Don't Go Vaping My Heart: A Case of Vaping-Associated Cardiomyopathy and Lung Injury.

The potential adverse effects of electronic cigarette (e-cigarette) use or vaping on pulmonary function have been previously well documented, with the diagnosis of e-cigarette- or vaping-use-associated lung injury (EVALI) has become increasingly common. The potential effects in terms of cardiovascular function and vaping is an area that is less well understood. We present a case of acute respiratory distress and newly onset reduced systolic function in a previously healthy young male.

Non-selective Aortic Root Angiographic Contrast Injection in a Case of Anomalous Right Coronary Artery Ostium.

Anomalous origin of the right coronary artery (RCA) is a rare congenital cardiovascular anomaly that can pose significant diagnostic challenges during cardiac evaluation. We present a case of a 54-year-old male patient with chest pain and a syncopal episode and subsequently diagnosed with non-ST-elevated myocardial infarction (NSTEMI). Coronary angiography revealed an anomalous origin of the RCA, making it difficult to precisely locate the artery's point of origin with selective contrast injection. During coronary angiography, the use of aortic root non-selective angiographic contrast injection aided in localizing the RCA ostium. Our case highlights the clinical significance of aortic contrast injection as a valuable and safe adjunctive technique in cases of anomalous coronary artery origins. Early detection and precise localization of such anomalies are essential for effective treatment planning and improved patient outcomes. Further studies may help validate the utility of aortic contrast injection in similar cases, thereby enhancing diagnostic accuracy and patient care in the management of anomalous coronary artery ostium.

Acne characteristics in Latin American patients and the potential role of trifarotene.

BACKGROUND: Individualization of treatment based on acne type and severity, location, disease burden, and patient preference is required to maximize efficacy, safety, and adherence to therapy. Latin American populations have unique attributes that must be considered as part of this process to improve clinical success and achieve patient goals. Acne is more common among patients with darker skin phototypes, in whom it is often associated with postinflammatory hyperpigmentation and scarring-the most important acne sequelae-potentially due to more frequent and more severe underlying inflammatory processes in this population. DISCUSSION: These data argue for an early and proactive approach to managing acne in these patients with agents that target the inflammatory processes that underlie acne and its sequelae. As a class, retinoids offer a spectrum of activity that may be useful in addressing the unique needs of Latin American populations. CONCLUSION: Trifarotene, a novel, selective retinoid, has been evaluated in relevant patient populations.

Winter connectivity and leapfrog migration in a migratory passerine.

Technological advances in migratory tracking tools have revealed a remarkable diversity in migratory patterns. One such pattern is leapfrog migration, where individuals that breed further north migrate to locations further south. Here, we analyzed migration patterns in the Painted Bunting (Passerina ciris) using a genetic-based approach. We started by mapping patterns of genetic variation across geographic space (called a genoscape) using 386 individuals from 25 populations across the breeding range. We then genotyped an additional 230 samples from 31 migration stopover locations and 178 samples from 16 wintering locations to map patterns of migratory connectivity. Our analyses of genetic variation across the breeding range show the existence of four genetically distinct groups within the species: Eastern, Southwestern, Louisiana, and Central groups. Subsequent assignment of migrating and wintering birds to genetic groups illustrated that birds from the Central group migrated during the fall via western Mexico or southern Texas, spent the winter from northeastern Mexico to Panama, and migrated north via the Gulf Coast of Mexico. While Louisiana birds overlapped with Central birds on their spring migratory routes along the Gulf Coast, we found that Louisiana birds had a more restricted wintering distribution in the Yucatan Peninsula and Central America. Further estimation of the straight-line distance from the predicted breeding location to the wintering location revealed that individuals sampled at lower winter latitudes traveled to greater distances (i.e., the predicted breeding area was further north; p > .001), confirming that these species exhibit a leapfrog migration pattern. Overall, these results demonstrate the utility of a genoscape-based approach for identifying range-wide patterns of migratory connectivity such as leapfrog migration with a high degree of clarity.

Pediatric Hepatitis C Quality Improvement Project Improves Healthcare Access.

OBJECTIVES: Incidence of hepatitis C virus (HCV) infection is increasing in women of reproductive age, leading to increased prevalence of HCV infection in children via vertical transmission. This quality improvement (QI) project aimed to increase referrals to and appointments scheduled with a specialty pediatric gastroenterology HCV clinic and the number of eligible children with HCV who completed treatment. METHODS: From July 2020 to August 2021, the QI team designed a project using the Model for Improvement and completed Plan Do Study Act cycles to test change ideas to improve HCV awareness and education for medical providers and families; standardize the referral process; track patients; increase clinic capacity; and connect families with community resource care coordination. Referrals to the pediatric HCV clinic, appointments scheduled, no shows, and treatment follow-up were tracked during the project period and a comparison timeframe from July 2019 to June 2020. RESULTS: There were improvements in several measures during the project period versus the comparison timeframe, with 80 versus 48 referrals received (66% increase), 115 versus 59 scheduled clinic visits (95% increase), and 7 versus 5 treatment completers (40% increase), along with a small (7%) decline in the proportion of scheduled clinic visits that were no shows. CONCLUSION: Application of QI methodology increased medical provider and caregiver awareness and engagement in accessing HCV healthcare available for at-risk children. More QI efforts should be accelerated to identify best practices amidst a nationwide HCV epidemic.

Analysis of STEMI and NSTEMI in a Community Cohort of Marijuana Users.

Background: Marijuana is the most commonly used illicit drug in the United States. Current research has yet to come to a consensus on its association with acute coronary syndrome (ACS). Herein, we aimed to analyze how marijuana use relates to acute ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Methods: Using a retrospective study design, we gathered data from August 2014 to September 2020 on all percutaneous coronary interventions (PCIs) done at Brookdale University Hospital Medical Center (BUHMC) in patients with NSTEMI and STEMI. To compare marijuana users (MUs) with non-users, t-tests and Chi-square tests were used. A total of 195 patients were included, with mean age at presentation of 47 years old; 59 were females (30.3%) and 136 were males (69.7%). We identified 37 patients who were MUs. MUs were younger than non-users (P < 0.01), had higher rates of alcohol (P = 0.025), opiate (P = 0.004) and cigarette (P ≤ 0.001) use. On admission, MUs had lower creatinine (P = 0.031), blood urea nitrogen (BUN) (P = 0.031), pro-B-type natriuretic peptide (PBNP) (P = 0.052), BMI (P = 0.014) and lower right coronary artery (RCA) disease (P = 0.026). Results: After logistic regression analyses, results showed that the severity of coronary artery disease (CAD) and admission diagnosis of STEMI or NSTEMI were not found to be significantly related to marijuana use. Age, alcohol, cigarette, creatinine, BUN, PBNP, BMI and RCA disease were significantly related to marijuana use. There was a negative correlation between marijuana use and RCA disease (MUs = 29.7% vs. non-users = 50%, P = 0.026). There was no significant association with STEMI, NSTEMI or the severity of CAD. Conclusion: As daily cannabis use is on the rise, more researches are needed to further determine the effects of marijuana use on CAD.

Aspiration thrombectomy for inferior vena cava tumor thrombus arising from hepatocellular carcinoma.

Pharmacomechanical therapy and catheter-directed thrombolysis have been shown to be very effective in the treatment of venous thromboembolism; however, there is much less data regarding inferior vena cava thrombi. Tumor thrombi pose an even greater clinical challenge as anti-coagulation and thrombolysis are not effective. We present the case of a 61-year-old male who presented with an inferior vena cava thrombus emanating from an accessory right hepatic vein, treated with aspiration thrombectomy.

A method for transforming knowledge discovery metamodel to ArchiMate models.

Enterprise architecture has become an important driver to facilitate digital transformation in companies, since it allows to manage IT and business in a holistic and integrated manner by establishing connections among technology concerns and strategical/motivational ones. Enterprise architecture modelling is critical to accurately represent business and their IT assets in combination. This modelling is important when companies start to manage their enterprise architecture, but also when it is remodelled so that the enterprise architecture is realigned in a changing world. Enterprise architecture is commonly modelled by few experts in a manual way, which is error-prone and time-consuming and makes continuous realignment difficult. In contrast, other enterprise architecture modelling proposal automatically analyses some artefacts like source code, databases, services, etc. Previous automated modelling proposals focus on the analysis of individual artefacts with isolated transformations toward ArchiMate or other enterprise architecture notations and/or frameworks. We propose the usage of Knowledge Discovery Metamodel (KDM) to represent all the intermediate information retrieved from information systems' artefacts, which is then transformed into ArchiMate models. Thus, the core contribution of this paper is the model transformation between KDM and ArchiMate metamodels. The main implication of this proposal is that ArchiMate models are automatically generated from a common knowledge repository. Thereby, the relationships between different-nature artefacts can be exploited to get more complete and accurate enterprise architecture representations.

Primary neuroendocrine prostate cancer with adrenal gland metastasis.

Primary neuroendocrine differentiation in prostate cancer occurs infrequently and represents a therapeutic challenge at present due to the poor prognosis involved. We present the case of a patient with de novo neuroendocrine prostate cancer who later developed metastases to adrenals bilaterally which were initially managed surgically.

Arrangement of the photoreceptor mosaic in a diabetic rat model imaged with multiphoton microscopy.

Diabetic retinopathy (DR) is defined as a microvascular pathology. However, some data have suggested that the retinal photoreceptors (PRs) might be important in the pathogenesis of this ocular disease. In this study the organization of the PRs in control and diabetic-induced rats was compared using multiphoton microscopy. The PR mosaic was imaged at different locations in non-stained retinas. The density of PRs was directly quantified from cell counting. The spatially resolved density presents a double-slope pattern (from the central retina towards the periphery) in both healthy and pathological samples, although the values for the latter were significantly lower all across the retina. Moreover, Voronoi analysis was performed to explore changes in PR topography. In control specimens a hexagonally packed structure was dominant. However, despite the non-controlled effects of the disease in retinal structures, this PR regularity was fairly maintained in diabetic retinas.

High Prevalence of Avian Influenza Virus Among Wild Waterbirds and Land Birds of Mexico.

Aquatic wild birds, especially waterfowl, have been long considered the main reservoirs of the avian influenza A virus; however, recent surveys have found an important prevalence of these viruses among land birds as well. Migration has been suggested as an important factor in the avian influenza virus dissemination. We aimed to estimate the prevalence of influenza A viruses in wild birds (waterbirds and land birds; resident and migratory) in eastern Mexico, where the three main North American migration flyways converge and where there was no previous information on this subject. We detected influenza with reverse transcription coupled with a PCR approach. Of the 534 birds sampled between 2010 and 2012, we detected the influenza A virus in a high proportion of birds (39%). Prevalence was particularly high in land birds (49%) when compared to aquatic birds (26%); there was no difference in overall prevalence between resident (39%) and migratory birds (39%). The high prevalence of the avian influenza virus in land birds was noteworthy in the innermost sampling areas in northern Mexico (Coahuila [82%] and Nuevo Leon [43%]).

Alta prevalencia del virus de la influenza aviar entre aves acuáticas silvestres y aves terrestres de México. Las aves silvestres acuáticas, especialmente las aves anseriformes, han sido consideradas durante mucho tiempo los principales reservorios del virus de la influenza aviar A; sin embargo, muestreos recientes también han encontrado una importante prevalencia de estos virus entre las aves terrestres. Se ha sugerido que la migración es un factor importante en la diseminación del virus de la influenza aviar. El objetivo de este estudio fue estimar la prevalencia de los virus de la influenza A en aves silvestres (aves acuáticas y terrestres; residentes y migratorias) en el este de México, donde convergen las tres rutas migratorias principales de América del Norte y donde no había información previa sobre este tema. Se detectó al virus de influenza mediante transcripción reversa acoplada a PCR. De las 534 aves muestreadas entre los años 2010 y 2012, se detectó al virus de la influenza A en una alta proporción de aves (39%). La prevalencia fue particularmente alta en las aves terrestres (49%) en comparación con las aves acuáticas (26%); no se observó diferencia en la prevalencia general entre las aves residentes (39%) y las migratorias (39%). La alta prevalencia del virus de la influenza aviar en las aves terrestres fue notable en las áreas de muestreo hacia el interior del norte de México (Coahuila [82%] y Nuevo León [43%]).

Adaptive genetic diversity and evidence of population genetic structure in the endangered Sierra Madre Sparrow (Xenospiza baileyi).

The magnitude and distribution of genetic diversity through space and time can provide useful information relating to evolutionary potential and conservation status in threatened species. In assessing genetic diversity in species that are of conservation concern, several studies have focused on the use of Toll-like receptors (TLRs). TLRs are innate immune genes related to pathogen resistance, and polymorphisms may reflect not only levels of functional diversity, but may also be used to assess genetic diversity within and among populations. Here, we combined four potentially adaptive markers (TLRs) with one mitochondrial (COI) marker to evaluate genetic variation in the endangered Sierra Madre Sparrow (Xenospiza baileyi). This species offers an ideal model to investigate population and evolutionary genetic processes that may be occurring in a habitat restricted endangered species with disjunct populations (Mexico City and Durango), the census sizes of which differ by an order of magnitude. TLRs diversity in the Sierra Madre Sparrow was relatively high, which was not expected given its two small, geographically isolated populations. Genetic diversity was different (but not significantly so) between the two populations, with less diversity seen in the smaller Durango population. Population genetic structure between populations was due to isolation and different selective forces acting on different TLRs; population structure was also evident in COI. Reduction of genetic diversity in COI was observed over 20 years in the Durango population, a result likely caused by habitat loss, a factor which may be the main cause of diversity decline generally. Our results provide information related to the ways in which adaptive variation can be altered by demographic changes due to human-mediated habitat alterations. Furthermore, our findings may help to guide conservation schemes for both populations and their restricted habitat.

Giant Left Main Coronary Artery Aneurysm Presenting as Multiple Implantable Cardioverter Defibrillator Shocks.

Giant aneurysms of the left main coronary artery are one of the rarest findings in cardiology, encountered in less than 0.02% of patients. The presentation is usually the same as coronary artery disease since most coronary aneurysms in the western world are associated with atherosclerosis. Here we report the first case of giant aneurysm of the left main coronary artery presenting as ventricular tachycardia with multiple shocks of the defibrillator in a 57-year-old man with heart failure. We also review the etiology, pathology, and management of coronary aneurysms.

[Penile cancer in Mexico: Twenty years experience at a tertiary academic hospital.] / Cáncer de pene en México: 20 años de experiencia en un hospital académico de tercer nivel.

OBJECTIVE: The aim of this study was to report clinical features and management of penile cancer (CP) at the National Cancer Institute (INCan) of Mexico City over 20 years. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 405 cases of primary penile cancer (PC) treated at our institution between 1989 until 2015. Diagnosis, treatment and oncological outcomes are reported. RESULTS: Clinicopathologic and demographic information was available for 375 patients (mean age, 56 ys). At diagnosis, 140 (37.3 %) patients were cN0, 71(18.9%) cN1, 164 (43.37%) cN2 and 33 (8%) cN3. 14% had metastatic disease (lung and bone). Initial treatment included partial penectomy (n=123; 33.6%), and total penectomy (n=126;33.6%). 138 (36.2%) patients with high risk disease underwent bilateral inguinal lymph node dissection. 8% (56) had positive lymph nodes. Kaplan-Meier survival analysis showed a 10-year CSS (cancer specific survival) rate of 70%. There was no significant difference in CSS when stratifying per age. Five-year CSS for pT1, pT2, pT3 and T4 was 96%, 88%, 58% y T4 0%, respectively. A difference in CSS was found between pT2 and pT3 (p=0.047). CONCLUSION: The findings of our descriptive analysis provide information on natural history of penile cancer in Mexico. The surgical penile removal of the primary tumour remains standard of care. There was no difference in survival for age group.

OBJETIVO: Revisar las características clínicas y el manejo del cáncer de pene (CP) en el Instituto Nacional de Cancerología (INCan) de la Ciudad de México en 20 años de experiencia.MATERIAL Y MÉTODOS: Revisamos de forma retrospectiva a 405 pacientes con diagnóstico de CP tratados en INCan entre enero de 1989 hasta diciembre de 2015. Se describieron la modalidad de presentación de los casos, los resultados de patología, tratamiento y la sobrevida. RESULTADOS: Las informaciones clínico-patológicas y los resultados oncológicos fueron completas en 375 pacientes (edad media 56,82). Al diagnóstico 140 casos (n.37,3%) fueron cN0, 71 casos (18,9%) cN1, 164 casos (43,37%) cN2, 33 casos (8%) cN3. El 14% tuvieron metástasis a distancia (pulmón, huesos). El tratamiento inicial incluyó falectomía parcial (n=123; 33,6% y falectomía total (n=126; 33,6%). De 138 (36,2%) pacientes de alto riesgo sometidos a disección de ganglios linfáticos inguinales bilaterales, solo el 8% (n.56) tenían ganglios linfáticos positivos. El análisis de supervivencia de Kaplan-Meier mostró una tasa de SCE (sobrevida cáncer específica) a 10 años del 70%. No hubo diferencias significativas en la supervivencia para el grupo de edad. La CSS a 5 años para pT1, pT2, pT3 y T4 fue del 96%, 88%, 58% y 0%, respectivamente. Se encontró diferencia en la supervivencia entre pT2 y pT3 (p 0,047).CONCLUSIÓN: Los hallazgos de nuestra casuística proporcionan información sobre la historia natural del cáncer de pene en México. La amputación quirúrgica del tumor primario sigue siendo el patrón uro-oncológico para el tratamiento definitivo del CP. No hubo diferencias en la supervivencia para el grupo de edad.

Surface Persistence of Trace Level Deposits of Highly Energetic Materials.

In the fields of Security and Defense, explosive traces must be analyzed at the sites of the terrorist events. The persistence on surfaces of these traces depends on the sublimation processes and the interactions with the surfaces. This study presents evidence that the sublimation process of these traces on stainless steel (SS) surfaces is very different than in bulk quantities. The enthalpies of sublimation of traces of four highly energetic materials: triacetone triperoxide (TATP), 2,4-dinitrotoluene (DNT), 2,4,6-trinitrotoluene (TNT), and 1,3,5- trinitrohexahydro-s-triazine (RDX) deposited on SS substrates were determined by optical fiber coupled-grazing angle probe Fourier Transform Infrared (FTIR) Spectroscopy. These were compared with enthalpies of sublimation determined by thermal gravimetric analysis for bulk amounts and differences between them were found. The sublimation enthalpy of RDX was very different for traces than for bulk quantities, attributed to two main factors. First, the beta-RDX phase was present at trace levels, unlike the case of bulk amounts which consisted only of the alpha-RDX phase. Second, an interaction between the RDX and SS was found. This interaction energy was determined using grazing angle FTIR microscopy. In the case of DNT and TNT, bulk and traces enthalpies were statistically similar, but it is evidenced that at the level of traces a metastable phase was observed. Finally, for TATP the enthalpies were statistically identical, but a non-linear behavior and a change of heat capacity values different from zero was found for both trace and bulk phases.

Dense Geographic and Genomic Sampling Reveals Paraphyly and a Cryptic Lineage in a Classic Sibling Species Complex.

Incomplete or geographically biased sampling poses significant problems for research in phylogeography, population genetics, phylogenetics, and species delimitation. Despite the power of using genome-wide genetic markers in systematics and related fields, approaches such as the multispecies coalescent remain unable to easily account for unsampled lineages. The Empidonax difficilis/Empidonax occidentalis complex of small tyrannid flycatchers (Aves: Tyrannidae) is a classic example of widely distributed species with limited phenotypic geographic variation that was broken into two largely cryptic (or "sibling") lineages following extensive study. Though the group is well-characterized north of the US Mexico border, the evolutionary distinctiveness and phylogenetic relationships of southern populations remain obscure. In this article, we use dense genomic and geographic sampling across the majority of the range of the E. difficilis/E. occidentalis complex to assess whether current taxonomy and species limits reflect underlying evolutionary patterns, or whether they are an artifact of historically biased or incomplete sampling. We find that additional samples from Mexico render the widely recognized species-level lineage E. occidentalis paraphyletic, though it retains support in the best-fit species delimitation model from clustering analyses. We further identify a highly divergent unrecognized lineage in a previously unsampled portion of the group's range, which a cline analysis suggests is more reproductively isolated than the currently recognized species E. difficilis and E. occidentalis. Our phylogeny supports a southern origin of these taxa. Our results highlight the pervasive impacts of biased geographic sampling, even in well-studied vertebrate groups like birds, and illustrate what is a common problem when attempting to define species in the face of recent divergence and reticulate evolution.

Passion Scale: Psychometric Properties and Factorial Invariance via Exploratory Structural Equation Modeling (ESEM) / Escala de Paixão: Propriedades Psicométricas e Invariância Fatorial via Exploratory Structural Equation Modeling (ESEM) / Escala de Pasión: Propiedades Psicométricas e Invariancia Factorial Mediante el Exploratory Structural Equation Modeling (ESEM)

Abstract Passion is an important element among the psychological processes involved in the performance of any activity, including sports practice. Given the scarcity of nationally valid and reliable instruments, this study has the purpose of presenting the adaptation processes of the Passion Scale to the Brazilian context. A total of 789 Brazilian athletes (age:16.62±3.20; 58.4% men) participated in the study. To evaluate their psychometric properties, the scale dimensionality was estimated through the Hull method and Exploratory Structural Equation Modeling, and the accuracy by composite reliability. The factorial invariance model was estimated between men and women, and between participants of different competitive levels. Results showed the two-factor structure of the scale, according to the theoretical hypothesis, with desirable accuracy indicators. Equivalence of the measurement model was demonstrated when evaluating participants of different sexes and different competitive levels. Results suggest adequacy of the Brazilian version for the evaluation of this construct.

Resumo A paixão é um importante elemento dentre os processos psicológicos envolvidos na realização de qualquer atividade, inclusive na prática esportiva. Dada a escassez de instrumentos válidos e fidedignos nacionalmente, esse estudo objetivou apresentar os processos de adaptação da Escala de Paixão para o contexto brasileiro. Participaram da pesquisa 789 atletas brasileiros (idade:16,62 ± 3,20; 58,4% homens). Visando a avaliação de suas propriedades psicométricas, a dimensionalidade da escala foi estimada através do método Hull e Exploratory Structural Equation Modeling, e a precisão pela fiabilidade compósita. Também se estimou a invariância do modelo fatorial entre homens e mulheres, e entre os participantes de diferentes níveis competitivos. Os resultados revelaram a estrutura bifatorial da escala, conforme hipótese teórica, com indicadores desejáveis de precisão. Também foi demostrada a equivalência do modelo de medida ao avaliar participantes dos diferentes sexos e diferentes níveis competitivos. Os resultados sugerem adequação da versão brasileira para avaliação deste construto.

Resumen La pasión es un importante elemento entre los procesos psicológicos involucrados en la realización de cualquier actividad, incluso en la práctica deportiva. Considerando la escasez de instrumentos válidos y fiables en ámbito nacional, este estudio busca presentar los procesos de adaptación de la Escala de Pasión al contexto brasileño. En el estudio participaron 789 atletas brasileños (edad: 16,62 ± 3,20; un 58,4% hombres). Para la evaluación de sus propiedades psicométricas, la dimensionalidad de la escala se estimó por medio del método Hull y Exploratory Structural Equation Modeling; y la precisión, por la fiabilidad compuesta. También se calculó la invariancia del modelo factorial entre los hombres y las mujeres, y entre los participantes de diferentes niveles competitivos. Los resultados revelaron la estructura bifactorial de la escala, que confirma la hipótesis teórica, con indicadores deseables de precisión. También se demostró la equivalencia del modelo de medida en la evaluación de los participantes de ambos sexos y diferentes niveles competitivos. Los resultados sugieren adecuar la versión brasileña para la evaluación en este constructo.

DAQUA-MASS: An ISO 8000-61 Based Data Quality Management Methodology for Sensor Data.

The Internet-of-Things (IoT) introduces several technical and managerial challenges when it comes to the use of data generated and exchanged by and between various Smart, Connected Products (SCPs) that are part of an IoT system (i.e., physical, intelligent devices with sensors and actuators). Added to the volume and the heterogeneous exchange and consumption of data, it is paramount to assure that data quality levels are maintained in every step of the data chain/lifecycle. Otherwise, the system may fail to meet its expected function. While Data Quality (DQ) is a mature field, existing solutions are highly heterogeneous. Therefore, we propose that companies, developers and vendors should align their data quality management mechanisms and artefacts with well-known best practices and standards, as for example, those provided by ISO 8000-61. This standard enables a process-approach to data quality management, overcoming the difficulties of isolated data quality activities. This paper introduces DAQUA-MASS, a methodology based on ISO 8000-61 for data quality management in sensor networks. The methodology consists of four steps according to the Plan-Do-Check-Act cycle by Deming.

Factores asociados con supervivencia a cinco años en niños con astrocitoma cerebral.

INTRODUCCIÓN: La segunda causa de muerte infantil es el cáncer, del cual las leucemias y los tumores del sistema nervioso central son las presentaciones más frecuentes; de los últimos, los astrocitomas representan 40 %. OBJETIVO: Identificar los factores asociados con la supervivencia a cinco años en niños con astrocitoma cerebral. MÉTODO: Estudio de casos y controles anidado en una cohorte retrospectiva en pacientes con diagnóstico de astrocitoma cerebral que recibieron tratamiento de diciembre de 2006 a enero de 2010. Se realizó estadística descriptiva y prueba de chi cuadrado; para evaluar la supervivencia se utilizó el método de Kaplan-Meier. RESULTADOS: Se incluyeron 21 pacientes con diagnóstico de astrocitoma cerebral; la supervivencia fue de 76 % a cinco años, el astrocitoma pilocítico fue el más frecuente (61 %), con una edad media de siete años; predominó el sexo masculino, la edad al fallecimiento osciló entre los ocho y 12 años (p = 0.022); 80 % de los pacientes fallecidos tuvo tumor con localización infratentorial d (RM = 17.3, IC 95 % = 1-622, p = 0.01). No hubo diferencia en la supervivencia atribuible al tratamiento. CONCLUSIÓN: La supervivencia a cinco años fue de 76 %; el factor de riesgo significativo que la limita es la localización infratentorial del tumor. INTRODUCTION: The second cause of children's death is cancer, with leukemia and central nervous system tumors being the most common, among which astrocytomas account for 40%. OBJECTIVE: To find out the factors associated with 5-year survival in children with cerebral astrocytoma. METHOD: Case-control study nested in a retrospective cohort of patients diagnosed with cerebral astrocytoma who received treatment from December 2006 to January 2010. Descriptive statistics and the chi-square test were carried out; the Kaplan-Meier method was used to assess survival. RESULTS: Twenty-one patients diagnosed with cerebral astrocytoma were included; survival was 76% at 5 years; with pilocytic astrocytoma being the most common (61%); mean age was 7 years, and male gender was predominant; age at death ranged from 8 to 12 years (p = 0.022), with 80% of deceased patients having infratentorial localization (OR = 17.3; 95% CI = 1-622; p = 0.01). There was no treatment-attributable survival difference. CONCLUSIONS: Five-year survival was 76%; the limiting risk factor is tumor infratentorial localization.