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El manuscrito hace una revisión a grandes rasgos de la obra de Giovanni Barbieri, apodado Il Guercino a raíz de su estrabismo, quien llegó a constituir uno de los pintores más destacados del barroco italiano, en gran medida ligado a la escuela Boloñesa de los Carracci. El escrito también rescata la sencillez y modestia del maestro, que a pesar de tantos ofrecimientos de la realeza europea decidió vivir en su terruño como una muestra inequívoca de humildad, la cual enalteció aún más su calidad de persona.

ABSTRACTThe use of convalescent plasma (CP) for hospitalized patients with SARS-CoV-2 infection might be a useful option in certain settings. Soon after the outbreak of COVID-19, the National Ministry of Health of Argentina recommended the use of CP transfusion for hospitalized patients with COVID-19 disease. Between 1 June and 3 October 2020, 480 patients, excluding those on invasive mechanical ventilation (IMV), received at least one CP infusion in the province of Santa Fe. We aimed to find factors associated with mortality among this cohort of patients. The median age was 60 years (interquartile range: 49–69 years) and 320 (66.7%) were males. Most of these patients (93.75%) received a single CP infusion, 82.1% and 95.6% before day 4 and day 7 of hospitalization, respectively. Anti-SARS-CoV-2 titers were determined in the CP units administered using Elecsys Anti-SARS-CoV-2 S assay. At 28 days of follow-up, 250 patients were discharged (52.1%), 131 (27.3%) remained hospitalized without and 16 (3.3%) with oxygen requirement, 27 (5.6%) were on IMV, and 56 (11.7%) had died. In the multivariate logistic regression analysis, the factors significantly associated with 28-day mortality were (i) requirement of IMV, (ii) the administration of CP after the third day of hospitalization, (iii) age, and (iv) number of comorbidities. The qualitative and quantitative analyses of antibodies against SARS-CoV-2 in the infused CP were not associated with mortality. Our findings may imply a seemingly favorable effect of CP administration among patients with severe COVID-19 disease when infused sooner after hospitalization.IMPORTANCEThe use of convalescent plasma (CP) could be an option for patients with severe COVID-19, especially in poor-resource countries where direct antiviral drugs are not commercially available. Currently, the U.S. Food and Drug Administration limits the CP administration for outpatients and inpatients with COVID-19 who are immunocompromised and only if high levels of anti-SARS-CoV-2 antibodies are confirmed in the CP unit. Although most of the randomized clinical trials failed to show a clear-cut benefit of CP in hospitalized patients with severe COVID-19, other studies have shown that if given early in the course of the disease, it might be a useful therapeutic option. In this retrospective study, we demonstrated that early treatment (within 3 days of hospitalization) was significantly associated with reduced 28-day mortality compared with those patients treated beyond day 3. The results from our study add up to the scientific evidence on the use of CP as a relatively safe, cheap, and possibly effective therapy in certain patients suffering from severe SARS-CoV-2 infection.

El filme retrata la vida de un cardiocirujano seco y egocéntrico abocado más enfermedades que enfermos, quien un buen día deberá experimentar en persona lo nefasto de tal actitud. Una hemoptisis intempestiva llevará al diagnóstico de un tumor maligno de laringe y la ulterior indicación de radioterapia. Esa negación tan frecuente en los pacientes aquí raya en lo inaudito, puesto que como maestro de la medicina no puede ser blanco de intervención. En medio de las largas esperas, marañas burocráticas y la frialdad de la relación médico-paciente, conoce a June, bajo tratamiento por un tumor cerebral con quien establecerá una suerte de coalición ante tan amenazante travesía. A partir de la experiencia como enfermo, el trato para con sus pacientes irá incorporando una auspiciosa cuota de empatía hacia quienes se hallan circunstancialmente abatidos por alguna dolencia. June no sobrevive al tumor, pero él consigue superarlo gracias a la extirpación quirúrgica, mostrándose ahora muy decidido a reorientar su vida profesional y familiar, tras tan doloroso aprendizaje. La historia no ha perdido vigencia. Quien más quien menos, todos sabemos de las desventuras atravesadas por muchos pacientes en su derrotero hacia la recuperación de una salud perdida.

IntroductionTuberculosis (TB) is a major health problem characterized by an immuno-endocrine imbalance: elevated plasma levels of cortisol and pro- and anti-inflammatory mediators, as well as reduced levels of dehydroepiandrosterone. The etiological agent, Mycobacterium tuberculosis (Mtb), is captured by pulmonary macrophages (Mf), whose activation is necessary to cope with the control of Mtb, however, excessive activation of the inflammatory response also leads to tissue damage. Glucocorticoids (GC) are critical elements to counteract the immunoinflammatory reaction, and peroxisome proliferator-activated receptors (PPARs) are also involved in this regard. The primary forms of these receptors are PPARϒ, PPARα, and PPARβ/δ, the former being the most involved in anti-inflammatory responses. In this work, we seek to gain some insight into the contribution of PPARϒ in immuno-endocrine-metabolic interactions by focusing on clinical studies in pulmonary TB patients and in vitro experiments on a Mf cell line.Methods and resultsWe found that TB patients, at the time of diagnosis, showed increased expression of the PPARϒ transcript in their peripheral blood mononuclear cells, positively associated with circulating cortisol and related to disease severity. Given this background, we investigated the expression of PPARϒ (RT-qPCR) in radiation-killed Mtb-stimulated human Mf. The Mtb stimulation of Mf derived from the human line THP1 significantly increased the expression of PPARϒ, while the activation of this receptor by a specific agonist decreased the expression of pro- and anti-inflammatory cytokines (IL-1β and IL-10). As expected, the addition of GC to stimulated cultures reduced IL-1β production, while cortisol treatment together with the PPARϒ agonist lowered the levels of this proinflammatory cytokine in stimulated cultures. The addition of RU486, a glucocorticoid receptor antagonist, only reversed the inhibition produced by the addition of GC.ConclusionThe current results provide a stimulating background for further analysis of the interconnection between PPARs and steroid hormones in the context of Mtb infection.

El artículo hace una reseña acerca del célebre Cuarteto Artemis en sus 3 décadas de recorrido, y gran capacidad para adaptarse a las peripecias experimentadas a lo largo de este período, preservando la calidad interpretativa como objetivo primordial. El conjunto había sufrido el tropiezo ocasionado por la partida de Friedemann Weigle quien aquejado de un trastorno bipolar y cuadro depresivo mayor pone fin a su vida el 6 de julio de 2015. Las vivencias de la agrupación aparecen bien reflejadas en el documental Artemis, The Neverending Quartet estrenado el año 2019 en Hamburgo, y posteriormente nominado al Golden Calf Film Award en la categoría de «Mejor Cortometraje Documental 2020». En sus 53 minutos la directora Hester Overmars nos brinda una pincelada a grandes rasgos de la agrupación, quien gracias a la posibilidad de asistir a los ensayos consigue registrar las experiencias detrás de bambalinas, a la par de permitirnos entrever aquellos esfuerzos reparadores, cual suerte de firme resiliencia colectiva. Teniendo a la música como principal protagonista, la película trasluce los avatares derivados de la dolorosa pérdida de un compañero de tantos años, y el empeño para no quedar atrapados en la encerrona de la desesperanza.

Dehydroepiandrosterone (DHEA) is an androgen synthesized by the adrenal cortex, which is an intermediary in the biosynthesis of sex hormones, such as testosterone and estradiol. DHEA mostly circulates as a conjugated ester, in the form of sulfate (DHEA-S). There exist several endogenous factors able to influence its synthesis, the most common ones being the corticotrophin-releasing hormone (CRH), adrenocorticotrophin (ACTH), growth factors, and proinflammatory cytokines, among others. Like other steroid hormones, DHEA, can alter the functioning of immune cells and therefore the course of diseases exhibiting an immune-inflammatory component, mostly from autoimmune or infectious nature. We herein review the role played by DHEA during a major infectious disease like tuberculosis (TB). Data recorded from TB patients, mouse models, or in vitro studies show that DHEA is likely to be implied in better disease control. This provides a stimulating background for carrying out clinical studies aimed at assessing the usefulness of DHEA as an adjuvant in TB patients.