Association of high-grade prostatic intraepithelial neoplasia immunohistochemical profile with acinar adenocarcinoma of the prostate.

BACKGROUND: Prostate carcinoma is the second leading cause of cancer and the fifth cause of cancer death in men worldwide. OBJECTIVE: To know high-grade prostatic intraepithelial neoplasia and prostate acinar adenocarcinoma immunohistochemical profiles. MATERIAL AND METHODS: Observational, analytical, cross-sectional, retrospective study of specimens obtained by cutting needle biopsy and prostate resection from subjects diagnosed with acinar adenocarcinoma of the prostate and high-grade prostatic intraepithelial neoplasia between January 2015 and December 2020. Tissue microarrays were performed and, subsequently, immunohistochemical studies for BCL2, EGFR, p53, Her2/neu and Ki67. Descriptive statistics were used to analyze clinicopathological factors. Qualitative variables were compared with Fisher's exact test. RESULTS: Twenty-three patients were studied; eight (34%) with angiolymphatic invasion, 14 (60.8%) with perineural invasion, five (21.2%) with prostatitis, and four (17.3%) with fibroadenomatous hyperplasia. HER2/neu (p = 0.1023), p53 (p = 1) and BCL2 expression (p = 0.4136) was observed. CONCLUSION: HER2/neu increased expression was identified in high-grade prostatic intraepithelial neoplasia and acinar adenocarcinoma of the prostate.

ANTECEDENTES: En el mundo, el carcinoma de próstata constituye la segunda causa de cáncer y la quinta causa de muerte por cáncer en hombres. OBJETIVO: Conocer el perfil inmunohistoquímico de la neoplasia intraepitelial prostática de alto grado y del adenocarcinoma acinar de próstata. MATERIAL Y MÉTODOS: Estudio observacional, analítico, transversal y retrospectivo de especímenes obtenidos por biopsia con aguja cortante y resección de próstata debido a diagnóstico de adenocarcinoma acinar de próstata y neoplasia intraepitelial de alto grado, entre enero de 2015 y diciembre de 2020. Se realizaron microarreglos tisulares y, posteriormente, estudios de inmunohistoquímica para BCL2, EGFR, p53, Her2/neu y Ki67. Se realizó estadística descriptiva para analizar los factores clinicopatológicos; las variables cualitativas se compararon con prueba exacta de Fisher. RESULTADOS: Se estudiaron 23 pacientes, ocho (34 %) con invasión angiolinfática, 14 (60.8 %) con invasión perineural, cinco (21.2 %) con prostatitis y cuatro (17.3 %) con hiperplasia fibroadenomatosa. Se observó expresión de HER2/neu (p = 0.1023), p53 (p = 1) y BCL2 (p = 0.4136). CONCLUSIÓN: Se identificó mayor expresión de HER2/neu en la neoplasia intraepitelial prostática de alto grado y el adenocarcinoma acinar de próstata.

[Association of high-grade prostatic intraepithelial neoplasia immunohistochemical profile with acinar adenocarcinoma of the prostate]. / Asociación entre el perfil inmunohistoquímico de la neoplasia intraepitelial de alto grado y del adenocarcinoma acinar de próstata.

Background: Prostate carcinoma is the second leading cause of cancer and the fifth cause of cancer death in men worldwide. Objective: To know high-grade prostatic intraepithelial neoplasia and prostate acinar adenocarcinoma immunohistochemical profiles. Material and methods: Observational, analytical, cross-sectional, retrospective study of specimens obtained by cutting needle biopsy and prostate resection from subjects diagnosed with acinar adenocarcinoma of the prostate and high-grade prostatic intraepithelial neoplasia between January 2015 and December 2020. Tissue microarrays were performed and, subsequently, immunohistochemical studies for BCL2, EGFR, p53, Her2/neu and Ki67. Descriptive statistics were used to analyze clinicopathological factors. Qualitative variables were compared with Fisher's exact test. Results: Twenty-three patients were studied; eight (34%) with angiolymphatic invasion, 14 (60.8%) with perineural invasion, five (21.2%) with prostatitis, and four (17.3%) with fibroadenomatous hyperplasia. HER2/neu (p = 0.1023), p53 (p = 1) and BCL2 expression (p = 0.4136) was observed. Conclusion: HER2/neu increased expression was identified in high-grade prostatic intraepithelial neoplasia and acinar adenocarcinoma of the prostate.

Antecedentes: En el mundo, el carcinoma de próstata constituye la segunda causa de cáncer y la quinta causa de muerte por cáncer en hombres. Objetivo: Conocer el perfil inmunohistoquímico de la neoplasia intraepitelial prostática de alto grado y del adenocarcinoma acinar de próstata. Material y métodos: Estudio observacional, analítico, transversal y retrospectivo de especímenes obtenidos por biopsia con aguja cortante y resección de próstata debido a diagnóstico de adenocarcinoma acinar de próstata y neoplasia intraepitelial de alto grado, entre enero de 2015 y diciembre de 2020. Se realizaron microarreglos tisulares y, posteriormente, estudios de inmunohistoquímica para BCL2, EGFR, p53, Her2/neu y Ki67. Se realizó estadística descriptiva para analizar los factores clinicopatológicos; las variables cualitativas se compararon con prueba exacta de Fisher. Resultados: Se estudiaron 23 pacientes, ocho (34 %) con invasión angiolinfática, 14 (60.8 %) con invasión perineural, cinco (21.2 %) con prostatitis y cuatro (17.3 %) con hiperplasia fibroadenomatosa. Se observó expresión de HER2/neu (p = 0.1023), p53 (p = 1) y BCL2 (p = 0.4136). Conclusión: Se identificó mayor expresión de HER2/neu en la neoplasia intraepitelial prostática de alto grado y el adenocarcinoma acinar de próstata.

Cervicovaginal and rectal colonization by group B Streptococci in Mexican women with full-term pregnancies.

BACKGROUND: A pregnant woman rectally or vaginally colonized by group B Streptococcus can infect her newborn. PATIENTS AND METHODS: Prospective, cross-sectional, analytical 24-month study in pregnant women. Women in labor with ≥ 36 weeks of gestation were included. Pregnancy was classified as normal or high-risk. Main risk factors of the pregnant women were analyzed. Rectal and vaginal samples were obtained, placed in Todd-Hewitt broth and subsequently inoculated in 5% sheep blood agar. Identification was carried out by biochemical tests and latex agglutination. RESULTS: 3,347 pregnant women were included. Mean age was 25.6 ± 5.3 years, 95.5% received antenatal care; 2,213 (66%) had normal-risk pregnancies, and in 1,370 (41%), delivery was by cesarean section. Overall colonization was 4.3% (145/3,347), and it was higher in the 30-34 years age group (6.8%). Serotype I (58%) was the most common. CONCLUSION: The percentage of colonization in this population was low. A routine cervicovaginal and rectal culture program in pregnant women and the intrapartum antimicrobial prophylaxis program are controversial in our region.

ANTECEDENTES: Una mujer embarazada colonizada por estreptococo del grupo B por vía rectal o vaginal puede infectar a su recién nacido. PACIENTES Y MÉTODOS: Estudio prospectivo, transversal y analítico, durante 24 meses, en embarazadas. Se incluyeron aquellas en trabajo de parto con ≥ 36 semanas de gestación. El embarazo se clasificó como normal o de alto riesgo. Se analizaron los principales factores de riesgo de las embarazadas. Se tomaron muestras rectales y vaginales, se colocaron en caldo Todd-Hewitt y posteriormente se inocularon en agar sangre de carnero al 5%. La identificación se realizó mediante pruebas bioquímicas y aglutinación con látex. RESULTADOS: Se incluyeron 3,347 embarazadas, edad media 25.6 ± 5.3 años, 95.5% con control prenatal; 2,213 (66%) embarazo de riesgo normal y 1,370 (41%) obtenidas por cesárea. La colonización global fue del 4.3% (145/3,347), siendo mayor en el grupo de edad de 30 a 34 años (6.8%). El serotipo I (58%) fue el más frecuente. CONCLUSIÓN: El porcentaje de colonización en esta población fue bajo. Un programa sistemático de cultivo cervicovaginal y rectal en mujeres embarazadas y el programa de profilaxis antimicrobiana intraparto son controvertidos en nuestra región.

Clinical and dosimetric factors associated with the development of hematologic toxicity in locally advanced cervical cancer treated with chemotherapy and 3D conformal radiotherapy.

AIM: To identify clinical and dosimetric factors associated with the development of hematologic toxicity (HT) for cervical cancer (CC) treated with chemotherapy and 3D conformal radiotherapy. BACKGROUND: Chemoradiotherapy is the standard of care management for CC patients with IB2-IVA clinical stages (CS). This treatment carries toxicities, standing out the one that occurs at the hematologic level. SUBJECTS AND METHODS: CC patients with IB2-IVA CS treated with chemotherapy and 3D conformal radiotherapy (50 Gy) plus Brachyterapy (7 Gy x3 or 9 Gy x2) at our institution between March 2016 and March 2017. Clinical and dosimetric factors were studied as was their probable association with the development of HT. RESULTS: 59 patients were analyzed. 89.8% of the subjects developed some grade of HT and 50.2% developed ≥grade 2 toxicity. No statistical relationship was found for the dosimetric factors: V10 > 90% (p = 0.47) and V20 > 80% (p = 0.17). Regarding clinical factors: neither age >50 years (p = 0.88) nor diabetes mellitus (DM) showed statistical relationship with development of ≥grade 2 HT (p = 0.88 and p = 0.61, respectively). On the contrary, obesity showed a significant association (p = 0.02). For other factors analyzed, we found statistical correlation for epidermoid histology and ≥III A CS (p = 0.01 and p = 0.02, respectively). CONCLUSIONS: We did not find statistical relationship between HT and the clinical factors of age >50 years and DM. Statistical relationship for the dosimetric factors V10 > 90% and V20 > 80% was not found as well. On the contrary, obesity, epidermoid histology and ≥IIIA CS, showed statistical significance for development of HT ≥grade 2.

Asociación de la hemorragia prerretiniana con la presencia y la gravedad de la retinopatía del prematuro en pacientes de alto riesgo.

OBJECTIVE: To assess whether preretinal hemorrhage (PRH) is associated with the presence and severity of retinopathy of prematurity (ROP) in high-risk patients. METHOD: Prospective cohort study, patients referred to the Department of Ophthalmology for ROP screening during October-November 2016 were evaluated weekly on 4 occasions to assess the relationship with PRH and the development of ROP as well as degree of severity associated. We used absolute, median frequencies with minimum and maximum values, χ2 test and Mann-Whitney U-test, as well as relative risk with 95% confidence interval. RESULTS: A total of 30 patients, in the first week 11 females (36%) and 4 males (13%) had PRH; in the 2nd week 13 patients (43%) presented PRH and 14 (46%) developed ROP; on the 3rd week there were no changes; in the last week 8 presented HPR (26%) and 11 patients (36%) with ROP. Stage I severity occurred more frequently. Statistical significance (p = 0.040) was found in the presence of PRH and the development of ROP in the first week with. CONCLUSIONS: HPR is a risk factor for the development of ROP during the first weeks of life and is associated with stages of mild severity.

Alteraciones puberales en adolescentes con leucemia en fase de vigilancia.

OBJECTIVE: To evaluate which factors are associated with alterations in pubertal development in pediatric patients with leukemia in the surveillance phase. METHOD: A case-control study was carried out, including patients aged 8-14 years with diagnosis of acute lymphoblastic leukemia under surveillance. Demographic data were collected, age at diagnosis, type of leukemia, risk of leukemia, duration and type of treatment received, time of surveillance phase; and pubertal development was assessed by Tanner stage, bone age, pelvic ultrasound for women, and LH levels. Fisher's exact test and Mann-Whitney U-test were used. RESULTS: Twenty-five pediatric patients with a diagnosis of acute lymphoblastic leukemia between 8 and 14 years of age with a median of 8 were included, only 4 (16%) presented pubertal alterations, 1 had pubertal delay and 3 advanced puberty. The history of radiotherapy was related to pubertal alterations (p = 0.03). CONCLUSIONS: The antecedent of having received radiotherapy as part of the treatment in patients with acute lymphoblastic leukemia is a risk factor for developing pubertal abnormalities.

Knowledge and attitude towards organ donation of medicine students of a Northwestern Mexico public university / Actitud y conocimiento sobre donación de órganos de estudiantes de medicina de una universidad pública del noreste de México

Objective: To evaluate the knowledge and attitude towards organ donation of medicine students of a Northwestern Mexico public university. Materials and Methods: A prolective, descriptive, observational, and cross-sectional study. A 34 items cross-sectional survey evaluating knowledge and attitude towards organ donation in 3,056 medicine students during 2013-2015. Descriptive statistics were used as absolute frequencies, percentages, mean and standard deviation, as well as the Chi-square test. A p < 0.05 was considered significant. Results: 74% of students would donate their own organs, mainly due to reciprocity (41%). 26% of students would not donate, 48% of them because of fear that their organs could be taken before death. 86% would donate organs from a relative. 64% have spoken about organ donation and transplantation with their family and 67% with friends. 50% said they had received no information about it. 68% understand the concept of brain death. Conclusion: Students received little information about organ donation during college. Despite that, most of them showed a positive attitude and are willing to donate.

Objetivo: Averiguar la actitud y el conocimiento que tienen los estudiantes de medicina de una universidad pública del noreste de México sobre la donación de órganos y tejidos. Material y métodos: Estudio prolectivo, descriptivo, observacional y trans- versal. Se incluyeron 3056 encuestas de 34 reactivos realizadas a estudiantes de medicina durante el periodo 2013-2015 y se eliminaron aquellas con menos del 80% de los reactivos contestados. Análisis estadístico: frecuencias absolutas, porcentajes, medias, desviación estándar y prueba de ji al cuadrado. Se consideró significativo un valor de p < 0.05. Resultados: El 74% de los estudiantes donaría sus órganos y el 41% lo haría por reciprocidad; del 26% que no donaría sus órganos, el 48% no lo haría por temor a que tomen sus órganos antes de estar muerto. Un 86% estaría dispuesto a donar los órganos de algún familiar. El 64% ha comentado el tema de la donación con su familia y el 67% con amigos. El 50% no ha recibido información alguna sobre el tema. El 68% entiende el concepto de muerte encefálica. Conclusión: Pocos estudiantes reciben información sobre donación de órganos al llegar a la universidad; pese a ello, la mayoría tiene una actitud positiva y estarían dispuestos a donar.

[Group B streptococcal perinatal infection: A Global, Latin American and Mexican Overview]. / Infección perinatal por estreptococo del grupo B: panorama global, en América Latina y en México.

Group B streptococci (Streptococcus agalactiae) cause a number of infections in women during pregnancy and postpartum, such as urinary tract infection, chorioamnionitis and endometritis, consequently may affect the newborn. Group B streptococci is the most common cause of severe infections in newborns in developed countries. Studies on the epidemiology of group B streptococci infections in Latin America are still limited. This information is also unknown in Mexico, but studies carried out in the center of the country have found high rates of vaginal colonization in pregnant women and there are case series and case reports of newborns. Microbiological and molecular epidemiology studies in Mexico have shown that populations of group B streptococci have a clonal distribution and that there are clones with genetic and phenotypic characteristics of high virulence that appear to be responsible for most of perinatal pathology. However, the actual role of group B streptococci in perinatal pathology in Mexico is unknown. Consequently, whether to perform or not the screening for determining the group B streptococci colonization status in pregnant women, and the indication or not for intrapartum antibiotic prophylaxis to prevent neonatal group B streptococci infection in Mexico, are still controversial.

[Effectiveness of trabeculectomy trabeculotomy in the reduction of intraocular pressure in patients with primary congenital glaucoma]. / Efectividad de la trabeculotomía más trabeculectomía en la reducción de la presión intraocular (PIO) en pacientes con glaucoma congénito primario (GCP).

OBJECTIVE: To evaluate the effectiveness of trabeculectomy trabeculotomy in the reduction of intraocular pressure in patients with primary congenital glaucoma. MATERIAL AND METHODS: A pre-experimental before and after study was conducted with several measurements after; patients with intraocular pressure≥21 mmHg were included, of both sexes, and children under six years, which had ​​the trabeculotomy trabeculectomy. Success was defined as the reduction of intraocular pressure<21 mmHg within three months after the procedure. For the descriptive analysis, medians with ranges and quartiles 25 and 75 were used. For the inferential analysis, we conducted a visual graphic and analysis of variance for repeated measures of Friedman. A value of p<0.05 was considered as significant. The software used was SPSSv15. RESULTS: 16 eyes were included with intraocular pressure 27.75 mmHg (23-40), vertical and horizontal corneal diameter of 14 mm (12-16), who had undergone trabeculectomy with mitomycin C trabeculectomy; at three months after surgery the intraocular pressure was 12.5 mmHg (8.5-23) (p<0.001) and no changes were observed in the corneal diameters. An eye with a flat anterior chamber was observed as an adverse effect. Thirteen eyes required topical hypotensors to achieve the target intraocular pressure. CONCLUSIONS: The treatment with trabeculectomy trabeculotomy in primary congenital glaucoma is effective in the reduction of the intraocular pressure.

[Factors associated with advanced thyroid cancer in pediatric patients in a high specialty medical unit in Northeast Mexico]. / Factores asociados a estadios avanzados de cáncer tiroideo en pacientes pediátricos de una UMAE del noreste de México.

INTRODUCTION: Thyroid cancer represents 2% of all childhood malignances. Its incidence rises 1.1% per year. In comparison with adults, childhood thyroid cancer is detected in a more advanced stage, but with a survival rate above 95%. The objective of this study was to evaluate whether there are factors associated with advanced stages of thyroid cancer in pediatric patients. RESULTS: Nineteen patients were included, 13 (68.4%) were female and six male, all between 7-15 years, with a median of 11 years. Fifteen in advanced and four in early stage. The median age of patients in advanced stage at time of diagnosis was 10.6 years (7-15) and 13.2 (12-14) were in early stage (p=0.075). There was a delay of nine months to get a diagnosis in advanced stage, and 7.2 in early stage (p=0.931). Three of the patients with advanced stage and two with early stage were from Nuevo León (Mexico) and the rest were foreign (p=0.567). In the group with advanced stage, two had thyroid cancer familiar history, and none in the early stage group (p=0.452). Nine patients in advanced stage and three in early stage presented thyroid nodule as the first sign of illness. Six patients in advanced stage and one in early stage presented goiter (p=0.590). None of the studied patients had radiation history. Six patients in advanced stage and one in early stage suffered from Hashimoto's Thyroiditis (p=0.590). Eleven in advanced stage and one in early stage had papillary histologic variety. Four in advanced stage and three in early stage had papillary histologic variety with a follicular patter (p=0.083). Eight patients presented lung metastasis at time of diagnosis (p=0.061). CONCLUSIONS: There are no factors associated with advanced stage thyroid cancer in pediatric populations. Although half of studied patients presented lung metastasis, treatment response and survival is satisfactory.

[Zoledronic acid (zoledronate) in children with osteogenesis imperfecta]. / Ácido zoledrónico (zolendronato) en niños con osteogénesis imperfecta.

INTRODUCTION: Zoledronic acid or zo/edronate is a potent bisphosphonate that recently has been used in children with osteoporosis and osteogenesis imperfecta (01), so it could be an option in the treatment of children with this terrible disease that virtually condemns them to a life of pain and prostration. The aim of this study was to evaluate the clinical and biochemical conditions of pediatric patients with 01 before and after treatment with zo /edronate. RESULTS: We included 14 patients, median age six years (6 months to 14 years), eight (57.1 %) males and six (42 .9%) females, weight 19 kg (5.8-45 kg). According to the type of 01, six (42.9%) were type I, six (42.9%) type Ill, and two (14.2%) type IV The functional score (Bleck) previous to treatment was 4 (1-9) and 6 (2-9) after treatment (p = 0.001). Pain intensity prior to zo/edronate was 2 (1-9) and 0 (0-2) after (p = 0.008). Previous fractures five (1-15) and post-treatment one (0-2) (p = 0.001 ). There were no significant differences in calcium, phosphorus, alkaline phosphatase, and parathyroid hormone. CONCLUSIONS: Zoledronic acid decreases the number of bone fractures and pain in children with osteogenesis imperfect and improves functional status. The most common side effects were fever and bone pain within five days after the infusion,which disappear paracetamol. No adverse long-term effects such as hypocalcemia or hypoparathyroidism were reported.

[Prolonged exposure to antibiotics and the risk of late-onset sepsis (LOS) in neonates of 1,000-1,500 g: a cohort study]. / Exposición prolongada a antibióticos y riesgo de sepsis tardía (ST) en neonatos de 1,000 a <1,500 g: estudio de cohorte.

OBJECTIVE: To determine whether prolonged exposure to antibiotics (>5 days) increases the risk of late-onset sepsis (LOS) in newborns of 1,000-1,500 g. METHODS: A cohort study in newborns with suspected perinatal infection, with a survival greater than seven days. The exposed cohort was composed of newborns with antibiotic therapy initiated at first postnatal day, lasting >5 days, with negative blood cultures before the fifth day of life, and without clinical evidence of sepsis. The non-exposed cohort was identical but with antibiotics stopped before the fifth day of life. Patients were followed daily for clinical and laboratory evidence of LOS. Others risk factors for LOS were analyzed. STATISTICAL ANALYSIS: We analyzed the incidence, the relative risk (RR) with 95% CI. To measure the time to occurrence of an event of LOS after exposure, Kaplan-Meier survival curve and log-rank test were used. RESULTS: We followed up 49 patients in each group. The incidence was 33.6%. The time of follow-up was 839 vs. 1,291 person-days. Prolonged exposure to antibiotics was associated with a higher risk of LOS (RR: 21.1; 95% CI: 6.5-68.9; p=0.000). The late-onset sepsis-free time was 17.1±1.1 vs. 26.3±0.8 days. CONCLUSIONS: The risk of LOS was higher in newborns with prolonged exposure to antibiotics and increased with the days of exposure.

[Evolution of pediatric patients with liver transplantation in a tertiary care hospital in northeast country]. / Evolución de los pacientes pediátricos con trasplante hepático (TH) en un hospital de tercer nivel del noreste del país.

INTRODUCTION: Liver transplantation is indicated for the treatment of pediatric patients with progressive liver disease in which an expected survival of less than a year would be achieved with the transplant. The aim of this study was to determine the evolution of pediatric liver transplant patients in a tertiary care hospital in the northeast country. RESULTS: Twelve patients subjected to liver transplantation included nine females and three males; one case required retransplantation. Age at transplantation was 3.3 years (range 0.11-14). The weight at transplantation was 12.4 kg (5.7-35.5). The most common indication for transplantation was biliary atresia in six patients (50%). According to the type of graft, 12 (92.3%) were from cadaveric donors, of which seven were segmental. The most common complications were infectious ones in nine patients (75%); surgical complications occurred in eight children (66.6%), with immediate postoperative bleeding in five cases (41.6%). The three-year survival in the entire series was 50%. CONCLUSIONS: This study demonstrates that pediatric liver transplantation is possible in this institution, with a better survival expectancy of patients in the future.

[Reference Intervals for total triiodothyronine (TT3), free thyroxine (FT4), and thyrotropin (TSH) by chemiluminescence immunoassay in children younger than six years old from northeastern Mexico]. / Valores de referencia de triyodotironina total (TT3), tiroxina libre (FT4) y tirotropina (TSH) obtenidos por quimioluminiscencia en niños menores de seis años del noreste de México.

BACKGROUND: Reference values according to age groups for each population are needed for the diagnosis and follow-up of pediatric patients with thyroid diseases. Such values are unknown for Mexican infants and children younger than six years. OBJECTIVE: To determine the reference values of total TT3, FT4 and TSH by chemiluminescence immunoassay in infants and children younger than six year old in Northeastern Mexico. MATERIAL AND METHODS: Thyroid hormone serum levels were determined by chemiluminescence immunoassay in healthy infants and children younger than six years old. RESULTS were analyzed according to gender in seven age groups: Newborns (NB), 1 to 6, 7 to 12, 13 to 18, 19 to 23, 24 to 35, and 36 to 71 months. RESULTS: A total of 405 infants and children were included, 209 male and 196 female, 1.6 ± 1.4 years of age (4 days to 5.6 years). Thyroid hormones: Although there were not significant differences according to gender, in NB TSH and FT4 serum levels were higher (p = 0.001 and p = 0.000, respectively) and TT3 levels were lower (p = 0.000). CONCLUSIONS: Serum levels of TSH and TT4 were higher and TT3 lower in newborns, which has been previously reported even for other measurement methods and other populations. These results allow counting with reference values of these hormones for this region.

[Hepatic steatosis (HS) as a factor associated with the presence of metabolic risk in schoolchildren and obese adolescents]. / Esteatosis hepática (EH) como factor asociado a la presencia de riesgo metabólico en escolares y adolescentes obesos.

INTRODUCTION: One of the complications associated with obesity is nonalcoholic fatty liver disease (NAFLD), which is defined as an excessive accumulation of fat in hepatocytes, and is characterized by chronic elevation of aminotransferases and ultrasonographic abnormalities (increased echogenicity). In the USA it is now the most common liver disease. Prevalence is around 15-25% in the general population, and this increases to 57.5-75% in obese people. The aim of this study was to evaluate whether hepatic steatosis is a factor associated with the presence of metabolic risk in children and obese adolescents. MATERIALS AND METHODS: A retro- and perspective cross-sectional study in the High Specialty Medical Unit No. 25 of the Mexican Social Security Institute in Monterrey, Nuevo Leon, Mexico, in which the clinical records of patients from 5 to 15 years of age, referred with a diagnosis of obesity, were reviewed in the period of January 1, 2012 to June 30, 2013. Children and adolescent patients diagnosed with obesity were included, but we excluded patients with a history of acute and chronic viral hepatitis and use of antiepileptic and hepatotoxic drugs. For descriptive analysis we used absolute frequencies, percentages, means, and standard deviations. For inferential analysis we used chi-square test, Fisher exact test, and Student t test to establish the association of NAFLD with the studied variables. The odds ratio was measured, considering 95% CI and statistical significance p < 0.05. RESULTS: 160 children and adolescent patients were included with median age 11.23 ± 2.2 years, of which 85 (53.1%) were male and 75 (46.9%) were female. All were obese, with BMI and abdominal circumference greater than the 95th percentile for age. In total, 131 (81.8%) patients had NAFLD and 29 (18.2 %) patients did not. HOMA index was increased by 3.9 ± 2.1 (p < 0.05) in patients in the NAFLD group with a mean of 6.4 ± 4.9 in the group without NAFLD. The cutoff point we found for insulin resistance associated with NAFLD was 9. We found four subjects with high LDL levels of (> 130), and none in the control group. Transaminase levels were significantly higher in the group of patients with NAFLD, ALT greater than 40 U/l in 127 (96.94%) of patients with NAFLD (OR: 63.5; 95% CI: 18.5-217; p < 0.005). LDL-C greater than 130 mg/dl occurred in four (3%) patients with NAFLD, and in none of the patients without NAFLD (p = 0.0001). Acanthosis nigricans was found in 128 (97.7%) patients with NAFLD and in only one (3.4 %) in the group without NAFLD (OR: 1194.7; 95% CI: 119.8-1191.5; p = 0.0001). CONCLUSION: Obesity and insulin resistance are risk factors for the development of fatty liver in children and adolescents.

Gut microbiota in preterm infants receiving breast milk or mixed feeding.

BACKGROUND: Preterm birth is the leading cause of mortality in newborns, with very-low-birth-weight infants usually experiencing several complications. Breast milk is considered the gold standard of nutrition, especially for preterm infants with delayed gut colonization, because it contains beneficial microorganisms, such as Lactobacilli and Bifidobacteria. AIM: To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less. METHODS: An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less, born at the University Hospital Dr. José Eleuterio González at Monterrey, Mexico. A total of 40 preterm neonates were classified into breast milk feeding (BM) and mixed feeding (MF) groups (21 in the BM group and 19 in the MF group), from October 2017 to June 2019. Fecal samples were collected before they were introduced to any feeding type. After full enteral feeding was achieved, the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing. Numerical variables were compared using Student's t-test or using the Mann-Whitney U test for nonparametric variables. Dominance, evenness, equitability, Margalef's index, Fisher's alpha, Chao-1 index, and Shannon's diversity index were also calculated. RESULTS: No significant differences were observed at the genus level between the groups. Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group (P < 0.011). In addition, higher counts of Gammaproteobacteria were detected in the final than in the initial sample (P = 0.040). According to the Margalef index, Fisher's alpha, and Chao-1 index, a decrease in species richness from the initial to the final sample, regardless of the feeding type, was observed (P < 0.050). The four predominant phyla were Bacteroidetes, Actinobacteria, Firmicutes, and Proteobacteria, with Proteobacteria being the most abundant. However, no significant differences were observed between the initial and final samples at the phylum level. CONCLUSION: Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria, contributing to the literature of the gut microbiota structure of very low-birth-weight, preterm.

[Clinical and immunological characteristics in pediatric patients with coccidioidomycosis in northeastern Mexico]. / Características clínicas e inmunológicas en pacientes pediátricos con coccidioidomicosis del noreste de México.

BACKGROUND: Coccidioidomycosis is a systemic fungal disease caused by Coccidioides spp. Patients with phagocytic, cellular, or humoral immunodeficiencies exhibit immunodeficiencies that confer increased susceptibility to fungal infections. In Mexico there is an underreporting of this disease and no studies currently describe the immune status of these patients in an endemic area. OBJECTIVE: To describe the clinical and immunological characteristics of pediatric patients with coccidioidomycosis. MATERIALS AND METHODS: Pediatric patients with diagnosis of coccidioidomycosis from two tertiary level hospitals of northeastern Mexico were included, from the period 2008-2012; immune status was assessed by clinical history, immunoglobulins levels, levels of lymphocytes T, B, and NK (natural killer), and the nitroblue tetrazolium test. RESULTS: Thirty patients were included, 18 male (60%). The age at diagnosis was five years (median, range 0.25-13). Twelve were from Coahuila (40%). Residual pulmonary coccidioidomycosis was the clinical type presentation found in 16 patients (53%). A primary humoral immunodeficiency was found in three patients (10%) and a secondary immunodeficiency in another three (10%). Case fatality rate was 16%. CONCLUSIONS: . The disease predominated in male patients. In 33% of patients, levels of IgG were elevated, probably due to stimulation by chronic fungal infection. In 20% of patients, immunodeficiency was documented. There was a high mortality rate.

Procalcitonin and C-reactive protein: markers in the early diagnosis of anastomotic leak.

OBJECTIVE: To determine the efficacy of serum procalcitonin (PCT) and C-reactive protein (CRP) in the early diagnosis of anastomotic leak (AL) in patients undergoing colorectal surgery. METHOD: Diagnostic test in a tertiary care hospital. Patients who did not have preoperative measurements of PCT and CRP were excluded. Those with postoperative infection not related to AL were eliminated. The diagnostic efficacy measures were sensitivity (Sn), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratios, and area under the receiver operating characteristic curve (AUROC). RESULTS: Thirty-nine patients were analyzed; six had AL (15.4%). PCT and CRP increased on the second postoperative day, only in patients with AL. The cut-off points at the second postoperative day were 1.55 ng/mL for PCT and 11.25 mg/L for CRP. The most efficacious test was PCR at second postoperative day (AUROC: 1.00; Sn: 100%; Sp: 96.7%; PPV: 85.7%; NPV: 100%; LR+: 33.0). CONCLUSIONS: CRP at second postoperative day was the most effective test in the early diagnosis of AL in patients undergoing colorectal surgery, with a cut-off point lower than that reported in the international literature.

OBJETIVO: Determinar la eficacia de la procalcitonina (PCT) y la proteína C reactiva (PCR) séricas en el diagnóstico de fuga anastomótica (FA) en los pacientes sometidos a cirugía colorrectal. MÉTODO: Prueba diagnóstica en un hospital de tercer nivel. Se excluyeron los pacientes que no tuvieron mediciones preoperatorias de PCT y PCR. Se eliminaron los que cursaron con infección posoperatoria no relacionada con FA. Las medidas de eficacia diagnóstica fueron sensibilidad (S), especificidad (E), valores predictivos positivo (VPP) y negativo (VPN), razones de verosimilitud positiva (RV+) y negativa (RV−), y área bajo la curva característica operativa del receptor (AUROC). RESULTADOS: Se analizaron 39 pacientes, de los cuales 6 (15.4%) tuvieron FA. La PCT y la PCR aumentaron al segundo día posoperatorio solo en los pacientes con FA. Los puntos de corte al día 2 fueron 1.55 ng/ml para PCT y 11.25 mg/l para PCR. La prueba más eficaz fue la PCR al día 2 (AUROC: 1.00; S: 100%; E: 96.7%; VPP: 85.7%; VPN: 100%; RV+: 33.0). CONCLUSIONES: La PCR en el segundo día posoperatorio fue la prueba más eficaz en el diagnóstico temprano de FA en los pacientes sometidos a cirugía colorrectal, con un punto de corte inferior a lo reportado en la literatura internacional.

Frontal penetrating arrow injury: A case report.

BACKGROUND: Penetrating arrow injuries of the head and neck are exceedingly rare in pediatric patients. This pathology has high morbidity and mortality because of the presence of vital organs, the airway, and large vessels. Therefore, the treatment and removal of an arrow is a challenge that requires multidisciplinary management. CASE SUMMARY: A 13-year-old boy was brought to the emergency room after an arrow injury to the frontal region. The arrowhead was lodged in the oropharynx. Imaging studies showed a lesion of the paranasal sinuses without compromising vital structures. The arrow was successfully removed by retrograde nasoendoscopy without complications, and the patient was discharged. CONCLUSION: Although rare, maxillofacial arrow injuries have high morbidity and mortality and require multidisciplinary management to preserve function and aesthetics.

Factores asociados a sobrevida a un año en pacientes postoperados de glioblastoma.

OBJECTIVE: To identify factors associated with one-year survival in postoperative glioblastoma patients at a hospital in northeastern Mexico. MATERIAL AND METHODS: Nested case-control study. Patients operated on for glioblastoma between 2016-2019 were included. Information about clinical and surgical factors was obtained, survival was calculated by Kaplan-Meier analysis. Descriptive analysis was performed with medians and ranges, and inferential analysis with χ2, Fisher and Student t test, odds ratio and 95% confidence interval. A value of p < 0.05 was considered significant. RESULTS: Sixty-two patients with glioblastoma were included, 27 (43.5%) women and 35 (56.5%) men, median age 56 years (range: 6-83). Median survival was 3.6 months (1-52), 45 (72.6%) survived less than 12 months. The factors associated with a higher survival were administration of adjuvant treatment (p < 0.001), better functional status (p = 0.001), and absence of post-surgical complications (p = 0.034). CONCLUSIONS: Most patients with glioblastoma survive less than 12 months and the factors most strongly associated with longer survival are administration of adjuvant treatment, better functional status of the patient and absence of post-surgical complications.

OBJETIVO: Identificar los factores asociados a la sobrevida a un año en pacientes postoperados de glioblastoma en un hospital del noreste de México. MATERIAL Y MÉTODOS: Estudio de casos y controles anidado en una cohorte. Se incluyeron pacientes operados de glioblastoma entre 2016 y 2019. Se obtuvo la información sobre factores clínicos y quirúrgicos, se calculó la sobrevida mediante análisis de Kaplan-Meier. El análisis descriptivo se realizó con medianas y rangos, y el inferencial con prueba de χ2, Fisher, t de Student, razón de momios e intervalo de confianza al 95%. Se consideró significativo un valor de p < 0.05. RESULTADOS: Se incluyeron 62 pacientes con glioblastoma, 27 (43.5%) mujeres y 35 (56.5%) hombres, mediana de edad de 56 años (rango: 6-83). La mediana de sobrevida fue de 3.6 meses (1-52), 45 (72.6%) sobrevivieron menos de 12 meses. Los factores asociados a mayor sobrevida fueron: administración de tratamiento adyuvante (p < 0.001), mejor estado funcional (p = 0.001) y ausencia de complicaciones posquirúrgicas (p = 0.034). CONCLUSIONES: La mayoría de los pacientes con glioblastoma sobreviven menos de 12 meses y los factores más fuertemente asociados a mayor sobrevida son administración de tratamiento adyuvante, mejor estado funcional del paciente y ausencia de complicaciones posquirúrgicas.