Adherence to optimal medical therapy and control of cardiovascular risk factors in patients after ST elevation myocardial infarction in Mexico.

Introduction: In developing countries, there is a notable scarcity of real-world data on adherence to optimal medical therapy (OMT) and its correlation with major cardiovascular adverse events (MACEs) after ST-elevation myocardial infarction (STEMI). Our study focuses on addressing this gap by evaluating adherence to OMT, examining its influence on the risk of MACEs after STEMI, and assessing subsequent cardiovascular risk factor control in Mexico. Methods: We conducted a prospective observational study of post-STEMI patients after hospital discharge. Adherence to treatment was assessed over a median of 683 days (interquartile range: 478-833) using the Simplified Medication Adherence Questionnaire (SMAQ). Patients were followed up for 4.5 years to monitor MACEs (cardiovascular death, cardiogenic shock, recurrent myocardial infarction, and heart failure). Results: We included 349 patients with a mean age of 58.08 years (±10.9), predominantly male (89.9%). Hypertension (42.4%), smoking (34.3%), type 2 diabetes mellitus (31.2%), obesity (22.92%), and dyslipidemia (21.4%) were highly prevalent. Adherence to OMT per SMAQ was 44.7%. The baseline clinical characteristics of adherent and non-adherent patients did not significantly differ. OMT prescription rates were as follows: acetylsalicylic acid, 91.1%; P2Y12 inhibitors, 76.5%; and high-intensity statins, 86.6%. While non-adherent patients had a numerically higher rate of MACEs (73 vs. 49 first events), there was no statistically significant difference (hazard ratio 1.30, 95% confidence interval 0.90-1.88). Discussion: In this real-world study of patients after STEMI, we observed low adherence to OMT, a low proportion of global cardiovascular risk factor control, and a numerically higher incidence of recurrent major adverse cardiovascular events in non-adherent patients. Strategies to improve adherence to OMT and risk factor control are needed.

Carcinoma Intraductal de Glándula Parótida. Reporte de un Caso en Chile

El carcinoma intraductal es una neoplasia maligna de glándulas salivales infrecuente, la cual se caracteriza por un crecimiento predominantemente intraductal, cuyas células poseen un fenotipo con características ductales. Histológicamente se encuentra compuesto por múltiples estructuras quísticas, con arquitectura cribiforme y proliferación celular con fenestraciones flexibles y una apariencia reticular irregular. Se presenta el caso de una paciente, género femenino, de 67 años, con antecedentes de artritis reumatoidea y una neoplasia intraepitelial tratada (NIE I), que consulta en el policlínico de cirugía del Hospital Regional Antofagasta en el año 2017 por aumento de volumen de consistencia firme, en área de glándula parótida izquierda, de aproximadamente un año de evolución, con dolor de intensidad moderada. Mediante pruebas inmunohistoquímicas se logra confirmar el diagnóstico de carcinoma intraductal de parótida.

Intraductal carcinoma is a rare malignant neoplasm of the salivary glands characterized by predominantly intraductal growth, isolated cells a phenotype with ductal characteristics. Histologically, it is composed of multiple cystic structures, with cribiform architecture and cell proliferation which can present floppy fenestrations and an irregular slits appearance. We present the case of a 67-year- old female patient with a history of rheumatoid arthritis and a treated intraepithelial neoplasm (NIE I), who consulted at the surgery polyclinic of the Hospital Regional Antofagasta in 2017 for increased volume of firm consistency, in the left parotid gland area, approximately one year in evolution, with pain of moderate intensity. Immunohistochemical tests confirm the diagnosis of intraductal parotid carcinoma.

Trombocitopenia inducida por rifampicina / Rifampicin-induced thrombocytopenia

RESUMEN La trombocitopenia inducida por rifampicina es un fenómeno de origen inmune cuya presentación es inusual pero potencialmente fatal. Se presenta el caso de un paciente inmunocomprometido y con tuberculosis diseminada quien desarrolló trombocitopenia inducida por rifampicina en las primeras 12 horas tras inicio de la terapia antituberculosa sin que mediara sensibilización previa al medicamento. Se confirmó la relación de causa-efecto al resolverse la trombocitopenia con la suspensión de la rifampicina y al reaparecer con la re-exposición al fármaco.

SUMMARY Rifampicin-induced thrombocytopenia is a rare but potentially fatal immune phenomenon. We report the case of an immunocompromised patient with disseminated tuberculosis who developed rifampicin-induced thrombocytopenia 12 hours after starting anti-tuberculous therapy without previous drug sensitization. The cause-effect relationship was confirmed when thrombocytopenia resolved with rifampicin suspension but later reappeared upon drug re-exposure.

Home Environmental Influences on Childhood Obesity in the Latino Population: A Decade Review of Literature.

Latinos are the largest and fastest-growing ethnically diverse group in the United States. Latino children are also among the most overweight and obese ethnic groups of children in the United States. Research over the last decade has identified the home environment as a key influence on the diet and physical activity of children. To summarize cross-sectional and longitudinal research that has identified factors within the home environment of Latino families that are associated with childhood obesity and to provide recommendations for future research and intervention development with Latino families. A decade review from 2005 to 2015 was conducted. Studies identifying factors within the home environments of Latino families that were associated with childhood obesity were examined. Five main factors were identified across the literature as home environment factors that are associated with childhood obesity in Latino children. These factors included: parental influences (e.g., parent feeding practices, modeling), screen time, physical activity/sedentary behavior, socioeconomic status/food security and sleep duration. The current review identified several home environment factors that may contribute to the disparities in childhood obesity for Latino children. Results from this review such as, focusing on decreasing controlling parent feeding practices, and increasing parent modeling of healthy behaviors and child sleep duration, can be used in developing culturally-specific interventions for Latino children.

Epidemiología de las infecciones bacterianas en pacientes con cirrosis hepática, experiencia de un centro español de atención terciaria / Epidemiology of bacterial infections in patients with liver cirrhosis. Experience in a Spanish tertiary health center

Introducción. Las infecciones bacterianas representan una complicación grave de la cirrosis. En los últimos años se han observado cambios en el espectro microbiológico de estas infecciones, fundamentalmente, el aumento de infecciones por gérmenes multirresistentes. Objetivo. Establecer la proporción de infecciones por microorganismos multirresistentes en pacientes cirróticos ingresados en un centro de atención de Madrid, y analizar su epidemiología, factores de riesgo e impacto clínico. Materiales y métodos. Se hizo un estudio retrospectivo en el cual se evaluaron 294 pacientes hospitalizados por infección bacteriana en el Hospital General Universitario Gregorio Marañón de Madrid, entre junio de 2011 y junio de 2013. Resultados. Se aislaron 310 microorganismos de 223 pacientes; 109 (35,2 %) eran Gram positivos, 167 (53,9 %), Gram negativos, y 34 (11 %), hongos. El agente etiológico más frecuente fue Escherichia coli (98 aislamientos). Las infecciones se habían adquirido en la comunidad en 22,9 % de los casos, se asociaron con la atención de salud en 38,1 % y se adquirieron durante la estancia hospitalaria en 39 %. Los pacientes con aislamientos multirresistentes desarrollaron con más frecuencia choque séptico (p=0,05), y presentaron peor función hepática y alta mortalidad durante la estancia hospitalaria (p=0,017). El ingreso previo, el uso de antibióticos en los 60 días anteriores, la adquisición de la infección en el hospital o asociada a un ingreso reciente y el aislamiento de bacterias en los cultivos de control, se determinaron como posibles factores de riesgo para el desarrollo de la infección multirresistente. Discusión. Los resultados del estudio confirmaron que el espectro microbiológico de las infecciones bacterianas en pacientes con cirrosis ha sufrido importantes cambios. Las infecciones por gérmenes multirresistentes causan infecciones con gran morbimortalidad y el fracaso del tratamiento antibiótico habitual. Para controlarlas de forma eficaz, es imprescindible detectar precozmente a aquellos pacientes con factores de riesgo.

Introduction: Bacterial infections represent a serious complication of liver cirrhosis. Traditionally, Gram negative bacteria have been described as the microorganisms responsible for the majority of the infections. However, in the past few years, changes in the microbiological spectrum have been described, and multiresistant bacteria are observed more frequently. Objective: To assess the proportion of patients with infections caused by multiresistant bacteria admitted to our hospital, and to obtain information about their epidemiology, risk factors and clinical impact. Materials and methods: We performed a retrospective evaluation of 294 cirrhotic patients admitted to our unit due to infection between June, 2011, and June, 2013. Results: We isolated 310 microorganisms from 294 patients; 109 (35.2%) were Gram positive, 167 (53.9%), Gram negative, and 34, fungi (11%). As for the microbiological agents, the most frequent was Escherichia coli (98 isolations). The infection was community-acquired in 22.9% of cases, healthcare-associated in 38.1% and nosocomial in 39%. Worse liver infections and septic shock were more frequent among patients with multiresistant isolates (p=0.05); and intrahospital mortality was also higher among them (p=0.017). Previous hospital admission, antibiotic treatment 60 days before, nosocomial or healthcare-associated acquisition and bacterial isolation in control cultures were identified as possible risk factors for the development of multiresistant infection. Discussion: The results of our study confirm that important changes have ocurred in the microbiological spectrum of bacterial infections in patients with liver cirrhosis. Multiresistant bacteria are associated with high morbidity and mortality, as well as failure of traditional antibiotic treatment. Successfull control of the infection requires an early identification of patients at risk.

Immortalization of bovine umbilical vein endothelial cells: a model for the study of vascular endothelium.

Endothelial cells perform a large array of physiological functions that are influenced by their cellular heterogeneity in the different vascular beds. Vein endothelial cells isolated from the umbilical cords are commonly used to study vascular endothelium. Primary cultures of these cells, however, have low proliferative capacity and a limited life span. We have immortalized bovine umbilical vein endothelial cells (BUVEC) by transfection with an expression vector containing the human papillomavirus type 16 E6E7 oncogenes. Expression of E6E7 extended the life span of BUVEC from 40 to more than 1-20 cell replication cycles with no signs of senescence. Four immortalized clones were isolated and found to maintain endothelial cell properties, such as the uptake of acetylated low density lipoprotein, the expression of the von Willebrand protein, the binding of endothelial cell-specific lectins and proliferative responses to the specific endothelial cell mitogen, vascular endothelial growth factor. Moreover, clone BVE-E6E7-1, like its wild-type counterparts, expressed prolactin mRNA and decreased its proliferation in response to the anti-angiogenic 16-kDa fragment of prolactin. This clone showed little signs of genetic instability as revealed by centrosome and chromosome number analysis. Thus, immortalized E6E7 BUVEC cell lines retain endothelial cell characteristics and could facilitate studies to investigate the action of regulatory factors of vascular endothelium. Moreover, being the first non-human umbilical vein endothelial cell lines, their use should provide insights into the mechanisms governing species-related heterogeneity of endothelial cells.