Bladder embryonal rhabdomyosarcoma presenting in the perinatal period: Report of two consecutive cases.

Bladder embryonal rhabdomyosarcomas (ERMS) are malignant soft tissue tumors that rarely present in the perinatal period. Herein, we report two cases that were diagnosed in the newborn period (one with concomitant posterior urethral valves [PUV]), managed with chemotherapy and surgical resection to minimize the need for radiation.

Endocytosis blocks the vesicular secretion of exosome marker proteins.

Exosomes are secreted vesicles of ~30 to 150 nm diameter that play important roles in human health and disease. To better understand how cells release these vesicles, we examined the biogenesis of the most highly enriched human exosome marker proteins, the exosomal tetraspanins CD81, CD9, and CD63. We show here that endocytosis inhibits their vesicular secretion and, in the case of CD9 and CD81, triggers their destruction. Furthermore, we show that syntenin, a previously described exosome biogenesis factor, drives the vesicular secretion of CD63 by blocking CD63 endocytosis and that other endocytosis inhibitors also induce the plasma membrane accumulation and vesicular secretion of CD63. Finally, we show that CD63 is an expression-dependent inhibitor of endocytosis that triggers the vesicular secretion of lysosomal proteins and the clathrin adaptor AP-2 mu2. These results suggest that the vesicular secretion of exosome marker proteins in exosome-sized vesicles occurs primarily by an endocytosis-independent pathway.

Tratamiento quirúrgico de la enfermedad pilonidal sacrocoxígea. Experiencia de un centro en los últimos 4 años

Objetivo: Evaluar los resultados a largo plazo en el tratamiento quirúrgico de la enfermedad pilonidal sacrocoxígea (EPS), comparando las diferentes técnicas quirúrgicas utilizadas, complicaciones, tiempo de cicatrización y recidiva. Material y Método: Estudio trasversal retrospectivo. Se revisaron las fichas de los pacientes intervenidos por EPS entre enero 2017 hasta agosto 2021. Para el seguimiento se obtuvo la información desde los registros de los controles periódicos en nuestro centro y aquellos que no continuaron con estos controles se contactaron telefónicamente. Resultados: Se recopilaron 309 casos, con una media de seguimiento de 15,6 meses. Las técnicas más utilizadas para la fase crónica de EPS fueron marsupialización y Karydakis, con tiempo de cicatrización completa de 54,5 y 18,2 días, respectivamente. La presencia de complicaciones prolongó el tiempo de cicatrización en 46,5 días en Karydakis, con mínimo impacto en marsupialización. La tasa de recidiva fue menor en Karydakis y en etapa aguda cuando se realiza destechamiento y legrado. La profilaxis antibiótica no afectó el riesgo de complicaciones postoperatorias. Discusión: El desarrollo de complicaciones postoperatorias tiene mayor impacto en la cicatrización de la técnica cerrada que en la abierta, siendo esta última más tolerante en cuanto a la cicatrización frente a complicaciones. Conclusión: La intervención con técnica de Karydakis logra la cicatrización de la herida operatorio en menor tiempo que la marsupialización, sin embargo, al desarrollar complicaciones, este tiempo aumenta 3,5 veces más. La recurrencia fue menor en Karydakis. En absceso se recomienda el desteche y legrado por sobre el drenaje exclusivo

Aim: To evaluate long-term results in the surgical treatment of sacrococcygeal pilonidal disease (SPD) comparing the different surgical techniques used, complications, healing time and recurrence. Material and Method: Retrospective cross-sectional study. The files of the patients operated on for EPS between January 2017 and August 2021 were reviewed. For follow-up, information was obtained from the records of the periodic controls in our center; those who did not continue with these controls were contacted by telephone. Results: 309 cases were collected, with a mean follow-up of 15.6 months. The most used techniques for the chronic phase of EPS were marsupialization and Karydakis, achieving complete wound healing in 54.5 and 18.2 days, respectively. The presence of complications prolonged the healing time by 46.5 days in Karydakis, with minimal impact on marsupialization. The recurrence rate was lower in Karydakis and in the acute stage when unroofing and curettage were performed. Antibiotic prophylaxis did not increase the risk of postoperative complications. Discussion: The development of postoperative complications has a greater impact on the healing of the closed technique than in the open technique, the last one seems to be more tolerant in terms of healing in the presence of complications. Conclusion: The intervention with the Karydakis technique achieves healing of the surgical wound in less time than marsupialization, however, when complications develop, this time increases 3.5 times more. Recurrence was lower in Karydakis. In abscess weaning and curettage is recommended over the exclusive drainage.

Alteraciones neuropsiquiátricas en menores de 18 años expuestos a opioides en el periodo prenatal: Revisión Narrativa

El consumo de opioides ha venido incrementando en los últimos años, generando una crisis de salud pública que afecta a todo tipo de población. El uso de sustancias opiáceas ilegales en embarazadas también está en incremento, por lo que, en la práctica clínica se evidencian con mayor frecuencia resultados neonatales adversos como el síndrome de abstinencia neonatal (NAS). Adicionalmente, los niños expuestos prenatalmente a estas sustancias pueden sufrir alteraciones cognitivas, motoras o psiquiátricas durante el transcurso de su vida. Este artículo tiene como objetivo proporcionar una revisión de la literatura actualizada acerca del uso de opioides durante el embarazo y las consecuencias para los niños expuestos a estas sustancias.

Opioid consumption has increased greatly in recent years, creating a public health crisis that affects all types of population. The use of illegal opiates amongst pregnant women has also risen, causing a surge in the frequency in which adverse neonatal outcomes, such as Neonatal Abstinence Syndrome (NAS), are seen in clinical practice. Furthermore, children exposed prenatally to these substances have cognitive, motor and psychiatric adverse outcomes throughout their lifetime. This article's objective is to provide an updated literature review about opioid use during pregnancy and its consequences on children exposed in-utero.

Apparent regional differences in the spectrum of BARD1 pathogenic variants in Spanish population and importance of copy number variants.

Only up to 25% of the cases in which there is a familial aggregation of breast and/or ovarian cancer are explained by germline mutations in the well-known BRCA1 and BRCA2 high-risk genes. Recently, the BRCA1-associated ring domain (BARD1), that partners BRCA1 in DNA repair, has been confirmed as a moderate-risk breast cancer susceptibility gene. Taking advantage of next-generation sequencing techniques, and with the purpose of defining the whole spectrum of possible pathogenic variants (PVs) in this gene, here we have performed a comprehensive mutational analysis of BARD1 in a cohort of 1946 Spanish patients who fulfilled criteria to be tested for germline pathogenic mutations in BRCA1 and BRCA2. We identified 22 different rare germline variants, being 5 of them clearly pathogenic or likely pathogenic large deletions, which account for 0.26% of the patients tested. Our results show that the prevalence and spectrum of mutations in the BARD1 gene might vary between different regions of Spain and expose the relevance to test for copy number variations.

Efficacy of Virtual Reality in Neurorehabilitation of Spinal Cord Injury Patients: A Systematic Review / Eficacia de la Realidad Virtual en la Neurorrehabilitación de Pacientes con Lesión de Médula Espinal: una Revisión Sistemática

ABSTRACT This systematic review (SR) analyzed the effectiveness of interventions using virtual reality (VR) technology as a neurorehabilitation therapy in people with spinal cord injury (SCI). The SR was developed under the guidelines of the PRISMA statement and the recommendations of the Cochrane Collaboration, along with the PEDro and National Institute of Health scales to assess the risk of bias and methodological quality. The Cochrane, IEEE, BVS/LILACS, MEDLINE/PubMed, and Web of Science databases were browsed to identify studies that, between 2010 and 2020, evaluated the efficacy of these therapies. Out of 353 retrieved studies, 11 were finally selected after the application of the defined inclusion and exclusion criteria. These articles presented good methodological quality as they were mostly controlled clinical trials that analyzed mixed therapies with conventional therapies. Interventions based on non-immersive or immersive VR technology that achieved functional motor, balance, and psycho-emotional health improvement with positive effects on motivation, self-confidence, commitment, and active participation were identified in a total sample of 155 SCI patients. It was concluded that such VR technology is an effective tool of neurorehabilitation complementary to conventional therapies, which promotes functional improvement in SCI patients both in the clinic and at home.

RESUMEN Esta revisión sistemática (RS) analizó la eficacia de las intervenciones que utilizan la tecnología de realidad virtual (RV) como terapia de neurorrehabilitación en personas con lesión de médula espinal (LME). La RS fue desarrollada bajo los lineamientos de la declaración PRISMA y las recomendaciones de la Colaboración Cochrane, junto con las escalas de PEDro y del National Institute of Health para evaluar el riego de sesgo y la calidad metodológica. Se revisaron las bases de Cochrane, IEEE, BVS/LILACS, MEDLINE/PubMed y Web of Science para identificar estudios que, entre 2010 y 2020, evaluaron la eficacia de dichas terapias. De 353 estudios recuperados, 11 fueron finalmente seleccionados tras la aplicación de los criterios de inclusión y exclusión definidos. Dichos artículos presentaron una buena calidad metodológica, al ser mayormente ensayos clínicos controlados que analizaron terapias mixtas con terapias convencionales. Se identificaron intervenciones basadas en tecnología de RV no inmersiva o inmersiva que lograron una mejora funcional motora, de equilibrio y de salud psico-emocional con efectos positivos de motivación, seguridad, compromiso y activa participación en una muestra total de 155 pacientes con LME. Se concluyó que dicha tecnología de RV es una herramienta eficaz de neurorrehabilitación complementaria a las terapias convencionales, al promover una mejora funcional en pacientes con LME tanto en la clínica como en casa.

Economic burden and health-related quality of life in tenosynovial giant-cell tumour patients in Europe: an observational disease registry.

BACKGROUND: Tenosynovial Giant-Cell Tumour (TGCT) is a benign clonal neoplastic proliferation arising from the synovium, causing a variety of symptoms and often requiring repetitive surgery. This study aims to define the economic burden-from a societal perspective-associated with TGCT patients and their health-related quality of life (HRQOL) in six European countries. METHODS: This article analyses data from a multinational, multicentre, prospective observational registry, the TGCT Observational Platform Project (TOPP), involving hospitals and tertiary sarcoma centres from six European countries (Austria, France, Germany, Italy, the Netherlands, and Spain). It includes information on TGCT patients' health-related quality of life and healthcare and non-healthcare resources used at baseline (the 12-month period prior to the patients entering the registry) and after 12 months of follow-up. RESULTS: 146 TGCT patients enrolled for the study, of which 137 fulfilled the inclusion criteria. Their mean age was 44.5 years, and 62% were female. The annual average total costs associated with TGCT were €4866 at baseline and €5160 at the 12-month follow-up visit. The annual average healthcare costs associated with TGCT were €4620 at baseline, of which 67% and 18% corresponded to surgery and medical visits, respectively. At the 12-month follow-up, the mean healthcare costs amounted to €5094, with surgery representing 70% of total costs. Loss of productivity represented, on average, 5% of the total cost at baseline and 1.3% at follow-up. The most-affected HRQOL dimensions, measured with the EQ-5D-5L instrument, were pain or discomfort, mobility, and the performance of usual activities, both at baseline and at the follow-up visit. Regarding HRQOL, patients declared a mean index score of 0.75 at baseline and 0.76 at the 12-month follow-up. CONCLUSION: The results suggest that TGCT places a heavy burden on its sufferers, which increases after one year of follow-up, mainly due to the healthcare resources required-in particular, surgical procedures. As a result, this condition has a high economic impact on healthcare budgets, while the HRQOL of TGCT patients substantially deteriorates over time.

Scleral-fixated intraocular lens implants-evolution of surgical techniques and future developments.

Varied options are available for the implantation of secondary intraocular lens implants in the absence of zonular or capsular support. Loss of the capsule can occur in the context of complicated cataract surgery, trauma or inherited conditions such as Marfan syndrome or pseudoexfoliation. Approaches to overcome this include optical measures such as the use of spectacles or contact lenses, and surgical therapy incorporating the use of anterior chamber, iris-fixated or scleral-fixated lenses. Surgical techniques to implant scleral-fixated lenses have undergone various modifications, since the first publication of sutured intrascleral fixation described in the 1980s. However, despite the advances in surgical techniques, studies are limited either by their retrospective nature, small sample size and most importantly small duration of follow-up. This comprehensive review aims to amalgamate the evolution of various surgical techniques with regards to intrascleral lens fixation and suggests areas for future development.

Delivery of cardiovascular progenitors with biomimetic microcarriers reduces adverse ventricular remodeling in a rat model of chronic myocardial infarction.

Despite tremendous progress in cell-based therapies for heart repair, many challenges still exist. To enhance the therapeutic potential of cell therapy one approach is the combination of cells with biomaterial delivery vehicles. Here, we developed a biomimetic and biodegradable micro-platform based on polymeric microparticles (MPs) capable of maximizing the therapeutic potential of cardiac progenitor cells (CPCs) and explored its efficacy in a rat model of chronic myocardial infarction. The transplantation of CPCs adhered to MPs within the infarcted myocardial microenvironment improved the long-term engraftment of transplanted cells for up to one month. Furthermore, the enhancement of cardiac cellular retention correlated with an increase in functional recovery. In consonance, better tissue remodeling and vasculogenesis were observed in the animals treated with cells attached to MPs, which presented smaller infarct size, thicker right ventricular free wall, fewer deposition of periostin and greater density of vessels than animals treated with CPCs alone. Finally, we were able to show that part of this beneficial effect was mediated by CPC-derived extracellular vesicles (EVs). Taken together, these findings indicate that the biomimetic microcarriers support stem cell survival and increase cardiac function in chronic myocardial infarction through modulation of cardiac remodeling, vasculogenesis and CPCs-EVs mediated therapeutic effects. The biomimetic microcarriers provide a solution for biomaterial-assisted CPC delivery to the heart. STATEMENT OF SIGNIFICANCE: In this study, we evaluate the possibility of using a biomimetic and biodegradable micro-platform to improve cardiovascular progenitor therapy. The strategy reported herein serves as an injectable scaffold for adherent cells due to their excellent injectability through cardiac catheters, capacity for biomimetic three-dimensional stem cell support and controllable biodegradability. In a rat model of chronic myocardial infarction, the biomimetic microcarriers improved cardiac function, reduced chronic cardiac remodeling and increased vasculogenesis through the paracrine signaling of CPCs. We have also shown that extracellular vesicles derived from CPCs cultured on biomimetic substrates display antifibrotic effects, playing an important role in the therapeutic effects of our tissue-engineered approach. Therefore, biomimetic microcarriers represent a promising and effective strategy for biomaterial-assisted CPC delivery to the heart.

[Thoracic endometriosis and lymphangioleiomyomatosis: Coincidence or hormonal rational?] / Endométriose thoracique et lymphangioléïmyomatose : coïncidence ou rationnel hormonal?

INTRODUCTION: Lymphagioleiomyomatosis (LAM) and endometriosis are two diseases that occur in young women. The main thoracic complication of both diseases is pneumothorax. CASE REPORT: We describe the case of a 45-year-old woman who presented with a right-sided pneumothorax. The clinical context and the perioperative findings were suggestive of thoracic endometriosis, while the histology of the pulmonary biopsy and the evolution of her case were in favour of LAM. This presentation indicates the coexistence of the two diseases, which has never previously been described in the literature. The case raises the question as to whether it should be policy to systematically undertake a pulmonary biopsy in cases of thoracic endometriosis. CONCLUSIONS: LAM and endometriosis are both diseases under hormonal influence. To date, we do not know if there is any direct link between the two diseases or if the presentation that we describe here occurred by chance.

Tracheal obstruction due to tumour: use of veno-venous extracorporeal membrane oxygenation during rigid bronchoscopy.

Tracheal tumour is rare but can lead to upper airway obstruction and acute respiratory distress. Its management includes surgical resection, radiotherapy or interventional bronchoscopy. Ventilation or difficulties with tracheal intubation can occur during the peri-operative course resulting in serious adverse consequences. We report the case of an 83-year-old man with an obstructive tracheal chondrosarcoma resected by rigid bronchoscopy undergoing veno-venous extracorporeal membrane oxygenation. Such support should be considered when the patient's airway patency cannot be ensured by conventional methods.

Deficiencia e insuficiencia de vitamina D en mujeres post cirugía bariátrica Roux en Y / Vitamin D deficiency and insufficiency among women with Roux-en-Y bariatric surgery / Deficiência e Insuficiência de vitamina D em mulheres post cirurgia bariátrica Roux em Y

Objetivo Determinar la relación entre la falta de seguimiento, adherencia al tratamiento con multivitamínicos y niveles séricos de 25-OH vitamina D (Vit-D) en mujeres post-cirugía BPRY, en la UNEME de la ciudad de Tijuana, Baja California, México. Métodos Estudio Transversal analítico que incluyó mujeres post-cirugía BPRY (GCa, n=13), con Obesidad Mórbida (GOM, n=13) y mujeres aparentemente sanas (GCo, n=13). Posterior a la autorización mediante consentimiento informado escrito, se realizó una historia clínica, valoración antropométrica, aplicación del instrumento de medición y en una segunda cita se tomó una muestra sanguínea para la cuantificación de Vit-D. El instrumento de medición fue validado mediante Kappa de Cohen mayor al 80% y alfa de Cronbach de 1. El análisis estadístico de los datos se realizó mediante pruebas de diferencia de medias t de Student y ANOVA donde se consideró una p < 0.05 en una prueba a dos colas. Se determinó prevalencia, significancia estadística de la falta de adherencia y seguimiento en relación a los niveles de Vit-D. Resultados La prevalencia de falta de adherencia al tratamiento multivitamínico en estas mujeres con post-cirugía BPRY fue de 85% y la falta de seguimiento post quirúrgico que incluye pruebas de laboratorio de micronutrientes fue del 100%. Se encontró una diferencia estadísticamente significativa entre las medias de los niveles de Vit-D entre las mujeres con y sin adherencia al multivitamínico p < 0.05, IC 95%. Conclusiones Se demostró que la falta de adherencia y seguimiento al tratamiento con multivitamínicos son factores de riesgo para la insuficiencia y deficiencia de Vit-D en pacientes con post-cirugía BPRY.

Objective To determine the interrelationships among lack of compliance, multi-vitamin treatment adherence, and serum levels of 25-OH vitamin D among women with Roux-en-Y bariatric surgery in the UNEME of Tijuana, Baja California, Mexico. Methods This is an analytical and transversal study on women with Roux-en-Y bariatric surgery (GCa, n=13) with morbid obesity (GOM, n=13), and apparently healthy women (GCo, n=13). After the corresponding written informed consents, in a first appointment, the medical record, the anthropometric assessment, and the administration of the instrument were performed, while in a second appointment, blood samples were taken in order to measure the vitamin D levels. The assessment instrument was validated through a Cohen Kappa greater than 80% and a Cronbach Alpha of 1. Student's t test and two-tailed, p < 0.05 ANOVAS were calculated. Results While a lack of adherence to multi-vitamin treatment was found in 85% of the women, a lack of post-surgical follow-up, including micro-nutrients lab tests, was found in 100%. A statistically significant difference between the mean vitamin D levels of women with and without multi-vitamin treatment adherence was found (p < 0.05, CI 95%). Conclusions It was demonstrated that the lack of adherence to multi-vitamin treatments is a vitamin D deficiency risk factor among patients with Roux-en-Y bariatric surgery.

Objetivo Determinar a relação entre a falta de seguimento, aderência ao tratamento com multivitamínicos e niveis séricos de 25-OH vitamina D (Vit-D) em mulheres post-cirurgia BPRY, na UNEME da cidade de Tijuana, Baja California, México. Métodos. Estudo Transversal analítico que incluiu mulheres post-cirurgia BPRY (GCa, n=13), com Obesidade Mórbida (GOM, n=13) e mulheres aparentemente saudáveis (GCo, n=13). Posterior à autorização mediante consentimento informado escrito, realizou-se uma história clínica, avaliação antropométrica, aplicação do instrumento de medição e em uma segunda consulta tomou-se uma amostra sanguínea para a quantificação de Vit-D. O instrumento de medição foi validado mediante Kappa de Cohen maior a 80% e alfa de Cronbach de 1. A análise estatística dos dados realizou-se mediante probas de diferencia de média t de Student e ANOVA onde se considerou uma p < 0.05 em um teste bilateral. Determinou-se prevalência, significância estatística da falta de aderência e seguimento em relação aos níveis de Vit-D. Resultados A falta de aderência ao tratamento multivitamínico nestas mulheres bariátricas foi de 85% e a falta de seguimento post cirúrgico que inclui testes de laboratório de micronutrientes foi de 100%. Encontrou-se uma diferença estatisticamente significativa entre a média dos níveis de Vit-D entre as mulheres com e sem aderência no multivitamínico p < 0.05, IC 95%. Conclusões . Demostrou-se que a falta de aderência e seguimento no tratamento com multivitamínicos são fatores de risco para a insuficiência e deficiência de Vit-D em pacientes bariátricos.

H5N1 Influenza A Virus PB1-F2 Relieves HAX-1-Mediated Restriction of Avian Virus Polymerase PA in Human Lung Cells.

Highly pathogenic influenza A viruses (IAV) from avian hosts were first reported to directly infect humans 20 years ago. However, such infections are rare events, and our understanding of factors promoting or restricting zoonotic transmission is still limited. One accessory protein of IAV, PB1-F2, was associated with pathogenicity of pandemic and zoonotic IAV. This short (90-amino-acid) peptide does not harbor an enzymatic function. We thus identified host factors interacting with H5N1 PB1-F2, which could explain its importance for virulence. PB1-F2 binds to HCLS1-associated protein X1 (HAX-1), a recently identified host restriction factor of the PA subunit of IAV polymerase complexes. We demonstrate that the PA of a mammal-adapted H1N1 IAV is resistant to HAX-1 imposed restriction, while the PA of an avian-origin H5N1 IAV remains sensitive. We also showed HAX-1 sensitivity for PAs of A/Brevig Mission/1/1918 (H1N1) and A/Shanghai/1/2013 (H7N9), two avian-origin zoonotic IAV. Inhibition of H5N1 polymerase by HAX-1 can be alleviated by its PB1-F2 through direct competition. Accordingly, replication of PB1-F2-deficient H5N1 IAV is attenuated in the presence of large amounts of HAX-1. Mammal-adapted H1N1 and H3N2 viruses do not display this dependence on PB1-F2 for efficient replication in the presence of HAX-1. We propose that PB1-F2 plays a key role in zoonotic transmission of avian H5N1 IAV into humans.IMPORTANCE Aquatic and shore birds are the natural reservoir of influenza A viruses from which the virus can jump into a variety of bird and mammal host species, including humans. H5N1 influenza viruses are a good model for this process. They pose an ongoing threat to human and animal health due to their high mortality rates. However, it is currently unclear what restricts these interspecies jumps on the host side or what promotes them on the virus side. Here we show that a short viral peptide, PB1-F2, helps H5N1 bird influenza viruses to overcome a human restriction factor of the viral polymerase complex HAX-1. Interestingly, we found that human influenza A virus polymerase complexes are already adapted to HAX-1 and do not require this function of PB1-F2. We thus propose that a functional full-length PB1-F2 supports direct transmission of bird viruses into humans.

Correlación entre hiperfiltración glomerular y proteinuria en pacientes fumadores de mediana edad sin otras comorbilidades / Correlation between glomerular hyperfiltration and proteinuria in medium age smoking patients with no other comorbidities

Resumen ANTECEDENTES: En México los reportes mencionan entre 114 y 122 decesos diarios asociados con el tabaquismo. En 2011, Hallan y Orth publicaron los resultados de un seguimiento a 10 años de más de 65,000 participantes, concluyeron que el riesgo de insuficiencia renal es tres a cuatro veces mayor en fumadores que en no fumadores. OBJETIVO: Demostrar que el consumo del tabaco en pacientes sin comorbilidades puede favorecer la hiperfiltración glomerular, aumentado así el riesgo de enfermedad renal crónica. MATERIAL Y MÉTODO: Estudio transversal analítico, prospectivo, efectuado con pacientes del Hospital General Xoco, que se dividieron en dos grupos. Se tomaron muestras de sangre para obtener las concentraciones séricas de creatinina y urea; con las fórmulas MDRD y CKD EPI se estimó la tasa de filtración glomerular. El análisis estadístico se realizó con el programa SPSS V21. RESULTADOS: Se incluyeron 152 pacientes. La mayoría de la población fumadora tenía dependencia alta con 20 casos y prevalencia de 27%, con valor de p = 0.023 para la tasa de filtración glomerular por la fórmula MDRD y p = 0.006 por CKD-EPI, con diferencias estadísticamente significativas. Se demostró una correlación positiva estadísticamente significativa (r = 0.413, p < 0.01) entre el índice tabáquico y la tasa de filtración glomerular medida por MDRD. De igual manera, se encontró correlación positiva estadísticamente significativa (r = 0.238, p = 0.041) entre el índice tabáquico y la tasa de filtración glomerular medida por CKD-EPI. CONCLUSIÓN: El tabaquismo condiciona mayor hiperfiltración glomerular en comparación con los no fumadores; esta relación es dosis-dependiente.

Abstract BACKGROUND: In Mexico the reports mention between 114 and 122 daily deaths associated with smoking. In 2011, Hallan and Orth published the results of a 10-year follow-up of more than 65,000 participants, concluding that the risk of developing renal failure is 3 to 4 times higher in smokers than in non-smokers. OBJECTIVE: To demonstrate how the use of tobacco in patients without comorbidities may favor glomerular hyperfiltration, thus increasing the risk of chronic kidney disease. MATERIAL AND METHOD: A cross-sectional, analytical, prospective study was conducted with patients from the Xoco General Hospital, Mexico City; they were divided into 2 groups. Blood samples were taken to obtain the serum creatinine and urea values, using the MDRD and CKD formulas. EPI estimated the glomerular filtration rate. Statistical analysis was performed with the SPSS V21 program. RESULTS: There were included 152 patients. Majority of the smoking population had high dependence with 20 cases and a prevalence of 27%. With a value of p = 0.023 for glomerular filtration rate (GFR) by MDRD and p = 0.006 for CKD-EPI. They had statistically significant differences. A statistically significant positive correlation (r = 0.413, p < 0.01) between the smoking index and the GFR measured by MDRD was demonstrated in this study. Statistically significant positive correlation (r = 0.238, p = 0.041) was also found between smoking index and GFR measured by CKD-EPI. CONCLUSION: Smoking causes high glomerular hyperfiltration compared to not-smoking subjects; this relation is dosis-dependent.

Preparación y Caracterización de Nanocompositos Quitosano-Cobre con Actividad Antibacteriana para aplicaciones en Ingeniería de Tejidos / Preparation and characterization of Copper Chitosan Nanocomposites with Antibacterial Activity for Applications in Tissue Engineering

RESUMEN: El presente trabajo describe la preparación de nanocompositos formulados a partir de quitosano (QS)/nanopartículas de cobre (nCu) con características antibacterianas y aplicación potencial en ingeniería de tejidos. Para ello, se prepararon nanocompositos mediante mezclado en solución asistido con ultrasonido con el objetivo de incrementar la dispersión de la carga nanométrica en el biopolímero. El análisis de FTIR demostró que la presencia de nCu en la matriz de QS favorece la interacción del nCu con los grupos amino/hidroxilo de la molécula del QS. Se determinó mediante UV-Vis que los nanocompositos QS/nCu presentan absorción asociada con la presencia de nanopartículas y la posible liberación de iones Cu2+ en medio líquido. Mediante AFM se determinó que el QS hidratado forma una malla con microporos, que puede favorecer la penetración de bacterias en el nanocomposito y su interacción con las nCu. Finalmente, se determinó el efecto antibacteriano del material al contacto con la bacteria Staphylococcus aureus, en donde se presenta una actividad antibacteriana superior al 90% entre los 90 y 180 min de interacción. Dichos resultados sugieren que es posible obtener nanomateriales antibacterianos biocompatibles para su posible aplicación en ingeniería tisular.

ABSTRACT: The Present work describes the preparation of nanocomposites based on chitosan (QS)/copper nanoparticles (nCu) with antibacterial properties and potential application in tissue engineering. For this purpose, nanocomposites were prepared by solution blending with ultrasound assisted, aiming to increase the nanoparticles dispersion in the biopolymer. FTIR analyses demonstrates that nCu supported in QS increase their interaction of nanoparticles with amine/hydroxyl groups of QS molecule. UV-Vis analyses demonstrates that QS/nCu nanocomposites have an absorption signal associated with the presence of nanoparticles and the possible Cu2+ ions release in liquid media. AFM analyses shown that hydrated QS form a mesh with micro pores, improving the bacterial penetration and the direct contact with nCu. This behavior was corroborated by antibacterial assays, where QS/nCu nanocomposites shown an antibacterial activity higher than 90% between 90-180 minutes of interaction. Our results suggest that is possible to obtain combined antibacterial/biocompatible nanomaterials with potential application in tissue engineering.

Prognostic significance of renal vascular pathology in lupus nephritis.

We performed a retrospective cohort analysis to define the prognostic significance of vascular lesions documented in renal biopsies of lupus nephritis patients. A total of 429 patients were segregated into five groups: (1) no vascular lesions (NVL), (2) arterial sclerosis (AS), (3) non-inflammatory necrotizing vasculitis (NNV), (4) thrombotic microangiopathy (TMA), and (5) true renal vasculitis (TRV). Renal outcomes were analyzed by Cox regression models, and correlations between vascular lesions and activity/chronicity scores were determined by Spearman's coefficients. A total of 200 (46.6%) had NVL, 189 (44.0%) AS, six NNV (1.4%), 23 (5.4%) TMA, and 11 (2.6%) TRV. Patients with NVL were younger, with higher renal function; patients with TMA and TRV had lower renal function and higher arterial pressure at baseline. Antiphospholipid syndrome and positive lupus anticoagulant were more frequently observed in the TMA group. Five-year renal survival was 83% for NVL, 63% for AS, 67% for NNV, 31% for TMA, and 33% for TRV. NNV and TRV were significantly correlated with activity scores, while AS and chronic TMA were correlated with chronicity scores. Renal vascular lesions are associated with renal outcomes but do not behave as independent factors. The addition of vascular lesions to currently used scores should be further explored.

Experiencia con el balón de Bakri en hemorragia obstétrica / Brakri balloon experience in obstetric hemorrhage

Resumen OBJETIVO: reportar la experiencia con el balón de Bakri en el control de la hemorragia obstétrica, su relación con la cantidad y concentraciones de hemoglobina antes y después de su aplicación. MATERIALES Y MÉTODOS: estudio prospectivo y observacional efec- tuado en dos unidades hospitalarias del 1 de enero al 31 de diciembre de 2016. A todas las pacientes se les aplicó el balón de Bakri por falta de respuesta a los uterotónicos. Variables de estudio: datos clínicos, cantidad de pérdida sanguínea antes y después de la aplicación del balón, cantidad de sangrado en el posparto y transcesárea, tiempo trascurrido entre el diagnóstico y la colocación, tiempo de llenado y volumen administrado, concentraciones de hemoglobina y pruebas de coagulación al ingreso a la unidad de atención, postsangrado y posterior a la aplicación, indicación de hemocomponentes, cantidad y tiempo de permanencia del balón, éxito y complicaciones. Se realizó análisis estadístico de todas estas variables. RESULTADOS: se incluyeron 20 pacientes con hemorragia posparto y transcesárea. La cantidad de sangrado después de la aplicación, tanto en los casos de posparto como transcesárea, fue menor y se obtuvo una adecuada respuesta. El tiempo medio entre el diagnóstico de la hemorragia y la colocación del balón fue de 30 minutos, tiempo medio de llenado de 5 minutos y cantidad media de llenado de 400 mL. El tiempo medio de permanencia del balón fue de 29.5 horas. En 95% de los casos se consiguió una respuesta favorable para el control de la hemorragia, sin complicaciones. CONCLUSIONES: la aplicación del balón de Bakri resultó en una medida útil, rápida y sin complicaciones para controlar la hemorragia obstétrica.

Abstract OBJECTIVE: To present the results obtained by using the Bakri Balloon to control obstetric hemorrhage. MATERIALS AND METHOD: Prospective, observational study within two inpatient medical care units from January 1 to December 31 2016. All of them were applied the Bakri Balloon because of failure to respond to uterotonic drug therapy. The following were analized: clinical data, amount of bleeding before and after the balloon, amount of postpartum or transcesarean bleeding, time between diagnosis and insertion, insufflation time and supplied volumen, hemoglobin levels and coagulation tests results initially, post-hemorrhage and post insertion, use of and amount of haemocomponents ministered, and the balloons use time, success, and complications. RESULTS: 20 patients with postpartum and transesarean hemorrhage are included. The amount of bleeding after insertion, both in postpartum and trans cesarean was reduced and there was an adequate response in hemoglobin levels. The average time between hemorrhage diagnosis and balloon insertion was thirty minutes; average insufflation time, five minutes, and average volumen supplied 400 mL. Balloon's average use time, 29.5 hours. In 95% of the cases there was a positive response for hemorrhage control, with no complications derived from use. CONCLUSIONS: The Bakri Balloon proved to be a useful, quick and complication-free therapy for controlling obstetric hemorrhage.