The neutrophil-to-lymphocyte ratio as a prognostic biomarker in Guillain-Barre syndrome: a systematic review with meta-analysis

Background and objectivesGuillain-Barre syndrome (GBS) is an immune-mediated neuropathy. This has raised the possibility that the neutrophil-lymphocyte ratio (NLR) may be a biomarker of its activity. We conducted a systematic review and meta-analysis to summarize the evidence of NLR as a potential biomarker for GBS.MethodsWe systematically searched databases (PubMed, Ovid-Medline, Embase, Scopus, Web of Science, SciELO Citation Index, LILACS, and Google Scholar) until October 2021 for studies evaluating pre-treatment NLR values in GBS patients. A meta-analysis using a random-effects model to estimate pooled effects was realized for each outcome and a narrative synthesis when this was not possible. Subgroup and sensitivity analysis were realized. GRADE criteria were used to identify the certainty of evidence for each result.ResultsTen studies from 745 originally included were selected. Regarding GBS patients versus healthy controls, a meta-analysis of six studies (968 patients) demonstrated a significant increase in NLR values in GBS patients (MD: 1.76; 95% CI: 1.29, 2.24; I2 = 86%) with moderate certainty due to heterogeneity of GBS diagnosis criteria used. Regarding GBS prognosis, assessed by Hughes Score ≥ 3, NLR had a sensitivity between 67.3 and 81.5 and a specificity between 67.3 and 87.5 with low certainty due to imprecision, and heterogeneity. In relation to respiratory failure, NLR had a sensitivity of 86.5 and specificity of 68.2 with high and moderate certainty, respectively.DiscussionWith moderate certainty, mean NLR is higher in GBS patients compared to healthy controls. Furthermore, we found that NLR could be a prognostic factor for disability and respiratory failure with low and moderate certainty, respectively. These results may prove useful for NLR in GBS patients; however, further research is needed.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285212

Leiomiosarcoma uterino con metástasis atípica posterior a una histerectomía total: reporte de caso

Introduction: Uterine leiomyosarcoma is a rare and highly aggressive sarcoma, which can metastasize most frequently to the lung and liver. Its prognosis is poor, with early total abdominal hysterectomy being the first line treatment. Other alternatives are chemotherapy with regimens of doxorubicin, ifosfamide or gemcitabine, alone or in combination. Case report: We present a 40-year-old Peruvian woman who underwent hysterectomy for suspected leiomyoma; however, pathology revealed a final diagnosis of uterine leiomyosarcoma. She could not be notified due to loss to follow-up. Two years later, she again presented with metastases in the thigh, breast, liver, lungs and scalp. He was given Ifosfamide and Doxorubicin every 21 days for 3 courses, however, due to disease progression, palliative treatment was decided. Finally, he died two months after treatment. Conclusion: A case of uterine leiomyosarcoma with atypical metastasis is presented to promote early and differentiated diagnosis of leiomyoma, low grade leiomyosarcoma and high grade leiomyosarcoma to define the correct treatment.Introducción: El leiomiosarcoma uterino es un sarcoma poco frecuente sumamente agresivo, que puede presentar metástasis más frecuentemente a pulmón e hígado. Su pronóstico es malo, siendo la histerectomía total temprana el tratamiento de primera línea Otras alternativas son la quimioterapia con regímenes de doxorrubicina, ifosfamida o gemcitabina, solos o en combinación. Reporte de caso: Presentamos a una mujer peruana de 40 años que fue sometida a histerectomía por sospecha de leiomioma; sin embargo, la patología reveló un diagnóstico final de leiomiosarcoma uterino. No se le pudo notificar debido a la pérdida de seguimiento. Dos años más tarde, volvió a presentar metástasis en muslo, mama, hígado, pulmones y cuero cabelludo. Se le administró Ifosfamida y Doxorubicina cada 21 días durante 3 cursos; sin embargo, debido a la progresión de la enfermedad, se decidió un tratamiento paliativo. Finalmente, falleció dos meses después del tratamiento. Conclusión: Se presenta un caso de leiomiosarcoma uterino con metástasis atípica para promover el diagnóstico precoz y diferenciado de leiomioma, leiomiosarcoma de bajo grado y leiomiosarcoma de alto grado para definir el tratamiento correcto

Mean Platelet Volume in Neonatal Sepsis: Meta-Analysis of Observational Studies

"first_pagesettingsOrder Article Reprints Open AccessSystematic Review Mean Platelet Volume in Neonatal Sepsis: Meta-Analysis of Observational Studies by Carlos J. Toro-Huamanchumo 1ORCID,Cielo Cabanillas-Ramirez 2,3ORCID,Carlos Quispe-Vicuña 3,4ORCID,Jose A. Caballero-Alvarado 5ORCID,Darwin A. León-Figueroa 3,6ORCID,Nicolás Cruces-Tirado 7 andJoshuan J. Barboza 3,8,*ORCID 1 Escuela de Medicina, Universidad Cesar Vallejo, Trujillo 13007, Peru 2 Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru 3 Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13007, Peru 4 Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru 5 Facultad de Medicina, Universidad Privada Antenor Orrego, Trujillo 13007, Peru 6 Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 14000, Peru 7 Facultad de Ciencias de la Salud, Universidad Señor de Sipán, Chiclayo 14006, Peru 8 Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15046, Peru * Author to whom correspondence should be addressed. Children 2022, 9(12), 1821; https://doi.org/10.3390/children9121821 Received: 5 October 2022 / Revised: 21 November 2022 / Accepted: 22 November 2022 / Published: 25 November 2022 (This article belongs to the Section Pediatric Infectious Diseases) Download Browse Figures Review Reports Versions Notes Abstract Introduction: Early onset neonatal sepsis (EONS), particularly in preterm sepsis, is a potentially fatal issue. Evaluation of mean platelet volume (MPV) as an EONS predictor was the goal. Methods: Four databases were used to conduct a systematic evaluation of cohort and case–control studies. Up till the end of October 2022, 137 articles were found utilizing the search method. Following the review, 12 studies were included. Leukocytes, MPV, platelets, gender, birth weight, gestational age, mortality, and C-reactive protein (CRP) were all taken into account while analyzing the prediction of EONS. Inverse-variance methodology and the random-effects model were used. Using GRADE, the evidence’s quality was evaluated. Results: Neonatal patients with sepsis had significantly higher MPV levels than do neonates without sepsis (MD 1.26; 95% CI 0.89–1.63; p < 0.001). An increased MPV during the first 24 h postpartum was associated with high CRP values and high risk of neonatal mortality. In the investigations, the MPV cutoff for sepsis patients was 9.95 (SD 0.843). Overall certainty of the evidence was very low. Conclusions: The increased MPV during the first 24 h postpartum may be predictive of EONS and mortality. Future studies are warranted.

Coinfection of Monkeypox virus and Varicella Zoster Virus: A Scoping review

   In recent years, although the pandemic caused by COVID-19 has not yet been overcome, a new pandemic caused by monkeypox has created a new global health crisis. Monkeypox is a re-emerging zoonotic disease caused by a virus of the genus Orthopoxvirus that is transmitted by direct, sexual or respiratory droplet contact; its clinical manifestations include fever, rash on the face and extremities and lymphadenopathy. However, cases of coinfection of monkeypox with varicella zoster virus have been reported  even before the monkeypox pandemic was established. In these cases, a difficulty has been noted in making the differential diagnosis of monkeypox, since the clinical picture is usually very similar to that of herpes zoster. This is why the aim of this review is to explore the scope of the evidence on coinfection of varicella zoster virus with monkeypox.</p

A Bibliometric Analysis of the International Dental Journal (2011-2020)

Introduction: Bibliometrics is an area that allows for the evaluation of scientific publications by means of different indicators. The aim of this research was to perform a bibliometric study of the scientific production of the International Dental Journal (IDJ) between 2011 and 2020. Methods: All publications of the journal between 2011 and 2020 extracted from the Scopus database were included. The number of publications, most productive institutions, type of collaboration, most productive countries, most cited articles, and authors with the highest academic production were used as bibliographic indicators. It was exported to the SciVal tool for analysis. Results: A total of 630 documents published in IDJ by 1947 authors were collected, with a total of 7212 citations (11.4 citations per document). The United States was the country with the highest number of documents (100). The University of Adelaide (Australia) was the institution with the highest scientific production (16 publications), whilst the institution with the highest impact was the Universidade de São Paulo (Brazil), with 12.2 citations per paper. Marc Luiz Tennant was the author with the highest number of published manuscripts (13). Finally, most of the publications had international collaboration (146 documents). Conclusions: IDJ is a high-quality journal and, in the dental field, it has a high impact worldwide, which allows for a greater number of citations of its articles and placing it in the forefront of future research

A case report of blastic plasmacytoid dendritic cell neoplasm in a hispanic child

Plasmacytoid dendritic cell neoplasms are aggressive and rare hematologic malignancies characterized by clonal expansion of plasmacytoid dendritic cells with frequent cutaneous involvement. The pathogenesis is not well established, and it shows enhanced expression of CD56, CD4 and CD123 detected by flow cytometry and immunohistochemistry. We report a case report of this rare disease in a hispanic child with complete remission after using a protocol for high-risk acute lymphoblastic leukemia

Evaluating the diagnostic performance of hemoglobin in the diagnosis of iron deficiency anemia in altitude residents: A Scoping Review

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Factors Associated with Drug Consumption Without Scientific Evidence in Patients with Mild COVID-19 in Peru

Objective This study aimed to evaluate the factors associated with the consumption of drugs without scientific evidence in patients with mild COVID-19 infection in Peru. Methods An analytical cross-sectional study was carried out including 372 adult patients with a history of mild COVID-19 disease. Factors associated with drug consumption were evaluated by Poisson regressions with robust variance adjustment using the bootstrapping resampling method. Results Seventy-two percent consumed some medication without scientific evidence, with antibiotics (71%) and ivermectin for human use (68%) being the most commonly used. Factors associated with the consumption of drugs to treat mild COVID-19 infection were thinking that the drugs are not effective (adjusted prevalence ratio, 0.55; 95% confidence interval, 0.41-0.74) and not being informed about the efficacy of the drugs (adjusted prevalence ratio, 0.48; 95% confidence interval, 0.36-0.65). Conclusions Education of the population seems to be the main factor that increases the consumption of drugs without scientific evidence in the Peruvian population to treat mild COVID-19.Revisión por pare

Level of Knowledge Regarding Mpox among Peruvian Physicians during the 2022 Outbreak: A Cross-Sectional Study

Introduction: Due to the high incidence of mpox in Peru and the poor knowledge about this disease among healthcare workers in non-endemic countries, it is crucial to determine the knowledge status of Peruvian physicians. Methodology: We conducted an analytical cross-sectional study based on an online survey from August to September 2022. Physicians who had a medical license and lived and practiced medicine in Peru were included. To evaluate the factors associated with a higher level of knowledge, we used crude (cPR) and adjusted (aPR) prevalence ratios with 95% confidence intervals (95% CI) using Poisson regression. Results: We included 463 physicians. The mean age was 36.6 (SD: 10.3) years, and most were male (58.1%). Regarding knowledge, the median knowledge score was 14 [IQR: 13 to 15] out of 17 points. In terms of knowledge gaps, only 60.7% of the participants knew that there was an FDA-approved vaccine for mpox, 49.0% of participants knew about mpox proctitis and 33.3% acknowledged that it could be transmitted by the bite of an infected rodent. We found that taking care of patients with mpox (aPR: 1.39; 95% CI: 1.13 to 1.72) was associated with higher knowledge (>p50), while living in the eastern macro-region (aPR: 0.62; 95% CI: 0.42 to 0.93) was associated with lower knowledge (≤p50). Conclusions: Our study showed a high level of knowledge about mpox among Peruvian physicians. However, educational campaigns may be necessary, especially for physicians from the eastern region and those who do not have clinical experience with mpox

Nivel de conocimiento sobre Mpox entre médicos peruanos durante el brote de 2022: un estudio transversal

Introduction: Due to the high incidence of mpox in Peru and the poor knowledge about this disease among healthcare workers in non-endemic countries, it is crucial to determine the knowledge status of Peruvian physicians. Methodology: We conducted an analytical cross-sectional study based on an online survey from August to September 2022. Physicians who had a medical license and lived and practiced medicine in Peru were included. To evaluate the factors associated with a higher level of knowledge, we used crude (cPR) and adjusted (aPR) prevalence ratios with 95% confidence intervals (95% CI) using Poisson regression. Results: We included 463 physicians. The mean age was 36.6 (SD: 10.3) years, and most were male (58.1%). Regarding knowledge, the median knowledge score was 14 [IQR: 13 to 15] out of 17 points. In terms of knowledge gaps, only 60.7% of the participants knew that there was an FDA-approved vaccine for mpox, 49.0% of participants knew about mpox proctitis and 33.3% acknowledged that it could be transmitted by the bite of an infected rodent. We found that taking care of patients with mpox (aPR: 1.39; 95% CI: 1.13 to 1.72) was associated with higher knowledge (>p50), while living in the eastern macro-region (aPR: 0.62; 95% CI: 0.42 to 0.93) was associated with lower knowledge (≤p50). Conclusions: Our study showed a high level of knowledge about mpox among Peruvian physicians. However, educational campaigns may be necessary, especially for physicians from the eastern region and those who do not have clinical experience with mpox.Introducción: Debido a la alta incidencia de la mpox en Perú y al escaso conocimiento sobre esta enfermedad entre los trabajadores de la salud en países no endémicos, es crucial determinar el estado de conocimiento de los médicos peruanos. Metodología: Realizamos un estudio transversal analítico basado en una encuesta en línea de agosto a septiembre de 2022. Se incluyeron médicos que tenían licencia médica y residían y ejercían la medicina en Perú. Para evaluar los factores asociados a un mayor nivel de conocimiento se utilizaron razones de prevalencia crudas (cPR) y ajustadas (aPR) con intervalos de confianza del 95% (IC 95%) mediante regresión de Poisson. Resultados: Se incluyeron 463 médicos. La edad media fue de 36,6 (DE: 10,3) años y la mayoría eran hombres (58,1%). En cuanto a los conocimientos, la mediana de la puntuación de conocimientos fue de 14 [RIC: 13 a 15] sobre 17 puntos. En cuanto a las lagunas de conocimiento, solo el 60,7 % de los participantes sabía que existía una vacuna contra la mpox aprobada por la FDA, el 49,0 % de los participantes conocía la proctitis por mpox y el 33,3 % reconocía que podía transmitirse por la picadura de un roedor infectado. Encontramos que cuidar a pacientes con mpox (RPa: 1,39; IC 95%: 1,13 a 1,72) se asoció con un mayor conocimiento (>p50), mientras vivan en la macrorregión oriental (RPa: 0,62; IC 95%: 0,42 a 0,93) se asoció con un menor conocimiento (≤p50). Conclusiones: Nuestro estudio mostró un alto nivel de conocimiento sobre la mpox entre los médicos peruanos. Sin embargo, pueden ser necesarias campañas educativas, especialmente para los médicos de la región oriental y aquellos que no tienen experiencia clínica con la mpox