Clinical and sociodemographic factors that may influence the resilience of women surviving breast cancer: cross-sectional study.

PURPOSE: Breast cancer is one of the most common diseases, affecting many thousands of women. Although more than 80% of women survive the experience, very few studies have been conducted to examine the question of resilience among long-term survivors of breast cancer. The aim of this study is to describe the clinical and sociodemographic factors that correlate with greater resilience in women survivors of breast cancer, in the Costa del Sol Health Area (Spain). METHODS: Accordingly, a descriptive cross-sectional study was conducted, with respect to 59 survivors of breast cancer, who each completed a questionnaire for analysis according to the Connor-Davidson Resilience Scale (CD-RISC). RESULTS: The median resilience score was 77 (interquartile range 70-80). The group of patients who had survived for six or more years since the diagnosis had a higher score for total resilience (90: IR 76-92) than those diagnosed more recently (74: IR 65.7-83.7) (p = 0.012). Regarding the patients' education background, the group with no formal qualifications or only primary studies had a score of 72 (IR 64-84), versus 79 (IR 74-89.7) for the group with higher levels of education (p = 0.016). Of the clinical variables, only the administration of chemotherapy was significantly associated with the score obtained on the CD-RISC scale (p = 0.012). CONCLUSIONS: The results obtained in this study lead us to conclude that sociodemographic and clinical factors have a positive impact on the level of resilience among women resident in the Costa del Sol Health Area and who are long-term survivors of breast cancer.

Initial Experience in Urological Surgery with a Novel Robotic Technology: Magnetic-Assisted Robotic Surgery in Urology.

Introduction and objective: Magnetic-assisted robotic surgery (MARS) has been developed to maximize patient benefits of minimally invasive surgery while enhancing surgeon control and visualization. MARS platform (Levita Magnetics) comprises two robotic arms that provide control to an external magnetic controller and an off-the-shelf laparoscopic camera. Our aim was to evaluate the safety and efficacy of the MARS platform in laparoscopic renal and adrenal procedure for the first time. Methods: This is a prospective, single-arm, open-label study (Clinical Trials Identifier: NCT05353777) including patients with renal or adrenal pathology analysis, submitted to laparoscopic procedure between April and June 2022. Patients were followed up to 30 days postoperatively. Preoperative, intraoperative, and postoperative data were recorded. Polynomial regression was used to determine the learning curve for docking time. Results: Fifteen cases were performed using the MARS platform (three partial nephrectomies, five total nephrectomies for benign pathology analysis, four radical nephrectomies, and three adrenalectomies) corresponding to 10 women and 5 men (mean age, 55 years [18-77]; average body mass index, 29 cm/m2 [22-39]). No cases required conversion to open procedure and all patients were discharged on the first or second postoperative day. No complications or re-admissions were reported within the first 30 days. All oncologic cases had negative margins. Learning curve was achieved by the fourth case, diminishing docking time from 5.22 (2.6-11.5) to 2.68 minutes (2.1-3.8) (p = 0.002). The learning curve was fitted to a cubic regression (R2 = 0.714). Conclusion: This is the first clinical study demonstrating the safety and versatility of the MARS platform in urologic procedures. The robot was especially useful for tissue retraction, avoiding additional incisions and the need for a surgical assistant while increasing surgeon control and visualization. The learning curve was rapid, achieving a short docking time. MARS is a promising new technology that could be successfully evaluated in other surgeries.

[Perioperative management of paragangliomas and pheochromocytomas]. / Manejo perioperatorio de feocromocitoma y paraganglioma.

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, characterized by a high morbidity rate due to catecholamine excess. These high levels are independent of physiologic stressors. For the diagnosis, a biochemical workup is paramount. The most widely used are plasma-free metanephrines and urinary fractionated metanephrines. Imaging studies should be initiated once the biochemical diagnosis is established. Evaluation of the patient with pheochromocytomas and paragangliomas must be done taking into account the leading causes of perioperative morbidity and mortality. The two primary interventions that have reduced perioperative mortality are alpha-adrenergic blockade and intravascular volume normalization. Another significant advance has been the establishment of laparoscopic surgery as the gold standard for the surgical approach. No anesthetic technique has been found to be superior to another. Intraoperative hemodynamic instability has been correlated with poorer outcomes; thus one of the main intraoperative goals is maintaining hemodynamic stability. Lower morbidity and almost zero mortality rates due to preoperative and intraoperative management improvements have led to a focus on the immediate and long-term postoperative care. Anual lifelong follow-up is recommended to detect recurrent disease.

Los feocromocitomas y paragangliomas son tumores neuroendocrinos raros, caracterizados por una alta tasa de morbilidad debida a un exceso de niveles de catecolaminas. Este exceso de catecolaminas es independiente de los estresores fisiológicos. Para el diagnóstico de un feocromocitoma-paraganglioma son fundamentales las pruebas bioquímicas. Las más utilizadas son las metanefrinas fraccionadas urinarias o metanefrinas libres plasmáticas. Seguido del diagnóstico bioquímico, debe realizarse un estudio imagenológico. La evaluación del paciente con diagnóstico de feocromocitoma-paraganglioma debe realizarse teniendo presente sus principales causas de morbimortalidad perioperatoria. Las dos grandes intervenciones que han disminuido la mortalidad perioperatoria son la introducción del α bloqueo y la restauración de la volemia. El otro gran avance ha sido la introducción de la cirugía laparoscópica como el estándar de oro para el abordaje quirúrgico. En relación con el manejo intraoperatorio, no se ha identificado que alguna técnica anestésica sea superior a otra. Sí se ha logrado establecer criterios de inestabilidad hemodinámica que se correlacionan con mayor morbilidad, por lo que los principales objetivos intraoperatorios son mantener estabilidad hemodinámica. El avance en el manejo preoperatorio e intraoperatorio con la consecuente disminución en la mortalidad relacionada a esta patología ha llevado el foco al manejo postoperatorio tanto agudo como a largo plazo. También se debe considerar el riesgo de recurrencia tumoral, por lo que estos pacientes deben tener un control anual de por vida.

Ameloblastoma uniquístico con patrón plexiforme: revisión de la literatura a propósito de un caso clínico / Unicystic ameloblastoma with a plexiform pattern: literature review regarding a clinical case

En 1827 el médico James William Cusack describió una lesión tumoral expansiva con características clínicas similares al ameloblastoma. Para el 2017 la Organización Mundial de la Salud lo clasificó como un tumor odontogénico benigno de origen epitelial. En la actualidad hemos aceptado la teoría de su etiología asociada con una mutación en el biomarcador BRAF-V600E, donde se presentan claras heterogeneidades extra/intratumorales en el metabolismo de la tumorogénesis; la mutación en BRAF genera cambios en la regulación de la odontogénesis, en conjunto con el gen CDC73 presente en el cromosoma 1 q25-q32, lo que produce un cambio en la proteína parafibromina que inhibe la proliferación celular durante el crecimiento y la división celular, esto afecta en conjunto al gen p53 y su homólogo p63 presentes en el cromosoma 17, por lo que se tiene como resultado la expresión de quistes y tumores dentales como el ameloblastoma. La presente obra muestra el caso clínico de un paciente femenino de 11 años de edad con aumento de volumen en la región submandibular izquierda de 7 × 4 cm, con seis años de evolución; de tal manera que fue diagnosticado con ameloblastoma uniquístico y tratado de forma conservadora mediante enucleación, posteriormente fue valorada anualmente hasta que la paciente cumplió los 18 años de edad (AU)

In 1827, physician James William Cusack described an expansive tumor lesion with clinical characteristics similar to ameloblastoma. For 2017, the World Health Organization classified it as a benign odontogenic tumor of epithelial origin. Currently, we have accepted the theory of its etiology associated with a mutation in the BRAF-V600E biomarker, where there are clear extra/intratumoral heterogeneities in the metabolism of tumorigenesis; the BRAF mutation generates changes in the regulation of odontogenesis, together with the CDC73 gene present on chromosome 1 q25-q32, producing a change in the parafibromin protein that inhibits cell proliferation during cell growth and division, which together it affects the p53 gene and its p63 homolog is present on chromosome 17, resulting in the expression of dental cysts and tumors such as ameloblastoma. This work provides the clinical case of an 11-year-old patient with an increase in volume in the left submandibular region of 7 × 4 cm of 6 years of evolution. Being diagnosed as a unicistic ameloblastoma and treated conservatively by enucleation, it is subsequently evaluated annually until the patient reaches 18 years of age (AU)

Regulación de la implantología dental en México / Regulation of dental implantology in Mexico

Introducción: los implantes dentales se han convertido en uno de los tratamientos odontológicos con mayor demanda en todo el mundo, no sólo por el nivel máximo de funcionalidad y de estética, sino también debido a su estabilidad, osteointegración y facilidad en su rehabilitación. Es incierto si los implantes dentales se encuentran normados formalmente en México, lo que motiva a la revisión del estado actual. Objetivo: evidenciar el estado actual de la legislación de la práctica de la implantología dental en México a través de una revisión en la literatura. Material y métodos: revisión de las legislaciones existentes en México para la aplicación de implantes dentales y su contraparte en el mundo a través de la evaluación de normas expedidas en América y Europa. Resultados: se contabilizó un total de 17 escuelas de implantes dentales que cuentan con el reconocimiento de la Secretaría de Educación Pública, de las cuales tres son públicas y 14 privadas. Se presentó una discrepancia en los planes de estudio que va de 16 a 36 meses. Las escuelas no contaron con un aval normativo. Las normas internacionales para control de calidad y aplicación de la tecnología en implantes se ubicaron en Canadá, Estados Unidos, España, Reino Unido y Francia. Conclusiones: contar con un antecedente normativo establecido por los países de primer mundo y ausente en México permite evidenciar la necesidad de implementar una Norma Oficial Mexicana que regule la fabricación, distribución y almacenamiento de los implantes dentales en México. A la vez, la revisión sugiere que la Secretaría de Educación Pública norme los créditos mínimos necesarios en las instituciones educativas reconocidas para la formación de recursos humanos que ejercen la implantología dental (AU)

Introduction: dental implants have become one of the dental treatments with the highest demand in the world, not only because of the highest level of functionality and aesthetics, but also because of their stability, osseointegration and ease of rehabilitation. It is uncertain if dental implants are formally regulated in Mexico, which motivates the review of the current status. Objective: to demonstrate the current state of the legislation for the practice of dental implantology in Mexico through a review of the literature. Material and methods: review of the existing legislation in Mexico, for the application of dental implants and its counterpart in the world, through the evaluation of standards issued in America and Europe. Results: a total of 17 dental implant schools that have the recognition of the Ministry of Public Education were counted, of which 3 are public and 14 private. There was a discrepancy in the study plans that ranged from 16 to 36 months. Schools will not have regulatory backing. The international standards for quality control and application of technology in implants were located in Canada, the United States, Spain, the United Kingdom and France. Conclusions: having a normative antecedent established by the countries of the first world and absent in Mexico, allows to demonstrate the need for the implementation of an Official Mexican Standard, which regulates the manufacture, distribution and storage of dental implants in Mexico. At the same time, the review suggests that the Ministry of Public Education regulate the minimum necessary credits in recognized educational institutions, for the training of human resources that practice dental implantology (AU)

Retrograde intrarenal surgery using the single - use flexible ureteroscope Uscope 3022 (Pusen™): evaluation of clinical results.

INTRODUCTION: Reusable endoscopes have some limitations regarding their continued use. To sort out these problems, several disposable devices have appeared on the market. Our objective is to show our clinical results with a new digital flexible single-use ureteroscope. MATERIALS AND METHODS: This study presents a prospective series of patients who underwent endoscopic surgery as treatment for renal stones using the digital disposable endoscope Uscope 3022™. Demographic, procedure and stone information were registered including surgery time, stone-free rate, need of ureteral catheterization and complications, among others. The behavior of the ureteroscope in terms of image quality and problems associated with flexibility and the working channel were also registered. RESULTS: A total of 71 procedures were included in the analysis. The mean age was 49.9 years old, with 70.4% of male patients. Mean stone size was 11.4 mm (4 to 40 mm). The most frequent stone location was in the lower calyces (28.2%). The stone burden was high (>2 cm) in 8.4% of patients. The mean surgical time was 56.6 minutes (15-180 min). In 94.4% of the cases, a laser was used with dusting parameters. The global stone-free rate (SFR) was 95.2%, but in the subgroups analysis SFR were significantly superior in stones less than 10 mm (97.9%) versus stones between 10 and 20 mm (94.5%) and greater than 20 mm (78.3%) (p <0.01). The postoperative placement of double-J stents was required in 66.2% of patients. Two minor complications were recorded and they were related to the ureteral access sheath used. There were no problems regarding the performance of the ureteroscope. CONCLUSIONS: The clinical data observed in this series does not differ from the results traditionally obtained with other reusable devices. To our knowledge, this series is the first worldwide report evaluating the clinical behavior and results in humans of the Uscope 3022.

Dientes natales asociados con enfermedad de Riga-Fede: actualización literaria a propósito de un caso / Riga-Fede disease associated with natal teeth: review of the literature a propos of a case

El italiano Antonio Riga describe una lesión ulcerativa en el vientre lingual relacionada con traumatismo crónico por los órganos dentales de erupción atípica prematura, no fue hasta que el italiano Francesco Saverio Fede, en 1890 realizó la primera publicación de la entidad patológica. En 2002, la Sociedad Argentina de Dermatología incluyó la úlcera eosinófila de la mucosa oral dentro de la clasificación de Fitzpatrick. La presencia de los dientes neonatales y natales se origina por una alteración en conjunto de los cromosomas 4, 5 y 14 (AU)

The Italian Antonio Riga describes an ulcerative injury in the lingual belly related to chronic traumatism by the dental organs of a premature atypical eruption, it was not until the Italian Francesco Saverio Fede, in 1890, made the first publication of the pathological entity. In 2002, the Argentinean Society of Dermatology included the eosinophilic ulcer of the oral mucous within the classification of Fitzpatrick. The presence of the neonatal and natal teeth is caused by a combined alteration of chromosomes 4, 5 and 14 (AU)

Tratamiento alternativo in vitro en sinusitis y neoplasias del seno maxilar / Alternative treatment in vitro on sinusitis and maxillary sinus

RESUMEN El presente artículo está enfocado en demostrar que es factible realizar una comunicación bucosinusal de modo in vitro utilizando cráneos humanos que fueron aportados por el panteón municipal de la ciudad de Morelia. La finalidad útil de este procedimiento está enfocada en controlar los síntomas de la sinusitis. Igualmente analizar la posibilidad de ingresar farmacológicamente a la cavidad neumática en casos de crecimientos neoplásicos valiéndonos de las cualidades permeables en la mucosa. Comprobamos que es un estudio experimental, longitudinal, analítico de riesgo mínimo que se implementó de manera in vitro en los segundos premolares o primeros molares permanentes de 10 cráneos de restos humanos. Teniendo como resultado siete abordajes de los cuales el 85.71% se reportó como favorable al procedimiento quirúrgico, demostrando que es un procedimiento adecuado, económico que no requiere equipo sofisticado.

ABSTRACT This article is focused on demonstrating that it is feasible to carry out a communication mode buco-sinus in vitro using human skulls that were provided by the municipal cemetery of the city of Morelia. The useful purpose of this procedure is focused on controlling the symptoms of sinusitis. Also discuss the possibility of joining pharmacologically pneumatic cavity in cases of growth neoplásicos availing ourselves of the permeable qualities in the mucosa. We check that it is an experimental, longitudinal, analytical study of minimal risk that I implement way in vitro in the second premolars or fi rst molars permanent ten skulls of human remains. Resulting in seven approaches which the 85.71% reported as favorable to the surgical procedure, showing that it is a suitable, economical procedure which does not require sophisticated equipment.

Síndrome de Gorlin-Goltz, actualización: a propósito de un caso en el Hospital Infantil de Morelia / Gorlin-Goltz syndrome update: apropos of a case at the Morelia Children Hospital

Este síndrome fue escrito en 1960 por Robert J Gorlin, patólogo bucalinvestigador formado en Minnesota y por Robert W Goltz, dermatólogo. Es un trastorno autosómico dominante ocasionado por el gen Patched 1 (PTCH1) que se ubica en el cromosoma 9q223, caracterizado por defectos en el desarrollo y alta predisposición al cáncer. La prevalencia es de 1/56,000 y 1/221,000 pacientes. El padecimiento se caracteriza por desarrollo de carcinomas basocelulares, queratoquistes odontogénicos y malformaciones esqueletales. Debido a su alta predisposición al desarrollo de carcinomas basocelulares agresivos, debe diagnosticarse temprana y oportunamente para un pronóstico favorable.

Robert Gorlin a mouth researcher trained pathologist Minnesota andRobert Goltz a dermatologist described this syndrome in 1960. It is anautosomal dominant disorder, caused by the Patched 1 gene (PTCH1)located on chromosome 9q223 characterized by developmental defectsand a high predisposition to cancer. The incidence is 1/56,000 and1/221,000 patients. The condition is characterized by the developmentof basal cell carcinomas, odontogenic keratocystic and skeletalmalformations. Due to its high predisposition to the development ofaggressive basal cell carcinomas should be early and timely diagnosisfor a favorable prognosis.

Nefrectomía radical derecha con resección de trombo tumoral en vena cava inferior nivel III / Right radical nephrectomy with inferior vena cava tumor thrombus level III

INTRODUCCIÓN: El CCR presenta una tendencia conocida a propagarse mediante la formación de trombo tumoral a la vena renal o vena cava inferior (4-10 por ciento ) El nivel que alcanza dicho tumor, está en directa relación con la sobrevida estimada a 5 años. MATERIALES Y MÉTODOS: Se presenta un caso de un paciente de sexo masculino de 58 años de edad, con antecedentes de Dm2 No IR y Tabaquismo crónico, el cual consulto por cuadro de 10 meses de evolución caracterizado por hematuria macroscópica. Dentro de la analítica sanguínea, destacaba paciente anémico, con hemoglobina de 8 g/dL y creatinemia de 1.1mg/mL. Se solicita URO-TAC, evidenciándose tumor renal derecho, de 18 cms en su eje largo, asociado a trombo en vena cava inferior, que se alojaba hasta el diafragma (Nivel III), no observándose metástasis a distancia o adenopatías de aspecto patológico. RESULTADOS: Se propone nefrectomía radical abierta por vía anterior, posteriormente se aísla y controla VCI, la cual se abre en su eje longitudinal. Se realiza trombectomia convencional con cierre primario, verificando hermeticidad del vaso. El tiempo operatorio total fue de 260 minutos, con un sangrado estimado de 1600ml. Se requirió transfusión de 3U de GR intraoperatorios sin incidentes reportados. El manejo post-operatorio inmediato fue en unidad de cuidados intensivos por 24 hrs, con un tiempo hospitalario total de 5 días. El paciente evoluciona favorablemente, sin complicaciones, destacando dentro de los exámenes de control, creatinina de 1.3 mg/dL. A la fecha, no hay evidencia de enfermedad residual clínica, o radiológica. CONCLUSIÓN: La nefrectomía radical convencional con trombo en vena cava inferior (nivel III) es el estándar de tratamiento para pacientes cáncer renal localmente avanzado en condiciones para afrontar la cirugía

INTRODUCTION: CCR presents a known trend to spread by means of a tumor thrombus in renal vein or inferior vena cava (4-10 pertcent ) The level reached by such tumor has a direct relation with the 5-year survival rate. MATERIALS AND METHODS: A 58-year old male patient presented with a history of Dm2 No IR and chronic tabaquism who enquired about 10-month symptoms, characterized by macroscopic hematuria. Amongst the blood analytics, an anemic patient stood out, whose hemoglobin level is 8 g/dL and 1.1mg/mL creatinemia. URO-TAC is requested which shows right kidney tumor, of 18 centimeters on its longer axis, associated to thrombus in the inferior vena cava, extended to the diaphragm (Level III), without presence of distant metastasis or adenopathies with pathological aspect. RESULTS: Anterior open radical nephrectomy is suggested, posteriorly isolated and VCI controlled, which is performed on its longitudinal axis. Conventional thrombectomy with primary closing and verification of vessel hermetism are performed. Operative time was 260 minutes. Estimated blood loss was 1600ml. 3U of GR intraoperative transfusion was required and no incidents were reported. Postoperative management took place in intensive care unit for 24 hours and the patient was discharged 5 days after surgery. The patient evolves favorably, without complications, presenting a 1.3 mg/dL creatinine level. To date, there is no evidence of clinical residual or radiological illness. CONCLUSION: Radical nephrectomy with inferior vena cava thrombus (level III) is the standard treatment for kidney cancer patient presenting local progression in a condition to withstand surgery.

Association of the -250G/A promoter polymorphism of the hepatic lipase gene with the risk of peripheral arterial disease in type 2 diabetic patients.

AIM: This study aimed to investigate the association between a polymorphism in the hepatic lipase (LIPC) gene promoter and the presence of peripheral arterial disease (PAD) in persons with type 2 diabetes. PATIENT AND METHODS: We evaluated 120 type 2 diabetics and identified those with PAD according to the ankle-arm index. The G-250A polymorphisms in the promoter of the LIPC gene were studied by PCR restriction. A logistic regression analysis was performed to determine the association between the rare allele and PAD. RESULTS: The prevalence of PAD was 19%. The frequency of the -250A allele was 0.211 in the group without PAD and 0.395 in the group with PAD (P<.05). Carriers of the -250A allele differed only in the ankle-arm index (0.92+/-0.12 for carriers vs. 1.00+/-0.12 for noncarriers, P<.05), with the difference remaining significant after adjustment for covariates (age; sex; waist-to-hip ratio; body mass index; duration of diabetes; smoking; hypertension; glycated hemoglobin; triglycerides; HDL cholesterol; LDL cholesterol; small, dense LDL cholesterol). Only smoking [odds ratio (OR)=6.93, 95% confidence interval (CI)=2.12-22.69, P=.001] and the -250A allele (OR=2.89, 95% CI=1.07-7.84, P=.036) were significantly associated with vascular disease in the logistic regression analysis. CONCLUSIONS: Patients with type 2 diabetes who are carriers of the rare -250A allele in the promoter of the hepatic lipase gene are susceptible to PAD.