Persistently high incidence rates of childhood acute leukemias from 2010 to 2017 in Mexico City: A population study from the MIGICCL.

Introduction: Over the years, the Hispanic population living in the United States has consistently shown high incidence rates of childhood acute leukemias (AL). Similarly, high AL incidence was previously observed in Mexico City (MC). Here, we estimated the AL incidence rates among children under 15 years of age in MC during the period 2010-2017. Methods: The Mexican Interinstitutional Group for the Identification of the Causes of Childhood Leukemia conducted a study gathering clinical and epidemiological information regarding children newly diagnosed with AL at public health institutions of MC. Crude age incidence rates (cAIR) were obtained. Age-standardized incidence rates worldwide (ASIRw) and by municipalities (ASIRm) were calculated by the direct and indirect methods, respectively. These were reported per million population <15 years of age; stratified by age group, sex, AL subtypes, immunophenotype and gene rearrangements. Results: A total of 903 AL cases were registered. The ASIRw was 63.3 (cases per million) for AL, 53.1 for acute lymphoblastic leukemia (ALL), and 9.4 for acute myeloblastic leukemia. The highest cAIR for AL was observed in the age group between 1 and 4 years (male: 102.34 and female: 82.73). By immunophenotype, the ASIRw was 47.3 for B-cell and 3.7 for T-cell. The incidence did not show any significant trends during the study period. The ASIRm for ALL were 68.6, 66.6 and 62.8 at Iztacalco, Venustiano Carranza and Benito Juárez, respectively, whereas, other municipalities exhibited null values mainly for AML. Conclusion: The ASIRw for childhood AL in MC is among the highest reported worldwide. We observed spatial heterogeneity of rates by municipalities. The elevated AL incidence observed in Mexican children may be explained by a combination of genetic background and exposure to environmental risk factors.

Reduction of atmospheric emissions due to switching from fuel oil to natural gas at a power plant in a critical area in Central Mexico.

A case study was conducted to evaluate the SO2 emission reduction in a power plant in Central Mexico, as a result of the shifting of fuel oil to natural gas. Emissions of criteria pollutants, greenhouse gases, organic and inorganic toxics were estimated based on a 2010 report of hourly fuel oil consumption at the "Francisco Pérez Ríos" power plant in Tula, Mexico. For SO2, the dispersion of these emissions was assessed with the CALPUFF dispersion model. Emissions reductions of > 99% for SO2, PM and Pb, as well as reductions >50% for organic and inorganic toxics were observed when simulating the use of natural gas. Maximum annual (993 µg/m3) and monthly average SO2 concentrations were simulated during the cold-dry period (152-1063 µg/m3), and warm-dry period (239-432 µg/m3). Dispersion model results and those from Mexico City's air quality forecasting system showed that SO2 emissions from the power plant affect the north of Mexico City in the cold-dry period. The evaluation of model estimates with 24 hr SO2 measured concentrations at Tepeji del Rio suggests that the combination of observations and dispersion models are useful in assessing the reduction of SO2 emissions due to shifting in fuels. Being SO2 a major precursor of acid rain, high transported sulfate concentrations are of concern and low pH values have been reported in the south of Mexico City, indicating that secondary SO2 products emitted in the power plant can be transported to Mexico City under specific atmospheric conditions. Implications: Although the surroundings of a power plant located north of Mexico City receives most of the direct SO2 impact from fuel oil emissions, the plume is dispersed and advected to the Mexico City metropolitan area, where its secondary products may cause acid rain. The use of cleaner fuels may assure significant SO2 reductions in the plant emissions and consequent acid rain presence in nearby populated cities and should be compulsory in critical areas to comply with annual emission limits and health standards.

[Identificación de fármacos reguladores de la actividad del promotor Egr-1 en fibroblastos humanos transducidos con AdΔegr-1-Luc7]. / Identification of drugs as regulators on the activity of Egr-1 promoter in human fibroblasts transduced with AdΔegr-1-Luc7.

INTRODUCCIÓN: La proteína de respuesta temprana a crecimiento 1 (EGR-1) es un factor de transcripción involucrado en la diferenciación y la proliferación celulares, cuya expresión es regulada por su promotor en respuesta a diversos factores físicos y químicos, y a fármacos. Aquí se describen algunos de los principales efectos de los fármacos esteroides y del factor de crecimiento epitelial 1 (EGF-1) sobre la actividad del promotor, mediante un sistema reportero transducido por el adenovirus AdΔegr-1-Luc7 en fibroblastos primarios humanos. MÉTODO: Los fibroblastos primarios humanos fueron cultivados en pase 5, transducidos con AdΔegr-1-Luc7 y expuestos a betametasona, hidrocortisona, dexametasona, testosterona, beta-estradiol y EGF-1 durante 1, 3 y 6 horas. La actividad de reportero fue cuantificada por luminometría y ajustada a la concentración de proteínas totales. RESULTADOS: La actividad del promotor en presencia de betametasona, hidrocortisona, dexametasona, testosterona y beta-estradiol fue similar a la actividad basal del promotor a las 1, 3 y 6 horas. El control positivo mostró una actividad 17.8 veces mayor a las 6 horas (p ≤ 0.05). De manera similar, las células expuestas a EGF-1 mostraron una actividad 22.07 veces mayor que las células sin fármaco. CONCLUSIÓN: La actividad del promotor Egr-1 en fibroblastos humanos es regulada negativamente por los fármacos esteroides y positivamente por el EGF-1. INTRODUCTION: The early growth response protein (EGR-1) is a transcription factor involved in cell differentiation and proliferation, whose expression is regulated by its promoter in response to various physical, chemical and drug factors. Hereby, we describe some of the main effects of steroid drugs and EGF-1 on promoter activity, through a reporter system transduced by AdΔegr-1-Luc7 in human primary fibroblasts (HPF). METHODS: Human primary fibroblasts transduced with AdΔegr-1-Luc7 were exposed to betamethasone, hydrocortisone, dexamethasone, testosterone, beta-estradiol, and EGF-1 during 1, 3 and 6 h. Reporter assay was quantified by luminometry. RESULTS: The activity of the promoter in presence of betamethasone, hydrocortisone, dexamethasone, testosterone and beta-estradiol were similar to the basal activity of the promoter at 1, 3 and 6 h. The positive control showed an activity 17.8 folds higher (p ≤ 0.05) at 6 h. EGF-1 showed activity of 22.07 folds greater than cells without drug. CONCLUSION: The activity of the EGR-1 promoter in human fibroblasts is negatively regulated by steroid drugs and positively by the EGF-1.

TNFα and IL-6 Responses to Particulate Matter in Vitro: Variation According to PM Size, Season, and Polycyclic Aromatic Hydrocarbon and Soil Content.

BACKGROUND: Observed seasonal differences in particulate matter (PM) associations with human health may be due to their composition and to toxicity-related seasonal interactions. OBJECTIVES: We assessed seasonality in PM composition and in vitro PM pro-inflammatory potential using multiple PM samples. METHODS: We collected 90 weekly PM10 and PM2.5 samples during the rainy-warm and dry-cold seasons in five urban areas with different pollution sources. The elements, polycyclic aromatic hydrocarbons (PAHs), and endotoxins identified in the samples were subjected to principal component analysis (PCA). We tested the potential of the PM to induce tumor necrosis factor alpha (TNFα) and interleukin 6 (IL-6) secretion in cultured human monocytes (THP-1), and we modeled pro-inflammatory responses using the component scores. RESULTS: PM composition varied by size and by season. PCA identified two main components that varied by season. Combustion-related constituents (e.g., vanadium, benzo[a]pyrene, benzo[a]anthracene) mainly comprised component 1 (C1). Soil-related constituents (e.g., endotoxins, silicon, aluminum) mainly comprised component 2 (C2). PM from the rainy-warm season was high in C2. PM (particularly PM2.5) from the dry-cold season was rich in C1. Elevated levels of cytokine production were associated with PM10 and C2 (rainy-warm season), whereas reduced levels of cytokine production were associated with PM2.5 and C1 (dry-cold season). TNFα secretion was increased following exposure to PM with high (vs. low) C2 content, but TNFα secretion in response to PM was decreased following exposure to samples containing ≥ 0.1% of C1-related PAHs, regardless of C2 content. The results of the IL-6 assays suggested more complex interactions between PM components and particle size. CONCLUSIONS: Variations in PM soil and PAH content underlie seasonal and PM size-related patterns in TNFα secretion. These results suggest that the mixture of components in PM explains some seasonal differences in associations between health outcomes and PM in epidemiologic studies. CITATION: Manzano-León N, Serrano-Lomelin J, Sánchez BN, Quintana-Belmares R, Vega E, Vázquez-López I, Rojas-Bracho L, López-Villegas MT, Vadillo-Ortega F, De Vizcaya-Ruiz A, Rosas Perez I, O'Neill MS, Osornio-Vargas AR. 2016. TNFα and IL-6 responses to particulate matter in vitro: variation according to PM size, season, and polycyclic aromatic hydrocarbon and soil content. Environ Health Perspect 124:406-412; http://dx.doi.org/10.1289/ehp.1409287.

Induction of c-Jun by air particulate matter (PM10) of Mexico city: Participation of polycyclic aromatic hydrocarbons.

The carcinogenic potential of urban particulate matter (PM) has been partly attributed to polycyclic aromatic hydrocarbons (PAHs) content, which activates the aryl hydrocarbon receptor (AhR). Here we report the effect of PM with an aerodynamic size of 10 µm (PM10) on the induction of AhR pathway in A549 cells, evaluating its downstream targets CYP1B1, IL-6, IL-8 and c-Jun. Significant increases in CYP1B1 protein and enzyme activity; IL-6 and IL-8 secretion and c-Jun protein were found in response to PM10. The formation of PAH-DNA adducts was also detected. The involvement of AhR pathway was confirmed with Resveratrol as AhR antagonist, which reversed CYP1B1 and c-Jun induction. Nevertheless, in IL-6 and IL-8 secretion, the Resveratrol was ineffective, suggesting an effect independent of this pathway. Considering the role of c-Jun in oncogenesis, its induction by PM may be contributing to its carcinogenic potential through induction of AhR pathway by PAHs present in PM10.

Variation in the composition and in vitro proinflammatory effect of urban particulate matter from different sites.

Spatial variation in particulate matter-related health and toxicological outcomes is partly due to its composition. We studied spatial variability in particle composition and induced cellular responses in Mexico City to complement an ongoing epidemiologic study. We measured elements, endotoxins, and polycyclic aromatic hydrocarbons in two particle size fractions collected in five sites. We compared the in vitro proinflammatory response of J774A.1 and THP-1 cells after exposure to particles, measuring subsequent TNFα and IL-6 secretion. Particle composition varied by site and size. Particle constituents were subjected to principal component analysis, identifying three components: C(1) (Si, Sr, Mg, Ca, Al, Fe, Mn, endotoxin), C(2) (polycyclic aromatic hydrocarbons), and C(3) (Zn, S, Sb, Ni, Cu, Pb). Induced TNFα levels were higher and more heterogeneous than IL-6 levels. Cytokines produced by both cell lines only correlated with C(1) , suggesting that constituents associated with soil induced the inflammatory response and explain observed spatial differences.

Estrés postraumático en la población pediátrica atendida en el Hospital Infantil del estado de Chihuahua, México / Posttraumatic stress disorder in a pediatric population treated at the Children's Hospital of the State of Chihuahua, Mexico

Introducción. Ante el incremento de acciones violentas de diversa índole en nuestra comunidad surge la preocupación respecto a las consecuencias psicológicas en los niños que viven algún evento traumático. Por lo anterior, el objetivo del presente estudio fue identificar los factores relacionados con el desarrollo de trastorno de estrés postraumático en la población pediátrica atendida en el área de Psicología Infantil del Hospital Infantil del estado de Chihuahua. Métodos. Se realizó un estudio transversal retrospectivo en el que se analizaron los expedientes de de pacientes atendidos en el área de psicología infantil del Hospital Infantil del estado de Chihuahua durante un periodo de 3 meses. Se realizó el estudio de frecuencias y el análisis bivariado. Resultados. Se analizaron 125 expedientes que representaron 51% del total de la consulta del Departamento de Salud Mental. De estos, 41.6% correspondieron al género masculino y 58.4% al femenino. En 52 pacientes el evento desencadenante fue la violencia, mientras que en 73 pacientes éste se debió a accidentes. La edad de los pacientes se encontró dentro del rango de los 5 y los 15 años y la mayor prevalencia entre los 5 y 7 años y medio. No se encontró asociación estadísticamente significativa entre la escolaridad de los padres, la religión de la familia ni el tipo de familia (integrada o desintegrada) con el desarrollo de trastorno de estrés postraumático. Conclusiones. El trastorno de estrés postraumático en la población pediátrica ha aumentado de forma considerable en los últimos años. La identificación adecuada de los pacientes que presentan datos sugestivos del diagnóstico es de suma importancia para poder imple-mentar terapias que permitan evitar las consecuencias psicológicas.

Background. Due to the increase in various types of violent actions in our community, there is a preoccupation regarding the psychological consequences for children who survive a traumatic event. The aim of this study was to identify factors related to the development of posttraumatic stress disorder (PTSD) in pediatric patients treated in the Department of Child Psychology at Children's Hospital of the State of Chihuahua (HIECH). Methods. We conducted a retrospective cross-sectional study examining the clinical files during a 3-month period of patients treated in the Department of Child Psychology of HIECH. The study was conducted with frequencies and bivariate analysis. Results. We analyzed a total of 125 clinical files of which 41.6% corresponded to males and 58.4% to females. In 52 patients the triggering event was a violent action, whereas in 73 patients the event was due to accidents. The age of the patients was between 5 and 15 years and the highest prevalence was found in patients between 5 and 7 years of age. No statistically significant association was found in regard to parental education, religion, or family type (integrated or disintegrated) with the development of PTSD. Conclusions. Posttraumatic stress disorder in the pediatric population has increased considerably in recent years. Proper identification of patients with data suggestive of the diagnosis is important in order to implement therapies that avoid the psychological consequences.

Consumo y dependencia al tabaco como factor asociado a la tuberculosis pulmonar / Consumption and dependence to the tobacco like factor associated with the pulmonary tuberculosis

Objetivo: determinar la asociación entre el consumo y dependencia al tabaco como factor asociado a la tuberculosis pulmonar. Material y método: estudio analítico, retrospectivo de casos y controles, con pacientes registrados en la Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis (ESN-PCT) de dos centros de salud DISA V Lima- Ciudad. La muestra estuvo conformada por 35 pacientes con tuberculosis pulmonar (casos) y 70 sintomáticos respiratorios (controles), fueron incluidos pacientes de ambos sexos que se encontraban dentro de los 6 meses del esquema I y sintomáticos respiratorios que tuvieron baciloscopía negativa. Para la recolección de datos se usó una ficha sociodemográfica, se aplicó la prueba de Fagerstrõm y se solicitó la participación mediante el consentimiento informado. Resultados: se halló que 94,3% (casos) y 90,0% (controles), respondió que alguna vez en su vida habían fumado, de ellos el 65,7% (casos) y el 64,3% (controles) fumó durante los últimos 30 días. A su vez que el mayor porcentaje en casos asociado con la dependencia a la nicotina moderado-severa fue 51,4%. Conclusiones: las personas que consumen cigarro tienen mayor posibilidad de contraer la enfermedad y que la dependencia a este se considera factor asociado a la tuberculosis pulmonar porque el odds ratio es significativo. Con mayor predominancia en el sexo masculino entre los 18 a 40 años.

Objective: Was to determine the association between snuff use and dependence as a factor associated with pulmonary tuberculosis. Material and methods: Analytical, Case-control retrospective, with patients enrolled in the Health Strategy for Prevention and Control of Tuberculosis (ESN-PCT) from two health centers DISA V Lima-City. The sample consisted of 35 patients with pulmonary tuberculosis (cases) and 70 with respiratory symptoms (controls) were included patients of both sexes who were within six months of Schedule I and respiratory symptoms who were smear negative. For data collection will use a demographic sheet, we apply the Fagerstrõm test and asked to participate through informed consent. In terms of results it was found that smoking was answered affirmatively. Results: By 94.3% (cases) and 90.0% (control), once in his life smoked, of whom 65.7% (cases) and 64.3 % (controls) smoked during the past 30 days. At the same time that the greatest percentage of cases associated with nicotine dependence was moderate-severe 51.4%. Conclusion: That people who consume cigarettes are more likely to contract the disease and that this dependence is considered factor associated with pulmonary tuberculosis because the odds ratio is significant. With higher predominance of males between 18-40 years.

Screening for tuberculosis infection in spanish healthcare workers: Comparison of the QuantiFERON-TB gold in-tube test with the tuberculin skin test.

OBJECTIVE: The risk of latent tuberculosis (LTBI) in healthcare workers (HCWs) is high. Until recently, the tuberculin skin test (TST) was the only diagnostic test available for Mycobacterium tuberculosis infection. A new enzyme-linked immunosorbent assay test, the QuantiFERON-TB Gold (QFT-G) test, was recommended by the US Centers for Disease Control and Prevention as an alternative test for the diagnosis of LTBI in HCWs. The purpose of our study was to compare the TST and the QFT-G test in Spanish HCWs in order to improve procedures for the detection of LTBI. METHODS: A cross-sectional study with blinded comparison of TST and QFT-G test results was carried out among 134 HCWs at an 800-bed Spanish university hospital. The level of interferon-gamma production stimulated by the QFT-G test was measured. A concentration of at least 0.35 IU/mL was considered a positive result. An induration of at least 5 mm in non-BCG-vaccinated or at least 15 mm in BCG-vaccinated HCWs for the TST was considered positive. RESULTS: Of the 134 HCWs included (mean age, 33.4 years; 101 [75.4%] women; 47 [35.1%] BCG vaccinated), the LTBI prevalence diagnosed with any test was 11.2% (95% confidence interval, 6.6%-18.1%), with the TST was 8.96%, and with the QFT-G test was 5.97% (nonsignificant differences). The QFT-G test value was higher in subjects with TST induration of at least 15 mm than in subjects with TST induration of less than 15 mm (P < .001). Overall agreement between the results of the two tests was found in 94% of HCWs (kappa = 0.56), but agreement was only 59% in HCWs who had a positive result for both tests. Disagreement was present in the results found for 5% of HCWs. CONCLUSIONS: Few studies have compared both tests in populations with high M. tuberculosis exposure but low BCG vaccination prevalence. Agreement between both tests is high, especially among negative results. Studies are needed to clarify the reasons for disagreement and to establish the best TST and QFT-G test cutoff point.

Acceso vascular para hemodiálisis: injerto arterio-arterial, Humero-humeral: presentación de un caso / Vascular access for hemodialysis: arterio-arterial graft, from proximal brachial artery to distal brachial artery: report of a case

Objetivo: Reportar la experiencia de nuestro servicio en el manejo de un paciente multiabordado, para lograr un acceso vascular para hemodiálisis, cuando las posibilidades descritas en la literatura se han agotado. Material y métodos: Paciente femenina de 73 años, con cavidad no útil para diálisis, que durante el lapso de 3 años, fue sometida a más de 20 abordajes para lograr una vía de acceso vascular para hemodiálisis en cuello, miembros superiores y miembros inferiores. Finalmente se le realizó un puente arterial humero-humeral, terminolateral, con politetrafluoroetileno. Resultados: La paciente durante el lapso de seis meses, se ha hemodializado satisfactoriamente a través del puente arterio-arterial, sin ninguna complicación. Conclusión: La realización de un puente arterio-arterial, con material sintético, como vía de acceso vascular para hemodiálisis ha demostrado ser útil y una opción cuando las vías descritas en la literatura se han agotado. Este caso constituye el inicio de un protocolo para valorar la utilidad, vida media, complicaciones y riesgos a largo plazo.

Evaluación del nivel de atención y grado de satisfacción de las mujeres sometidas a la anticoncepción quirúrgica voluntaria en los distritos de Rímac - Los Olivos - San Martín de Porras / Evaluation of the attention level and degree of satisfaction of the women submissive the voluntary surgical contraception in the districts of Rímac - Los Olivos - San Martín de Porres

El nivel de atención recibido fue óptimo y bueno en las mujeres sometidas al AQV y en su mayor porcentaje mostraron satisfacción después de la operación. Las características personales de las mujeres no influye en la percepción del trato recibido en el hospital, siendo el grado de instrucción la única variable personal que se relaciona con la percepción del tiempo empleado en el transcurso de la atención. Las características personales y factores subjetivos de las mujeres operadas no influyen en la decisión de las candidatas para animarse o desanimarse luego de conservar con ellas. El haber sido informadas sobre el método, riesgo, eficacia, molestias intra y postoperatoria y haber recibido los beneficios de la gratuidad asimismo el nivel de atención, el trato recibido en el hospital y la percepción del tiempo guarda relación con la satisfacción de las mujeres después de la operación.

Loxoscelismo / Loxoscelism

El envenenamiento por mordedura de la araña Loxosceles reclusa, es un padecimiento que causa lesiones necróticas en piel y tejido celular subcutáneo, y manifestaciones sistémicas que pueden ser leves como hemólisis mínima hasta coagulación intravascular diseminada. La pérdida de la extremidad es frecuente cuando no se logra detener la evolución de las lesiones dérmicas y el uso de Dapsone, aunque controversial, ha resultado de utilidad para el manejo de éstas. En este artículo se presenta la experiencia en el Servicio de Angíología del Hospital de Especialidades Centro Médico ®La Raza¼ en el manejo de esta tan especial patología que conlleva en muchas ocasiones a diagnósticos equívocos y por ende a manejos inadecuados

Symposium Trasplante de órganos en México: Registro Nacional de Trasplantes, trasplantes de órganos en México / Symposium: organs transplant in Mexico: National Register of Trasplants. Organ trasplants in Mexico

Objetivo. Informar acerca de los resultados obtenidos por el Registro Nacional de trasplantes en la procuración y distribución de órganos de acuerdo a los principios de ética y justicia. Sede. Subsecretaría de Servicios de Salud, Registro Nacional de trasplantes. (RNT). Diseño. Estudio retrospectivo, longitudinal observacional. Material y métodos. En México existen actualmente más de 70 centros de trasplante renal, los que se ubican en 21 de las 32 entidades federativas, siendo el Distrito Federal el sitio donde se localiza el mayor número de éstos; así mismo, se cuenta con más de 75 centros de trasplante corneal en todo el país. El sistema de informática del RNT recibe informes trimestrales y anuales de todos los centros adscritos al programa, la información recibida es procesada en un sistema de informática integrado por una computadora Olivetti M-300-30 y un paquete de software Works 2.0 de Microsoft, donde radica la base de datos de RNT, en esta base de datos se manejan todos los elementos de carácter estadístico, además de los datos generales de cada centro como: ubicación geográfica, responsables, licencias, tipos de órganos que se implantan en cada centro, etc. El marco jurídico que regula la práctica de trasplantes en México lo integran: La Ley General de Salud; El Reglamento en materia de Control Sanitario de la Disposición de Organos y Tejido y Cadáveres de seres humanos y la Norma Técnica No. 323 para la Disposición de Organos y Tejidos de seres humanos con fines terapéuticos. Resultados. En México se han realizado un total de 22,968 trasplantes de órganos, de los cuales 4,178 fueron de riñón, la fuente de donación fue principalmente donadores vivos de 3,656 casos (87.5 por ciento), así mismo, la donación de cadáver se constituyó por 522 casos(12.5 por ciento)

Complicaciones del sistema nervioso central en triquinosis / Central nervous system complications in trichinosis

Se presentaron dos pacientes de 9 y 11 años de edad, con cuadros clínicos similares consistentes en un síndrome febril de causa inaparente, edema palpebral, mialgias y compromiso encefálico importante. El hemograma demostró una eosinofilia marcada y el estudio del líquido cefalorraquídeo fue normal. En ambos la biopsia muscular confirmó el diagnóstico de triquinosis. Tratados con tiabendazol y corticoides, hacen una evolución favorable con regresión de la sintomatología

Golpe de calor en lactantes / Heatstroke in infants

Se presentan 4 casos en lactantes de encefalopatía aguda, con hipertermia, shock y fenómenos hemorragíparos. Se describe el cuadro clínico, de laboratorio y anatomopatológico, señalándose su predominio en el sexo masculino y las lesiones anatomopatológicas más características