Spontaneous splenic rupture, an unusual presentation of tuberculosis.

INTRODUCTION: Spontaneous splenic rupture from tuberculosis (TB) is a very unusual presentation within the wide range of presentations of this infectious disease. CLINICAL CASE: A 40-year-old male with a diagnosis of human immunodeficiency virus, begins with fever and pain in the left hypochondrium. A computed tomography scan was performed, showing probable splenic abscesses; suddenly, it begins with hemodynamic deterioration, exacerbation of pain, a surgical exploration was performed, showing spontaneous splenic rupture. Microscopic study of the spleen shows the presence of Mycobacterium tuberculosis. CONCLUSIONS: This is yet another presentation of TB, which can become a surgical emergency.

INTRODUCCIÓN: La ruptura esplénica espontánea por tuberculosis es una presentación muy inusual dentro de la amplia gama de presentaciones de esta enfermedad infectocontagiosa. CASO CLÍNICO: Masculino de 40 años con diagnóstico de VIH, inicia con fiebre y dolor en hipocondrio izquierdo. Se realiza TAC evidenciando probables abscesos esplénicos; súbitamente comienza con deterioro hemodinámico, agudización del dolor, se realiza exploración quirúrgica evidenciando ruptura esplénica espontánea. Al estudio microscópico del bazo se observa presencia de Mycobacterium Tuberculosis. CONCLUSIONES: Esta es una presentación más de la TB, la cual puede convertirse en una urgencia quirúrgica.

[Perfil de expresión de Ki67 en lesiones melanocíticas palmoplantares: estudio de casos y controles]. / Expression profile of Ki67 in palmoplantar melanocytic lesions: a case-control study.

INTRODUCCIÓN: El melanoma acral lentiginoso es una neoplasia maligna que afecta a población predominantemente no caucásica. Debido al diagnóstico tardío suele tener mal pronóstico, además de que se considera una neoplasia biológicamente más agresiva, incluso cuando se detecta tempranamente. OBJETIVO: Determinar la expresión de Ki67 en el melanoma acral lentiginoso invasor y compararla con los nevos acrales. MÉTODO: Estudio transversal, descriptivo, observacional. Se realizó inmunohistoquímica con marcador Ki67 en 17 biopsias de melanoma acral lentiginoso invasor (casos) y 17 biopsias de nevos palmoplantares (controles). Se determinó la expresión nuclear de Ki-67 y se comparó entre ambos grupos. RESULTADOS: La media de expresión de Ki67 fue del 8.5% en el grupo control y del 34% en el grupo de melanomas, siendo esta diferencia estadísticamente significativa (p < 0.0001). DISCUSIÓN: La expresión de Ki67 en los melanomas acrales es considerablemente mayor que en los nevos acrales. El valor pronóstico del marcador Ki67 sigue siendo considerado controversial. Sin embargo, hay estudios en los que en combinación con otros marcadores se refuerza su valor pronóstico. CONCLUSIONES: Por la gran diferencia en inmunorreactividad de Ki67 entre melanomas y nevos, la expresión de Ki67, referida como índice proliferativo, podría ser considerada como factor pronóstico incluso más objetivo que el índice mitótico. BACKGROUND: Acral lentiginous melanoma is a malignant neoplasm which appears in hands and feet. Acral lentiginous melanoma has an unclear etiology, and usually affects non-Caucasian population. Because it is frequently diagnosed lately, acral melanoma has bad prognosis; however, it is biologically more aggressive than other clinicopathological types of melanoma, even when diagnosed early. OBJECTIVE: To determine the expression of Ki67 in invasive lentiginous acral melanoma and to compare it with acral nevi. METHOD: Cross-sectional, descriptive, observational study. Immunohistochemistry with Ki67 marker was performed on 17 biopsies of invasive lentiginous acral melanoma (cases) and 17 biopsies of palmoplantar nevi (controls). Nuclear expression of Ki-67 was determined and both were compared between both groups. RESULTS: The mean expression of Ki67 was 8.5% in the control group, and 34% in the melanoma group, which was statistically significant (p < 0.0001). DISCUSSION: Ki67 expression in acral lentiginous melanomas is higher than in acral nevi. Prognostic value of Ki67 is still considered controversial. However, there are several studies where, in combination with other markers, their prognostic value is reinforced. CONCLUSIONS: Due to the wide gap in Ki67 expression between melanomas and nevi showed in this study, Ki67 expression, referred to as a proliferative index, could be considered as a prognostic factor even more objective than the mitotic index.

Assessment of the toll-like receptor 4 Asp299Gly, Thr399Ile and interleukin-8 -251 polymorphisms in the risk for the development of distal gastric cancer.

BACKGROUND: The intensity of the inflammation induced by Helicobacter pylori colonization is associated with the development of distal gastric cancer (GC). The host response to H. pylori has been related to genetic polymorphisms that influence both innate and adaptive immune responses.Our aim was to investigate whether the presence of the TLR4 Asp299Gly, TLR4 Thr399Ile and IL-8-251 A/T polymorphisms had any influence in the development of distal GC in a Mexican population. METHODS: We studied 337 patients that were divided in two groups: 78 patients with histologically confirmed distal GC and 259 non-cancer controls. The presence of H. pylori in the control population was defined by positive results of at least two of four diagnostic tests: serology, histology, rapid urease test and culture. Human DNA was purified and genotyped for TLR4 Asp299Gly polymorphism by pyrosequencing, for TLR4 Thr399Ile by PCR-RFLP and for IL8-251 by the amplification refractory mutation system (ARMS)-PCR. RESULTS: The non-cancer control group was found to be in Hardy-Weinberg equilibrium at the polymorphic loci studied (chi-square H-W = 0.58 for IL8-251, 0.42 for TLR4 Asp299Gly and 0.17 for TLR4 Thr399Ile). The frequencies of mutated alleles (homozygous plus heterozygous) were compared between cases and controls. We found no significant difference for TLR4- Asp299Gly [the 7.7% of distal GC patients and 7.7 % non-cancer controls (p = 0.82)] and for TLR4 Thr399Ile [the 1.3% of GC patients and the 5% of the control population (p = 0.2)]. In contrast, for IL-8-251 A/T, 80.77% of the GC patients and 66.4% in the control group age and gender matched had at least one copy of mutated allele (OR = 2.12, 95% CI = 1.1-4.2) (p = 0.023). CONCLUSION: This study showed that the IL8-251*A allele could be related to the development of distal gastric cancer in this Mexican population.

[The effect of MTHFR polymorphisms, pregnancy and first intercourse on cervical cancer in a population from the Northeastern Mexico]. / Interacciones entre polimorfismos del gen MTHFR, gestaciones e inicio de vida sexual modifican el riesgo para cáncer cérvico-uterino en una población del noreste de México.

OBJECTIVE: To investigate the possible association among MTHFR polymorfhisms, environmental factors and cervical cancer (CC) in the Mexican population. METHODS: Seventy patients with CC and 89 control women were questioned about clinical data and their 677 and 1298 genotypes of MTHFR gene were analized. RESULTS: Multipregnancies (0-2 vs. > or = 3, OR 2.1), an early age of first intercourse (IVS) (17 < or = vs. > or = 18 years, OR 4.3) or both factors (OR 3.5) were significantly associated with CC. MTHFR 677, 1298 polymorphisms and their combinations were not different between cases and controls. However, a significant association between pregnancies, IVS and MTHFR polymorphisms (presence of 1298C allele or 677TT genotype) was observed. The 1298C allele plus multipregnancies and IVS < or = 17 years, or both factors, increased 4.3, 5.3, and 11.8 times the risk for CC, respectively, while 677TT genotype changed the risk 2.0, 1.9, and 4.2 times, respectively. CONCLUSION: The 1298C allele increases the risk of CC strongly in women with multipregnancies and early age of IVS, while 677TT genotype has a lower risk without becoming a protection factor.

Comparision of endoscopy-based and serum-based methods for the diagnosis of Helicobacter pylori.

UNLABELLED: Available commercial tests for the diagnosis of Helicobacter pylori infection are based on different types of antigen preparations and hence the diagnostic utility differs substantially. OBJECTIVE: To assess the diagnostic value of the determination of Immunoglobulin (Ig) A and IgG antibodies to H pylori whole cell (WC) and IgG antibodies to cytotoxin associated gene A (CagA) using an in-house ELISA in relation to the results obtained with different invasive methods. METHODS: The study population consisted of 251 Mexican adults, mean age 53 years, age range 15 to 92 years and female to male ratio of 1.5. Peptic ulcer disease was present in 10.8% of these patients, 5.2% had gastric cancer, 11.2% had esophagitis and 72.9% had nonulcer dyspepsia. Biopsy specimens from the body and the antrum of the stomach were obtained for culture, histology and rapid urease test. ELISAs to detect IgA and IgG WC and CagA antibodies were performed using serum. RESULTS: H pylori status was established by the results of the invasive tests. Eighty (31.9%) patients positive to the three tests and 38 (15.1%) negative to all the tests were identified. Based on this result, the sensitivity and specificity of the serology assays were 97.5% and 78.9% for the IgG WC and 70% and 73.7% for the IgA WC, respectively. However, if H pylori status was defined by the positive result of at least one or two invasive diagnostic tests, the sensitivity for the IgG WC decreased to 87.3% and 66.7% respectively, but the specificity was essentially the same. Similar results were obtained for the sensitivity and specificity of IgA using the same criteria. A low CagA prevalence was observed (39%). CONCLUSIONS: Testing for serological IgG antibodies to H pylori WC was the best to assess whether infection by H pylori was present. Neither the IgA WC nor the IgG CagA ELISAs add significant value in the diagnosis of H pylori.

Obesity-related non-alcoholic steatohepatitis and TGF-beta1 serum levels in relation to morbid obesity.

Non-alcoholic steatohepatitis (NASH) can vary from mild hepatic inflammation and steatosis to cirrhosis, and is most frequently associated with obesity, Type 2 diabetes mellitus, hypertension, and the female gender. The prevalence of fatty liver and NASH in the general population is 20% and 3%, respectively. In Western countries, 15-20% of the population is obese and 74-90% of them exhibit fatty changes in liver biopsies. We assessed the prevalence of NASH in morbidly obese patients and evaluated serum TGF-beta1 concentrations in different stages of liver fibrosis. Thirty-five obese patients were evaluated, nine male and 26 female. Their mean body mass index (BMI) was 43.62 +/- 7.92 kg/m2. Liver biopsies were evaluated by light microscopy; graded and staged according to Brunt's system. Serum obtained from patients was used to detect TGF-beta1 concentrations by an ELISA method. Serum alanine transaminase (ALT) levels were elevated in four of the patients and the mean level was 49.98 +/- 94.7 (8-65 IU/L). NASH was diagnosed in 32 (91%) of the biopsies, and the most common pattern seen was mixed, predominantly macrovesicular steatosis. Some degree of fibrosis was seen in 34 (97%) of the biopsies and 22 (63%) were at stage 2 (range 1-3). Serum concentrations of TGF-beta1 had no relationship with the stages of fibrosis. In conclusion, NASH and fibrosis are common in our obese patients, as observed in other studies. TGF-beta1 may play a key role in liver fibrogenesis.

Interacciones entre polimorfismos del gen MTHFR, gestaciones e inicio de vida sexual modifican el riesgo para cáncer cérvico-uterino en una población del noreste de México / The effect of MTHFR polymorphisms, pregnancy and first intercourse on cervical cancer in a population from the Northeastern Mexico

Objective. To investigate the possible association among MTHFR polymorfhisms, environmental factors and cervical cancer (CC) in the Mexican population. Methods. Seventy patients with CC and 89 control women were questioned about clinical data and their 677 and 1298 genotypes of MTHFR gene were analized. Results. Multipregnancies (0-2 vs. > 3, OR 2.1), an early age of first intercourse (IVS) (17 < vs. > 18 years, OR 4.3) or both factors (OR 3.5) were significantly associated with CC. MTHFR 677, 1298 polymorphisms and their combinations were not different between cases and controls. However, a significant association between pregnancies, TVS and MTHFR polymorphisms (presence of 1298C allele or 677TT genotype) was observed. The 1298C allele plus multipregnancies and IVS < 17 years, or both factors, increased 4.3, 5.3, and 11.8 times the risk for CC, respectively, while 677TT genotype changed the risk 2.0, 1.9, and 4.2 times, respectively. Conclusion. The 1298C allele increases the risk of CC strongly in women with multipregnancies and early age of IVS, while 677TT genotype has a lower risk without becoming a protection factor.

Objetivo. Buscar la asociación entre polimorfismos de la enzima metilentetrahidrofolato reductasa (MTHFR), factores ambientales y cáncer cérvico-uterino (CaCU) en mujeres del noreste de México. Métodos. Setenta pacientes con CaCU y 89 mujeres controles se sometieron a un interrogatorio clínico y a genotipificación de los polimorfismos 677C -> T y 1298A -> C del gen MTHFR. Resultados. La multigestación (0-2 vs.> 3, OR 2.1), un temprano inicio de vida sexual (IVS) (17 < vs. > 18 años, OR 4.3) o la combinación de ambos factores (OR 3.5), estuvieron asociados significativamente al CaCU. Los polimorfismos de MTHFR 677, 1298 y sus combinaciones no fueron diferentes entre casos y controles. Sin embargo, se observó una interacción significativa entre las gestaciones, el IVS y los polimorfismos de MTHFR (presencia del alelo 1298C o del genotipo 677TT). El alelo 1298C combinado con multigestación, con un IVS < 17 años, o con ambos factores, incrementó el riesgo para CaCU en 4.3, 5.3 y 11.8 veces, respectivamente, en tanto que el genotipo 677TT modificó este riesgo a 2.0, 1.9, y 4.2 veces, respectivamente. Conclusión. El alelo 1298C incrementa considerablemente el riesgo para CaCU en mujeres multigestas y con un IVS temprano, en tanto que el genotipo 677TT disminuye este riesgo, pero sin llegar a convertirse en un factor protector.