Juvenile stress causes reduced locomotor behavior and dendritic spine density in the prefrontal cortex and basolateral amygdala in Sprague-Dawley rats.

Little has been investigated about the effects of stress on synaptic communication at prepubertal age, a stage considered as juvenile. This period of development is related to socialization through play. Our group has studied the changes of neuronal morphology in limbic structures caused by stress at prenatal and at early postnatal ages (before weaning) in the rat. In the present study, we assessed the effect of restraint stress at juvenile ages. Male Sprague-Dawley rats from postnatal day (PD) 21 to PD35 were restrained (from movement) for 2 hrs. Locomotor activity in a novel environment was evaluated at three different ages, prepubertal PD38, pubertal PD50, and postpubertal PD68. Using the Golgi-Cox procedure, the dendritic morphology was evaluated in the pyramidal neurons of the prefrontal cortex (PFC), hippocampus, and basolateral amygdala (BLA). Juvenile stress caused a reduced locomotor activity at PD38 and PD68 together with reduction in dendritic spines after puberty in the PFC and at all the studied ages in the BLA. In addition, dendritic length was also reduced in the PFC at PD38 and PD68 and CA1 of the ventral hippocampus at PD50 and PD68. Our results suggest that stress in the juvenile stage can cause changes at the level of behavior and synaptic communication with an effect that remains until adulthood.

Clinical outcomes in patients with atrial fibrillation treated with DOACs in a specialized anticoagulation center: Critical appraisal of real-world data.

AIMS: Direct oral anticoagulants (DOAC) are progressively replacing vitamin K antagonists in the prevention of thromboembolism in patients with atrial fibrillation. However, their real-world clinical outcomes appear to be contradictory, with some studies reporting fewer and others reporting higher complications than the pivotal randomized controlled trials. We present the results of a clinical model for the management of DOACs in real clinical practice and provide a review of the literature. METHODS: The MACACOD project is an ongoing, observational, prospective, single-center study with unselected patients that focuses on rigorous DOAC selection, an educational visit, laboratory measurements, and strict follow-up. RESULTS: A total of 1,259 patients were included. The composite incidence of major complications was 4.93% py in the whole cohort vs 4.49% py in the edoxaban cohort. The rate of all-cause mortality was 6.11% py for all DOACs vs 5.12% py for edoxaban. There weren't differences across sex or between Edoxaban reduced or standard doses. However, there were differences across ages, with a higher incidence of major bleeding complications in patients >85 years (5.13% py vs 1.69% py in <75 years). CONCLUSIONS: We observed an incidence of serious complications of 4.93% py, in which severe bleeding predominated (3.65% py). Considering our results, more specialized attention seems necessary to reduce the incidence of severe complications and also a more critical view of the literature. Considering our results, and our indirect comparison with many real-world studies, more specialized attention seems necessary to reduce the incidence of severe complications in AF patients receiving DOACs.

Activity and safety of topical pimecrolimus in patients with early stage mycosis fungoides (PimTo-MF): a single-arm, multicentre, phase 2 trial.

BACKGROUND: The calcineurin pathway is often activated in mycosis fungoides. We aimed to assess the activity and safety of topical pimecrolimus, a calcineurin inhibitor, in patients with early mycosis fungoides. METHODS: PimTo-MF was a single-arm, multicentre, phase 2 trial done at six medical centres in Spain. Patients (aged ≥18 years) had histologically confirmed early mycosis fungoides (stages IA-IIA) and an Eastern Cooperative Oncology Group performance status of 0-1. Key exclusion criteria included the use of concurrent treatments for mycosis fungoides, including sunbathing, topical or systemic corticosteroids, and other calcineurin inhibitors. Patients applied topical pimecrolimus 1% cream on their skin lesions twice daily for 16 weeks (1 g per 2% of body surface), with subsequent follow-up of 12 months. Dosage modifications were not allowed. To evaluate adherence to the treatment, patients were instructed to return all empty tubes to the hospital (as per drug accountability protocols). The primary endpoint was the overall response ratein the intention-to-treat population. PimTo-MF is registered with EudraCT, 2014-001377-14, and is complete. FINDINGS: Between March 1, 2015, and Sept 30, 2016, 39 patients were enrolled. All patients were assessable, with a median age of 51·5 years (IQR 45-62), and the population was predominantly male (24 male [62%], 15 female [38%]). Median follow-up after baseline was 5·7 years (IQR 5·7-6·2). 22 (56%) of 39 patients had an overall response (one complete response, 21 partial responses). Responses were observed across IA (14 [54%] of 26 patients) and IB (eight [73%] of 11 patients) clinical stages, but not IIA. Topical pimecrolimus was well tolerated and no patient required a dose reduction or discontinued treatment because of unacceptable drug-related toxicity. No patients were lost to follow-up or discontinued treatment. 13 (33%) of 39 patients reported adverse events; transitory mild burning or pruritus (grade 1) was the most common, seen in eight (21%) patients. In three (8%) of these patients, the burning or pruritus was considered related to treatment. No grade 4 or 5 adverse events were observed. INTERPRETATION: Pimecrolimus 1% cream seems active and safe in patients with early stage mycosis fungoides. Our findings should be taken with caution until long-term follow-up data are obtained that confirm the safety of this treatment. Further controlled clinical trials are warranted to confirm these results. FUNDING: Instituto de Salud Carlos III and the European Regional Development Fund. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

A Replicable and Reproducible Digital Method for Quantifying Maxillary Sinus Airway Changes after Sinus Lifts Using the Lateral Window Approach Technique-A Retrospective Study.

In the present retrospective study, we aimed to assess the replicability and reproducibility of a novel digital measurement technique for analyzing the volumes of the left and right maxillary sinuses and the nasal and maxillary sinus airway complex after a sinus lift procedure using the lateral window approach, to provide an accurate measurement technique for easily applying in clinical practice and to allow pre-operative assessment of maxillary sinus lift surgery, avoiding complications and making surgery more predictable. MATERIAL AND METHODS: Thirty patients with partially edentulous posterior maxilla were selected and submitted to bilateral sinus lift using the lateral window approach technique, with grafting materials selected and submitted to cone beam computed tomography (CBCT) scans, both pre- and postoperatively. Then, datasets were uploaded to therapeutic digital planning software to measure the volume of the right and left maxillary sinuses and the nasal and maxillary sinus airway complex. Gage R&R statistical analysis was performed to assess the replicability and reproducibility of the digital measurement technique. RESULTS: The variability attributable to the novel digital measurement technique was 3.4% for replicability and 3.4% for reproducibility of the total variability of the samples. CONCLUSION: The novel digital method proposed is a replicable and reproducible technique for analyzing the volume of the right and left maxillary sinuses and the nasal and maxillary sinus airway complex after a sinus lift using the lateral window approach technique, allowing an accurate pre-operative assessment of maxillary sinus lift surgery, avoiding complications and making surgery more predictable.

[Liaison geriatrics with nursing homes in COVID time. A new coordination model arrived to stay]. / La Geriatría de Enlace con residencias en la época de la COVID-19. Un nuevo modelo de coordinación que ha llegado para quedarse.

Older people living in nursing homes fulfil the criteria to be considered as geriatric patients, but they often do not have met their health care needs. Current deficits appeared as a result of COVID-19 pandemic. The need to improve the coordination between hospitals and nursing homes emerged, and in Madrid it materialized with the implantation of Liaison Geriatrics teams or units at public hospitals. The Sociedad Española de Geriatría y Gerontología has defined the role of the geriatricians in the COVID-19 pandemic and they have given guidelines about prevention, early detection, isolation and sectorization, training, care homes classification, patient referral coordination, and the role of the different care settings, among others. These units and teams also must undertake other care activities that have a shortfall currently, like nursing homes-hospital coordination, geriatricians visits to the homes, telemedicine sessions, geriatric assessment in emergency rooms, and primary care and public health services coordination. This paper describes the concept of Liaison Geriatrics and its implementation at the Autonomous Community of Madrid hospitals as a result of COVID-19 pandemic. Activity data from a unit at a hospital with a huge number of nursing homes in its catchment area are reported. The objective is to understand the need of this activity in order to avoid the current fragmentation of care between hospitals and nursing homes. This activity should be consolidated in the future.

[Evolution of COVID-19 at nursing homes from the second wave to vaccination. Description of a coordination program between Primary Care, Geriatrics and Public Health.] / Evolución de la COVID-19 en las residencias de personas mayores desde la segunda ola hasta la vacunación. Descripción de un programa de coordinación entre Atención Primaria, Geriatría y Salud Pública.

OBJECTIVE: Nursing homes have suffered in a particularly pronounced way from the effects of COVID-19 so it is very convenient to know the evolution in them of the disease and the impact of SARS-CoV2 vaccination The objective of this study was to analyze COVID-19 pandemic evolution from the start of the second wave to the end of the vaccination campaign at the nursing homes. A coordination program between Primary Care and Geriatrics and Public Health services was activated. METHODS: 2,668 seniors were followed at 39 nursing homes. Data from new cases, active cases, mortality and place of treatment of COVID-19 were collected. A descriptive analysis was performed with the measurement of the absolute number of positive SARS-CoV-2 cases and the frequency distribution. RESULTS: Between August 7th 2020 and February 26th 2021, 30 outbreaks occurred at 21 nursing homes. 300 people tested positive for SARS-CoV-2 (11% of total residents). The daily average of active cases was 27,166 were hospitalized (55%). 66 patients died (22% of those infected), 54 of them (78%) at the hospital. 1,984 PCR tests were performed. The temporary profile of new cases did not follow a distribution "in waves" as in the community. Thirty-seven days after the start of the second dose of vaccination, there were no active cases until March 1st, when new cases were under study for possible vaccine leakage. CONCLUSIONS: The incidence of COVID-19 at nursing homes after the first wave of the pandemic has apparently been lower. The transmission in these centers has followed a different distribution than at community. Mass vaccination has achieved the practical disappearance of the disease.

OBJETIVO: Los centros residenciales han sufrido de una manera especialmente acusada los efectos de la COVID-19 por lo que es muy conveniente conocer la evolución en ellos de la enfermedad y el impacto de la vacunación frente al SARS-CoV2. El objetivo de este estudio fue conocer la evolución de la pandemia de COVID-19 desde el comienzo de la segunda ola hasta el final del proceso de vacunación en las residencias de personas mayores de un área sanitaria, en la cual se activó un programa de coordinación entre Atención Primaria y los servicios de Geriatría y Salud Publica. METODOS: Se siguió a 2.668 personas mayores en 39 residencias. Se recogieron datos de casos nuevos, activos, fallecidos y lugar de tratamiento de la COVID-19. Se realizó un análisis descriptivo con la medición del número absoluto de casos positivo de SARS-CoV-2 y la distribución de frecuencias. RESULTADOS: Entre el 7 de agosto de 2020 y el 26 de febrero de 2021 se produjeron 30 brotes en 21 residencias. Se detectaron 300 casos positivos de SARS-CoV-2 (11% de los residentes totales). La media diaria de casos activos fue 27. Fueron hospitalizados 166 (55%). Fallecieron 66 pacientes (22% de los infectados), 54 de ellos (78%) en el hospital. Se realizaron 1.984 test PCR. El perfil temporal de aparición de casos nuevos no siguió una distribución "en olas" como en la comunidad. Treinta y siete días después del inicio de la segunda dosis de vacunación, no existieron casos activos hasta el 1 de marzo en que aparecieron nuevos casos en estudio por posible escape vacunal. CONCLUSIONES: La incidencia de la COVID-19 en las residencias de personas mayores tras la primera ola de la pandemia es aparentemente inferior. La transmisión en estos centros sigue una distribución diferente a la de la comunidad. El efecto de la vacunación masiva consigue la práctica desaparición de la enfermedad.

Helminth Egg Automatic Detector (HEAD): Improvements in development for digital identification and quantification of Helminth eggs and its application online.

Conventional analytical techniques for evaluating Helminth eggs are based on different steps to concentrate them in a pellet for direct observation and quantification under a light microscope, which can generate under-counts or over-counts and be time consuming. To enhance this process, a new approach via automatic identification was implemented in which various image processing detectors were developed and incorporated into a Helminth Egg Automatic Detector (HEAD) system. This allowed the identification and quantification of pathogenic eggs of global medical importance. More than 2.6 billion people are currently affected and infected, and this results in approximately 80,000 child deaths each year. As a result, since 1980 the World Health Organization (WHO) has implemented guidelines, regulations and criteria for the control of the health risk. After the initial release of the analytical technique, two improvements were developed in the detector: first, a texture verification process that reduced the number of false positive results; and second, the establishment of the optimal thresholds for each species. In addition, the software was made available on a free platform. After performing an internal statistical verification of the system, testing with internationally recognized parasitology laboratories was carried out, Subsequently, the HEAD System is capable of identifying and quantifying different species of Helminth eggs in different environmental samples: wastewater, sludge, biosolids, excreta and soil, with in-service sensitivity and specificity values for the open library for machine learning TensorFlow (TF) model of 96.82% and 97.96% respectively. The current iteration uses AutoML Vision (a computer platform for the automatization of machine learning models, making it easier to train, optimize and export results to cloud applications or devices). It represents a useful and cheap tool that could be utilized by environmental monitoring facilities and laboratories around the world.•The HEAD Software will significantly reduce the costs associated with the detection and quantification of helminth eggs to a high level of accuracy.•It represents a tool, not only for microbiologists and researchers, but also for various agencies involved in sanitation, such as environmental regulation agencies, which currently require highly trained technicians.•The simplicity of the device contributes to the control the contamination of water, soil, and crops, even in poor and isolated communities.

Aberrant immunophenotypes in acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) is the most prevalent hematologic neoplasia worldwide. To classify leukemia, we analyzed the immunophenotypic characteristics in the neoplastic cells obtained with antibodies by cell flow cytometry or immunohistochemistry. The aberrant immunophenotypes are antigen expression patterns that differ from the normal hematopoietic maturation process, which can include some different lineage antigens such as myeloid antigens in ALL or asynchronous expression of antigens. These aberrant immunophenotypes have been studied as prognostic factors and residual disease markers. In this review, some aspects of aberrant immunophenotypes are addressed, including definition, epidemiology, and potential uses.

La leucemia linfoblástica aguda es la neoplasia hematológica más prevalente en el mundo. Para clasificar la leucemia se utilizan características inmunofenotípicas en las células neoplásicas que se pueden observar con anticuerpos en la citometría de flujo o mediante inmunohistoquímica. Los inmunofenotipos aberrantes son los patrones de expresión de los antígenos que difieren del proceso normal de maduración hematopoyética, y pueden incluir antígenos de linajes diferentes, como antígenos mieloides en la leucemia linfoblástica aguda, o la expresión asincrónica de antígenos. Estos inmunofenotipos aberrantes se han estudiado como factores de pronóstico y como marcadores de enfermedad mínima residual. En esta revisión se abordan algunos aspectos de los inmunofenotipos aberrantes, incluyendo su definición, epidemiología y usos potenciales.

Determination of acidic pharmaceuticals and potential endocrine disrupting compounds in wastewaters and spring waters by selective elution and analysis by gas chromatography-mass spectrometry.

Although the trend in development of analytical methods for emerging contaminants is towards reduced sample preparation and increased detector selectivity, there are still benefits from removal of matrix material during sample preparation. This paper describes a simple method for acidic pharmaceuticals and a range of potential endocrine disrupting compounds in untreated wastewaters and spring waters. It is based on separation of the two classes during elution from the extraction cartridge with final analysis by gas chromatography-mass spectrometry. 3,4-D was used as the recovery standard for the acids while 4-n-nonylphenol and [2H4]estrone were used for the endocrine disrupters; mean recoveries varied between 89% and 111%. The method was also extensively validated by fortification with the target compounds. Recoveries of acids were from 68% to 97% with relative standard deviations generally less than 10% and recoveries of endocrine disrupters were 68-109% with relative standard deviations less than 20%. Detection limits varied from 0.005 to 1 ng/L in spring water, and from 0.5 to 100 ng/L in untreated wastewater. Concentrations of the analytes in the wastewater ranged from 0.018 to 22.4 microg/L. Values were comparable to reported data, although concentrations were generally relatively high, probably because of a lack of treatment. Triclosan, phthalates, estrone, 17beta-estradiol, ibuprofen, and naproxen were present in the spring water from aquifers recharged indirectly with this wastewater after its use for irrigation; concentrations ranged from 0.01 to 25.0 ng/L. The much lower concentrations compared to wastewater indicate effective removal processes on passage through the soil and subsoil.

[Do nurses utilize the scientific method?]. / Utilizan las enfermeras el método científico?

The authors wanted to discover the utilization of the Process of Nursing Attention and the NANDA Diagnoses, as well as the main reasons why these methods are or are not put to use. The authors conclude that the non-use of these methods is due to their difficult and complicated language.

Aberrant immunophenotypes in acute lymphoblastic leukemia / Inmunofenotipos aberrantes en la leucemia linfoblástica aguda

Abstract Acute lymphoblastic leukemia (ALL) is the most prevalent hematologic neoplasia worldwide. To classify leukemia, we analyzed the immunophenotypic characteristics in the neoplastic cells obtained with antibodies by cell flow cytometry or immunohistochemistry. The aberrant immunophenotypes are antigen expression patterns that differ from the normal hematopoietic maturation process, which can include some different lineage antigens such as myeloid antigens in ALL or asynchronous expression of antigens. These aberrant immunophenotypes have been studied as prognostic factors and residual disease markers. In this review, some aspects of aberrant immunophenotypes are addressed, including definition, epidemiology, and potential uses.

Resumen La leucemia linfoblástica aguda es la neoplasia hematológica más prevalente en el mundo. Para clasificar la leucemia se utilizan características inmunofenotípicas en las células neoplásicas que se pueden observar con anticuerpos en la citometría de flujo o mediante inmunohistoquímica. Los inmunofenotipos aberrantes son los patrones de expresión de los antígenos que difieren del proceso normal de maduración hematopoyética, y pueden incluir antígenos de linajes diferentes, como antígenos mieloides en la leucemia linfoblástica aguda, o la expresión asincrónica de antígenos. Estos inmunofenotipos aberrantes se han estudiado como factores de pronóstico y como marcadores de enfermedad mínima residual. En esta revisión se abordan algunos aspectos de los inmunofenotipos aberrantes, incluyendo su definición, epidemiología y usos potenciales.

Influenza Vaccine Coverage among Pregnant Women in a Public Hospital System during the 2009-2010 Pandemic Influenza Season.

The purpose of this study was to compare influenza vaccination rates of pregnant women in a public safety-net health system to national coverage rates during the 2009-2010 pandemic influenza season. A chart review of a random sample of deliveries was undertaken to determine rates of coverage and predictors of vaccine coverage of women who obtained prenatal care and delivered in our health system. Rates were calculated from deliveries from when the vaccine was first available through April 30, 2010. Coverage rates were 54% for the seasonal influenza vaccine and 51% for the H1N1 vaccine. Race/ethnicity, insurance status and language spoken did not predict the receipt of either vaccine. When we included only births which occurred through March 12, 2010, as was done in a large population-based study, the rates were 61% and 59%, respectively. Our rates are about 10% higher than the rates reported in that study. Our comprehensive strategy for promoting vaccine coverage achieved higher vaccination rates in a safety-net health system, which serves groups historically less likely to be vaccinated, than those reported for the pregnant population at large.

The removal of microorganisms and organic micropollutants from wastewater during infiltration to aquifers after irrigation of farmland in the Tula Valley, Mexico.

The Tula Valley receives untreated wastewater from Mexico City for agricultural irrigation, half of which infiltrates to aquifers from where drinking water is extracted. Samples of wastewater and infiltrated water from three areas of the valley were analyzed for microorganisms, organic micropollutants, and some basic parameters. Concentrations of microorganisms in the infiltrated water were generally very low but the incidence of fecal coliforms (present in 68% of samples), somatic bacteriophages (36%), Giardia spp. (14%), and helminth eggs (8%) suggested a health risk. Organic micropollutants, often present at high concentrations in the wastewater, were generally absent from the infiltrated water except carbamazepine which was in 55% of samples (up to 193 ng/L). There was no correlation between carbamazepine concentrations and the presence of microorganisms but highest concentrations of carbamazepine and boron coincided. A treatment such as nanofiltration would be necessary for the infiltrated water to be a safe potable supply.

Ultrasound-assisted emulsification-microextraction of fragrance allergens in water.

A method based on ultrasound-assisted emulsification-microextraction (USAEME) and gas chromatography-mass spectrometry (GC-MS) has been developed for the analysis of regulated fragrance allergens in water. Extraction conditions such as the type of solvent, extraction temperature, irradiation time, and salting-out effect were optimized using a multivariate approach. Compounds were extracted during 2 min in an acoustically emulsified media formed by 100 µL chloroform and 10 mL sample. The USAEME process provided an efficient and exhaustive extraction (enrichment factor ∼100) and, after centrifugation, the extract was ready for GC analysis. Validation was performed using spiked ultrapure water as well as other most complex matrices such as sewage water. Recoveries between 75% and 110% were generally obtained, and precision was characterized by RSD values <10% in most cases. The limits of detection (LODs) were at the sub-nanogram per millilitre level. The proposed procedure was applied to the determination of allergens in several real samples including tap water, baby bathwater, recreational place water, public washing place water, and sewage water. The presence of some of the target compounds was confirmed in all the samples excluding tap water, demonstrating the ubiquity of this group of cosmetic and personal care products ingredients.

The analysis of a group of acidic pharmaceuticals, carbamazepine, and potential endocrine disrupting compounds in wastewater irrigated soils by gas chromatography-mass spectrometry.

The analysis of pharmaceuticals and potential endocrine disruptors in the environment has rightly concentrated on their presence in wastewaters and possible contamination of receiving bodies, such as groundwaters. However, wastewater is increasingly being reused for irrigation and in order to fully understand the environmental fate of these compounds, reliable methods for their analysis in soil are required, of which there are relatively few available. This article reports a method for a range of acidic pharmaceuticals, carbamazepine, and endocrine disrupting compounds in soils with final analysis by gas chromatography-mass spectrometry. Two soil types (Phaeozom and Leptosol) and three fortification levels were used to validate the method. Recoveries of acidic pharmaceuticals varied between 62 and 102%, carbamazepine from 75 to 118%, and potential endocrine disruptors between 54 and 109%; most recoveries were between 75 and 95% and relative standard deviations were generally less than 10%. Detection limits were between 0.25 and 2.5 ng/g except for phthalates and 4-nonylphenols (25 ng/g). The method was used to analyze soils where untreated wastewaters have been used to irrigate crops for approximately 90 years. Concentrations of acidic pharmaceuticals in the soil were <1 ng/g and potential endocrine disruptors varied from below the limit of detection (estrone, 17beta-estradiol, and 17alpha-ethinylestradiol) to 2079 ng/L (bis-diethylhexyl phthalate). This data indicated that despite the continuous application of the contaminants over many years, concentrations were generally lower than those expected to be contributed by a single irrigation event. Only carbamazepine, at concentrations of 6.48 ng/g (in Phaeozem) and 5.14 ng/g (in Leptosol), showed any evidence of persistence in the soils analyzed.

The effects of temperature, pH, and ammonia concentration on the inactivation of Ascaris eggs in sewage sludge.

The reported inactivation of Ascaris eggs during alkaline sludge stabilization is highly variable. The objective of our research was to better understand the sources of this variability by quantifying the effects of temperature, pH, and ammonia concentration on the inactivation of indigenous Ascaris eggs in wastewater sludge. Primary sludge was supplemented with ammonia (0, 1000, and 5000 mg/l NH(3)-N) and Ca(OH)(2) and incubated in sealed bottles across the range of temperatures (20, 30, 40, and 50 degrees C) and pH (7 and 12) that may be encountered during treatment. Changes in egg viability over time were fit to a two-parameter kinetic model (shoulder and first-order region); to compare treatment conditions, the time for 99% inactivation (t(99)) was also calculated. Each 10 degrees C increase in temperature caused a significant decrease in t(99) at every pH and ammonia concentration tested. At 50 degrees C, the effect of temperature was dominant, such that no effect of pH or ammonia was observed. At 30 and 40 degrees C, raising the pH from 7 to 12 decreased t(99), but at 20 degrees C no pH effect was seen over 80 d (very little inactivation occurred). At 20, 30, and 40 degrees C, the addition of ammonia dramatically decreased t(99). The effect of pH could not be completely separated from that of ammonia, as the unamended sludge samples contained 100-200mg/l indigenous ammonia. Because temperature, pH, and ammonia all contributed to Ascaris egg inactivation, it is essential that these parameters are measured and accounted for when assessing the effectiveness of alkaline stabilization. Furthermore, inactivation by ammonia could be exploited to improve the effectiveness of alkaline sludge stabilization.

Reacción leucemoide monocítica asociada a tuberculosis ganglionar / Monocytic leukemoid reaction associated to tuberculosis lymphadenitis

En la reacción leucemoide (RL) un aumento importante en la cantidad de leucocitos, así como la presencia de células inmaduras en la sangre periférica, obligan al médico a descartar una leucemia aguda o crónica. Las RL pueden ser linfocíticas, granulocíticas, eosinofilicas y monocíticas, siendo estas últimas las más raras. Se informa el caso de una paciente de 64 años de edad con combe, PPD y anticuerpos antituberculosis positivos, así como leucocitosis y monocitosis persistente y linfadenitis granulomatosa en el reporte histopatológico de dos biopsias ganglionares, por lo que se concluye en una RL monocítica asociada a tuberculosis ganglionar, máxime que las alteraciones hematológicas y las adenomegalias desaparecieron con el tratamiento antifimico

Trombocitemia esencial infantil / Essential thrombocythemia in children

Introducción. La trombocitemia esencial (TE) es un síndrome mieloproliferativo poco frecuente caracterizado por una elevación importante de la cuenta plaquetaria, un incremento moderado de los leucocitos y anemia. Caso clínico. Escolar femenino de once años de edad con un cuadro de 45 días de evolución con cefalea, vómito, lipotimias y pérdida de peso. Diez días antes de su ingreso se agregó fiebre y dolor en hipocondrio derecho. A la exploración física: palidez y esplenomegalia. Por laboratorio trombocitosis persistente; el resto de exámenes incluyendo el cariotipo de la médula ósea, normales o negativos. Conclusiones. La TE es un diagnóstico al que se llega por exclusión. Se presenta la manera en que se llegó a este diagnóstico en nuestra paciente siendo este caso de TE infantil el primero reportado en México