Diurnal variations of airborne pollen concentration and the effect of ambient temperature in three sites of Mexico City.

Pollen is an important cause of allergic respiratory ailments in the Mexico City Metropolitan Area (MCMA). However, very little is known if ambient air temperature correlates with the early blooming of plants observed in other urban areas around the world. A research study was conducted during the dry season of 2012-2013 at three representative sites of the MCMA with different urban characteristics with the aim to understand the relationships between the profusion and diversity of pollen against temperature and other meteorological variables and degree of urbanization. Pollen samples were collected using a Hirst-type trap sampler in the sites: Merced (highly urbanized), Iztapalapa (medium-high urbanized) and Coyoacan (moderately urbanized). Urbanization levels were determined using a composite index based on population density, proportion of surface covered by construction and asphalt, and urban heat island intensity. A set of representative pollen sampling tapes were assayed under a light microscope at magnification of ×1,000 and converted to grains per cubic meter. The most representative pollen types found in the three sites were, regardless of urbanization levels were: Fraxinus, Cupressaceae/Taxodiaceae, Casuarina, Alnus, Myrtaceae, and Pinus. Total pollen concentration was greatest in the moderately urbanized area, although earlier blooming took place at the highly urbanized zone. Total pollen concentration in the medium-high urbanized site has the lowest because the green areas in this zone of MCMA are few. In a diurnal basis, the most abundant pollen types peaked near midday or in the afternoon evening at the three sites. A Spearman test showed a positive correlation among bihourly pollen concentrations, temperature and relative humidity in all sites, but wind speed just correlated in Iztapalapa and Coyoacan. The results obtained suggest that Urban Heat Island Intensity can disturb flowering periods and pollen concentrations, largely in the highly urbanized areas. A principal components analysis established that the concentrations of each pollen type differed across the urbanization gradients. Additionally, it was found that a large number of allergenic pollens are produced by ornamental trees, some only recently introduced by urban planners.

[Orbital emphysema after Valsalva maneuver. Report of one case]. / Enfisema orbitario espontáneo tras la maniobra de Valsalva.

Orbital emphysema is a rare complication of orbital and facial trauma, involving the sinuses and occasionally the nasal cavity. Most cases occur as a result of trauma but spontaneous orbital emphysema has been reported. Clinical manifestations are often delayed until the upper airway pressure increases as when blowing or coughing. Along with the fracture, the rupture of the underlying mucosa is essential for emphysema to manifest. We report a 29-years-old male who consulted in the emergency room due to eyelid swelling after a Valsalva maneuver, a couple of hours after suffering a facial injury secondary to a fall. In the presence of eyelid emphysema, the patient underwent craniofacial imaging studies, confirming an ethmoidal lamina papyracea fracture.

Binding by calmodulin is coupled to transient unfolding of the third FF domain of Prp40A.

Human pre-mRNA processing protein 40 homolog A (hPrp40A) is a splicing factor that interacts with the Huntington's disease protein huntingtin (Htt). Evidence has accumulated that both Htt and hPrp40A are modulated by the intracellular Ca2+ sensor calmodulin (CaM). Here we report characterization of the interaction of human CM with the third FF domain (FF3 ) of hPrp40A using calorimetric, fluorescence and structural approaches. Homology modeling, differential scanning calorimetry and small angle X-ray scattering (SAXS) data show FF3 forms a folded globular domain. CaM was found to bind FF3 in a Ca2+ -dependent manner with a 1:1 stoichiometry and a dissociation constant (Kd ) of 25 ± 3 µM at 25°C. NMR studies showed that both domains of CaM are engaged in binding and SAXS analysis of the FF3 -CaM complex revealed CaM occupies an extended configuration. Analysis of the FF3 sequence showed that the anchors for CaM binding must be buried in its hydrophobic core, suggesting that binding to CaM requires unfolding of FF3 . Trp anchors were proposed based on sequence analysis and confirmed by intrinsic Trp fluorescence of FF3 upon binding of CaM and substantial reductions in affinity for Trp-Ala FF3 mutants. The consensus model of the complex showed that binding to CaM binding occurs to an extended, non-globular state of the FF3 , consistent with coupling to transient unfolding of the domain. The implications of these results are discussed in the context of the complex interplay of Ca2+ signaling and Ca2+ sensor proteins in modulating Prp40A-Htt function.

Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them.

INTRODUCTION AND AIMS: Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation. MATERIALS AND METHODS: A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment. RESULTS: The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2 months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs. CONCLUSIONS: A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.

Spontaneous and deliberate creative cognition during and after psilocybin exposure.

Creativity is an essential cognitive ability linked to all areas of our everyday functioning. Thus, finding a way to enhance it is of broad interest. A large number of anecdotal reports suggest that the consumption of psychedelic drugs can enhance creative thinking; however, scientific evidence is lacking. Following a double-blind, placebo-controlled, parallel-group design, we demonstrated that psilocybin (0.17 mg/kg) induced a time- and construct-related differentiation of effects on creative thinking. Acutely, psilocybin increased ratings of (spontaneous) creative insights, while decreasing (deliberate) task-based creativity. Seven days after psilocybin, number of novel ideas increased. Furthermore, we utilized an ultrahigh field multimodal brain imaging approach, and found that acute and persisting effects were predicted by within- and between-network connectivity of the default mode network. Findings add some support to historical claims that psychedelics can influence aspects of the creative process, potentially indicating them as a tool to investigate creativity and subsequent underlying neural mechanisms. Trial NL6007; psilocybin as a tool for enhanced cognitive flexibility; https://www.trialregister.nl/trial/6007 .

Fibrosis assessment in patients with nonalcoholic fatty liver disease: Adherence to proposed algorithms and barriers to complying with them. / Evaluación de fibrosis en pacientes con enfermedad por hígado graso no alcohólico: adherencia a los algoritmos propuestos y barreras para cumplir con ellos.

INTRODUCTION AND AIMS: Fibrosis staging in patients with nonalcoholic fatty liver disease (NAFLD) is carried out through the application of stepwise algorithms but there is little real-world data on their use. Our aim was to calculate the number of patients with NAFLD and indeterminate or high risk for fibrosis, assessed through noninvasive scores, that consequently underwent further staging evaluation. MATERIALS AND METHODS: A cross-sectional multicenter cohort study was conducted on patients with NAFLD evaluated by hepatologists within the time frame of June 1 and July 31, 2018. The FIB-4 and NAFLD fibrosis scores were calculated in all the patients, and if at least one of the scores suggested indeterminate or high risk for fibrosis, we believed the patient should have undergone additional fibrosis staging assessment. RESULTS: The study included 238 patients. The median time interval from NAFLD diagnosis and inclusion in the analysis was 12.2months (IQR 3.0-36.5). A total of 128 (54%) patients had at least one noninvasive score that suggested indeterminate or high risk for fibrosis but studies to confirm the fibrosis grade (elastography, biopsy, etc.) were performed on only 72 (56%). The main barriers encountered by the physicians for applying the staging algorithms were related to health insurance coverage and imaging study costs. CONCLUSIONS: A high percentage of patients with NAFLD were at indeterminate or high risk for fibrosis, according to noninvasive scores, but additional studies were carried out on only half of them, showing low adherence to current recommendations.

Down-regulation of epidermal growth factor receptor-dependent signaling by Porphyromonas gingivalis lipopolysaccharide in life-expanded human gingival fibroblasts.

BACKGROUND AND OBJECTIVE: Human gingival fibroblasts exhibit proliferative responses following epidermal growth factor exposure, which are thought to enhance periodontal regeneration in the absence of bacterial products such as lipopolysacharide. However, lipopolysaccharide challenge activates human gingival fibroblasts to release several inflammatory mediators that contribute to the immune response associated with periodontitis and attenuate wound repair. We tested the hypothesis that Porphyromonas gingivalis lipopolysaccharide-activated signaling pathways down-regulate epidermal growth factor receptor-dependent events. MATERIAL AND METHODS: To study lipopolysaccharide/epidermal growth factor interactions in human gingival fibroblasts, we introduced the catalytic subunit of human telomerase into human gingival fibroblasts, thereby generating a more long-lived cellular model. These cells were characterized and evaluated for lipopolysaccharide/epidermal growth factor responsiveness and regulation of epidermal growth factor-dependent pathways. RESULTS: Comparison of human telomerase-transduced gingival fibroblasts with human gingival fibroblasts revealed that both cell lines exhibit a spindle-like morphology and express similar levels of epidermal growth factor receptor, CD14 and Toll-like receptors 2 and 4. Importantly, human telomerase-transduced gingival fibroblasts proliferation rates are increased 5-9 fold over human gingival fibroblasts and exhibit a longer life span in culture. In addition, human telomerase-transduced gingival fibroblasts and human gingival fibroblasts exhibit comparable profiles of mitogen-activated protein kinase kinase (extracellular signal-regulated kinase 1/2) activation upon epidermal growth factor or P. gingivalis lipopolysaccharide administration. Interestingly, treatment with P. gingivalis lipopolysaccharide leads to a down-regulation of epidermal growth factor-dependent extracellular signal-regulated kinase 1/2, p38 and cyclic-AMP response element binding protein phosphorylation in both cell types. CONCLUSION: These studies demonstrate that human telomerase-transduced gingival fibroblasts exhibit an extended life span and recapitulate human gingival fibroblasts biology. Moreover, this system has allowed for the first demonstration of lipopolysaccharide down-regulation of epidermal growth factor activated pathways in human gingival fibroblasts and should facilitate the analysis of signaling events relevant to the pathogenesis and treatment of periodontitis.

Access to direct-acting antivirals for the treatment of hepatitis C in a country with limited resources. / Evaluación del acceso a antivirales para el tratamiento de la hepatitis C en un país con recursos limitados.

AIMS: To estimate the number of patients that have access to treatment of hepatitis C with direct-acting antivirals in Argentina and evaluate the factors associated with the lack of access. MATERIALS AND METHODS: A cross-sectional cohort study was conducted that included all the consecutive prescriptions of direct-acting antivirals issued at health centers that participated in the ECHOTM telemedicine project directed by the Hospital Italiano de Buenos Aires, within the time frame of January 2016 and February 2017. RESULTS: A total of 143 treatment prescriptions were included and overall access was 70% (95% CI 62-77%). The only independent factor associated with a lack of treatment access was coverage by a public healthcare system (OR 4.98 [95% CI 2.05- 12.09]). CONCLUSION: Patients with hepatitis C that were covered by a public healthcare system had a 4 times higher chance of not having access to treatment with direct-acting antivirals than patients covered by other healthcare systems (private insurance or the social welfare system).

Neumonías complicadas. ¿Un problema aún?

Introducción. La neumonía adquirida en la comunidad complicada (CCAP) se caracteriza por una enfermedad grave, hospitalización y un curso prolongado. Las complicaciones de la neumonía se produ­cen cuando la infección no se limita al parén­quima pulmonar, sino que se extiende a áreas vecinas, o cuando el desarrollo de la infección es más complejo que el habitual por diferentes motivos. Estas complicaciones pulmonares suponen solo el 1% al 3% de las mismas, pero este porcentaje aumenta a casi un 40% en caso de precisar ingreso hospi­talario, por lo que se considera una patología fundamentalmente hospitalaria. Objetivo. El propósito de este estudio fue analizar las complicaciones de la neumonía bacteriana adquirida en la comunidad y describir sus características epidemiológicas, clínicas y etiológicas en el periodo de estudio.Material y método. Este es un estudio retrospectivo y descriptivo de las neumonías bacterianas complicadas y sus características en el Hospital del Niño Dr. José Renán Esquivel. Se realizó la búsqueda de los expedientes clínicos de los pacientes con diagnóstico de egreso de neumonía bacteriana adquirida en la comunidad complicada con derrame pleural, neumotórax, pioneumotórax, neumonía necrotizante y absceso pulmonar en el periodo del 1 de enero de 2015 al 31 de diciembre de 2020.Todos los expedientes médicos recuperados se analizaron para obtener información de las complicaciones de la neumonía bacteriana adquirida en la comunidad con relación a datos epidemiológicos, frecuencia, características, tratamiento y evolución clínica. Resultados. De acuerdo con los datos obtenidos de los boletines estadísticos del Hospital Del Niño Dr. José Renán Esquivel para el periodo comprendido entre el 1 de enero de 2015 al 31 de diciembre de 2020 se encontraron 2519 neumonías bacterianas, correspondiendo al 30% de las neumonías. De las neumonías bacterianas, 277 casos de neumonía complicada cumplieron los criterios de inclusión representando un 11% de las neumonías bacterianas. La complicación más frecuente, en todos los grupos de edad, fue el derrame pleural paraneumónico con una frecuencia de 170 casos (61%). La edad promedio de los pacientes con neumonías complicadas fue de 51.7 meses (rango de 27 días a 164 meses) y el grupo de 1 ­ 4 años fue el más afectado presentando 118 (43%) casos de complicaciones. La duración promedio de hospitalización fue de 14.8 días con un rango de 9- 38 días. Los pacientes recibieron antibióticos endovenosos de amplio espectro siendo el tratamiento empírico inicial más utilizado ceftriaxona más clindamicina. La duración promedio del tratamiento con antibióticos fue de 12.7 días con un rango de 10 a 25 días y varió de acuerdo con el tipo de complicación. Se reportaron 68 cultivos positivos, 39 en muestras de líquido pleural y 29 en hemocultivos. Encontramos que el rendimiento de los cultivos bacterianos fue mayor en los cultivos de líquido pleural en comparación con los hemocultivos, 28% vs 10% respectivamente. Los patógenos más frecuentemente aislados fueron el Staphylococcus aureus en 34 (50 %) pacientes, el Streptococcus pneumoniae en 21 (31%) pacientes y el Haemophilus influenzae en 6 (9%) pacientes en los 68 cultivos positivos. Conclusiones. El grupo de 1 ­ 4 años es el más afectado presentando 118 (43%) casos de complicaciones. El derrame pleural es la complicación más frecuente de la neumonía bacteriana adquirida en la comunidad. Se reportaron 68 cultivos positivos y el rendimiento fue mayor en los cultivos de líquido pleural en comparación con los hemocultivos. Los patógenos más frecuentemente aislados fueron el Staphylococcus aureus y el Streptococcus pneumoniae. La mayoría de los pacientes se recuperaron a pesar de la importante morbilidad. (provisto por Infomedic International)

Introduction. Complicated community-acquired pneumonia (CCAP) is characterized by severe illness, hospitalization, and a long course. The complications of pneumonia occur when the infection is not limited to the lung parenchyma, but spreads to neighboring areas, or when the development of the infection is more complex than usual for different reasons. These pulmonary complications account for only 1% to 3% of them, but this percentage increases to almost 40% if hospital admission is required, which is why it is considered a fundamentally hospital pathology.   Objective. The purpose of this study was to analyze the complications of community-acquired bacterial pneumonia and describe its epidemiological, clinical, and etiological characteristics in the study period. Material and method. This is a retrospective and descriptive study of complicated bacterial pneumonias and their characteristics at the Hospital del Niño Dr. José Renán Esquivel. A search was made of the clinical records of patients with a diagnosis of discharge from community-acquired bacterial pneumonia complicated by pleural effusion, pneumothorax, pioneumothorax, necrotizing pneumonia and lung abscess in the period from January 1, 2015 to December 31, 2020. All medical records retrieved were analyzed to obtain information on the complications of community-acquired bacterial pneumonia in relation to epidemiological data, frequency, characteristics, treatment, and clinical evolution. Results. According to the data obtained from the statistical bulletins of the Hospital Del Niño Dr. José Renán Esquivel for the period from January 1, 2015 to December 31, 2020, 2,519 bacterial pneumonias were found, corresponding to 30% of pneumonia. Of the bacterial pneumonias, 277 cases of complicated pneumonia met the inclusion criteria, representing 11% of the bacterial pneumonia. The most frequent complication, in all age groups, was parapneumonic pleural effusion with a frequency of 170 cases (61%). The average age of patients with complicated pneumonia was 51.7 months (range from 27 days to 164 months) and the 1-4-year-old group was the most affected, presenting 118 (43%) cases of complications. The average length of hospitalization was 14.8 days with a range of 9-38 days. Patients received broad-spectrum intravenous antibiotics, the most widely used initial empirical treatment being ceftriaxone plus clindamycin. The average duration of antibiotic treatment was 12.7 days with a range of 10 to 25 days and varied according to the type of complication. 68 positive cultures were reported, 39 in pleural fluid samples and 29 in blood cultures. We found that the yield of bacterial cultures was higher in pleural fluid cultures compared to blood cultures, 28% vs 10% respectively. The most frequently isolated pathogens were Staphylococcus aureus in 34 (50%) patients, Streptococcus pneumoniae in 21 (31%) patients, and Haemophilus influenzae in 6 (9%) patients in the 68 positive cultures. Conclusions. The 1­4-year-old group is the most affected, presenting 118 (43%) cases of complications. Pleural effusion is the most common complication of community-acquired bacterial pneumonia. 68 positive cultures were reported positive, and the yield was higher in pleural fluid cultures compared to blood cultures. The most frequently isolated pathogens were Staphylococcus aureus and Streptococcus pneumoniae. Most of the patients recovered despite significant morbidity. (provided by Infomedic International)

Migración de fragmento de bezoar gástrico gigante como causa de obstrucción intestinal distal / Giant gastric bezoar fragment migration as a cause of distal intestinal obstruction

Introducción. Comunicar un caso clínico poco habitual y revisar el manejo. Material y Métodos. Presentación de un caso clínicoResultados. La obstrucción intestinal es una urgencia frecuente. La impactación de un bezoar es una etiología poco habitual.Cuando el bezoar intestinal asocia un bezoar gástrico se generan dudas sobre la etiología del bezoar intestinal, fragmentación y migración versus formación primaria en intestino delgado, y sobre la actitud a tomar con el bezoar gástrico, que generalmente es asintomático. Conclusiones. La enterotomía y extracción del bezoar intestinal es el tratamiento de elección. Debe asociar la extracción de los bezoares en otras localizaciones. (AU)

Introduction. Report an unusual clinical case and review the management. Material and methods. Presentation of a clinical caseResults. Bowel obstruction is a common emergency. Bezoar impaction is an unusual etiology. When the intestinal bezoar associates a gastric bezoar, doubts are raised about the etiology of the intestinal bezoar, fragmentation and migration versus primary formation in the small intestine, and about the attitude to take with the gastric bezoar, which is generally asymptomatic. Conclusions. Enterotomy and removal of the intestinal bezoar is the treatment of choice. It must associate the extraction of the bezoars in other locations. (AU)

Management of interruptions to fractionated radiotherapy treatments: Four and a half years of experience.

BACKGROUND AND PURPOSE: The study objective was to report our four-and-a half years experience (March 1 2011-August 15 2015) of a program to manage interruptions in fractionated radiotherapy treatments. METHODS: A program was developed, based on a specific database, to manage treatment interruptions. Benefits of the program were analyzed in reference to previously published data. Analysis was also performed of two measures to reduce OTT prolongation and improve treatment outcomes: working on public holidays and conducting treatment unit maintenance on Saturdays. RESULTS: The study included 2352 patients. Patients with head and neck cancer obtained the greatest benefit from the program, with a mean increase in TCP of 3.5% and a benefit of at least 4% in 45.6% of them. In prostate cancer patients, the likelihood of biochemical failure was reduced by a mean of 2.0% and was reduced by at least 4% in 19.7% of them. Application of the two proposed measures would have improved the TCP by a mean of 5.4% in head and neck cancer patients. The impact of the compensations program and proposed measures is lesser in the remaining cancer types studied. CONCLUSIONS: Implementation of a compensation program has a significant impact on patients with head and neck or prostate cancer but OTT prolongation remains excessive in many treatments. The introduction of fractions on public holidays would assist in the meeting of recommendations for these patients.

High-altitude pulmonary edema with absent right pulmonary artery.

High-altitude pulmonary edema potentially is fatal. Adults with unilateral absence of a right pulmonary artery are particularly susceptible to high-altitude pulmonary edema. The occurrence of high-altitude pulmonary edema was documented in a child with congenital absence of the right pulmonary artery. Improvement occurred only upon descent to low altitude. Physicians should be aware of this life-threatening condition in children ascending to high altitude, particularly in individuals with unilateral absence of a pulmonary artery.

Distinct quality of depressed mood: an attempt to develop an objective measure.

Since the time of Kraepelin, in continental Europe the sadness of depression has been considered to have a "distinct quality' basic to the diagnosis of pathological depression. This distinct quality has been interpreted by observers but patients have been noted to have difficulty verbalizing differences from normal sadness. The authors have used a discriminant analysis to study how patients define pathological sadness and as a result have developed a Pathological Sadness Index with a sensitivity of 0.94, a specificity of 0.96 and a total misclassification rate of 5% (kappa w = 0.90).

Psychogenic paranoid psychosis: an empirical study.

The present study was aimed at assessing the psychopathological manifestations, stress factors, evolution and social adaptation of 29 patients diagnosed with psychogenic paranoid psychosis. This syndrome is seen as an entity in itself, and is closely related to trigger factors; stability in the symptomatology of each relapse; favourable response to treatment; tendency to relapse, and recovery of the previous level of functioning.

Endocardial fibroelastosis occurring in a mother and daughter.

Endocardial fibroelastosis (EFE) in a mother and daughter are reported. This entity has a primary and secondary form. In this case, the 23-year-old mother died 11 months after delivery with findings of EFE. At age 3(1/2) years, the daughter was admitted in congestive heart failure and did not respond to medical management. The autopsy findings revealed EFE. Endocardial fibroelastosis in both mother and daughter is a very rare finding.

[E rosette inhibition in alcoholic liver disease]. / Inhibición de rosetas E en la enfermedad hepática alcohólica.

Various studies performed in chronic alcoholic patients have demonstrated immunologic alterations, which have been described more often in patients with alcoholic hepatitis or liver cirrhosis. We have observed that the serum of some patients with alcoholic liver cirrhosis produces the inhibition of E rosette formation by T lymphocytes. This observation induced us to study E rosette formation and its probable inhibition by the serum of chronic alcoholic patients. Subjects were split into three groups: Group 1: n = 21. Normal individuals. Group 2: n = 15. Chronic alcoholic patients without cirrhosis. Group 3: n = 26. Chronic alcoholic patients with histologically demonstrated liver cirrhosis. E rosette and E rosette inhibition (TIRE) sera tests were performed utilizing subject's sera tested against lymphocytes of normal individuals not related to group 1. The results found are listed in detail in Table 1 (mean = -SD) and Figure 1 (median), for each of the test groups. We applied unifactorial variance analysis and observed highly significant differences between the groups studied in all tests performed. It was found that tests that utilized I.E. discriminate most efficiently among the three groups of patients and that those which utilize unabsorbed assay serum (S/A) yield the best differentiation. Using this last assay it was observed that 20/21 control individuals showed less than 15% inhibition. On this basis, we decided to separate the results into 15% regular intervals (Table 3). Inhibition above 30% was found only in cirrhotic patients with the exception of one individual of the control group and one non-cirrhotic alcoholic patient with no alcoholic liver disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Use of medroxyprogesterone in human hepatic cirrhosis]. / Utilización de medroxiprogesterona en cirrosis hepática humana.

The effect of medroxyprogesterone in 14 patients with hepatic cirrhosis demonstrated with histological technics was studied. Eight of the 14 patients were controlled over a period of one year and three months. Six of this eight patients presented subjective clinical improvement and the ascitis disappeared in 5/7 cases, so that the doses of lactona could be diminished. Three of the male patients recovered their sexual potency although all were in alcoholic abstinence for more than one year. Histologically 5/6 patients presented a diminishing fibrosis in the control biopsy and the 3 patients controlled with hemodynamic studies presented lower portal pression. We didn't found secondary effects, except obesity in 3 cases. We concluded that it would be important to continue this experience with a greater number of patients and adding appropriate biochemical controls.

[Infections during the hospitalization of patients with liver cirrhosis]. / Infecciones durante la internación de pacientes con cirrosis hepática.

We studied retrospectively the clinical records of 291 hospital patients with liver cirrhosis, 95% of which was alcohol related. Within this group, 114 patients presented 155 episodes of infection in 144 separate hospital admissions. In a previous communication, we pointed out that although infection was the fourth cause of admission, it was the main cause of death in this group. The main incidence of infection was among the female group. The most common infections episodes were respiratory and bacterial spontaneous peritonitis (BSP). On admission, 57% of the patients were diagnosed as belonging to the C Child group; 38% presented sepsis and 22% were hospitalary infections. The most frequent infections were respiratory and BSP. We obtained bacteriologic documentation in 55% of the episodes with prevalence of Gram negative bacilli (E. coli), with high relative frequency of neumoccocus. The most frequent complications were related to hepatic insufficiency. Global death rate was 27.1%, while nosocomial death rates were 42.1% and 40.9% for patients with Child C. We observed the highest incidence of mortality in patients with SBP and non localized bacteriemia. Survival rates were 42% for 2 years and 18% for 5 years. In summary, we stress the relevancy of checking the presence of infection systematically in every cirrhotic patient with encephalopathy and/or renal insufficiency without justifiable cause.

Superior vena cava syndrome due to a leiomyosarcoma of the anterior mediastinum: A case report and literature overview.

INTRODUCTION: Leiomyosarcomas are an infrequent cause of malignant superior vena cava syndrome (VCS). PRESENTATION OF CASE: A 51-year old male patient was admitted for a three-day history of dyspnoea, dysphagia and erythema of the head and neck. Computed tomography and magnetic resonance imaging showed a lesion arising on the anterior mediastinum, which was in close proximity with a thrombus in the superior vena cava. Surgical excision was performed, including open resection of the primary tumour and an atrio-innominate vein bypass with 8-mm polytetrafluoroethylene (PTFE). Histology confirmed a leiomyosarcoma and postoperative radiotherapy sessions were performed. Due to evidence of enlargement of the thrombus, a second intervention was undertaken. In this procedure, a remainder of the primary tumour was resected and the superior vena cava reconstructed with an autologous pericardium patch. The patient recovered satisfactorily and was discharged on the seventh postoperative day, with no evidence for relapse after 10 months of follow-up. DISCUSSION: Leiomyosarcomas comprise less than 2% of the tumours of the mediastinum and are a rare cause of paraneoplastic VCS. Male patients in their sixties are most commonly affected. Relapses seem to be common, and thus a careful follow-up is often recommended. CONCLUSION: In spite of the limited data on the management of thoracic leiomyosarcomas, surgery is currently considered the mainstay of treatment.

[Biomonitoring pesticides: a national need?]. / Biomonitorización de plaguicidas: una necesidad del país?

The word biomarker is being used more frequently during the last decade. Currently, a great amount of research is directed to fnd toxicological biomarkers for several different chemical substances, since persons are more exposed now than decades before. For this reason, it is important to perform a biomonitoring of such substances in order to assess the possibility that low quantities could cause health problems. Obtaining toxicological values through biomonitoring is also useful to control the exposure. The markers of poisoning by chemicals available worldwide are numerous, but unfortunately in Chile only a few are being used. It is essential to have more toxicology and environmental laboratories to test the levels of exposure of our population.