Hospital San Juan de Dios

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by inflammation and immune-mediated damage with mucocutaneous, musculoskeletal, cardiopulmonary, and renal involvement. It typically affects younger women; however, late-onset presentations can occur and often display distinct clinical features. We report the case of a septuagenarian woman who presented with massive pericardial effusion and type 3 cardiorenal syndrome. Further evaluation revealed class IV lupus nephritis, confirming a diagnosis of late-onset SLE according to the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) criteria. Cardiac and serous membrane involvement is more common in late-onset SLE than in classical SLE.

Introduction The Latin American Hematopoietic Stem Cell Transplantation (HSCT) in Inborn Errors of Immunity (IEIs) Group (GLATEII) was established at the 2023 Latin American Society for Immunodeficiencies (LASID) meeting in Mexico. Its goal is to unite Latin American immunologists and transplant specialists. We agreed to hold monthly meetings to discuss HSCT issues in IEIs, develop guidelines, and conduct multicenter reports on HSCT in IEIs. This report summarizes GLATEII’s activities. Results To date, GLATEII has held 19 online meetings, one each month. Since February 2024, these meetings have been hosted and recorded by LASID. A total of 12 recordings are available up to April 2025, with an average of 23 participants per meeting (range 12–30). Attendees mainly include pediatric and adult immunologists and transplant specialists, along with infectologists and hematologists. Participants represent 38 institutions across 11 countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Germany, Mexico, Paraguay, Peru, Uruguay, and the USA. Topics discussed include local experiences with HSCT for IEIs, case discussions, post-HSCT immune reconstitution, post-HSCT vaccination, and HSCT in specific IEIs. Regional concerns such as “transplante social,” Bacillus Calmette–Guérin vaccination issues, IEI awareness gaps, financial shortages for treatments or studies, and access disparities have also been addressed. GLATEII has conducted multicenter reports on specific IEIs, one of which will be presented at LASID 2025. Conclusion GLATEII has successfully maintained monthly meetings focused on HSCT in IEIs from a Latin American perspective, highlighting regional similarities and differences. These gatherings promote advances in diagnosis, treatment, and transplant techniques while strengthening regional and international networks of healthcare professionals. We invite all LASID members to expand and continue these valuable activities.

This study aims to assess the rate of histopathologic diagnostic discordances between the local reviewer in each country of the Sarcoma European and Latin-American Network (SELNET) consortium and expert soft tissue and bone pathologists present in the SELNET network and to evaluate the causes of discrepancies. Histologic diagnosis at the local center of each country from the SELNET consortium and its relative agreement with the revised diagnosis of expert pathologists from the SELNET pathologist network were evaluated in 347 cases of bone or soft tissue tumors over 3 years. Diagnostic concordance was observed in 296 cases (85.3% with a Cohen's κ = 0.84, P < .001), whereas in the remaining 51 cases (14.7%), diagnostic discordance was observed. In 19 of 51 cases, the discordance was considered major because it was related to a significant change in clinical management. Minor histologic discordances were observed in the remaining 32 cases. The most frequent reason for diagnostic discordances was incorrect morphologic interpretation and/or the unavailability of key diagnostic immunohistochemical markers (41.2%), or the unavailability of molecular testing to confirm morphologic and immunohistochemical data (21.6%). Incorrect interpretations of morphologic features alone occurred in 37.2% of cases. A diagnostic agreement of 85.3% was obtained between the original diagnosis in each country of the SELNET consortium and the expert pathologist of the network. Morphologic assessment of tumors, the use of newer immunohistochemical markers, and molecular analysis on a limited number of cases were found to be useful in correcting discrepancies.

Metastatic castration-resistant prostate cancer (mCRPC) is an aggressive, lethal state of prostate cancer, for which early progression is an indicator of poor prognosis. The ability to predict this progression is of paramount clinical importance for guiding personalized treatment strategies. We aimed to develop and validate a novel machine learning (ML) model to predict early progression (≤ 12 months) to mCRPC and compare its performance against standard ML algorithms. This was a retrospective analysis of 172 patients with mHSPC from the publicly available MSK-IMPACT cohort. Inclusion criteria specified patients with mHSPC who had undergone genomic profiling and progressed to mCRPC during follow-up. Patients with incomplete data were excluded. We collected 11 clinical, pathological, and genomic variables. The primary outcome was early progression (≤ 12 months) to mCRPC. Model performance was evaluated using a stratified fivefold cross-validation, with AUC as the primary metric. A novel Rivality Index (RINH)-based model, adapted from chemoinformatics, demonstrated significantly superior predictive performance (AUC: 0.86) compared to a panel of standard ML algorithms, none of which exceeded an AUC of 0.67. The model achieved an accuracy of 0.74, a sensitivity of 0.70, and a specificity of 0.77. Key limitations include the retrospective design and use of a single-institution data set. This novel RINH model offers a robust tool for risk stratification in mHSPC patients, capable of personalizing therapeutic strategies. However, external validation in multi-center, prospective cohorts is an essential next step before its consideration as a clinical decision support tool.

Background:Muscle enhancement through autologous fat grafting has become an important aspect of body contouring procedures, targeting several muscle groups, including the rectus abdominis, deltoids, biceps, trapezius, longissimus, hamstrings, and vastus muscles.Methods:Patients who underwent the ultrasound-guided rectus abdominis fat transfer technique were evaluated using preoperative and postoperative magnetic resonance imaging (MRI) scans to assess the anatomy of the rectus abdominis muscles. Preoperative MRI measured the muscle thickness of the middle and lower rectus abdominis segments on both sides, as they were the most representative. Postoperative imaging was performed 6 months after surgery, assessing the total thickness of the rectus abdominis segments (including fat graft and muscle), the muscle thickness alone, and the remaining fat graft thickness.Results:The ultrasound-guided rectus abdominis fat transfer technique was performed on 20 patients between September 2022 and April 2023. Of these, 6 were men and 14 were women, with a mean age of 37.05 years (range: 25–57 y). Postoperative MRI revealed a statistically significant increase in the total thickness of the muscle segments (including muscle and fat) compared with preoperative measurements.Conclusions:Ultrasound-guided fat grafting is a safe and effective procedure currently used in abdominal etching. Long-term MRI assessments showed significant fat retention and rectus abdominis muscle enhancement.

<title>Abstract</title> <italic>Trials</italic> guidance: The Abstract should not exceed 350 words. Please minimize the use of abbreviations and do not cite references in the abstract. The abstract must include the following separate sections: <bold>Background</bold> <italic>: Mycobacterium tuberculosis</italic> acquisition after exposure is common but difficult to diagnose and frequently requires serial testing given that immunological evidence of infection can take several weeks to develop. Even though tuberculosis infection (TBI) is asymptomatic, its long-term effects remain unclear due to poorly understood host-pathogen interactions and delayed disease development, and research has shown that active mycobacterial replication and inflammation occur during TBI. Although the main purpose of antituberculosis prophylaxis has been to prevent people with established TBI from progressing to active tuberculosis disease, a few studies have suggested that this prophylaxis, when administered during the window period after exposure, can prevent the acquisition of TBI in very young children. Considering that newer preventive regimens are shorter and safer, this study aims to assess whether tuberculosis prophylaxis —when given in the window period after exposure— can prevent new infections in older children and adolescents who have been recently exposed. <bold>Methods</bold> : A multicentre cluster-randomized controlled clinical trial will be performed in Chile. A total of 360 households (clusters) with children aged ≥5 to &lt;18 years, who have been recently exposed to a new case of pulmonary tuberculosis will be randomized to intervention or control arm. In the intervention arm, contacts will receive immediate tuberculosis prophylaxis, regardless of the interferon-gamma release assay (IGRA) result. In the control arm, participants will receive tuberculosis prophylaxis only if the IGRA test results positive, as per standard of care. In both arms, the prophylaxis scheme will be the usual weekly isoniazid plus rifapentine for 12 weeks regimen. The primary outcome will be assessed at the individual level by IGRA conversions from negative at baseline to positive at the 12-week follow-up. <bold>Discussion</bold> : This trial will establish the effectiveness of a window prophylaxis strategy in reducing the risk of TBI acquisition after exposure in a community setting, a strategy that can potentially contribute to global tuberculosis elimination by reducing <italic>M. tuberculosis</italic> reservoirs. <bold>Trial registration</bold> : ClinicalTrials.gov, NCT07086820. Registered 17 July 2025, https://clinicaltrials.gov/study/NCT07086820.

La granulomatosis con poliangitis, previamente conocida como granulomatosis de Wegener, es una vasculitis de pequeños vasos, la cual afecta principalmente los pulmones, los riñones y la vía respiratoria superior. Dicha patología es infrecuente en la infancia. Se presenta el caso de una femenina de 13 años con diagnóstico final de granulomatosis con poliangitis, y revisión de literatura asociada. Se trata de una niña asmática de 13 años, quien consulta por cuadro crónico de fiebre nocturna, síntomas respiratorios y pérdida de peso. Con hallazgos en el examen físico de epiescleritis, púrpura palpable, presencia de nódulos subglóticos y cavitación a nivel de ápice pulmonar derecho. Se diagnostica tras descartar diferentes etiologías infecciosas y neoplásicas, con positividad de anticuerpos antiproteinasa 3 (ANTI-PR3), un tipo de anticuerpo anticitoplasma de neutrófilo con patrón citoplasmático difuso en la inmunofluorescencia indirecta (ANCA-C) altamente específico de dicha vasculitis.