Effectiveness and Safety of Cannabinoids as an Add-On Therapy in the Treatment of Resistant Spasticity in Multiple Sclerosis: A Systematic Review.

Background: Spasticity continues to be a very prevalent, highly invalidating, and difficult-to-manage symptom in patients with multiple sclerosis (MS). The aim of this systematic review is to evaluate the effectiveness of the use of cannabis and cannabinoids in these patients, evaluating its use as an additional therapy. Methods: We performed a systematic review of the literature searching in the major scientific databases (PubMed, Scopus, EMBASE, WOS, and Cochrane Library) for articles from January 2017 to May 2022 containing information about the effectiveness of cannabis and cannabinoids in patients with insufficient response to first-line oral antispastic treatment. Results: A total of five medium high-quality articles were selected to be part of the study and all evaluated the effectiveness of the tetrahydrocannabinol (THC) and cannabidiol (CBD) spray. The effectiveness of this drug and the significant improvements are produced on the patient-related spasticity assessment scales, obtaining improvement up to 45%; and on quality of life, producing a decrease in the appearance of symptoms related to spasticity, as well as an increase in the development of basic activities of daily living. The average dose is 5-7 sprays/day. The discontinuation rate for these treatments is around 40% due to lack of effectiveness and adverse events. All reported adverse effects are mild to moderate in severity and their incidence is ∼17%, although this figure tends to decrease with drug use. Conclusions: Adding the THC:CBD sprays have been shown to be more effective in treating MS spasticity than optimizing the dose of first-line antispastic drugs in selected responders patients. The safety and tolerability profiles remain in line with those obtained in other trials. More patients would benefit from treatment if the initial response search period was extended.

Síndrome inflamatorio multisistémico post-COVID en niños: reporte de casos en Montevideo, Uruguay, 2020-2021 / Multsystemic inflammatory syndrome in post-Covid children: clinical case studies in Montevideo, Uruguay, 2020-2021 / Sindrome inflamatório multisistêmico pós-COVID em crianças: relato de casos em Montevdéu, Uruguai, 2020-2021

El síndrome inflamatorio multisistémico asociado a COVID-19 es una presentación postinfecciosa, que puede ser particularmente grave, pudiendo producir una severa disfunción multiorgánica. Se presenta una serie de 6 casos clínicos, asistidos en Servicio Médico Integral, Montevideo-Uruguay, con el fin de exponer las características clínicas y paraclínicas de este nuevo síndrome, y la evolución clínica de los mismos. Se realiza un estudio observacional descriptivo. La edad media fue de 6 años, con predominio en sexo femenino. Estos pacientes tuvieron una presentación clínica leve a moderada, con buena evolución Las manifestaciones clínicas principales fueron: fiebre, compromiso gastrointestinal, mucocutáneo y afectación ocular; dos de estos pacientes presentaron compromiso cardiovascular. Todos tuvieron alteraciones en la paraclínica, destacándose reactantes de fase aguda elevados. Todos los pacientes recibieron inmunoglobulina intravenosa y corticoides, tres de ellos recibieron heparina de bajo peso molecular por valor de D-dímeros 5 veces por encima del valor de referencia. No descartamos el impacto del diagnóstico y tratamiento precoz en la buena evolución de estos niños.

The Multisystem Inflammatory Syndrome associated with COVID-19 is a postinfectious presentation, which can be particularly serious, and can produce severe multiorgan dysfunction. A report of 6 clinical cases, assisted in the Comprehensive Medical Service, Montevideo-Uruguay, is presented in order to expose the clinical and paraclinical characteristics of this new syndrome, and their clinical evolution. A descriptive observational study was carried out. The mean age was 6 years, with a predominance of females. These patients had a mild to moderate clinical presentation, with good evolution. The main clinical manifestations were: fever, gastrointestinal and mucocutaneous involvement, and ocular involvement; two of these patients had cardiovascular compromise. All had alterations in the paraclinical, standing out elevated acute phase reactants. All patients received intravenous immunoglobulin and corticosteroids, three of them received low molecular weight heparin with a value of D-dimers 5 times higher than the reference value. We do not rule out the impact of early diagnosis and treatment on the positive evolution of these children.

A Síndrome Inflamatória Multissistêmica associada à COVID-19 é uma apresentação pósinfecciosa, que pode ser particularmente grave e produzir disfunção grave de múltiplos órgãos. Apresentamos um relato de 6 casos clínicos, atendidos no Serviço Médico Integral, Montevidéu-Uruguai, com o objetivo de expor as características clínicas e para clínicas desta nova síndrome, e sua evolução clínica. Tratase de um estudo observacional descritivo. A média de idade foi de 6 anos, com predomínio do sexo feminino. Esses pacientes tinham apresentação clínica leve a moderada, com boa evolução. As principais manifestações clínicas foram: febre, envolvimento gastrointestinal, muco cutâneo e ocular; dois desses pacientes apresentaram comprometimento cardiovascular. Todos apresentavam alterações para clínicas, destacandose elevados reagentes na fase aguda. Todos os pacientes receberam imunoglobulina e corticosteroides endovenosos, três deles receberam heparina de baixo peso molecular com valor do dímero D 5 vezes acima do valor de referência. Não descartamos o impacto do diagnóstico e tratamento precoces na evolução positiva dessas crianças.

Research on aging during the Venezuelan humanitarian crisis: the experience of the Maracaibo aging study.

BACKGROUND: Venezuela is in the throes of a complex humanitarian crisis that is one of the worst in decades to impact any country outside of wartime. This case analysis describes the challenges faced by the ongoing Maracaibo Aging Study (MAS) during the deteriorating conditions in Venezuela. When the MAS began in 1997, it focused on memory-related disorders. Since then, strategic planning and proactive community participation allowed us to anticipate and address logistical, funding, and ethical challenges, and facilitated the enrollment and retention of more than 2500 subjects over 55 years of age. All participants, who are residents of the city of Maracaibo, Venezuela, underwent various assessments on several occasions. Here, we discuss how our approach to implementing a longitudinal, population-based study of age-related conditions has allowed our research program to continue throughout this period of political, economic, and social upheaval. DISCUSSION: As the social context in Venezuela became more complicated, new challenges emerged, and strategies to sustain the study and participation were refined. We identified five main mechanisms through which the evolving humanitarian crisis has affected implementation of the MAS: 1) community dynamics; 2) morale of researchers, staff, and participants; 3) financial feasibility; 4) components of the research process; and 5) impact on the health of staff, participants, and their families. Strategies to compensate for the impact on these components were implemented, based on inputs from community members and staff. Improved communication, greater involvement of stakeholders, broadening the scope of the project, and strengthening international collaboration have been the most useful strategies. Particular demands emerged, related to the increased mortality and comorbidities of participants and staff, and deterioration of basic services and safety. CONCLUSION: Although the MAS has faced numerous obstacles, it has been possible to continue a longitudinal research project throughout the humanitarian crisis, because our research team has engaged the community deeply and developed a sense of mutual commitment, and also because our project has provided funding to help keep researchers employed, somewhat attenuating the brain drain.

Microscopic examination after concentration techniques for Blastocystis sp. detection in serial faecal samples: How many samples are needed?

OBJECTIVE: Blastocystis sp. is one of the most frequently observed intestinal parasites in humans. It is suggested that sensitivity of classical parasitological tests for the Blastocystis sp. diagnosis increases when increasing the number of investigated samples, although there is a lack of information. The aim of the study is to evaluate the sensitivity of classical parasitological tests for the Blastocystis sp. diagnosis depending on the number of investigated samples and to determine risk factors associated to high parasite burden. METHODS: Retrospective study where patients in whom three consecutive stool samples were examined for parasitic diagnosis through microscopic examination at Vall d'Hebron University Hospital (Barcelona, Spain) from January to April 2019 were included. To determine risk factors associated to high parasite burden, a case-control study was performed including patients with at least one positive stool sample for Blastocystis sp.: cases were those patients with only one or two positive stool samples, and controls were those with all three stool positive samples). Clinical records were reviewed from included patients to collect clinical and demographic information. RESULTS: In 2771 patients three consecutive stool samples were examined for parasitic diagnosis, with an overall prevalence of Blastocystis sp. detection of 23.3%. The proportions of positive cases depending on the number of investigated samples were: 22.3% when taking into account the first sample, 22.9% when taking into account the first and second samples, and 23.3% when taking into account the three samples, with no statistically significant differences among them. For the case-control study we finally included 63 cases and 133 controls. No differences were found regarding clinical and demographic characteristics among groups. CONCLUSION: Prevalence of Blastocystis sp. infection was high in our study (23.3%). The sensitivity of classical parasitological methods for Blastocystis sp. diagnosis did not increase when increasing the number of investigated samples, and no risk factors associated to high parasite burden were identified.

Evaluation of risk factors associated to detection of Blastocystis sp. in fecal samples in population from Barcelona, Spain: a case-control study.

Blastocystis sp. is the most common intestinal parasite isolated in humans. The aim of the study was to describe the risk factors associated to Blastocystis sp. detection. A case-control retrospective study was carried out at Vall d'Hebron University Hospital (Barcelona, Spain), which receives all fecal samples collected in Barcelona at primary care level. Eligible patients were patients older than 18 years in whom three consecutive stool samples were examined for parasitic diagnosis from January to December 2017. Positive patients for Blastocystis sp. were assigned as cases whereas negative patients were assigned as controls. Overall, 4174 patients were eligible for the study, from whom 724 (17.3%) had Blastocystis sp. detection. From these, 170 cases (Blastocystis sp. positive) and 170 controls (Blastocystis sp. negative) were randomly selected for inclusion. One hundred and twenty-six (37.1%) of them were immigrants, and 171 (50.3%) patients had traveled out of Spain the year before. The majority of individuals had jobs with no direct contact with other people (health personnel, teachers, and caregivers) (85.6%), and 29.4% were in usual contact with animals. Regarding clinical information, 68.2% of patients presented digestive symptoms, 3.5% presented an immunosuppressant condition, and 6.5% were infected by other intestinal parasites. Variables associated to Blastocystis sp. detection were being born in Africa, having traveled abroad, and working in direct contact with other people. Having other intestinal parasitic infections had a protective value. Our study provides new insights into the epidemiology of Blastocystis sp. in industrialized countries.

Colonic anastomosis and colonic polyp mucosal metastasis of signet ring cell gastric adenocarcinoma.

The mucosal metastasis of adenocarcinomas located in colonic mucosa is not infrequent. We present a clinical report of a patient diagnosed with a gastric multifocal signet ring cell adenocarcinoma without any evidence of visceral dissemination with the exception of mucosal infiltration of signet ring cell adenocarcinoma in a colonic polyp and in the mucosa of previous colonic anastomosis. The histopathological study of suspect lesions in the colonic mucosa is necessary to correctly approach the treatment of these patients.

Atresia pulmonar con septum interventricular intacto: presentación de un caso diagnosticado por ecocardiografía fetal / Pulmonary atresia with intact ventricular septum: case report with diagnosis by fetal echocardiography

La atresia pulmonar con Septum Interventricular Intacto (APSI) es una malformación cardíaca congénita rara que involucra el ventrículo derecho (VD) y en la cual no se establece comunicación a través de la válvula pulmonar. El objetivo de este trabajo es reportar el diagnóstico prenatal de un feto con APSI y ventrículo derecho pequeño o Tipo I de Greenwold. El caso fue referido para estudio prenatal por la muerte de uno de los fetos, realizándose en el otro, el diagnóstico de APSI por ecocardiografía fetal y confirmándose su hallazgo por anatomía patológica. Discutimos la utilidad diagnóstica del estudio ecocardiográfico en el feto con CC y revisamos las diferentes opciones terapéuticas quirúrgicas en este tipo de patología

Feto acárdico amorfo o teratoma placentario? / Amorphous acardius fetus or placental teratoma

Se presenta un caso en el cual se plantea el diagnóstico diferencial entre feto acárdico amorfo y teratoma placentario. La sonografía prenatal diagnóstico embarazo gemelar con muerte de un feto. Los hallazgos de patología mostraron una masa paraplacentaria cubierta de piel, en cuyo interior había varios tipos de tejidos sin organización, a excepción de la colocación longitudinal de elementos cartilaginosos, a modo de columna rudimentaria. Esto último indica el diagnóstico de feto amorfo, pero, no había cordón umbilical, lo que, para algunos, es esencial en la diferenciación con el tumor placentario

Leiomioma vaginal: comunicación de un caso / Vaginal leiomyoma: report of a case

El fibroma vaginal es una neoplasia benigna poco frecuente. Puede aparecer en cualquier parte de la vagina pero especialmente en el tercio superior de la pared anterior; su consistencia puede ser desde sólida hasta quística. Puede ser asintomaticos o causar dolor o síntomas urinarios. Se presenta un caso de una paciente de 27 años que consultó por dispareunia y presentaba una tumoración quística en la pared anterior de vagina. Se practicó enunciación de la tumoración; el estudio anatomo-patológico diagnóstico un leiomioma vaginal. Se reporta el caso lo poco frecuente de la patología. Se revisa bibliografía nacional