Observational study of multiple myeloma in Latin America.

Relatively little is known about the outcomes of multiple myeloma in Latin America, a world region where incorporation of novel agents is generally slow. In the current retrospective-prospective study, we aimed to describe the patterns of care and treatment results in five Latin American countries. Between April 2007 and October 2009, patients who had been diagnosed from January 2005 to December 2007 were registered at 23 institutions from Argentina, Brazil, Chile, Mexico, and Peru. We divided patients into two cohorts, according to transplantation eligibility, and analyzed them with regard to first-line treatment and overall survival (OS). We analyzed a total of 852 patients, 46.9 % of whom were female. The median follow-up was 62 months. Among transplantation-ineligible patients (N = 461), the mean age was 67.4 years, approximately one third of patients received a thalidomide-based treatment in the first line, and the median OS was 43.0 months. Transplantation-eligible patients (N = 391) had a mean age of 54.7 years and a median OS of 73.6 months. Autologous transplantation was performed in 58.6 % of the patients for whom this procedure was initially planned and in only 26.9 % of the overall patients. Our long-term results reflect the contemporary literature for patients with multiple myeloma treated with autologous transplantation and thalidomide-based regimens in clinical trials and observational studies. However, further efforts are needed to approve and incorporate novel agents in Latin American countries, as well as to increase access to transplantation, in order to achieve the expected improvements in patient outcomes.

Acinetobacter baumannii infections in a tertiary care hospital in Mexico over the past 13 years.

BACKGROUND: Acinetobacter baumannii has evolved from an opportunistic pathogen into a common and persistent nosocomial bacterium capable of causing severe infections during endemic and epidemic periods. METHODS: The study period extended from January 1999 to December 2011 and involved patients hospitalized at the Hospital Civil de Guadalajara, Fray Antonio Alcalde, Jalisco, Mexico. From each patient, a single isolate was obtained, and a total of 3,680 unique isolates were collected. Susceptibility tests were performed according to the guidelines of the Clinical and Laboratory Standards Institute. RESULTS: A. baumannii has disseminated throughout the Hospital Civil de Guadalajara, Fray Antonio Alcalde, since 1999. A. baumannii isolates obtained from patients treated in the adult intensive care unit represent the majority of the isolates that have been collected. In addition, A. baumannii was isolated from the adult neurosurgical ward and the adult internal medicine ward, and these isolates were frequently obtained from secretions. A persistent decrease in the susceptibility of A. baumannii isolates to meropenem (92% in 1999 to 12% in 2011), imipenem and amikacin has been observed. CONCLUSIONS: A. baumannii became an endemic nosocomial pathogen during the study period at the Hospital Civil de Guadalajara, Fray Antonio Alcalde, and has exhibited a persistent decrease in susceptibility to all categories of antimicrobial agents over the past 13 years.

[Unifocal eosinophilic granuloma of the temporal bone]. / Granuloma eosinófilo unifocal de hueso temporal.

We present a case of a twelve year old child with a eosinophilic granuloma of the temporal bone. The eosinophilic granuloma is the most frecuent and most benign form of the histiocytosis of the Langerhans cells. The frecuency of the othological manifestations of this condition varies between 15-60 percent and radiologically, the images are characterized by litho-lesions with sharp edges. The diagnosis is histological and the treatment includes surgical intervention accompanied by inter-lesion corticoid-therapy and/or radiotherapy.

[Papilar thyroid carcinoma. An unusual clinic]. / Carcinoma papilar de tiroides de localizacion inusual.

The Papillary carcinoma is the most frequent neoplasic tumour of the thyroid gland. It accounts for 70-75% of all malignant thyroid tumours. In 80-90% of cases it presents as a slow-growing single thyroid node. Nevertheless, in 10-26% of cases, the initial presentation is a lateral neck mass without palpable thyroid mass. We present the case of a 67 year- old patient who attended to the ENT out-patient clinic with a lateral neck mass which had been growing slowly over the course of number of years.

[Child nasopharyngeal angiofibroma]. / Angiofibroma nasofaringeo infantil.

Angiofibromas are benign tumors, highly vascularized, that affect male adolescents and young men. We present a clinical case of an 11-year-old patient with an angiofibroma of the nasopharynx, reviewing the etiopathogenic theories and current surgical approaches.

From gold nanobipyramids to nanojavelins for a precise tuning of the plasmon resonance to the infrared wavelengths: experimental and theoretical aspects.

Anisotropic gold nanoparticles and in particular with shapes exhibiting tips are known to present an extremely strong localized electromagnetic field. This field is mostly located at the top of the tips and can be used in various optical applications. Moreover, as a consequence of their anisotropy, they present two plasmon resonance bands corresponding to the transverse and longitudinal resonance modes. Tuning the aspect ratio it becomes possible to display SPR bands near the near infrared region. This was particularly investigated in the case of nanorods and also for bipyramids. In this paper we report a high yield synthesis approach that allows one to precisely control the aspect ratio of bipyramids and to elongate the structure until they adopt a javelin-like aspect. We were able to prepare nano-javelins with surface plasmon resonances up to 1850 nm, opening important perspectives in terms of optical applications in the NIR and IR regions. The synthetic methods are fully reported and the optical properties were correlated with the theoretical approach, taking into consideration not only the aspect ratio but also the truncation of the nano-objects.

Polyunsaturated fatty acids and parasitism: effect of a diet supplemented with fish oil on the course of rat trichinellosis.

Dietary fish oil has a beneficial effect on heart and some bacterial diseases and apart from other effects, some studies have revealed their ability to modulate the course of inflammatory and autoimmune diseases. The study here reported was designed to evaluate the possible influence of a fish oil supplement on the course of a Trichinella infection. Nutritional, parasitological and immunological parameters were analyzed. Two groups of 20 Wistar rats, one fed a standard diet and the other one a standard diet supplemented with fish oil, were infected with 1000 L1 larvae. Other two uninfected groups served as control. Results were as follows: fish oil diet intake and infection have, respectively, a positive and a negative effect on growth and food utilization. The negative effect is detected later in animals fed the fish oil diet. A reduction of 30.9 and 36.6% in the number of adult worms and L1 larvae, respectively, was observed in the fish oil group as compared to the standard diet group. Production of IFNgamma (Th1 response) and IL4 (Th2) response was measured in stimulated splenic cells. The fish oil diet increased both IFNgamma and IL4 levels. At 6 days after infection both IFNgamma and IL4 responses were detected, but at 36 days after infection only IL4 was detected in the standard group. The level of somatic and cuticular antibodies was not affected by the diet.

[Infections due to herpes-varicella viruses in Hodgkin's disease (author's transl)]. / Infecciones por herpes virus-varicela en la enfermedad de Hodgkin.

The infections due to herpes-varicella viruses occurring in 191 patients with Hodgkin's disease form the basis of this report. There were overall 41 episodes (26.7%) in 40 patients, distributed as follows: varicella in three cases, atypical herpes-varicella in two cases, and herpes zoster in 36 cases, the latter showing systemic spread in seven instances, one to the central nervous system (myelitis) and six to the skin. The mortality was 2.5% of all infections, and 33% of the varicella cases. Morbidity was apparent as postherpetic neuralgia in seven patients (19.4%), postherpetic paraplegia in one case (2.5%), and severe thrombocytopenia in another case (2.5%). The statistical study of the factors contributing to the development of reactivation episodes demonstrated that neither age, sex, or previous splenectomy were influential. The results obtained in relation to the stage and histologic type of Hodgkin's disease can not be fully evaluated because of the artifact introduced by other variables such as type of therapy and observation time. There was a clear relationship with the aggressiveness of therapy, because 81.7% of the viral episodes occurred in patients submitted to total radiotherapy with or without chemotherapy, or with partial radiotherapy plus chemotherapy. In the patients with systemic spread there was a clear relationship with prior splenectomy (p less than 0.005). The clinical features of these patients are commented upon.

[Esophageal foreign bodies. Our ten years of experience]. / Cuerpos extraños esofágicos: nuestra experiencia en diez años.

OBJECTIVE: To study the management of esophageal foreign bodies. MATERIAL AND METHODS: A retrospective study was made of all rigid esophagoscopies performed for suspected foreign bodies in the esophagus by an otolaryngology department for ten years. RESULTS: Rigid esophagoscopy was performed for suspected foreign bodies in 46 patients (27 females, 19 males); age range 22 months to 88 years. In 40 cases an impacted foreign body was found. The most frequent location was the upper third of the esophagus (33/82.5%). The most common type of foreign body was chicken bones in adults (17/42) and coins in children (2/4). Nine patients (all adults) had complications. CONCLUSIONS: Due to its low cost and morbility, flexible endoscopy is the first choice for managing esophageal foreign bodies. Rigid esophagoscopy is still an appropriate technique when flexible endoscopy fails or it is not possible.

Plasmonic bipyramids for fluorescence enhancement and protection against photobleaching.

A great number of studies focus their interest on the photophysical properties of fluorescent hybrid gold nanoparticles for potential applications in biotechnologies such as imaging and/or treatment. Spherical gold nanoparticles are known to quench a chromophore fluorescent signal, when moieties are located in their close vicinity. The use of a polymer spacer on such a system allowed only partial recovery of the dye emission by controlling the surface to dye distance. Gold-based anisotropic sharp nanostructures appear to exhibit more interesting features due to the strong electric field generated at their edges and tips. In this paper, a complete study of hybrid fluorescent bipyramidal-like gold nanostructures is presented. We describe the chemical synthesis of gold bipyramids functionalized with fluorescent water-soluble polymers and their photophysics both in solution and on a single object. We show that the use of a bipyramidal shape instead of a spherical one leads to total recovery of the fluorescence and even to an enhancement of the emission of the dyes by a factor of 1.4.

Thermogenesis associated to the intake of a diet non-supplemented or supplemented with n-3 polyunsaturated fatty acid-rich fat, determined in rats receiving the same quantity of metabolizable energy.

The beneficial effects of n-3 polyunsaturated fatty acids (PUFA) are well known, but their consumption in western countries is chronically insufficient, and so it is recommended that diets should be supplemented with a fat rich in these fatty acids. However, the effect of such diets on the energy expenditure remains a controversial question. Precise data concerning the effect of using under the same metabolizable energy intake, a diet non-supplemented or supplemented with a fat rich in n-3 PUFA are not available. This type of information was obtained using rats at weaning fed a diet supplemented or non-supplemented with 10% of fish oil. Between the 30th and 60th day after starting the experiment, the energy and protein balance was established by means of the comparative slaughter method. The blood levels of different metabolites were also determined. Although total thermogenesis did not vary between the two groups, consumption of the fish oil diet led to a lower level of thermogenesis associated with the oxidation of protein, and a higher one of that associated with the oxidation of fat. We conclude that the thermic effect of feeding is a combination of independent processes. Due to their specific metabolism, n-3 PUFA may be considered essential compounds to maintain the energy balance.

Validity of the computerized DIS for diagnosing psychiatric inpatients.

The validity of a self-administered, computerized version of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) was evaluated with a group of 41 psychiatric inpatients. Each patient was administered the computerized DIS (C-DIS) and a semi-structured clinical interview using the symptom checklist developed by Helzer et al. The concordance between the C-DIS and symptom checklist was comparable to that found in earlier studies of the original DIS. The overall distribution of kappas was also similar to those of previous studies. Overall, the results suggest that computerized administration may be a feasible alternative to face-to-face administration of the DIS.

Effects of treatment and alternative care on length of stay on a general hospital psychiatric unit--results of an audit.

Quality controls are becoming an important part of our health care system. A medical audit is one way of evaluating quality of care, and this paper describes the results of an audit conducted to investigate the reasons for a prolonged stay on a psychiatric inpatient unit. The results showed a decrease in the mean length of stay over a five year period, although the figure remained substantially above provincial norms. A review of the hospital charts of a random sample of one in six patients whose hospital stay exceeded 30 days was carried out. It revealed that in 50.0% of cases the reasons were "medically acceptable," in 10.3% the reasons were "medically unacceptable" and in 39.7% the reasons were "social and administrative" and beyond the control of the treating psychiatrist. The implication of these results are discussed.

Edema pulmonar en cirugía laparoscópica ginecológica / Pulmonary edema in surgery laparoscópica gynaecological

Reporte de de un caso de edema pulmonar en el postoperatorio inmediato de uan cirugia laparascópica ginecológica. La etiología del edema pulmonar en este caso no pudo ser determinada con precisión, pero se plantea con precisión, pero se plantearon dos posibles causas que lo explicaran. La primera sería un aumento súbito del retorno venoso luego de la remoción del CO2 de la cavidad peritoneal, lo que a su vez producira una sobre carga de liquidos. La segunda sería un aumento en la permeabilidad capilar pulmonar que podria resultar...