Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study.

BACKGROUND: Ampullary adenocarcinoma (AAC) is a rare neoplasm that accounts for only 0.2% of all gastrointestinal cancers. Its incidence rate is lower than 6 cases per million people. Different prognostic factors have been described for AAC and are associated with a wide range of survival rates. However, these studies have been exclusively conducted in patients originating from Asian, European, and North American countries. AIM: To evaluate the histopathologic predictors of overall survival (OS) in South American patients with AAC treated with curative pancreaticoduodenectomy (PD). METHODS: We analyzed retrospective data from 83 AAC patients who underwent curative (R0) PD at the National Cancer Institute of Peru between January 2010 and October 2020 to identify histopathologic predictors of OS. RESULTS: Sixty-nine percent of patients had developed intestinal-type AAC (69%), 23% had pancreatobiliary-type AAC, and 8% had other subtypes. Forty-one percent of patients were classified as Stage I, according to the AJCC 8th Edition. Recurrence occurred primarily in the liver (n = 8), peritoneum (n = 4), and lung (n = 4). Statistical analyses indicated that T3 tumour stage [hazard ratio (HR) of 6.4, 95% confidence interval (CI) of 2.5-16.3, P < 0.001], lymph node metastasis (HR: 4.5, 95%CI: 1.8-11.3, P = 0.001), and pancreatobiliary type (HR: 2.7, 95%CI: 1.2-6.2, P = 0.025) were independent predictors of OS. CONCLUSION: Extended tumour stage (T3), pancreatobiliary type, and positive lymph node metastasis represent independent predictors of a lower OS rate in South American AAC patients who underwent curative PD.

[Jarcho-Levin syndrome associated with maternal hypothyroidism]. / Síndrome de Jarcho-Levin: Caso asociado con hipotiroidismo materno.

BACKGROUND: Jarcho Levin syndrome is an eponymous syndrome consisting with a set of multiple vertebral and rib anomalies, characterized by a short neck, short trunk and short height, which trigger respiratory failure and early neonatal death. The frequency and spectrum of morphological defects in the environment is unknown. This article reports a case. CASE REPORT: a female newborn, product of the third pregnancy in a woman of 29 years, with a history of three previous miscarriages; she had a twin pregnancy and hypothyroidism later. Prenatal ultrasound performed at 28-29 weeks of gestation showed polyhydramnios, mild duodenal atresia, likely annular pancreas, and agenesis of lumbar vertebrae. At birth, turreted skull, short neck, thoracoabdominal dissociation, anal stenosis, hypotrophic external genitalia, hypoplastic pelvic limbs, and popliteal hyperflexion were found. Imaging identified intestinal atresia, scoliosis, lumbar vertebrae agenesis, and defects of segmentation on fourth and fifth right ribs. Laparotomy confirmed malrotation of the small intestine and colon, and complete annular pancreas with Meckel diverticulum. CONCLUSIONS: this syndrome is a set of phenotypes derived from skeletal malformations and other defects. The outcome depends on the severity and quality.

[Risk factors associated with neurocysticercosis in a public hospital in Mexico]. / Factores de riesgo asociados a neurocisticercosis en un hospital público de México.

OBJECTIVE: A case-control study was carried out to determine risk factors associated with neurocysticercosis in a public hospital in Mexico. METHODS: The following factors were analyzed: Socioeconomic, sociodemographic, hygiene, eating habits, and family history of neurocysticercosis in 85 cases and 170 controls. Cases were patients with cranial computed tomography images compatible with neurocysticercosis. The densitometric analysis (Hounsfield units) allowed us to distinguish normal tissue from physiological and pathological calcifications, and other types of lesions. Controls were admitted for neurocysticercosis but findings were not compatible with initial diagnosis. Statistical analysis was done using SPSS and Epi-info 2002. RESULTS: The most common clinical manifestation in patients was epileptic seizures OR=4.2 (IC 95% 2.40-9.67). With regards to risk factors, consumption of street food OR=2.33 (IC 95% 1.25-4.38), and family history of neurocysticercosis OR= 2.37 (IC 95% 1.11-5.04) were found to be associated with neurocysticercosis. In the north central region of Mexico where this study was performed, the disease was more frequent among urban populations.

Reacciones adversas asociadas a la vacunación con bacilo de Calmette y Guérin en una población infantil de la ciudad de Zacatecas, México / Adverse reactions in association with Bacillus Calmette-Guerin immunization in Mexican children

Introducción. La vacuna BCG (bacilo de Calmette y Guérin) previene formas graves de tuberculosis, los efectos adversos son poco frecuentes: abscesos locales, linfadenopatías, lesiones músculo-esqueléticas y enfermedad diseminada; manifestándose meses posteriores y persistiendo varias semanas, asociados con la técnica de aplicación, dosis, edad del niño y estados de inmuno-supresión. Métodos. Mediante un estudio retrospectivo, se evaluó la frecuencia de manifestaciones clínicas secundarias a BCG en niños atendidos durante el período de 8 años y 5 meses en una clínica pública de la ciudad de Zacatecas, México. Además, se determinaron las características demográficas, clínicas, perinatales y antropométricas. Resultados. Se identificaron 22 casos, con una frecuencia de eventos adversos de 1.47 x 10-3 (intervalo de confianza de 95% [IC95%): 0.8, 2.1 x 0-3); 12 fueron del sexo masculino. La manifestación más común fue linfadenopatía (10 casos), seguido por pústula persistente (5), nódulo persistente (4) y úlcera (2 casos), en 4 casos se identificaron factores de inmunosupresión. Conclusiones. La prevalencia de reacciones secundarias es baja, no hubo asociación con sexo, peso y talla al nacimiento, ni con antecedentes maternos. La mayor frecuencia fue de linfadenopatías (IC95%: 22.4, 68.5%). La secuela postratamiento más importante fue la hiperqueratosis. Se observaron bajos eventos adversos, y cuando éstos se presentaron fueron bien resueltos, médica y quirúrgicamente, sin secuelas de importancia.

Introduction. The vaccine BCG (bacillus Calmette and Guerin) prevents severe forms of tuberculosis. Adverse effects are rare and such as local abscesses, lymphadenopathy, skeletal muscle injury and disseminated disease; they usually occur months later and persist for several weeks. Adverse effects are related to technical implementation, doses, age and state of immunosuppression. Methods. A retrospective study assessed the frequency of clinical manifestations secondary to BCG, in children attended over 5 years and 8 months in a government clinic in the city of Zacatecas, Mexico. Demographic, clinical, perinatal, and anthropometric characteristics were determined. Results. Twenty-two cases were identified with an adverse event frequency of 1.47 x 10-3 (IC95%: 0.8, 2.1 x 10-3), 12 male/ 10 female children. The most frequent event was lymphadenopathy (10 cases), followed by persistent pustules (5), persistent nodule (4) and ulcer (2 cases). Immunosuppression was identified in 4 cases. Conclusions. The prevalence of adverse effects is low. There was no association with sex, height or weight at birth, neither with maternal background. The most frequent event was lymphadenopathy (IC95%: 22.4). Hyperkeratosis was the most important post-treatment sequela. BCG is a vaccine with few adverse events; they are clinically well resolved with no important sequelae.

Factores de riesgo asociados a neurocisticercosis en un hospital público de México / Risk factors associated with neurocysticercosis in a public hospital in Mexico

Objetivo: Determinar los factores de riesgo asociados con neurocisticercosis en un hospital público de México. Material y métodos: Se analizaron factores socioeconómicos, demográficos, patrones higiénicos, dietéticos y antecedentes familiares asociados en 85 casos y 170 controles. La muestra se tomó de pacientes que acudieron al estudio de tomografía de cráneo. Los casos presentaron calcificaciones en cráneo compatibles con neurocisticercosis y de acuerdo con la densitometría (Unidades Hounsfield) se definió el tejido normal, las calcificaciones fisiológicas, patológicas así como otras lesiones. Los controles compartían la misma demanda de atención, sin presentar el evento en estudio. Para el análisis estadístico se utilizaron los paquetes computacionales SPSS v 11® y Epi-Info 2002®. Resultados: Las principales manifestaciones clínicas fueron las crisis convulsivas RM 4.2 (IC95% 2.40-9.67); se consideraron factores de riesgo: ingerir alimentos en vía pública RM 2.33 (IC95% 1.25-4.38) y tener antecedentes familiares de neurocisticercosis RM2.37 (IC95% 1.11-5.04), predominó en la población urbana, en la región centro norte de la República Mexicana.

OBJECTIVE: A case-control study was carried out to determine risk factors associated with neurocysticercosis in a public hospital in Mexico. METHODS: The following factors were analyzed: Socioeconomic, sociodemographic, hygiene, eating habits, and family history of neurocysticercosis in 85 cases and 170 controls. Cases were patients with cranial computed tomography images compatible with neurocysticercosis. The densitometric analysis (Hounsfield units) allowed us to distinguish normal tissue from physiological and pathological calcifications, and other types of lesions. Controls were admitted for neurocysticercosis but findings were not compatible with initial diagnosis. Statistical analysis was done using SPSS and Epi-info 2002. RESULTS: The most common clinical manifestation in patients was epileptic seizures OR=4.2 (IC 95% 2.40-9.67). With regards to risk factors, consumption of street food OR=2.33 (IC 95% 1.25-4.38), and family history of neurocysticercosis OR= 2.37 (IC 95% 1.11-5.04) were found to be associated with neurocysticercosis. In the north central region of Mexico where this study was performed, the disease was more frequent among urban populations.