Present and past perspectives on Clostridium difficile infection. / Perspectivas históricas y vigentes sobre la infección por Clostridium difficile.

Clostridium difficile is a Gram-positive bacillus that has become one of the main hospital-acquired human gastrointestinal infections in recent years. Its incidence is on the rise, involving more virulent strains, affecting new and previously uncontemplated groups of patients, and producing changes in clinical presentation and treatment response that influence disease outcome. Early diagnosis and disease stratification based on the severity of C.difficile infection are essential for therapeutic management and the implementation of containment measures. However, the speed at which new strains with greater pathogenicity are developing is surpassing that of the development of new drugs, making it necessary to validate other therapeutic options. The present article is a review of the epidemiologic, pathophysiologic, diagnostic, and therapeutic aspects of C.difficile infection, from its first isolation to the present date, that aims to contribute to the preparation of general physicians and specialists, so that patients with this infection receive opportune and quality medical attention.

Serum IL-12 is increased in Mexican obese subjects and associated with low-grade inflammation and obesity-related parameters.

Interleukin-(IL-) 12 has been recently suggested to participate during development of insulin resistance in obese mice. Nevertheless, serum IL-12 levels have not been accurately determined in overweight and obese humans. We thus studied serum concentrations of IL-12 in Mexican adult individuals, examining their relationship with low-grade inflammation and obesity-related parameters. A total of 147 healthy individuals, 43 normal weight, 61 overweight, and 43 obese subjects participated in the study. Circulating levels of IL-12, tumor necrosis factor-alpha (TNF- α ), leptin, insulin, glucose, total cholesterol, and triglyceride were measured after overnight fasting in all of the study subjects. Waist circumference and body fat percentage were recorded for all the participants. Serum IL-12 was significantly higher in overweight and obese individuals than in normal weight controls. Besides being strongly related with body mass index (r = 0.5154), serum IL-12 exhibited a significant relationship with abdominal obesity (r = 0.4481), body fat percentage (r = 0.5625), serum glucose (r = 0.3158), triglyceride (r = 0.3714), and TNF- α (r = 0.4717). Thus, serum levels of IL-12 are increased in overweight and obese individuals and show a strong relationship with markers of low-grade inflammation and obesity in the Mexican adult population. Further research is needed to understand the role of IL-12 in developing obesity-associated alterations in humans.

Surgical technique in cadaveric donors for partial hand allotransplant in patients with rheumatoid arthritis.

For patients with severe hand deformities due to rheumatoid arthritis, we propose an allotransplantation of an osteomyotendinose structure (OMTS), preserving the recipient's skin and sensory nerves. Our objective was to develop the surgical technique in a 10 cadavers, five as donors and five as recipients. The donor's hand was 10% to 15% smaller than the recipient's. Dissections were performed by two surgical teams under magnification. In the donor, the OMTS was procured at the distal third of the forearm, maintaining the integrity of the arterial system, with its concomitant veins and motor branches of the median and ulnar nerves, leaving the skin envelope. In the recipient, the OMTS was removed, taking care to preserve the cutaneous cover with the digital arteries in continuity with the superficial palmar arch and radial and ulnar arteries. Also, the digital nerves were maintained in the skin flap, in continuity with the median and ulnar nerves. Their motor branches were divided after emergence from the main nerves. The superficial dorsal veins and radial nerve were kept adhered to the cutaneous cover. Then, the donor OMTS was placed within the recipient cutaneous flap; all the anatomic structures were repaired. The average surgical time was 780 minutes. Methylene blue was present in the digital arteries. There were no difficulties in the anatomic repair. The surgical technique is quite laborious, especially the dissection of the recipient interdigital spaces. Due to the requirement for arterial system integrity, the cutaneous flap must be viable. Also, the allotransplanted OMTS has all necessary conditions to obtain good tissue perfusion for subsequent function. Procurement without skin permits a greater opportunity to find donors, and greater social and personal acceptance by the recipient.

HNF-1alpha G574S is a functional variant with decreased transactivation activity.

AIM: To assess the functional consequence of the hepatocyte nuclear factor 1alpha gene (HNF-1alpha) G574S variant previously proposed as a diabetes susceptibility allele, in a group of Mexican Type 2 diabetic patients with end-stage renal disease (ESRD). METHODS: The transcriptional activity of the HNF-1alpha G574S recombinant protein on the human insulin promoter was assessed by transfection assays in RINm5f and HepG2 cell lines. RESULTS: Two unrelated Mexican diabetic patients with no known African ancestry were found to carry the G574S variant. This substitution was not found among unrelated healthy control subjects. Whereas the G574S HNF-1alpha transcription activation of the human insulin promoter was 40% lower than that of the wild-type protein in RINm5f beta cells, no difference was found in a hepatic cell line (HepG2). CONCLUSIONS: G574S affects the transactivation potential of HNF-1alpha on the insulin promoter in pancreatic beta-cells. Although it has been difficult to prove its role in the development of diabetes in case-control association studies, this variant exhibits functional effects consistent with it being a potential diabetes susceptibility allele.

[Peritonitis secondary to perforated pyometra in a patient with cervical cancer: report of a case]. / Peritonitis secundaria a piometra perforado en una paciente con cáncer cervical: informe de un caso.

We describe a clinical case of a postmenopausal woman with a perforated pyometra with clinical manifestations of generalized peritonitis. In the English literature there are 15 reported cases and only 2 secondary to cancer of cervix, our case in the 3rd. case reported in detail. We make pertinent considerations regarding the management of this extremely rare complication.

[Mortality in geriatric patients in the Hospital General of Mexico]. / Mortalidad en pacientes geriátricos del Hospital General de México.

In order to define the main diseases of the elderly and a possible changes of mortality causes at Hospital General of Mexico, SSA, the authors studied 586 autopsy reports of individuals over sixty years old, deceased between 1960 and 1965 and of 625 individuals of similar characteristics deceased between 1981 and 1985. The analysis of diseases showed qualitative and quantitative changes in the ten principal causes of death at each period: some of the most frequent diseases in the 60's, for instance, amebiasis, were not included among the then principal causes of death in the 80's. On the other hand, malignant neoplasms persisted as one of the principal death causes in both periods, but the most frequent carcinoma in the 60's, gastric carcinoma, was substituted in the 80's by bronchogenic carcinoma. This study suggests that great technical and sanitary interventions are necessary to promote health of third age persons, an increasing but poorly protected population in our country.

[The platelet response as a prognostic factor in invasive amebiasis of the liver]. / La respuesta plaquetaria como factor pronóstico en la amibiasis invasora del hígado.

A group of 96 patients with Invasive Hepatic Amebiasis, was studied in a prospective clinical trial. The platelet count was measured for each patient on admission and on the tenth day of treatment. The patient were classified into two groups: the first one for patients with unfavorable results and the second one for patients with favorable results. The presence of thrombocytosis was significant in the second group, with a sensitivity of 56% and specificity of 70% in the initial determination, and of 82% and 68% at the tenth day respectively. With this finding, it could be considered that thrombocytosis must be a good prognostic indicators in the Amebic Liver Abscess, and it could be possible to include it in a scale to elucidate the prognosis in a quantitative form, of this pathologic entity.