Biomarkers in breast cancer 2024: an updated consensus statement by the Spanish Society of Medical Oncology and the Spanish Society of Pathology.

This revised consensus statement of the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathological Anatomy (SEAP) updates the recommendations for biomarkers use in the diagnosis and treatment of breast cancer that we first published in 2018. The expert group recommends determining in early breast cancer the estrogen receptor (ER), progesterone receptor (PR), Ki-67, and Human Epidermal growth factor Receptor 2 (HER2), as well as BReast CAncer (BRCA) genes in high-risk HER2-negative breast cancer, to assist prognosis and help in indicating the therapeutic options, including hormone therapy, chemotherapy, anti-HER2 therapy, and other targeted therapies. One of the four available genetic prognostic platforms (Oncotype DX®, MammaPrint®, Prosigna®, or EndoPredict®) may be used in ER-positive patients with early breast cancer to establish a prognostic category and help decide with the patient whether adjuvant treatment may be limited to hormonal therapy. In second-line advanced breast cancer, in addition, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) and estrogen receptor 1 (ESR1) should be tested in hormone-sensitive cases, BRCA gene mutations in HER2-negative cancers, and in triple-negative breast cancer (TNBC), programmed cell death-1 ligand (PD-L1). Newer biomarkers and technologies, including tumor-infiltrating lymphocytes (TILs), homologous recombination deficiency (HRD) testing, serine/threonine kinase (AKT) pathway activation, and next-generation sequencing (NGS), are at this point investigational.

Identification, Biochemical Characterization, and In Vivo Detection of a Zn-Metalloprotease with Collagenase Activity from Mannheimia haemolytica A2.

Respiratory diseases in ruminants are a main cause of economic losses to farmers worldwide. Approximately 25% of ruminants experience at least one episode of respiratory disease during the first year of life. Mannheimia haemolytica is the main etiological bacterial agent in the ruminant respiratory disease complex. M. haemolytica can secrete several virulence factors, such as leukotoxin, lipopolysaccharide, and proteases, that can be targeted to treat infections. At present, little information has been reported on the secretion of M. haemolytica A2 proteases and their host protein targets. Here, we obtained evidence that M. haemolytica A2 proteases promote the degradation of hemoglobin, holo-lactoferrin, albumin, and fibrinogen. Additionally, we performed biochemical characterization for a specific 110 kDa Zn-dependent metalloprotease (110-Mh metalloprotease). This metalloprotease was purified through ion exchange chromatography and characterized using denaturing and chaotropic agents and through zymography assays. Furthermore, mass spectrometry identification and 3D modeling were performed. Then, antibodies against the 110 kDa-Mh metalloprotease were produced, which achieved great inhibition of proteolytic activity. Finally, the antibodies were used to perform immunohistochemical tests on postmortem lung samples from sheep with suggestive histology data of pneumonic mannheimiosis. Taken together, our results strongly suggest that the 110-Mh metalloprotease participates as a virulence mechanism that promotes damage to host tissues.

CRISPR/Cas9-Mediated Disruption of the pcz1 Gene and Its Impact on Growth, Development, and Penicillin Production in Penicillium rubens.

Penicillium rubens is a filamentous fungus of great biotechnological importance due to its role as an industrial producer of the antibiotic penicillin. However, despite its significance, our understanding of the regulatory mechanisms governing biological processes in this fungus is still limited. In fungi, zinc finger proteins containing a Zn(II)2Cys6 domain are particularly interesting regulators. Although the P. rubens genome harbors many genes encoding proteins with this domain, only two of them have been investigated thus far. In this study, we employed CRISPR-Cas9 technology to disrupt the pcz1 gene, which encodes a Zn(II)2Cys6 protein in P. rubens. The disruption of pcz1 resulted in a decrease in the production of penicillin in P. rubens. This decrease in penicillin production was accompanied by the downregulation of the expression of pcbAB, pcbC and penDE genes, which form the biosynthetic gene cluster responsible for penicillin production. Moreover, the disruption of pcz1 also impacts on asexual development, leading to decreased growth and conidiation, as well as enhanced conidial germination. Collectively, our results indicate that pcz1 acts as a positive regulator of penicillin production, growth, and conidiation, while functioning as a negative regulator of conidial germination in P. rubens. To the best of our knowledge, this is the first report involving a gene encoding a Zn(II)2Cys6 protein in the regulation of penicillin biosynthesis in P. rubens.

Discectomía endoscópica interlaminar de tercera generación: experiencia inicial en el Perú / Third generation endoscopic interlaminar discectomy: first Peruvian experience

RESUMEN El dolor lumbar discogénico es una entidad cuyo manejo médico inicial se da con terapia física, con un alto porcentaje de pacientes que experimentan disminución de sus molestias; sin embargo, a aquellos que muestran persistencia de síntomas se les indica cirugía. Tradicionalmente, se opta por la cirugía abierta o microdiscectomía para el manejo de hernia del núcleo pulposo; sin embargo, actualmente, la discectomía mediante endoscopía es una técnica con múltiples ventajas. En la presente revisión de la discectomía endoscópica de tercera generación, se describen sus indicaciones, una breve historia de la endoscopía espinal a nivel internacional y nacional, así como la técnica propiamente como tal, además de un caso conducido en nuestra institución.

ABSTRACT Discogenic low back pain is a condition whose typical initial medical management is that of physical therapy. A significant percentage of patients experience a reduction of their discomfort, but for those with persistent symptoms, surgery is recommended. Traditionally, open surgery or microdiscectomy has been the preferred choice for the treatment of herniated discs. Nevertheless, endoscopic discectomy is a technique with several advantages; in this review of third-generation endoscopic discectomy, its indications, a brief history of international and national spinal endoscopy, the technique and its application in our context are described, and a case handled in our institution is presented.

[Dietary and physical activity practices and preferences in children: An approach from school parliaments in educational public establishments]. / Prácticas y preferencias alimentarias y de actividad física en niños y niñas: Una aproximación desde los Parlamentos Escolares en establecimientos educacionales.

In Chile, overnutrition continues to increase, especially affecting children. Solving this public health problem requires the development of promotion and prevention strategies that consider the suggestions of the communities, especially those of the children themselves. OBJECTIVE: To know the opinions and suggestions of third and fourth-grade children from schools in the southern area of Santiago, Chile, regarding their eating practices and physical activity, as part of the FONDEF IT 1810016 project. SUBJECTS AND METHOD: Seven School Meetings were held in seven schools using a participatory qualitative methodology, collecting the opinions of 176 children regarding both their food and physical activity habits and preferences. RESULTS: The most consumed and preferred foods are those easy to prepare and highly available, such as bread, pasta, and milk. Foods that require preparation or are less available, such as fish, legumes, fruits, vegetables, and homemade preparations, are less consumed and have less preference. Regarding physical activities, video games and soccer stand out. Students propose increasing the hours of physical education and recesses and improving the availability and access to healthy foods in school environments as a solution strategy. CONCLUSIONS: School Meetings as a participatory strategy contribute to the joint generation of knowledge. The need to include communities as participants in health initiatives recognizes, through their role, children as subjects of rights.

Manejo ultra temprano del aneurisma cerebral roto. Reporte de caso y revisión de la literatura / Ultra-early management of ruptured brain aneurysm. A case report and literature review

Introducción : Los aneurismas intracraneales representan el 85% de casos de hemorragias subaracnoideas, dentro de las cuales las no traumáticas tienen una alta tasa de mortalidad (40-60%). En el manejo endovascular y microquirúrgico de esta enfermedad, el debate ha sido siempre intenso respecto a si el tratamiento temprano produce un beneficioso resultado funcional y reduce la morbi-mortalidad del paciente. Caso Clínico : Paciente mujer de 54 años, admitida con cefalea súbita y cuadro neurológico que cursó con rápido deterioro. La tomografía mostró hemorragia subaracnoidea por ruptura aneurísmica del complejo comunicante anterior; fue sometida a microcirugía dentro de las primeras 24 horas y transferida luego a UCI, sin complicaciones. Discusión : El tiempo de resolución, sea mediante clipaje microquirúrgico o tratamiento endovascular es tema de intensos debates. Las guías actuales señalan la necesidad del manejo más temprano posible de la patología. Conclusión : En nuestro caso, se obtuvo un buen resultado funcional debido a varios factores uno de ellos el ingreso precoz a cirugía. La actualización de las guías y nuevos estudios ayudarán a mejorar el conocimiento de la enfermedad y protocolos hospitalarios adecuados a la realidad clínica ayudarán a reducir su tiempo de resolución.

SUMMARY Introduction : Intracranial aneurysms account for 85% of all subarachnoid hemorrhages. Non-traumatic SAH has a high mortality rate (40-60%). Regarding the microsurgical and endovascular management for this pathology, there has been intense debate on whether early action is beneficial in terms of functional outcome and reduction of morbi-mortality. Clinical case : A 54-year-old woman admitted with a sudden, severe headache and a rapidly deteriorating neurological state at baseline, and with deterioration at the next hour. Tomography showed a subarachnoid hemorrhage due to ruptured aneurysm of the anterior communicating artery; the patient underwent surgery within the first 24 hours, with subsequent ICU management without complications. Discussion : The resolution time of this condition, either by micosurgery or endovascular management is a matter of intense debate. International guidelines point out the need of an earliest possible treatment. Conclusion : In our case, a good functional result was obtained due to several factors, one of which was early admission to surgery. The updating of guidelines and new studies will help to better understand the pathophysiology of SAH, and the creation of hospital protocols adapted to clinical realities will assist to reduce the resolution time of this pathology.

Enfermedad de Rosai-Dorfman intracraneal: un infrecuente diagnóstico diferencial del meningioma. Reporte de un caso ilustrativo

La Enfermedad de Rosai-Dorfman es un trastorno infrecuente y de etiología desconocida. La presentación intracraneal es aún más rara y suele imitar la apariencia de un meningioma en las imágenes del encéfalo. Se presenta el caso de un paciente varón de 38 años que ingresa por una tumoración intracraneal, extra-axial y supratentorial asociada a déficit neurológico leve; con diagnóstico presuntivo de meningioma de la convexidad. Después de la intervención quirúrgica, el diagnóstico histológico definitivo fue de Enfermedad de Rosai-Dorfman intracraneal. Se debe considerar la Enfermedad de Rosai-Dorfman intracraneal dentro del diagnóstico diferencial de una lesión intracraneal extra-axial sugestiva de un meningioma debido a la similitud en las neuroimágenes y la presentación clínica entre ambas patologías.

Rosai-Dorfman disease is an infrequent condition with no known etiology. The intracranial presentation is even rarer, and it resembles the appearance of a meningioma in image studies. We present the case of a 38-year-old male patient who was admitted because of an extra-axial supratentorial cranial tumor, associated to mild neurological deficit. The presumptive diagnosis was convexity meningioma. After surgery, the definitive histologic diagnosis was intracranial Rosai-Dorfman disease. This condition should be considered in the differential diagnosis of an extra-axial intracranial lesion suggesting meningioma, because of similar neuroimaging results and the similar clinical picture.

Continuous administration of leuprolide acetate improves urinary function in male rats with severe thoracic spinal cord injury.

AIMS: To determine if a continuous administration of leuprolide acetate (LA), a synthetic agonist for the gonadotrophin-releasing hormone receptor, facilitates the recovery of urinary function in spinal cord injured male rats. MAIN METHODS: Male Wistar rats were randomized into spinal cord injury (SCI; n = 7), SCI with continuous administration of LA for two weeks via implantation of a subcutaneous osmotic pump (SCI + LA; n = 7), Sham SCI (SH-SCI; n = 6) or no surgery (Intact; n = 6) groups. Micturition, hind-limb nociception and locomotor behaviors were analyzed before and after surgical procedures on days 7, 14, 21 and 28. After behavioral studies, electromyography of the external urethral sphincter (EUS-EMG) and cystometric (CMG) studies were performed in all groups. KEY FINDINGS: SCI significantly decreased frequency of voids and CMG parameters (p < 0.001), abolished the bursting activity of the EUS during CMG, significantly increased hind limb sensory threshold and decreased locomotor performance in comparison to the other groups (p < 0.001). Continuous LA treatment significantly increased the frequency of voids and improved CMG parameters (p < 0.001), exhibiting bursting EUS activity during CMGs, and enhanced locomotor performance in comparison to SCI rats (p < 0.001). SIGNIFICANCE: SCI severely affected behavioral and functional micturition processes, including sensory and locomotor functions. Systemic and uninterrupted treatment with LA improves the recovery of micturition behavior and the synergistic function of the EUS. Furthermore, sensory and locomotor responses were also improved in SCI rats. This procedure may have a therapeutic potential to facilitate urinary function recovery in patients with SCI.

Re-emerging threat of Trypanosoma cruzi vector transmission in El Salvador, update from 2018 to 2020.

BACKGROUND: Since the late twentieth century, Chagas disease gained global attention to suppress the vector burden as a main control strategy in endemic countries. In Central America, multi-national initiative successfully achieved significant reduction in the estimated disease prevalence as well as elimination of the region's principal vector species at the time in 2012. While the last decade has witnessed significant changes in ecosystem-such as urbanization and replacement of the main vector species-that can possibly affect the vector's habitation and residual transmission, the up-to-date vector burden in the region has not been evaluated thoroughly due to the cessation of active vector surveillance. The aim of this study was to update the risk of vector-borne Trypanosoma cruzi infection in El Salvador, the top Chagas disease-endemic country in Central America. METHODS: A nationwide vector survey was conducted in the domestic environment of El Salvador from September 2018 to November 2020. The selection of the houses for inspection was based on expert purposeful sampling. Infection for T. cruzi was examined by microscopic observation of the insects' feces, followed by a species confirmation using PCR. The data were analyzed using R software version 4.1.3. Proportion estimates with 95% confidence intervals were inferred using the Jeffrey's method provided under the epiR package. RESULTS: A total of 1529 Triatoma dimidiata was captured from 107 houses (infestation rate, 34.4%; 107/311) in all the fourteen departments of the country visited within the period; prevalence of T. cruzi infection was as high as 10% (153/1529). In the country, domestic T. dimidiata infestation was distributed ubiquitously, while T. cruzi infection rates varied across the departments. Five out of fourteen departments showed higher infection rates than the average, suggesting sporadic high-risk areas in the country. CONCLUSIONS: Our comprehensive study revealed substantial T. cruzi infection of T. dimidiata across the country, indicating potential active transmission of the disease. Therefore, strengthened surveillance for both vector and human infection is required to truly eliminate the risk of T. cruzi transmission in Central America.

Abordaje transforaminal percutáneo para el diagnóstico y tratamiento de un caso de espondilodiscitis tuberculosa lumbar con absceso epidural / Percutaneous transforaminal approach for the diagnosis and treatment of a case of lumbar tuberculous spondylodiscitis with epidural abscess

RESUMEN La enfermedad de Pott o espondilodiscitis tuberculosa representa menos del 1% de los casos de tuberculosis. Sin embargo, el curso clínico indolente de esta enfermedad hace que su diagnóstico sea generalmente tardío, causando con ello la destrucción de las estructuras vertebrales. La deformidad resultante de la columna vertebral requiere tratamiento quirúrgico, el cual es complejo y requiere una estancia hospitalaria prolongada. Se describe el caso de un paciente varón de 52 años que fue diagnosticado de espondilodiscitis lumbar luego de la correspondiente evaluación clínica y estudios imagenológicos sin mostrar respuesta al tratamiento antibiótico empírico. Un abordaje transforaminal percutáneo, técnica mínimamente invasiva, permitió el diagnóstico de espondilodiscitis tuberculosa y la mejoría sintomática del paciente.

SUMMARY Pott's disease or tuberculous spondylodiscitis accounts for less than 1% of tuberculosis cases. However, the indolent clinical course of this condition leads to a generally delayed diagnosis and to the destruction of the vertebral structures. The resulting spinal deformity requires surgical treatment, which is complex and demands a prolonged hospital stay. In this report, we present the case of a 52-year-old male patient who was diagnosed with lumbar spondylodiscitis by clinical and imaging studies, without response to an empiric antibiotic treatment. Transforaminal percutaneous approach, a minimally invasive technique, allowed the diagnosis of tuberculous spondylodiscitis and a symptomatic improvement of the patient.

Tracheal stenosis as a complication of prolonged intubation in coronavirus disease 2019 (COVID-19) patients: a Peruvian cohort.

Background: Tracheal stenosis (TS) is associated with prolonged intubation and inflammation due to coronavirus disease 2019 (COVID-19) infection. Because of the COVID-19 pandemic, longer times of mechanical ventilation have been required, and different tracheostomies beyond 10 to 12 days have been made. All of these have increased the number of cases and complexity of tracheal pathology in patients with severe COVID-19 infection. Methods: A retrospective, chart review, from patients who were managed in the Service of Thoracic Surgery of Guillermo Almenara Irigoyen National Hospital, Lima, Peru, with a diagnosis of TS, tracheo-esophageal fistula and tracheomalacia between June 2020 until May 2021. Results: Sixty-three patients were diagnosed with TS because of prolonged intubation due to COVID-19 infection. Mean hospitalization time in the intensive care unit (ICU) was 30 days. Mean mechanical ventilation time was 25 days. The most frequent anatomical localization of TS was upper and middle third (55.6%), upper third (44.4%). Fifty-three patients (84.1%) had TS between 1-4 cm, and ten patients (15.9%) had TS longer than 4 cm. Most patients with TS were classified with Cotton-Myer grade III (88.9%). Conclusions: We report a retrospective study of 63 patients with a diagnosis of TS, in whom corrective surgery was performed: cervical tracheoplasty, Montgomery T tube, or tracheostomy.

Yeast as a biological platform for vitamin D production: A promising alternative to help reduce vitamin D deficiency in humans.

Vitamin D is an important human hormone, known primarily to be involved in the intestinal absorption of calcium and phosphate, but it is also involved in various nonskeletal processes (molecular, cellular, immune, and neuronal). One of the main health problems nowadays is the vitamin D deficiency of the human population due to lack of sun exposure, with estimates of one billion people worldwide with vitamin D deficiency, and the consequent need for clinical intervention (i.e., prescription of pharmacological vitamin D supplements). An alternative to reduce vitamin D deficiency is to produce good dietary sources of it, a scenario in which the yeast Saccharomyces cerevisiae seems to be a promising alternative. This review focuses on the potential use of yeast as a biological platform to produce vitamin D, summarizing both the biological aspects of vitamin D (synthesis, ecology and evolution, metabolism, and bioequivalence) and the work done to produce it in yeast (both for vitamin D2 and for vitamin D3 ), highlighting existing challenges and potential solutions.

Food Availability in Different Food Environments Surrounding Schools in a Vulnerable Urban Area of Santiago, Chile: Exploring Socioeconomic Determinants.

The analysis of the food environment is used to identify areas with gaps in the availability of healthy foods and can be used as a public policy assessment tool. In recent decades, Chile has implemented several strategies and regulations to improve food environments, with encouraging results. Little is known about the scope of these measures in socially vulnerable environments. This study is part of a project that seeks to build an integrated intervention model for healthy school environments in a vulnerable area of Santiago, Chile. The objective of this study was to evaluate the availability of healthy and unhealthy foods around schools and the relationship between it and socioeconomic determinants of the school community in the Chilean context. A cross-sectional study to measure the food environment of informal markets (street food), formal markets (stores), and institutions (schools) was conducted in and around 12 schools (100 m surrounding schools) in a vulnerable urban area of Santiago, Chile. A lack of healthy foods was observed, which was related to some socio-economic determinants and the multidimensional poverty was the most relevant. The diagnosis of food environments around schools can represent an important target for governments to implement policies focused at improving the availability of healthy foods.

Esquema de ayuno intermitente y reducción de medidas antropométricas, perfil lipídico, presión arterial y riesgo cardiovascular / Scheme of intermittent fasting and reduction of anthropometric measures, lipid profile, blood pressure and cardiovascular risk

Introducción: El estilo de vida juega un rol fundamental en el riesgo de enfermedades cardiovasculares y enfermedades crónicas. Objetivo: Evaluar el efecto del esquema de ayuno intermitente 16/8 frente a las medidas antropométricas, valores de perfil lipídico, presión arterial y riesgo cardiovascular. Método: Estudio analítico longitudinal con intervención. Quince pacientes tratados en el área de nutrición en un centro privado entre enero y octubre del 2020 sometidos al esquema de ayuno intermitente 16/8 por cuatro meses, buscando la reducción de medidas antropométricas, perfil lipídico, presión arterial y/o riesgo cardiovascular. Variables: peso corporal, índice de masa corporal (IMC), índice cintura ­ cadera (ICC), circunferencia abdominal, perfil lipídico, riesgo cardiovascular según Framingham (tabla de Framingham AMR B), índices colesterol total/HDL y LDL/HDL. Resultados: La edad promedio fue 47.1 años, la talla promedio fue 1.66 m., el peso corporal promedio fue 84.3 Kg., el promedio del IMC fue 30.46, el promedio del ICC fue 0.94, el promedio de la circunferencia abdominal fue 99.87, el promedio del colesterol total, HDL y LDL fue 240.06, 43.73 y 153.2 respectivamente, el promedio del riesgo cardiovascular según Framingham fue 0.11% y el promedio de los índices colesterol total/HDL y LDL/HDL fue 5.88 y 3.69. La evaluación de promedios antes y después encontró diferencias significativas (p < 0.05) a los 3 y 4 meses de evaluación. Conclusiones: El esquema de ayuno intermitente mostró reducción significativa de las medidas antropométricas, perfil lipídico y riesgo cardiovascular. Adicionalmente se observó aumento del HDL.

Introduction: Lifestyle is a fundamental role in the risk of cardiovascular diseases and chronic diseases. Objective: To evaluate the effect of the 16/8 intermittent fasting scheme against anthropometric measurements, lipid profile values, blood pressure ​​and cardiovascular risk. Method: Longitudinal analytical study with intervention. Fifteen patients treated in the nutrition area in a private center between January and October 2020 submitted to the 16/8 intermittent fasting scheme for four months, seeking to reduce anthropometric measurements, lipid profile, blood pressure and / or cardiovascular risk. Variables: body weight, body mass index (BMI), waist-hip index (WHI), abdominal circumference, lipid profile, cardiovascular risk according to Framingham (Framingham AMR B table), total cholesterol / HDL and LDL / HDL indices. Results: The average age was 47.1 years, the average height was 1.66 m., The average body weight was 84.3 Kg., The average of the BMI was 30.46, the average of the WHI was 0.94, the average of the abdominal circumference was 99.87, the mean total cholesterol, HDL and LDL were 240.06, 43.73 and 153.2 respectively, the mean cardiovascular risk according to Framingham was 0.11% and the mean total cholesterol / HDL and LDL / HDL indices were 5.88 and 3.69. The evaluation of averages before and after found significant differences (p <0.05) at 3 and 4 months of evaluation. Conclusions: The intermittent fasting scheme showed a significant reduction in anthropometric measurements, lipid profile and cardiovascular risk. Additionally, an increase in HDL was observed.

Time course for urethral neuromuscular reestablishment and its facilitated recovery by transcutaneous neuromodulation after simulated birth trauma in rats.

The aims of the study were to determine the time-course of urinary incontinence recovery after vaginal distension (VD), elucidate the mechanisms of injury from VD leading to external urethral sphincter (EUS) dysfunction, and assess if transcutaneous electrical stimulation (TENS) of the dorsal nerve of the clitoris facilitates recovery of urinary continence after VD. Rats underwent 4-h VD, 4-h sham VD (SH-VD), VD plus 1-h DNC TENS, and VD plus 1-h sham TENS (SH-TENS). TENS or SH-TENS were applied immediately and at days 2 and 4 post-VD. Micturition behavior, urethral histochemistry and histology, EUS and nerve electrophysiology, and cystometrograms were evaluated. VD induced urine leakage and significantly disrupted EUS fibers and nerve-conduction (VD vs SH-VD group; p < 0.01). Urine leakage disappeared 13 days post-VD (p < 0.001). Structural and functional recovery of EUS neuromuscular circuitry started by day 6 post-VD, but did not fully recover by day 11 post-VD (p > 0.05). TENS significantly decreased the frequency of urine leakage post-VD (days 5-7; p < 0.01). We conclude that rat urinary continence after VD requires 2 weeks to recover, although urethra structure is not fully recovered. TENS facilitated urinary continence recovery after VD. Additional studies are necessary to assess if TENS could be used in postpartum women.

Synthesis of New Chitosan from an Endemic Chilean Crayfish Exoskeleton (Parastacus Pugnax): Physicochemical and Biological Properties.

Chitin is one of the most abundant natural polysaccharides in the world and it is mainly used to produce chitosan by a deacetylation process. In the present study, the extraction of chitin and chitosan from the Parastacus pugnax (P. pugnax) crayfish exoskeleton was studied for the first time. Thus, the P. pugnax crayfish exoskeleton was converted to chitosan following the steps of depigmentation, deproteinization, and deacetylation. The produced chitosan (Chitosan-CGNA) was characterized in terms of the protein content, solubility, degree of deacetylation, viscosity, molecular weight, FTIR, SEM, XRD, antimicrobial, and antioxidant activity. The results showed that the obtained chitosan had a high degree of deacetylation (91.55%) and a medium molecular weight (589.43 kDa). The antibacterial activity of the chitosan was tested against bacterial strains relevant for the food industry and the lowest minimum inhibitory concentration (MIC) values were evidenced with Salmonella tiphymurium (S. typhimurium), Staphylococcus aureus (S. aureus), Enterococcus faecalis (E. faecalis) and Listeria. Monocytogenes (L. monocytogenes). Moreover, the Chitosan-CGNA showed an effect on DPPH radical scavenging activity, and its antioxidant activity was dependent on concentration and deacetylation degree. These results suggest that P. pugnax exoskeleton could be an excellent natural source for the production of chitosan with potential applications in the health system, and to prevent infections associated with pathogens strains.

Craniectomía descompresiva como tratamiento primario de la hipertensión intracraneal por traumatismo encefalocraneano: Experiencia observacional en 24 pacientes

Introducción: el traumatismo encéfalo craneano es una de las principales causas de muerte en nuestro medio, El tratamiento médico y quirúrgico en la etapa inicial de un TEC severo se enfoca en evitar la elevación de la Presión Intracraneana. Objetivo : describir características asociados y sus principales complicaciones en aquellos pacientes sometidos a Craniectomía Descompresiva. Métodos : Estudio retrospectivo observacional descriptivo, realizado entre febrero de 2018 a julio de 2020 de pacientes operados de Craniectomía Descompresiva unilateral, admitidos por traumatismo encefalocraneano. Resultados : 66.7% fueron personas menores de 40 años; 87,5% fueron de sexo masculino; 16,7% de la población ingresaron con una ECG de 13-15, 37,5% de la población con una ECG de 9-12; 42.9% presentaron asimetría pupilar; 33,3% ingresaron por accidente de tránsito; 21,7% fueron Marshall II, 65,2% Marshall III y en 13,0% se halló un Marshall IV. Conclusiones : Los resultados sugieren que las características asociadas a la Craniectomía Descompresiva por TEC contribuyen en el manejo de esta patología.

Introduction: Head trauma is one of the main causes of death in Peru. Medical and surgical therapy during the initial stages of severe head trauma focus in preventing the elevation of intracranial pressure. Objective: To describe the associated characteristics and main complications in patients undergoing decompressive craniectomy. Methods: This is a retrospective observational study performed between February 2018 and July 2020 in patients who had been admitted because of head trauma and who had undergone unilateral decompressive craniectomy. Results: Two-thirds (66.7%) of patients were persons less than 40 years of age; 87.5% were males; 16.7% were admitted with Glasgow Coma Score (GCS) scores between 13 and 15; 37.5% were admitted with GCS between 9 and 12; 42.9% had asymmetric pupils; 33.3% were admitted because of traffic accidents; 21.7% were Marshall II, 65.2% were Marshall III, and 13.0% were Marshall IV. Conclusions: Our results suggest that characteristics associated to decompressive craniectomy because of head trauma contribute for its proper management.

Elevated Pediatric Chagas Disease Burden Complicated by Concomitant Intestinal Parasites and Malnutrition in El Salvador.

The eradication of the vector Rhodnius prolixus from Central America was heralded as a victory for controlling transmission of Trypanosoma cruzi, the parasite that causes Chagas disease. While public health officials believed this milestone achievement would effectively eliminate Chagas disease, case reports of acute vector transmission began amassing within a few years. This investigation employed a cross-sectional serosurvey of children either presenting with fever for clinical care or children living in homes with known triatomine presence in the state of Sonsonate, El Salvador. Over the 2018 calendar year, a 2.3% Chagas disease seroprevalence among children with hotspot clustering in Nahuizalco was identified. Positive serology was significantly associated with dogs in the home, older participant age, and a higher number of children in the home by multivariate regression. Concomitant intestinal parasitic infection was noted in a subset of studied children; 60% having at least one intestinal parasite and 15% having two or more concomitant infections. Concomitant parasitic infection was statistically associated with an overall higher parasitic load detected in stool by qPCR. Lastly, a four-fold higher burden of stunting was identified in the cohort compared to the national average, with four-fifths of mothers reporting severe food insecurity. This study highlights that polyparasitism is common, and a systems-based approach is warranted when treating Chagas disease seropositive children.

Giant benign teratoma occupying the left hemithorax with pleural effusion: a rare presentation.

Mature teratomas are the third most common mediastinal tumors. Giant teratoma in pediatric population is rare. A resection of giant benign teratoma in left hemithorax was performed in a 4-year-old patient. The computed tomography scan showed the presence of a large multiloculated mediastinal mass extending to the left pleural space and pleural effusion. The patient underwent total resection of the mediastinal mass via a median sternotomy associated to left anterior thoracotomy. Entry into the pleural space was performed through the sixth intercostal space to obtain safe visualization of the cavity and proceed to tumor excision. The collapsed left lung was re-expanded, and the patient was extubated. Despite the size and the surrounding structures of the teratoma, our preoperative preparation and surgical technique were effective and resulted in favorable recovery without complications and a posterior normal left lung function.