Transcaval approach for aortic endoprosthesis insertion. A new anesthetic challenge.

The treatment of acute aortic syndrome has been benefited in recent years from the huge progress in endovascular techniques, compared to classical surgical treatment, by open surgery. Nevertheless, for endovascular treatment to be successful, it is essential for the patient to present adequate vascular access. Those cases with unfavourable vascular anatomy make it necessary to consider open surgery with significant morbidity, or even to reject surgery. A new approach to the abdominal aorta has recently been described as an indication for these patients with impossibility of other vascular access and absolute or relative contraindication to the transthoracic approach. The anesthetic management of the aortic syndrome is well known and, even though there are a variety of options, all of them have proven safety and efficacy. The implementation of new surgical approaches and new possible complications imply a challenge for the anesthesiologist which, for now, has little or none scientific evidence. We present the first case of transcaval aortic endoprosthesis implantation in Spain, its anesthetic implications, and a review of the literature.

Factors associated with referrals for directly observed treatment and unsuccessful treatment.

To describe the characteristics of people indicated for directly observed treatment (DOT) in Spain, and the factors associated with unsuccessful treatment.This was a multicentre observational study based on a prospective follow-up of patients over 18 years old diagnosed with TB between 2006 and 2019 from the registry of the Programa Integrado de Investigación en Tuberculosis (PII-TB). Sociodemographic and clinical variables were collected. Adjusted odds ratios (aORs) were calculated for the indication of DOT and for having an unsuccessful treatment.A total of 7,883 patients were included. The indication of DOT was associated with being homeless (aOR 5.93, 95% CI 3.03-11.59), inactivity status (aOR 2.55, 95% CI 2.02-3.23), alcohol consumption (aOR 1.94, 95% CI 1.51-2.48), parenteral drug use (aOR 1.77, 95% CI 1.06-2.95) and HIV diagnosis (aOR 1.96, 95% CI 1.16-3.29). Unsuccessful treatment was associated with having an HIV diagnosis (aPR 2.31, 95% CI 1.31-4.08), having a worse clinical and radiological evolution (clinical progression: APR 15.59, 95% CI 8.21-29.60; radiological progression: aPR 12.84, 95% CI 6.46-25.52), need for hospitalisation (aPR 1.73, 95% CI 1.10-2.73), unsatisfactory tolerability (aPR 2.82, 95% CI 1.49-5.29), the existence of difficulties in understanding the prescribed treatment (aPR 1.92, 95% CI 1.21-3.06), as well as worse treatment satisfaction (aPR 7.27, 95% CI 4.32-12.24).The prioritisation of vulnerable populations is a key aspect to carry out the new Global Plan to End TB 2023-2030. In these groups DOT indication should be increased to ensure adherence and patient follow-up and outcomes..

Active immunization with a structurally aggregated PD-L1 antigen breaks T and B immune tolerance in non-human primates and exhibits in vivo anti-tumoral effects in immunocompetent mouse tumor models.

Despite the clinical success of the programmed death ligand 1 (PD-L1) blocking therapy in cancer treatment, only a subset of patients exhibits durable responses, therefore further exploration of other immunotherapeutic alternatives are needed. This paper reported the development of the PKPD-L1Vac vaccine, a new protein vaccine candidate that uses aluminum phosphate as an adjuvant and as an antigen the extracellular domain of human PD-L1 fused to a 47 amino-terminal portion of the LpdA protein from N. meningitides (PKPD-L1). The PKPD-L1 antigen has different physical and biological characteristics than those found in the natural molecule and in others PD-L1 vaccine candidates. The quimeric protein has a reduced binding capacity to the PD-1 and CD80 receptors to decrease their pro-tumoral activity. Besides, the distinctive feature of the PKPD-L1 polypeptide to be structurally aggregated could be desirable for its immunogenic properties. PKPD-L1Vac elicited anti-PD-L1-specific IgG antibodies and T lymphocyte-mediated immunity in mice and non-human primates. The vaccine administration demonstrated antitumor activity on CT-26 and B16-F10 primary tumor models in mice. Moreover, the immunization with PKPD-L1Vac increased the tumor-infiltrating lymphocytes and decreased the proportion of CD3+CD8+PD1+high anergic T cells in CT-26 tumor tissues, suggesting that the vaccine may remodel the tumor microenvironment. In summary, the PKPD-L1Vac vaccine exhibits very promising preclinical results and deserves to move forward to a phase I clinical trial.

CD38 a biomarker and therapeutic target in non-hematopoietic tumors.

The type II transmembrane glycoprotein CD38 has recently been implicated in regulating metabolism and the pathogenesis of multiple conditions, including aging, inflammation and cancer. CD38 is overexpressed in several tumor cells and microenvironment tumoral cells, associated to migration, angiogenesis, cell invasion and progression of the disease. Thus, CD38 has been used as a progression marker for different cancer types as well as in immunotherapy. This review focuses on describing the involvement of CD38 in various non-hematopoietic cancers.

Effective discrimination of gas-phase peptide conformers using TIMS-ECD-ToF MS/MS.

In the present work, four, well-studied, model peptides (e.g., substance P, bradykinin, angiotensin I and AT-Hook 3) were used to correlate structural information provided by ion mobility and ECD/CID fragmentation in a TIMS-q-EMS-ToF MS/MS platform, incorporporating an electromagnetostatic cell (EMS). The structural heterogeneity of the model peptides was observed by (i) multi-component ion mobility profiles (high ion mobility resolving power, R ∼115-145), and (ii) fast online characteristic ECD fragmentation patterns per ion mobility band (∼0.2 min). Particularly, it was demonstrated that all investigated species were probably conformers, involving cis/trans-isomerizations at X-Pro peptide bond, following the same protonation schemes, in good agreement with previous ion mobility and single point mutation experiments. The comparison between ion mobility selected ECD spectra and traditional FT-ICR ECD MS/MS spectra showed comparable ECD fragmentation efficiencies but differences in the ratio of radical (˙)/prime (') fragment species (H˙ transfer), which were associated with the differences in detection time after the electron capture event. The analysis of model peptides using online TIMS-q-EMSToF MS/MS provided complementary structural information on the intramolecular interactions that stabilize the different gas-phase conformations to those obtained by ion mobility or ECD alone.

Severe perinatal hemolytic disease due to anti-e.

Maternal antibody-mediated fetal red blood cell destruction secondary to non-D Rh system antibodies is a significant cause of hemolytic disease of the fetus and newborn. Here, we report a rare case of severe perinatal hemolytic disease associated with maternal antibody to the e antigen. In addition to severe anemia, the infant developed hyperbilirubinemia. Resolution of the infant's anemia and hyperbilirubinemia occurred after treatment with phototherapy, intravenous immunoglobulin, and transfusion.Maternal antibody-mediated fetal red blood cell destruction secondary to non-D Rh system antibodies is a significant cause of hemolytic disease of the fetus and newborn. Here, we report a rare case of severe perinatal hemolytic disease associated with maternal antibody to the e antigen. In addition to severe anemia, the infant developed hyperbilirubinemia. Resolution of the infant's anemia and hyperbilirubinemia occurred after treatment with phototherapy, intravenous immunoglobulin, and transfusion.

Caracterización de pacientes mayores de quince años con pulpitis reversibles

Fundamento: la mayoría de las urgencias estomatológicas se deben a enfermedades pulpares y periapicales. Objetivo: caracterizar a los pacientes con pulpitis reversibles, que acudieron por urgencias a la Clínica Estomatológica Docente Provincial de Sancti Spíritus, entre junio de 2018 y junio de 2019. Métodos: se realizó un estudio observacional descriptivo de corte transversal, en la institución y durante el período antes definido. El universo lo constituyeron 334 pacientes que acudieron por odontalgia por caries dental, y la muestra 205 pacientes con diagnóstico de pulpitis reversibles. Se estudiaron las variables: edad,sexo, factores de riesgo asociados, factores etiológicos y región anatómica afectada. Resultados: las pulpitis reversibles fueron más frecuentes en el sexo femenino (56,6 porciento) y el grupo de 30 a44 años (37,6 porciento). La pulpitis aguda serosa transitoria estuvo presente en el 60 porciento de la muestra. La cariesdental fue el factor etiológico predominante (92,7 porciento). El 28,3 porciento poseía como factor de riesgo asociado la experiencia anterior a caries. El sector posteroinferior resultó el más afectado (50,7 porciento). Conclusiones: se caracterizaron los pacientes con diagnóstico de pulpitis reversibles, con mayoría en su fase de pulpitis aguda supurada transitoria. La caries dental estuvo presente en la totalidad de la población estudiada.[AU]

Diagnostic benefits of adding EspC, EspF and Rv2348-B to the QuantiFERON Gold In-tube antigen combination.

Interferon (IFN)-γ release assays (IGRAs) are used to diagnose latent tuberculosis (TB) infection (LTBI). To improve the accuracy of these tests, different approaches, such as alternative cytokine detection and using different antigens, are considered. Following this purpose, this study aims to evaluate the addition of EspC, EspF and Rv2348-B to those present in the QuantiFERON-TB Gold In-Tube (QFN-G-IT). We included 115 subjects: 74 active TB patients, 17 LTBI individuals and 24 healthy controls. Whole blood samples were collected in QFN-G-IT and in-house tubes containing different combinations of EspC, EspF and Rv2348-B, together with ESAT-6, CFP-10, and TB7.7. After overnight incubation at 37 ºC, plasma was harvested and IFN-γ quantified. IFN-γ levels in the QFN-G-IT and in-house tubes correlated very good (Spearman Rho(r) > 0.86). In-house antigen combinations distinguished healthy individuals from those with active TB and LTBI (specificities and sensitivities higher than 87.5% and 96.3%, respectively [AUC > 0.938]). Adding EspC, EspF and Rv2348-B, increased the sensitivity of the test, being the addition of EspC and Rv2348-B the combination that yielded a higher sensitivity with no specificity loss. Addition of these antigens could improve diagnosis in patients with impaired or immature immune response who are at high risk of developing TB.

100% peer review in radiation oncology: is it feasible?

PURPOSE: Peer review has been proposed as a strategy to ensure patient safety and plan quality in radiation oncology. Despite its potential benefits, barriers commonly exist to its optimal implementation in daily clinical routine. Our purpose is to analyze peer-review process at our institution. METHODS AND MATERIALS: Based on our group peer-review process, we quantified the rate of plan changes, time and resources needed for this process. Prospectively, data on cases presented at our institutional peer-review conference attended by physicians, resident physicians and physicists were collected. Items such as time to present per case, type of patient (adult or pediatric), treatment intent, dose, aimed technique, disease location and receipt of previous radiation were gathered. Cases were then analyzed to determine the rate of major change, minor change and plan rejection after presentation as well as the median time per session. RESULTS: Over a period of 4 weeks, 148 cases were reviewed. Median of attendants was six physicians, three in-training-physicians and one physicist. Median time per session was 38 (4-72) minutes. 59.5% of cases presented in 1-4 min, 32.4% in 5-9 min and 8.1% in ≥ 10 min. 79.1% of cases were accepted without changes, 11.5% with minor changes, 6% with major changes and 3.4% were rejected with indication of new presentation. Most frequent reason of change was contouring corrections (53.8%) followed by dose or fractionation (26.9%). CONCLUSION: Everyday group consensus peer review is an efficient manner to recollect clinical and technical data of cases presented to ensure quality radiation care before initiation of treatment as well as ensuring department quality in a feedback team environment. This model is feasible within the normal operation of every radiation oncology Department.

Use of IP-10 detection in dried plasma spots for latent tuberculosis infection diagnosis in contacts via mail.

The aim of this study was to test the use of IP-10 detection in dried plasma from contact studies individuals (contacts of smear positive patients), by comparing it with IP-10 and IFN-γ detection in direct plasma, to establish IP-10 detection in DPS as a useful assay for LTBI diagnosis. Whole blood samples were collected from 80 subjects: 12 with active tuberculosis (TB), and 68 from contact studies. The amount of IFN-γ produced by sensitized T cells was determined in direct plasma by QuantiFERON Gold In-Tube test. IP-10 levels were determined in direct and dried plasma by an in-house ELISA. For dried plasma IP-10 determination, two 25 µl plasma drops were dried in Whatman903 filter paper and sent by mail to the laboratory. Regarding TB patients, 100.0%, 91.7% and 75.0% were positive for IFN-γ detection and IP-10 detection in direct and dried plasma, respectively. In contacts, 69.1%, 60.3% and 48.5% had positive results after IFN-γ and IP-10 in direct and dried plasma, respectively. The agreement among in vitro tests was substantial and IP-10 levels in direct and dried plasma were strongly correlated (r = 0.897). In conclusion, IP-10 detection in dried plasma is a simple and safe method that would help improve LTBI management.

La hipovitaminosis D grave al ingreso en el paciente crítico se asocia a fracaso renal agudo y mal pronóstico / Severe vitamin D deficiency upon admission in critically ill patients is related to acute kidney injury and a poor prognosis

OBJETIVOS: Determinar la prevalencia de hipovitaminosis D al ingreso en el Servicio de Medicina Intensiva (SMI), así como su asociación con el pronóstico del paciente crítico. DISEÑO: Análisis observacional prospectivo llevado a cabo desde enero a noviembre de 2015. Los pacientes incluidos fueron seguidos hasta su fallecimiento o alta hospitalaria. Ámbito: SMI polivalente de un hospital universitario. PACIENTES: Todos los individuos adultos que ingresaron en el SMI durante el periodo de estudio y que no presentaban factores conocidos que pudieran alterar los valores sanguíneos de 25(OH)D. INTERVENCIONES: Determinación de los niveles séricos de 25(OH)D en las primeras 24 h de ingreso en el SMI. Principales variables de interés: Prevalencia de hipovitaminosis D al ingreso en UCI y mortalidad a los 28 días. RESULTADOS: Se incluyeron 135 individuos. El 74% de los pacientes presentó niveles bajos de 25(OH)D en el momento de su ingreso en el SMI. El grupo de pacientes que fallecieron presentaba niveles significativamente inferiores al grupo de pacientes que sobrevivieron (8,14 ng/mL [6,17-11,53] vs. 12 ng/mL [7,1-20,30], p = 0,04) y el valor en sangre de 25(OH)D al ingreso se mostró como factor de riesgo independiente en el análisis multivariado (OR 2,86; IC 95% 1,05-7,86, p = 0,04). La curva ROC fue de 0,61 (IC 95% 0,51-0,75) y el mejor punto de corte para predecir mortalidad fue de 10,9 ng/mL. Los pacientes con valores de 25(OH)D < 10,9 ng/mL también presentaron mayores tasas de fracaso renal agudo (13 vs. 29%, p = 0,02). CONCLUSIÓN: Existe una elevada prevalencia de hipovitaminosis D en el momento de ingreso en el SMI. La hipovitaminosis D severa (25[OH]D < 10,9 ng/mL) al ingreso en el SMI se asocia a mayor incidencia de fracaso renal agudo y mayor mortalidad

OBJECTIVES: To evaluate the prevalence of vitamin D deficiency in critically ill patients upon admission to an Intensive Care Unit (ICU) and its prognostic implications. DESIGN: A single-center, prospective observational study was carried out from January to November 2015. Patients were followed-up on until death or hospital discharge. SETTING: The department of Critical Care Medicine of a university hospital. PATIENTS: All adults admitted to the ICU during the study period, without known factors capable of altering serum 25(OH)D concentration. INTERVENTIONS: Determination of serum 25(OH)D levels within the first 24 h following admission to the ICU. Main variables of interest: Prevalence and mortality at 28 days. RESULTS: The study included 135 patients, of which 74% presented deficient serum 25(OH)D levels upon admission to the ICU. Non-survivors showed significantly lower levels than survivors (8.14 ng/ml [6.17-11.53] vs. 12 ng/ml [7.1-20.30]; P = .04], and the serum 25(OH)D levels were independently associated to mortality (OR 2.86; 95% CI 1.05-7.86; P = .04]. The area under the ROC curve was 0.61 (95% CI 0.51-0.75), and the best cut-off point for predicting mortality was 10.9 ng/ml. Patients with serum 25(OH)D < 10.9 ng/ml also showed higher acute kidney injury rates (13 vs. 29%; P = .02). CONCLUSION: Vitamin D deficiency is highly prevalent upon admission to the ICU. Severe Vitamin D deficiency (25[OH]D < 10.9 ng/ml) upon admission to the ICU is associated to acute kidney injury and mortality

Intervención educativa sobre violencia intrafamiliar y maltrato infantil en familias disfuncionales / Educative intervention about intrafamily violence and children abuse in dysfunctional families

Introducción: la familia es la célula elemental de la sociedad, donde sus integrantes satisfacen sus intereses afectivos y sociales, pero a menudo se ve afectada por la presencia de violencia. Objetivo: evaluar los conocimientos que sobre violencia intrafamiliar y maltrato infantil tienen las familias disfuncionales antes y después de una estrategia de intervención. Métodos: se realizó una investigación tipo cuasi experimental antes y después sin grupo control de las familias disfuncionales pertenecientes al consultorio número 11 del Policlínico Docente Marta Martínez Figuera ubicado en Güines, Mayabeque, en el periodo comprendido entre el mes de febrero del año 2015 a mayo del año 2017. El universo de estudio estuvo conformado por 245 familias, la muestra fue de 178 familias disfuncionales. Resultados: antes de la intervención los resultados encontrados evidenciaron que la ingestión de alcohol fue la condición en el medio familiar más asociada a violencia, los golpes y/o castigos físicos fueron la principal manifestación de maltrato infantil, la persona del núcleo que más propició el maltrato fue la madre, los niños hipercinéticos fueron los más vulnerables y reconocieron el maltrato físico como forma más frecuente. Después de la intervención, se evidenciaron los gritos y/o amenazas verbales como principal manifestación de maltrato infantil, los niños rebeldes a la disciplina son los más afectados y la forma más relevante fue el maltrato psicológico y/o emocional. Conclusiones: antes de la intervención existían escasos conocimientos relacionados con la violencia intrafamiliar y el maltrato infantil, ganándose estos, después de la estrategia de intervención(AU)

Introduction: the family is the main cell of the society, where its members satisfy the affective and social interests, but sometimes it is affected by the presence of violence. Objective: to evaluate knowledge about intrafamily violence, and children abuse that dysfunctional families have before and after an intervention strategy.Methods: a cuasi experimental investigation before and after without control group of dysfunctional families from Doctor's Office # 11 at "Marta Martinez Figuera" teaching policlinic located in Güines, Mayabeque, was performed from February, 2015 to May, 2017. The universe was formed by 245 families; the sample was of 178 dysfunctional families. Results: before the intervention, the found results evidenced that alcohol ingestion was the most associated condition to violence within the families, bumps and physical punishments were the main manifestations of children abuse, the person from the household that most favored the abuse was their mothers, hyperactive children were the most vulnerable and recognized the physical abuse as the most frequent cause. After the intervention, shouts and verbal intimidations resulted as the main manifestations of children abuse, rebelled children to discipline are the most affected and the most relevant were the psychological and/or emotional abuse. Conclusions: before the interventions there were insufficient knowledge related to intrafamily violence and children abuse, and they were improved after the intervention strategy(AU)

Severe vitamin D deficiency upon admission in critically ill patients is related to acute kidney injury and a poor prognosis. / La hipovitaminosis D grave al ingreso en el paciente crítico se asocia a fracaso renal agudo y mal pronóstico.

OBJECTIVES: To evaluate the prevalence of vitamin D deficiency in critically ill patients upon admission to an Intensive Care Unit (ICU) and its prognostic implications. DESIGN: A single-center, prospective observational study was carried out from January to November 2015. Patients were followed-up on until death or hospital discharge. SETTING: The department of Critical Care Medicine of a university hospital. PATIENTS: All adults admitted to the ICU during the study period, without known factors capable of altering serum 25(OH)D concentration. INTERVENTIONS: Determination of serum 25(OH)D levels within the first 24h following admission to the ICU. MAIN VARIABLES OF INTEREST: Prevalence and mortality at 28 days. RESULTS: The study included 135 patients, of which 74% presented deficient serum 25(OH)D levels upon admission to the ICU. Non-survivors showed significantly lower levels than survivors (8.14ng/ml [6.17-11.53] vs. 12ng/ml [7.1-20.30]; P=.04], and the serum 25(OH)D levels were independently associated to mortality (OR 2.86; 95% CI 1.05-7.86; P=.04]. The area under the ROC curve was 0.61 (95% CI 0.51-0.75), and the best cut-off point for predicting mortality was 10.9ng/ml. Patients with serum 25(OH)D<10.9ng/ml also showed higher acute kidney injury rates (13 vs. 29%; P=.02). CONCLUSION: Vitamin D deficiency is highly prevalent upon admission to the ICU. Severe Vitamin D deficiency (25[OH]D<10.9ng/ml) upon admission to the ICU is associated to acute kidney injury and mortality.

Cutaneous pseudolymphoma secondary to exogenous pigment in a polychrome tattoo

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Immunoglobulin E-mediated severe allergy to hyoscine butylbromide

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