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BACKGROUND: Hemodialysis (HD) patients present an increased carotid intima-media thickness (CIMT) and calcified plaques, and studies have demonstrated that CIMT is predictor for cardiovascular death in this patient population; hence, the importance of identifying early non-invasive markers of atherosclerosis. We aim to propose a new three-perspective CIMT measuring method in HD population, and to further investigate the possible use and value of this method to predict outcomes. METHODS: A cross-sectional study was conducted, the CIMT was measured with duplex ultrasound during the perioperative access planning. Software provided maximum CIMT in a 10 mm (mm) width of the common carotid artery. CIMT was measured in Right (R) and Left (L) carotid arteries, both in anterior (a), lateral (l), and posterior (p) view. The sum of these values (Ra+Rl+Rp+La+Ll+Lp) was completed and termed as Sixth Carotid Intimal (SCI) score. We stratified either in low (summation <4) or high (>=4) SCI score groups. Demographics, patency rates, complications, and mortality were collected; chi-square test was used for our analysis. RESULTS: A total of 30 patients (mean age 49 years and 56% females) that underwent access creation in the upper arm from 2010 to 2016 were selected and studied. A low SCI score was found 19 patients and 11 had high SCI, no significant difference was observed in demographics, history cardiovascular disease, and clinical outcomes as early thrombosis, and primary, primary-assisted patency at 12 months. Interestingly, during the follow up period of 36 months a significant higher difference in late thrombosis rates occurred (63.6% vs 26.3%, p = .044) and a higher all-cause mortality (54.4% vs 15.7%, p = .025) in patients with SCI score group above 4. CONCLUSIONS: The SCI score method, might offer a screening tool for traditional cardiovascular risk factors in HD patients. In this study, we demonstrate an increased rate in late thrombosis and mortality in those with high SCI. Further research is necessary to better define the role of CIMT in vascular surgical procedures.
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Las enfermedades de Alzheimer y esclerosis múltiple son neurodegenerativas, con tratamientos complejos y de costos elevados, orientados a disminuir la progresión de la sintomatología. Sin embargo, a causa de la falta de terapias adecuadas y de los posibles efectos adversos ocasionados por tratamientos de primera línea, es necesario implementar mejores abordajes terapéuticos complementarios que no produzcan mayores efectos secundarios y mejoren la sintomatología de dichas patologías. La restricción calórica y el ayuno intermitente han demostrado ser estrategias novedosas y beneficiosas en enfermedades neurodegenerativas, a través de mecanismos inmunitarios, metabólicos y fisiológicos. Con el objetivo de determinar el uso del ayuno intermitente y la restricción calórica como tratamiento coadyuvante en esclerosis múltiple y enfermedad de Alzheimer, se realizó una revisión narrativa de artículos originales en revistas científicas, en idiomas inglés y español, de 2018 a 2022. El uso de la restricción calórica y ayuno intermitente han generado cambios positivos produciendo disminución de estados proinflamatorios, estrés oxidativo y envejecimiento. Se consideran abordajes que modulan la progresión de la enfermedad y mejoran la función cognitiva por vías de señalización de monofosfato de adenosina cinasa, factor de crecimiento similar a la insulina y la enzima sirtuina, generando un efecto neuroprotector.
Alzheimer's disease and multiple sclerosis are neurodegenerative disorders with expensive and complex treatments aimed at reducing the progression of symptoms. However, due to the lack of adequate therapies and the possible adverse effects caused by first-line treatments, it's necessary to implement better complementary therapeutic approaches that do not produce major side effects and improve symptoms. Caloric restriction and intermittent fasting have been shown to be novel and beneficial strategies in neurodegenerative diseases, through immune, metabolic, and physiological mechanisms. To determine the use of intermittent fasting and caloric restriction as a new treatment in multiple sclerosis and Alzheimer's disease, a narrative review of original articles in both national and international scientific journals, in English and Spanish languages with no greater obsolescence than five years. The use of caloric restriction and intermittent fasting have generated positive changes, producing a decrease in pro-inflammatory states, oxidative stress, and aging. Approaches that modulate disease progression and improve cognitive function of adenosine monophosphate kinase, insulin-like growth factor, and sirtuin enzyme pathways are considered, generating a neuroprotective effect.
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El SalvadorRESUMO
Background: High-quality clinical care requires excellent interdisciplinary communication, especially during emergencies, and no tools exist to evaluate communication in critical care. We describe the development of a pragmatic tool focusing on interdisciplinary communication during patient deterioration (CritCom). Methods: The preliminary CritCom tool was developed after a literature review and consultation with a multidisciplinary panel of global experts in communication, pediatric oncology, and critical care to review the domains and establish content validity iteratively. Face and linguistic validity were established through cognitive interviews, translation, and linguistic synthesis. We conducted a pilot study among an international group of clinicians to establish reliability and usability. Results: After reviewing 105 potential survey items, we identified 52 items across seven domains. These were refined through cognitive interviews with 36 clinicians from 15 countries. CritCom was piloted with 433 clinicians (58% nurses, 36% physicians, and 6% other) from 42 hospitals in 22 countries. Psychometric testing guided the refinement of the items for the final tool. CritCom comprised six domains with five items each (30 total). The final tool has excellent reliability (Cronbach's alpha 0.81-0.86), usability (93% agree or strongly agree that the tool is easy to use), and similar performance between English and Spanish tools. Confirmatory factor analysis was used to establish the final 6-domain structure. Conclusions: CritCom is a reliable and pragmatic bilingual tool to assess the quality of interdisciplinary communication around patient deterioration for children in diverse resource levels globally. Critcom results can be used to design and evaluate interventions to improve team communication.
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BACKGROUND: Bone neoplasms are usually misdiagnosed causing a delay in their treatment. Bone neoplasms are usually confused with tendinitis, 31% of the cases corresponds to osteosarcomas and in 21% to Ewing's sarcomas. OBJECTIVE: To create a clinical-radiographic instrument of high diagnostic suspicion of knee bone neoplasms to prevent a delay in diagnosis. METHOD: A clinimetric study (sensitivity, consistency and validity) was performed in the bone tumor service, Hospital de Ortopedia de la Unidad Médica de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, in México City. RESULTS: Characteristics of 153 patients were collected. For the sensitivity phase, 3 domains (signs, symptoms, and radiology) and 12 items were included. Consistency was evaluated with ICC (0.944), 95%CI (0.865-0.977), p < 0.001 and a-Cronbach (0.863). Index obtained a sensitivity of 0.80 and a specificity of 0.882 were obtained. The positive predictive value of the test was 66.6% and the negative predictive value was 93.75%. The positive likelihood ratio was 6.8 and the negative likelihood ratio was 0.2. Validity was evaluated using r-Pearson (0.894; p < 0.001). CONCLUSIONS: A high suspicion clinical-radiographic index was designed to detect malignant knee tumors with adequate sensitivity, specificity, appearance, content, criteria, and construct validity.
ANTECEDENTES: Los tumores óseos suelen ser subdiagnosticados, provocando un retraso en su tratamiento. El diagnóstico erróneo más frecuente es tendinitis, en el cual el 31% corresponden a osteosarcomas y el 21% a sarcomas de Ewing. OBJETIVO: Crear un instrumento clínico-radiográfico de alta sospecha diagnóstica de tumores óseos de rodilla. MÉTODO: Se realizó un estudio clinimétrico (sensibilidad, consistencia y validez) en el servicio de tumores óseos del Hospital de Ortopedia de la Unidad Médica de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, en Ciudad de México. RESULTADOS: El índice se realizó tomando las características de 153 pacientes. Para la fase de sensibilidad se incluyeron tres dominios (signos, síntomas y radiología) y 12 ítems. La consistencia se evaluó con coeficiente de correlación intraclase (0.944), intervalo de confianza del 95% (0.865-0.977), p < 0.001 y α de Cronbach (0.863). Se obtuvo una sensibilidad del instrumento de 0.80 y una especificidad de 0.882. El valor predictivo positivo de la prueba fue del 66.6% y el valor predictivo negativo fue de 93.75%. La razón de verosimilitud positiva fue de 6.8 y la razón de verosimilitud negativa fue de 0.2. La validez se evaluó mediante r-Pearson (0.894; p < 0.001). CONCLUSIONES: Se diseñó un índice clínico-radiográfico de alta sospecha para detectar tumores malignos de rodilla con adecuada sensibilidad, especificidad y validez de apariencia, de contenido, de criterio y de constructo.
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Neoplasias Ósseas , Joelho , Humanos , Neoplasias Ósseas/diagnóstico por imagem , México , Valor Preditivo dos Testes , Estudos Retrospectivos , Joelho/diagnóstico por imagem , Joelho/patologiaRESUMO
BACKGROUND: Bone neoplasms require an adequate clinical-radiographic evaluation for their diagnosis. Plain radiographs are the usual method to establish the diagnosis and evaluate differential diagnoses in the study of bone tumor pathology. OBJECTIVE: To recognize the frequency of radiographic characteristics and associate them with bone tumor pathology. METHOD: Radiographic data were collected from 132 patients with tumor pathology confirmed by biopsy from bone tumors service of the Traumatology and Orthopedics Hospital Unidades Médicas de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, Ciudad de México, during 2019. RESULTS: 132 patients were registered. The most frequent benign tumor was osteochondroma (27.3%), and malignant was osteosarcoma (9.8%). Active lytic lesions (odds ratio [OR]: 6.9; 95% confidence interval [95% CI]: 2.83-16.85) or aggressive (OR: 26.85; 95% CI: 3.21-224) were associated with giant cells tumors. Poorly differentiated intraosseous blast lesions of bone lineage (OR: 36.15; 95% CI: 4.4-295.5) were associated with osteosarcoma. The periosteal reaction (OR: 36.15; 95% CI: 4.4-295.5), the moth-eaten or permeative pattern (OR: 11.75; 95% CI: 1.26-109) and the central location of the lesion (OR: 3.03; 95% CI: 1.37-6.69) were associated with malignant tumor lesions. CONCLUSIONS: Poorly defined intraosseous blast lesions of bone lineage, periosteal reaction, and moth-eaten or permeative pattern of destruction are associated with malignant lesions.
ANTECEDENTES: Los tumores óseos requieren una adecuada evaluación clínico-radiográfica para su diagnóstico. Las radiografías simples son el método incruento usual para establecer el diagnóstico y evaluar diagnósticos diferenciales en el estudio de la patología tumoral ósea. OBJETIVO: Reconocer la frecuencia de las características radiográficas y asociarlas con patología tumoral ósea. MÉTODO: Se recolectaron datos radiográficos de 132 pacientes con patología tumoral confirmada mediante biopsia del servicio de tumores óseos del Hospital de Traumatología y Ortopedia Unidades Médicas de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, en Ciudad de México, durante el año 2019. RESULTADOS: Integraron la muestra 132 pacientes. El tumor benigno más frecuente fue el osteocondroma (27.3%), y el maligno, el osteosarcoma (9.8%). Las lesiones líticas activas (odds ratio [OR]: 6.9; intervalo de confianza del 95% [IC95%]: 2.83-16.85) o agresivas (OR: 26.85; IC95%: 3.21-224) se asociaron a tumor de células gigantes. Las lesiones blásticas de estirpe ósea mal diferenciadas intraóseas (OR: 36.15; IC95%: 4.4-295.5) se asociaron a osteosarcoma. La reacción perióstica (OR: 36.15; IC95%: 4.4-295.5), el patrón apolillado o permeativo (OR: 11.75; IC95%: 1.26-109) y la ubicación central (OR: 3.03; IC95%: 1.37-6.69) se asociaron a lesiones tumorales malignas. CONCLUSIONES: Las lesiones blásticas de estirpe ósea mal definidas intraóseas, la reacción perióstica y el patrón de destrucción apolillado o permeativo se asocian a lesiones malignas.
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Neoplasias Colorretais , Osteossarcoma , Humanos , Estudos Retrospectivos , Neoplasias Colorretais/patologia , MéxicoRESUMO
Existen reportes con diversos propósitos sobre las causas de mortalidad del profesional médico. Objetivo: Caracterizar las causas de muerte de los médicos fallecidos en Honduras en el período 2001-2015. Material y métodos: Estudio retrospectivo descriptivo, del 1 de enero 2001 al 31 de diciembre 2015. La muestra del estudio fueron 408 médicos fallecidos, según la base de datos del Colegio Médico de Honduras. Variables estudiadas: edad, sexo y causas de muerte. Se cotejaron las bases de datos del Colegio Médico de Honduras, Registro Nacional de las Personas, Instituto Nacional de Estadísticas y Dirección de Medicina Forense. Se catalogaron las causas de muerte reportadas según Clasificación Internacional de Enfermedades, CIE-10, 2008. Resultados: 408 médicos fallecidos, 365(89.5%) hombres y 43(10.5%) mujeres; la edad promedio al fallecimiento: hombres 69 años y mujeres 51. Las causas de muerte por su orden: cardiovasculares 117(28.7%), neoplasias malignas 90(22%), 76(18.6%) por causas externas, entre ellas, accidentes automovilísticos, homicidios y suicidios, diabetes mellitus 39(9.6%) y cirrosis hepática 20 (4.9%). Conclusiones: el 50.7% de las muertes de los médicos en Honduras, del 2001 al 2015 ocurrieron por enfermedades cardiovasculares y cáncer. Las causas externas y la diabetes mellitus tienen un papel importante en la mortalidad. La enfermedad cardiovascular predominó en el sexo masculino...(AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Médicos , Causas de Morte , Autopsia/métodos , Atestado de Óbito , Mortalidade/tendências , Pessoal de SaúdeRESUMO
The lateral septum (LS) is a limbic nucleus interconnected with several brain areas involved in the regulation of mood and reward. Vasopressin (AVP) is a neuropeptide that has been related to the effects of drugs of abuse, but its role in the addictive process is poorly understood. LS expresses a high density of AVP 1A receptors (V1A ). The aim of this work was to examine whether the modulation of LS AVP system affects the behavioral and neurochemical responses to amphetamine (AMPH) in male rats. Our results show that AMPH-induced conditioned place preference (CPP) produces a decrease in LS AVP content. Besides, we demonstrate that the microinjection of AVP in the LS impairs the expression of AMPH-induced CPP and that this effect is mediated by the activation of the V1A receptor in the LS. AVP microinjection in the LS elicited a decrease in neuronal activity in the nucleus accumbens (NAc) in animals subjected to AMPH conditioning. Finally, AVP microinjection in the LS decreased dopamine (DA) release in the NAc. Overall, our data demonstrate that intra-LS AVP diminishes the expression of AMPH conditioning behavior while decreasing neuronal activity and DA release in the NAc. Presumably, the effects of AVP in the LS produce an inhibition of GABAergic projections to the VTA, increasing local inhibitory tone in this nucleus, which in turn reduces the activity of DA projections to NAc. Thus, these results contribute to the knowledge about the role of AVP in LS in regulating the reward circuit and addictive like behaviors.
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Anfetamina/farmacologia , Dopamina/metabolismo , Núcleo Accumbens/efeitos dos fármacos , Núcleos Septais/efeitos dos fármacos , Vasopressinas/farmacologia , Animais , Estimulantes do Sistema Nervoso Central , Condicionamento Operante/efeitos dos fármacos , Masculino , Atividade Motora/efeitos dos fármacos , RatosRESUMO
Los exámenes escritos como parte de la evaluación de los aprendizajes son un mecanismo regulador del proceso educativo, que permite comprobar si se adquirieronlas habilidades y destrezas planificadas. Objetivo: Determinar las características y habilidadescognitivas valoradas enlos exámenes escritos de las asignaturas de Patología, Carrera de Medicina. Material y Métodos: Estudio transversal descriptivo. La unidad de análisis consistió en exámenes escritosde la asignatura de Patología I con 49 preguntas y Patología II con 46, realizados en el primer semestre del 2017. El número de secciones fueron 14; 6 en Patología I y 8 en Patología II, con un total de 433 estudiantes. Losexámenes revisados fueron del primer y último parcial 862; 296 en Patología I y 566 en Patología II. Se revisaron 1 324 preguntas, clasificándose según habilidad cognitiva memoria, compresión, análisis y síntesis. Para el análisis de los datos se utilizaronlos programas SPSS y Excel. Resultados: En las asignaturas de Patología I y II, se aplicaron exámenes escritos unificados; se emplearon 3 tipos de reactivos; selección única 30(61%) y 30(65%); completación 15(31%) y 10(22%);enumeración 4(8%) y 6(13%), respectivamente. Las habilidades cognitivas: memoria 71(72.5%)y 74(80.5%); comprensión 22(22.5%) y 17(18.5%);1Profesor Titular II, Departamento de Psiquiatría, UNAH.2 Profesor Titular IV, Departamento de Patología, UNAH.3 Pedagoga UTES, UNAH.4 Profesor Titular I, Departamento Ciencias Morfológicas, UNAH. 5 Asistente Técnico UTES, UNAH.Autor de correspondencia: nsabillon2002@yahoo.esRecibido: 25/6/18 Aceptado: 6/11/18análisis 5( 5%) y 1(1%). El número de preguntas acertadas en las habilidades cognitivas de patología 1 fue: memoria 7 250, comprensión 2 206 y análisis 468. El porcentaje de aciertos por habilidades cognitivas, fue: 50% y 57.3% en memoria; 15.2 % y 12.2 % en comprensión; 3.2 % y 1.1% en análisis. Conclusión: En la evaluación de los aprendizajes, mediante exámenes escritos en las asignaturas de Patología, el tipo de pregunta de mayor frecuencia fue selección única yla habilidad cognitiva más evaluada y acertada fue memoria...(AU)
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Humanos , Questões de Prova , Avaliação Educacional/métodos , Desempenho Acadêmico , Patologia , Estudantes de MedicinaRESUMO
Exhaustion of superficial veins coupled with the presence of intrathoracic central venous occlusions remains a significant obstacle for hemodialysis access creation; complex arteriovenous graft (AVG) configurations have been described. The axillary-iliac AVG was first reported in 1987, and few authors have explored this access. We evaluated our experience with this AVG configuration utilizing the early cannulation (EC) graft Flixene™ (Atrium ™, Hudson, NH, USA). Eight patients (75 % men; mean age 37 ± 10 years) with End-Stage Renal Disease (ESRD) underwent axillo-iliac AVG creation with Flixene™ grafts; all had exhausted peripheral veins, occluded thoracic central veins, and inadequate femoral veins. Inflow from the axillary artery and outflow in iliocaval system was assessed prior to access creation. An axillary-to-common iliac AVG was constructed using a 6 mm (mm) EC graft and tunneled in the chest and abdominal wall. Eight grafts were implanted; all were patent after placement. Seven (88 %) were successfully used for hemodialysis within 72 h and one (12 %) within 96. During the mean follow-up of 6 months, 5 (62 %) patients underwent thrombectomy, 1 (12 %) of them had balloon angioplasty at the vein anastomosis, and 2 (25 %) grafts were removed secondary to infection. The remaining grafts are still functioning. Complications as high-output heart failure, steal syndrome and venous hypertension were not observed. Construction of axillo-iliac AVG with EC grafts in the setting of exhausted veins, occluded intrathoracic central veins and hostile groins, is a viable arteriovenous access alternative while avoiding central venous catheters.
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Derivação Arteriovenosa Cirúrgica/métodos , Prótese Vascular , Falência Renal Crônica/terapia , Diálise Renal/métodos , Adulto , Cateterismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
BACKGROUND: Campylobacter fetus is a pathogen of major concern for animal and human health. The species shows a great intraspecific variation, with three subspecies: C. fetus subsp. fetus, C. fetus subsp. venerealis, and C. fetus subsp. testudinum. Campylobacter fetus fetus affects a broad range of hosts and induces abortion in sheep and cows. Campylobacter fetus venerealis is restricted to cattle and causes the endemic disease bovine genital campylobacteriosis, which triggers reproductive problems and is responsible for major economic losses. Campylobacter fetus testudinum has been proposed recently based on genetically divergent strains isolated from reptiles and humans. Both C. fetus fetus and C. fetus testudinum are opportunistic pathogens for immune-compromised humans. Biochemical tests remain as the gold standard for identifying C. fetus but the fastidious growing requirements and the lack of reliability and reproducibility of some biochemical tests motivated the development of molecular diagnostic tools. These methods have been successfully tested on bovine isolates but fail to detect some genetically divergent strains isolated from other hosts. The aim of the present study was to develop a highly specific molecular assay to identify and quantify C. fetus strains. RESULTS: We developed a highly sensitive real-time PCR assay that targets a unique region of the 16S rRNA gene. This assay successfully detected all C. fetus strains, including those that were negative for the cstA gene-based assay used as a standard for molecular C. fetus identification. The assay showed high specificity and absence of cross-reactivity with other bacterial species. The analytical testing of the assay was determined using a standard curve. The assay demonstrated a wide dynamic range between 102 and 107 genome copies per reaction, and a good reproducibility with small intra- and inter-assay variability. CONCLUSIONS: The possibility to characterize samples in a rapid, sensitive and reproducible way makes this assay a good option to establish a new standard in molecular identification and quantification of C. fetus species.
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Técnicas de Tipagem Bacteriana/métodos , Campylobacter fetus/genética , Tipagem Molecular/métodos , RNA Ribossômico 16S/genética , Reação em Cadeia da Polimerase em Tempo Real , Técnicas de Tipagem Bacteriana/normas , Campylobacter fetus/isolamento & purificação , Variação Genética , Tipagem Molecular/normas , Reação em Cadeia da Polimerase em Tempo Real/normas , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Especificidade da EspécieRESUMO
Introducción: El osteosarcoma representa el 15% de las neoplasias óseas. En México, constituye el 4,5% de las neoplasias y el 46,6-74% de los tumores óseos malignos, con ligero predominio en los varones adolescentes y el 50-80% en rodilla y húmero proximal. Objetivo: Identificar la distribución, la frecuencia relativa y la tendencia del osteosarcoma y su proyección a cinco años. Materiales y Métodos: Estudio epidemiológico, de registro de pacientes con diagnóstico histológico de osteosarcoma entre 2005 y 2014. Se analizaron los siguientes datos: edad, sexo, diagnóstico, localización, lado y estadio con estadística descriptiva y dispersión.Los resultados se sometieron a análisis mediante el índice de Pearson y regresión lineal por método de mínimos cuadrados. Resultados: Se analizaron 4744 casos. La incidencia de osteosarcoma fue del 3,29% y constituyó el 56,2% de los tumores óseos malignos primarios. La edad de los pacientes era 18.6 ± 16.8 años, con mayor incidencia en la segunda década de la vida (54,1%); la relación hombre:mujer era de 1,64:1. El 55,8% comprometía la rodilla, seguida del húmero proximal (7,1%). La variedad histológica predominante fue osteoblástica (76,9%). El estadio IIB fue más frecuente (77,6%), seguido del IIIB (13,8%). A los cinco años, se predice un aumento en la incidencia de osteosarcoma. Conclusiones: Esta es la mayor serie de osteosarcoma en América Latina. Se predice un incremento en la incidencia de osteosarcoma. Es necesario identificar factores de riesgo para establecer este comportamiento particular. Nivel de Evidencia: IV
Introduction: Osteosarcoma represents 15% of bone neoplasms. In Mexico, it accounts for 4.5% of neoplasms and 46.6% to 74% of malignant bone tumors with a slight predominance of teenage males, 50-80% affects the knee and proximal humerus. Objective: To identify the distribution, relative frequency and tendency of osteosarcoma and its projection to five years. Methods: Epidemiologic study of a patient database with histological diagnosis of osteosarcoma from 2005 to 2014. Age, gender, diagnosis, location, side and stage were analyzed using descriptive statistics and dispersion. Results were measured with Pearson's index and lineal regression analysis by the least squares method. Results: We analyzed 4,744 cases. Osteosarcoma had a frequency of 3.29% and it accounted for 56.2% of primary malignant bone tumors. Patients´ age was 18.6 ± 16.8 years old with higher incidence in the second decade of life (54.1%); men to women ratio was 1.64:1. Osteosarcoma affected the knee in 55.8% of the cases, followed by the proximal humerus (7.1%). Predominant histologic subtype was osteoblastic (76.9%). IIB stage was more frequent (77.6%), followed by IIIB (13.8%). To five years, an increased incidence of osteosarcoma is predicted. Conclusions: This is the largest case series of osteosarcoma in Latin America. A rising incidence of osteosarcoma is predicted. It is necessary to identify risk factors to establish this particular behavior. Level of Evidence: IV
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Criança , Adolescente , Neoplasias Ósseas , Osteossarcoma/epidemiologia , México , IncidênciaRESUMO
Un grupo de sanitaristas analizó la realidad sanitaria nacional. Imaginó y propuso un sistema sanitario capaz de atender a todos con equidad. Síntesis de la Publicación del Grupo Técnico Salud "Una propuesta de SALUD PARA TODOS: Acortemos la brecha entre lo que se planifica y lo que realmente recibimos y necesitamos los argentinos"
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Administração em Saúde Pública , Recursos Financeiros em Saúde , Sistemas Nacionais de Saúde , Equidade , Política de SaúdeRESUMO
Campylobacter fetus subsp. venerealis is the causative agent of bovine genital campylobacteriosis, a sexually transmitted disease distributed worldwide. Campylobacter fetus subsp. venerealis biovar Intermedius strains differ in their biochemical behavior and are prevalent in some countries. We report the first genome sequence for this biovar, isolated from bull prepuce.
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Alcohol use disorders and alcohol dependency affect millions of individuals worldwide. The impact of these facts lies in the elevated social and economic costs. Alcoholic liver disease is caused by acute and chronic exposure to ethanol which promotes oxidative stress and inflammatory response. Chronic consumption of ethanol implies liver steatosis, which is the first morphological change in the liver, followed by liver fibrosis and cirrhosis. This review comprises a broad approach of alcohol use disorders, and a more specific assessment of the pathophysiologic molecular basis, and genetics, as well as clinical presentation and current modalities of treatment for alcoholic liver disease.
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Hepatopatias Alcoólicas/genética , Hepatopatias Alcoólicas/terapia , Causas de Morte , Humanos , Hepatopatias Alcoólicas/mortalidade , Organização Mundial da SaúdeRESUMO
UNLABELLED: Hepatic dysfunction caused by malignancy is uncommon and can be the result of primary hepatocellular carcinoma, liver metastasis, secondary malignancies, or a complication of chemotherapeutic agents. Hematological malignancies, as leukemia, non-Hodgkin lymphoma, and Hodgkin lymphoma, typically do not result in hepatic dysfunction and rarely manifest as fulminant liver failure. CASE PRESENTATION: A 43 year-old male was referred with 2-week diarrhea, nausea and vague abdominal discomfort. He was treated with oral antibiotics. However, symptoms progressed and he was admitted with advanced liver failure. On admission the patient was jaundiced, agitated, with tachycardia and hypotension. There were echymosis around the eyes and chest, active bleeding at sites of vein punctures and macroscopic hematuria. The abdomen was tender with an enlarged liver. Admission laboratory findings were consistent with acute hepato-renal failure. Viral hepatitis serology was negative, antinuclear antibody screen was negative, and iron panel was normal. Abdominal ultrasound showed liver and spleen enlargement. He developed refrac- tory hypoglycemia, further increase in serum lactate and died 5 days after admission. CONCLUSIONS: Acute liver failure is uncommon as the presenting feature of lymphoma. This fact may delay diagnosis, contributing to the reported poor prognosis. Establishing a diagnosis of malignancy as the cause of acute liver failure is difficult and requires a high index of suspicion. Given the poor prognosis associated with late or missed diagnosis and the potential benefits of early chemotherapy, lymphoma should be considered in any patient presenting with acute liver failure without an obvious etiology and associated with lactic acidosis and hepatomegaly.
Assuntos
Acidose Láctica/etiologia , Falência Hepática Aguda/etiologia , Neoplasias Hepáticas/complicações , Linfoma não Hodgkin/complicações , Adulto , Evolução Fatal , Humanos , Neoplasias Hepáticas/patologia , Linfoma não Hodgkin/patologia , MasculinoRESUMO
A complex situation of chemical exposure has been described in México in a zone that is in transition from rural activities towards intensive industrialization, which has brought environmental pollution: chloroform, methylene chloride, indigo and toluene are some of the pollutants found in the Atoyac and Xochiac rivers. A biomonitoring study was planned in order to establish whether there was a biological effect due to the environmental situation. Communities where leukaemia and thrombocytopenic purpura cases have been reported were included in the study, as well as other communities where such cases have not been described. Three occupations were distinguished, according to chemical exposure: industrial workers, agricultural workers and workers in households, education and commerce. A comprehensive analysis in the micronucleus (MN) test was used to study genotoxicity biomarkers. Two metabolic polymorphisms were determined, namely, glutathione transferase mu1 (GSTM1) and theta1 (GSTT1), which are relevant when oxidative responses are involved. Increased genotoxic damage was found, including cells with >1 MN, >1 chromatin bud, and nucleoplasmic bridges. The genotoxic damage was differentially distributed in the regions studied, being more affected those that are closer to the Atoyac and Xochiac rivers, indicating an effect due to environmental exposure to the contaminants present in the rivers. Further characterization of the exposure regimes in these communities will be done in order to contribute to the alleviation of the health risks that environmental pollution is posing on the inhabitants of this area.
Assuntos
Agricultura , Aberrações Cromossômicas/induzido quimicamente , Indústrias , Linfócitos/sangue , Testes para Micronúcleos/métodos , Exposição Ocupacional/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dano ao DNA , Feminino , Glutationa Transferase/genética , Humanos , Masculino , México , Micronúcleos com Defeito Cromossômico/induzido quimicamente , Pessoa de Meia-IdadeRESUMO
Este es un estudio observacional, decriptivo, transversal y retrospectivo. Se colectaron 226 artroplastías de cadera con acetábulo CLS de marzo de 1992 a diciembre de 1997, con 102 pacientes femeninos y 124 masculinos, con un promedio de edad de 36 años. La orientación de la copa CLS mostró una media de 46.1 grados; hasta el momento de cierre del presente estudio, ninguno de los pacientes había mostrado aflojamiento, migración o desgaste del implante. Nosotros lo atribuimos al hecho de que el acetábulo CLS tiene un sistema basado en la idea de "anclaje expansivo". Obviamente requerimos de un periodo mayor para tener resultado más confiables.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Artroplastia de Quadril , Acetábulo/cirurgia , Prótese de Quadril , Fenômenos BiomecânicosRESUMO
El presente es un trabajo retrospectivo, observacional, descriptivo y comparativo de 60 estudios radiológicos de artroplastías totales de cadera tomados al azar en que se eligió el cótilo acetabular de Robert Mathys con interior de polietileno de peso molecular ultra alto; en el periodo de diciembre de 1986 a octubre de 1996. La cabeza del vástago femoral fue de metal en 34 casos y de cerámica en 26 casos. El método para medir el desgaste fue propuesto por Scheier y Sandel, modificado por Buchhorn. Este estudio demuestra que la combinación cerámica con polietileno provoca menos desgaste de este último.
Assuntos
Radiografia , Aparelhos Ortopédicos , Cerâmica/uso terapêutico , Fricção , Prótese de Quadril , Estudo de AvaliaçãoRESUMO
Entre las principales características del Linfoma Gástrico están la variada apariencia endoscópica y la dificultad del diagnóstico mediante biopsia endoscópica convencional. Para valorar este problema se analizó la experiencia de 15 años del Instituto Oncológico Luis Razetti. Se clasificaron las lesiones (10 casos) morfológicamente en: a) tipo exofítico 5/50 por ciento b) tipo infiltrante 5/50 por ciento. Endoscópicamente fue más difícil de valorar el tipo infiltrante en su categoría de pliegue grueso 2/20 por ciento, arrojando un 33 por ciento de diagnósticos benignos. Histopatológicamente el diagnóstico fue benigno el 66 por ciento de las veces y dudoso en el 33 por ciento. El tipo exofítico en su categoría de mamelón erosionado fue el segundo más difícil en el diagnóstico endoscópico e histopatológico. Cuando las anteriores categorías se asociaban a ulceraciones, los diagnósticos malignos se incrementaban. El 40 por ciento de los casos fueron a cirugía sin diagnóstico histopatológico de malignidad. Los 10 casos correspondieron a Linfoma No Hodgkin difuso de células grandes, diagnóstico alcanzado en una sola oportunidad preoperatoriamente. No hubo correlación entre la morfología tumoral y la invasión intraparietal. Sólo 3 pacientes sobrevivieron más de 1 año. Se puede concluir que el método de video endoscopia puede ayudar a mejorar el conocimiento del endoscopista en el diagnóstico del linfoma gástrico, mientras que la biopsia con aro de polipectomía, los colorantes como el Indigo Carmín y las técnicas especiales como la mucosectomía, ayudan a mejorar el diagnóstico histopatológico, ya que la biopsia convencional aporta muestras pequeñas y a menudo superficiales
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Endoscopia Gastrointestinal , Endoscopia Gastrointestinal/estatística & dados numéricos , Histologia , Linfoma/diagnóstico , Patologia , Gastropatias/diagnóstico , Neoplasias Gástricas/diagnóstico , GastroenterologiaRESUMO
Se evaluaron 120 historias de pacientes, ingresados al Instituto en el lapso 1983-1990, en los que el diagnóstico definitivo fue Cáncer Colo-Rectal. Se analizaron las características clínicas, epidemiológicas, endoscópicas, radiológicas y patológicas de los diversos pacientes, así como su evolución de acuerdo a diversos parámetros (Edad, CEA. Dukes) y tratamiento. El diagnóstico tardío (10,8% de los casos diagnosticados por cuadros de obstrucción intestinal, el estadio avanzado de la enfermedad), (48,3% de casos correspondientes a Dukes C y D), y la alta tasa de mortalidad (34,1% de casos fallecidos antes del primer año del diagnóstico); siguen siendo los problemas básicos por controlar. El hallazgo de un alto porcentaje de cáncer en sujetos menores de 40 años (25,8%) y de cáncer de localización rectal (49,1%), nos obliga a plantearnos la posibilidad de controlar la enfermedad en nuestro medio mediante la evaluación colonica integral, de toda persona joven con clínica, equívoca, pero facilmente atribuible a enfermedad hemorroidal o amibiasis