. Also, RFA may play a role in downstaging cancer with a potential increase in OS in nonmetastatic cases. Large prospective cohorts are required to evaluate this technique in clinical practice.

Speciation genomics and the role of depth in the divergence of rockfishes (Sebastes) revealed through Pool-seq analysis of enriched sequences.

Speciation in the marine environment is challenged by the wide geographic distribution of many taxa and potential for high rates of gene flow through larval dispersal mechanisms. Depth has recently been proposed as a potential driver of ecological divergence in fishes, and yet it is unclear how adaptation along these gradients' shapes genomic divergence. The genus Sebastes contains numerous species pairs that are depth-segregated and can provide a better understanding of the mode and tempo of genomic diversification. Here, we present exome data on two species pairs of rockfishes that are depth-segregated and have different degrees of divergence: S. chlorostictus-S. rosenblatti and S. crocotulus-S. miniatus. We were able to reliably identify "islands of divergence" in the species pair with more recent divergence (S. chlorostictus-S. rosenblatti) and discovered a number of genes associated with neurosensory function, suggesting a role for this pathway in the early speciation process. We also reconstructed demographic histories of divergence and found the best supported model was isolation followed by asymmetric secondary contact for both species pairs. These results suggest past ecological/geographic isolation followed by asymmetric secondary contact of deep to shallow species. Our results provide another example of using rockfish as a model for studying speciation and support the role of depth as an important mechanism for diversification in the marine environment.

Ruxolitinib como uso compasivo para la covid-19 frente al tratamiento con cloroquinas: Reporte de 100 casos en el Hospital de Especialidades Portoviejo - Ecuador / Ruxolitinib como uso compasivo para la Covid-19 frente al tratamiento con cloroquinas: Reporte de 100 casos en el Hospital de Especialidades Portoviejo - Ecuador

El uso compasivo de ruxolitinib en la covid-19 demostró una mejoría en las imágenes de tórax y mayor número de altas en el grupo que lo usó vs. el grupo 1 (cloroquinas y azitromicina), con descenso de los marcadores inflamatorios. Existe un artículo que señaló que un caso que fue refractario a la terapia anti-IL6, pero respondió a la inhibición de Jak-Stat con ruxolitinib.1 La comorbilidad más frecuente en ambos grupos fue la hipertensión arterial, seguida por la diabetes tipo 2; el grupo 1 presentó un mayor número de pacientes que no presentaban comorbilidades (18 pacientes). El número de hombres con enfermedad por SARS-CoV2 fue mayor en el grupo 1, con 31 hombres (62,0%) frente un total de 19 mujeres (38,0%), mientras que, en el grupo 2, el 25,0% eran hombres y mujeres, el 25,0%. La gravedad de la covid-19 fue definida como moderada: adolescente o adulto con signos clínicos de neumonía (fiebre, tos, disnea, taquipnea), en particular SpO2 ≥ 90% con aire ambiente; y grave: adolescente o adulto con signos clínicos de neumonía (fiebre, tos, disnea, taquipnea) más alguno de los siguientes: frecuencia respiratoria > 30 inspiraciones/min, dificultad respiratoria grave o SpO2 < 90% con aire ambiente.2 El síndrome de dificultad respiratoria aguda (SDRA) en ambos grupos fue de un pro medio de relación entre la presión arterial de oxígeno y la fracción inspirada de oxígeno (PaFi) en el grupo ruxolitinib 135,3 mmHg vs. Grupo control PaFi 138,9 mmHg. Se definió la eficacia por descenso de los marcadores inflamatorios, mejoría gasométrica de la PaFi, menor requerimiento de oxígeno, disminución del ingreso a unidad de cuidados intensivos de los pacientes con sintomatología grave, demostración de la seguridad del fármaco en los 10 días posteriores a su uso y detallado del número de casos con alta médica.

The group with compassionate use of ruxolitinib for Covid-19 showed improved chest images and a larger number of discharged patients, compared to group 1 (chloro quines and azithromycin), with a decrease in inflammatory markers. There is one arti cle that described a case which refractory to anti-IL6 therapy but responded to Jak-Stat inhibition with ruxolitinib.1 The most common comorbidity in both groups was arterial hypertension, followed by diabetes type 2; group 1 showed a larger number of patients without comorbidities (18 patients). The number of male patients with the disease caused by SARS-CoV2 was larger in group 1, with 31 males (62.0%), compared to a total of 19 females (38.0%), whereas in group 2, 25.0% were males, and 25.0% females. The severity of Covid-19 was defined as moderate: adolescent or adult with clinical signs of pneumonia (fever, cough, dys pnea, tachypnea), particularly SpO2 ≥ 90% on ambient air; and severe: adolescent or adult with clinical signs of pneumonia (fever, cough, dyspnea, tachypnea) plus some of the following: respiratory rate > 30 breaths/min, severe respiratory distress or SpO2 < 90% on ambient air.2 The acute respiratory distress syndrome (ARDS) in both groups had an average ratio of pressure arterial oxygen and fraction of inspired oxygen (PaFi) of 135.3 mmHg in the ruxolitinib group versus 138.9 mmHg in the control group. Efficacy was defined as: decrease in inflammatory markers, gasometric improvement in the PaFi, lower oxygen requirement, lower number of patients with severe symptoms admitted to the Intensive Care Unit, proof of the drug's safety 10 days after use, and detailed number of discharged patients.

The growth of Escherichia coli cultures under the influence of pheomelanin nanoparticles and a chelant agent in the presence of light.

Growing concern of antibiotic resistance has increased research efforts to find nonspecific treatments to inhibit pathogenic microorganisms. In this regard, photodynamic inactivation is a promising method. It is based on the excitation of a photosensitizer molecule (PS) with UV-Vis radiation to produce reactive oxygen species. The high reactivity of such species nearby the PS leads to oxidation of bacterial cell walls, lipid membranes (lipid peroxidation), enzymes, and nucleic acids, eventually producing cell death. In the last decade, many studies have been carried out with different photosensitizers to suppress the growth of bacteria, fungi, viruses, and malignant tumors. Here, our main motivation is to employ pheomelanin nanoparticles as sensitizers for inhibiting the growth of the Gram-negative bacteria E. coli, exposed to blue and UVA radiation. In order to perform our experiments, we synthesized pheomelanin nanoparticles from L-DOPA and L-cysteine through an oxidation process. We carried out experiments at different particle concentrations and different energy fluences. We found that cultures exposed to UVA at 166 µg/mL and 270 J/cm2, in conjunction with ethylenediaminetetraacetic acid (EDTA) as an enhancer, decreased in the viable count 5 log10. Different reactive oxygen species (singlet oxygen, hydroxyl radicals, and peroxynitrates) were detected using different procedures. Our results suggest that the method reported here is effective against E. coli, which could encourage further investigations in other type of bacteria.

ß1-receptor polymorphisms and junctional ectopic tachycardia in children after cardiac surgery.

Junctional ectopic tachycardia (JET) is a potentially life-threatening postoperative arrhythmia in children with specific congenital heart defects and can contribute significantly to postoperative morbidity for at-risk populations. In adults, ß1-adrenergic receptor (ADRB1) and ß2-adrenergic receptor (ADRB2) genotypes have been associated with increased risk for arrhythmias. However, their association with arrhythmia risk in children is unknown. We aimed to test associations between ADRB1 and ADRB2 genotypes and postoperative JET in patients with congenital heart defects. Children who underwent cardiac surgery were genotyped for the ADRB1 p.Ser49Gly (rs1801252; c.145A>G), p.Arg389Gly (rs1801253; c.1165C>G), ADRB2 p.Arg16Gly (rs1042713; c.46A>G), and p.Glu27Gln (rs1042714; c.79G>C) polymorphisms. The occurrence of postoperative JET was assessed via cardiologist-interpreted electrocardiograms. Genotype associations with JET were analyzed via logistic regression, adjusted for clinical variables associated with JET, with separate analysis in patients not on a ß-blocker. Of the 343 children included (median age 8 months, 53% boys, 69% European ancestry), 45 (13%) developed JET. The Arg389Arg genotype was not significantly associated with JET in the overall population (odds ratio [OR] = 1.96, 95% confidence interval [CI] = 0.96-4.03, p = 0.064), but was nominally associated in patients not taking a ß-blocker (n = 324, OR = 2.25, 95% CI = 1.05-4.80. p = 0.034). None of the other variants were associated with JET. These data suggest that the ADRB1 Arg389Arg genotype may predict risk for JET following cardiac surgery in pediatric patients in the absence of ß-blockade. Whether treatment with a ß-blocker ameliorates this association requires further research.

Leiomiosarcoma peritoneal en un canino: reporte de caso / Peritoneal leiomyosarcoma in a canine: case report

RESUMEN El propósito de este estudio fue para presentar y documentar un leiomiosarcoma peritoneal en un canino y sus hallazgos histopatológicos e Inmunohistoquímica. El paciente, una hembra de 5 años de edad, de raza Chow-Chow, fue llevada a la Clínica Veterinaria de la Universidad de los Llanos, debido a pérdida de peso, postración y baja condición corporal. Al examen físico presentó mucosas pálidas, aumento de la silueta abdominal con contenido de fluido serosanguinolento. A la palpación se evidenció en el epigastrio craneal una masa no dolorosa, de consistencia dura, de superficie irregular y desplazable caudalmente. Anormalidades bioquímicas séricas incluyeron proteínas totales plasmáticas aumentadas, globulina y creatinina. Así, una laparotomía exploratoria fue realizada, identificando una masa en el mesenterio unida a la porción de intestino grueso. En el reporte se señalaron los siguientes hallazgos macroscópicos: una masa firme de 18 cm de longitud y 13 cm de ancho, con una superficie irregular, gran vascularización. Las muestras de tejido fueron fijadas en formalina buferada al 10% para análisis histopatológico e Inmunohistoquímica. Las muestras fueron procesadas por los métodos de rutina para microscopía y coloración con hematoxilina-eosina (HE), tricrómico de Masson, anticuerpos anti-citoqueratina CK5, anti-actina de músculo liso, vimentina y KIT(CD117). En conclusión, el tumor fue clasificado por histopatología como de origen mesenquimal e inmunopositividad citoplasmática difusa interna de células neoplásicas para actina de músculo liso, vimentina y negatividad para KIT, condujo al diagnóstico de leiomiosarcoma.

ABSTRACT The purpose of this study is to present a peritoneal leiomyosarcoma in a canine and its histopathological and immunohistochemical findings. The patient, a 5-year old female Chow-Chow, was brought to Los Llanos University veterinary clinic due to loss of appetite, prostration and poor corporal condition. Physical examination showed pale mucous membranes, increased abdominal silhouette with a serosanguineous fluid content. Palpation at the cranial epigastrium evidenced a painless mass of hard consistency, irregular surface and caudally displaceable. Serum biochemical abnormalities included increased plasma total protein, globulin and creatinine. Thus, an exploratory laparotomy was performed, identifying a mass in the mesentery attached to a portion of the small intestine. In its report it was stated the following macroscopic findings: a firm mass of 18 cm long and 13 cm wide, with irregular surface, great vascularization. Tissue samples were fixed in 10% buffered formalin for histopathological and immunohistochemical analysis. Samples were processed by routine methods for microscopy and stained with hematoxylin-eosin (HE), Masson trichrome, anti-cytokeratin CK5, anti-smooth muscle actin, vimentin and KIT(CD117) antibodies. In conclusion, the tumor was classified by histopathology as of mesenchymal origin and internal diffuse cytoplasmic immunopositivity of neoplastic cells for smooth muscle actin, vimentin and was negative for KIT led to diagnose of leiomyosarcoma.

Deterioro Cognitivo en pacientes diabéticos entre 55 a 65 años de edad. Reporte final de estudio observacional, transversal en la ciudad de Guayaquil / Cognitive impairment in diabetic patients between 55 and 65 years old. Final report of a cross-sectional, observational study in Guayaquil city

RESUMEN Introducción: La Diabetes Mellitus es la enfermedad metabólica más frecuente. Su efecto deletéreo sobre la cognición es poco reconocido. La demencia es la enfermedad neurodegenerativa más común y la población diabética está en mayor riesgo de desarrollarla a futuro. Objetivo: Comparar la función cognitiva de los individuos diabéticos de mediana edad, con un grupo control no diabético, y así determinar población en riesgo de desarrollar deterioro cognitivo. Metodología: Se realizó un estudio observacional, poblacional, de corte transversal en Guayaquil. Se han estudiado 309 individuos -142 diabéticos y 167 no diabéticos- entre 55 y 65 años de edad a quienes se les practicaron pruebas neuropsicológicas para determinar su funcionamiento cognitivo en atención, velocidad de procesamiento, memoria y función ejecutiva. Resultados: Las comparaciones entre ambos grupos demostraron diferencias significativas en cuanto a hipertensión arterial sistólica (p< .001), hiperlipidemia (p< .001) e índice de riesgo cardiovascular (p< .001). El rendimiento cognitivo fue menor en los pacientes diabéticos luego de considerar la diferencia en años de escolaridad (pruebas de memoria con valores p entre .000 y .002; pruebas de atención con valores p entre .000 y .019; función ejecutiva con valores p entre .000 y .001). No hubo correlación significativa entre los años de evolución de la enfermedad y deterioro cognitivo (memoria -.055; atención -.040; función ejecutiva .0169). La relación entre los niveles de hemoglobina glicosilada y deterioro cognitivo sí fueron significativos para todas las funciones cognitivas evaluadas (memoria -.219; atención -.186; función ejecutiva -.269). Conclusión: La población diabética de mediana edad tiene un rendimiento cognitivo inferior a la no diabética. La identificación temprana de población en riesgo de desarrollar demencia en la adultez mayor permitirá diseñar estrategias de intervención que permitan retardar la aparición clínica de la demencia en individuos vulnerables.

ABSTRACT Introduction: Diabetes mellitus is a frequent and systemic illness. Deleterious effects on cognition are one of its lesser known consequences. Diabetic individuals are at an increased risk for development of dementia in the future. Objective: To compare cognitive function in middle aged diabetic population with non-diabetic control group, in order to determine high risk population for developing cognitive decline or dementia in the future. Methodology: This is a cross-sectional, observational study conducted in Guayaquil. We studied 309 individuals between the ages of 55 and 65 years, of which 142 were diabetics and 167 were non-diabetic controls. A neuropsychological evaluation was performed to assess memory, attention, executive functioning and processing speed. Results: Group comparisons revealed significant differences between diabetics and non-diabetics in systolic blood pressure (p<.001), hyperlipidemia (p<.001) and cardiovascular risk (p < .001). Cognitive performance, after considering differences in scholarship, was lower in diabetic people (memory p values between .000 and .002; attention p values between .000 and .019; executive function p values between .000 and .001). Correlation between years of disease and cognitive decline was not significant (memory -.055; attention -.040; executive function .0169). Correlation between glycated hemoglobin and cognitive performance was significant for all evaluated functions (memory -.219; attention -.186; executive function -.269). Conclusion: Middle aged diabetic population has lower cognitive performance compared with non diabetics. The identification of individuals at risk for cognitive decline will contribute to the development and implementation of intervention strategies that will allow the slowing of cognitive decline in vulnerable individuals.

Diabetes Is Associated with Cognitive Decline in Middle-Aged Patients.

BACKGROUND: Diabetes is a major contributor to dementia in the elderly. Identifying mild cognitive decline in younger individuals with diabetes could aid in preventing the progression of the disease. The aim of our study is to compare whether patients with diabetes experience greater cognitive decline than those without diabetes. METHODS: We conducted a cross-sectional study using population-based recruitment to identify a cohort of individuals with diabetes and corresponding control group without diabetes of 55-65 years of age. We defined diabetes according to the American Diabetes Association and conducted a battery of standardized neuropsychological tests consisting of nine verbal and nonverbal tasks assessing three cognitive domains. We defined cognitive decline as an abnormal test in one or more of the domains. We used hierarchical regression to predict abnormal cognitive function by diabetes status, adjusting for gender, education, hypertension, and depression. RESULTS: We included 142 patients with diabetes and 167 control group patients. Those with diabetes had a mean age of 59 ± 4 years, 54% were women, the mean education level was 11 ± 4.5 years of schooling, and their hemoglobin A1c was 8.6 ± 2.5. They had an overall lower mean of all five executive function measures, all seven attention measures, and all five memory measures (P < 0.05). In multivariate analyses, all executive function beta coefficients for diabetes were significant, whereas attention had four out of seven and memory had four out of five. CONCLUSIONS: Diabetes is associated with cognitive decline in younger patients with diabetes. Preventive strategies should be developed for the prevention of dementia in younger populations.

Increasing myocardial infarction mortality trends in a middle-income country.

BACKGROUND: Developed countries continue to show a decrease in cardiovascular disease (CVD) mortality. Little is known about CVD mortality trends in low and middle-income countries. The aim of our study is to describe myocardial infarction (MI) mortality trends and evaluate if differences between ethnic groups and geographic regions are present among the Ecuadorians with acute MI. METHODS: We conducted a cross sectional analysis mortality national registry and included deaths related to MI between 2012 and 2016 that had complete demographic data. To describe the general population, we used the 2010 census and applied estimates as population projections. We calculated age and sex standardized MI mortality rates per 100,000. We compared trends in MI mortality rate for every ethnic group and geographic region and used linear regression to estimate predictors of the changing mortality rates. RESULTS: We included 18,277 MI deaths between the years 2012 and 2016. The mean age of death was 73.6±19.5, 59% were male and 33% were illiterate. From 2012 to 2016, the standardized MI mortality rate increased from 51 to 157 deaths per 100,000. The most significant predictors of the increasing mortality rate were living in the coast (ß=0.10), belonging to a mixed race (ß=-0.033) and the year of death (ß=0.013). CONCLUSIONS: Our study found a worrisome increase in MI mortality between 2012-2016 in Ecuador, a middle-income country in South America. This rapid increase seems to be driven by geographic and racial differences. A thorough evaluation of the causes of this increase has to be undertaken by the Ecuadorian health authorities.

Prevalence, Time Trends, and Utilization Patterns of Psychotropic Polypharmacy Among Pediatric Medicaid Beneficiaries, 1999-2010.

OBJECTIVES: This study estimated the prevalence, time trends, and state-level variation of same- and multiclass psychotropic polypharmacy among youths in Medicaid fee-for-service plans. METHODS: Using pharmacy records from 29 Medicaid states from 1999 to 2010, the authors constructed ten two-year cohorts of beneficiaries between ages 0 and 17 years who received at least one psychotropic to treat a mental disorder. Polypharmacy was defined as any period in which dispensed days' supply of psychotropics overlapped for more than 45 days. Same- and multiclass psychotropic polypharmacy prevalence was stratified by age and state. RESULTS: A total of 692,485 children were included across each two-year cohort. The prevalence of any-class and multiclass psychotropic polypharmacy grew steadily, from 21.2% and 18.8% in 1999-2000 to 27.3% and 24.4% in 2009-2010, respectively. The prevalence increased with older age, with highest estimates for late adolescents. For same-class psychotropic polypharmacy, a constant upward trend was noted over time, except for antidepressants. Polypharmacy increased over the decade for central nervous system stimulants, from .1% to .6%, and for alpha-agonists, from .1% to .4%. Heterogeneous prevalences of psychotropic polypharmacy were noted across states, ranging from 6.9% to 48.8% for any-class psychotropic polypharmacy, from .4% to 6.4% for same-class antidepressant polypharmacy, and from .1% to 4.6% for antipsychotics. CONCLUSIONS: The study found an overall increasing trend of psychotropic polypharmacy coupled with significant variation across the examined states. A more granular assessment that considers patient characteristics and local contextual factors is warranted.

Assessing the Effect of Pharmacist Care on Diabetes-Related Outcomes in a Rural Outpatient Clinic: A Retrospective Case-Control Study.

BACKGROUND: The care of diabetic patients in rural areas is complicated by factors such as poor health literacy, cultural barriers, and primary care provider (PCP) shortages. Integrating pharmacist care in diabetes management in these settings may increase access to care and improve patient outcomes. OBJECTIVE: To evaluate differences in diabetes-related outcomes in patients with type 2 diabetes (T2DM) managed by a pharmacist diabetes clinic compared with patients only managed by PCPs in a rural family medicine clinic. METHODS: This was a retrospective case-control study. The primary outcome was achievement of hemoglobin A1C (A1C) reduction ≥0.5%. Secondary outcomes included average A1C reduction, achievement of A1C goal, angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) use, statin use, blood pressure control, and frequency of nephropathy screenings. Patients ≥18 years old with an A1C ≥7% were eligible. Cases included patients established with the pharmacist diabetes clinic. Cases were matched to controls in a 1:1 ratio based on PCP, age (±5 years), gender, and race. RESULTS: A total of 21 pharmacist-managed patients met inclusion criteria. Cases were significantly more likely to experience an A1C reduction ≥0.5% (odds ratio = 7.51; 95% CI = 1.54-36.61; P < 0.01). Statistically significant improvements were also noted for ACE inhibitor/ARB use, statin use, and nephropathy screenings among cases. CONCLUSION: Patients managed by a pharmacist diabetes clinic were more likely to experience improved diabetes-related outcomes, including A1C reduction ≥0.5%. Pharmacist care, when added to standard care, can improve outcomes for patients with T2DM in rural areas.

Prevalence of metabolic syndrome and prediabetes in an urban population of Guayaquil, Ecuador.

AIMS: To determine the prevalence of metabolic syndrome and prediabetes in a population of the city of Guayaquil, Ecuador, aged 55-65 years; to observe if there are differences in prevalence between males and females, and to describe the frequency with which each component of the metabolic syndrome is found in this population. MATERIALS AND METHODS: population-based cross-sectional study in Guayaquil. We recruited people of both genders, with ages ranging from 55 to 65 years. Through clinical history, physical examination and laboratory tests, we obtained necessary data to diagnose metabolic syndrome and/or prediabetes. Statistical analysis was performed using SPSS(®) 22. RESULTS: we obtained a sample of 213 patients, 64.5% were females and 35.5% were males. Mean age was 60.3 years (±3.1). A total 65.8% of patients had increased waist circumference, and 45% were diagnosed with metabolic syndrome. Hypertriglyceridemia was the most prevalent condition in males, while women more commonly had low HDL. Prediabetes was diagnosed in 45.9% of our patients, and 19.5% had both disorders. There was no significant difference on metabolic syndrome prevalence between genders, but prediabetes was significantly more common in women. CONCLUSION: we found a high prevalence of metabolic syndrome and prediabetes in Guayaquil, higher than what was reported in other areas. Abdominal obesity is even more prevalent. Women have prediabetes more frequently than men. Our patients, given their age, are at higher risk of cardiovascular disease and cognitive decline by having metabolic syndrome and/or prediabetes.

Using dislocations to probe surface reconstruction in thick freely suspended liquid crystalline films.

Surface interactions can cause freely suspended thin liquid crystalline films to form phases different from the bulk material, but it is not known what happens at the surface of thick films. Edge dislocations can be used as a marker for the boundary between the bulk center and the reconstructed surface. We use noncontact mode atomic force microscopy to determine the depth of edge dislocations below the surface of freely suspended thick films of 4-n-heptyloxybenzylidene-4-n-heptylaniline (7O.7) in the crystalline B phase. Here, 3.0±0.1 nm high steps are found with a width that varies with temperature between 56 and 59°C. Using a strain model for the profile of liquid crystalline layers above an edge dislocation to estimate the depth of the dislocation, we find that the number of reconstructed surface layers increases from 4 to 50 layers as the temperature decreases from 59 to 56°C. This trend tracks the behavior of the phase boundary in the thickness dependent phase diagram of freely suspended films of 7O.7, suggesting that the surface may be reconstructed into a smectic F region.

Does Intensive Glucose Control Prevent Cognitive Decline in Diabetes? A Meta-Analysis.

Diabetes mellitus is associated with cognitive decline and impaired performance in cognitive function tests among type 1 and type 2 diabetics. Even though the use of tight glucose control has been limited by a reported higher mortality, few reports have assessed the impact of treatment intensity on cognitive function. We conducted a meta-analysis to evaluate if an intensive glucose control in diabetes improves cognitive function, in comparison to standard therapy. We included 7 studies that included type 1 or type 2 diabetics and used standardized tests to evaluate various cognitive function domains. Standardized mean differences (SMDs) were calculated for each domain. We found that type 1 diabetics get no cognitive benefit from a tight glucose control, whereas type 2 diabetics get some benefit on processing speed and executive domains but had worse performances in the memory and attention domains, along with a higher incidence of mortality when using intensive glucose control regimes.

Púrpura fulminans asociada a un caso probable de síndrome de choque tóxicoestafilocócico en el Hospital III Cayetano Heredia, Piura, Perú / Purpura fulminans related to a probable case of staphylococcal toxic shock syndrome in the Hospital III Cayetano Heredia, Piura, Peru

Introducción: púrpura fulminans por infección estafilocócica es una asociación poco común que se viene observado con mayor frecuencia en los últimos años. Caso clínico: se presenta aquí el caso de una paciente de 20 años que desarrolló púrpura fulminans asociada a un caso probable de síndrome de choque tóxico estafilocócico. La paciente ingresó por emergencia con diagnóstico de shock séptico de foco ginecológico y falla orgánica múltiple requiriendo intervención quirúrgica. Durante su estancia en la unidad de cuidados intensivos mejoró el estado hemodinámico, pero desarrolló púrpura y necrosis digital en ambos pies y segundo dedo de mano derecha. Fue transferida al servicio de medicina interna y finalmente fue dada de alta.

Introduction: Purpura fulminans due to staphylococcal infection, is an uncommon association which had been observed frequently in the last years. Case report: Purpura fulminans related to a probable case of staphylococcal toxic shock syndrome in a 20 years old female patient is presented. She was admitted in the emergency room and septic shock of gynecologic origin and multiple organ failure were diagnosed, and she required surgical intervention. While she was in the intensive care unit she improved hemodynamic condition, but she developed purpura and digital necrosis in both feet and in the second finger of the right hand. She was transferred to the internal medicine service and finally, she was discharged from hospital.