Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012." DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

Impact of the Discordance Between Scales of Memorial Sloan-Kettering Cancer Center and International Metastatic Renal Cell Carcinoma Database Consortium in Patients' Prognosis With Metastatic Renal Cancer.

Background: In Mexico, about 30% of renal cancer patients are diagnosed in a metastatic state. Despite the recent advances in the treatment of cancer, metastatic renal cancer is still an incurable illness. Thus, identifying prognostic factors helps improve prognosis accuracy and survival prediction for patients. Methods: In this study, we retrospectively analyzed 26 patients with histological diagnosis of renal cell carcinoma, including clear cell and other subtypes in stage IV (metastatic), recurrent or unresectable disease. We performed a multivariate analysis of overall survival regarding the congruity between prognostic scales. Results: Our results showed a significant difference in favor of patients with congruity between scales for progression-free survival (18.9 vs. 3.1 months; P = 0.048) and a tendency towards better overall survival in patients with the congruity of both scales compared to the discordant patients (112 vs. 32 months; P = 0.99). Conclusion: This study highlights the discordance between Memorial Sloan-Kettering Cancer Center and International Metastatic Renal Cell Carcinoma Database Consortium scales, which was associated with worse prognosis with a significant difference in progression-free survival but not in overall survival.

Plaque-associated human microglia accumulate lipid droplets in a chimeric model of Alzheimer's disease.

BACKGROUND: Disease-associated microglia (DAMs), that surround beta-amyloid plaques, represent a transcriptionally-distinct microglial profile in Alzheimer's disease (AD). Activation of DAMs is dependent on triggering receptor expressed on myeloid cells 2 (TREM2) in mouse models and the AD TREM2-R47H risk variant reduces microglial activation and plaque association in human carriers. Interestingly, TREM2 has also been identified as a microglial lipid-sensor, and recent data indicates lipid droplet accumulation in aged microglia, that is in turn associated with a dysfunctional proinflammatory phenotype. However, whether lipid droplets (LDs) are present in human microglia in AD and how the R47H mutation affects this remains unknown. METHODS: To determine the impact of the TREM2 R47H mutation on human microglial function in vivo, we transplanted wild-type and isogenic TREM2-R47H iPSC-derived microglial progenitors into our recently developed chimeric Alzheimer mouse model. At 7 months of age scRNA-seq and histological analyses were performed. RESULTS: Here we report that the transcriptome of human wild-type TREM2 and isogenic TREM2-R47H DAM xenografted microglia (xMGs), isolated from chimeric AD mice, closely resembles that of human atherosclerotic foam cells. In addition, much like foam cells, plaque-bound xMGs are highly enriched in lipid droplets. Somewhat surprisingly and in contrast to a recent in vitro study, TREM2-R47H mutant xMGs exhibit an overall reduction in the accumulation of lipid droplets in vivo. Notably, TREM2-R47H xMGs also show overall reduced reactivity to plaques, including diminished plaque-proximity, reduced CD9 expression, and lower secretion of plaque-associated APOE. CONCLUSIONS: Altogether, these results indicate lipid droplet accumulation occurs in human DAM xMGs in AD, but is reduced in TREM2-R47H DAM xMGs, as it occurs secondary to TREM2-mediated changes in plaque proximity and reactivity.

Prevalence and Molecular Profile of Breast Carcinoma Using Immunohistochemistry Markers in Mexican Women.

BACKGROUND: In Mexico, breast cancer is the leading cause of death by malignant tumors in women aged 20 and older. The World Health Organization estimates that 69% of deaths caused by breast cancer occur in developing countries. Little is known about the prevalence of breast carcinoma in Mexico and its molecular subclassification. METHODS: This retrospective cross-sectional study included patients who underwent a mastectomy (single, radical or lumpectomy) or a breast tumor biopsy (core-needle or excisional) from January 2002 to December 2018. The primary purpose of the study was to determine the prevalence and molecular profile of breast in comprehensive cancer center in Mexico and compare our results with those published in the US. This study was approved by our scientific and bioethical committee. RESULTS: The final analysis included 379 patients. The youngest patient was 23 years old and the oldest patient was 89; the mean age at diagnosis was 54.63 years. Patients of 40 years old or younger accounted for 48 of the cases (12.66%) and those older than 40 accounted for 331 of the cases (87.33%). The molecular subclassification showed luminal A subtype in 139 cases (36.67%), luminal B subtype in 143 cases (37.73%), human epidermal growth factor receptor 2-positive carcinomas in 32 cases (8.44%) and triple-negative carcinomas in 65 cases (17.15%). Diabetes mellitus was present in 43 patients (11.34%), hypertension in 78 patients (20.58%), obesity in 82 patients (21.63%) and 66 patients reported being treated with exogenous hormone therapy (17.41%). CONCLUSIONS: Breast carcinoma occurs at an earlier age in Mexican women compared to women in the US. Hormone-positive tumors were found to be more prevalent in older patients, while high-grade tumors were more frequently identified in younger patients.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

OBJECTIVE: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". DESIGN: A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. RESULTS: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. CONCLUSIONS: Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

Accidentes en la edad pediátrica / Accidents in the pediatric age

Se realizó un estudio transversal de tipo descriptivo en el Hospital Pediátrico Provincial Docente Mártires de Las Tunas, en el período comprendido entre el primero de enero y el 31 de diciembre de 2006, con el objetivo de determinar algunas variables epidemiológicas en la ocurrencia de accidentes en la edad pediátrica. Para satisfacer los requerimientos de este estudio se entrevistaron familiares de los niños que ingresaron por esta causa. Se evaluaron las variables: edad, sexo, tipo de accidente, hora y lugar de ocurrencia del mismo, luego se procesaron y se lograron los diferentes resultados. Se obtuvo, que el grupo de edad más afectado es el entre 5 y 15 años y del sexo masculino; los accidentes más frecuentes son los traumas y más de la mitad ocurrieron en el hogar, durante el horario entre la 1 00 PM y las 6 59 PM. Se hace una revisión sobre el tema, así como de la repercusión que tienen los accidentes para la familia y la sociedad y se hacen algunas recomendaciones para frenar esta gran epidemia que cobra miles de vidas cada año(AU)

A traverse study, of descriptive type, at Mártires de Las Tunas Provincial Teaching Pediatric Hospital , in the period between January 1st and December 31 of 2006 was carried out, with the objective of determining some epidemiologic variables in the occurrence of accidents in the pediatric age. To satisfy the requirements of this study the relatives of the children that entered in the study were interviewed . The variables age, sex, type of accident time and place of occurrence were evaluated. They were then processed and the different results were obtained. It was found out that the most affected age group was the one between 5 and 15 years and those of the male gender; the most frequent accidents were the traumas and more than the half happened at home, between 1 00 PM and 6 59 PM. A review is made on the topic, as well as of the repercussion that accidents have for the family and society; and some recommendations are made to stop this great epidemic that charges thousands of lives every year(AU)

Evaluación nutricional de niños que asisten a círculos infantiles municipio Las Tunas / Nutritional Appraisal of the Children Attending day Care Centres Las Tunas Municipality

El arte de la nutrición data desde tiempos remotos y es considerada como una ciencia desde hace siglos. Su crecimiento y desarrollo son índices de salud y bienestar de la población. Se realizó un estudio del estado nutricional de los niños que asisten a círculos infantiles del municipio Las Tunas. La muestra fue integrada por 760 niños de siete círculos infantiles, de ellos 401 del sexo masculino y 359 del sexo femenino. Luego de realizar una revisión sobre el tema, se procedió al análisis estadístico de los resultados. Se concluyó, que la mayoría de los niños se encuentran en los percentiles 10 y 90 en las variables estudiadas: peso/edad y talla/edad, además, se comprobó que existe un número creciente de niños que evolucionan sobre el percentil 90(AU)

The art of nourishment dates back from ancient times, but nourishment as a constituted science exists only a few centuries ago. It was during the Renaissance that a proper description of malnutrition was done. Growth and development are considered sensible indexes of health and nourishment of the population. Many adversities, lack of food , privation, ignorance, accidents influence on what today is called nutritional state. A descriptive study was carried out in order to know the nutritional state of the children attending day care centres in Las Tunas municipality. The sample included 760 children from 7 day care centres. The children were divided first according to their age, from one to five years of age, and also according to their gender. The childrens height was measured in centimetres and the weight in kilograms. 401 children were male and 359 were female. After carrying out a revision on the theme, the statistical analysis of the results was done. It is concluded that most of the children are within the percentiles 10 and 90 in all the variables studied: weight /age and height /age. Besides it was proved that there is a growing number of children that go over the percentile of 90, that is, from overweight to obese(AU)

Meningoencefalitis Bacteriana por Haemophilus Influenzae / Bacterial Meningoencephalitis by Haemophilus Influenzae

Se realiza un estudio epidemiológico, retrospectivo y descriptivo de 134 niños egresados del Hospital Pediátrico Docente Provincia Mártires de Las Tunas, en el período comprendido de enero de 1985 hasta diciembre del 2000, con el objetivo de evaluar el comportamiento clínico epidemiológico de las meningoencefalitis bacterianas por Haemophilus influenzae en nuestro medio. La enfermedad predomina en el sexo masculino y en menores de 5 años, y más frecuentemente en el grupo de 1 4 años. Se encontró relación directa entre la lactancia artificial y la entidad. En la mayor parte de nuestros pacientes se encontraron síntomas respiratorios previos. Las principales complicaciones estuvieron dadas por el edema cerebral y el shock séptico; los antibióticos con mejores resultados fueron las cefalosporinas de tercera generación y el cloranfenicol(AU)

A retrospective and descriptive epidemiological study of 134 children discharged from the Paediatric Educational Provincial Hospital Martires de Las Tunas, was carried out during the period from January 1985 to December 2000 with the objetive of evaluating the clinicolepidemiological be haviour of the bacterial meningoencephalitis by haemophilus influenzae in our medium. There was a predominance of the rickness in younger than five years old males and more frequently in the group oh 1 to 4 years old. A direct relation betweon the artificial lactation and the entity. In the mejority oy our patients, previous respiratory symptoms were found. The main complications were cerebral aedema and septical shock; the antibiotics with the best results were the third generation cephalosporines and chloranfenicol(AU)

Factores de Riesgos en Recién Nacidos que Ingresan en un Hospital Pediátrico / Factors of Risk for Hospitalizing New Born Children in a Pediatric Hospital

Se presentan los resultados de un estudio sobre posibles factores de riesgos por los cuales son ingresados en un hospital Pediátrico. La muestra estuvo constituida por 152 recién nacidos que ingresaron en las diferentes salas del Hospital Pediátrico Docente Provincial Mártires de Las Tunas, desde enero de 1999 hasta diciembre del 2000. A la par se seleccionó un grupo control compuesto por 152 recién nacidos de la misma edad y que no se enfermaron en esta época de la vida. Diversas variables fueron evaluadas como posibles factores de riesgo. Para el análisis estadístico se agruparon los datos en tablas de contingencia 2 x 2, y se calculó el riesgo, con límite de confianza superior al 95 por ciento. Se constataron como factores asociados los siguientes: enfermedades de la madre durante el embarazo, escolaridad de la madre menos de noveno grado, nacer antes de las 36,6 semanas, nacer por parto distócico, pesar menos de 2500 gramos y ser hijo de una madre soltera. Como factores protectores encontramos: madre ama de casa, recibir lactancia materna, tener más de 21 días de nacido y como factores sin ninguna asociación: ingreso de la madre durante el embarazo y el sexo del niño(AU)

The results of a study about possible factors of risk for hospitalizing new born children in a paediatric hospital, are presented here. A sample of one hundred and fifty two new norn children hospitalized in the pediatric educational hospital Martires de Las Tunas during the period of time from January 1999 to December 2000, was compared to a sample of are hundred and fifty two new born of the same age, who didn't get risk in the same period of life. Diverse variants were evaluated as possible factors of risk. For the statistical analysis, the facts were grouped in contingency charts of 2 x 2, the risk was calculated in a confidence limit over 95 per cent. As associated factors were established: mother's rickness during pregnancy, having had medicines during pregnancy, mother's scholarhiyn of less than 9 th grade, having been born defore 36,6 weeks, having been born by dystocial delivery, having weighed less than 2500 grams and having been the child of a single mother as detective factors m ther as a housewife, recciving mother lactation and age of more than 21 days; and as no associative factors, mother's haspitalization during pregnancy and child sex(AU)

Factores de riesgos de gravedad por accidentes en niños / Risk factors for graveness by accidents in children

Se presentan los resultados de un estudio sobre posibles factores de riesgo para ingreso en una Terapia Intensiva Pediátrica por accidentes. Se tomaron 91 niños que ingresaron en la Terapia Intensiva del Hospital Pediátrico Docente Provincial Mártires de Las Tunas, todos por accidentes graves, en el período de enero de 1999 a diciembre del 2000, y se compararon con 91 niños que ingresaron por accidentes en otras salas del hospital. Se evaluaron diversas variables como posibles factores de riesgo. Para el análisis estadístico se agruparon los datos en tablas de contingencia 2x2, y se calculó el riesgo, con límite de confianza superior al 95 por ciento. Se constataron como factores asociados: sexo masculino, accidente fuera del hogar, edad mayor de un año, estar acompañado de otros niños, escolaridad de la madre menos de noveno grado, vivir solo con un padre y el tiempo transcurrido para recibir atención médica después de una hora de haber ocurrido el accidente. Como factores protectores: procedencia urbana, vacaciones escolares y madre ama de casa; y como factores sin asociación: tipo de accidente(AU)

The results of a study about possible factors of risk to hospitalize children in a Pediatric Intensive Therapy due to accidents are presented here. Ninety one children hospitalized in the provincial Pediatrics Educational Hospital Mártires de Las Tunas, were taken as the sample, all of them due to serious accidents January 1999 to December 2000, are compared with ninety one children hospitalized for accidents in other rooms of the hospital. Diverse variants were evaluated as possible factors of risk. For the statistical analysis, the facts were grouped in contingency charts of 2x2; the risk was calculated in a confidence limit over 95 per cent. As associated factors were established: male sex, out of home accidents, more than one year old of age, being in company with other child, mother's scholoship of then 9 th grade, living alone with a father, and a time of more than an hour offer accidents to receive medical attention. As protective factors: urban origin, vacations, mother as housewife; and as associative factors: type of accident and surgical treatment(AU)

Exámenes de laboratorio en porfiria / Laboratory tests in the diagnosis of porphyrias

Las porfirias son un grupo de enfermedades causadas por defectos en la síntesis de hem. Se deben a deficiencias enzimáticas hereditarias. Los patrones de excreción de porfirinas dependen del tipo de defecto enzimático, y de ello depende también la manifestación clínica de las diferentes variedades. Fotosensibilidad y lesiones cutáneas son características de Porfiria Aguda Intermitente. Los pacientes se presentan con el inicio agudo de síntomas neurológicos o abdominales (el grupo hepático) y tienden a tener producción y niveles excretorios, aumentados de ácido delta amino levulínico y porfobilinogteno durante los ataques agudos. Usualmente existe un aumento en la actividad de sintetasa de ácido delta-aminolevulínico. Drogas que inducen enzimas hepáticas se sabe son precipitantes de ataques agudos (por ejemplo, barbitúricos). Una revisión de las diferentes pruebas, incluyendo el test de Watson-Schwartz y de Hoesch, además de maniobras simples al lado de la cama como exposición de la orina a la luz solar y a luz ultravioleta se presentan con los resultados típicos observados en las diferentes variedades de porfiria e ilustraciones de los cambios de color observados en las diferentes pruebas