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Introduction: Breast cancer (BC) is the leading cause of death among women, primarily due to its potential for metastasis. As BC progresses, the extracellular matrix (ECM) produces more type-I collagen, resulting in increased stiffness. This alteration influences cellular behaviors such as migration, invasion, and metastasis. Specifically, cancer cells undergo changes in gene expression that initially promote an epithelial-to-mesenchymal transition (EMT) and subsequently, a transition from a mesenchymal to an amoeboid (MAT) migration mode. In this way, cancer cells can migrate more easily through the stiffer microenvironment. Despite their importance, understanding MATs remains challenging due to the difficulty of replicating in vitro the conditions for cell migration that are observed in vivo. Methods: To address this challenge, we developed a three-dimensional (3D) growth system that replicates the different matrix properties observed during the progression of a breast tumor. We used this model to study the migration and invasion of the Triple-Negative BC (TNBC) cell line MDA-MB-231, which is particularly subject to metastasis. Results: Our results indicate that denser collagen matrices present a reduction in porosity, collagen fiber size, and collagen fiber orientation, which are associated with the transition of cells to a rounder morphology with bleb-like protrusions. We quantified how this transition is associated with a more persistent migration, an enhanced invasion capacity, and a reduced secretion of matrix metalloproteinases. Discussion: Our findings suggest that the proposed 3D growth conditions (especially those with high collagen concentrations) mimic key features of MATs, providing a new platform to study the physiology of migratory transitions and their role in BC progression.

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Background: Pituitary neuroendocrine tumors (PitNETs) are a diverse group of benign neoplasms that account for a significant proportion of intracranial tumors (13%). The coexistence of PitNET with other intracranial lesions, such as meningiomas and intracranial aneurysms, has been constantly reported in the literature; yet, the pathophysiological mechanisms remain unknown, and the appropriate management is controversial. This study aims to describe the clinical characteristics, surgical treatment, and outcomes of patients with PitNET with coexisting intracranial lesions in a single healthcare center. Methods: A retrospective analysis was conducted on 12 patients who underwent surgical treatment for PitNET and another intracranial lesion at our single tertiary referral center over 15 years from January 2008 to May 2023. Results: Among these coexisting lesions, aneurysms were the most commonly found (41.67%), followed by meningiomas (33.33%). Surgical intervention for both lesions was performed in a single-stage procedure for most cases (75%), employing transcranial, endoscopic endonasal, and combined approaches. We found low preoperative Karnofsky Performance Scale scores in three patients, with significant differences in functional outcomes. Conclusion: These findings contribute to the limited knowledge about PitNET coexisting with other intracranial lesions and emphasize the importance of patient-tailored, multidisciplinary management in these unusual scenarios.

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Background: Microsurgical treatment of paraclinoid aneurysms is a complex task that generally requires anterior clinoid process (ACP) removal to obtain adequate surgical exposure. This procedure poses a considerable technical difficulty due to the association of the ACP to critical neurovascular structures. Furthermore, anatomical variations in the parasellar region, such as the caroticoclinoid foramen (CCF) or an interclinoid bridge (ICB), may impose additional challenges and increase surgical complications. The present study aims to briefly review some anatomic variations in the parasellar region and describe a step-by-step surgical technique for a hybrid anterior clinoidectomy based on the senior author's experience. Methods: We present two cases with bone variations on the parasellar region in patients with a paraclinoid aneurysm and another with a posterior communicating segment aneurysm treated by microsurgical clipping at our hospital. Results: We focused on safely dealing with these variations during surgery, without further complications, and with good postoperative results. Patients were discharged with no significant deficit. Postoperative control, computed tomography angiography showed complete exclusion of aneurysms. Conclusion: Although anatomical variations in the parasellar region can complicate surgical clipping of these aneurysms, it is essential to ensure the best possible surgical outcome to conduct thorough preoperative and radiological evaluations.

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Background: Tuberculum sellae meningiomas (TSM) account for 3-10% of intracranial meningiomas. Visual loss is the presenting symptom in up to 80% of cases. Surgical management poses a great challenge due to tumor proximity to neurovascular structures such as the optic nerve and the internal carotid artery (ICA); hence, there is controversy regarding the optimal approach. The aim of this study is to determine differences in visual outcomes between transcranial (TCA) and endoscopic endonasal (EEA) approaches. Methods: A retrospective study including 29 patients with TSM surgically treated by TCA or EEA between 2011 and 2023 in a single referral center was conducted. Pre-and post-operative neuro-ophthalmologic evaluations, focusing on visual acuity and campimetry, were evaluated. Results: Sixteen (55.16%) patients were intervened through a TCA and the remaining 13 (44.84%) via an EEA. The lesions in each group were similar in terms of pre- operative volume (15.12 vs 12.9 cm3, p = 0.497) and neurovascular invasion (optic canal invasion 48.26 vs 41.37%, p = 0.664; ICA 44.81 vs 31.03%, p = 0.797). There were no significant differences in visual outcomes between both approaches; TCA presented an improvement of 5.18 points in visual fields (p = 0.140), whereas EEA had an improvement of 17.39 points in visual acuity (p = 0.114). Conclusion: EEA seems to offer greater improvement in visual acuity than TCA. However, the ideal approach should be individualized; taking into account the tumor's volume and invasiveness, as well as the patient's visual complaints.

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Background: Giant intracranial aneurysms cause symptoms due to mass effect and can mimic other lesions in imaging studies. The coexistence of tumors and aneurysms is relatively rare, with meningiomas being the predominant tumors found in such cases. The relationship between these two entities is complex and represent a neurosurgical challenge. Case Description: A 61-year-old woman presented with intermittent headache, vertigo, right peripheral facial palsy, hearing loss, and left hemiparesis. Magnetic resonance imaging revealed two lesions: a supratentorial paraclinoid lesion in the left frontotemporal region and a right infratentorial extra-axial mass, suggestive of a meningioma. The patient underwent a two-staged surgical intervention to address both lesions. Conclusion: In this particular case, the lesions were located on different sides and in different cranial compartments, making it even rarer.

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Craniopharyngiomas (CPs) are Rathke's cleft-derived benign tumors originating most commonly in the dorsum sellae and representing 2% of intracranial neoplasms. CPs represent one of the more complex intracranial tumors due to their invasive nature, encasing neurovascular structures of the sellar and parasellar regions, making its resection a major challenge for the neurosurgeon with important postoperative morbidity. Nowadays, an endoscopic endonasal approach (EEA) provides an "easier" way for CPs resection allowing a direct route to the tumor with direct visualization of the surrounding structures, diminishing inadvertent injuries, and providing a better outcome for the patient. In this article, we include a comprehensive description of the EEA technique and nuances in CPs resection, including three illustrated clinical cases.

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Objective The purpose of this study was to analyze and discuss the clinical characteristics, long-term outcome, and prognostic factors of cerebellar strokes treated in a single health care facility in Mexico. Methods We retrospectively reviewed the medical records of adult patients admitted to our hospital with diagnosis of cerebellar ischemic and hemorrhagic stroke between 2018 and 2020. Baseline data included sociodemographic and radiological variables, treatment (surgical versus conservative), and Glasgow Coma Scale on arrival (GCSOA). The final neurological outcome was evaluated with the Glasgow Outcome Scale (GOS) six months after hospital discharge. Results Ten patients (seven male and three female) with a mean age of 57.9 ± 9.3 years were included, six with cerebellar ischemic infarction and four with cerebellar hemorrhage. Out of the 10 patients, four underwent surgery (suboccipital decompressive craniectomy {SDC} ± ventriculostomy). The outcome was favorable in four cases (40%) and unfavorable in six (60%). Patients who underwent surgical treatment fared worse with all four cases associating poor outcome. The comparison between good and poor outcome groups showed significant differences in the presence of obstructive hydrocephalus (one versus six, p = 0.05) and poorer GCSOA (6.16 ± 1.72 versus 12.5 ± 3.6, p = 0.05), associating poorer outcome. Conclusion There is still controversy regarding the appropriate management of cerebellar strokes. The presence of obstructive hydrocephalus and poorer GCSOA are associated to worse outcomes.

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Objetivo: Describir las características de la Injuria Renal Aguda (IRA) en pacientes hospitalizados en un hospital de tercer nivel de enero a abril del 2016. Material y métodos: Estudio descriptivo, transversal y retrospectivo que incluyó a los pacientes que ingresaron a los servicios de hospitalización de Medicina y Unidad de Cuidados Intensivos. El diagnóstico de IRA y su clasificación según severidad fueron establecidos según los criterios propuestos por Kidney Disease: Improving Global Outcomes. La función renal al alta fue evaluada mediante la estimación de la tasa de filtración glomerular (TFG). Resultados: La frecuencia general de IRA fue 64,83%. En el servicio de Medicina, la frecuencia fue 57,06% y en UCI, 88,14%. La mortalidad general fue 27,45%. Los pacientes con IRA presentaron anemia, diabetes y enfermedad renal crónica en 84,97%, 20,92% y 19,61%, respectivamente. Según severidad, la frecuencia general fue estadio 3: 46,41%, estadio 1: 30,07% y estadio 2: 23,53%. Las categorías de etiología probable más frecuentes fueron intrínseca (41,83%), pre-renal (27,45%) y multifactorial (15,03%). La mediana de TFG al alta en los pacientes que estuvieron en UCI fue 114,40 ml/min/1,73 m2 y en Medicina, 84,89 ml/min/1,73 m2. Según severidad, la menor mediana de TFG al alta se presentó en los pacientes con estadio 3 y, según etiología probable, aquellos que desarrollaron IRA intrínseca y multifactorial presentaron menor función renal al alta. Conclusiones: IRA es un trastorno frecuente en pacientes hospitalizados. La TFG al alta fue significativamente mayor en los pacientes en UCI que en aquellos en Medicina.

Objetive: To describe the characteristics of Acute Kidney Injury (AKI) in hospitalized patients in a tertiarylevel hospital from January to April of 2016. Material and methods: Retrospective descriptive study that included patients admitted to medical ward and Intensive Care Unit. AKI diagnosis and severity stage were established according to Kidney Disease: Improving Global Outcomes criteria. Kidney function at discharge was evaluated by estimating the glomerular filtration rate (GFR). Results: Overall frequency of AKI was 64.83%. In the medical ward, frequency was 57.06% and in ICU, 88.14%. Overall mortality was 27.45%. The proportion of patients with AKI who had anemia, diabetes and chronic kidney disease was 84.97%, 20.92% and 19.61%, respectively. According to severity stage, the overall frequency was stage 3: 46.41%, stage 1: 30.07% and stage 2: 23.53%. The most frequent categories of probable etiology were intrinsic (41.83%), prerenal (27.45%) and multifactorial (15.03%). The GFR median at discharge in ICU was 114.40 ml/min/1.73 m2, whereas in medical ward, 84.89 ml/min/1.73 m2. According to the severity stage, the lowest GFR median at discharge occurred in patients with stage 3 and, according to probable etiology, those who developed intrinsic and multifactorial AKI had lower kidney function at discharge. Conclusions: AKI is a frequent disorder in hospitalized patients. The GFR at discharge was significantly higher in patients who were in ICU than in medical ward.

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Resumen: El médico internista actualmente se enfrenta a grandes retos, entre ellos destaca la gran cantidad de información que se produce todos los días y tener que tomar decisiones en cuanto a la atención de los pacientes con esta gran cantidad de información disponible. La tecnología de la información y comunicación nos permite acercar la información al mismo sitio de la atención, haciendo mejor uso de los recursos de que dispone el médico para beneficio de los pacientes que atiende.

Abstract: The internist is currently facing major challenges, among them the large amount of information produced every day and having to make decisions regarding the care of patients with this large amount of available information. The information and communication technology allows us to bring the information to the same site of care, making better use of the available resources in benefit of patients.

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Resumen: De los pacientes a quienes se les ha practicado un evento quirúrgico no cardiaco, 5% tiene complicaciones cardiacas importantes en los primeros 30 días posoperatorios. Algunos factores, como el envejecimiento de la población y el incremento de comorbilidades, así como la tasa de complicaciones han ido en aumento, el equipo quirúrgico debe enfrentar complicaciones pulmonares, tromboembólicas, renales, etc., que también pueden sobrevenir. Por ello, la valoración integral de cada paciente debe ponderar los beneficios contra los riesgos del evento quirúrgico. Contar con fuentes de información basada en evidencia, en el sitio mismo de la toma de decisiones, evitará áreas de incertidumbre de conocimientos en la valoración integral de los pacientes, por esta razón las tecnologías de la información y comunicación serán herramientas de gran utilidad y apoyo en la toma de decisiones para mayor seguridad de los pacientes.

Abstract: Out of patients who have undergone a non-cardiac surgical event, 5% have significant cardiac complications within the first 30 days postoperatively. Some factors, such as the aging of the population and the increase of comorbidities, as well as the rate of complications have been increasing, the surgical team must face pulmonary, thromboembolic, renal complications, etc. that can also occur. That is why the integral assessment of each patient must weigh benefits against risks of surgical event. Having sources of information based on evidence, at the site of decision-making, will avoid areas of knowledge uncertainty in the integral assessment of patients, for this reason the information and communication technologies will be very useful tools and support in making decisions, for greater patient safety.

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BACKGROUND AND OBJECTIVE: The characteristics of human hematopoietic stem cells are conditioned by the microenvironment of the bone marrow, where they interact with other cell populations, such as mesenchymal stem cells and endothelial cells; however, the study of this microenvironment is complex. The objective of this work was to develop a 3D culture system by magnetic levitation that imitates the microenvironment of human HSC. METHODS AND RESULTS: Human bone marrow-mesenchymal stem cells, umbilical cord blood-hematopoietic stem cells and a non-tumoral endothelial cell line (CC2811, LonzaⓇ) were used to develop organotypic multicellular spheres by the magnetic levitation method. We obtained viable structures with an average sphericity index greater than 0.6, an average volume of 0.5 mm3 and a percentage of aggregation greater than 70%. Histological studies of the organotypic multicellular spheres used hematoxylin and eosin stains, and an evaluation of vimentin expression by means of immunohistochemistry demonstrated an organized internal structure without picnotic cells and a high expression of vimentin. The functional capacity of human hematopoietic stem cells after organotypic multicellular spheres culture was evaluated by multipotency tests, and it was demonstrated that 3D structures without exogenous Flt3L are autonomous in the maintenance of multipotency of human hematopoietic stem cells. CONCLUSIONS: We developed organotypic multicellular spheres from normal human cells that mimic the microenvironment of the human hematopoietic stem cells. These structures are the prototype for the development of complex organoids that allow the further study of the biology of normal human stem cells and their potential in regenerative medicine.

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Objetivo: el objetivo general de esta investigación es hacer una aproximación para evaluar la asociación entre alteración del metabolismo de la homocisteínametionina y folato en embarazos complicados con restricción de crecimiento intrauterino (RCIU) idiopático, a través del estudio de los niveles de homocisteína pre y posparto, vitamina B12 y folato, así como las frecuencias alélicas y genotípicas de los polimorfismos genéticos de enzimas que participan en la vía metabólica de la homocisteína-metionina y folato en gestantes con embarazos complicados con RCIU idiopático y en condiciones fisiológicas en embarazo normal. Materiales y métodos: estudio piloto observacional analítico de tipo casos y controles. Se estudiaron 8 gestantes con embarazos con restricción de crecimiento intrauterino idiopático y 21 gestantes control con embarazos sin complicaciones y recién nacido sano. Se analizaron las concentraciones de folato, vitamina B12 y homocisteína en el tercer trimestre de embarazo, así como los niveles de homocisteína posparto. Se determinaron los genotipos de las gestantes para los polimorfismos MTHFR C677T, MTHFR A1298C, MTRR A66G, CBS 844ins68, CBS VNTR31pb, CBS C699T y CBS C1080T por medio de reacción en cadena de la polimerasa (PCR) y polimorfismos de longitud de los fragmentos de restricción (RFLP).Resultados: los polimorfismos MTHFR C677T y el genotipo 18/18 del polimorfismo CBS VNTR- 31pb, de manera independiente y en coexistencia, se asociaron a niveles bajos de folato. Igualmente, el genotipo 18/18 del polimorfismo CBS VNTR- 31pb, solo y cuando coexistía con el polimorfismo MTHFR C677T, se asoció con RCIU idiopático. Conclusiones: el metabolismo de la homocisteínametionina y folato es importante para el crecimiento y desarrollo del embrión-feto. El compromiso de estas rutas metabólicas se asocia a complicaciones del embarazo como RCIU idiopático. Los resultados preliminares de este estudio deben incentivar el estudio del metabolismo de la homocisteínametionina y folato en complicaciones del embarazo como la RCIU, así como en condiciones fisiológicas en el embarazo normal en nuestra población.

Objective: This work was aimed at evaluating the association between homocysteine-metionine and folate metabolism alteration and pregnancies complicated by idiopathic intrauterine growth restriction (IUGR). This was done by studying pre- and post-partum homocysteine, vitamin B12 and folate levels, as well as allele and genotype frequency for genetic polymorphisms from enzymes participating in the homocysteine-methionine and folate metabolic route in pregnant women having pregnancies complicated by idiopathic IUGR and physiological conditions during normal pregnancy. Materials and methods: This was an analytical observational (cases and controls) pilot study. Eight pregnant women suffering IUGR were studied, as well as 21 pregnant women as control whose pregnancy had no complications and healthy newborn. Folate, vitamin and B12 homocysteine concentrations as well as postpartum homocysteine levels were analyzed during the third trimester of pregnancy. The pregnant women’s genotypes were determined formethylenetetrahydrofolate reductase (MTHFR) C677T, MTHFR A1298C, methionine synthase reductase (MTRR) A66G, cystathionine betasynthase (CBS) 844ins68, CBS 31pb VNTR, CBS C699T and CBS C1080T polymorphisms by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Results: MTHFR C677T polymorphisms and the CBS 31bp VNTR 18/18 genotype (independently and in coexistence) were associated with low folate levels. The CBS 31bp VNTR 18/18 genotype alone and when coexisting with MTHFR C677T was associated with idiopathic IUGR. Conclusions: Homocysteine-methionine and folate metabolism is important for embryo-fetus growth and development. Compromise of these metabolic routes is associated with pregnancy complications such as idiopathic IUGR. This study's preliminary results should encourage studying homocysteine-methionine and folate metabolism in complications regarding pregnancy such as IUGR and in physiological conditions during normal pregnancy in our population.

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Antecedentes: La República de Guatemala desde el año 2003 ha sido parte de los contingentes de mantenimiento y estabilización de la paz en las Naciones Unidas, con tropas desplegadas en las Repúblicas de Haití y república Democrática del Congo. El 2 de noviembre de 2010, la Oficina Regional Para Centro América y Panamá de los Centros para el Control y Prevención de Enfermdades de Estados Unidos (CDC-CAP), recibió una llamada del Centro Médico Militar de la ciudad de Guatemala, respecto a un soldado recién regresado de la República democrática del Congo (CRD) con un cuadro de enfermedad febril muy sugerente de malaria. El paciente falleció 48 horas después de haber sido admitido al hospital...

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En dos centros hospitalarios se realizó un ensayo clínico, aleatorizado, doble ciego, placebo controlado, para medir la eficacia de la timomodulina en la disminución de la frecuencia y duración de las reagudizaciones infecciosas en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Se administraron cápsulas de 80 mg de timomodulina tres veces al día ó placebo con la misma presentación. Del primero de enero de 1994 al 31 de marzo de 1995 se incluyeron 88 pacientes con EPOC confirmada clínica, funcional y radiológicamente. El tratamiento se administró durante un trimestre (invierno) y se hizo seguimiento durante los tres trimestres siguientes. La mayor reducción en el número de episodios infecciosos se observó en el transcurso del segundo trimestre de seguimiento: 0.19 (ñ 0.39) vs 0.50 (ñ 0.62), p=0.007, para el brazo de timomodulina y placebo, respectivamente, lo que correspondió a una reducción de 62 por ciento. El número de días en cama durante el primer trimestre fue de 0.06 (ñ 0.33) vs 0.95 (ñ 2.46), p=0.02 para timomodulina y placebo, respectivamente, y correspondió a una reducción de días en cama de 94 por ciento. Se obervó un incremento en los tres tipos de linfocitos T, CD3, CD4 y CD8. El análisis de mediciones repetidas mostró un incremento estadísticamente significativo en la proporción de CD3 (p= 0.004), CD4 (p=0.11) y CD8 (p= 0.01). Con base en estos resultados se propone administrar durante dos periodos del año la timomodulina, durante el primero y tercer trimestres, lo que reducira en gran medida el costo excesivo de ciclos repetidos de antibióticos y días de incapacidad y hospitalización

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Se estudió el peso coroporal, el consumo de dieta, la eficacia dietaria *índice de conversión alimentaria) y las concentraciones séricas de Zn, Cu, Fe, Ca y Mg en ratas albinas Wistar adultas, machos, alimentadas con una dieta que contenía 20,0 por ciento de zeolita (Heulandita-Clinoptilolita) durante 40 días. Se encontraron concentraciones séricas más altas de Cu y Mg en el grupo que consumió la zeolita al 20 por ciento en comparación con el grupo control (p < 0,05). Se concluye que la ingestión de zeolita (Heulandita-Clinoptilolita) en las condiciones de este experimento afectó el peso corporal y el índice de conversión alimentaria, y aumentó las concentraciones séricas de Cu y Mg, pero no influyó adversamente sobre el perfil sérico de los 5 metales estudiados

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Se estudiò el efecto de la deficiencia de cinc sobre el crecimiento, el peso corporal, peso absoluto y relativo del higado, cerebro, riñòn, testiculo y adenohipòfisis, ademàs del comportamiento de de razòn de conversiòn alimentaria en 3 grupos de ratas albinas machos, de 12 animales cada uno y 28 dias de nacidas. El perìodo experimental fue de 29 dias y al tèrmino de èste se encontrò que los animales del grupo deficiente en cinc presentaron un retardo del crecimiento. Tambièn este grupom presentò una menor concentraciòn adenohipofisiaria de hormona de crecimiento, asì como un incremento en los valores de la razòn de conversiòn alimentaria

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Se estudiaron la actividadad proteolítica de homogenezados de mucosa gástrica y las características del perfil de la curva de la referida actividad en ratas que recibieron administración de metronidazol, según esquema de la clínica médica del ser humano. No se encontraron cambios significativos en ninguno de los factores estudiados

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