Aparición de porfiria cutánea tarda durante el tratamiento con peg-interferón más ribavirina en un paciente con hepatitis C crónica con viremia indetectable

La porfiria cutánea tarda (PCT) es considerada una manifestación extrahepática de la infección por el virus de la hepatitis C (HCV). La frecuencia de esta asociación es variable y no es claro el mecanismo por el cual el virus la desencadena. Se presenta un hombre de 47 años con hepatitis C, genotipo-1b, que durante el tratamiento con peg-interferón alfa-2b más ribavirina sin viremia detectable en las semanas 12, 24 y 48, en la semana 44 consulta por presentar lesiones dermatológicas fotosensibles. Con el diagnóstico presuntivo de PCT se realizó biopsia cutánea y el dosaje de porfirinas urinarias fue 4185 ug/24hs (vn: < 250). El análisis cromatográfico reveló el típico patrón de PCT, confirmando el diagnóstico. El gen HFE de la hemocromatosis mostró mutaciones de carácter heterocigoto (H63D y C282Y), asociación frecuente en los pacientes con sobrecarga de hierro y PCT. El tratamiento antiviral de la infección por HCV puede mejorar las manifestaciones de la PCT. La ocurrencia de novo de ésta fue reportada recientemente durante el tratamiento de la hepatitis C crónica con interferón y ribavirina pero no hay casos relatados de aparición tardía de PCT en pacientes HCV con viremia no detectable. La presencia de la mutación del gen HFE y la posibilidad de un aumento de oferta de hierro por la acción hemolítica de la ribavirina podrían explicar un exceso de hierro capaz de desencadenar la crisis de PCT. Tampoco son concluyentes los estudios con respecto al aumento o no de la concentración de hierro en hígado en pacientes con anemia que reciben ribavirina

Tafonomía y modos de preservación de los espinicaudados (crustacea-branchiopoda) de la formación La Matilde (jurásico medio) de la Provincia Santa Cruz (Argentina)

El propósito de este trabajo fue identificar las especies de espinicaudados provenientes de seis localidades de la Fm. La Matilde, describir los modos preservacionales y determinar los procesos tafonómicos involucrados en su fosilización Para este fin, se extrajeron datos morfométricos y tafonómicos de 300 especímenes en total. Además, se realizó el análisis de la composición elemental de los fósiles y de las rocas portadores, mediante un espectrómetro dispersivo en energía (EDS). Los análisis taxonómicos confirmaron la presencia de dos especies, Eosolimnadiopsissantacrucencis Gallego, 1994 y “Lioestheria” malacaraensis Tasch, 1987, asignando por primera vez esta última en la familia Fushunograptidae. El estudio tafonómico reveló diferencias en los procesos diagenéticos involucrados en la preservación de las valvas.Atributos tafonómicos, como la ausencia de alineamiento y distribución al azar de los restos de las valvas resultaron homogéneos en todas las localidades. Así mismo, los restos de valvas presentaron un bajo grado de fragmentación e incluso se registraron valvas articuladas. La coloración de las valvas, a su vez, resultó muy variable dentro y entre localidades. Los análisis químicos exploratorios expusieron diferencias en las abundancias relativas elementales, entre el sedimento y los fósiles, y a la vez permitieron detectar la preservación de restos de valva original. Todos estos datos nos permitieron definir para la Formación La Matilde (Jurásico Medio) un ambiente de aguas someras con acumulaciones de ΄conchostracos΄ autóctonas, influenciado por la actividad volcánica, caracterizado principalmente por la baja energía e influencia del transporte en la depositación de los restos

Preservational Analysis Of Jurassic Clam Shrimps From La Matilde Formation (Patagonia, Argentina) By Libs And Raman Spectroscopies

Preservation of arthropod cuticles is of paramount importance for taphonomic interpretations in which the fossil record of the chitin-protein complex is considered a key molecular signature of the group studied. In this work, different specimens of clam shrimps and their surrounding sedimentary matrix recovered from four localities of the La Matilde Formation (Patagonia, Argentina) were chemically analyzed for the first time by Laser-induced breakdown spectroscopy (LIBS) and RAMAN spectroscopic techniques. The spectral data recorded from the fossils were processed and analyzed through multivariate statistics, including Principal Component Analysis (PCA), Nonmetric Multidimensional Scaling (NMDS), and Analysis of Similarities (ANOSIM). The correlation between the different colorations featured by the specimens and the atomic chemical composition of their carapaces was systematically investigated to gain a better understanding of the fossilization processes together with more detailed interpretations. We found that the carapaces featuring a yellow-brown color exhibited a similar chemical profile with iron predominance, while those with the same color as the sedimentary matrix presented a distinctive composition. Considering the volcanic influence to which the different localities studied and carapaces were exposed, we propose that the clam shrimps from the four localities were preserved in at least three ways, namely, (1) pyritization; (2) admixed preservation; and (3) impression, each with distinctive characteristics of the taphonomic processes involved. Overall, results obtained provide useful information to achieve a more comprehensive knowledge about the taphonomy of fossils in a Jurassic lacustrine paleo-environment, as the La Matilde Formation.Fil: Jiménez, Victoria Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; ArgentinaFil: Monferran, Mateo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; ArgentinaFil: Diaz Pace, Diego Martin. Universidad Nacional del Centro de la Provincia de Buenos Aires. Centro de Investigaciones en Física e Ingeniería del Centro de la Provincia de Buenos Aires. - Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Centro de Investigaciones en Física e Ingeniería del Centro de la Provincia de Buenos Aires. - Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas. Centro de Investigaciones en Física e Ingeniería del Centro de la Provincia de Buenos Aires; ArgentinaFil: Copello, Guillermo Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Metabolismo del Fármaco. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Metabolismo del Fármaco; ArgentinaFil: Pellerano, Roberto Gerardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Química Básica y Aplicada del Nordeste Argentino. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas Naturales y Agrimensura. Instituto de Química Básica y Aplicada del Nordeste Argentino; ArgentinaFil: Cabaleri, Nora Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geocronología y Geología Isotópica. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geocronología y Geología Isotópica; ArgentinaFil: Gallego, Oscar Florencio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; Argentin

Combination of analytic techniques to chemical characterization and preservation of Jurassic clam shrimp carapaces from La Matilde formation, Patagonia

Chemical studies of fossil clam shrimps have taken relevance in the possibility of inferring about fossilization processes. Laser–induced Breakdown Spectroscopy (LIBS) is an attractive technique for geological analyses because the laser can ablate a few micrograms directly from a small area on the solid sample. On the other hand, RAMAN spectroscopy is a technique that allows rapid and non-destructive in situ detection of the components of the samples and has been used in micropalaeontology to identify carbonaceous materials. In this study, the aim was an analysis of the preservation of the clam shrimp Eosolimnadiopsis? Santacrucensis Gallego, 1994 from La Matilde Formation (Jurassic) using diverse methods including LIBS, RAMAN and X–ray fluorescence (XRF) techniques as well as surrounding rock. Afterwards LIBS results were evaluated using principal component analysis (PCA). According to XRF data, Si was the main element, indicating that the rock sample consists primarily of silicate minerals. Our results of LIBS and PCA analysis indicate chemical changes between the points from carapaces and rock matrix. Some areas of the carapace showed high peaks of Ca, Na, Mg and it was variable for Si, while in other parts of the carapace and rock matrix the Si remained at high intensity. Also, RAMAN spectroscopic analysis revealed the presence of amorphous carbon. This is the first report and evaluation on the LIBS and RAMAN techniques applied to fossil clam shrimps and contributes to obtaining a range of additional information to subsequently establish the different mechanisms involved in the taphonomic history of these organisms.Fil: Jiménez, Victoria Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; ArgentinaFil: Monferran, Mateo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; ArgentinaFil: Sperança, Marco A.. Universidade Federal do São Carlos; BrasilFil: Castro, Jeyne P.. Universidade Federal do São Carlos; BrasilFil: Catelani, Tiago A.. Universidade Federal do São Carlos; BrasilFil: Pellerano, Roberto Gerardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Química Básica y Aplicada del Nordeste Argentino. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas Naturales y Agrimensura. Instituto de Química Básica y Aplicada del Nordeste Argentino; ArgentinaFil: Perino, Ernesto. Universidad Nacional de San Luis; ArgentinaFil: Pereira, Edenir R.. Universidade Federal do São Carlos; BrasilFil: Cabaleri, Nora Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geocronología y Geología Isotópica. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geocronología y Geología Isotópica; ArgentinaFil: Gallego, Oscar Florencio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; Argentin

International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis

Abstract Importance: A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide. Objective: To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics. Design, setting, and participants: Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience). Main outcomes and measures: In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree. Results: Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients. Conclusions and relevance: In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis

International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients with Psoriasis

Importance: A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide. Objective: To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics. Design, Setting, and Participants: Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience). Main Outcomes and Measures: In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree. Results: Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients. Conclusions and Relevance: In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.

High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery -a Bayesian individual patient data meta-analysis of three randomized clinical trials

Background: The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. Our objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect. Methods: Multilevel Bayesian logistic regression analysis on individual patient data from three randomized clinical trials carried out on surgical patients at Intermediate-to-High Risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. We studied the effect of high PEEP with recruitment maneuvers versus Low PEEP Ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect. Results: Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio (OR) for High PEEP with recruitment maneuvers compared to Low PEEP was 0.85 (95% Credible Interval [CrI] 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (OR: 0.67 [0.50 to 0.87]) and those at high risk for PPCs (OR: 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results. Conclusion: High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of PPC occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy