Espondilodiscitis infecciosa por abscesos de psoas secundario a infección por Burkholderia cepacia

Context: Infection by the Burkholderia cepacia complex is a clinical entity rarely reported in the literature outside the context of pneumonia in patients with cystic fibrosis or chronic granulomatosis; its appearance in soft tissues or the articular system is scarce.   Case description: We report the case of a 59-year-old man with diabetes mellitus 2 who was admitted with chronic low back pain secondary to multiple bilateral abscesses at the level of the psoas muscles associated with spondylodiscitis. After draining the abscesses, Burkholderia cepacia was isolated in culture.   Conclusions: This is the second report of deep posed abscess associated with infection by bacteria of the genus Burkholderia cepacia. The extrapulmonary and specifically musculoskeletal behavior is a fact to consider within the spectrum of clinical manifestations associated with this disease.   Key words: psoas abscess, Burkholderia cepacia, spondylodiscitisIntroducción: La infección por el complejo Burkholderia cepacia se trata de una entidad clínica raramente reportada en la literatura fuera del contexto de neumonía en pacientes con fibrosis quística o granulomatosis crónica; su aparición en tejidos blandos o del sistema articular son escasos. Caso: Reportamos el caso de un hombre de 59 años de edad con diabetes mellitus 2 quien ingresó con cuadro de dolor lumbar crónico secundario a múltiples abscesos de forma bilateral a nivel de los músculos psoas asociado a espondilodiscitis. Tras el drenaje de los abscesos se aisló en cultivo Burkholderia cepacia. Conclusiones: Este es el segundo reporte de absceso profundo de posas a nivel mundial y el primero en el continente americano asociado a infección por bacterias del género Burkholderia cepacia. El comportamiento extrapulmonar y específicamente muscoloesquelético es un hecho a considerar dentro del espectro de manifestaciones clínicas asociadas a esta enfermedad

Espondilodiscitis infecciosa por abscesos de psoas secundario a infección por Burkholderia cepacia

Context: Infection by the Burkholderia cepacia complex is a clinical entity rarely reported in the literature outside the context of pneumonia in patients with cystic fibrosis or chronic granulomatosis; its appearance in soft tissues or the articular system is scarce.   Case description: We report the case of a 59-year-old man with diabetes mellitus 2 who was admitted with chronic low back pain secondary to multiple bilateral abscesses at the level of the psoas muscles associated with spondylodiscitis. After draining the abscesses, Burkholderia cepacia was isolated in culture.   Conclusions: This is the second report of deep posed abscess associated with infection by bacteria of the genus Burkholderia cepacia. The extrapulmonary and specifically musculoskeletal behavior is a fact to consider within the spectrum of clinical manifestations associated with this disease.   Key words: psoas abscess, Burkholderia cepacia, spondylodiscitisIntroducción: La infección por el complejo Burkholderia cepacia se trata de una entidad clínica raramente reportada en la literatura fuera del contexto de neumonía en pacientes con fibrosis quística o granulomatosis crónica; su aparición en tejidos blandos o del sistema articular son escasos. Caso: Reportamos el caso de un hombre de 59 años de edad con diabetes mellitus 2 quien ingresó con cuadro de dolor lumbar crónico secundario a múltiples abscesos de forma bilateral a nivel de los músculos psoas asociado a espondilodiscitis. Tras el drenaje de los abscesos se aisló en cultivo Burkholderia cepacia. Conclusiones: Este es el segundo reporte de absceso profundo de posas a nivel mundial y el primero en el continente americano asociado a infección por bacterias del género Burkholderia cepacia. El comportamiento extrapulmonar y específicamente muscoloesquelético es un hecho a considerar dentro del espectro de manifestaciones clínicas asociadas a esta enfermedad

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- A nd middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

Analytical Solutions of the Electrical RLC Circuit via Liouville–Caputo Operators with Local and Non-Local Kernels

In this work we obtain analytical solutions for the electrical RLC circuit model defined with Liouville–Caputo, Caputo–Fabrizio and the new fractional derivative based in the Mittag-Leffler function. Numerical simulations of alternative models are presented for evaluating the effectiveness of these representations. Different source terms are considered in the fractional differential equations. The classical behaviors are recovered when the fractional order α is equal to 1

Espondilodiscitis infecciosa por abscesos de psoas secundario a infección por Burkholderia cepacia

Context: Infection by the Burkholderia cepacia complex is a clinical entity rarely reported in the literature outside the context of pneumonia in patients with cystic fibrosis or chronic granulomatosis; its appearance in soft tissues or the articular system is scarce.   Case description: We report the case of a 59-year-old man with diabetes mellitus 2 who was admitted with chronic low back pain secondary to multiple bilateral abscesses at the level of the psoas muscles associated with spondylodiscitis. After draining the abscesses, Burkholderia cepacia was isolated in culture.   Conclusions: This is the second report of deep posed abscess associated with infection by bacteria of the genus Burkholderia cepacia. The extrapulmonary and specifically musculoskeletal behavior is a fact to consider within the spectrum of clinical manifestations associated with this disease.   Key words: psoas abscess, Burkholderia cepacia, spondylodiscitisIntroducción: La infección por el complejo Burkholderia cepacia se trata de una entidad clínica raramente reportada en la literatura fuera del contexto de neumonía en pacientes con fibrosis quística o granulomatosis crónica; su aparición en tejidos blandos o del sistema articular son escasos. Caso: Reportamos el caso de un hombre de 59 años de edad con diabetes mellitus 2 quien ingresó con cuadro de dolor lumbar crónico secundario a múltiples abscesos de forma bilateral a nivel de los músculos psoas asociado a espondilodiscitis. Tras el drenaje de los abscesos se aisló en cultivo Burkholderia cepacia. Conclusiones: Este es el segundo reporte de absceso profundo de posas a nivel mundial y el primero en el continente americano asociado a infección por bacterias del género Burkholderia cepacia. El comportamiento extrapulmonar y específicamente muscoloesquelético es un hecho a considerar dentro del espectro de manifestaciones clínicas asociadas a esta enfermedad

Global Retinoblastoma Presentation and Analysis by National Income Level.

Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs