Does the esv3587290 Copy Number Variation in the VANGL1 Gene Differ as a Genetic Factor for Developing Nephritis in Mexican Childhood-Onset Systemic Lupus Erythematosus Patients?

A ~3-kb deletion-type DNA copy number variation (CNV, esv3587290) located at intron 7 of the VANGL1 gene (1p13.1, MIM*610132) has been proposed as a genetic factor in lupus nephritis (LN) development in adult systemic lupus erythematosus (SLE) patients across European-descent populations, but its replication in other ethnicities has been inconsistent and its association with LN in childhood-onset SLE (cSLE) remains unknown. Here, we performed an exploratory association study in a sample of 66 unrelated cSLE Mexican patients (11 males, 55 females; ages 7.8 to 18.6 years). Two stratified groups were compared: cSLE patients with (N = 39) or without (N = 27) LN, as diagnosed by renal biopsy (N = 17), proteinuria (N = 33), urinary protein-creatinine ratio > 0.2 (N = 34), and erythrocyturia and/or granular casts in urinary sediment (N = 16). For esv3587290 CNV genotyping, we performed an end-point PCR assay with breakpoint confirmation using Sanger sequencing. We also determined the allelic frequencies of the esv3587290 CNV in 181 deidentified ethnically matched individuals (reference group). The obtained genotypes were tested for Hardy-Weinberg equilibrium using the χ2 test. Associations between LN and esv3587290 CNV were tested by calculating the odds ratio (OR) and using Pearson's χ2 tests, with a 95% confidence interval and p ≤ 0.05. The esv3587290 CNV allele (OR 0.108, 95% CI 0.034-0.33, p = 0.0003) and the heterozygous genotype (OR 0.04, 95% CI 0.119-0.9811, p = 0.002) showed a significant protective effect against LN development. Finally, we characterized the precise breakpoint of the esv3587290 CNV to be NG_016548.1(NM_138959.3):c.1314+1339_1315-897del in our population. This report supports the notion that a broad genetic heterogeneity underlies the susceptibility for developing LN.

Segmental Clavicle Fracture in a Polytraumatized Patient: Case Report.

Clavicle fracture represents 5% of the fractures in adults. However, segmental clavicle fractures are infrequent and have been understudied in the current literature. Cases have been reported showing adequate results with both surgical and conservative management, and yet, it has not been possible to reach a consensus regarding diagnosis or management of such condition. A patient with a middle and lateral segmental clavicle fracture is reported, after presenting multiple trauma in a road traffic accident, also suffering trauma to the right hemi body, multiple rib segmental fractures and hemothorax. After stabilization, he was taken to surgery for open reduction and internal fixation of the clavicle using a double plate technique, as it has been rarely described in the literature. The functional result was shown to be adequate and satisfactory in the postoperative follow-up. Despite the limited evidence available on the management of this type of pathology, surgical management is a valid option given the risk of non-union. The foregoing is concluded by the potential harm in patient functionality.

Segmental Clavicle Fracture in a Polytraumatized Patient: Case Report / Fratura segmentar da clavícula em paciente politraumatizado: Relato de caso

Abstract Clavicle fracture represents 5% of the fractures in adults. However, segmental clavicle fractures are infrequent and have been understudied in the current literature. Cases have been reported showing adequate results with both surgical and conservative management, and yet, it has not been possible to reach a consensus regarding diagnosis or management of such condition. A patient with a middle and lateral segmental clavicle fracture is reported, after presenting multiple trauma in a road traffic accident, also suffering trauma to the right hemi body, multiple rib segmental fractures and hemothorax. After stabilization, he was taken to surgery for open reduction and internal fixation of the clavicle using a double plate technique, as it has been rarely described in the literature. The functional result was shown to be adequate and satisfactory in the postoperative follow-up. Despite the limited evidence available on the management of this type of pathology, surgical management is a valid option given the risk of non-union. The foregoing is concluded by the potential harm in patient functionality.

Resumo A fratura de clavícula representa 5% das fraturas em adultos. No entanto, as fraturas segmentares da clavícula são infrequentes e pouco estudadas na literatura atual. Há relatos de casos com bons resultados após o tratamento cirúrgico ou conservador, mas não existe consenso quanto ao diagnóstico ou manejo dessas lesões. Relata-se um paciente com fratura segmentar média e lateral da clavícula após politraumatismo em acidente de trânsito. O paciente também apresentava traumatismo em hemicorpo direito, múltiplas fraturas segmentares da costela e do hemotórax. Após estabilização, ele foi encaminhado à cirurgia para redução aberta e fixação interna da clavícula pela técnica de placa dupla, raramente descrita na literatura. O resultado funcional foi considerado satisfatório e adequado no acompanhamento pós-operatório. Apesar das poucas evidências sobre o manejo desse tipo de patologia, o tratamento cirúrgico é uma opção válida devido ao risco de não união, apesar da possível diminuição da funcionalidade do paciente.

Factores de riesgo y medidas preventivas del cáncer de mama en pacientes mujeres atendidas en el Centro de Salud Subtanjalla, Ica ­2019 / Risk factors and preventive measures for breast cancer in female patients treated at the Subtanjalla health center, Ica ­2019

El estudio tuvo como Objetivo: Identificar los factores de riesgo y medidas preventivas del cáncer de mama en pacientes mujeres atendidas en el centro de salud Subtanjalla de Ica -2019. Material y métodos: De tipo no experimental, descriptivo, transversal, con muestra de 108 mujeres, aplicándose un cuestionario estructurado de 15 preguntas, validado por expertos, y con Alfa de Cronbach de 0.77. Resultados: Los factores más relevantes menarquia precoz, que fue a los 12 años en el 35%, los antecedentes familiares con cáncer con un 51%, el 44% utiliza el inyectable como método anticonceptivo, el 65% a veces consume bebidas alcohólicas; en las medidas preventivas el 75% no realiza actividad física, el 49% no consume frutas y verduras frecuentemente, el 44% no se realiza el autoexamen de mama; según los factores de riesgo; el 44% de mujeres tienen entre 21 a 30 años; el 35% de mujeres tuvo su primera menstruación a los 12 años; el 32% de mujeres no utiliza ningún método anticonceptivo;, el 51% de mujeres tienen antecedentes de cáncer; el 81% de mujeres no consume cigarrillos, el 69% de mujeres consume bebidas alcohólicas a veces. El 75% de mujeres no realiza actividad preventiva, el 49% de mujeres tienen dieta saludable; el 44% de mujeres refiere realizar cada mes el autoexamen de mama. Conclusiones: Los datos estadísticos demuestran que existen factores de riesgo y medidas preventivas del cáncer de mama.

The study was Objective: To identify the risk factors and preventive measures of breast cancer in female patients treated at the Subtanjalla health center in Ica -2019. Material and methods:Non-experimental, descriptive, cross-sectional, with a sample of 108 women, applying a structured questionnaire of 15 questions, validated by experts, and with Cronbach's Alpha of 0.77. Results:The most relevant factors were early menarche, which was at 12 years of age in 35%, a family history of cancer with 51%, 44% used injectables as a contraceptive method, 65% sometimes consumed alcoholic beverages; In preventive measures, 75% do not perform physical activity, 49% do not consume fruits and vegetables frequently, 44% do not perform breast self-examination; according to risk factors; 44% of women are between 21 and 30 years old; 35% of women had their first menstruation at age 12; 32% of women do not use any contraceptive method; 51% of women have a history of cancer; 81% of women do not consume cigarettes, 69% of women sometimes consume alcoholic beverages. 75% of women do not carry out preventive activity, 49% of women have a healthy diet; 44% of women report performing a breast self-examination every month. Conclusions:Statistical data demonstrate that there are risk factors and preventive measures for breast cancer.Keywords: Risk factors, preventive measures, cancer.

Central venous-to-arterial CO2 difference as a biomarker of outcome in children who underwent surgery for congenital heart disease.

BACKGROUND: In congenital heart surgery, low cardiac output syndrome (LCOS) is a major cause of morbidity in the immediate post-operative period. A decrease in cardiac output leads to an increase in tissue oxygen consumption. Several biomarkers such as venous oxygen saturation (SvO2), arteriovenous oxygen difference (DavO2), and lactate can assess tissue perfusion in the presence of LCOS. Recently, central venous to arterial CO2 difference (ΔCO2) has been proposed as a biomarker of tissue ischemia that could be used as a predictor of death in neonatal patients. This study aimed to analyze the relationship between ΔCO2 and immediate post-operative outcomes in pediatric patients undergoing congenital heart surgery and its correlation with DavO2, SvO2, and lactate. METHODS: We conducted a longitudinal study of patients aged 0-18 years who underwent congenital heart surgery with or without cardiopulmonary bypass at the Instituto Nacional de Pediatría, from March 2019 to March 2021. RESULTS: Eighty-two patients were included; the median age was 17 months. About 59% had a ΔCO2 ≥ 6 mmHg. Patients with ΔCO2 ≥ 6 mmHg had a vasoactive-inotropic score > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048), and lactate > 2 mmol/L (p = 0.027), as well as a longer hospital stay (p = 0.043). Patients with ΔCO2 > 6 mmHg and vasoactive-inotropic score ≥ 10 were 12.6 times more likely to die. CONCLUSION: ΔCO2 is a good marker of tissue hypoperfusion and outcome in the post-operative period of congenital heart surgery.

INTRODUCCIÓN: En la cirugía cardiaca de malformaciones congénitas, el síndrome de bajo gasto cardiaco (SBGC) es una de las principales causas de morbilidad en el postoperatorio inmediato. La caída del gasto cardiaco aumenta el consumo de oxígeno en los tejidos. Varios biomarcadores, como la saturación venosa de oxígeno (SvO2), la diferencia arteriovenosa de oxígeno (DavO2) y el lactato han sido utilizados como indicadores hipoperfusión tisular en presencia de SBGC. Recientemente, la diferencia arteriovenosa de CO2 (ΔCO2) se ha propuesto como otro biomarcador de isquemia tisular que podría utilizarse como predictor de muerte en pacientes en edad neonatal. El objetivo de este estudio fue analizar la relación entre la ΔCO2 y la evolución postoperatoria de pacientes pediátricos operados de cardiopatías congénitas y correlacionarlo con la DavO2, SvO2 y lactato. MÉTODOS: Se realizó un estudio longitudinal en pacientes de 0 a 18 años operados de corazón con empleo de bomba de circulación extracorpórea en el Instituto Nacional de Pediatría. RESULTADOS: Se incluyeron 82 pacientes; la mediana de edad fue de 17 meses. El 59% presentó un ΔCO2 > 6 mmHg. Los pacientes con un ΔCO2 > 6 mmHg mostraron un puntaje de inotrópicos > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048) y lactato > 2 mmol/L (p = 0.027), así como mayor estancia hospitalaria (p = 0.043). Los pacientes con ΔCO2 > 6 mmHg y un puntaje de inotrópicos ≥ 10 presentaron una probabilidad de muerte 12.6 veces mayor. CONCLUSIONES: El ΔCO2 en el periodo postoperatorio de una cirugía cardiaca congénita es un buen marcador de hipoperfusión tisular y de desenlace.

Central venous-to-arterial CO2 difference as a biomarker of outcome in children who underwent surgery for congenital heart disease / Diferencia arteriovenosa de CO2 como biomarcador de desenlace en niños operados de cardiopatías congénitas

Abstract Background: In congenital heart surgery, low cardiac output syndrome (LCOS) is a major cause of morbidity in the immediate post-operative period. A decrease in cardiac output leads to an increase in tissue oxygen consumption. Several biomarkers such as venous oxygen saturation (SvO2), arteriovenous oxygen difference (DavO2), and lactate can assess tissue perfusion in the presence of LCOS. Recently, central venous to arterial CO2 difference (ΔCO2) has been proposed as a biomarker of tissue ischemia that could be used as a predictor of death in neonatal patients. This study aimed to analyze the relationship between ΔCO2 and immediate post-operative outcomes in pediatric patients undergoing congenital heart surgery and its correlation with DavO2, SvO2, and lactate. Methods: We conducted a longitudinal study of patients aged 0-18 years who underwent congenital heart surgery with or without cardiopulmonary bypass at the Instituto Nacional de Pediatría, from March 2019 to March 2021. Results: Eighty-two patients were included; the median age was 17 months. About 59% had a ΔCO2 ≥ 6 mmHg. Patients with ΔCO2 ≥ 6 mmHg had a vasoactive-inotropic score > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048), and lactate > 2 mmol/L (p = 0.027), as well as a longer hospital stay (p = 0.043). Patients with ΔCO2 > 6 mmHg and vasoactive-inotropic score ≥ 10 were 12.6 times more likely to die. Conclusion: ΔCO2 is a good marker of tissue hypoperfusion and outcome in the post-operative period of congenital heart surgery.

Resumen Introducción: En la cirugía cardiaca de malformaciones congénitas, el síndrome de bajo gasto cardiaco (SBGC) es una de las principales causas de morbilidad en el postoperatorio inmediato. La caída del gasto cardiaco aumenta el consumo de oxígeno en los tejidos. Varios biomarcadores, como la saturación venosa de oxígeno (SvO2), la diferencia arteriovenosa de oxígeno (DavO2) y el lactato han sido utilizados como indicadores hipoperfusión tisular en presencia de SBGC. Recientemente, la diferencia arteriovenosa de CO2 (ΔCO2) se ha propuesto como otro biomarcador de isquemia tisular que podría utilizarse como predictor de muerte en pacientes en edad neonatal. El objetivo de este estudio fue analizar la relación entre la ΔCO2 y la evolución postoperatoria de pacientes pediátricos operados de cardiopatías congénitas y correlacionarlo con la DavO2, SvO2 y lactato. Métodos: Se realizó un estudio longitudinal en pacientes de 0 a 18 años operados de corazón con empleo de bomba de circulación extracorpórea en el Instituto Nacional de Pediatría. Resultados: Se incluyeron 82 pacientes; la mediana de edad fue de 17 meses. El 59% presentó un ΔCO2 > 6 mmHg. Los pacientes con un ΔCO2 > 6 mmHg mostraron un puntaje de inotrópicos > 5 (p < 0.001), DavO2 > 5 mL/dL (p = 0.048) y lactato > 2 mmol/L (p = 0.027), así como mayor estancia hospitalaria (p = 0.043). Los pacientes con ΔCO2 > 6 mmHg y un puntaje de inotrópicos ≥ 10 presentaron una probabilidad de muerte 12.6 veces mayor. Conclusiones: El ΔCO2 en el periodo postoperatorio de una cirugía cardiaca congénita es un buen marcador de hipoperfusión tisular y de desenlace.

Vacunación de BCG en el medio rural y la importancia del conocimiento de sus beneficios / BCG vaccination in rural areas and the importance of knowledge of its benefits

Objetivo General: Establecer nivel de conocimiento sobre tuberculosis y vacuna, BCG., de padres y representantes, en Ambulatorio Gabriel Trompiz, Tucacas, Estado Falcón. Metodología: Es un estudio descriptivo de tipo transversal, con una muestra poblacional de 180 madres, padres y representantes entre octubre y diciembre de 2022. Se utilizaron encuestas, formularios elaborados y validados en estudios anteriores; la información fue procesada con el programa estadístico Microsoft Excel. Resultados: la mayor parte de la población respondió que la tuberculosis es una enfermedad producida por un virus, con respecto a la importancia de las inmunizaciones, un 20% desconocía la importancia de la vacunación. El 77% conocían información básica acerca de la vacuna BCG. En cuanto a las enfermedades prevenibles por esta vacuna, un 54% respondió que se trataba sobre la tuberculosis, mientras que casi la mitad de la población estudiada tenía la creencia que tenía que ver con el resfriado común. El 72% de la población considera que la fiebre es una contraindicación para la aplicación de la vacuna BCG. Se demostró que existía una gran desinformación con respecto a la vacunación en la población infantil en el medio rural venezolano(AU)

To establish the level of knowledge about tuberculosis and BCG vaccine., of parents and representatives in the Gabriel Trompiz outpatient clinic, Tucacas, Falcon State. Methodology: it is a descriptive cross-sectional study, with a population sample of 180 mothers, fathers and representatives between October and December 2022. Surveys, forms prepared and validated in previous studies were used, the information was processedwith the Microsoft Excel statistical program. Results: most of the population answered that tuberculosis was a disease caused by a virus, regarding the importance of immunizations, 20% were unaware of the importance of vaccination. 77% knew basic information about the BCG vaccine. Regarding the diseases preventable by this vaccine, 54% answered that it was about tuberculosis, while almost half of the population studied believed that it had to do with the common cold. 72% of the population considers that fever is a contraindication for the application of the BCG vaccine. It was demonstrated that there was a great amount of misinformation regarding vaccination in the child population in rural Venezuela(AU)

Risk factors for reamputation in patients with diabetic foot: A case-control study.

BACKGROUND: Reamputation as a complication of diabetic foot ulcers presents a high economic burden and represents a therapeutic failure. It is paramount to identify as early as possible patients in whom a minor amputation may not be the best option. The purpose of this investigation was to do a case-controlled study to determine risk factors associated with re-amputation in patients with DFU (diabetic foot ulcers) at two University Hospitals. METHODS: Multicentric, observational, retrospective, case-control study from clinical records of 2 university hospitals. Our study included 420 patients, with 171 cases (re-amputations), and 249 controls. We performed a multivariate logistic regression analysis and time-to-event survival analysis to identify re-amputation risk factors. RESULTS: Statistically significant risk factors were artery history of tobacco use (p = 0.001); male sex (p = 0.048); arterial occlusion in Doppler ultrasound (p = 0.001); percentage of stenosis in arterial ultrasound >50 % (p = 0.053); requirement of vascular intervention (p = 0.01); and microvascular involvement in photoplethysmography (p = 0.033). The most parsimonious regression model suggests that history of tobacco use, male sex, arterial occlusion in ultrasound, and percentage of stenosis in arterial ultrasound >50 % remained statistically significant. The survival analysis identified earlier amputations in patients with larger occlusion in arterial ultrasound, high leukocyte count, and elevated ESR. CONCLUSION: Direct and surrogate outcomes in patients with diabetic foot ulcers identify vascular involvement as an important risk factor for reamputation. LEVEL OF EVIDENCE: III.

Percepción de la imagen corporal relacionado al nivel de autoestima en estudiantes del quinto grado de secundaria de la I.E. José Toribio Polo, Ica. 2019 ­2020 / Perception of body image related to the level of self-esteem in students of the fifth grade of secondary school of the I.E. Jose Toribio Polo, Ica. 2019 ­2020

El presente estudio tuvo como Objetivo: Establecer la relación entre la percepción de la imagen corporal y el nivel de autoestima en estudiantes del quinto grado de secundaria de la I.E. José Toribio Polo, Ica. 2019 ­2020. Material y métodos: Es una investigación cuantitativa, de diseño descriptivo de corte transversal. La muestra estuvo constituida por 75 estudiantes. Resultados: El 58,67% de estudiantes tiene moderada insatisfacción corporal, el 25,33% tiene leve insatisfacción corporal, el 13,33% tiene severa insatisfacción corporal y el 2,67% no tiene insatisfacción corporal. El 53,33% de estudiantes tienen autoestima media, el 46,67% tienen autoestima baja y el 1,33% tiene autoestima elevada. Conclusiones: Con la prueba estadística se demuestra que existe relación entre la percepción de la imagen corporal relacionado al nivel de autoestima en estudiantes del quinto grado de secundaria de la I.E. José Toribio Polo, Ica. 2019 ­2020. (AU)

The Objective of this study was to: Establish the relationship between the perception of body image and the level of self-esteem in students of the fifth grade of secondary school of the I.E. Jose Toribio Polo, Ica. 2019 ­2020. Material and methods: It are quantitative research, with a descriptive cross-sectional design. The sample consisted of 75 students. Results:58.67% of students have moderate body dissatisfaction, 25.33% have mild body dissatisfaction, 13.33% have severe body dissatisfaction and 2.67% do not have body dissatisfaction. 53.33% of students have medium self-esteem, 46.67% have low self-esteem and 1.33% have high self-esteem. Conclusions: With the statisticaltest, it is shown that there is a relationship between the perception of body image related to the level of self-esteem in students of the fifth grade of secondary school of the I.E. Jose Toribio Polo, Ica. 2019 ­2020. (AU)

Fluid overload as a predictor of morbidity and mortality in pediatric patients following congenital heart surgery.

BACKGROUND: Patients undergoing congenital heart surgery with cardiopulmonary bypass frequently require the administration of intravenous fluids and blood products due to hemodynamic instability. Correctly performed fluid resuscitation can revert the state of tissue hypoperfusion in the different organs. However, excessive fluid administration and acute kidney injury may promote fluid overload (FO) and increase the risk of complications, hospital stay, and mortality. METHODS: We conducted a prospective longitudinal study of pediatric patients with congenital heart surgery and cardiopulmonary bypass in the Pediatric Cardiac Intensive Care Unit (PCICU), Instituto Nacional de Pediatría, from July 2018 to December 2019. Fluid overload was quantified every 24 hours during the first 3 days of stay at the PCICU and expressed as a percentage. We recorded PCICU stay, days of mechanical ventilation, and mortality as outcome variables. RESULTS: We included 130 patients. The main factors associated with fluid overload were age < 1 year (p < 0.001), weight < 5 kg (p < 0.001), and longer cardiopulmonary bypass time (p = 0.003). Patients with fluid overload ≥ 5% had higher inotropic score (p < 0.001), higher oxygenation index (p < 0.001), and longer mechanical ventilation time (p < 0.001). Fluid overload ≥ 5% was associated with higher postoperative mortality (odds ratio 89, p = 0.004). CONCLUSIONS: Fluid overload can be used as a prognostic factor in the evolution of pediatric patients undergoing congenital heart surgery since it is associated with increased morbidity and mortality.

INTRODUCCIÓN: Los pacientes con cirugía cardiaca congénita en la que se emplea una bomba de circulación extracorpórea frecuentemente requieren la administración de líquidos intravenosos y hemoderivados por inestabilidad hemodinámica. La resucitación con volumen realizada adecuadamente puede revertir el estado de hipoperfusión tisular en los diferentes órganos. Sin embargo, el ingreso excesivo de líquidos y la falla renal aguda pueden favorecer la sobrecarga hídrica (SH) e incrementar el riesgo de complicaciones, la estancia hospitalaria y la mortalidad. MÉTODOS: Se llevó a cabo un estudio prospectivo longitudinal de pacientes pediátricos con cirugía del corazón y empleo de bomba de circulación extracorpórea en la Unidad de Cuidados Intensivos Cardiovasculares (UCICV), Instituto Nacional de Pediatría, de julio 2018 a diciembre 2019. La SH, registrada como porcentaje, fue cuantificada cada 24 horas durante los primeros 3 días de estancia en UCICV. Como variables de desenlace se registraron la estancia en UCICV, el tiempo de ventilación mecánica y la mortalidad. ­. RESULTADOS: Se incluyeron 130 pacientes. Los principales factores asociados con la SH fueron la edad < 1 año (p < 0.001), peso < 5 kg (p < 0.001) y mayor tiempo de circulación extracorpórea (p = 0.003). Los pacientes con SH ≥ 5% presentaron mayor puntaje inotrópico (p < 0.001), mayor índice de oxigenación (p < 0.001) y mayor tiempo de ventilación mecánica (p < 0.001). La SH ≥ 5% se asoció con una mayor probabilidad de muerte en el periodo posoperatorio (razón de momios: 89, p = 0.004). CONCLUSIONES: La SH puede utilizarse como factor pronóstico en la evolución de los pacientes pediátricos operados de corazón, ya que se asocia con una mayor morbimortalidad.

Fluid overload as a predictor of morbidity and mortality in pediatric patients following congenital heart surgery / Sobrecarga hídrica como predictor de morbilidad y mortalidad en pacientes pediátricos operados de corazón

Abstract Background: Patients undergoing congenital heart surgery with cardiopulmonary bypass frequently require the administration of intravenous fluids and blood products due to hemodynamic instability. Correctly performed fluid resuscitation can revert the state of tissue hypoperfusion in the different organs. However, excessive fluid administration and acute kidney injury may promote fluid overload (FO) and increase the risk of complications, hospital stay, and mortality. Methods: We conducted a prospective longitudinal study of pediatric patients with congenital heart surgery and cardiopulmonary bypass in the Pediatric Cardiac Intensive Care Unit (PCICU), Instituto Nacional de Pediatría, from July 2018 to December 2019. Fluid overload was quantified every 24 hours during the first 3 days of stay at the PCICU and expressed as a percentage. We recorded PCICU stay, days of mechanical ventilation, and mortality as outcome variables. Results: We included 130 patients. The main factors associated with fluid overload were age < 1 year (p < 0.001), weight < 5 kg (p < 0.001), and longer cardiopulmonary bypass time (p = 0.003). Patients with fluid overload ≥ 5% had higher inotropic score (p < 0.001), higher oxygenation index (p < 0.001), and longer mechanical ventilation time (p < 0.001). Fluid overload ≥ 5% was associated with higher postoperative mortality (odds ratio 89, p = 0.004). Conclusions: Fluid overload can be used as a prognostic factor in the evolution of pediatric patients undergoing congenital heart surgery since it is associated with increased morbidity and mortality.

Resumen Introducción: Los pacientes con cirugía cardiaca congénita en la que se emplea una bomba de circulación extracorpórea frecuentemente requieren la administración de líquidos intravenosos y hemoderivados por inestabilidad hemodinámica. La resucitación con volumen realizada adecuadamente puede revertir el estado de hipoperfusión tisular en los diferentes órganos. Sin embargo, el ingreso excesivo de líquidos y la falla renal aguda pueden favorecer la sobrecarga hídrica (SH) e incrementar el riesgo de complicaciones, la estancia hospitalaria y la mortalidad. Métodos: Se llevó a cabo un estudio prospectivo longitudinal de pacientes pediátricos con cirugía del corazón y empleo de bomba de circulación extracorpórea en la Unidad de Cuidados Intensivos Cardiovasculares (UCICV), Instituto Nacional de Pediatría, de julio 2018 a diciembre 2019. La SH, registrada como porcentaje, fue cuantificada cada 24 horas durante los primeros 3 días de estancia en UCICV. Como variables de desenlace se registraron la estancia en UCICV, el tiempo de ventilación mecánica y la mortalidad. Resultados: Se incluyeron 130 pacientes. Los principales factores asociados con la SH fueron la edad < 1 año (p < 0.001), peso < 5 kg (p < 0.001) y mayor tiempo de circulación extracorpórea (p = 0.003). Los pacientes con SH ≥ 5% presentaron mayor puntaje inotrópico (p < 0.001), mayor índice de oxigenación (p < 0.001) y mayor tiempo de ventilación mecánica (p < 0.001). La SH ≥ 5% se asoció con una mayor probabilidad de muerte en el periodo posoperatorio (razón de momios: 89, p = 0.004). Conclusiones: La SH puede utilizarse como factor pronóstico en la evolución de los pacientes pediátricos operados de corazón, ya que se asocia con una mayor morbimortalidad.

Factores asociados con amputación de miembros inferiores de pacientes con pie diabético en una cohorte / Factors associated with lower limb amputation of patients with diabetic foot in a cohort

Introducción: El desarrollo de ulceraciones en el Pie Diabético (PD) puede derivar en amputación de miembros inferiores e incluso impactar la morbi mortalidad de los pacientes diabéticos. Por lo anterior, este estudio pretende evaluar las características de los pacientes con PD hospitalizados y manejados en un hospital regional. Materiales y métodos: 121 pacientes son incluidos en el estudio de cohorte retrospectiva entre amputados y no amputados, tomados de la base de datos del hospital entre enero de 2013 y enero de 2018. Los datos demográficos, así como factores relacionados fueron analizados con regresión logística bi y multivariada en relación con la amputación de miembro inferior como variable de desenlace, calculando razón de probabilidades (OR) con intervalos de confianza del 95%. Dicha información fue analizada con el programa estadístico STATA. Resultados: 81 pacientes requirieron amputación de miembros inferiores. En la regresión logística bivariada hay 3 factores relacionados con amputación [nivel de Wagner (p < 0.05 CI 95%), la presencia de leucocitosis (p <0.05 CI 95%) y el compromiso vascular en Doppler arterial (p < 0.05 CI 95%)], sin embargo, la regresión multivariada sólo relaciona el compromiso vascular del Doppler arterial como estadísticamente significativo con amputación de miembros inferiores (p < 0.05 CI 95%). Conclusión: Se muestran 3 factores estadísticamente significativos con la amputación de miembros inferiores en PD (Wagner, leucocitosis y compromiso vascular), reflejando la importancia de un diagnóstico temprano y un manejo adecuado como parte clave en el manejo de esta patología.

Introduction: The development of ulcerations in the Diabetic Foot (DP) can lead to lower limb amputation and even impact the morbidity and mortality of diabetic patients. Therefore, this study aims to evaluate the characteristics of patients with PD hospitalized and managed in a regional hospital. Materials and methods: 121 patients are included in the retrospective cohort study between amputees and non-amputees, taken from the hospital database between January 2013 and January 2018. Demographic data, as well as related factors, were analyzed with logistic regression. bi and multivariate in relation to lower limb amputation as an outcome variable, calculating odds ratio (OR) with 95% confidence intervals. This information was analyzed with the STATA statistical program. Results: 81 patients required lower limb amputation. In the bivariate logistic regression there are 3 factors related to amputation [Wagner level (p < 0.05 95% CI), the presence of leukocytosis (p < 0.05 95% CI) and vascular compromise on arterial Doppler (p < 0.05 95% CI). )], however, multivariate regression only relates vascular compromise on arterial Doppler as statistically significant to lower limb amputation (p < 0.05 95% CI). Conclusion: 3 statistically significant factors are shown with lower limb amputation in PD (Wagner, leukocytosis and vascular compromise), reflecting the importance of early diagnosis and adequate management as a key part in the management of this pathology.

Indicadores antropométricos y descontrol glucémico en diabetes tipo 2 con enfermedad renal / Anthropometric indicators and poor glycemic control in type 2 diabetes with kidney disease

Introducción: la relación de los indicadores antropométricos y de composición corporal, con la evolución de la enfermedad renal en pacientes con diabetes tipo 2 sigue siendo controversial. Objetivo: identificar la asociación de los indicadores de la enfermedad renal con indicadores de control metabólico y antropométricos en pacientes con diabetes tipo 2. Material y métodos: se realizó un estudio transversal analítico en 395 pacientes del primer nivel de atención. La glucosa, hemoglobina glucosilada (HbA1c), perfil de lípidos y creatina se midió en ayuno. La enfermedad renal crónica (ERC) se consideró cuando la excreción de albumina urina- ria (EAU) > 30 mg/g y con la reducción del nivel de la tasa de filtrado glomerular < 60 mL/min/1.73 m2, utilizando la ecuación CKD-EPI. Se midió el peso y circunferencia de cintura, así como la composición corporal a través de bioimpedancia. Resultados: un 17% de la población presentó ERC con alteración de la EAU y 6.6% con una TFG reducida. Un mayor tiempo de diagnóstico de la enfermedad, mayor nivel de HbA1c y menor nivel grasa corporal se asoció a una EAU > 30 mg/g, (p < 0.05). La disminución de la TFG (< 60 mL/ min/1.73 m2) se asoció con mayor edad, ser mujer, tener mayor circunferencia de cintura y menor porcentaje de grasa corporal (p < 0.05). Conclusiones: un mayor nivel de circunferencia de cintura y menor porcentaje de grasa corporal se asocian a mayor evolución de la ERC en pacientes con diabetes tipo 2. El descontrol glucémico se identificó en pacientes con mayor excreción de albumina urinaria.

Background: The relationship of anthropometric and body composition indicators with the evolution of kidney disease in patients with type 2 diabetes, is still inconsistent. Objective: To identify the association of indicators of kid- ney disease with indicators of metabolic and anthropometric control in patients with type 2 diabetes. Material and methods: An analytical cross-sectional study was carried out in 395 patients of the first level of care. The glucose, glycosylated hemoglobin (HbA1c), creatinine and lipid profile were measured. The kidney disease (CKD) was made when urinary albumin excretion (UAE) > 30 mg/g and with a reduction in the level of glomerular filtration rate < 60 mL/min/1.73 m2, using the CKD-formula. Weight and waist circumference were measured, as well as the body composition through bioimpedance. Results: Seventeen percent of the population has a diagnosed with CKD with alteration of the UAE and 6.6% had a reduced GFR. A longer time of diagnosis of the diabetes, hig- her HbA1c level and body fat were associated with an UAE > 30 mg/g, (p < 0.05). The decline in GFR (< 60 mL/min/ 1.73 m2) was associated with older age, being a woman, greater waist circumference, and a higher percentage of body fat (p < 0.05). Conclusions: A higher level of waist circumference and a lower percentage of body fat are associated with a greater evolution of chronic kidney disease in patients with type 2 diabetes. Glycemic uncontrol is identified in patients with high urinary albumin excretion.

Mexican consensus on Hodgkin's lymphoma.

El linfoma de Hodgkin (LH) se debe a la transformación clonal de células originadas en los linfocitos B, lo que genera las células binucleadas patognomónicas de Reed-Sternberg. El LH es una enfermedad de células B con una distribución bimodal, con mayor incidencia en la adolescencia y la tercera década de la vida y un segundo pico en personas mayores de 55 años. Las células del LH clásico habitualmente sufren una reprogramación de la expresión génica, ya que pierden la expresión de la mayoría de los genes típicos de las células B y han adquirido la expresión de múltiples genes que son típicos de otros tipos de células del sistema inmunitario. El algoritmo de tratamiento dependerá si se trata de LH clásico o de predominio linfocítico, si es un estadio temprano con marcadores de pronóstico desfavorables o no, el esquema inicial de manejo y si existe enfermedad voluminosa, entre las variables más relevantes.Hodgkin's lymphoma (HL) is due to the clonal transformation of cells originating from B lymphocytes, generating the pathognomonic binucleate Reed-Sternberg cells. HL is a B cell disease with a bimodal distribution, with higher incidence in adolescence and the third decade of life, showing a second peak in people over 55 years of age. Classic Hodgkin lymphoma cells routinely undergo gene expression reprogramming, as they lose the expression of most of the typical B-cell genes and acquire the expression of multiple genes that are typical of other types of cells in the immune system. The treatment algorithm will depend on whether it is classic or predominantly lymphocytic HL, if it is early stage with unfavorable prognostic markers or not, the initial management regimen, and whether there is bulky disease, among the most relevant variables.

Mexican Consensus on Hodgkin's Lymphoma.

Hodgkin's lymphoma is due to the clonal transformation of cells originating from B lymphocytes, generating the pathognomonic binucleate Reed-Sternberg cells. Hodgkin's lymphoma is a B cell disease with a bimodal distribution, with higher incidence in adolescence and the third decade of life, showing a second peak in people over 55 years of age. Classic Hodgkin lymphoma cells routinely undergo gene expression reprogramming, as they lose the expression of most of the typical B-cell genes and acquire the expression of multiple genes that are typical of other types of cells in the immune system. The treatment algorithm will depend on whether it is classic or predominantly lymphocytic HL, if it is early stage with unfavorable prognostic markers or not, the initial management regimen, and whether there is bulky disease, among the most relevant variables.

El linfoma de Hodgkin (LH) se debe a la transformación clonal de células originadas en los linfocitos B, lo que genera las células binucleadas patognomónicas de Reed-Sternberg. El LH es una enfermedad de células B con una distribución bimodal, con mayor incidencia en la adolescencia y la tercera década de la vida y un segundo pico en personas mayores de 55 años. Las células del LH clásico habitualmente sufren una reprogramación de la expresión génica, ya que pierden la expresión de la mayoría de los genes típicos de las células B y han adquirido la expresión de múltiples genes que son típicos de otros tipos de células del sistema inmunitario. El algoritmo de tratamiento dependerá si se trata de LH clásico o de predominio linfocítico, si es un estadio temprano con marcadores de pronóstico desfavorables o no, el esquema inicial de manejo y si existe enfermedad voluminosa, entre las variables más relevantes.

Therapeutic effect of two muscle strengthening programs in patients with patellofemoral pain syndrome. A randomized controlled clinical trial / Efecto terapéutico de dos programas de fortalecimiento muscular en pacientes con síndrome de dolor pátelofemoral. Ensayo clínico controlado aleatorizado

Abstract Introduction: Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders affecting the knee joint. Conservative treatment reduces pain and improves functional capacity in the short and medium-term. Objective: To determine the therapeutic effect of two muscle strengthening exercise programs in patients with PFPS from Bogotá, Colombia, aged between 15 and 40 years. Materials and methods: Experimental randomized controlled clinical trial conducted in 40 patients with PFPS from Bogotá, Colombia, aged 15-40 years, with a mild to moderate level of physical activity. Participants were randomly distributed into 2 intervention groups: Group A: 8-week-long core, hip and knee muscles strengthening exercises program; Group B: 8-week-long hip and knee muscles strengthening exercises program. The level of pain was measured using the Visual Analog Scale and the Kujala Anterior Knee Pain Scale. Results: The addition of core muscle strengthening exercises to the traditional treatment improved the quality of life of participants in the intervention group A, where a significant reduction of pain, with a statistically significant difference in the total score of the Kujala scale (p=0.025) was observed. Conclusions: Including core muscle strengthening exercises in the conservative management of PFPS increases its effectiveness to reduce pain and improve the quality of life of these patients. ClinicalTrials.gov Identifier: NCT04011436

Resumen Introducción. El síndrome de dolor pátelofemoral (SPF) es una de las alteraciones musculoesqueléticas más frecuentes que afectan la articulación de la rodilla. El tratamiento conservador reduce el dolor y mejora la capacidad funcional en el corto y mediano plazo. Objetivo. Establecer el efecto terapéutico de dos programas de ejercicios de fortalecimiento muscular en pacientes con SPF de Bogotá, Colombia, con edades entre 15 y 40 años. Materiales y métodos. Ensayo clínico controlado aleatorio experimental realizado en 40 pacientes con SPF de Bogotá, Colombia, con edades entre los 15 y 40 años, con nivel de actividad física leve a moderada y que fueron distribuidos de forma aleatoria en 2 grupos de intervención: Grupo A: programa de ejercicios de fortalecimiento de los músculos del core, la cadera y la rodilla con una duración de 8 semanas; Grupo B: programa de ejercicios de fortalecimiento de los músculos de la cadera y la rodilla con la misma duración. El nivel de dolor se midió a través de la Escala Visual Analógica y de la Escala de Kujala para dolor patelofemoral. Resultados. La adición de ejercicios de fortalecimiento de los músculos del core al tratamiento tradicional mejoró la calidad de vida de los participantes en el grupo de intervención A, donde se observó una reducción significativa del dolor con una diferencia estadísticamente significativa en la puntuación total de la escala Kujala (p=0.025). Conclusiones. Incluir ejercicios de fortalecimiento de los músculos del core al manejo conservador del SPF aumenta su efectividad para reducir el dolor y mejorar la calidad de vida de estos pacientes. ClinicalTrials.gov Identifier: NCT04011436

Epidemiology and Clinical Characteristics of Non-Hodgkin Lymphoma in Mexico.

BACKGROUND: There is no epidemiological registry in Mexico. The information about the epidemiology in our country is obtained by these types of studies, such as multicentric studies. A lot of improvements in the survival in non-Hodgkin lymphoma patients had occurred in the last 20 years. The access to treatment in these types of pathology could change the prognostic factors in Mexican Mestizos patients. The primary objective of the study was to learn what the most frequent histological varieties of non-Hodgkin lymphoma in Mexico are. The secondary objectives included clinical characteristics, treatments used, treatment response, disease-free survival and overall survival. METHODS: A retrospective, descriptive study of consecutive cases was carried out in 14 hospitals across 14 Mexican states with patients diagnosed with non-Hodgkin lymphoma using the World Health Organization (WHO) 2008 criteria. Inclusion criteria included: ≥ 18 years of age, male or female, any clinical stage at diagnosis, who had received any chemotherapy regimen, with a known outcome. Descriptive statistics was performed for all variables, and survival was assessed using Kaplan-Meier curves. RESULTS: Totally, 609 patients were enrolled, of which 545 were B-cell lymphomas and 64 were T-cell lymphomas. Median ages were 61 and 50, respectively. B-cell lymphomas were more common in males with 52.1%, and 65.5% of T-cell lymphomas occurred in females. For B-cell lymphomas, the two most frequent histological subtypes were diffuse large B-cell lymphoma in 63.9%, followed by follicular lymphoma at 18%. Meanwhile, 50% of T-cell lymphomas were of the T/natural killer (NK) subtype, and 87.1% of the patients received a CHOP-like regimen. Radiotherapy was given to 31% of B-cell Lymphomas and 46.9% of T-cell lymphomas. Overall survival at 9 years was 84.6% for B-cell lymphomas, and 73.4% for T-cell lymphomas. CONCLUSIONS: Diffuse large B-cell lymphoma constitutes the most frequent subtype for B-cell lymphomas in Mexico. The most frequent T-cell lymphoma is the NK/T histological subtype.

Patients aged ninety years and older are exposed to increased risk of one-year mortality after hip fractures.

BACKGROUND: The increase in the population over 90 years old suggests an expected surge in the number of extreme elderly patients sustaining hip fractures. OBJECTIVE: The aim of this study is to identify factors associated with 1-year mortality and determine the conditions that are associated with an unfavorable survival outcome in nonagenarians. DESIGN: Cross-sectional study SUBJECTS: Nonagenarian patients presenting with hip fractures between 2013 and 2018. METHODS: Bivariate and multivariate analyses were performed to identify variables associated with mortality, and a survival analysis was conducted to determine whether the Charlson Comorbidity Index (CCI) is associated with mortality. RESULTS: A total of 127 patients, with a mean age of 92.84 years was assessed, identifying 1-year mortality rate in 53.5% of patients. According to the bivariate analysis, requirement of postoperative vasopressor support, transfusion, decompensated heart failure and general anesthesia were associated with a higher probability of 1-year mortality after surgery. Body mass index, health status, dementia or CCI ≥ 3 were not associated with mortality. Similarly, the Kaplan-Meier survival analysis showed no difference in mortality rate of patients with CCI ≥ 3 (p = 0.282). CONCLUSION: Patients older than 90 years with hip fractures have higher mortality rates per year than younger patients. Some associations were found, but more studies are needed to reach final conclusions, which could help identify higher-risk patients and be able to implement additional measures.

Results of accelerated partial breast irradiation in patients not suitable for external beam irradiation stratified by GEC-ESTRO, ASTRO, and ABS guidelines.

PURPOSE: This study aims to review the outcome of an institution in multicatheter/interstitial accelerated partial breast irradiation (MC-APBI) for treatment of patients with breast cancer, either with strong criteria for APBI or unable to be treated with whole-breast irradiation. The outcomes were also stratified by the American Society for Radiation Oncology, American Brachytherapy Society, and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology patient selection criteria. METHODS: The study includes 118 patients and 120 MC-APBI treatments, treated in a single tertiary center, between November 2003 and August 2016. The analysis is focused on the clinical baseline characteristics, local control, relapse-free survival, disease-specific survival (DSS), and overall survival. RESULTS: In accordance to the American Society for Radiation Oncology, American Brachytherapy Society, and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology, 17.1% were "unsuitable," 19.2% were "unacceptable," and 19.5% were "high risk," respectively. The main reasons why high-risk patients were submitted to MC-APBI were as follows: cardiopathy (n = 7), social difficulties (n = 4), and mobility limitations (n = 4). At the median followup period of 86.5 months, ipsilateral breast tumor recurrence was observed in one (0.8%) patient. The 3-year and 5-year relapse-free survival were 100% and 99.1%, respectively. DSS was 100%. CONCLUSIONS: This study demonstrated excellent control rates, DFS, and DSS of MC-APBI, rendering APBI as an excellent treatment for patients with breast cancer, even those who are not necessarily eligible for this treatment approach. The selection criteria for ABPI diverge according to different guidelines and are based on studies with discrepancies, making extremely possible that these recommendations could be changed.