Endoscopic Ultrasound-Guided Tissue Acquisition Versus Fine Needle Aspiration for Diagnosis of Pancreatic Ductal Adenocarcinoma.

OBJECTIVES: Compare the 22G needle versus EchoTip ProCore® 20 (Cook Medical, Bloomington, IN, USA) on their handling, specimen suitability, amount of tissue obtained, diagnostic performance, the possibility of immunohistochemistry, and rate of adverse events. MATERIALS AND METHODS: This is a retrospective, comparative study of consecutively examined patients with pancreatic masses who underwent endosonography-guided fine needle aspiration (FNA) via the 22G needle, and endosonography-guided tissue acquisition (TA) via ProCore 20 (PC20). The operator evaluated needle insertion and subjectively classified the specimen. The pathologist measured the samples, classified the amount of tissue, and determined the influence of bleeding on the interpretation. RESULTS: A total of 129 patients participated in the study, out of whom 52 underwent endosonography-guided FNA with 22G and 77 underwent endosonography-guided TA with a PC20 needle. Malignant lesions were found in 106, and 23 had benign lesions. The duodenal route was used in 62% of patients. The 22G needle was easier to introduce (p=0.0495). However, PC20 obtained a larger amount (p<0.01) with fewer punctures (p<0.001). The PC20 also yielded a larger average microcore diameter (p=0.0032). Microhistology was adequate for 22G and PC20 in 22 (42.2%) and 50 (78.1%) specimens, respectively (p<0.001). Bleeding was not significantly different (p>0.999). Immunohistochemistry was possible in 36 (69.2%) and 40 (51.9%) specimens obtained by 22G and PC20, respectively (p=0.075). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 22G were 93.5%, 100%, 100%, 66.7%, and 94.2%, respectively; and for PC20, it was 95%, 100%, 100%, 85%, and 96.1%, respectively. Mild bleeding was the most common early adverse event, occurring in 2/52 (3.8%) 22G and 4/77 (5.2%) PC20 cases (p>0.05). CONCLUSIONS: The PC20 required fewer punctures and reduced the need for immunohistochemistry as it yielded better and larger microcores. Its ease of insertion into the target lesion makes it a good option to obtain satisfactory microcore specimens in difficult positions, such as the transduodenal route.

Acute phase characteristics and long-term complications of pulmonary embolism in COVID-19 compared to non-COVID-19 cohort: a large single-centre study.

BACKGROUND: To compare the severity of pulmonary embolism (PE) and the long-term complications between patients with and without COVID-19, and to investigate whether the tools for risk stratification of death are valid in this population. METHODS: We retrospectively included hospitalized patients with PE from 1 January 2016 to 31 December 2022. Comparisons for acute episode characteristics, risk stratification of the PE, outcomes, and long-term complications were made between COVID and non-COVID patients. RESULTS: We analyzed 116 (27.5%) COVID patients and 305 (72.4%) non-COVID patients. In patients with COVID-19, the traditional risk factors for PE were absent, and the incidence of deep vein thrombosis was lower. COVID patients showed significantly higher lymphocyte count, lactate dehydrogenase, lactic acid, and D-dimer levels. COVID patients had PE of smaller size (12.3% vs. 25.5% main pulmonary artery, 29.8% vs. 37.1% lobar, 44.7% vs. 29.5% segmental and 13.2% vs. 7.9% subsegmental, respectively; p < 0.001), less right ventricular dysfunction (7.7% vs. 17.7%; p = 0.007) and higher sPESI score (1.66 vs. 1.11; p < 0.001). The need for mechanical ventilation was significantly higher in COVID patients (8.6% vs. 1.3%; p < 0.001); However, the in-hospital death was less (5.2% vs. 10.8%; p = 0.074). The incidence of long-term complications was lower in COVID cohort (p < 0.001). PE severity assessed by high sPESI and intermediate and high-risk categories were independently associated with in-hospital mortality in COVID patients. CONCLUSION: The risk of in-hospital mortality and the incidence of long-term complications were lower in COVID-19. The usual tools for risk stratification of PE are valid in COVID patients.

Increases in Future AR Count and Size: Overview of the ARTMIP Tier 2 CMIP5/6 Experiment.

The Atmospheric River (AR) Tracking Method Intercomparison Project (ARTMIP) is a community effort to systematically assess how the uncertainties from AR detectors (ARDTs) impact our scientific understanding of ARs. This study describes the ARTMIP Tier 2 experimental design and initial results using the Coupled Model Intercomparison Project (CMIP) Phases 5 and 6 multi-model ensembles. We show that AR statistics from a given ARDT in CMIP5/6 historical simulations compare remarkably well with the MERRA-2 reanalysis. In CMIP5/6 future simulations, most ARDTs project a global increase in AR frequency, counts, and sizes, especially along the western coastlines of the Pacific and Atlantic oceans. We find that the choice of ARDT is the dominant contributor to the uncertainty in projected AR frequency when compared with model choice. These results imply that new projects investigating future changes in ARs should explicitly consider ARDT uncertainty as a core part of the experimental design.

Perfil antropométrico de la selección madrileña (España) de fútbol femenino SUB-16 y SUB-18 / Anthropometric Profile of the Madrid Women's Soccer Team U-16 and U-18

Durante la temporada 2017-2018 y siguiendo el protocolo de la Sociedad Internacional para el Avance de la Cineantropometría, se evaluó la composición corporal el somatotipo y proporcionalidad de 25 jugadoras españolas de elite de 15-18 años (15,48 ± 1,05). El porcentaje de grasa corporal (%GC) analizado por antropometría estuvo en un rango de 14,21% - 17,30 % y mediante BIA entre 24,20%-29,63%. La menor adiposidad correspondió a jugadoras de banda y la mayor a porteras y delanteras. El somatotipo medio fue 3,67-4,10-1,90 para el conjunto de la muestra; En la categoría sub-18 (3,10-4,33-1,82) la dispersión somatotípica fue menor y la mesomorfia mayor que en la categoría Sub 16 (3,20-3,97-1,95). En análisis de proporcionalidad, mostro que las jugadoras, sobre todo las Sub18, presentan menores pliegues subcutáneos y mayores perímetros en la extremidad inferior que el modelo Phantom. (AU)

During the 2017-2018 season and following the protocol of the International Society for the Advancement of Kineanthropometry, the body composition, somatotype and proportionality of 25 female elite Spanish soccers players aged 15-18 were evaluated (15.48 ± 1.05). The percentage of body fat (%BF) analyzed by anthropometry was in the range of 14.21% - 17.30% and by BIA between 24.20%- 29.63%. The lowest adiposity corresponded to female wing players and the highest to female goalkeepers and strikers. The average somatotype was 3.67-4.10-1.90 for the whole sample; in the under 18 years category (3.10-4.33-1.82) the somatotypic dispersion was lower and the mesomorphia higher than in the under 16 years category (3.20-3.97-1.95). In proportionality analysis, it showed that the players, especially the under 18 players, had lower subcutaneous skinfolds and higher perimeters in the lower limb than the Phanton model. (AU)

Asociación entre desnutrición crónica y distensión abdominal en preescolares de Mizantéferi, sur-oeste de Etiopía / Association between chronic malnutrition and abdominal distension in prescholars of Mizantéferi, south-west Ethiopia

INTRODUCCIÓN: La desnutrición crónica es un problema de salud pública que afecta a 155 millones de menores de 5 años en el mundo. Un niño desnutrido es más susceptible a infecciones como las parasitarias intestinales causadas por helmintos y protozoos. Estas enfermedades dañan el estado de salud, contribuyendo al círculo vicioso entre desnutrición e infección. OBJETIVOS: El propósito de este estudio fue analizar la relación de la distensión abdominal y el retraso en el crecimiento. MÉTODOS: La muestra fue de 161 niños y niñas entre 3 y 6 años asistentes a un centro escolar en Mizantéferi, Etiopia. Se clasificaron en función de la talla para la edad de acuerdo a las referencias de crecimiento de la OMS, así como según su grado de distensión abdominal. RESULTADOS: Existe una asociación (p < 0.005). entre crecimiento retardado y distensión abdominal. El paso de desnutrición leve a moderada o de moderada a grave incrementa el riesgo de distensión abdominal 1,67 veces (IC95% 1,19 - 2,38). CONCLUSIONES: La distensión abdominal es un indicador fácil de reconocer que alerta sobre una potencial parasitosis intestinal

INTRODUCTION: Stunting is a public health problem that affects 155 million children under the age of five worldwide. A malnourished child is more susceptible to infections such as intestinal parasites caused by helminths and protozoa. These diseases damage health status, contributing to the vicious circle between malnutrition and infection. OBJECTIVES: The purpose of this study was to analyse the relationship between abdominal distension and growth retardation. METHODS: The sample was 161 children aged 3-6 years attending a school in Mizantéferi, Ethiopia. They were classified according to height-for-age according to WHO growth references, as well as according to their degree of abdominal distension. RESULTS: There is an association (p < 0.005) between growth retardation and abdominal distension. The change from mild to moderate or moderate to severe malnutrition increases the risk of abdominal distension 1.67 times (CI95% 1.19 - 2.38). CONCLUSIONS: Abdominal distension is an easily recognized indicator that warns of potential intestinal parasitosis

Chronic invasive rhinosinusitis by Conidiobolus coronatus, an emerging microorganism.

Fungi from the Conidiobolus genus have been implicated in the development of chronic invasive fungal rhinosinusitis, mainly in tropical countries. The mycosis associated to these fungi may cause irreversible facial deformities and is potentially fatal. The authors present the first case of a chronic invasive fungal rhinosinusitis due to Conidiobolus coronatus diagnosed in a 66-year-old Caucasian male patient, living in Portugal without any travels abroad and complaining of progressive refractory nasal obstruction, facial pain and anosmia. Upon the culture of samples collected during sinus endoscopic surgery, colonies that presented a macroscopic aspect remembering wax were detected. The microscopic evaluation allowed the observation of simple conidiophores forming spherical conidia, and of conidiophores that presented hair-like appendages. Together, these characteristics allowed the identification of the fungi as a Conidiobolus, which was confirmed upon the DNA sequencing. The authors emphasised the role of this fungi as an emergent microorganism as well as the difficulties associated to the diagnosis and treatment.

Invasive Fungal Infections After Kidney Transplantation: A Single-center Experience.

INTRODUCTION: Invasive fungal infections (IFI) affecting transplant recipients are associated with increased mortality and graft dysfunction. OBJECTIVE: Describe the frequency, clinical features, and outcomes of IFI (except pneumocystis infection) in kidney transplant recipients. METHOD: Single-center descriptive study including every kidney transplant recipient with a culture-proven or probable IFI between 2003 and 2013, according to the EORTC-MSG criteria. RESULTS: We identified 45 IFI. There were 13 cases of invasive candidiasis (C. albicans: 6 and non-C. albicans candidial spp.: 7), 11 cases of pulmonary aspergillosis (A. fumigatus: 9 and A. flavus: 2); 11 cases of subcutaneous mycosis (Alternaria spp.: 9, Paecilomyces spp.: 1, and Pseudallescheria spp.: 1); 7 cases of cryptococcosis; 2 cases of pneumonia by non-Aspergillus molds (Mucor spp.: 1 and Cunninghamella spp.: 1); and 1 case of Geotrichum capitatum pneumonia. All patients were recipients from deceased donors. Six cases occurred in the first 3 months post-transplant, 15 cases between the third and twelfth months, and 21 cases after the twelfth month. Treatment options were fluconazole for Candida infections, voriconazole or caspofungin for aspergillosis, liposomal amphotericin for cryptococcosis, and itraconazole plus excision or cryotherapy for subcutaneous mycosis. Fifteen patients died (33%). Mortality rates were 15% for invasive candidiasis, 45% for aspergillosis, 71% for cryptococcosis, 100% for non-Aspergillus molds and G. capitatum pneumonia, and 0% for subcutaneous mycosis. Six patients who survived (14%) started regular hemodialysis. CONCLUSION: IFI still have a high mortality and morbidity in kidney transplant recipients, as verified in this report. We reinforce the need for a high index of suspicion and prompt treatment.

Does adding intravenous fentanyl to caudal block in children enhance the efficacy of multimodal analgesia as reflected in the plasma level of catecholamines?

BACKGROUND AND OBJECTIVE: Several studies showed that single analgesic modality management can attenuate perioperative stress, but little is known about the effect of multimodal analgesia on catecholamine responses to surgical trauma in children. METHODS: Fifty children (American Society of Anesthesiologists Grade I or II) were randomly allocated to one of two groups: one received general anaesthesia and a caudal block (control group), and one group was given general anaesthesia, caudal block and intravenous (i.v.) fentanyl 2 microg kg(-1) (fentanyl group). Plasma epinephrine and norepinephrine concentrations were measured three times during the perioperative period: at induction time (T(0)), at the end of surgery (T(1)) and when the children were fully awake in the postanaesthesia care unit (T(2)). RESULTS: There was a significant reduction in the catecholamine levels in the two groups when (T(1)) and (T(2)) were compared with T(0). When plasma epinephrine levels (at T(0), T(1) and T(2)) between the two groups were compared, a statistically significant reduction at T(2) was obtained in the fentanyl group, when compared with the control group. However, plasma norepinephrine levels showed no statistically significant difference between the two groups (at T(0), T(1) and T(2)). CONCLUSION: These findings suggest that the multimodal analgesic approach of adding i.v. low-dose fentanyl to a caudal block may decrease the plasma epinephrine release in children undergoing inguinal herniotomy.

Acidentes típicos de trabalho em pessoal de enfermagem: fatores associados / Occupational accidentes involving nursing professionals related factors

Na presente investigaçäo estudaram-se os acidentes típicos de trabalho, entre profissionais e ocupacionais que trabalham em um hospital, dentro da realidade nacional. A partir dos dados obtidos, identificou-se a incidência e o tipo de acidentes típicos de trabalho que foram notificados, ocorridos em um hospita-escola de grande porte e estudaram-se alguns fatores biológicos, sócio-econômicos e ligados à profissäo que poderiam estar associados aos acidentes típicos de trabalho. Durante seis meses consecutivos, diariamente, foi consultado o registro do Serviço de Assistência Médica e Social do pessoal do hospital de grande porte em estudo e foram identificados os profissionais e ocupacionais de enfermagem que se acidentaram. Os mesmos foram entrevistados em seus locais de trabalho ou no domicílio, se afastados de sua atividade. Os dados coletados foram analisados tendo em vista a ocorrência dos acidentes típicos de trabalho e as variáveis biológicas (sexo, idade, fase do ciclo menstrual, gravidez e aleitamento materno), sócio econômicas (estado civil, renda e escolaridade) e profissionais (categoria profissional-ocupacional, plantäo, duplicidade de emprego, período do turno em que ocorreu o acidente, unidade onde trabalha, horário, intervalo de repouso, há quantos dias foi a última folga, o dia da semana em que ocorreu o evento). O total de indivíduos expostos foi de 1392 e destes, 48(3,44%) profissionais de enfermagem se acidentaram, com a seguinte distribuiçäo: 21 atendentes de enfermagem, 16 auxiliares de enfermagem, 02 técnicos de enfermagem, e 08 enfermeiros. Os acidentes apresentaram a seguinte distribuiçäo: perfuraçäo 17 (35%), contusäo 11 (23%), corte 09 (19%), contaminaçäo 03 (6%) e outros 08 (17%). A regiäo do corpo mais atingida foi o membro superior-dedo (54%). A central de material e as unidades de internaçäo de cirurgia foram os locais onde o pessoal mais se acidentou (33% do total acidentes). Das variáveis estudadas, o turno de trabalho manhä e o dia da última folga (quanto mais próximo, maior o percentual) parecem ter sido as mais relevantes. Os autores concluem que, na presente amostra, a desatençäo (descuido) foi mais relevante que a fadiga, como determinante da ocorrência do acidente