Lupus Erythematosus Tumidus: Clinical and Pathological Features in a Series of 20 Patients.

OBJECTIVE: We sought to assess the clinicopathologic/immunophenotypical features in patients with lupus erythematosus tumidus (LET). METHODS: All skin biopsies diagnosed as LET in 16 years were retrieved from our pathology laboratory. Clinical charts were reviewed and immunohistochemical markers were performed. Subpopulations of cells in the infiltrates were studied, as well as the number/distribution of plasmacytoid dendritic cells (PDC), which were compared with two control groups: normal skin and discoid lupus erythematosus. Direct immunofluorescence was performed when available. RESULTS: We found 20 patients (11 men and 9 women; mean age 43.5 years); the mean evolution previous to diagnosis was 20.3 months. They all had erythematous, nonscarring urticarial-like plaques: 8 in the head region only, 8 in trunk/limbs only; both segments were affected in 2 patients; topography was unknown in 2. Except for 1 patient, no one developed systemic lupus erythematosus. A dense perivascular/periadnexal superficial-to-deep lymphocytic infiltrate and stromal mucin deposition were characterized histopathologically; interphase changes were absent. Immunophenotype supported an inflammatory profile. The differential count of CD123 + PDC in 10/20 cases of LET (n = 1180) was notably higher than 5 cases of discoid lupus erythematosus (n = 419) and 5 cases of normal skin (n = 38). No immune deposits were found in 2 cases. CONCLUSION: LET is a rare, peculiar form of cutaneous lupus erythematosus that only exceptionally evolves to systemic lupus erythematosus . Its clinical-pathologic/immunophenotypical features are very characteristic. The amount of CD123 + PDC is a very helpful feature among the criteria for its diagnosis and seems to be relevant in its pathogenesis.

Erratum to "From ACTH-Dependent to ACTH-Independent Cushing's Syndrome from a Malignant Mixed Corticomedullary Adrenal Tumor: Potential Role of Embryonic Stem Cells".

[This corrects the article DOI: 10.1155/2020/4768281.].

From ACTH-Dependent to ACTH-Independent Cushing's Syndrome from a Malignant Mixed Corticomedullary Adrenal Tumor: Potential Role of Embryonic Stem Cells.

OBJECTIVE: To report the immunohistochemical and molecular evaluation of a patient with ectopic ACTH syndrome (EAS) from a MCAT which has single cells with features of both 96 medullary and cortical differentiation. Case Description and Methods. A 16-year-old woman presented with severe EAS and a large right MCAT composed of ACTH-secreting cells resembling pheochromocytoma and another lineage similar to adrenal carcinoma. Immunohistochemistry (IHC) showed positivity for medullary (ACTH, chromogranin A, synaptophysin, and PS-100) and epithelial components (inhibin, melan-A, and calretinin). Embryonic stem cell markers were evaluated using RT/PCR and immunofluorescence. After initial surgery, the tumor recurred shifting to rapidly progressive ACTH-independent liver metastasis. RESULTS: Histopathology and IHC revealed two distinct and intermingled cellular patterns, while some cells immunostained for both medullary and cortical markers. Demonstration of all stem cell biomarkers by RT/PCR and immunofluorescence was predominantly localized to the nucleus, whereas SOX2 immunoreactivity was evident in the cytoplasm as well. CONCLUSION: The expression of cancer stem cell biomarkers points towards the involvement of primitive embryonic cells as the origin of this neoplasm and maybe to the clinically aggressive and biochemically changing behavior.

The origin of the recent (2012-2016) seismic activity in the Guadalajara, Jalisco, Mexico, area: A block boundary interaction?

The central part of Jalisco, Mexico, has experienced low-magnitude earthquake sequences and swarms. Although the effects of these earthquakes have been limited to relatively small areas, the earthquakes have caused general alarm among the population and, in some cases, have been catastrophic. These earthquake swarms are significant because they affect the most populous area of the state, including the capital city of Guadalajara. An extraordinary example is an earthquake swarm that started on 8 May 1912 and lasted until September of that year. The region remained seismically quiescent until May 2012, when seismic activity resumed, lasting to the present. We analyze the recent seismic activity, starting with the earthquake of 18 May 2012 (03:07 UT) at the western edge of Lake Chapala and ending with the magnitude 4.2 earthquake on 3 November 2016. Our analysis includes eight earthquakes with magnitudes between 3.5 and 4.8, the revision of hypocenter locations, and the determination of focal mechanism solutions using the inversion of the moment tensor method. When possible, inversion solutions are compared with solutions obtained with the first arrival polarity method. We compare our results for the recent seismicity with the distribution of reported damage associated with historical earthquakes. Our work indicates a N-S trending seismic source zone and an orientation of nodal planes that suggests reactivation of preexisting local faults induced by the interaction of the western border of the Trans-Mexican Volcanic Belt with the eastern border of the Jalisco Block.

Intubación traqueal con dispositivo supraglótico I-gel en pacientes pediátricos: Serie de casos prospectiva / Tracheal intubation with I-gel supraglottic device in pediatric patients: a prospective case series

Abstract Introduction: Currently, there are no devices showing an acceptable success rate in blind intubation in pediatrics. Objectives: The purpose of this particular series of cases is to identify the percentage of successful blind intubations using the Igel laryngeal mask in children between 2 and 35 kg of body weight, in addition to evaluating seal pressure, fiber optics vision through the device, and reporting the occurrence of complications. Materials and methods: A prospective case series in pediatrics; patients from 2 to 35 kg. Results: According to our study, the overall percentage of blind intubation was 23%, while the percentages of ideal and low vision to facilitate the insertion of the bronchoscope into the airway, and then inserting a tracheal tube through the fiber optics was 70%. Conclusion: We feel that the supraglottic I-gel is not the appropriate device for blind intubation; however, it is an acceptable recommendation to conduct fiber optics intubation.

Resumen Introducción: No hay un dispositivo en la actualidad que demuestre apropiado porcentaje de éxito de intubación a ciegas en pediatría. Objetivos: El propósito de esta serie de casos es conocer el porcentaje de éxito de intubación a ciegas a través de la máscara laríngea I-gel en niños pesando entre 2 y 35 kilos, además evaluar la presión de sello, la visión fibroscópica a través del dispositivo y reportar la aparición de complicaciones. Materiales y Métodos: Serie prospectiva de casos en pediatría, en pacientes de 2 a 35 kilos. Resultados: En nuestro estudio el porcentaje global de intubación a ciegas fue del 23%, el porcentaje de visión ideal y visión baja, que permiten fácil introducción del broncoscopio en la via aérea y luego a través del fibroscopio introducir un tubo traqueal, fue de un 70%. Conclusiones: Consideramos que el I-gel supraglótico no es un dispositivo adecuado para intubación a ciegas. Sin embargo, tiene un valor aceptable para recomendar realizar intubación fibro-óptica a través del dispositivo supraglótico I-gel. Results: According to our study, the overall percentage of blind intubation was 23%, while the percentages of ideal and low vision to facilitate the insertion of the bronchoscope into the airway, and then inserting a tracheal tube through the fiber optics was 70%. Conclusions: We feel that the supraglottic I-gel is not the appropriate device for blind intubation; however, it is an acceptable recommendation to conduct fiber optics intubation.

Effect of intrauterine injection of human chorionic gonadotropin before embryo transfer on clinical pregnancy rates from in vitro fertilisation cycles: a prospective study.

BACKGROUND: The implantation process after embryo transfer depends on the embryo quality and endometrial receptivity. It is estimated that fifty to seventy-five per cent of pregnancies are lost due to a failure of implantation. There is evidence that there is an early secretion of human chorionic gonadotrophin before embryo implantation, and this secretion has been linked to an important function in angiogenesis and the inflammatory response that promotes the implantation process. Our objective was to determine the effects of intrauterine injection of human chorionic gonadotropin (hCG) before the embryo transfer in an in vitro fertilisation cycle. METHODS: A prospective randomised study was conducted in Reproductive Medicine Centre PROCREA in Mexico City. Infertile patients who had a medical indication for in vitro fertilisation were studied. Two groups were included (n 210); the intervention group received an intrauterine injection of 500 IU of hCG before the embryo transfer (n 101). The control group (n 109) did not receive hCG. Comparisons were performed using a chi-square test. RESULTS: The clinical pregnancy rate (CPR) was our principal outcome. The implantation rate was a secondary outcome. The implantation rate was significantly higher in the hCG group compared to the control group (52.4% vs 35.7%, p 0.014). The clinical pregnancy rate was also significantly higher (50.4 vs 33.0%, p 0.010). No adverse effects were observed. CONCLUSIONS: The intrauterine injection of hCG before embryo transfer showed a significant increase in the clinical pregnancy rate. More clinical trials are needed to reproduce these results on this promising intervention. The live birth rate must be included in subsequent studies.

Hepatotoxicity associated with dietary energy supplements: use and abuse by young athletes.

 In recent years there has been a significant increase in the consumption of dietary energy supplements (DES) associated with the parallel advertising against obesity and favoring high physical performance. We present the case and outcome of a young patient who developed acute mixed liver injury (hepatocellular and cholestatic) after ingestion of various "over the counter" products to increase muscle mass and physical performance (NO Xplode®, creatine, L-carnitine, and Growth Factor ATN®). The diagnosis was based on the exclusion of other diseases and liver biopsy findings. The dietary supplement and herbal multivitamins industry is one with the highest growth rates in the market, with annual revenues amounting to billions and constantly lacking scientific or reproducible evidence about the efficacy and/or safety of the offered products. Furthermore, and contrary to popular belief, different forms of injury associated with these natural substances have been documented particularly in the liver, supporting the need of a more strict regulation.

[Stress test at 44 °C and 80 % of humidity and usefulness of ice suit]. / Prueba de esfuerzo a 44°C y 80 % de humedad. Utilidad del traje con hielo.

OBJECTIVE: to compare the fatigue in a stress test at high temperature and humidity in eight healthy volunteers. METHODS: the time of pedaling on the ergometer cycle was measured to know the exercise's efficiency at 30 km/h until the volunteers presented exhaustion or their heart frequency increased to > 160 beats/min. A basal test in the tunnel's ventilation of the Naica mine at 37.5°C and 40 % humidity was done. We repeated the stress test at the entrance of the cave, where temperature was 44°C and 80 % humidity. We compared using the protector equipment with ice and cold air breathing suit. RESULTS: the stress test al 44°C and 80 % humidity with the protector suit was interrupted in 75 % of participants because of an increase in the heart frequency (> 160 per minute) The exercise time was duplicated in 62 % and was increased in 100% of the participants with an average increase of 2.25 times and a rank of (1.12-3.3). Using the statistical Wilcoxon test the differences between the times of stress test with and without equipment at 44°C and 80 % humidity had a Z of 2.52 and a p of .012 was done.

Trombosis mesentérica venosa: Factores de riesgo, diagnóstico y resultados en el manejo quirúrgico / Venous mesenteric thrombosis: risk factors, diagnosis, and results of surgical management

Objetivo: Reportar la experiencia en el manejo quirúrgico de pacientes con trombosis mesentérica venosa. Sede: Hospital de Tercer Nivel. Diseño: Estudio observacional, descriptivo, transversal, retrospectivo, Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Pacientes y métodos: Estudio retrospectivo en el que se incluyeron 8 pacientes intervenidos quirúrgicamente durante un periodo de 5 años. Cinco de los pacientes tenían antecedentes o factores asociados a trombosis. El síntoma más común en la mayoría fue dolor abdominal de más de tres días de evolución. En todos, la trombosis mesentérica venosa se clasificó como secundaria y fue necesario realizar resección intestinal del segmento afectado. Seis pacientes tuvieron buena evolución y permanecieron con manejo anticoagulante. Dos pacientes fallecieron por complicaciones embólicas pulmonares. Conclusiones: La trombosis mesentérica venosa es una entidad rara con sintomatología vaga. Antecedentes del paciente, sospecha diagnóstica y estudios de imagen son los factores más importantes para realizar el diagnóstico al que es infrecuente llegar antes de la operación. La cirugía con resección del segmento afectado conlleva a resultados aceptables.

Objective: To report our experience with patients with mesenteric vein thrombosis managed surgically. Setting: Third level health care hospital. Design: Observational, descriptive, retrospective study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and methods: During a 5-year period, eight patients with mesenteric vein thrombosis were managed surgically; five of them had known risk factors for the development of venous thrombosis or had previous events of thrombosis at other sites. Abdominal pain was the predominant symptom, in most cases of three or more days. All had secondary vein thrombosis and required resection of the affected bowel. Six of them survived and were kept on anticoagulation therapy. Two patients died due to pulmonary embolism. Conclusions: Mesenteric vein thrombosis is a rare entity with vague symptoms. Medical history of the patient, clinical suspicion, and radiological studies are the most important factors for diagnosis; this latter is rarely attained preoperatively. Surgical management with resection of affected bowel leads to acceptable outcomes.

Short report: limited and short-lasting humoral response in Taenia solium: seropositive households compared with patients with neurocysticercosis.

Epidemiologic data suggest that 30-40% of Taenia solium-seropositive people become spontaneously negative without acquiring cysticercosis. To compare the responses of these individuals with those of patients with neurocysticercosis, we screened seropositive persons among family members of 16 patients. We searched for specific antibodies in patients and their 118 households by an enzyme-linked immunoelectrotransfer blot assay using specific glycoproteins of T. solium metacestodes. We found six seropositive individuals without neurocysticercosis among members of four families. The matching patients were young, harbored viable cysts, and had short evolution of disease. The baseline response of healthy seropositive individuals was scarce and showed a low frequency of antibodies against glycoproteins GP39-42 and GP24, which are immunodominant in patients with neurocysticercosis. Moreover, they became spontaneously negative in few months. The response of patients was heterogeneous as shown in other studies. The results of this work support a highly dynamic host-parasite immunologic interaction and suggest individual susceptibility or level of exposure among family members.