Discordant results for ALK based on immunohistochemistry versus fluorescence in situ hybridization in a cohort of patients diagnosed with lung adenocarcinoma.

INTRODUCTION: Anaplastic lymphoma kinase (ALK) rearrangement located on the short arm of chromosome 2, region 2 and band 3 is frequent in lung cancer patients who respond to targeted therapies with ALK inhibitors Therefore, their identification has become a standard diagnostic test in patients with advanced NSCLS, as such chromosomal alterations may lead to the activation of important signalling pathways involved in cell survival and proliferation. METHODS: To investigate the ALK gene status, we performed FISH and IHC assays in 18 lung adenocarcinoma patients, 12 women and 6 men, aged between 29 and 85 years. Paraffin-embedded samples were analyzed in the Pathology Department of the Hospital Universitario San Ignacio. RESULTS: Results between the two techniques in 5 patients showed discordant patterns, being positive for FISH and negative for IHC. The borderline to define ALK positivity was set at 15%, These results present experimental evidence that the techniques differ in specific situations. CONCLUSIONS: Our findings show that it is advisable to investigate the ALK gene status in patients with suspected lung cancer using both FISH and IHC in combination.

Malaria parasite infection compromises colonization resistance to an enteric pathogen by reducing gastric acidity.

Malaria parasite infection weakens colonization resistance against Salmonella enterica serovar (S.) Typhimurium. S. Typhimurium is a member of the Enterobacterales, a taxon that increases in abundance when the colonic microbiota is disrupted or when the colonic mucosa is inflamed. However, here, we show that infection of mice with Plasmodium yoelii enhances S. Typhimurium colonization by weakening host control in the upper GI tract. P. yoelii-infected mice had elevated gastric pH. Stimulation of gastric acid secretion during P. yoelii infection restored stomach acidity and colonization resistance, demonstrating that parasite-induced hypochlorhydria increases gastric survival of S. Typhimurium. Furthermore, blockade of P. yoelii-induced TNF-α signaling was sufficient to prevent elevation of gastric pH and enhance S. Typhimurium colonization during concurrent infection. Collectively, these data suggest that abundance in the fecal microbiota of facultative anaerobes, such as S. Typhimurium, can be increased by suppressing antibacterial defenses in the upper GI tract, such as gastric acid.

Aedes aegypti, the dengue fever mosquito in Mexico City. Early invasion and its potential risks.

INTRODUCTION: Mexico City has no endemic presence of Aedes aegypti, and it is therefore free of vector-borne diseases, such as dengue fever, Zika and chikungunya. However, evidence has shown the presence of Aedes aegypti eggs in the city since 2015. OBJECTIVE: To report the constant and increasing presence of Aedes aegypti eggs in Mexico City from 2015 to 2018. METHODS: Surveillance was carried out using ovitraps. Eggs were counted and hatched in order to determine the species. RESULTS: From 2015 to 2018, 378 organisms were identified as Ae. aegypti. In total, 76 Aedes aegypti-positive ovitraps were collected at 50 different places in 11 boroughs of the city. Northeastern Mexico City was the area with the highest number of positive traps. CONCLUSIONS: The results may be indicating a period of early colonization and the probable existence of cryptic colonies of the mosquito; Mexico City could be at risk of experiencing vector-borne epidemics.

INTRODUCCIÓN: La Ciudad de México no tiene presencia endémica de Aedes aegypti, por lo que está libre de enfermedades transmitidas por vector como dengue, Zika y chikunguña. Sin embargo, existe evidencia de la presencia de huevecillos en la urbe desde 2015. OBJETIVO: Reportar la presencia constante y en aumento de huevecillos de Aedes aegypti en la Ciudad de México de 2015 a 2018. MÉTODO: Se realizó vigilancia a través de ovitrampas; se contabilizaron y eclosionaron huevecillos para determinar la especie. RESULTADOS: De 2015 a 2018 fueron identificados 378 organismos como Aedes aegypti. En total fueron colectadas 76 ovitrampas positivas a Aedes aegypti en 50 sitios distintos de 11 alcaldías. El noreste de la Ciudad de México fue el área con mayor positividad. CONCLUSIONES: Los resultados pueden estar indicando un periodo de colonización incipiente y la probable la existencia de colonias crípticas del mosquito, por lo que la Ciudad de México podría estar en riesgo de presentar epidemias de enfermedades transmitidas por vector.

El mosquito del dengue en la Ciudad de México. Invasión incipiente de Aedes aegypti y sus potenciales riesgos / Aedes aegypti, the dengue fever mosquito in Mexico City. Early invasion and its potential risks

Resumen Introducción: La Ciudad de México no tiene presencia endémica de Aedes aegypti, por lo que está libre de enfermedades transmitidas por vector como dengue, Zika y chikunguña. Sin embargo, existe evidencia de la presencia de huevecillos en la urbe desde 2015. Objetivo: Reportar la presencia constante y en aumento de huevecillos de Aedes aegypti en la Ciudad de México de 2015 a 2018. Método: Se realizó vigilancia a través de ovitrampas; se contabilizaron y eclosionaron huevecillos para determinar la especie. Resultados: De 2015 a 2018 fueron identificados 378 organismos como Aedes aegypti. En total fueron colectadas 76 ovitrampas positivas a Aedes aegypti en 50 sitios distintos de 11 alcaldías. El noreste de la Ciudad de México fue el área con mayor positividad. Conclusiones: Los resultados pueden estar indicando un periodo de colonización incipiente y la probable la existencia de colonias crípticas del mosquito, por lo que la Ciudad de México podría estar en riesgo de presentar epidemias de enfermedades transmitidas por vector.

Abstract Introduction: Mexico City has no endemic presence of Aedes aegypti, and it is therefore free of vector-borne diseases, such as dengue fever, Zika and chikungunya. However, evidence has shown the presence of Aedes aegypti eggs in the city since 2015. Objective: To report the constant and increasing presence of Aedes aegypti eggs in Mexico City from 2015 to 2018. Methods: Surveillance was carried out using ovitraps. Eggs were counted and hatched in order to determine the species. Results: From 2015 to 2018, 378 organisms were identified as Ae. aegypti. In total, 76 Aedes aegypti-positive ovitraps were collected at 50 different places in 11 boroughs of the city. Northeastern Mexico City was the area with the highest number of positive traps. Conclusions: The results may be indicating a period of early colonization and the probable existence of cryptic colonies of the mosquito, and Mexico City could be therefore at risk of experiencing vector-borne epidemics.

Pulmonary Adenofibromas: A Clinicopathologic Correlation of 13 Cases.

Thirteen cases of primary pulmonary adenofibromas are presented. The patients are 8 women and 5 men between the ages of 41 and 73 years (average: 57 y). The patients presented with nonspecific symptomatology or their tumor was identified during routine chest films. A wedge resection was performed in all cases with lymph node sampling. Grossly, the tumors varied in size from 1 to 2.5 cm in greatest dimension. The entire tumor was histologically evaluated in all cases. All the tumors shared similar histologic features namely leaf-like/phyllodes-like growth patterns with varying areas of sclerosis, focal inflammation, and entrapped epithelium. A wide panel of immunohistochemical studies was performed including epithelial, neural, muscle, and vascular markers, all of which showed negative staining. The tumors were positive only for vimentin in the stroma and keratin in the entrapped epithelium. Further evaluation in 6 cases using in situ hybridization for the solitary fibrous tumor was performed and was negative. Clinical follow-up in all the patients showed no evidence of recurrence or metastatic disease, during a period of 12 to 36 months. The current cases highlight the unusual occurrence of pulmonary adenofibromas and the importance of separating these tumors from other tumors that may have the potential to recur or metastasize. The use of proper immunohistochemical stains/molecular analysis aids in the proper classification of these tumors.

Caracterización de los hallazgos electrocardiográficos y su relación con la mortalidad en la enfermedad cerebrovascular aguda / Characterization of electrocardiographic findings and their relationship with mortality in acute cerebrovascular disease

RESUMEN Introducción: En Cuba, los estudios descriptivos y experimentales que exploran los trastornos cardiovasculares secundarios a enfermedades neurológicas son escasos, tanto en el campo de la clínica como de la neurocardiología. Objetivos: Caracterizar los hallazgos electrocardiográficos en las primeras 72 horas de evolución de la enfermedad cerebrovascular y su relación con la mortalidad. Método: Se realizó un estudio observacional, descriptivo, de corte longitudinal prospectivo, en 166 pacientes ingresados en el Hospital Clínico-Quirúrgico Joaquín Albarrán, con el diagnóstico de enfermedad cerebrovascular de cualquier etiología y forma de presentación, durante el período de enero de 2015 a diciembre de 2016. Resultados: Los hallazgos electrocardiográficos estuvieron presentes en el 32,5% de los pacientes, fundamentalmente la taquicardia sinusal (27,7 %), la inversión de la onda T y las extrasístoles auriculares (13,3% cada uno). Se encontró una frecuencia significativamente mayor de cambios electrocardiográficos en los pacientes con hemorragia subaracnoidea (33,3% frente a 5,4%), menor puntuación en la escala de coma de Glasgow (29,7% frente a 5,4%) y localización a nivel de los ganglios basales (50,0%). La presencia de nuevos hallazgos electrocardiográficos se relacionó con una probabilidad 7,2 veces mayor de muerte intrahospitalaria (40,7% frente a 7,1%). Conclusiones: La presencia de nuevas alteraciones electrocardiográficas en pacientes con enfermedad cerebrovascular puede ser empleado como un marcador de riesgo de mortalidad intrahospitalaria.

ABSTRACT Introduction: In Cuba, descriptive and experimental studies that explore cardiovascular disorders secondary to neurological diseases are scarce, both in the clinical and neurocardiology fields. Objectives: To characterize the electrocardiographic findings in the first 72 hours of evolution of the cerebrovascular disease and its relation to mortality. Method: An observational, descriptive, longitudinal prospective study was carried out in 166 patients admitted to the Hospital Clínico-Quirúrgico Joaquín Albarrán, with the diagnosis of cerebrovascular disease of any etiology and form of presentation, during the period of January 2015 to December 2016. Results: Electrocardiographic findings were present in 32.5% of patients, mainly sinus tachycardia (27.7%), T wave inversion and premature atrial contractions (13.3% each). A significantly higher frequency of electrocardiographic changes was found in patients with subarachnoid hemorrhage (33.3% vs. 5.4%), lower score on the Glasgow coma scale (29.7% vs. 5.4%) and location at the level of the basal ganglia (50.0%). The presence of new electrocardiographic findings was related to a 7.2 times greater probability of in-hospital death (40.7% vs. 7.1%). Conclusions: The presence of new electrocardiographic alterations in patients with cerebrovascular disease can be used as a marker of risk of in-hospital mortality.

Dose-response study for the highly aggressive and metastatic primary F3II mammary carcinoma under direct current.

Electrochemical treatment has been suggested as an effective alternative to local cancer therapy. Nevertheless, its effectiveness decreases when highly aggressive primary tumors are treated. The aim of this research was to understand the growth kinetics of the highly aggressive and metastatic primary F3II tumor growing in male and female BALB/c/Cenp mice under electrochemical treatment. Different amounts of electric charge (6, 9, and 18 C) were used. Two electrodes were inserted into the base, perpendicular to the tumor's long axis, keeping about 1 cm distance between them. Results have shown that the F3II tumor is highly sensitive to direct current. The overall effectiveness (complete response + partial response) of this physical agent was ≥75.0% and observed in 59.3% (16/27) of treated F3II tumors. Complete remission of treated tumors was observed in 22.2% (6/27). An unexpected result was the death of 11 direct current-treated animals (eight females and three males). It is concluded that direct current may be addressed to significantly affect highly aggressive and metastatic primary tumor growth kinetics, including the tumor complete response. Bioelectromagnetics. 39:460-475, 2018. © 2018 Wiley Periodicals, Inc.

Precisiones teórico-metodológicas para la comprensión de la ética y la bioética médica / Theoretical-methodological precisions for understanding the ethics and the medical bioethics

El pensamiento ético y bioético es una de las áreas de conocimiento recurrentes en el ejercicio reflexivo del profesional de la salud en Cuba; sin embargo, se detectan insuficiencias relacionadas con imprecisiones y falta de claridad en el pensamiento ético-moral por parte de este personal, según se observa en materiales evaluados para su publicación, en los ejercicios para el proceso de obtención de categorías docentes y en la presentación de las evaluaciones de posgrados. El artículo tiene el objetivo de argumentar precisiones teórico- metodológicas para la elaboración de trabajos en ética y bioética.

The ethical and bioethical thought is one of the recurrent areas of knowledge in the reflexive exercise of health professionals in Cuba. However, according to the observations of evaluated materials for their publication, in the exercises for the process of obtaining educational categories and in the presentation of postgraduate evaluations, inadequacies related with imprecision and lack of clarity are detected in the ethical-moral thought on the part of health professionals. The article has the objective of arguing theoretical- methodological precisions for the elaboration of works in ethics and bioethics.

La Medicina Interna en el ambiente hospitalario / The Internal Medicine in the hospitable environment

Introducción: los cambios del contexto de trabajo en los hospitales para los internistas exigen perfeccionar el funcionamiento de sus servicios. Objetivos: identificar problemas que afectan a la especialidad Medicina Interna y los cambios organizativos necesarios para su solución, en un hospital clínico-quirúrgico. Material y Métodos: se realizó investigación cualitativa, basada en la actividad de un grupo nominal que dio salida a tareas propias de la dirección estratégica. Resultados: se definió la misión, visión y líneas estratégicas de trabajo del Servicio de Medicina Interna, se caracterizó el contexto y definieron como problemas en orden de prioridad: Deterioro del método clínico; práctica de una Medicina biologicista; insuficiente disponibilidad de camas; limitaciones en los recursos humanos, materiales y financieros para la máxima calidad de la atención y sobrecarga de los servicios clínicos. Se definieron las fortalezas, debilidades, amenazas y oportunidades. De ellas se derivaron propuestas de acciones ofensivas, adaptativas, defensivas y de supervivencia para lograr un cambio positivo en el trabajo de esta especialidad. Conclusiones: la gestión del capital humano en Medicina Interna implica una estructura colaborativa más eficiente para el hospital, que depare mejor utilización de los internistas como médico generalista e integrador, lo que contribuiría a disminuir las fronteras físicas de las salas y centrar el trabajo en los enfermos.

Introduction: the work context changes of the internists demand to make perfect the functioning of their services. Objectives: identify problems that affect the Internal Medicine and the necessary organizative changes to solve them, at a clinical-surgical hospital. Material and Methods: it was a qualitative research based on the activity of a nominal group that gave vent to own tasks of the strategic direction. Results: the mission, vision and the Internal Medicine service's strategic lines of work were defined; the context was assigned priority to its problems: Deterioration of the clinical method; the practice of a biologist medicine; insufficient availability of beds; Limitations in human, materials and financiers resources for the maximum quality of attention; Overload of the clinical services. It was defined fortresses, weaknesses, threats and opportunities. The offensive, adjustatives, defensives and survival actions to achieve a positive change were derived. Conclusions: the management of the human capital in internal medicine implies a collaborative structure more efficient for the hospital, that better utilization of the internists like generalist and integrative doctor that would contribute to diminish the physical frontiers of the wards and centering the work in the sick persons.

Locally-advanced primary neuroendocrine carcinoma of the breast: case report and review of the literature.

BACKGROUND: Primary neuroendocrine carcinoma of the breast is a heterogeneous group of rare tumors with positive immunoreactivity to neuroendocrine markers in at least 50% of cells. Diagnosis also requires that other primary sites be ruled out and that the same tumor show histological evidence of a breast in situ component. Primary neuroendocrine carcinoma of the breast rarely presents as locally advanced disease and less frequently with such widespread metastatic disease as described herein. The review accompanying this case report is the first to provide an overview of all the cases of primary neuroendocrine carcinoma of the breast published in the literature and encompasses detailed information regarding epidemiology, histogenesis, clinical and histologic diagnosis criteria, classification, surgical and adjuvant treatment, as well as prognosis. We also provide recommendations for common clinical and histologic pitfalls associated with this tumor. CASE PRESENTATION: We describe a case of a 51-year-old Hispanic woman initially diagnosed with locally-advanced invasive ductal carcinoma that did not respond to neoadjuvant treatment. After undergoing modified radical mastectomy the final surgical pathology showed evidence of alveolar-type primary neuroendocrine carcinoma of the breast. The patient was treated with cisplatin/etoposide followed by paclitaxel/carboplatinum. Thirteen months after surgery the patient is alive, but developed pulmonary, bone, and hepatic metastasis. CONCLUSION: The breast in situ component of primary neuroendocrine carcinoma of the breast may prevail on a core biopsy samples increasing the probability of underdiagnosing this tumor preoperatively. Being aware of the existence of this disease allows for timely diagnosis and management. Optimal treatment requires simultaneous consideration of both the neuroendocrine and breast in situ tumor features.

Seroprevalence of antibodies against Salmonella enterica subsp. enterica serovar gallinarum-pullorum in wild doves (Zenaida asiatica and Zenaida macroura) from the northeast of Mexico.

A cross-sectional survey was conducted in order to determine the seroprevalence and to identify some factors associated with the presence of antibodies against Salmonella enterica subsp. enterica serovar Gallinarum-Pullorum in white-winged (Zenaida asiatica) and mourning doves (Zenaida macroura) from hunting areas of Northeast Mexico. From September to October 2006, 201 serum samples were analyzed with the seroagglutination test. The overall seroprevalence of S. enterica subsp. enterica serovar Gallinarum-Pullorum was 26.3%, and was similar for white-winged doves (26.4%) and mourning doves (26.1%), but higher for juveniles (30.8%) and females (34.6%). Seroprevalence was associated with the weight of the doves (prevalence ratio [PR]=1.52, P<0.0001) and the municipality where the doves were hunted (PR=1.31, P<0.0001). This survey study emphasizes the need to conduct similar studies on wild birds to determine the risk of S. enterica subsp. enterica serovar Gallinarum-Pullorum to commercial flocks. In addition, to the best of our knowledge this is the first report of the serological evidence suggesting infection with S. enterica subsp. enterica serovar Gallinarum-Pullorum in wild white-winged and mourning doves.

Morbid obesity impacts mortality in blunt trauma.

Twenty-six per cent of adults in the Unites States are obese and trauma remains a major cause of death. We assessed the impact of morbid obesity on mortality in patients with blunt trauma. We reviewed the records of patients with a body mass index 40 kg/m2 or greater injured by blunt trauma from 1993 to 2003 and compared them with a 4:1 control population with a normal body mass index and matched for sex and constellation of injuries. For comparison, patients were categorized by Injury Severity Score 9 or less or Injury Severity Score 10 or greater. Student t test and chi2 were used for statistical analysis. P < 0.05 was considered significant. One hundred seven morbidly obese patients were identified and compared with 458 control subjects with a normal body mass index and matched for sex and constellation of injuries. Although the morbidly obese patients were found to be significantly younger, those who incurred multiorgan injury experienced a significantly longer hospital length of stay and displayed a greater than fourfold increase in mortality when compared with the control subjects. Furthermore, the number of morbidly obese patients admitted over the 10-year period significantly increased by fourfold (0.4% to 1.5%). Over the last decade, there has been a significant increase in morbidly obese patients cared for in our trauma center. Although these patients were significantly younger with a similar Glasgow Coma Score as that of the control population, morbid obesity significantly increased mortality when the injury from blunt trauma transitioned from a single to a multiorgan injury.

Clinical guideline for diagnosis and management of melioidosis.

Melioidosis is an emerging infection in Brazil and neighbouring South American countries. The wide range of clinical presentations include severe community-acquired pneumonia, septicaemia, central nervous system infection and less severe soft tissue infection. Diagnosis depends heavily on the clinical microbiology laboratory for culture. Burkholderia pseudomallei, the bacterial cause of melioidosis, is easily cultured from blood, sputum and other clinical samples. However, B. pseudomallei can be difficult to identify reliably, and can be confused with closely related bacteria, some of which may be dismissed as insignificant culture contaminants. Serological tests can help to support a diagnosis of melioidosis, but by themselves do not provide a definitive diagnosis. The use of a laboratory discovery pathway can help reduce the risk of missing atypical B. pseudomallei isolates. Recommended antibiotic treatment for severe infection is either intravenous Ceftazidime or Meropenem for several weeks, followed by up to 20 weeks oral treatment with a combination of trimethoprim-sulphamethoxazole and doxycycline. Consistent use of diagnostic microbiology to confirm the diagnosis, and rigorous treatment of severe infection with the correct antibiotics in two stages; acute and eradication, will contribute to a reduction in mortality from melioidosis.

Clinical guideline for diagnosis and management of melioidosis

Melioidose é uma infecção emergente no Brasil e em países vizinhos da América do Sul. O amplo espectro de apresentação clínica inclui pneumonia adquirida na comunidade, septicemia, infecção do sistema nervoso central e infecção de partes moles de menor severidade. O diagnóstico depende essencialmente da identificação microbiológica. Burkholderia pseudomallei, a causa bacteriana da melioidose, é facilmente cultivada em sangue, escarro e em outras amostras clínicas. Entretanto, B. pseudomallei pode ser difícil de identificar com segurança e também ser confundido com outras bactérias Gram negativas. Os exames sorológicos podem dar suporte a um diagnóstico de melioidose, mas não fornece um diagnóstico definitivo por si só. A realização de investigação laboratorial seqüenciada pode ajudar a reduzir o risco de não reconhecer isolados incomuns de B. pseudomallei. O tratamento antibiótico recomendado para infecção severa é Ceftazidima ou Meropenem endovenosos por várias semanas, seguido por um tratamento oral com uma combinação de Sulfametoxazol-Trimetopim e Doxiciclina por até 20 semanas. O uso consistente do diagnóstico microbiológico e o tratamento rigoroso da infecção severa com antibióticos adequados nas duas etapas, aguda e de erradicação, contribuirão para a redução da mortalidade por melioidose.

Selective management of blunt hepatic injuries including nonoperative management is a safe and effective strategy.

BACKGROUND: The justification and preference for operative versus nonoperative management of hepatic injuries caused by blunt trauma remains ambiguous. This review assesses the outcome of operative and nonoperative management of liver injury after blunt trauma. METHODS: We retrospectively reviewed the demographics, severity of injury, severity of liver injury, associated concomitant injuries, management scheme, and outcome of patients with documented hepatic injury from 1993 to 2003. RESULTS: The overall mortality rate was 9.4%, with 3.7% caused by the liver injury itself. Fifty-nine percent (330 of 561) of liver injuries were of low severity (grades I and II), with an overall mortality rate of 6.6% caused by concomitant injuries and liver-related mortality of 0%. Forty-one percent (231 of 561) of liver injuries were high-severity injuries (grades III, IV, and V). Mortality for nonoperative management of high-severity liver injuries was 2.2%. If operative intervention was required because of hemodynamic instability or concomitant injuries then the mortality rate was significantly higher at 30%. Forty-two of the 378 (11%) liver injuries treated nonoperatively required an adjunctive procedure for successful management. CONCLUSIONS: Selective management of liver injuries presented a low liver-related mortality rate. Low-grade injuries can be managed nonoperatively with excellent results. High-grade injuries can be managed nonoperatively, if operative intervention is not required for hemodynamic instability or associated injuries, with a low mortality. In these patients, adjunctive procedures will be required selectively for successful nonoperative management of high-grade liver injuries. High-grade injuries requiring operative management because of hemodynamic instability or concomitant injuries continue to have significantly higher mortality.

Profitable versus unprofitable expansion of trauma and critical care surgery.

BACKGROUND: The American Association for the Surgery of Trauma has proposed that the specialty of trauma and critical care include emergency surgery. We assessed whether this change will have an impact on the financial challenges that this specialty confronts, including inadequate reimbursement for efforts exerted. METHODS: Over a 2-year period, we collected financial data on 6 trauma and critical care surgeons. Three included emergency surgery as part of their practice, but no private elective component. The other 3 included both emergency surgery and a private elective component. RESULTS: Trauma and critical care surgeons who had included emergency surgery but no private elective component had significantly lower charges (5,941,482 US dollars vs 9,209,535 US dollars), collections (1,439,913 US dollars vs 2,973,319 US dollars), generated relative value units (50,440 vs 80,327), generated reimbursement per relative value units (28.55 US dollars vs 37.02 US dollars), and margins (0.20 US dollars vs 1.48 US dollars) than their counterparts who had an elective surgery component. CONCLUSION: The addition of emergency surgery did not improve the financial viability of trauma and critical care as a specialty. Without significant hospital or governmental financial support, the only viable financial option is to develop a substantial private practice that cross-subsidizes the practice of trauma and critical care. The appropriate professional bodies should incorporate changes in work processes that will allow the specialty to survive professionally but also financially.