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BACKGROUND: SARS-CoV2 induces flu-like symptoms that can rapidly progress to severe acute lung injury and even death. The virus also invades the central nervous system (CNS), causing neuroinflammation and death from central failure. Intravenous (IV) or oral dexamethasone (DXM) reduced 28 d mortality in patients who required supplemental oxygen compared to those who received conventional care alone. Through these routes, DMX fails to reach therapeutic levels in the CNS. In contrast, the intranasal (IN) route produces therapeutic levels of DXM in the CNS, even at low doses, with similar systemic bioavailability. AIMS: To compare IN vs. IV DXM treatment in hospitalized patients with COVID-19. METHODS: A controlled, multicenter, open-label trial. Patients with COVID-19 (69) were randomly assigned to receive IN-DXM (0.12 mg/kg for three days, followed by 0.6 mg/kg for up to seven days) or IV-DXM (6 mg/d for 10 d). The primary outcome was clinical improvement, as defined by the National Early Warning Score (NEWS) ordinal scale. The secondary outcome was death at 28 d between IV and IN patients. Effects of both treatments on biochemical and immunoinflammatory profiles were also recorded. RESULTS: Initially, no significant differences in clinical severity, biometrics, and immunoinflammatory parameters were found between both groups. The NEWS-2 score was reduced, in 23 IN-DXM treated patients, with no significant variations in the 46 IV-DXM treated ones. Ten IV-DXM-treated patients and only one IN-DXM patient died. CONCLUSIONS: IN-DMX reduced NEWS-2 and mortality more efficiently than IV-DXM, suggesting that IN is a more efficient route of DXM administration.

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BACKGROUND: By end December of 2021, COVID-19 has infected around 276 million individuals and caused over 5 million deaths worldwide. Infection results in dysregulated systemic inflammation, multi-organ dysfunction, and critical illness. Cells of the central nervous system are also affected, triggering an uncontrolled neuroinflammatory response. Low doses of glucocorticoids, administered orally or intravenously, reduce mortality among moderate and severe COVID-19 patients. However, low doses administered by these routes do not reach therapeutic levels in the CNS. In contrast, intranasally administered dexamethasone can result in therapeutic doses in the CNS even at low doses. METHODS: This is an approved open-label, multicenter, randomized controlled trial to compare the effectiveness of intranasal versus intravenous dexamethasone administered in low doses to moderate and severe COVID-19 adult patients. The protocol is conducted in five health institutions in Mexico City. A total of 120 patients will be randomized into two groups (intravenous vs. intranasal) at a 1:1 ratio. Both groups will be treated with the corresponding dexamethasone scheme for 10 days. The primary outcome of the study will be clinical improvement, defined as a statistically significant reduction in the NEWS-2 score of patients with intranasal versus intravenous dexamethasone administration. The secondary outcome will be the reduction in mortality during hospitalization. CONCLUSIONS: This protocol is currently in progress to improve the efficacy of the standard therapeutic dexamethasone regimen for moderate and severe COVID-19 patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04513184 . Registered November 12, 2020. Approved by La Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS) with identification number DI/20/407/04/36. People are currently being recruited.

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BACKGROUND: Acute upper extremity injuries remain one of the most common consultations in the emergency departments for plastic surgery services. These injuries can affect a person's quality of life and negatively affect work-related or social interactions if not properly managed. We aim to evaluate our experience and management in a specialized referral center in Mexico City. METHODS: A retrospective review was performed. All patients with hand trauma managed by our service from July 2010 to June 2015 were included; their demographic characteristics were described as well as the most common patterns of injury, management, and outcome. RESULTS: A total of 4751 patients with injuries in the upper extremities were included, 77% were males with a mean age of presentation of 26.9 ± 17.9 years; the age group most commonly affected was between 16 to 30 years (39%); 54% of the cases affected the right hand. Lacerative wounds were the most common mechanism of injury (60.7%), followed by blunt trauma (28.7%). Management was surgical in 87% of the cases. CONCLUSIONS: Upper extremity trauma encompasses a wide range of clinical presentations, from simple lacerations to catastrophic injuries that require extensive or multiple reconstructive procedures. The clear understanding of the trauma mechanisms and how they are related with certain patterns of injury might maximize awareness and guide a surgeon's management effectively.

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OBJECTIVE: We studied the cost of health care for women with breast cancer treated at the Mexican Social Security Institute (IMSS, per its abbreviation in Spanish). MATERIAL AND METHODS: Using the Medical and Operative Information Systems of the IMSS, we constructed a cohort of patients diagnosed in 2002 and followed these patients to the end of 2006, identifying the use of resources and imputing the IMSS-specific cost structure. RESULTS: Only 14% of women were diagnosed in stage 1 and 48% were diagnosed in stages III-IV. The average cost of their medical care per patient-year was $MX110,459. Costs for stage 1 were $MX74,522 compared to $102,042 for stage II, and were $MX154,018 for stage III and $MX199,274 for stage IV. CONCLUSIONS: Breast cancer accounts for a significant part of the IMSS health budget. Later stage at diagnosis is associated with higher economic costs per patient-year of treatment and lower probability of five-year survival.

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OBJETIVO: Calcular el costo de atención de las pacientes con cáncer de mama tratadas en el Instituto Mexicano del Seguro Social. MATERIAL Y MÉTODOS: A través del Sistema de Información Médico Operativa del IMSS, se conformó una cohorte de pacientes con diagnóstico reciente en 2002 que recibió seguimiento hasta finales de 2006. Se identificó el uso de recursos y se le adjudicó el costo de atención del IMSS. RESULTADOS: Sólo 14 por ciento se diagnosticó en fase I y 48 por ciento en las fases III-IV. El costo de atención promedio por año-paciente se estimó en 110 459 pesos y para las mujeres diagnosticadas en 2002 la etapa I tuvo un costo de 74 522 pesos, comparado con 102 042 en la etapa II, 154 018 en la etapa III y 199 274 en la IV. CONCLUSIONES: El cáncer mamario representa un presupuesto significativo en el IMSS y entre más tardía es la etapa de detección, más altos resultan los costos económicos por año-paciente y más baja la probabilidad de sobrevida a cinco años.

OBJECTIVE: We studied the cost of health care for women with breast cancer treated at the Mexican Social Security Institute (IMSS, per its abbreviation in Spanish). MATERIAL AND METHODS: Using the Medical and Operative Information Systems of the IMSS, we constructed a cohort of patients diagnosed in 2002 and followed these patients to the end of 2006, identifying the use of resources and imputing the IMSS-specific cost structure. RESULTS: Only 14 percent of women were diagnosed in stage 1 and 48 percent were diagnosed in stages III-IV. The average cost of their medical care per patient-year was $MX110,459. Costs for stage 1 were $MX74,522 compared to $102,042 for stage II, and were $MX154,018 for stage III and $MX199,274 for stage IV. CONCLUSIONS: Breast cancer accounts for a significant part of the IMSS health budget. Later stage at diagnosis is associated with higher economic costs per patient-year of treatment and lower probability of five-year survival.

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In this study, we have analyzed the chemical composition and antiproliferative activity of propolis from three different arid and semiarid regions of Sonora, Mexico. We identified and quantitated the main chemical constituents of propolis by HPLC-MS. The most abundant constituents of propolis were pinocembrin, pinobanksin 3-acetate, and chrysin. Sonoran propolis had a strong antiproliferative activity on both murine and human cancer cell lines in a concentration-dependent manner. The propolis constituents CAPE, galangin, xanthomicrol and chrysin showed significant antiproliferative activity on most of the cancer cells tested. DNA harvested from cancer cell cultures treated with Sonoran propolis exhibited a ladder of internucleosomal DNA cleavage characteristic of apoptosis. In summary, we have identified and quantitated the main constituents of Sonoran propolis. These propolis samples possess a strong antiproliferative activity on cancer cell lines.

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Objetivo: Evaluar la estimulación ventricular rápida en la Valvuloplastía Aórtica Percutánea como estrategia para obtener estabilidad del balón. Material y métodos: En septiembre de 2004 se inició un protocolo prospectivo. Tres enfermos masculinos consecutivos con estenosis valvular aórtica significativa fueron tratados con este método. Las edades fueron 13, 6 y 5 años. En todos se colocó un electrodo bipolar en el ventrículo derecho. Durante el procedimiento se registró la presión arterial sistémica con un catéter en la aorta descendente. La estimulación ventricular se inició a una frecuencia de 150 por minuto y se aumentó hasta obtener un descenso del 50% en la presión arterial sistémica y entonces el balón se infló para realizar la valvuloplastía aórtica. La estimulación se suspendió hasta que el balón fue completamente desinflado. Resultados: Los gradientes transvalvulares antes de la valvuloplastía fueron 90 y 110 mmHg. Las presiones en aorta fueron de 90, 110 y 55 mmHg. Se obtuvo una reducción del 50% de la presión sistémica con 170, 250 y 220 por minuto de estimulación. La duración de la estimulación rápida en los tres casos fue de 15 segundos. Se logró estabilización del balón sin movimientos en los dos casos. Los gradientes obtenidos después de la valvuloplastía fueron 23, 28 y 15 mmHg. No hubo modificación en el grado de insuficiencia aórtica después del procedimiento. En el primero se mantuvo grado I y en el segundo y tercer casos, no se observó regurgitación en el aortograma. Conclusiones: La estimulación cardíaca rápida estabiliza el balón durante la valvuloplastía, es segura, efectiva y puede disminuir la incidencia de insuficiencia aórtica.

Objective: To evaluate rapid ventricular pacing in balloon aortic valvuloplasty, an initial strategy to achieve balloon stability. Material and methods: From September to December 2004, a prospective protocol was started: three male consecutive patients with aortic valve stenosis were treated by this strategy. Age of the patients were 13, 6 and 5 years old. All had a bipoplar pacing catheter placed in the right ventricle. Invasive systemic pressures were documented with a catheter in the descending aorta. Rapid ventricular pacing was initiated at the rate of 150 per minute and increased to a rate required to achieve a drop in systemic pressure by 50%. The balloon was inflated only after the pacing rate was reached and the blood pressure dropped. Pacing was continued until the balloon was completely deflated. Results: The systolic gradients across the aortic valve before balloon dilatation were 90, 110 and 55 mmHg. The systolic pressures in aorta were 90 and 110 mmHg. The pacing rate to drop the pressure by 50% were 170, 250 and 220 per minute. The pacing time was 15 seconds in all patients. Balloon stability at time of inflation was achieved in all cases with no balloon movement. The post-ballooning gradients were 23, 28 and 15 mmHg. Angiogram performed post balloon dilatation showed no change compared with the pre-balloning angiogram in aorta: trivial aortic incompetence in the first case and none in the second and third cases. Conclusions: Rapid ventricular pacing to stabilise the balloon during balloon aortic valvuloplasty seems to be safe and effective and may decrease the incidence of aortic incompetence.

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OBJECTIVE: To evaluate rapid ventricular pacing in balloon aortic valvuloplasty, an initial strategy to achieve balloon stability. MATERIAL AND METHODS: From September to December 2004, a prospective protocol was started: three male consecutive patients with aortic valve stenosis were treated by this strategy. Age of the patients were 13, 6 and 5 years old. All had a bipoplar pacing catheter placed in the right ventricle. Invasive systemic pressures were documented with a catheter in the descending aorta. Rapid ventricular pacing was initiated at the rate of 150 per minute and increased to a rate required to achieve a drop in systemic pressure by 50%. The balloon was inflated only after the pacing rate was reached and the blood pressure dropped. Pacing was continued until the balloon was completely deflated. RESULTS: The systolic gradients across the aortic valve before balloon dilatation were 90, 110 and 55 mmHg. The systolic pressures in aorta were 90 and 110 mmHg. The pacing rate to drop the pressure by 50% were 170, 250 and 220 per minute. The pacing time was 15 seconds in all patients. Balloon stability at time of inflation was achieved in all cases with no balloon movement. The post-ballooning gradients were 23, 28 and 15 mmHg. Angiogram performed post balloon dilatation showed no change compared with the pre-balloning angiogram in aorta: trivial aortic incompetence in the first case and none in the second and third cases. CONCLUSIONS: Rapid ventricular pacing to stabilise the balloon during balloon aortic valvuloplasty seems to be safe and effective and may decrease the incidence of aortic incompetence.

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A chelating cyclophane has been synthesized by cyclocondensation of two ethylenediaminetetraacetic (EDTA) units with two p-phenylenediamine units: the resulting cyclophane is 2,9,18,25-tetraoxo-4,7,20,23-tetrakis(carboxymethyl)-1,4,7,10,17,20,23,26-octaaza[10.10]paracyclophane, abbreviated as (bis-edtapdn)H(4). Cyclocondensation of two EDTA and two 1,5-diaminonaphthalene units has given the naphthalenophane, 2,9,22,29-tetraoxo-4,7,24,27-tetrakis(carboxymethyl)-1,4,7,10,21,24,27,30-octaaza[10.10](1,5)naphthalenophane, (bis-edtanap)H(4). Studies of electronic and EPR spectra have been carried out on the binuclear Cu(2+) complexes of these new ligands and of related chelating cyclophanes, 2,9,25,32-tetraoxo-4,7,27,30-tetrakis(carboxymethyl)-1,4,7,10,24,27,30,33-octaaza[10.1.10.1]paracyclophane, abbreviated as (bis-edtabpm)H(4), and 2,9,25,32-tetraoxo-4,7,27,30-tetrakis(carboxymethyl)-1,4,7,10,24,27,30,33-octaaza-17,40-dioxa[10.1.10.1]paracyclophane, abbreviated as (bis-edtabpe)H(4). Common features of these chelating cyclophanes are as follows: (1) amino, amide, and pendant carboxymethyl donor groups are substituents in the cyclophane ring, and (2) the amide groups are directly bound to the aromatic groups. These ligands formed neutral binuclear Cu(2+) chelates [Cu(2)L](0) that are water-insoluble. In alkaline solutions, these Cu(2+) complexes were converted to anionic chelates [Cu(2)(LH(-)(4))](4)(-) in which deprotonated amide nitrogens coordinated Cu(2+) ions. These anionic metal chelates of (bis-edtapdn)H(4), (bis-edtabpm)H(4), and (bis-edtabpe)H(4) exhibited three pi-pi transition bands in the spectral range 240-340 nm, in contrast to the uncoordinated cyclophanes, which showed a single band in this spectral range. The unusual pi-pi transition spectra of the [Cu(2)(LH(-)(4))](4)(-) complexes originate from the combined effect of metal-ligand charge transfer and proximity of the pi systems. The absorption and emission spectra of (bis-edtanap)H(4) were also influenced by coordination with copper. The EPR spectrum of [Cu(2)(bis-edtanapH(-)(4))](4)(-) in a methanol glass matrix showed a hyperfine structure due to the spin exchange between two Cu(2+) ions. These unusual spectral and magnetic properties arise from the strong coordination between Cu(2+) ions and deprotonated amide nitrogens that are bound to the pi systems.