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Boron Schiff bases derived from a-amino acids as nucleoli/cytoplasm cell-staining fluorescent probes in vitro
(The Royal Society of Chemistry, 2020-08-26) Lara-Cerón, Jesús A.; Jiménez Pérez, Víctor M.; Xochicale-Santana, Leonardo; Ochoa, María E.; Chávez-Reyes, Arturo; Muñoz-Flores, Blanca M.
The size, shape, and number of nucleoli in a cell's nucleus might help to distinguish a malignant from a benign tumor. Cellular biology and histopathology often require better visualization to understand nucleoli-related processes, thus organelle-specific fluorescent markers are needed. Here, we report the design, synthesis, and fully chemo-photophysical characterization of fluorescent boron Schiff bases (BOSCHIBAs), derived from a-amino acids (i.e., phenylalanine, tyrosine and tryptophan), with nucleoli- and cytoplasm-specific staining in cells. It is the first time that Boron Schiff bases derived from a-amino acids act as notorious dual (nucleoli and cytoplasm) cell-staining fluorescent probes. The boron derivatives not only showed good photostability and acceptable quantum yields ($5%) in solution, but also exhibited low cytotoxicity (>90% cell viability at 0.1 and 1 mg mL 1), which make them good candidates to be used in medical diagnosis.
The human-specific duplicated α7 gene inhibits the ancestral α7, negatively regulating nicotinic acetylcholine receptor-mediated transmitter release
(American Society for Biochemistry and Molecular Biology, 2020-10-22) Martín-Sánchez, Carolina; Alés, Eva; Balseiro-Gómez, Santiago; Atienza, Gema; Arnalich, Francisco; Bordas, Anna; Cedillo, José L; Extremera, María; Chávez-Reyes, Arturo; Montiel, Carmen
Gene duplication generates new functions and traits, enabling evolution. Human-specific duplicated genes in particular are primary sources of innovation during our evo- lution although they have very few known functions. Here we examine the brain function of one of these genes (CHRFAM7A) and its product (dupα7 subunit). This gene results from a partial duplication of the ancestral CHRNA7 gene encoding the α7 subunit that forms the homopentameric α7 nicotinic acetylcholine receptor (α7-nAChR). The functions of α7- nAChR in the brain are well defined, including the modula- tion of synaptic transmission and plasticity underlying normal attention, cognition, learning, and memory processes. Howev- er, the role of the dupα7 subunit remains unexplored at the neuronal level. Here, we characterize that role by combining immunoblotting, quantitative RT-PCR and FRET techniques with functional assays of α7-nAChR activity using human neuroblastoma SH-SY5Y cell variants with different dupα7 expression levels. Our findings reveal a physical interaction between dupα7 and α7 subunits in fluorescent protein-tagged dupα7/α7 transfected cells that negatively affects normal α7-nAChR activity. Specifically, in both single cells and cell populations, the [Ca2+]i signal and the exocytotic response induced by selective stimulation of α7-nAChR were either significantly inhibited by stable dupα7 overexpression or augmented after silencing dupα7 gene expression with specific siRNAs. These findings identify a new role for the dupα7 subunit as a negative regulator of α7-nAChR-mediated control of exocytotic neurotransmitter release. If this effect is exces- sive, it would result in an impaired synaptic transmission that could underlie the neurocognitive and neuropsychiatric dis- orders associated with α7-nAChR dysfunction.
Rescate de hipoxemia grave con uso de óxido nítrico inhalado y decúbito prono en neumonía COVID-19 en un lactante
(Sociedad Chilena de Pediatría, 2021) Donoso Fuentes, Alejandro; Díaz, Franco
Los mecanismos fisiopatológicos que conducen a hipoxemia grave en COVID-19 son heterogéneos, y su importancia relativa pueden diferir de las cohortes de PARDS habituales. La sinergia de DP y NOi puede revertir la hipoxemia grave en COVID-19 cuando el shunt intrapulmonar aumentado es predominantemente por una desregulación de la vasoconstricción hipóxica, evitando la progresión de terapias potencialmente iatrogénicas y sus complicaciones.
Asociación del nivel socioeconómico y educacional en los egresos por cáncer de mama en Chile durante los años 2001 al 2016
(Asociación Nacional Científica de Estudiantes de Medicina de Chile (ANACEM), 2021) Morales, C.; de la Fuente, M.; Araya, F.; Diaz, X.; Burgos, S.; Bravo, M.E.
Introducción El cáncer de mama constituye la primera causa de muerte en los cánceres en Chile según Globocan 2018. Dentro de los factores que explican esta alta mortalidad encontramos una baja tasa de detección y de realización de mamografías en los niveles socioeconómicos altos. Es por esto que comprender las causas de defunción y los factores que afectan en la mortalidad y letalidad por cáncer de mama en los últimos 17 años nos permitirá enfocar las políticas públicas de los próximos 50 años. Los objetivos generales de este trabajo fueron caracterizar los egresos hospitalarios en los pacientes por cáncer de mama según la edad, el sexo, la previsión, el nivel socioeconómico y educacional en Chile durante los años 2001 al 2016 y calcular la mortalidad y letalidad específica en estas mismas variables durante los años 2001 a 2016. El objetivo específico es asociar las variables socioeconómicas y educacionales, estimando los Odd’s ratios de las variables en los egresos hospitalarios por cáncer de mama en Chile durante los años 2001 al 2016. Materiales y Métodos: Estudio de cohorte longitudinal retrospectivo en 81,072 egresos hospitalarios y 20,220 defunciones obtenidas de la página DEIS MINSAL, años 2001 - 2016. Para el análisis univariado se efectuó una regresión de ajuste de tasas Praisweinstein según edad y sexo según modelo OMS de ajuste de tasas. Para las variables de tipo discreta se describieron mediante porcentajes y tasas y para las variables de tipo continua se utilizó mediana y desviación estándar. Se efectuó un test de smirnovkolmolgorov para determinar el tipo de distribución y de normalidad de las muestras. Para las variables de tipo dicotómica se utilizó un modelo de regresión logística binaria para describir estas variables y determinar la posible asociación entre el nivel socioeconómico y educacional de las pacientes diagnosticadas por cáncer de mama. Resultados: Murieron 1,88 veces más personas de nivel socioeconómico alto con un IC entre 1,83- 1,94 con respecto a la población de nivel socioeconómico bajo. En cambio, las personas con un mayor nivel educacional murieron 0,5 veces menos según la regresión realizada respecto al bajo nivel educacional con un IC entre 0,47- 0,52, pero a menor nivel educacional aumentó 20 veces la mortalidad, constituyendo una causa inversa. Respecto al sexo las mujeres murieron 2,08 veces más que los hombres. Para el nivel socioeconómico alto en relación al bajo un OR [1.88 (1.83 a 1,94)], p<0,0001], para el nivel educacional alto en relación al bajo fue a favor del mayor nivel educacional con OR [0,5 (0,47 - 0,52)] y en cuanto a la comparación de sexos un OR [1,04 (1,03-2,17), p=0,039]. Es decir, la diferencia entre mortalidad que hubo fue significativa para todos los intervalos tanto para sexo, nivel educacional como para nivel socioeconómico. Se encontró una constante de 0,013 de mortalidad basal, es decir, todos tienen 1,3% de riesgo de morir por cáncer de mama independiente del nivel socioeconómico, educacional y del sexo. Conclusión: Existen diferencias estadísticamente significativas respecto a la mortalidad entre los niveles socioeconómicos altos y bajos y también en nivel educacional, sin embargo, al realizar los métodos de regresión se obtuvo una mayor mortalidad y mayor riesgo de morir por cáncer de mama en los niveles socioeconómicos más altos asociados a, probablemente, la menor cantidad de tamizajes y realización de mamografías en este estrato. A partir del año 2008 se observó un incremento a los niveles originales observados al inicio del segundo milenio incrementando las diferencias existentes en los índices de desigualdad tanto por nivel educacional como por nivel socioeconómico incrementando en 20 veces respecto al nivel educacional, y 1.88 respecto al nivel socioeconómico.
Puesta al día: carcinoma paratiroideo
(Sociedad Médica de Santiago; Sociedad Chilena de Medicina Interna , 2021) Silva-Figueroa, Angélica; Barberán, Marcela; Campusano, Claudia; Salman, Patricio; Trejo, Pamela; Rivera, Sandra; Florenzano, Pablo; Velasco, Soledad; Illanes, Francisca; Trincado, Patricio; Canessa, José; Solar, Antonieta; Marcela, Moreno; Eugenin, Daniela; Jiménez, Beatriz; Arroyo, Patricia
Parathyroid carcinoma is a rare malignant disease that presents as a sporadic or familial primary hyperparathyroidism (PHP). The latter is associated with some genetic syndromes. It occurs with equal frequency in both sexes, unlike PHP caused by parathyroid adenoma that is more common in women. It hould be suspected in cases of severe hypercalcemia, with high parathyroid hormone levels and a palpable cervical mass. Given the difficulty in distinguishing between parathyroid carcinoma and adenoma prior to the surgery, the diagnosis is often made after parathyroidectomy. The only curative treatment is complete surgical resection with oncologic block resection of the primary tumor to ensure free margins. Adjuvant therapies with chemotherapy or radiation therapy do not modify overall or disease-free survival. Recurrences are common and re-operation of resectable recurrent disease is recommended. The palliative treatment of symptomatic hypercalcemia is crucial in persistent or recurrent disease after surgery since morbidity and mortality are more associated with hypercalcemia than with tumor burden.
Pericarditis posterior a la administración de vacuna mRNA contra COVID-19
(Sociedad Chilena de Pediatría, 2021) Díaz, Franco; Ampuero, Camila; Donoso F., Alejandro
Tal como fue descrito previamente, la vacuna mRNA no tiene el virus en su estructura, por lo que las causas de inflamación miocárdica aún no están precisadas, postulando mecanismos como inmunidad cruzada, autoanticuerpos, efecto de las proteínas S circulantes, entre otros. El riesgo beneficio de la administración de vacunas mRNA en adolescentes entre 12 y 18 años, únicas aprobadas a la fecha para ese grupo de edad, es un tema de debate candente en la actualidad. Desde el punto de vista epidemiológico, el uso de vacunas en adolescentes previene un número mucho mayor de casos, hospitalizaciones y cuadros graves. Estas estimaciones fueron realizadas durante el pico de casos de la pandemia, con una alta circulación viral en la comunidad, por lo que pudieran ser diferentes en situaciones futuras con pocos casos en una población adulta vacunada
Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia
(Sociedad Chilena de Pediatria, 2021) Wooldridge, Gavin; O’Brien, Nicole; Muttalib, Fiona; Abbas, Qalab; Adabie Appiah, John; Baker, Tim; Bansal, Arun; Basnet, Sangita; Campos-Miño, Santiago; Carla de Souza, Daniela; Díaz, Franco; Dramowski, Angela; Fernández-Sarmiento, Jaime; Fustiñana, Ana; González, Gustavo; Jabornisky, Roberto; Jaramillo-Bustamante, Juan Camilo; Chor Yek Kee Yek Kee; Lang, Hans-Joerg; Soares Lanziott, Vanessa; Kohn Loncarica, Guillermo; Mohsenibod, Hadi; Ode, Bunmi; Murthy, Srinivas; Amelie von Saint Andre-von Arnim; Hansmann, Andreas; González-Dambrauskas, Sebastián
The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children was released in 2020 and is intended for use in all global settings that care for children with sepsis. However, practitioners managing children with sep- sis in resource-limited settings (RLS) face several challenges and disease patterns not experienced by those in resource-rich settings. Based upon our collective experience from RLS, we aimed to reflect on the difficulties of implementing the international guidelines. We believe there is an urgent need for more evidence from RLS on feasible, efficacious approaches to the management of sepsis and septic shock that could be included in future context-specific guidelines.
Concurrencia de encefalitis diseminada aguda en lactante con síndrome inflamatorio multisistémico asociado a infección por SARS-CoV-2
(Sociedad Chilena de Pediatría, 2021) Ampuero Acuña, Camila; Díaz, Franco; Donoso, Alejandro
La presente comunicación permite destacar que en el curso de MIS-C puede existir una grave complicación como ADEM. Aunque en un inicio el tratamiento inmunomodulador con altas dosis de metilprednisolona y IGIV no varía de forma significativa, es de importancia una precoz intervención pues un tratamiento oportuno tiene resultados clínicos favorables, además de ser relevante el disponer de este antecedente para un adecuado seguimiento. Finalmente, en el niño con MIS-C y encefalopatía con déficit neurológico se debe considerar la eventual existencia de ADEM, entre las posibles complicaciones del sistema nervioso central.
A randomized clinical trial to assess the effectiveness of pre- and post-surgical pelvic floor physiotherapy for bowel symptoms, pelvic floor function, and quality of life of patients with rectal cancer: CARRET protocol
(BMC, 2021-01) Sacomor, Cinara; Lorca, Luz Alejandra; Martinez-Mardones, Mónica; Salas-Ocaranza, Roberto Ignacio; Reyes-Reyes, Guillermo Patricio; Pizarro-Hinojosa, Marta Natalia; Plasser-Troncoso, Jorge
Background: There is scarcity of trials about preventative strategies for low anterior resection syndrome (LARS) in rectal cancer patients. The aim of this study is to evaluate the effectiveness of a pre- and post-surgical pelvic floor rehabilitation program on the bowel symptoms, pelvic floor function, and quality of life of rectal cancer patients. Methods: A randomized controlled trial with parallel groups (pelvic floor rehabilitation versus control group), with a blinded evaluator. Participants and setting: 56 stage I to III rectal cancer patients aged from 18 to 80 years old undergoing sphincter preservation surgery at Hospital del Salvador and who have a sufficient knowledge of Spanish. Main outcome measures: ICIQ-B questionnaire for intestinal symptoms, high-resolution anorectal manometry (Alacer Multiplex 24-channel manometry equipment) for anorectal function, pelvic floor muscle strength test with Oxford Modified Scale, and a quality of life test with the EORTC QLQ C30 questionnaire. The evaluations will be carried out at five stages: before surgery, before and after the pelvic floor rehabilitation, and during a 3-month and 1-year follow-up. Interventions: one pre-rehabilitation session and 9 to 12 sessions of pelvic floor rehabilitation, including patient education, pelvic floor muscle exercises, pelvic floor electromyography biofeedback, and capacitive and sensory rectal training with a balloon probe. Rehabilitation will begin 3– 5weeks before the ileostomy is removed (four sessions) and around 3 weeks after stoma removal (5–8 sessions). Discussion: We expect the program to improve the bowel symptoms, pelvic floor function, and quality of life of rectal cancer patients.
En época de COVID-19: ¿cómo las estrategias de recuperación avanzadas (STAR) pueden ayudar a dar soluciones a los pacientes oncológicos?
(Sociedad Médica de Santiago, 2021-01-11) Martinez-Mardones, Monica; Reyes, Guillermo; Salas, Roberto; Fernández, Rodrigo; Melkonian, Ernesto; Mordojovich, Eduardo; Silva, Cristóbal; Suazo, Cristóbal
Background: SARS-CoV-2 hampered the resolution of multiple diseases, including cancer. Aim: To show that a multidisciplinary program of Strategies to Advance Recovery (STAR) can be implemented in a public hospital in Chile, despite the global pandemic and state of a national catastrophe, to provide a solution to cancer patients. Material and Methods: A retrospective descriptive study, of patients requiring an elective resolution of a colorectal cancer. Patients met the inclusion criteria, established in the STAR program. A total of 24 perioperative interventions were performed in the protocol. Demographic variables, days of hospitalization, complications, mortality, and readmissions were described. Results: The 24 interventions of the protocol were successfully implemented, although some partially. Sixteen patients aged 53 to 83 years (50% women) were operated. The median length of hospitalization was four days (range 2 to 9). Four complications were recorded, all were grade I or II according to the Clavien-Dindo classification. Two patients were readmitted. There were no reoperations or mortality. One patient was infected with coronavirus, diagnosed at the time of readmission. Conclusions: The STAR protocol reduces the length of hospital stay. In a pandemic context such as COVID-19 it becomes a useful resource and can be implemented in cancer patients, as herein reported.
Cobertura de partes blandas del Pulgar. Guía en la toma de decisiones
(Elsevier, 2021-02-27) Ruiz Riquelme, Pablo; Urrutia Hoppe, Esteban
Resumen Las lesiones digitales son extremadamente frecuentes y cuando estas involucran al pulgar pueden comprometer importantemente la función de la mano, tanto así que su amputación afecta hasta un 50% la función global de la mano y disminuye su fuerza hasta en un 20%. Para poder mantener el largo del pulgar en muchas ocasiones se requiere de cobertura mediante el uso de colgajos, los cuales no siempre son realizados por un cirujano de mano. La elección correcta del colgajo es esencial para evitar la restricción de movilidad y limitación funcional del dedo lesionado, existiendo múltiples alternativas descritas, que varían en su capacidad de cobertura y complejidad, haciendo difícil una adecuada elección. Nuestro objetivo es resumir y entregar una estrategia de análisis de lesiones del pulgar que permita comprender el tipo de lesión y objetivos del tratamiento quirúrgico, para así optimizar la cobertura según cada caso y los resultados a largo plazo. Nivel de Evidencia: IV
Qué hay de nuevo en el estudio y manejo de las fracturas de tobillo: revisión de literatura
(Medwave, 2021-03-19) Ruiz Riquelme, Pablo; Filippi, Jorge
El conocimiento acerca del manejo de las fracturas de tobillo ha tenido un gran crecimiento los últimos años. La tomografía axial computarizada y el mejor entendimiento biomecánico han renovado conceptos tanto del diagnóstico como del tratamiento. Pese a ello, actualmente existen consideraciones sobre el manejo de fracturas maleolares sin consenso. Esta revisión pretende actualizar conceptos sobre el estudio y manejo de las fracturas de tobillo. Serán discutidos los conceptos de estabilidad, estudios radiológicos, uso de tomografía axial computarizada, manejo de lesiones ligamentarias asociadas (ligamento deltoideo y sindesmosis) y manejo de fracturas del maléolo posterior. Se planteará la opinión de los autores y la evidencia en la literatura para cada pregunta propuesta.
Spanish translation, face validity, and reliability of the ICIQ-B Questionnaire with colorectal cancer patients
(Sociedade Brasileira de Coloproctologia, 2021-06) Sacomori, Cinara; Lorca, Luz Alejandra; Martinez-Mardones, Mónica; Benavente, Paulina; Plasser, Jorge; Pardoe, Megan
Purpose To describe the English-to-Spanish translation process and preliminary psychometric analysis (face validity, cultural adaptation, and test retest reliability) of the International Consultation on Incontinence Questionnaire – Bowels Module (ICIQB) among Chilean colorectal cancer patients. Materials and Methods The face validity was studied with 10 colorectal cancer patients, and the test-retest reliability, with 15 patients, 1 month before and 6 months after cancer surgery. Results Two rounds of translation/back translation resulted in a Spanish version. The English expression open your bowels was translated as defecar, as it is easily understandable in Spanish. The patients reported that the instrument was easy to answer, with clear instructions, and that it was adequate to appraise their health condition. The testretest reliability was good (Spearman rho [ρ] 0.842); only item 15a, the Bristol Stool Scale, obtained a moderate correlation (ρ¼0.639). The patients reported a variety of symptoms, including increased bowel movements, nocturnal bowel movements, fecal urgency, and incontinence. Conclusions The first Spanish version of the ICIQ-B was culturally adapted for Chilean colorectal cancer patients, and showed good test-retest reliability. It might be a reference for other Spanish-speaking countries and for patients with other conditions. The ICIQ-B is a robust comprehensive questionnaire for bowel function.
Therapeutic plasma exchange in critically ill children: experience of the pediatric intensive care unit of two centers in Chile
(Elsevier, 2021-06-04) Bustos B, Raúl; Hickmann O., Lilian; Cruces R., Pablo; Díaz, Franco
Introduction : Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used in a wide spectrum of diseases. We aim to review the indications, complications, and outcomes of critically ill children who received TPE and to compare a membrane versus centrifugal method in this cohort. Methods : A retrospective observational study in two pediatric intensive care units in Chile during eight years (2011–2019) Results: A total of 36 patients underwent 167 TPE sessions (20 centrifugation and 16 membrane- based). The more frequent indications for TPE were autoimmune neurological diseases in 14 cases, renal diseases (9), and rheumatological disorders (5). 58% of children received other immunomodulatory therapy. According to ASFA, 45% of cases were I-II category, 50% to III, and 5% not classified. Response to treatment was complete in 64% (23/36) and partial in 33% (12/36). Complications occurred in 17.4% of sessions, and the most frequent was transient hypotension during the procedure. Overall survival at discharge from the PICU was 92%. Patients who received TPE as a single therapy (n = 26) survived 96%. The clinical outcomes between the two apheresis methods were similar. Survivors had a significantly lower PELOD score on admission (14.5 vs. 6.5, p= 0.004). Conclusions: TPE is mainly indicated as a rescue treatment in neurological autoimmune diseases refractory to conventional immunomodulatory treatment. Complications in critically ill children are mild and low. The outcome in children requiring TPE as a single therapy is good, and no differences were observed with centrifugation or membrane method.
Renal infarction assicated wit hastmpto,atic covid-19 infection
(Elsevier, 2021-07) Murray, Nigel P.; Fuentealba, Cynthia; Reyes, Eduardo; Salazar, Aníbal
Renal infarction is an infrequent condition resulting from obstruction of a renal artery. The symptoms it causes are non-specific and as a result the diagnosis may be missed, resulting in loss of renal parenchyma, or the risk of other thrombotic phenomenon. The estimated incidence of renal infarction, based on emergency service admissions, is between 0.004 and 0.007%.1 Four risk groups for renal infarction have been suggested: renal infarction of cardiac origin, the most common of which is atrial fibrillation; renal infarction associated with renal artery injury; renal infarction associated with thrombophilia, and; finally, idiopathic. The SARS-CoV-2 infection (Covid-19) has been associated with an increased risk of both arterial and venous thrombosis. A meta-analysis reported an incidence of venous thrombosis in 22.7% of Intensive care unit (ICU) patients and 7.9% in non-ICU patients2 and reports of an increased risk of arterial thrombosis in severely ill patients, even in those patients receiving antithrombotic prophylaxis with low molecular weight heparin.3,4 Arterial thrombosis has involved the cerebral, coronary, the aorta and peripheral arteries.3,4 In a report on 241 patients with severe COVID-19, 5.7% suffered from acute ischaemic cerebrovascular disease.3 However, there is limited evidence of the risk of both arterial and venous thrombosis in patients with asymptomatic COVID-19. In this context of asymptomatic patients, we present the case of a previously healthy 25-year-old man with no known risk factors for thrombosis who presented to the emergency services with severe loin pain and had a positive polymerase chain reaction (PCR) test for SARS-CoV-2 infection. The angio-computed tomography (CT) of the abdomen and pelvis showed images consistent with thrombosis in one of the two left renal arteries, associated with renal infarction. We present the clinical and laboratory findings, along with the patient's management.
Ecografía axilar prequirúrgica en pacientes con cáncer de mama: Estudio prospectivo para valorar la capacidad de predecir la carga tumoral axilar
(Elsevier; Sociedad Española de Radiología Médica, 2021-07-12) Neira Vallejos, Paulina; Aguirre Donoso, Bernardita; Arancibia, Patricia; Jacard Cangas, Marcela; Torres Castro, Soledad; Ibarra Valencia, Álvaro; Behnke Arriagada, Carolina; Castro Cruz, Magdalena
Objetivo: El objetivo de este estudio fue determinar la capacidad del ultrasonido axilar para predecir el número de ganglios con metástasis encontrados en la cirugía axilar de ganglio centinela o linfadenectomía axilar, en pacientes con diagnóstico reciente de cáncer de mama efectuado por biopsia percutánea. Métodos: Estudio prospectivo que incluyó pacientes diagnosticadas con cáncer de mama infiltrante mediante biopsia percutánea, que fueron evaluadas con ultrasonido axilar, caracterizando los ganglios en no sospechosos o sospechosos, cuantificando estos últimos y comparando este número con el resultado patológico de la cirugía axilar. Resultados: fueron incluidas 142 pacientes, cuatro de ellas con cáncer bilateral. Ciento treinta y tres de los 146 tumores se presentaron clínicamente como T1-T2 N0. La mediana de ganglios sospechosos en ultrasonido fue de 2 (1-6) y la mediana de ganglios sospechosos resultantes en la biopsia quirúrgica fue de 1 (1-16), sin diferencia signiﬁcativa (p = 0,1). La correlación entre el número de ganglios positivos encontrados por ultrasonido axilar y el número de ganglios axilares metastásicos hallados en cirugía fue del 72,7% (p = 0,0002), y la concordancia del 79% (IC95% 62,4-95,6%; p = 0,0001). La sensibilidad del ultrasonido axilar para diagnosticar alta carga tumoral axilar, con tres o más ganglios metastásicos versus baja carga tumoral, con 0, 1 o 2 ganglios metastásicos, fue del 86,6%; la especiﬁcidad, del 83,3%; el valor predictivo positivo, del 92%, y valor predictivo negativo del 71,4%. Conclusión: Nuestros resultados muestran que el ultrasonido axilar dirigido antes de la cirugía es capaz de diferenciar entre una axila de baja carga tumoral y una de alta carga tumoral, y puede ser usado como una herramienta para seleccionar qué tipo de tratamiento elegir, lo que debe ser demostrado en estudios aleatorizados multiinstitucionales.
Dysregulated immune responses in COVID-19 patients correlating with disease severity and invasive oxygen requirements.
(Frontiers Media S.A., 2021-10-21) García-González, Paulina; Tempio, Fabian; Fuentes, Camila; Merino, Consuelo; Vargas, Leonardo; Simon, Valeska; Ramirez-Pereira, Mirliana; Rojas, Verónica; Tobar, Eduardo; Landskron, Glauben; Araya, Juan Pablo; Navarrete, Mariela; Bastias, Carla; Tordecilla, Rocío; Varas, Macarena A; Maturana, Pablo; Marcoleta, Andrés E; Allende, Miguel L; Naves, Rodrigo; Hermoso, Marcela A; Salazar-Onfray, Flavio; Lopez, Mercedes; Bono, María-Rosa; Osorio, Fabiola
The prognosis of severe COVID-19 patients has motivated research communities to uncover mechanisms of SARS-CoV-2 pathogenesis also on a regional level. In this work, we aimed to understand the immunological dynamics of severe COVID-19 patients with different degrees of illness, and upon long-term recovery. We analyzed immune cellular subsets and SARS-CoV-2-specific antibody isotypes of 66 COVID-19 patients admitted to the Hospital Clínico Universidad de Chile, which were categorized according to the WHO ten-point clinical progression score. These included 29 moderate patients (score 4-5) and 37 severe patients under either high flow oxygen nasal cannula (18 patients, score 6), or invasive mechanical ventilation (19 patients, score 7-9), plus 28 convalescent patients and 28 healthy controls. Furthermore, six severe patients that recovered from the disease were longitudinally followed over 300 days. Our data indicate that severe COVID-19 patients display increased frequencies of plasmablasts, activated T cells and SARS-CoV-2-specific antibodies compared to moderate and convalescent patients. Remarkably, within the severe COVID-19 group, patients rapidly progressing into invasive mechanical ventilation show higher frequencies of plasmablasts, monocytes, eosinophils, Th1 cells and SARS-CoV-2-specific IgG than patients under high flow oxygen nasal cannula. These findings demonstrate that severe COVID-19 patients progressing into invasive mechanical ventilation show a distinctive type of immunity. In addition, patients that recover from severe COVID-19 begin to regain normal proportions of immune cells 100 days after hospital discharge and maintain high levels of SARS-CoV-2-specific IgG throughout the study, which is an indicative sign of immunological memory. Thus, this work can provide useful information to better understand the diverse outcomes of severe COVID-19 pathogenesis.
Transient acquired factor XII deficiency associated with moderately severe Covid-19 pneumonia
(Elsevier, 2021-11) Murray, Nigel P.; Guzman, Eghon; Del Prado, Monica
The case report demonstrates the importance of investigating alternative causes of a prolonged APTT in patients with Covid-19. Although Covid-19 is associated with thrombotic complications it is possible that immune dys-regulation associated with SARS-CoV-2 may lead to other coagulation factor inhibitors and a hemorrhagic tendency. Clinical decisions on anticoagulant treatment may be influenced by the APTT and modified in patients with Covid-19. Management of these cases requires the clinical acumen to balance the potential for haemorrhagic and thrombotic complications of SARS-CoV-2 infection. The abnormalidades in the coagulation tests may persist long after clinical remission and resolution of inflammatory markers.
Comparison of Interleukin-6 plasma concentration in multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 and pediatric sepsis
(Frontiers Media S.A., 2021-11-15) Díaz, Franco; Busto B., Raúl; Yagnam, Felipe; J. Karsies, Todd; Vásquez-Hoyos, Pablo; Jaramillo-Bustamante, Juan-Camilo; Gonzalez-Dambrauskas, Sebastián; Drago, Michelle; Cruces, Pablo
Importance: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection is thought to be driven by a post-viral dysregulated immune response, where interleukin 6 (IL-6) might have a central role. In this setting, IL-6 inhibitors are prescribed as immunomodulation in cases refractory to standard therapy. Objective: To compare plasma IL-6 concentration between critically ill children with MIS-C and sepsis. Design: A retrospective cohort study from previously collected data. Setting: Individual patient data were gathered from three different international datasets. Participants: Critically ill children between 1 month-old and 18 years old, with an IL-6 level measured within 48 h of admission to intensive care. Septic patients were diagnosed according to Surviving Sepsis Campaign definition and MIS-C cases by CDC criteria. We excluded children with immunodeficiency or immunosuppressive therapy. Exposure: None. Main Outcome(s) and Measure(s): The primary outcome was IL-6 plasma concentration in MIS-C and sepsis group at admission to the intensive care unit. We described demographics, inflammatory biomarkers, and clinical outcomes for both groups. A subgroup analysis for shock in each group was done. Results: We analyzed 66 patients with MIS-C and 44 patients with sepsis. MIS-C cases were older [96 (48, 144) vs. 20 (5, 132) months old, p < 0.01], but no differences in sex (41 vs. 43% female, p = 0.8) compared to septic group. Mechanical ventilation use was 48.5 vs. 93% (p < 0.001), vasoactive drug use 79 vs. 66% (p = 0.13), and mortality 4.6 vs. 34.1% (p < 0.01) in MIS-C group compared to sepsis. IL-6 was 156 (36, 579) ng/dl in MIS-C and 1,432 (122, 6,886) ng/dl in sepsis (p < 0.01), while no significant differences were observed in procalcitonin (PCT) and c-reactive protein (CRP). 52/66 (78.8%) patients had shock in MIS-C group, and 29/44 (65.9%) had septic shock in sepsis group. Septic shock had a significantly higher plasma IL-6 concentration than the three other sub-groups. Differences in IL-6, CRP, and PCT were not statistically different between MIS-C with and without shock. Conclusions and Relevance: IL-6 plasma concentration was elevated in critically ill MIS-C patients but at levels much lower than those of sepsis. Furthermore, IL-6 levels don’t discriminate between MIS-C cases with and without shock. These results lead us to question the role of IL-6 in the pathobiology of MIS-C, its diagnosis, clinical outcomes, and, more importantly, the off-label use of IL-6 inhibitors for these cases.
Impacto en el patrón de atención en cirugía de cabeza y cuello y las medidas sanitarias adoptadas durante los primeros 150 días de la era COVID-19
(Sociedad de Cirujanos de Chile, 2021-12) Toledo-Villegas, Karina; Silva-Figueroa, Angélica; Castro S., Rodrigo; Aguilar C., Oscar; Inturias C., Rene; Gallego C., Alejandra; González-Prado, Miguel
Introducción: La pandemia COVID-19 generó una reestructuración en la atención quirúrgica mundialmente debido a su alta transmisibilidad y la inherente limitación de los recursos humanos y materiales disponibles. Objetivo: Describir el impacto de la pandemia COVID-19 en el Equipo de Cirugía Cabeza y Cuello del Complejo Asistencial Barros Luco Trudeau (CABL) en su ejecución clínico-quirúrgica y la secuenciación organizada de las medidas sanitarias aplicadas a lo largo del tiempo durante los primeros 150 días de iniciada la pandemia en Chile. Materiales y Método: Realizamos una revisión retrospectiva de los pacientes sometidos a cirugía y/o evaluados ambulatoriamente durante el período COVID-19 comprendido entre el 3 de marzo y el 31 de julio de 2020, comparado con el mismo intervalo de tiempo de 2019. Características clínicas y medidas sanitarias empleadas durante este período fueron sintetizadas. Resultados: Detectamos un descenso del 64% en atención ambulatoria y un descenso del 58% en la carga quirúrgica, comparado con el año 2019. Durante el período COVID-19 de 2020, un total de 61 pacientes fueron sometidos a intervención quirúrgica. La principal indicación de cirugía fue cáncer en un 75,4% (46). No se reportaron pacientes contagiados por COVID-19 en los 14 días siguientes a la hospitalización. Se discuten las consideraciones perioperatorias empleadas y restricciones nacionales/institucionales sanitarias. Conclusión: La crisis sanitaria mundial secundaria al COVID-19 generó una reducción en las atenciones ambulatorias y cirugías realizadas por Equipo de Cabeza y Cuello CABL. A pesar de las restricciones sanitarias, organizamos estratificadamente la atención para preservar la resolución de casos críticos no diferibles en cabeza y cuello

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