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En el Departamento de Caquetá (Colombia) se evaluó la situación epidemiológica de la leishmaniosis para los años 2011 a 2014. A partir de las fichas de notificación de cada paciente disponibles en la Secretaría de Salud departamental de Caquetá, se analizaron las diferentes manifestaciones clínicas de la enfermedad y los factores asociados para cada caso, en los 16 municipios. De los 1150 casos registrados, 536 correspondieron a la población civil y 614 a personal de las fuerzas armadas. El 78,5% de los pacientes eran hombres y el 21,5% mujeres. La leishmaniosis cutánea prevaleció y solo 14 personas han presentado la forma clínica mucocutánea. Municipios como Florencia, Cartagena del Chairá y San Vicente del Caguán aportaron el mayor número de pacientes. La localización de las lesiones en el cuerpo, se presentó principalmente en las extremidades superiores e inferiores; la manifestación clínica fue mayor en pacientes de 19 a 35 años, con 80,6% y 12,7% en las edades de 36 a 80 años y en menores de 18 años fue de 6,43%. Igualmente se evaluó la prevalencia según pertenencia étnica, métodos de protección y condiciones ambientales que favorecen la transmisión de la enfermedad. [ABSTRACT FROM AUTHOR]

Background: Patients' lack of knowledge about their own disease may function as a barrier to shared decision-making and well-being. This study aimed to evaluate the impact of written educational materials on breast cancer patients., Methods: This multicenter, parallel, unblinded, randomized trial included Latin American women aged ≥18 years with a recent breast cancer diagnosis yet to start systemic therapy. Participants underwent randomization in a 1:1 ratio to receive a customizable or standard educational brochure. The primary objective was accurate identification of molecular subtype. Secondary objectives included identification of clinical stage, treatment options, participation in decision-making, perceived quality of information received, and illness uncertainty. Follow-up occurred at 7-21 and 30-51 days post-randomization., Clinicaltrials: gov identifier: NCT05798312., Results: One hundred sixty-five breast cancer patients with a median age of 53 years and 61 days from diagnosis were included (customizable: 82; standard: 83). At first available assessment, 52%, 48%, and 30% identified their molecular subtype, disease stage, and guideline-endorsed systemic treatment strategy, respectively. Accurate molecular subtype and stage identification were similar between groups. Per multivariate analysis, customizable brochure recipients were more likely to identify their guideline-recommended treatment modalities (OR: 4.20,p = 0.001). There were no differences between groups in the perceived quality of information received or illness uncertainty. Customizable brochure recipients reported increased participation in decision-making (p = 0.042)., Conclusions: Over one third of recently diagnosed breast cancer patients are incognizant of their disease characteristics and treatment options. This study demonstrates a need to improve patient education and shows that customizable educational materials increase patients' understanding of recommended systemic therapies according to individual breast cancer characteristics., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

This clinical quandary details a Mexican man, aged 77 years, who presented to the oncology clinic with a sternal mass. Based on the results, the patient fulfilled the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for Sjögren syndrome, thus the diagnosis triggered by immune checkpoint inhibitors was definitively established.

Northern New Jersey was inside one of the worst initial coronavirus disease 2019 pandemic epicenters in the United States. At the peak of the pandemic surge in mid-April 2020, New Jersey saw 8045 hospitalized patients with severe coronavirus disease 2019 symptoms, of which 2002 were in intensive care unit beds (86.3% of statewide capacity), including 1705 requiring mechanical ventilation. Because of the severity of pulmonary dysfunction/hypoxia, the unprecedented numbers of critically ill patients, the national opioid shortage, and transmission prevention measures for standard palliative care treatment protocols in place for refractory and/or end-of-life dyspnea were found to be ineffective in providing adequate symptom relief. The aim of the following Notes From the Field is to provide concise, pragmatic, and experiential reflection by 3 palliative care advanced practice nurses from 3 different hospital systems within the pandemic epicenter. The novel methods and opioid strategies implemented by their respective palliative care teams to ensure continued effective and appropriate treatment for end-of-life dyspnea are described. These accounts include Lessons Learned in order to assist others who may need to quickly implement changes in the future due to pandemic resurgence or second-wave events., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 by The Hospice and Palliative Nurses Association. All rights reserved.)

Background: We sought to develop and externally validate a nomogram and web-based calculator to individually predict the development of serious complications in seemingly stable adult patients with solid tumours and episodes of febrile neutropenia (FN)., Patients and Methods: The data from the FINITE study (n=1133) and University of Salamanca Hospital (USH) FN registry (n=296) were used to develop and validate this tool. The main eligibility criterion was the presence of apparent clinical stability, defined as events without acute organ dysfunction, abnormal vital signs, or major infections. Discriminatory ability was measured as the concordance index and stratification into risk groups., Results: The rate of infection-related complications in the FINITE and USH series was 13.4% and 18.6%, respectively. The nomogram used the following covariates: Eastern Cooperative Group (ECOG) Performance Status ⩾2, chronic obstructive pulmonary disease, chronic cardiovascular disease, mucositis of grade ⩾2 (National Cancer Institute Common Toxicity Criteria), monocytes <200/mm(3), and stress-induced hyperglycaemia. The nomogram predictions appeared to be well calibrated in both data sets (Hosmer-Lemeshow test, P>0.1). The concordance index was 0.855 and 0.831 in each series. Risk group stratification revealed a significant distinction in the proportion of complications. With a ⩾116-point cutoff, the nomogram yielded the following prognostic indices in the USH registry validation series: 66% sensitivity, 83% specificity, 3.88 positive likelihood ratio, 48% positive predictive value, and 91% negative predictive value., Conclusions: We have developed and externally validated a nomogram and web calculator to predict serious complications that can potentially impact decision-making in patients with seemingly stable FN.

Pineapple production in Costa Rica increased nearly 300-fold during the last 30 yr, and >40,000 hectares of land are currently dedicated to this crop. At the end of the pineapple cropping cycle, plants are chopped and residues incorporated into the soil in preparation for replanting. Associated with increased pineapple production has been a large increase in stable fly, Stomoxys calcitrans (L.), populations. Stable flies are attracted to, and oviposit in, the decomposing, chopped pineapple residues. In conjunction with chemical control of developing larvae, adult trapping is an important control strategy. In this study, four blue-black fabric traps, Nzi, Vavoua, Model H, and Ngu, were compared with a white sticky trap currently used for stable fly control in Costa Rica. Overall, the white sticky trap caught the highest number of stable flies, followed by the Nzi, Vavoua, Model H, and Ngu. Collections on the white sticky trap increased 16 d after residues were chopped; coinciding with the expected emergence of flies developing in the pineapple residues. During this same time period, collections in the blue-black fabric traps decreased. Sex ratio decreased from >7:1 (females:males) 3-7 d after chopping to 1:1 at 24-28 d. White sticky, Nzi and Vavoua traps collected similar numbers of colonizing flies 3-7 d after residues were chopped. However, white sticky traps collected more flies once emergence from the pineapple residues began. Although white sticky traps collected more flies than fabric traps, they remain labor intensive and environmentally unsound because of their disposable and nonbiodegradable nature., (Published by Oxford University Press on behalf of the Entomological Society of America 2015. This work is written by US Government employees and is in the public domain in the US.)

Purpose: To validate a prognostic score predicting major complications in patients with solid tumors and seemingly stable episodes of febrile neutropenia (FN). The definition of clinical stability implies the absence of organ dysfunction, abnormalities in vital signs, and major infections., Patients and Methods: We developed the Clinical Index of Stable Febrile Neutropenia (CISNE), with six explanatory variables associated with serious complications: Eastern Cooperative Oncology Group performance status ≥ 2 (2 points), chronic obstructive pulmonary disease (1 point), chronic cardiovascular disease (1 point), mucositis of grade ≥ 2 (National Cancer Institute Common Toxicity Criteria; 1 point), monocytes < 200 per μL (1 point), and stress-induced hyperglycemia (2 points). We integrated these factors into a score ranging from 0 to 8, which classifies patients into three prognostic classes: low (0 points), intermediate (1 to 2 points), and high risk (≥ 3 points). We present a multicenter validation of CISNE., Results: We prospectively recruited 1,133 patients with seemingly stable FN from 25 hospitals. Complication rates in the training and validation subsets, respectively, were 1.1% and 1.1% in low-, 6.1% and 6.2% in intermediate-, and 32.5% and 36% in high-risk patients; mortality rates within each class were 0% in low-, 1.6% and 0% in intermediate-, and 4.3% and 3.1% in high-risk patients. Areas under the receiver operating characteristic curves in the validation subset were 0.652 (95% CI, 0.598 to 0.703) for Talcott, 0.721 (95% CI, 0.669 to 0.768) for Multinational Association for Supportive Care in Cancer (MASCC), and 0.868 (95% CI, 0.827 to 0.903) for CISNE (P = .002 for comparison between CISNE and MASCC)., Conclusion: CISNE is a valid model for accurately classifying patients with cancer with seemingly stable FN episodes., (© 2015 by American Society of Clinical Oncology.)

Background: Bariatric surgery for severe obesity has demonstrated significant health benefits, but it is not without complications. Transoral approaches to weight loss offer a minimally invasive option., Objective: To evaluate the safety and feasibility of a transoral suturing procedure for weight loss., Design: Single-center, uncontrolled study with a 1-year follow-up., Setting: Hospital de Clinicas, Caracas, Venezuela., Patients: Sixty-four patients (mean age [SD] 31.5 +/- 10.1 years, range 16-62 years; mean (SD) preoperative body mass index [BMI] 39.9 +/- 5.1 kg/m(2), range 28.0-60.2 kg/m(2)) were enrolled between 2003 and 2005., Intervention: Endoluminal vertical gastroplasty by using a continuous suture pattern to treat obesity., Main Outcome Measurements: Short-term complication monitoring and patient weight before the procedure and at 1, 3, and 12 months after the procedure., Results: The outpatient procedures were performed in approximately 45 minutes. Patients had a significant reduction in BMI at 12 months (mean [SD] BMI 39.9 +/- 5.1 kg/m(2) vs 30.6 +/- 4.7 kg/m(2); P < .001) and a percentage of excess weight loss (%EWL) (SD) of 21.1 +/- 6.2, 39.6 +/- 11.3, and 58.1 +/- 19.9 at 1, 3, and 12 months, respectively. By comparing the study's subpopulations, group I (baseline BMI >or=40 kg/m(2), n = 33), group II (baseline BMI 35-40 kg/m(2), n = 19), and group III (baseline BMI <35 kg/m(2), n = 12) demonstrated a %EWL (SD) of 48.9 +/- 10.7, 56.5 +/- 13.9, and 85.1 +/- 24.0, respectively, at 12 months after the procedure (P = .037 when comparing group I vs II; P < .001 when comparing group II vs III and group I vs III). No patients experienced any serious adverse events., Limitations: This study represents a single center's clinical experience, with no sham control., Conclusions: Endoluminal vertical gastroplasty by using a continuous suture pattern is associated with significant weight loss. Additional studies are needed to demonstrate the procedure's long-term safety and efficacy.

A case presentation of a pregnant 32-year-old woman with advanced amyotrophic lateral sclerosis who presented in labor at 38+6 weeks gestation is described. Amyotrophic lateral sclerosis is a progressive neuromuscular disease that attacks nerve cells in the brain and spinal cord. It is usually diagnosed after the fourth decade of life, and is more commonly seen in men than women; thus, it is rarely found in the obstetric population. When the perinatal team is confronted with a pregnant woman with ALS,patient management can be a challenge.

Levels of mRNAs encoding metabolic enzymes and their cellular activities were measured on continuous culture samples of the parasitic protists Trypanosoma brucei and Trichomonas vaginalis. The organisms were grown in chemostats at varying growth rates under glucose limitation or in the presence of excess glucose (EG), resulting in extensive adaptation of the cellular activities of glycolytic enzymes. rRNA and mRNA for beta-tubulin were monitored as controls. In Trypanosoma brucei levels of all RNAs showed a biphasic dependence on growth rate (= dilution rate D), with a sharp increase at higher D values. Cellular RNA levels of Trichomonas vaginalis rate-limited by glucose decreased slightly with increasing D. In EG-grown cells the opposite trend was observed. Equal levels for both carbon regimes were observed at intermediate D values. In both species the ratio between rRNA and mRNA encoding beta-tubulin was constant, independent of the carbon regime. mRNA encoding metabolic enzymes showed varying degrees of correlation with rRNA and beta-tubulin mRNA. In contrast, there was little to no correlation between mRNA levels and the activities of the enzymes they encode, even though only one of these is allosterically regulated. The data indicate that RNA levels in Trypanosoma brucei and Trichomonas vaginalis are determined by growth rate and in the latter species by the availability of the carbon and energy source. Rates of synthesis of metabolic enzymes are most likely regulated at the post-transcriptional level.