Increased histopathological yield for granulomatosis with polyangiitis based on nasal endoscopy of suspected active lesions.

PURPOSE: To present the results of an endoscopic and histopathologic evaluation of suspected nasal active granulomatosis with polyangiits (GPA) lesions, describe them as seen by the ENT specialist, and propose a guide for tissue sampling of the nasal cavity to improve the yield of confirmatory histology. METHODS: Randomly selected patients seen from December 1997-October 2007 had a thorough endoscopic nasal evaluation, preceded by careful cleansing of the nasal cavity. Endoscopic lesions were described; sensitivities, specificities, and predictive values of the composites of endoscopic and histological activity were determined. RESULTS: Six lesions, some not previously described in detail, were observed: white submucosal nodules, mucosal swelling, polypoid nodules, vascular submucosal dilatations, bloody submucosal patches, and ulcers. Of these, polypoid nodules (PPV 100%), persistent white submucosal nodules (PPV 81%), and bloody submucosal patches (PPV 93%) had the better diagnostic performance with confirmed histological diagnosis. CONCLUSIONS: Careful nasal cavity preparation, observation, and description of the nasal mucosa can guide tissue sampling documenting active GPA. This can lead to a better histological yield when definitive proof of the disease is needed.

The Zika Virus: An Association to Guillain-Barré Syndrome in the United States - A Case Report.

Case of a 37 year-old Puerto Rican male with no past medical history who was admitted to the hospital after developing paresthesia in the upper and lower extremities with associated skin rash, weakness, and dysautonomia. After rigorous analysis of the clinical patterns, neurologic manifestations, laboratory workups, CSF analysis, and nerve conduction studies we conclude the existence of a strong relationship between the Zika virus and the Guillain-Barré syndrome. The patient recovered promptly and his response to treatment was excellent.

Etiology of cutaneous vasculitis: utility of a systemic approach / Etiología de las vasculitis cutáneas: utilidad de una aproximación sistémica.

Cutaneous vasculities (CV) represents a diagnostic challenge, occurs as primary cutaneous disorder or as a manifestation of other entities. Objective: To search the cause of CV. Methods: Patients with CV were prospectively evaluated. In all patients, skin biopsies were drawn, and direct immunofluorescence was done in most of the patients. American College of Rheumatology (ACR) and Chapel Hill Consensus Conference Criteria (CHCC) were used for classification. Results: 32 patients were studied. There was female predominance (71.8%). Children presented drug-associated CV or Schönlein-Henoch púrpura (SHP). Adults presented more frequently SHP, systemic lupus erythematosus or paraneoplastic vasculitis, other diagnosis as polyarteritis nodosa, microscopic polyangiitis, thrombotic vasculitis (post-puerperal), antiphospholipid syndrome, Churg-Strauss syndrome, and drug-associated CV were presented. Using the ACR and CHCC criteria, 50% of cases were classified. Discussion: In our institution, during this work the etiologic diagnostic of CV increased more than twice. However, in the case of HSV or LA and SHP none of the proposed criteria had high specificity; other parameters were used to discern between both. Six patients remained as not classified. In our view, cryoglobulins and hepatitis serology do not seem useful unless patient's history supports they need to be done. Unclassified patients were followed-up closely for 2 years.

Las vasculitis cutáneas (VC), primarias o como manifestación de enfermedades sistémicas, constituyen un reto diagnóstico. Objetivo: Determinar las causas de VC. Métodos: Se incluyeron pacientes con diagnóstico de CV, a los cuales se les realizó valoración clínica, biopsia cutánea y exámenes de laboratorio. En la mayoría de los casos se realizó inmunofluorescencia directa. Los casos se clasificaron con los criterios del American College of Rheumatology (ACR) y la Chapel Hill Consensus Conference (CHCC). Resultados: Se incluyeron 32 pacientes; la frecuencia fue mayor en mujeres (71.8%). Los niños presentaron VC asociadas a medicamentos o púrpura de Schönlein-Henoch (PSH). En adultos se reportó con más frecuencia PSH, vasculitis asociada a lupus eritematoso sistémico y vasculitis paraneoplásicas; otros diagnósticos etiológicos incluyeron poliarteritis nodosa (PAN), poliangeítis microscópica (PAM), vasculitis trombótica (pospuerperal), síndrome antifosfolípidos (SAF), síndrome de Churg-Strauss (SCS) y VC asociada a medicamentos. Utilizando los criterios del ACR y la CHCC para vasculitis se clasificó el 50% de los casos. Discusión: En el Hospital Gea, durante este trabajo, el diagnóstico etiológico de las CV se incrementó más del doble. Sin embargo, en relación a los diagnósticos vasculitis por hipersensibilidad (VHS) y PSH ninguna de las clasificaciones utilizadas contaba con criterios específicos. Seis pacientes permanecieron sin clasificar. Observamos que los estudios de crioglobulinas y serología para hepatitis no son útiles como estudios iniciales, salvo que la historia clínica del paciente lo sugiera. Los pacientes sin clasificar se siguieron por dos años.

Genetic variants in ATP6 and ND3 mitochondrial genes are not associated with aggressive prostate cancer in Mexican-Mestizo men with overweight or obesity.

Mitochondrial defects have been related to obesity and prostate cancer. We investigated if Mexican-Mestizo men presenting this type of cancer, exhibited somatic mutations of ATP6 and/or ND3.Body mass index (BMI) was determined; the degree of prostate cancer aggressiveness was demarcated by the Gleason score. DNA from tumor tissue and from blood leukocytes was amplified by the polymerase chain reaction and ATP6 and ND3 were sequenced. We included 77 men: 20 had normal BMI, 38 were overweight and 19 had obesity; ages ranged from 52 to 83. After sequencing ATP6 and ND3, from DNA obtained from leukocytes and tumor tissue, we did not find any somatic mutations. All changes observed, in both genes, were polymorphisms. In ATP6 we identified, in six patients, two non-synonymous nucleotide changes and in ND3 we observed that twelve patients presented non-synonymous polymorphisms. To our knowledge, this constitutes the first report where the complete sequences of the ATP6 and ND3 have been analyzed in Mexican-Mestizo men with prostate cancer and diverse BMI. Our results differ with those reported in Caucasian populations, possibly due to ethnic differences.

Sarcoidosis: a single hospital-based study in a 24-year period.

BACKGROUND: Clinical presentation of sarcoidosis varies according to race and geographical area. We describe the clinical spectrum and outcome of sarcoidosis in Mexican patients compared with other populations. METHODS: We reviewed the medical charts of 21 patients with sarcoidosis seen at a referral hospital in 1989-2012; organ involvement was assessed using the ACCESS instrument. We compared our results with the ACCESS and Latin American studies. We used descriptive statistics and reported odd ratios with 95% CI. RESULTS AND CONCLUSION: Fifty-two percent were women; median age was 31 years; median time to diagnosis, 5.5 months. Frequency of organ involvement was: constitutional symptoms 62%, lungs 66.6%, skin 42.8%, bone marrow 23.4%, lymph node 19%, liver 19%, and eye 19%. After one year of follow-up, 47.5% of patients were asymptomatic without treatment, 38% asymptomatic on treatment, and 14.2% symptomatic on treatment. In our patients, pulmonary involvement was lower (66.6 vs. 94.9%; p = 0.001) and cutaneous (42.8 vs. 15.8%; p = 0.003) and bone marrow (23.4 vs. 4.7%; p = 0.001) were higher than in the ACCESS cohort. Data regarding Latin American populations was scarce. The clinical spectrum of sarcoidosis in our population differed from other studies, with a higher frequency of cutaneous sarcoidosis and less pulmonary involvement.

Short-Term Adverse Effects of the Fourth Dose of Vaccination against COVID-19 in Adults over 40 Years of Age.

Booster vaccines are a strategy to mitigate the conditions in the health, social, and economic fields that the COVID-19 pandemic has brought. A series of adverse effects have been observed since the first vaccination. The present investigation aims to describe the short-term adverse effects of the fourth dose against COVID-19 in adults older than 40 from a region of Peru. The study population was over 40 years of age at the COVID-19 vaccination center in Trujillo, Peru. A 21-day follow-up was conducted from vaccination with the fourth dose, considering sex, age, body mass index, comorbidities, history of COVID-19 infection, vaccination schedule, and simultaneous vaccination against influenza as variables of interest. Multinomial logistic regression with robust variance was used to estimate the risk ratio (RR). In total, 411 people were recruited, and it was found that 86.9% of the participants presented adverse effects after injection with the fourth dose of the vaccine against COVID-19. Pain at the injection site was the most reported symptom after 3 days. Assessment of adverse effects after 3 days found that age ≥ 60 years was associated with a lower likelihood of adverse effects compared to those younger than 60 years (RRc: 0.32; 95% CI: 0.0.18-0.59), males compared to females were associated with a lower likelihood of adverse effects (RRc: 0.54; 95% CI 0.30-0.98), being overweight (RRc: 2.34; 95% CI: 1.12-4.89), and last vaccine with Pfizer-BioN-Tech (RRc: 0.42; 95% CI: 0.18-0.96). Associated adverse effects are mild to moderate. Injection site pain and general malaise are the most frequent adverse effects.

Giant cell arteritis in Mexican patients.

BACKGROUND: Giant cell arteritis (GCA) is the most common primary systemic vasculitis worldwide, although it seems to be very rare in some areas, such as Latin America. OBJECTIVES: The objective of the study was to describe the clinical, laboratory, and treatment features in a Mexican Mestizo population with GCA. METHODS: Retrospective data chart review (1989-2010). RESULTS: Twenty-two patients with GCA were identified, 18 women and 4 men. Mean age was 73 (SD, 7.9) years. Diagnosis was made at a mean of 67 (SD, 83.6) days from symptom onset. Most frequent presenting symptoms included headache (90%), constitutional symptoms (86%), and polymyalgia rheumatica (59%). Severe cranial ischemic complications were present in 32%. Amaurosis fugax and blindness were present in 36% and 27%, respectively. High erythrocyte sedimentation rate was present in 89% of patients. Rapid response to prednisone treatment was seen, but in 10 patients, relapse occurred, possibly related to fast tapering. Additional treatment was methotrexate (n = 8), azathioprine (n = 5), and cyclophosphamide (n = 3). Median follow-up was 242 (SD, 214) weeks. CONCLUSIONS: Giant cell arteritis is rarely recognized in Latin America. We report on characteristics of GCA in a population of Mexican Mestizos, as ours is the largest series to be reported from Latin America so far. When compared with other series, age at onset is similar, females are more affected, and although a good response to corticosteroid treatment was seen, a higher frequency of amaurosis fugax and blindness was observed, accounting for an unfavorable functional outcome in 6 (27%) of 22 patients.

DNA binding activity studies and computational approach of mutant SRY in patients with 46, XY complete pure gonadal dysgenesis.

Mutations of SRY are the cause of 46,XY complete pure gonadal dysgenesis (PGD) in 10-15% of patients. In this study, DNA was isolated and sequenced from blood leukocytes and from paraffin-embedded gonadal tissue in five patients with 46,XY complete PGD. DNA binding capability was analyzed by three different methods. The structure of the full length SRY and its mutant proteins was carried out using a protein molecular model. DNA analysis revealed two mutations and one synonymous polymorphism: in patient #4 a Y96C mutation, and a E156 polymorphism; in patient #5 a S143G mosaic mutation limited to gonadal tissue. We demonstrated, by all methods used, that both mutant proteins reduced SRY DNA binding activity. The three-dimensional structure of SRY suggested that besides the HMG box, the carboxy-terminal region of SRY interacts with DNA. In conclusion, we identified two SRY mutations and a polymorphism in two patients with 46,XY complete PGD, demonstrating the importance of the carboxy-terminal region of SRY in DNA binding activity.

Immunohistochemistry screening of sebaceous lesions for Muir-Torre syndrome in a 26-year period in a Mexican population.

Muir-Torre syndrome (MTS) is an autosomal dominant genodermatosis defined as the association of rare sebaceous gland skin tumors, keratoacanthomas, and a personal or familial history of malignant visceral tumors. Germline mutations in certain mismatch repair genes (MMR) have been identified in MTS families and their identification is a cornerstone for diagnosis of MTS. We reviewed our series of sebaceous neoplasms and performed immunohistochemistry (IHC) in order to screen for new MTS cases. Sebaceous neoplasms and visceral tumors from the same patient diagnosed between 1980-2006 were included. Immunohistochemistry to determine the presence or absence of MMR gene products in skin and visceral tumors was performed with mouse monoclonal antibodies anti-MSH2, anti-MSH6 and anti-MLH1. Six sebaceous neoplasms were identified in six females. Four patients presented a lack of expression of at least one of the MMR proteins in visceral and cutaneous neoplasms, thus warranting the diagnosis of MTS. Immunohistochemistry is a useful and accessible technique for the characterization of MMR gene expression in patients with sebaceous neoplasms.

Coexistance of Amyloidosis and Primary Sjögren's Syndrome: An Overview.

BACKGROUND: The association of primary Sjogren´s Syndrome (SS) and amyloidosis has been recognized but scarcely assessed. OBJECTIVE: Herein we analyzed the literature regarding this association in order to describe a SS phenotype prone to both conditions. METHODS: PubMed and CINAHL databases were searched from inception until April 2016 for the keywords: Amyloidosis, amyloid, Sjögren's syndrome and their combinations. RESULTS: Most of the cases corresponded to localized amyloidosis mainly at skin and lung, whereas only three cases were systemic. Other places of localized amyloidosis were the kidney, tracheobronchial, tongue, breast, salivary gland and vocal cord. Most of the localized forms corresponded to AL type, whereas AA amyloidosis was uncommon. The diagnosis of amyloidosis followed the SS onset (1-25 years) and in the majority of patients the presence of B cell hyperactivity traduced by hypergammaglobulinemia, positive rheumatoid factor and/or anti-Ro/SSA and anti-La/SSB antibodies were observed. In seven patients, an associated lymphoma was also documented. CONCLUSION: The spectrum of lymphoid proliferation associated with SS extends beyond the classical B cell lymphoma. Localized or systemic amyloidosis might coexist with primary SS. Localized amyloidosis should be suspected in patients with consistently high serologic activity and suggestive lesions.

Elastographic ultrasound: an additional image tool in Sjögren's syndrome.

AIM: To evaluate the stiffness of parotid and submandibular glands using elastography ultrasound and to correlate it with B-mode ultrasonographical, clinical and serological features, salivary profibrotic and inflammatory chemokines, and salivary gland fibrosis. METHODS: We performed B-mode and elastography ultrasound of major salivary glands of 26 patients with primary Sjögren's syndrome. We registered the shear wave velocity (SWV) and correlated it with the morphologic ultrasonographic changes assessed by the Hocevar scale. We assessed the European League Against Rheumatism (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), non-stimulated whole salivary flow rate (NSWSF), C3 and C4 levels, anti-Ro/La antibodies, salivary inflammatory (C-X-C motif ligand 13 [CXCL13], CXCL10, CXCL8, C-C motif ligand 2 [CCL2], interleukin 10 [IL-10] and IL-6) and pro-fibrotic (CXCL14, CCL28, tumor necrosis factor-related apoptosis-inducing ligand and transforming growth factor ß) chemokines and cytokines and evaluated the presence of fibrosis in the minor salivary gland. RESULTS: Ninety-two percent of patients were women; mean age was 51.1 ± 11 years; median disease duration was 6.1 years; 92.3% had oral symptoms and 26.9% fibrosis. The median B-mode score was 22.2 points and the median SWV 2.5 m/s (τ = 0.53, P = 0.001). The SWV correlated with the NSWSF (τ = -0.53, P = 0.001), ESSDAI (τ = 0.31, P = 0.03), glandular ESDDAI domain (τ = 0.36, P = 0.02), C4 levels (τ = -0.32, P = 0.04), salivary CXCL13 (τ = 0.29, P = 0.03) and CXCL10 (τ = 0.30, P = 0.003), but not with age and fibrosis. CONCLUSION: WV correlated with the B-mode ultrasound score, systemic and glandular activity and in a large degree with CXCL10, an inflammatory chemokine, but not with fibrosis. An increased SWV might represent chronic glandular inflammation rather than fibrotic changes in these patients.

[Work accidents associated with the discouragement of SERUMS physicians to work in the primary care services of Lima, Peru]. / Accidentes laborales asociados al desánimo de médicos SERUMS para laborar en el primer nivel de atención de Lima, Perú.

BACKGROUND: Employee retention is an important issue, because professionals are required in primary care services (PCS). The objective was to determine whether accidents were associated with the discouragement of physicians to work in PCS in Lima, Peru. METHODS: Analytical cross-sectional study of secondary data from a database generated from a survey of physicians who performed his Rural and Urban Health Care Service (Servicio Rural y Urbano-Marginal en Salud: SERUMS). We only included physicians who said at the beginning of their SERUMS that they could work in PCS in Lima. Those who completed their service and reported that they no longer wished to work in Lima were defined as change of intention to work in PCS. This was associated with having a work accident and was adjusted with other variables. RESULTS: Out of 124 physicians, 63% (78) were men. Median age was 26 years (interquartile range: 25-27 years). After they completed their SERUMS, 12% (15) said they changed their mind and that they wished to work in Lima. In the multivariate analysis, having had an accident diminished the frequency of changing their mind of working in the PCS (aPR: 0.28, 95% CI: 0.14-0.54, p < 0.001), adjusted for eight variables. CONCLUSIONS: A previous study found that work accidents decreased the frequency outside Lima, but our study states the opposite, probably because of the perception that a job in the capital would allow them to be closer to services; to be cared for in case of any emergency.

INTRODUCCIÓN: la retención laboral es un tema de suma importancia, porque se requiere de profesionales en el primer nivel de atención (PNA). El objetivo fue determinar si los accidentes laborales se asociaron al desánimo de los médicos para trabajar en el PNA de Lima, Perú. MÉTODOS: estudio transversal analítico de datos secundarios de una base de datos generada de una encuesta a médicos que realizaron su Servicio Rural y Urbano-Marginal en Salud (SERUMS). Se incluyó solo a los médicos que manifestaron al inicio del SERUMS que podían trabajar en el PNA de Lima. Se definió como cambio de intención de trabajo en el PNA a los que finalizando el SERUMS refirieron que ya no deseaban laborar en Lima. Esto se asoció según si tuvieron un accidente laboral y se ajustó por otras variables. RESULTADOS: de los 124 médicos el 63% fueron hombres (78). La mediana de edad fue de 26 años (rango intercuartílico: 25-27 años). Después de su SERUMS, el 12% (15) manifestó que cambió su interés y que deseaba trabajar en la capital. En el análisis multivariado, haber tenido un accidente laboral disminuyó la frecuencia del cambio de intención de trabajo en el PNA (RPa: 0.28, IC 95%: 0.14-0.54, p < 0,001), ajustado por ocho variables. CONCLUSIONES: en un estudio previo los accidentes laborales disminuyeron la frecuencia de trabajar en provincias, pero nuestro estudio dice lo contrario, posiblemente por la percepción de que un trabajo en la capital del país permite estar más cerca de los servicios para ser atendido en caso de cualquier emergencia.

Perinuclear anti-neutrophil cytoplasmic antibodies (p-anca) in chronic ulcerative colitis: experience in a Mexican institution.

AIM: To assess the prevalence and clinical value of p-ANCA in a sample of Mexican ulcerative colitis (UC) patients. METHODS: In a prospective, IRB-approved protocol, p-ANCA was determined in 80 patients with UC (mean age, 32 +/- 12.9 years). The severity and extension of disease were determined by clinical methods, searching a statistical association with p-ANCA status. RESULTS: p-ANCA were detected in 41 (51%) patients. Severity of disease was the only clinical variable statistically associated with their presence (P < 0.0001; OR = 9; CI 95% = 3.2-24.7). CONCLUSION: The prevalence of p-ANCA was similar to that reported in other countries. Their presence was associated to UC severity, but offered no more information than the obtained by clinical methods.

Hybrid Natural Orifice Translumenal Endoscopic Surgery Transvaginal Nephrectomy in a Low-Resource Setting.

INTRODUCTION: Hybrid natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) reduces the invasiveness of conventional laparoscopic surgery and overcomes the limitation of pure NOTES, especially in the absence of angulated instruments. PATIENTS AND METHODS: The patients were 66-, 69-, and 32-year-old women with complaints of recurrent flank pain and urinary tract infection due to an obstructed nonfunctioning kidney. Materials used were standard laparoscopic instruments and a 30° 10-mm high-definition laparoscope. Under general anesthesia, each patient was placed in a lithotomy position with the affected side up at 45°. A Veress needle was initially inserted through the umbilicus and was later replaced with a 10-mm laparoscopic port, with an additional 5-mm port also inserted at the affected lower quadrant site. The patient was then positioned in a steep Trendelenburg position, and a 10-mm port was inserted through the posterior vaginal wall under direct vision from the abdominal cavity that was later used for the laparoscope. Nephrectomy proceeded despite noted severe adhesions, and the kidney was placed in the specimen retrieval bag. The vaginal port site was enlarged to 3 cm for extraction of the specimen. A Penrose drain was placed at the lower quadrant 5-mm trocar site. The vaginal wound was repaired using running 2-0 absorbable sutures. RESULTS: Three cases of transvaginal hybrid NOTES nephrectomy were successfully completed with a median operative time of 310 minutes and mean estimated blood loss of 300 mL. Median renal dimensions were as follows: craniocaudal, 10.2 (range, 10.6-9) cm; laterolateral, 6.5 (range, 7-5.3) cm; and anteroposterior, 4.8 (range, 6.5-3.9) cm. The patients resumed regular diet as early as Day 1 postoperatively. The drain was removed prior to discharge. The mean date of discharge was Day 3 postoperatively. There were no noted surgical complications according to the Clavien-Dindo grading system. CONCLUSIONS: Hybrid NOTES transvaginal nephrectomy is a feasible and reproducible procedure in selected patients regardless of laterality for better cosmesis, reduced postoperative pain, and early recovery.

Epstein-Barr virus-associated gastric carcinoma: Evidence of age-dependence among a Mexican population.

AIM: To investigate features of Epstein-Barr virus (EBV)-associated gastric carcinoma (EBVaGC) among a Mexican population. METHODS: Cases of primary gastric adenocarcinoma were retrieved from the files of the Departments of Pathology at the Instituto Nacional de Cancerologia and the Instituto Nacional de la Nutricion in Mexico City. The anatomic site of the gastric neoplasia was identified, and carcinomas were histologically classified as intestinal and diffuse types and subclassified as proposed by the Japanese Research Society for Gastric Cancer. EBV-encoded small non-polyadenylated RNA-1 (EBER-1) in situ hybridization was conducted to determine the presence of EBV in neoplastic cells. RESULTS: We studied 330 consecutive, non-selected, primary gastric carcinomas. Among these, there were 173 male and 157 female patients (male/female ratio 1.1/1). EBER-1 was detected in 24 (7.3%) cases (male/female ratio: 1.2/1). The mean age for the entire group was 58.1 years (range: 20-88 years), whereas the mean age for patients harboring EBER-1-positive gastric carcinomas was 65.3 years (range: 50-84 years). Age and histological type showed statistically significant differences, when EBER-1-positive and -negative gastric carcinomas were compared. EBER-1 was detected in hyperplastic- and dysplastic-gastric mucosa surrounding two EBER-1-negative carcinomas, respectively. CONCLUSION: Among Latin-American countries, Mexico has the lowest frequency of EBVaGC. Indeed, the Mexican population >50 years of age was selectively affected. Ethnic variations are responsible for the epidemiologic behavior of EBVaGC among the worldwide population.

Gonadoblastoma in Turner syndrome patients with nonmosaic 45,X karyotype and Y chromosome sequences.

Turner syndrome (TS) is a disorder caused by partial or complete X-chromosome monosomy. Studies in TS patients with different karyotypes have demonstrated the presence of Y-chromosome-derived sequences (4-61%). Early detection of Y-chromosome sequences in TS is of great importance because of the high risk of gonadal tumor development. We investigated the presence of Y-chromosome sequences in TS patients with a 45,X karyotype. One hundred seven unrelated 45,X Mexican TS patients recruited between 1992 and 2003 were included. Y-chromosome-derived sequences were found by polymerase chain reaction in 10 (9.3%) patients. Six subjects underwent gonadectomy and in one of them a gonadoblastoma was found; another developed a gonadoblastoma with dysgerminoma. Because of the high proportion (33%) of gonadal tumors in patients with Y-chromosome sequences found among our patients of mestizo origin, adequate counseling regarding a gonadectomy should be given.

[Predictors of colectomy in patients with ulcerative colitis. A cohort analysis of 184 cases]. / Predictores de colectomía en enfermos con colitis ulcerativa crónica inespecífica (CUCI). Análisis de una cohorte de 184 casos.

BACKGROUND: At the present time procto-colectomy is the only potentially curative therapeutic measure for patients with ulcerative colitis (UC). Due to its morbidity and mortality, several prognostic indexes have been proposed to identify subjects in whom surgery could be beneficial. However, they have limited availability or they are very cumbersome for the individual patient. AIM: To analyze demographic, clinical and biochemical variables in a group of 184 Mexican patients with UC in order to identify predicting factors for procto-colectomy. PATIENTS AND METHODS: Subjects were divided into two groups: A. Those in whom a procto-colectomy was performed (n = 52) and B. Patients on medical treatment in = 132). Continuous variables were analyzed by means of the Student's t test and categorical variables by means of chi-square statistic. A multivariate analysis was performed using logistic regression. RESULTS: The main indication for surgery was failure to medical treatment (78%). Procto-colectomy was elective in 28 cases and an emergency procedure in 14 (7 failures to medical treatment, 4 colonic perforations, 2 toxic megacolons and 1 uncontrolled hemorrhage). All operated subjects had pancolitis and showed more bloody bowel movements per day (> 10), fever (> 38.5 degrees C), tachycardia, hipoalbuminemia and hospitalizations. Only hypoalbuminemia in subjects with universal colitis was consistently associated to procto-colectomy. CONCLUSION: Pancolitis, hypoalbuminemia and previous hospitalizations were the strongest predictors of procto-colectomy in our cohort. Thus, serum protein determinations can be useful in patients with universal UC to decide surgical therapy.

Histopathological environment besides the focus score in Sjögren's syndrome.

AIM: To compare the prevalence of diverse histopathologic features among patients with Sjögren's syndrome (SS) and controls, and to evaluate their relationship with age, a focus score (FS) ≥ 1 and some clinical and serological SS features. METHODS: A blinded pathologist examined 63 SS and 11 control minor salivary gland biopsies. Focal lymphocytic sialadenitis (FLS) was defined as a focus score (FS) ≥ 1. We also evaluated lymphoepithelial lesions, germinal centers (GCs), epithelial metaplasia, dilatation and hyperplasia in the main secretory duct, perivascular cell infiltrate, adipose infiltration, acinar atrophy, interstitial fibrosis and lymphocytes/plasma cells remote from the FLS. We registered demographics, anti-Ro/La status and clinical features. We used Kendall's tau coefficients and logistic regression analysis. RESULTS: Sjögren's syndrome patients had a higher frequency of FS ≥ 1 (92% vs. 27%), acinar atrophy (78% vs. 18%), lymphocytes and plasma cells external to the FSL (92% vs. 64%) and stromal fibrosis (68% vs. 36%). A FS ≥ 1 correlated with the presence of GCs and acinar atrophy; whereas age correlated with duct dilation, duct epithelial hyperplasia, adipose infiltration and fibrosis. SS patients with hepatic involvement exhibited more frequent duct dilatation. After adjusting by age, anti-Ro/SSA (odds ratio [OR] 30.8, 95% CI 2.2-423.5, P = 0.01), a FS ≥ 1 (OR 54.3, 95% CI 4.8-612, P = 0.001) and fibrosis (OR 15.2, 95% CI 1.2-186.2, P = 0.03) were associated with SS. CONCLUSION: Other histologic findings coexist with FLS, but only GC formation and acinar atrophy correlated with a FS ≥ 1. Age is mostly correlated with the remaining histological features. However, the clinical relevance of these findings is unknown.

Performance and bacterial population composition of an n-hexane degrading biofilter working under fluctuating conditions.

In this work, several conditions of pH and inlet load (IL) were applied to a scale laboratory biofilter treating n-hexane vapors during 143 days. During the first 79 days of operation (period 1, P1), the system was fed with neutral pH mineral medium (MM) and the IL was progressively decreased from 177 to 16 g m(-3) h(-1). A maximum elimination capacity (EC) of 30 g m(-3) h(-1) was obtained at an IL of 176.9 ± 9.8 g m(-3) h(-1). During the following 64 days (period 2, P2), acidic conditions were induced by feeding the biofilter with acidic buffer solution and pH 4 MM in order to evaluate the effect of bacterial community changes on EC. Within the acidic period, a maximum EC of 54 g m(-3) h(-1) (IL 132.3 ± 13 g m(-3) h(-1)) was achieved. Sequence analysis of 16S rDNA genes amplified from the consortium revealed the presence of Sphingobacteria, Actinobacteria, and α-, ß- and γ-Proteobacteria. An Actinobacteria of the Mycobacterium genus had presence throughout the whole experiment of biofiltration showing resistance to fluctuating pH and IL conditions. Batch tests confirm the bacterial predominance and a negligible contribution of fungi in the degradation of n-hexane.

[Study of correlation between diagnostic hypertriglyceridemic waist and metabolic syndrome in adults in Trujillo, Peru]. / Estudio de correlación entre los diagnósticos de cintura hipertrigliceridémica y síndrome metabólico en adultos de Trujillo, Perú

OBJECTIVES: To determine the correlation between hypertriglyceridemic waist (HTGW) and metabolic syndrome (MS) in adults of Trujillo according to diagnostic criteria. MATERIALS AND METHODS: Observational, prospective and cross-sectional study with a sample of 500 adults in Trujillo, selected by probability sampling and stratified by sex and age. Information on anthropometric measurements, blood pressure and biochemical tests was collected; Criteria proposed by the ATP III and Joint Interim Statement (JIS) for MS, as well as Gomez and JIS for HTGW were applied. EPIDAT software was used to calculate Z test, Student t test and the Kappa (k) with a confidence interval (CI) of 95%. RESULTS: Information regarding 239 men and 261 women were collected. The frequency of HTGW according to Gomez criteria was 30% in the total sample, 29.7% in men and 30.3% women. According to JIS criteria the frequency was 34% in the total sample, 38.1% in men and 30.3% women. Metabolic Syndrome with JIS criteria had good agreement with HTGW according to Gomez criteria with k = 0.63 and according to JIS criteria with k = 0.66. CONCLUSIONS: Good agreement was evidenced between the HTGW according to Gomez and JIS criteria and MS according to JIS.