Integra as Firstline Treatment for Scalp Reconstruction in Elderly Patients.

PURPOSE: Large scalp defects pose a reconstructive problem especially in elderly patients. The purpose of the study is to describe our experience of oncologic scalp reconstruction using a dermal matrix (Integra). MATERIAL AND METHODS: We conducted a retrospective cohort study (January 2007 to March 2021) of patients who had undergone scalp tumor excision and reconstruction using Integra and a split-thickness skin graft (STSG). The primary end point was Integra and STSG success (defined by ≥75% percent take) and the secondary end point was postoperative complications. Both end points were assessed by the surgeon during follow-up. Demographic data, tumor characteristics, average defect size, time between stages and full-thickness scalp defects were characterized using descriptive statistics. Univariate and multivariate logistic regression models were used to evaluate the association between variables and end points. RESULTS: The sample included 70 patients with a mean (SD) age of 83.3 (7.0) years, 75.7% men and 92.9% with comorbidities. Mean (SD) defect area was 23 (17.0) cm2 and the mean (SD) first-to-second phase interval was 30.6 (8.4) days. Sixty-four patients (91.4%) underwent outpatient surgery. Integra and STSG success rates were 87.1% (95% CI: 77.69 to 93.74%) and 100%, respectively. The complications rate was 18.6% (95% CI: 9 to 28%). Mean (SD) follow-up was 18 (16.7) months. Univariate and multivariate logistic regression analysis showed no association between variables and the primary and secondary end points. CONCLUSIONS: Reconstruction of oncologic scalp defects using Integra can be performed under sedation and local anesthesia. Integra should be considered as firstline treatment for the reconstruction of scalp defects in elderly patients with comorbidities, given the low postoperative major complications rate and Integra and STSG take success.

Tracking medical genetic literature through machine learning.

There has been remarkable progress in identifying the causes of genetic conditions as well as understanding how changes in specific genes cause disease. Though difficult (and often superficial) to parse, an interesting tension involves emphasis on basic research aimed to dissect normal and abnormal biology versus more clearly clinical and therapeutic investigations. To examine one facet of this question and to better understand progress in Mendelian-related research, we developed an algorithm that classifies medical literature into three categories (Basic, Clinical, and Management) and conducted a retrospective analysis. We built a supervised machine learning classification model using the Azure Machine Learning (ML) Platform and analyzed the literature (1970-2014) from NCBI's Entrez Gene2Pubmed Database (http://www.ncbi.nlm.nih.gov/gene) using genes from the NHGRI's Clinical Genomics Database (http://research.nhgri.nih.gov/CGD/). We applied our model to 376,738 articles: 288,639 (76.6%) were classified as Basic, 54,178 (14.4%) as Clinical, and 24,569 (6.5%) as Management. The average classification accuracy was 92.2%. The rate of Clinical publication was significantly higher than Basic or Management. The rate of publication of article types differed significantly when divided into key eras: Human Genome Project (HGP) planning phase (1984-1990); HGP launch (1990) to publication (2001); following HGP completion to the "Next Generation" advent (2009); the era following 2009. In conclusion, in addition to the findings regarding the pace and focus of genetic progress, our algorithm produced a database that can be used in a variety of contexts including automating the identification of management-related literature.

Proposed guidelines on the nomenclature and annotation of dynamic human embryo monitoring by a time-lapse user group.

STUDY QUESTION: Can the approach to, and terminology for, time-lapse monitoring of preimplantation embryo development be uniformly defined in order to improve the utilization and impact of this novel technology? SUMMARY ANSWER: The adoption of the proposed guidelines for defining annotation practice and universal nomenclature would help unify time-lapse monitoring practice, allow validation of published embryo selection algorithms and facilitate progress in this field. WHAT IS KNOWN ALREADY: An increasing quantity of publications and communications relating to time-lapse imaging of in vitro embryo development have demonstrated the added clinical value of morphokinetic data for embryo selection. Several articles have identified similar embryo selection or de-selection variables but have termed them differently. An evidence-based consensus document exists for static embryo grading and selection but, to date, no such reference document is available for time-lapse methodology or dynamic embryo grading and selection. STUDY DESIGN, SIZE AND DURATION: A series of meetings were held between September 2011 and May 2014 involving time-lapse users from seven different European centres. The group reached consensus on commonly identified and novel time-lapse variables. PARTICIPANTS/MATERIALS, SETTING, METHODS: Definitions, calculated variables and additional annotations for the dynamic monitoring of human preimplantation development were all documented. MAIN RESULTS AND THE ROLE OF CHANCE: Guidelines are proposed for a standard methodology and terminology for the of use time-lapse monitoring of preimplantation embryo development. LIMITATIONS, REASONS FOR CAUTION: The time-lapse variables considered by this group may not be exhaustive. This is a relatively new clinical technology and it is likely that new variables will be introduced in time, requiring revised guidelines. A different group of users from those participating in this process may have yielded subtly different terms or definitions for some of the morphokinetic variables discussed. Due to the technical processes involved in time-lapse monitoring, and acquisition of images at varied intervals through limited focal planes, this technology does not currently allow continuous monitoring such that the entire process of preimplantation embryo development may be visualized. WIDER IMPLICATIONS: This is the first time that a group of experienced time-lapse users has systematically evaluated current evidence and theoretical aspects of morphokinetic monitoring to propose guidelines for a standard methodology and terminology of its use and study, and its clinical application in IVF. The adoption of a more uniform approach to the terminology and definitions of morphokinetic variables within this developing field of clinical embryology would allow practitioners to benefit from improved interpretation of data and the sharing of best practice and experience, which could impact positively and more swiftly on patient treatment outcome. STUDY FUNDING/COMPETING INTERESTS: There was no specific funding for the preparation of these proposed guidelines. Meetings were held opportunistically during scientific conferences and using online communication tools. H.N.C. is a scientific consultant for ESCO, supplier of Miri TL. I.E.A. is a minor shareholder in Unisense Fertilitech, supplier of the EmbryoScope. Full disclosures of all participants are presented herein. The remaining authors have no conflict of interest.

The human first cell cycle: impact on implantation.

The morphology of fertilization events has been related to successful implantation by subjective criteria (pronuclei score, pronuclei symmetry and position). This work first described these events by time-lapse technology and then compared the timings of fertilization events (second polar body extrusion, first and second pronuclei appearance, abuttal and fading) in implanted versus nonimplanted embryos in a 2-year cohort retrospective study. A total of 1448 transferred embryos from 842 patients undergoing intracytoplasmic sperm injection with oocyte donation were monitored, 212 embryos from treatments where the number of gestational sacs matched the number of transferred embryos and 687 embryos from treatments no biochemical pregnancy was achieved. The timings at which second polar body extrusion (3.3-10.6 h), pronuclear fading (22.2-25.9 h) and length of S-phase (5.7-13.8 h) occurred were linked successfully to embryo implantation. The other parameters were apparently not related, as determined by image acquisition and time-lapse analysis.

[Renal transplantation in Maastricht II asystole: report of a first case in Mexico]. / Trasplante renal en asistolia Maastrich II. Reporte del primer caso en México.

On May 6, 2012, an 18-year-old patient was admitted to the emergency room with sever traumatic brain injury and cardiovascular arrest; resuscitation maneuvers were started with a compressor table AUTOPULSE®. After 30 minutes, death was pronounced. Later, compressions were restarted. After the family agreed with the donation, blood samples were obtained to do serology tests and to obtain blood group and Rh factor and a cardiopulmonary bypass was started by femoral approach. After 2 hours and 35 minutes, extraction of the kidneys was performed. This case represented the first organ procurement from a non-heart-beating Maastricht II donor in our country. After 60 days, both receptors remained free of dialysis.

Neurosarcoidosis: Clinical, biological, and MRI presentation of central nervous system disease in a national multicenter cohort.

INTRODUCTION: Neurosarcoidosis (NS) is a systemic inflammatory granulomatous disease affecting of patients with sarcoidosis. Its diagnosis is difficult as there is no specific test for it. Because of its rarity, the management of NS has so far only been described in case series and short retrospective cohorts. The objective of this study is description of the clinical, paraclinical presentation and the therapeutic management of central nervous system (CNS) involvement in NS patients in France. METHODS: This multicenter, retrospective, observational study involved patients hospitalized between 2010 and 2019 with a diagnosis of sarcoidosis and CNS involvement. RESULTS: We included 118 patients (38 with isolated NS, 80 with NS associated with systemic sarcoidosis). NS was the initial presentation in 78% of patients, with cranial nerve involvement (36%), medullary symptoms (23%), and seizures (21%). Twenty-one percent of the patients had already been diagnosed with systemic sarcoidosis. The most frequent biological abnormality was lymphopenia (62.5%), while angiotensin-converting enzyme was increased in 21%. Meningitis was present in 45% and hyperproteinorachia in 69.5% of cases. MRI mainly revealed white matter abnormalities and leptomeningeal enhancement (34%). Corticosteroids were the most useful treatment, and immunosuppressive agents were used in steroid-resistant patients and to limit side effects. Methotrexate, cyclophosphamide, and anti-TNFα were also used, exhibiting good efficacy. CONCLUSIONS: This cohort contributes to a better understanding of the clinical phenotype and associated imaging and biological abnormalities. Sharing of clinical, biological, and imaging data, as well as the therapeutic responses, of patients with NS helps to better understand and manage this disease that affects a small number of patients per center. A database project could be implemented in the future to enable this.

Mesenchymal Stem Cells: Case Report of an Adjuvant Ambulatory Therapy for a COVID-19 High-Risk and Steroid-hypersensitive Patients.

INTRODUCTION: Due to the rapid progression of COVID-19 to severe and critical stages, thousands of patients have required the use of intensive care unit (ICU) treatment, placing an excessive strain on health systems. Immunomodulatory effects of Wharton's Jelly Mesenchymal Stem Cells (WJ-MSCs) have shown promising results in the treatment of patients with COVID-19. However, the effect of promptly applied cell therapy on ambulatory patient prognosis has not been described. This case report presents the clinical outcome of a multimorbid, steroid-hypersensitive, COVID-19 patient treated with WJ-MSCs transplantation. CASE PRESENTATION: A 67-year-old woman with Type 2 diabetes, overweight (82 kg, 168 cm, BMI = 29.053), hypertension (190/60 mmHg) and steroid-hypersensitivity, tested positive for COVID-19 after presenting typical symptoms such as fatigue, chest pain, myalgia, nasal congestion, dysgeusia, anosmia and oxygen saturation (SpO2) 94% - 96%, with normal body temperature (36°C). The patient received pharmacologic treatment but, when symptoms worsened, WJ-MSCs were transplanted to modulate the suspected onset of the cytokine release syndrome. Significant improvement of symptoms and clinical parameters (inflammatory markers and CT score) was observed, and the patient fully recovered within a short period of time. CONCLUSION: The present case report exhibits the favorable outcome of using Wharton's Jelly Mesenchymal Stem Cells (WJ-MSCs) as an ambulatory and adjuvant therapy for COVID-19. Prompt WJ-MSCs infusion can be a safe ambulatory adjuvant therapy in COVID-19 infection care, preventing disease progression to critical stages and avoiding hospital overcrowding.

Extensive myelitis with eosinophilic meningitis after Chimeric antigen receptor T cells therapy.

Immune effector cell-associated neurotoxicity syndrome (ICANS) is a frequent adverse event after Chimeric antigen receptor T cells (CAR-T cells). A patient treated with anti-CD19 CAR-T cells for a refractory mantle cell lymphoma presented at Day 8 post-infusion with extensive myelitis. Unusual eosinophilia was disclosed in the patient's cerebrospinal fluid. After treatment with methylprednisolone and siltuximab, a decrease in clinical symptoms and magnetic resonance imaging lesions were obtained. This unprecedented presentation of eosinophilic meningitis after CAR-T cells therapy highlights the need for a better understanding of the physiopathology of ICANS, especially to identify potentially targetable pathways.

Elevated levels of serum CDCP1 in individuals recovering from severe COVID-19 disease.

BACKGROUND: COVID-19 survivors report residual lung abnormalities after discharge from the hospital. The aim of this study was to identify biomarkers in serum and induced sputum samples from patients after hospitalization for COVID-19. METHODS: Patients admitted to hospitals in Spain with laboratory-confirmed COVID-19 were recruited for this study. SARS-CoV-2-infected patients were divided into groups with mild/moderate and severe disease according to the severity of their symptoms during hospitalization. Levels of 92 biomarkers were measured in serum and induced sputum samples. RESULTS: A total of 108 patients (46.2% severe cases) were included in this study. The median number of days after the onset of symptoms was 104. A significant difference was observed in diffusing capacity for carbon monoxide (DLCO), an indicator of lung function, whereby DLCO <80% was significantly lower in severe cases (p <0.001). Differences in inflammatory biomarkers were observed between patients with mild/moderate and severe disease. For some biomarkers, correlations in serum and induced sputum levels were detected. Independent predictors of severe disease were DLCO <80% and the serum CDCP1 value. CONCLUSIONS: Higher levels of CDCP1 remain after hospital discharge and are associated with the severity of COVID-19. The possible prognostic implications warrant further investigation.

Immune and spermatogenesis-related loci are involved in the development of extreme patterns of male infertility.

We conducted a genome-wide association study in a large population of infertile men due to unexplained spermatogenic failure (SPGF). More than seven million genetic variants were analysed in 1,274 SPGF cases and 1,951 unaffected controls from two independent European cohorts. Two genomic regions were associated with the most severe histological pattern of SPGF, defined by Sertoli cell-only (SCO) phenotype, namely the MHC class II gene HLA-DRB1 (rs1136759, P = 1.32E-08, OR = 1.80) and an upstream locus of VRK1 (rs115054029, P = 4.24E-08, OR = 3.14), which encodes a protein kinase involved in the regulation of spermatogenesis. The SCO-associated rs1136759 allele (G) determines a serine in the position 13 of the HLA-DRß1 molecule located in the antigen-binding pocket. Overall, our data support the notion of unexplained SPGF as a complex trait influenced by common variation in the genome, with the SCO phenotype likely representing an immune-mediated condition.

[Analysis of care in cardiorespiratory arrest in an emergency medical unit]. / Análisis de la asistencia a la parada cardiorrespiratoria por una Unidad Medicalizada de Emergencias.

OBJECTIVE: To describe the epidemiological profile of cardiac arrests and to determine factors associated with successful cardiopulmonary resuscitation (CPR). DESIGN: Retrospective descriptive observational study. SITES: Badajoz city (Spain) and population attended by the Medical Emergency Unit of the Public Health System in that city. PARTICIPANTS: A study 359 cardiac arrests resuscitated between January 2002 and May 2009. RESULTS: Out of the cardiac arrests that ocurred in adults, 65.40% were male, the cause was not traumatic in 88%; 65.70% occurred in the patient's home,and in 6% of the cases there had been basic life support. The higher success rate after was achieved in adult male patients (OR: 0,43; CI 95%; 0.25-0.73; P=.002), whose rhythm was shockable (OR: 0,16; CI 95%: 0,09-0,27; P<.001) and when the start time of advanced life support was equal to or less than 10 minutes (OR: 0,22; CI 95%: 0,10-0,49; P<.001). In a multivariant analysis success of CPR was independently associated with male gender, initial shockable rhythm, and the onset of advanced life support within 10 minutes. Nine children were revived, but success was not achieved in any. CONCLUSIONS: Cardiac arrests are more common in adults and in few cases CPR is previously performed. Male gender, an initial shockable rhythm, and the early initiation of advanced life support, are associated with higher success of CPR. There were few CPR performed in cardiac arrest in children, and the prognosis was more unfavorable.

[The Erectile Function Pineda Visual Analog Scale (EFP-VAS): An alternative to the International Index of Erectile Function (IIEF-5)]. / Escala Visual Analógica de Función Eréctil Pineda (EVAFEP): una alternativa al Índice Internacional de Función Eréctil (IIEF-5).

OBJECTIVE: To develop an analog visual instrument to diagnose patients with erectile dysfunction, to establish the ability to understand it in the population and to compare it with the "gold standard" scale for the disease, providing a basis for its future validation. MATERIAL AND METHODS: Cross-sectional study that included all 18 years old men and older, of the urology service of Juarez Hospital of Mexico City, whose reason for consultation was erectile dysfunction. The patients were assessed using two clinical tools: the International Index of Erectile Function and the Erectile Function Pineda Visual Analog Scale consecutively. The sociodemographic features of the patients included age, language, educational level, location and marital status. The comprehension, the response time and the degree of dysfunction were assessed. The qualitative variables were analyzed with Pearson's chi square and the quantitative variables with the Mann-Whitney U test. RESULTS: The final registry included 227 patients, finding an average age of 55.6±14 years. The majority of the population (94.7%) communicated through the Spanish language. There are statistically significant differences between both scales, in the understanding, the degree of dysfunction, the final score and the response time, all with a p=,0001. The patients with lower educational level were able to respond completely and more quickly the Erectile Function Pineda Visual Analog Scale questionnaire than the International Index of Erectile Function. However, we cannot assume that they understand it better. CONCLUSIONS: The Erectile Function Pineda Visual Analog Scale is a prototype of a visual scale that can be used as an alternative to the International Index of Erectile Function questionnaire, especially in patients with academic and linguistic limitations.

[Rotura inusual de cuerpo cavernoso: resultados del manejo quirúrgico oportuno]. / Unusual cavernous body break: results of timely surgical management.

BACKGROUND: The rupture of the cavernous body (faux pas du coit) refers to the solution of continuity in its surrounding tunica albuginea. It occurs in one of 175,000 hospital admissions, accounting for 58% of penile lesions. When the erect penis flexes abnormally, the abrupt increase in intracavernous pressure exceeds the tensile strength of the tunica albuginea and often determines transverse laceration of the proximal body of the penis. CLINICAL CASE: A 29-year-old male patient presented to the emergency department for an 8-h course of evolution characterized by detumescence, lateral deviation, violet coloration and penile pain, following the introduction of the erect penis into his underwear. The patient was taken as soon as possible to surgical exploration and a 1 × 1 cm continuity solution was repaired in the right corpus cavernosum. CONCLUSION: The fracture of the penis is a rare disease and a urological emergency. Immediate repair of the rupture of the penis has a low complication rate, shorter hospital stay and better long-term results.

ANTECEDENTES: La rotura del cuerpo cavernoso (faux pas du coit) se refiere a la solución de continuidad en su túnica albugínea circundante. Se presenta en una de 175,000 admisiones hospitalarias, representando el 58% de las lesiones peneanas. Cuando el pene erecto se dobla anormalmente, el incremento abrupto de la presión intracavernosa excede la fuerza tensional de la túnica albugínea y determina a menudo la laceración transversal del cuerpo proximal del pene. CASO CLÍNICO: Paciente masculino de 29 años de edad que se presentó al servicio de urgencias por un padecimiento de 8 horas de evolución caracterizado por detumescencia, desviación lateral, coloración violácea y dolor peneanos, posterior a la introducción del pene erecto en su ropa interior. Se llevó al paciente lo antes posible a exploración quirúrgica y se realizó reparación de una solución de continuidad de 1 × 1 cm en el cuerpo cavernoso derecho. CONCLUSIÓN: La fractura del pene es una patología poco frecuente y una emergencia urológica. La reparación inmediata de la rotura del pene tiene una baja tasa de complicaciones, menor estancia hospitalaria y mejores resultados a largo plazo.

Early Palma procedure after iliac vein injury in abdominal penetrating trauma.

Ligation for penetrating abdominal vein trauma may have better outcome than a vascular reconstruction in an unstable patient. However, symptoms of chronic venous insufficiency may appear over time. We describe our surgical experience with 4 patients who underwent iliac vein ligation followed by venous bypass with a modified Palma derivation between 48 and 240 hours after sustaining penetrating abdominal trauma with concomitant iliac vein injury. Patients were assessed for venous symptoms and conduit patency with continuous wave Doppler and duplex scanning. One graft occluded acutely and the remaining three remain patent with functioning valves. In order to preserve venous outflow after severe iliac vein injury, we think that venous ligation as a part of damage control surgery followed by a modified Palma operation may prevent chronic symptoms of venous outflow obstruction without compromising an already injured patient.

Tick-borne lymphadenopathy: a new infectious disease in children.

OBJECTIVE: To describe the epidemiologic and clinical aspects of patients with tick-borne lymphadenopathy (TIBOLA). PATIENTS AND METHODS: The study included all patients treated in our hospital who presented characteristic clinical signs of TIBOLA consisting in the presence of an inoculation lesion after a tick bite with regional lymphadenopathies. The study was carried out at the "Corporació Parc Taulí" hospital in the city of Sabadell, Barcelona, Spain. The inclusion period was from April 2000 to April 2006. Serology tests were performed for Rickettsia conorii, R. slovaca, and Borrelia burgdorferi. The presence of Rickettsia was assessed by means of polymerase chain reaction (PCR)-restriction fragment length polymorphism (PCR-RFLP) and linear-after-the exponential-PCR in blood, skin biopsy, and ticks from the patients. RESULTS: Thirty-six patients fulfilled the inclusion criteria. Twenty-eight patients were children. In most cases, infection occurred between the months of October and April. In 34 patients the tick bite was on the scalp. A necrotic eschar surrounded by a perilesional erythematous halo was observed in 29 cases. All patients had painful regional lymphadenopathies. Serology for R. conorii was positive in 8 cases and for R. slovaca in 2. PCR was negative. The tick, identified as Dermacentor marginatus, was studied in 7 patients. Four of the 7 D. marginatus were positive for sequences compatible with R. slovoca as determined by RFLP or DNA sequencing. Thirty-three patients received antibiotic treatment. Progress was satisfactory in all cases. CONCLUSIONS: TIBOLA is present in Catalonia (Northeastern Spain) mainly in children. Although clinical and epidemiologic manifestations are very specific microbiologic confirmation is difficult.

Effects of Local Use of Insulin on Wound Healing in Non-diabetic Patients.

BACKGROUND: Clinical trials have shown the positive effects of local insulin therapy in the formation of new vessels and fibrosis in acute and chronic diabetic wounds without major adverse effects. OBJECTIVE: The aim of this study was to investigate the effects of local insulin use on wound healing in non-diabetic patients. METHODS: A randomized, split-plot, double-blind, placebo-controlled trial was conducted. Ten non-diabetic patients with full-thickness acute wounds were recruited (5 due to trauma, 3 to burns, and 2 to pressure). All wounds received standard bedside treatment. Each wound was divided into 2 zones. One side received a standard care plus insulin, while the other received standard care plus injection of saline solution. A biopsy specimen was taken from both sites on days 0 and 14. The amount of blood vessel growth and the percentage of fibrosis were evaluated. RESULTS: A significant difference in the number of new vessels was observed on the insulin-treated site (70.6 [29.21]) compared to saline only (26.5 [34.3]; P < .04). The percentage of fibrosis (insulin 34.7 [28.02] vs saline 27.8 [29.9]) showed no significant difference. No adverse events related to the study occurred. The clinical implications of this study are considerable in terms of the formation of blood vessels but not fibrosis. CONCLUSION: We suggest that local insulin administration is a safe therapeutic option for angiogenesis in wounds of non-diabetic patients.

HISTORIQUE: Les essais cliniques démontrent les effets positifs de l'insulinothérapie localisée pour former de nouveaux vaisseaux ou une fibrose en cas de plaies aiguës ou chroniques causées par le diabète, sans entraîner de réactions indésirables majeures. OBJECTIF: La présente étude visait à évaluer les effets de l'utilisation localisée d'insuline chez des patients non diabétiques. MÉTHODOLOGIE: Les chercheurs ont réalisé un essai aléatoire et contrôlé contre placebo, en parcelles divisées et à double insu. Ils ont recruté dix patients non diabétiques ayant des plaies aiguës de pleine épaisseur (cinq à cause d'un traumatisme, trois à cause de brûlures et deux à cause de pression). Toutes les plaies ont fait l'objet de soins standards au chevet du patient et chacune a été divisée en deux zones. Une zone faisait l'objet de soins standards avec l'ajout d'insuline et l'autre zone, de soins standards avec l'injection de soluté physiologique. Les chercheurs ont prélevé une biopsie dans chaque zone les jours 0 et 14. Ils ont évalué la croissance des vaisseaux sanguins et le pourcentage de fibrose. RÉSULTATS: Les chercheurs ont observé une différence significative dans le nombre de nouveaux vaisseaux de la zone traitée à l'insuline (70,6 ± 29,21) par rapport à celle traitée à l'aide de soluté physiologique (26,5 ± 34,3; P <0,04). Ils n'ont pas constaté de différence significative dans le pourcentage de fibrose (insuline 34,7 ± 28,02 et soluté physiologique 27,8 ± 29,9) ni de réactions indésirables liées à l'étude. Les conséquences cliniques de la présente étude sont considérables à l'égard de la formation de vaisseaux sanguins, mais pas de la fibrose. CONCLUSION: Selon les chercheurs, l'administration localisée d'insuline serait sécuritaire pour l'angiogenèse des plaies des patients non diabétiques.

Evolution of oral health in oral cancer patients with and without dental treatment in place: Before, during and after cancer treatment.

BACKGROUND: This study aims to evaluate the influence of two dental treatment protocols, outpatient non-regulated treatment versus supervised hospital treatment, on the oral health of patients undergoing oral cancer (only radiochemotherapy treatment, not surgical) treatment. MATERIAL AND METHODS: The study used a quasi-experimental approach justified on ethical grounds. A total of 41 patients were included in the control group (outpatient non-regulated treatment) and 40 patients in the experimental group (in-hospital supervised treatment). The patients were treated only with chemotherapy (not surgical treatment was made) for oral cancer. This decision was taken by the oncology committee of the hospital without being influenced by this study. Data regarding plaque index, daily brushing habits, appearance of new cavities, need for extractions, appearance of candidiasis and use of prosthetics in both groups were collected at three points throughout the study: before starting cancer treatment, during treatment and after treatment. The values obtained using the Student's t-test and chi-squared were compared. RESULTS: Based on similar patient backgrounds, throughout cancer treatment the intervention under study resulted in a decrease in plaque index, necessary extractions, and incidence of decay, as well as an increase in daily brushing among other improvements in oral health observed in the experimental group versus the control group. CONCLUSIONS: From our data, we can confirm that supervised dental treatment performed during oral cancer treatment produced an improvement in the oral health of patients with oral cancer. Key words:Oral cancer, dental treatment, quality of life, oncology, dentistry.

[Program of organ and tissue donation in subjects with cerebral death in the State of San Luis Potosí between 1999-2002. Legal implications and study results]. / Programa de donación de órganos y tejidos de individuos con muerte cerebral en San Luis Potosí. Impacto de los aspectos médico-legales en los resultados de 1999-2002.

INTRODUCTION: The transplantation program of organs obtained from deceased donors requires a complex structural organization. Medical, logistic, and cultural aspects must be taken into account. MATERIAL AND METHODS: We analyzed the detection of possible organ donors in San Luis Potosí, Mexico, from August 21, 1999 to August 30, 2002. We studied the main causes of brain death, donor conversion, legal implications, reasons for donation and refusal to donate. RESULTS: 71.42% of donors and 64.15% of non donors required legal intervention. The main cause of brain death was brain traumatic injury (66.97%). The donation rate per one million inhabitants was 8.3. CONCLUSIONS: Adequate forensic management has a positive influence on achieved deceased donors. An effective team work and coordination with the State Council of Transplants has allowed the State of San Luis Potosí to have the highest rate of organ donation in Mexico.

Persistent neonatal hypoglycemia secondary to hyperinsulinism/hyperammonemia. Case report

Introduction: Hyperinsulinism/hyperammonemia syndrome (HI/HA) is a rare genetic disease caused by the activation of mutations in the GLUD1 gene. It is characterized by recurrent symptomatic hypoglycemic episodes, poor tolerance to fasting, and requirement for high metabolic fluxes of glucose, with an insulin/ glucose ratio ≥0.3. Case presentation: Preterm male newborn (36 2/7 weeks of gestation) who was delivered by caesarean section due to acute fetal distress. At birth, the patient presented with weak cry, hypotonia, mild respiratory distress, and recurrent episodes of hypoglycemia, thus 10% dextrose and hydrocortisone were administered initially. Treatment with octeoctride was started, but due to the patient's poor response, laboratory tests were performed, reporting the following findings: serum ammonia: 137.6, insulin: 39.1 µIU/mL, blood glucose: 26.06 mg/dL, and insulin/blood glucose ratio: 1.5, leading to the diagnosis of HI/HA syndrome. Treatment with diazoxide was initiated, achieving a progressive improvement in blood glucose levels; however, afterwards, he presented seizures, so midazolam, phenobarbital and valproic acid were added to the treatment regimen. When hypoglycemia and seizure episodes resolved, the patient was discharged at 2 months and 5 days of life, and a treatment based on oral administration of diazoxide, phenobarbital and valproic acid was prescribed. Conclusion: HI/HA syndrome is characterized by recurrent episodes of hypoglycemia and hyperammonemia; therefore, the presence of these two conditions in neonates is highly suggestive of the disease. Timely diagnosis and treatment are required to avoid neurological sequelae, and transdisciplinary assessment is of great importance, as it increases the likelihood of early diagnosis and timely administration of diazoxide to restore normal glucose levels.

Introducción. El síndrome hiperinsulinismo/hiperamoniemia (HI/HA) es una enfermedad genética rara causada por la activación de mutaciones en el gen GLUD1. Este síndrome se caracteriza por hipoglucemias sintomáticas recurrentes, poca tolerancia al ayuno y requerimiento de altos flujos metabólicos de glucosa, con un índice insulina/glucosa ≥0.3. Presentación del caso. Recién nacido masculino pretérmino de 36 2/7 semanas de gestación que nació por cesárea debido a sufrimiento fetal agudo. Al nacer, el paciente presentó llanto débil, hipotonia, dificultad respiratoria leve y episodios recurrentes de hipoglicemia, por lo que inicialmente se administró dextrosa 10% e hidrocortisona. Se inició tratamiento con octeoctride, pero ante la pobre respuesta, se realizaron exámenes de laboratorio en los que se reportó lo siguiente: amonio sérico: 137.6 pmol/L, insulina: 39.1 µUl/mL, glucemia: 26.06 mg/dL y relación insulina/glucemia: 1.5, lo que permitió diagnosticarlo con síndrome HI/HA. Se inició tratamiento con diazóxido, lográndose mejora progresiva de la glicemia; pero posteriormente presentó crisis convulsivas, por lo que se agregó midazolam, fenobarbital y ácido valproico al tratamiento. Al resolver la hipoglicemia y las convulsiones, el paciente fue dado de alta a los 2 meses y 5 días de vida, prescribiéndose un tratamiento basado en la administración oral de diazóxido, fenobarbital y ácido valproico. Conclusión. El síndrome HI/HA se caracteriza por hipoglucemias recurrentes e hiperamoniemia; por tanto, la presencia de estas dos condiciones en neonatos es altamente sugestiva de la enfermedad. Su diagnóstico y tratamiento deben ser oportunos para evitar secuelas neurológicas, siendo la valoración transdisciplinaria de gran importancia, pues aumenta las probabilidades de un diagnóstico temprano y administración oportuna de diazóxido para restablecer los niveles normales de glucosa.