Documento español de consenso sobre diagnóstico,estabilización y tratamiento del síndrome inflamatorio multisistémico pediátrico vinculado a SARS-CoV-2 (SIM-PedS)

A new paediatric multisystem inflammatory syndrome, linked to SARS-CoV-2, has been described. The clinical picture is variable and is associated with an active or recent infection due to SARS-CoV-2. A review of the existing literature by a multidisciplinary group of paediatric specialists is presented in this document. Later, they make recommendations on the stabilisation, diagnosis, and treatment of this syndrome.     

Adoption of the chronic care model to improve HIV care: In a marginalized,largely aboriginal population

Objective

To measure the effectiveness of implementing the chronic care model (CCM) in improving HIV clinical outcomes.

Design

Multisite, prospective, interventional cohort study.

Setting

Two urban community health centres in Vancouver and Prince George, BC.

Participants

Two hundred sixty-nine HIV-positive patients (18 years of age or older) who received primary care at either of the study sites.

Intervention

Systematic implementation of the CCM during an 18-month period.

Main outcome measures

Documented pneumococcal vaccination, documented syphilis screening, documented tuberculosis screening, antiretroviral treatment (ART) status, ART status with undetectable viral load, CD4 cell count of less than 200 cells/mL, and CD4 cell count of less than 200 cells/mL while not taking ART compared during a 36-month period.

Results

Overall, 35% of participants were women and 59% were aboriginal persons. The mean age was 45 years and most participants had a history of injection drug use that was the presumed route of HIV transmission. During the study follow-up period, 39 people died, and 11 transferred to alternate care providers. Compared with their baseline clinical status, study participants showed statistically significant (P < .001 for all) increases in pneumococcal immunization (54% vs 84%), syphilis screening (56% vs 91%), tuberculosis screening (23% vs 38%), and antiretroviral uptake (47% vs 77%), as well as increased viral load suppression rates among those receiving ART (72% vs 90%). Stable housing at baseline was associated with a 4-fold increased probability of survival. Aboriginal ethnicity was not associated with better or worse outcomes at baseline or at follow-up.

Conclusion

Application of the CCM approach to HIV care in a marginalized, largely aboriginal patient population led to improved disease screening, immunization, ART uptake, and virologic suppression rates. In addition to addressing underlying social determinants of health, a paradigm shift away from an “infectious disease” approach to a “chronic disease management” approach to HIV care for marginalized populations is strongly recommended.     

Meningioma presenting as an intraoral mass in a patient with neurofibromatosis type 1

A 77-year-old woman with neurofibromatosis type 1 presented with ill-fitting dentures due to intraoral extension of a right temporal fossa mass. Computed tomographic scanning demonstrated that the masticator space mass bowed the zygomatic arch and remodeled the lateral orbit and maxillary sinus walls, findings that were consistent with the clinical diagnosis of a neurofibroma with possible malignant transformation. However, light microscopic, immunohistochemical, and ultrastructural examination of tissue from an incisional biopsy specimen were diagnostic of meningioma. This case illustrates that the clinicopathologic differential diagnosis of an enlarging mass in patient with neurofibromatosis should include sporadic, unrelated neoplasms as well as tumors known to be associated with the syndrome.     

Bronchial Plasma Exudation After Adenosine Monophosphate or Methacholine Challenge

Nonspecific hyperresponsiveness to adenosine monophosphate is better related to airway inflammation than methacholine. Adenosine induces mast cells and other cells to release inflammatory mediators that produce bronchoconstriction and perhaps other inflammatory effects, such as plasma exudation, which have not been well studied. We compared the plasma exudation effect, as measured in induced sputum, between adenosine and methacholine challenge in healthy and asthmatic subjects. In a cross-over design, 42 subjects were randomly challenged with adenosine or methacholine. After recovery, induced sputum was collected on 2 separate days, 48 to 72 hours apart. In the control group, an additional challenge with saline was performed. Differential cell counts and albumin and alpha2-macroglobulin levels were determined. The sputum volume obtained was sufficient to measure proteins in only 34 subjects: 10 healthy individuals and 24 mild asthmatics. There was a significant difference between adenosine and methacholine in sputum albumin (mean differences: 68[73.4] μg/L in controls, p = 0.039 and 48.0[162.9] μg/L in asthmatics) and cell counts, but only a tendency in alpha2-macroglobulin. PC20 adenosine was better related to eosinophil counts than methacholine (r = -0.44, p = 0.014). Albumin or alpha2-macroglubulin levels were not significantly correlated with baseline FEV₁, PC20, or eosinophil counts. Adenosine, but not methacholine challenge, produces a mild airway plasma exudation that does not seem to be relevant to bronchoconstriction. However, this could be relevant, to some supernatant measurements after adenosine challenge.     

Tratamiento adyuvante del cáncer gástrico resecable: experiencia en un servicio de Oncología

Introduction. The curative management of gastric adenocarcinoma depends on complete resection of the primary tumour. The relapse rates from the recurrent cancer are between 40% and 70%. Until recently, attempts at preventing recurrence, usually using adjuvant chemotherapy, have been ineffective. Based on INT-0116 results, gastric cancer patients from stage IB (T1N1 or T2a/b N0) to stage IV (T4 N1,2,3 M0/T1,2,3 N3M0) received combined chemotherapy and radiotherapy treatment following gastric resection. Material and methods. Patients (n=39) were included over 36 months. Results. The main toxicity was digestive grade 1 or 2 in 17/39 (44%) cases. More frequent haematological toxicity was grade 1–2 neutropenia, in 7/39 patients (26.5%). Asthenia was a relevant toxicity in 17/39 (44%) of our patients. With a median follow-up of 20.2 months, we have not reached the median overall survival nor the median disease-free survival. There was recurrence in 14/39 (35.8%) cases and the remainder are disease-free (64.2%). Conclusions. More studies are necessary to evaluate better the disease-free survival following gastric cancer resection. Also, less toxic treatments need to be developed so as to increase treatment compliance.