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A nomogram for relapse/death and contemplating adjuvant therapy for parathyroid carcinoma
(Elsevier, 2023-08) Silva-Figueroa, Angélica
The staging systems proposed to date for PC have not been adequately validated. Recent multivariate have been carried out in large national and international databases to search for prognostic factors for survival and relapse in PC. Advanced age, male gender, high PTH and calcium levels at diagnosis, tumor size >30 mm, angioinvasion, presence of distant metastases, and specific tumor microenvironmental factors, such as parafibromin staining and tumor-infiltrating lymphocytes, have been strongly correlated with decreased OS and CSS, and with increased risk of local and distant recurrence. Because of their prognostic significance, these host and tumor factors should be included in any PC staging system. However, there is a need to promote collaborative PC registry plans to collate data on the above prognostic factors as well as new ways in a standardized global registry. Such a resource could be used to stratify patients with PC and identify those at high risk for relapse and death who may benefit from strict surveillance or adjuvant therapeutic care. PC is an indolent cancer with a high recurrence rate of 3 to 5 years after the first surgical intervention. Progression can remain dormant for decades until patients present with distant metastases. Such heterogeneity and neoplastic latency make OS an ambitious endpoint to achieve, and pursuing OS contradicts the actual needs of patients with this endocrine neoplasm. More relevant endpoints focus on achieving normal blood biochemistry to improve quality of life and intervening to lengthen recurrence/metastasis event-related-free survival. Surgery remains the standard treatment because traditional therapies, such as EBRT and chemotherapy, do not benefit patients with advanced unresectable or metastatic PC, new options are emerging for patients with PC. Genomic and phenotypic profiling can continue to inform personalized therapeutic strategies to expand the clinical options available to patients with PC.
The Akin osteotomy without fixation in open hallux abducto-valgo correction surgery: A single center retrospective analysis of 286 cases
(Elsevier, 2023-01-06) Testa, Enrique Adrián; Porreca, Annamaria; Ruiz Nasarre, Alberto; Poggio Cano, Daniel; Alvarez Goenaga, Fernando; Ledermann, Gerardo; Baduell, Albert; Ruiz Riquelme, Pablo
Between 2011 and 2018, 222 patients, 286 feet (147 left, 139 right) met the inclusion criteria. We found an average difference between pre-op and post-op at 3 months of distal articular set angle (DASA) of 7.0 degrees and average interphalangeal joint obliquity angle (IPOA) of 12.0 degrees (p < 0.001). All cases achieved fusion but in 5.9 % (17/289 cases) of cases, we observed delayed consolidation. The average union time in these cases was 22.1 weeks. Hyperextension of the distal fragment (mal union in plantar flexion) was observed in 7 cases (2.4 %). None of the 7 cases required correction. Out of 286 surgeries, 8 (2.7 %) required reoperation, but only one case for a hypocorrection required Akin's re osteotomy. Regarding the inter- and intra-observer correlations, good and excellent reliability are observed for all parameters under consideration. Conclusion The absence of internal fixation would appear not to impair osteotomy healing and complication rates compared with techniques with fixation would not appear to be worse. The results are encouraging; nevertheless, we believe that further studies need to be performed in order to confirm the data.
Anatomical variations and abnormalities of the maxillary region and clinical implications: A systematic review and metaanalysis
(Wolters Kluwer Health, 2023-07-05) Valenzuela-Fuenzalida, Juan José; Baez-Flores, Belén; Ávila-Sepúlveda, Roberto; Moya-Medina, Claudia; Pérez-Jiménez, Rubén; López, Esteban; Sánchis, Juan; Orellana-Donoso, Mathias; Leyton-Silva, Javiera; Rodríguez, Macarena-Cecilia; Iwanaga, Joe
Objetivo: El objetivo de esta revisión es investigar y analizar las variaciones anatómicas presentes en el seno maxilar (SM), a través de la examinación de la prevalencia de estas variaciones, así como la correspondiente prevalencia de patologías clínicamente significativas y complicaciones asociadas a ellas. Métodos: El proceso de búsqueda se realizó en las siguientes bases de datos; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS y GOOGLE SCHOLAR, utilizando como términos de búsqueda; “Hueso maxilar”, “Seno maxilar”, “Seno paranasal”, “Variaciones anatómicas”, “Sinusitis” y “Anatomía clínica”. Resultados: Se incluyeron un total de 26 artículos y 12969 muestras, de las cuales se registró el sexo de 12,594 sujetos, dando un total de 5802 hombres y 6792 mujeres. Las variantes reportadas por los incluidos fueron células de Haller, Concha Bullosa, Número de septos, Seno hipoplásico, Agger Nasi, Engrosamiento de la mucosa MS, Desviación del tabique nasal, Ostium accesorio y Células de Onodi. Entre los mencionados, los que presentaron mayor número de estudios (entre 8 y 10 estudios incluidos) fueron: las Células de Haller, la Concha Bullosa y el Número de septos, donde la prevalencia fue de 0,30, 0,36, 0,39 respectivamente. Estas variaciones pueden provocar sinusitis, provocar algunos tipos de tumores o afectar estructuras vecinas que podrían verse comprometidas por esta variación. Conclusión: Como resultado, es ciertamente complejo distinguir la presencia de variaciones anatómicas de anomalías patológicas. Por tanto, el conocimiento de las diferentes variaciones y sus relaciones clínicas podría ser un activo útil para los médicos dedicados a esta región.
Antidiabetic potential of extracts from Cylindropuntia imbricata (Haw.) F.M. Knuth, Opuntia engelmannii Salm-Dyck ex Engelm., Ibervillea sonorae (S. Wats.) Greene and Theobroma cacao L.
(Universidad Nacional Autónoma de México; Facultad de Estudios Superiores Zaragoza., 2024-07-30) De la Sota- Esparza, Gastaldo Emmanuel; Alvarado-Vásquez, Marco Antonio; Rivas-Morales, Catalina; Rocha-Estrada, Alejandra; Chavez-Reyes, Arturo; Ortíz-Martínez, David Mizael
Diabetes mellitus is a disease that affects more than 537 million people in the world without decreasing. When diabetes becomes complicated, it damages several organs until it causes death. The drugs in use to counteract the disease produce side effects; a circumstance that has led to research on plants with anti-diabetic properties. The objective of this study was to evaluate the antidiabetic potential of extracts obtained by maceration of the following parts of the plant: Cylindropuntia imbricata (Cactaceae) cladode and seed, Opuntia engelmannii (Cactaceae) cladode and seed, Ibervillea sonorae (Cucurbitaceae) root and Theobroma cacao (Malvaceae) seed mixed with solvents of different polarity (hexane, ethyl acetate, dichloromethane and methanol). A total of 24 extracts were obtained and subjected to the following analyses: 1) phytochemical screening to determine their composition, 2) toxicity in B16F10 cells using the alamar blue test, 3) antioxidant capacity through DPPH inhibition, and 4) in vitro evaluation to determine their antihyperglycemic capacity (inhibition of alpha-glucosidase). The results obtained from methanolic extracts with O. engelmannii and T. cacao seeds, as well as ethyl acetate extracts with T. cacao and C. imbricata seeds showed antioxidant and antihyperglycemic activity. No toxicity in B16F10 cells, and antidiabetic potential in vitro. La diabetes mellitus es una enfermedad que no decrece y afecta a más de 537 millones de personas en el mundo. La diabetes al complicarse daña varios órganos hasta causar la muerte. Los fármacos en uso para contrarrestar la enfermedad producen efectos secundarios; circunstancia que ha propiciado la investigación en plantas con propiedades antidiabéticas. El objetivo de este estudio fue evaluar el potencial antidiabético de los extractos obtenidos por maceración de las siguientes partes de la planta: del cladodio y semilla de Cylindropuntia imbricata (Cactaceae), del cladodio y semilla de Opuntia engelmannii (Cactaceae), de la raíz de Ibervillea sonorae (Cucurbitaceae) y de la semilla de Theobroma cacao (Malvaceae) mezcladas con solventes de diferente polaridad (hexano, acetato de etilo, diclorometano y metanol). Se obtuvieron un total de 24 extractos sometidos a los análisis: 1) de cribado fitoquímico para determinar su composición, 2) de toxicidad en células B16F10 mediante la prueba de azul alamar, 3) de capacidad antioxidante a través de la inhibición de DPPH, y 4) de evaluación in vitro para conocer su capacidad antihiperglucémica (inhibición de la alfa glucosidasa). Los resultados obtenidos, de los extractos metanólicos con las semillas de O. engelmannii y T. cacao, así como los de acetato de etilo con las semillas de T. cacao y C. imbricata mostraron una actividad antioxidante y antihiperglucémica. Sin toxicidad en las células B16F10, y con potencial antidiabético in vitro.
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.
Atypical presentation of COVID-19: chronic bilateral testicular pain with lower extremity peripheral polyneuropathy, case report
(Elsevier, 2022-01) Salazar, Aníbal; Gonzalez, Agustín; Murray, Nigel P.; Castro, Carlos
In context of COVID-19 pandemic, there has been different presentations of the infection. The relationship of testicular pain with COVID-19 has not been extensively studied. We present a 31 years old male, with SARS-COV-2 infection, repeatedly consulting for intermittent bilateral testicular pain. Two months later he reported acute loss sensibility and pain in extremities, being diagnosed with axonal fine fiber polyneuropathy. Although the presence of SARS-COV-2 in testis remains controversial, there is a potential orchiepididymitis risk due to viral binding to ACE2 receptor in testicle, and also could induce systemic vasculitis as another possible cause of orchitis.
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.
Capnometry after an inspiratory breath hold, PLATCO2, as a surrogate for PaCO2 in mild to moderate Pediatric Acute Respiratory Distress Syndrome: A feasibility study
(Wiley Periodicals, 2023-07-10) Cruces, Pablo; Moreno, Diego; Reveco, Sonia; Améstica, Marjorie; Araneda, Patricio; Ramirez, Yennys; Vásquez-Hoyos, Pablo; Díaz, Franco
Objective: Accurate and reliable noninvasive methods to estimate gas exchange are necessary to guide clinical decisions to avoid frequent blood samples in children with pediatric acute respiratory distress syndrome (PARDS). We aimed to investigate the correlation and agreement between end‐tidal PCO2 measured immediately after a 3‐s inspiratory‐hold (PLATCO2) by capnometry and PaCO2 measured by arterial blood gases (ABG) in PARDS. Measurements and Main Results: All patients were in volume‐controlled ventilation mode. The regular end‐tidal P P CO ETCO ( ) 2 2 (without the inspiratory hold) was registered immediately after the ABG sample. An inspiratory‐hold of 3 s was performed for lung mechanics measurements, recording PETCO2 in the breath following the inspiratory‐hold. (PLATCO2). End‐tidal alveolar dead space fraction (AVDSf) was calculated as [( – )/ PP P aCO ETCO aCO ] 2 2 2 and its surrogate (S)AVDSf as [( CO – )/ CO PLAT 2 ETCO PLAT 2 P ] 2 . Measurements of PaCO2 were considered the gold standard. We performed concordance correlation coefficient (ρc), Spearman's correlation (rho), and Bland–Altmann's analysis (mean difference ± SD [limits of agreement, LoA]). Eleven patients were included, with a median (interquartile range) age of 5 (2–11) months. Tidal volume was 5.8 (5.7–6.3) mL/kg, PEEP 8 (6–8), driving pressure 10 (8–11), and plateau pressure 17 (17–19) cm H2O. Forty‐one paired measurements were analyzed. PaCO2 was higher than PETCO2 (52 mmHg [48–54] vs. 42 mmHg [38–45], p < 0.01), and there were no significant differences with PLATCO2 (50 mmHg [46–55], p > 0.99). The concordance correlation coefficient and Spearman's correlation between PaCO2 and PLATCO2 were robust (ρc = 0.80 [95% confidence interval [CI]: 0.67–0.90]; and rho = 0.80, p < 0.001.), and for PETCO2 were weak and strong (ρc = 0.27 [95% CI: 0.15–0.38]; and rho = 0.63, p < 0.01). The bias between PLATCO2 and PaCO2 was −0.4 ± 3.5 mmHg (LoA −7.2 to 6.4), and between PETCO2 and PaCO2 was −8.5 ± 4.1 mmHg (LoA −16.6 to −0.5). The correlation between AVDSf and (S)AVDSf was moderate (rho = 0.55, p < 0.01), and the mean difference was −0.5 ± 5.6% (LoA −11.5 to 10.5) Conclusion: This pilot study showed the feasibility of measuring end‐tidal CO2 after a 3‐s end‐inspiratory breath hole in pediatric patients undergoing controlled ventilation for ARDS. Encouraging preliminary results warrant further study of this technique.
The CAPRA-S Score and Immune Dysfunction as a Guide to Outcome in Men Treated with Prostatectomy Radical as Mono-Therapy for Prostate Cancer
(Archivos Españoles de Urología, 2022-08) Murray, Nigel P.; Aedo, Sócrates; Fuentealba, Cynthia; Reyes, Eduardo; Salazar, Aníbal
Objective: Incorporate the immune function as determined by the absolute lymphocyte count (ALC) into the CAPRA-S risk stratification score to determine if predictive values could be improved. Materials and Methods: The clinical pathological findings in the surgical specimen and total PSA were used to define the three CAPRA-S risk groups. One month after surgery and at each follow up total PSA and the ALC were determined, until biochemical failure (BF) or the end of the study period. A cut off value of<1,000 lymphocytes/mm3 was used to define lymphocytopenia (LCP). Each CAPRA-S group was sub- ivided based on the presence or absence of LCP. Kaplan-Meier biochemical failure free survival (BFFS) curves and restricted mean biochemical failure free survival times were calculated for each group. Results: 404 patients participated of whom 103 (25.5%) underwent BF. 270 men were CAPRA-S low risk (LR), 89 intermediate risk (IR) and 45 high risk (HR), of whom LCP was found in 22 (8%) of low risk, 24 (27%) of intermediate risk and 17 (38%) of high risk men. LCP was significantly associated with a higher PSA, higher Gleason and CAPRA-S scores and BF. HRs were 1.76 for IR, 2.49 for HR and 1.29 for LCP. Five-year BFFS for men without LCP, LR 93.5%, IR 61% and HR 36%, for those with LCP, LR 55%, IR 25% and HR 6%. All patients with LCP and IR or HR scores relapsed within 6 years. 10 year BFFS for men without LCP were 71% LR, 43% IR and 23% HR, LR with LCP 16%. Men with BF had increasing LCP approximately 18 months before BF. Conclusions: The incorporation of the ALC taken one month after surgery with the CAPRA-S improves risk stratification; decreases in the ALC suggest that BF is occuring. These results need to be confirmed with larger studies.
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.
Clinical and organizational framework of repurposing pediatric intensive care unit to adult critical care in a resource-limited setting: Lessons from the response of an urban general hospital to the COVID-19 pandemic
(Elsevier, 2022) Díaz, Franco; Kehr, Juan; Cores, Camila; Rubilar, Patricia; Medina, Tania; Vargas, Caroline; Cruces, Pablo
Purpose We aim to describe the action plan and clinical results of a COVID-19 unit for adult patient care in units intended for critically ill children, proposing a clinical/administrative framework. Methods We reviewed the preparedness of the PICU team before the surge of cases of COVID-19 and the organizational/administrative issues to increase critical beds in a six-bed PICU allocated to adult critical care in a government-funded general hospital in Latin America. We analyzed the prospectively collected administrative/clinical data of severe COVID-19 cases admitted to PICU during the peak of the first wave of the pandemic. Results We describe a 6-step preparedness plan: recruitment and education, admission criteria, children diversion, team hierarchy, and general and respiratory equipment. The 6-bed PICU was allocated to adult care for 20 weeks, progressively increasing capacity to a 23-bed dedicated COVID-19 unit managed by the PICU team. A six-block bed organizational units were implemented, and personnel increased from 40 to 125 healthcare workers in 24 h shifts. COVID-19 incidence in personnel was 0.5/1000 workdays. One hundred thirty-six patients were admitted, median age 59 (51,65) years old, 68% were male, and 63% had P/F ≤ 100. In addition, 48% received mechanical ventilation, the median length of stay was 7 (3,17), and in-hospital mortality was 15%. Conclusions We propose an organizational framework for the role of PICU in the hospital action plan to increase adult critical beds. The cohort of patients admitted to a PICU repurposed as a COVID-19 ICU had good outcomes. These data are valuable to plan coordinated actions of the healthcare system for future scenarios.
Clinical course of atypical parathyroid neoplasm with soft tissue extension
(Wiley, 2024-08-19) Feldman, Hope; Busaidy, Naifa; Tame-Elorduy, Andres; Silva-Figueroa, Angélica; Halfteck, Gili; Merriman, Kelly; Waguespack, Steven; Graham, Paul; Williams, Michelle; Perrier, Nancy
Background and Objectives: The American Joint Committee on Cancer (AJCC) TNM staging system defines atypical parathyroid neoplasia (APN) as tumor in situ (Tis) and reserves the definition of parathyroid carcinoma (PC) to parathyroid tumor with invasion into surrounding structures. Because the parathyroid gland has no true capsule, “extension” with APN versus microscopic “invasion” of surrounding soft tissue can be difficult and confusing for clinicians. We aimed to determine the clinical course of atypical parathyroid neoplasm with and without soft tissue extension and parathyroid carcinoma with only soft tissue invasion (pT1) and to report the outcomes. Methods: Following an IRB‐approved protocol, we identified all patients treated for parathyroid neoplasm or cancer at our single tertiary care cancer center from 1990 to 2021. We excluded all patients with evidence of clinical or pathologic gross invasion into surrounding structures (pT2 or higher), lymph node involvement, or metastatic disease. By definition, this excluded all cases where the distinction was clinically evident to the surgeon at the time of the operation based on finding a hard, firm, sticky, or discolored parathyroid gland. Only patients with pathologic T1 (pT1) parathyroid carcinoma or APN were included. All pathologic examinations were independently re‐reviewed by a single designated expert senior endocrine pathologist. The definition of APN strictly followed the WHO definition of a clinically worrisome lesion having features including fibrous bands or increased mitotic rate, necrosis, or trabecular growth that did not meet robust criteria for frank invasion. Pathologic T1 disease was defined as invasion limited to soft tissue. Analyses were performed using R version 4.0.2 and Jamovi. Results: Of all PC patients at our institution, only 71 met the strict inclusion criteria of APN or pT1. Forty‐four patients had pT1 disease and 27 had APN: 12 of the APN had soft tissue extension, and 15 had no soft tissue extension. The groups were similar with regard to age at diagnosis (p = 0.328). The average follow‐up duration was 84 months from initial surgical intervention. Of the 12 with APN, one patient (1/12; 8%) with soft tissue extension recurred, developed distant metastases, andsubsequently died during follow up. Of the 44 patients with pT1 PC, six developed distant metastases and 13 (13/44; 30%) died during the follow‐up period. One patient with APN and soft tissue extension recurred and died and no patient with APN and no soft tissue extension died. Conclusions: Patients with APN and extension into soft tissue have a clinical course similar to that of APN without soft tissue extension. APN with soft tissue extension is a different disease from pT1 disease with invasion of soft tissue. The pTis classification appears justified for APN with and without soft tissue extension.
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
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.
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.
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.
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.
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.
Exploring the lutein therapeutic potential in steatotic liver disease: mechanistic insights and future directions
(Frontiers Media S.A., 2024) Balboa, Elisa; Saud, Faride; Parra Ruiz, Claudia; De la Fuente, Marjorie; Landskron, Glauben; Zanlungo, Silvana
The global prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is increasing, now affecting 25%–30% of the population worldwide. MASLD, characterized by hepatic steatosis, results from an imbalance in lipid metabolism, leading to oxidative stress, lipoperoxidation, and inflammation. The activation of autophagy, particularly lipophagy, alleviates hepatic steatosis by regulating intracellular lipid levels. Lutein, a carotenoid with antioxidant and anti-inflammatory properties, protects against liver damage, and individuals who consume high amounts of lutein have a lower risk of developing MASLD. Evidence suggests that lutein could modulate autophagy-related signaling pathways, such as the transcription factor EB (TFEB). TFEB plays a crucial role in regulating lipid homeostasis by linking autophagy to energy metabolism at the transcriptional level, making TFEB a potential target against MASLD. STARD3, a transmembrane protein that binds and transports cholesterol and sphingosine from lysosomes to the endoplasmic reticulum and mitochondria, has been shown to transport and bind lutein with high affinity. This protein may play a crucial role in the uptake and transport of lutein in the liver, contributing to the decrease in hepatic steatosis and the regulation of oxidative stress and inflammation. This review summarizes current knowledge on the role of lutein in lipophagy, the pathways it is involved in, its relationship with STARD3, and its potential as a pharmacological strategy to treat hepatic steatosis.
Factores asociados a ventilación mecánica prolongada en niños con fallo respiratorio de causa pulmonar: estudio de cohortes del registro de LARed Network
(Elsevier, 2023-06-15) Barajas-Romero, Juan Sebastían; Vásquez-Hoyos, Pablo; Pardo, Rosalba; Jaramillo-Bustamante, Juan Camilo; Grigolli, Regina; Monteverde-Fernández, Nicolas; Gonzalez-Dambrauskas, Sebastián; Jabornisky, Roberto; Cruces, Pablo; Wegner, Adriana; Díaz, Franco; Pietroboni, Pietro
Objectives: To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). Design: Secondary analysis of a prospective cohort. Setting: PICUs in centers that are part of the LARed Network between April 2017 and January 2022. Participants: Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. Main variables of interest: Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. Results: 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). Conclusions: Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay

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