Characteristics and outcomes of multisystem inflammatory syndrome in children: A multicenter, retrospective, observational cohort study in Mexico.

Introduction: Multisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death. Methods: This multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression. Results: The study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4-2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8-31.0), platelet count <150,000 /mm3 (OR: 4.2, 95% CI: 1.2-14.7), international normalized ratio >1.2 (OR: 3.8, 95% CI: 1.05-13.9), and serum ferritin concentration >1,500 mg/dl at admission (OR: 52, 95% CI: 5.9-463) were risk factors for death. Discussion: Mortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases.

Vías de acceso para la infiltración de viscosuplementación en rodillas de pacientes con gonartrosis grado II-III / Access routes for infiltration of viscosuplementation in the knees of patients with grade II-III gonartrosis

Introducción: La infiltración de la rodilla es una labor cotidiana en la consulta ortopédica. Para alcanzar el mayor potencial terapéutico en la infiltración articular, es necesario inyectar directamente en el espacio articular y no en estructuras adyacentes. Objetivo: Determinar la exactitud y eficacia de los diferentes puntos de infiltración de la rodilla en pacientes con gonartrosis grado II ­ III, considerando los portales de abordaje anterolateral (AL), anteromedial (AM), suprapatelar lateral (SPL), medio patelar lateral (MPL), medio patelar medial (MPM) y trans tendón (TT). Métodos: Estudio descriptivo y transversal. Se infiltraron 123 rodillas bajo control fluroscópico en las diferentes vías de acceso, teniendo como variables el sexo, artrografía positiva al primer intento, grado de dolor que presentan los pacientes durante la prueba así como complicaciones y efectos secundarios. Resultados: Se usó MPL en 20 rodillas teniendo una artrografía positiva en el 40%, 17 SPL con 70,5%, 20 MPM con 90%, 21 AL rodillas con 61,3%, 26 AM con 69,9%, 19 TT con 78,9%. Conclusión: El portal de abordaje MPM proporciona una mayor eficacia en comparación de los otros portales utilizados en este estudio. Siendo mayor el porcentaje de artrografías positivas en el primer intento de punción.

Introduction: Knee joint injection is a daily procedure in orthopedic outpatient visit. In order to obtain the maximum therapeutic benefit, it is necessary to perform the injection directly into the articular space and not into the adjacent structures. Objective: To establish the accuracy of the injection site into the knee joint in patients with grade II-III gonarthrosis. The portal approaches taken into consideration in this study were: Anterolateral (AL), Anteromedial (AM), Lateral Suprapatellar (LSP), Lateral mid-patellar (LMP), Medial mid-patellar (MMP) and Transtendinous (TT). Methods: A cross-sectional and descriptive study was conducted. A total of 123 knee joints were injected under fluoroscopy through the different approach portals. Variables: gender, positive arthrography at the first attempt, level of pain in patients during the procedure, as well as complications and side effects. Results: Lateral mid-patellar (LMP) approach was used on 20 knee joints with a 40% positive arthrography, 17 through LSP with 70.5%, 20 MMP with 90%, 21 AL with 61.3%, 26 M with 69.9%, 19 TT with 78.9% Conclusion: The medial mid-patellar approach portal provides the greatest effectiveness in comparison to the other portals used on this study. Additionally, a greater percentage of positive arthrography was achieved at the first attempt.

Evolución clínica de trabajadores con fractura de radio distal Fernández III. Tratamiento no complicado quirúrgico y no quirúrgico.

ANTECEDENTES: Las fracturas de radio distal Fernández III (FRDF III) son una urgencia muy frecuente. Las indicaciones quirúrgicas y no quirúrgicas persisten controversiales, así como el impacto funcional. OBJETIVO: Comparar la evolución clínica de los trabajadores con FRDF III, con manejo quirúrgico frente a no quirúrgico, no complicados, en un hospital especializado. MÉTODO: Estudio comparativo, observacional y longitudinal en trabajadores con FRDF III unilateral cerrada, de ambos sexos, con evolución menor de 5 días. Se excluyeron pacientes con comorbilidad afectante de consolidación ósea y polifracturados. Se eliminaron aquellos con información incompleta, con complicaciones, con aparato de yeso modificado 5 días después de su colocación, con mala reducción-estabilización acorde a la AO. Se aplicó la Escala Funcional de Mayo para Muñeca (EFMM) a los 3 y 6 meses del tratamiento. Se utilizó la prueba t de Student. RESULTADOS: 159 pacientes, 34% mujeres, 66% hombres. Edad promedio 40.18 años. Manejo quirúrgico 42,5% (placa 8.7%, fijador 29%, fijador + clavillo 8.7%); no quirúrgico 33%. Diferencias significativas (p ≤ 0.05): EFMM 3 y 6 meses; a 3 meses: dolor, prensión; a 6 meses: movilidad; y días totales de incapacidad. CONCLUSIONES: El tratamiento quirúrgico muestra mejores resultados funcionales, destacando el dolor y la prensión a 3 meses, y la movilidad a 6 meses, con reincorporación laboral en menos tiempo. BACKGROUND: This fracture is a very frequent emergency. Surgical and non-surgical management are still controversial, such as functional impact. OBJECTIVE: To compare clinical evolution of Fernandez III distal radius fractures, managed with surgically vs no surgical treatment, in a specialized hospital. METHOD: Comparative, observational, longitudinal study, released on workers with unilateral Fernandez III closed distal radius fractures, both sex, with evolution less than 5 days. Those patients with pathologies getting difficult in bone consolidation, and with several fractures were excluded. Those with incomplete information, complicated, and whom paste were modified after 5 days, and with bad reduction or stabilization fracture according AO were eliminated. Mayo Functional Wrist Scale (EFMM) was applied at 3 and 6 months. Student-t test was applied. RESULTS: 159 patients recruited, 34% females, 66% males. Medium age 40 years old. Surgical treatment 42.5% (plaque 8.7%, external fixation 29%, external fixation and nails 8.7%). Non-surgical treatment 33%. Significative differences (p≤0.05): EFMM at 3 and 6 months; pain, grasp at 3 months; mobility at 6 months; total laboral inhability days. CONCLUSIONS: Surgical treatment shows better functional results, specially pain and grasp at 3 months, mobility at 6 months, and faster returning to work.

Geminivirus Replication Protein Impairs SUMO Conjugation of Proliferating Cellular Nuclear Antigen at Two Acceptor Sites.

Geminiviruses are DNA viruses that replicate in nuclei of infected plant cells using the plant DNA replication machinery, including PCNA (proliferating cellular nuclear antigen), a cofactor that orchestrates genome duplication and maintenance by recruiting crucial players to replication forks. These viruses encode a multifunctional protein, Rep, which is essential for viral replication, induces the accumulation of the host replication machinery, and interacts with several host proteins, including PCNA and the SUMO E2 conjugation enzyme (SCE1). Posttranslational modification of PCNA by ubiquitin or SUMO plays an essential role in the switching of PCNA between interacting partners during DNA metabolism processes (e.g., replication, recombination, and repair, etc.). In yeast, PCNA sumoylation has been associated with DNA repair involving homologous recombination (HR). Previously, we reported that ectopic Rep expression results in very specific changes in the sumoylation pattern of plant cells. In this work, we show, using a reconstituted sumoylation system in Escherichia coli, that tomato PCNA is sumoylated at two residues, K254 and K164, and that coexpression of the geminivirus protein Rep suppresses sumoylation at these lysines. Finally, we confirm that PCNA is sumoylated in planta and that Rep also interferes with PCNA sumoylation in plant cells.IMPORTANCE SUMO adducts have a key role in regulating the activity of animal and yeast PCNA on DNA repair and replication. Our work demonstrates for the first time that sumoylation of plant PCNA occurs in plant cells and that a plant virus interferes with this modification. This work marks the importance of sumoylation in allowing viral infection and replication in plants. Moreover, it constitutes a prime example of how viral proteins interfere with posttranslational modifications of selected host factors to create a proper environment for infection.

Resultados del seguimiento a seis meses del manejo del pie equino varo aducto congenito con el metodo Ponseti

Clasificacion de Dimeglio

Mpg2 interacts and cooperates with Mpg1 to maintain yeast glycosylation.

Using a yeast two-hybrid screen, we isolated a gene from Schizosaccharomyces pombe, whose product interacts with Mpg1, a GDP-mannose-1-phosphate guanylyltransferase involved in the maintenance of cell wall integrity and glycosylation. We have designated this gene mpg2 based on its similarity to Mpg1. Mpg2 is evolutionarily conserved in higher eukaryotes. In the absence of Mpg2, defects in cell growth and sensitivity to hygromycin B are observed. When mpg1 is depleted, the lack of mpg2 causes a synthetic enhancement of the growth defect, the sensitivity to hygromycin B and the cell cycle phenotype previously reported for mpg1 mutant. Finally, Mpg1 overexpression complements the Δmpg2 mutant phenotypes. Taken together, these results indicate that mpg1 and mpg2 function together in glycosylation and septum formation.

Interaction between geminivirus replication protein and the SUMO-conjugating enzyme is required for viral infection.

Geminiviruses are small DNA viruses that replicate in nuclei of infected plant cells by using plant DNA polymerases. These viruses encode a protein designated AL1, Rep, or AC1 that is essential for viral replication. AL1 is an oligomeric protein that binds to double-stranded DNA, catalyzes the cleavage and ligation of single-stranded DNA, and induces the accumulation of host replication machinery. It also interacts with several host proteins, including the cell cycle regulator retinoblastoma-related protein (RBR), the DNA replication protein PCNA (proliferating cellular nuclear antigen), and the sumoylation enzyme that conjugates SUMO to target proteins (SUMO-conjugating enzyme [SCE1]). The SCE1-binding motif was mapped by deletion to a region encompassing AL1 amino acids 85 to 114. Alanine mutagenesis of lysine residues in the binding region either reduced or eliminated the interaction with SCE1, but no defects were observed for other AL1 functions, such as oligomerization, DNA binding, DNA cleavage, and interaction with AL3 or RBR. The lysine mutations reduced or abolished virus infectivity in plants and viral DNA accumulation in transient-replication assays, suggesting that the AL1-SCE1 interaction is required for viral DNA replication. Ectopic AL1 expression did not result in broad changes in the sumoylation pattern of plant cells, but specific changes were detected, indicating that AL1 modifies the sumoylation state of selected host proteins. These results established the importance of AL1-SCE1 interactions during geminivirus infection of plants and suggested that AL1 alters the sumoylation of selected host factors to create an environment suitable for viral infection.