The Choice of Anticoagulant Influences the Characteristics of Bone Marrow Aspirate Concentrate and Mesenchymal Stem Cell Bioactivity In Vitro.

Bone marrow aspirate concentrate (BMC) is commonly used as a therapeutic agent to resolve orthopedic injuries, using its unique cellularity to reduce inflammation and prime the region for repair. The aspiration of the bone marrow is performed using either sodium citrate (SC) or heparin sodium (HS) as an anticoagulant and processed via centrifugation to concentrate the cellular constituents. To date, the consideration of the impact of the two commonly used anticoagulants on the mesenchymal stem/stromal cell (MSC) population has been overlooked. The current study assesses the differences in the BMCs produced using 15% SC and HS at 1,000 U/mL or 100 U/mL final v./v. as an anticoagulant using in vitro metrics including total nucleated cell counts (TNC) and viability, the ability for mesenchymal stromal/stem cells (MSCs) to establish colony-forming units with fibroblast morphology (CFU-f), and cytokine expression profile of the MSC cultures. Our findings demonstrate that HS-derived BMC cultures result in higher CFU-f formation and CFU-f frequency at both concentrations assessed compared to SC-derived BMC cultures. In addition, there were significant differences in 27% (7 of 26) of the cytokines quantified in HS-derived BMC cultures compared to SC-derived BMC cultures with implications for MSC plasticity and self-renewal.

Evaluation of the Effectiveness of Autologous Bone Marrow Mesenchymal Stem Cells in the Treatment of Chronic Low Back Pain Due to Severe Lumbar Spinal Degeneration: A 12-Month, Open-Label, Prospective Controlled Trial.

BACKGROUND: Regenerative medicine interventions are applied to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous/allogenic biologics and it continues to expand. The anti-inflammatory, immunomodulatory, and regenerative properties of bone marrow mesenchymal stem cells (BM-MSCs), and investigation into their therapeutic efficacy and safety in patients with severe chronic low back pain, have not been demonstrated in controlled studies. Multiple pain generators have been hypothesized to be responsible in severe spinal degeneration and it is difficult to identify a single pain generator; consequently, resulting in inadequate therapeutic results. OBJECTIVES: The study was undertaken to evaluate the effectiveness of autologous bone marrow MSCs in the treatment of chronic low back pain due to severe lumbar spinal degeneration with involvement of multiple structures. STUDY DESIGN: Prospective, open-label, nonrandomized, parallel-controlled, 2-arm exploratory study. SETTING: A private, specialized, interventional pain management and regenerative medicine clinic. METHODS: The treatment group patients received a one-time bone marrow concentrate injection into spinal structures (i.e., discs, facets, spinal nerves, and sacroiliac joints), along with conventional treatment, whereas, the control group received conventional treatment with nonsteroid anti-inflammatory drugs, over-the-counter drugs, structured exercise programs, physical therapy, spinal injections and opioids, etc., as indicated. OUTCOMES ASSESSMENT: Outcomes were assessed utilizing multiple instruments, including the Oswestry Disability Index (ODI), Numeric Rating Scale (NRS-11), EuroQOL 5-Dimensional Questionnaire (EQ-5D-3L), Global Mental Health (GMH), and Global Physical Health (GPH). Multiple outcomes were assessed with primary outcomes being minimal clinically important differences (MCID) in ODI scores between the groups and/or a 2-point reduction in pain scores. In the study group, total nucleated cells, colony forming units-fibroblast, CD34-positive  cell numbers and platelets were also recorded, along with post-procedure magnetic resonance imaging changes. Outcomes were assessed at 1, 3, 6, and 12 months. RESULTS: Significant improvement was achieved in functional status measured by ODI, pain relief measured by NRS-11, and other parameters measured by EQ-5D-3L, GMH, and GPH, in the study group relative to the control group at all time periods. The results showed significant improvements at 12-month follow-up with 67% of the patients in the study group achieving MCID utilizing ODI when compared to 8% in the control group. Greater than 2-point pain reduction was seen in 74% of the patients at 3 months, 66% of the patients at 6 months, and 56% of the patients at 12 months. Both MCID and pain relief of 2 points were significantly different compared to the control group. Opioid use decreased in the investigational group, whereas, there was a slight increase in the control group. Age, gender, opioid use, and body mass index did not affect the outcomes in the stem cell group. LIMITATIONS: Single center, nonrandomized study. CONCLUSIONS: The first available controlled study utilizing BM-MSCs in severe degenerative spinal disease with interventions into multiple structures simultaneously, including disc, facet joints, nerve roots, and sacroiliac joint based on symptomatology, showed promising results.

The functionality and translatability of neocartilage constructs are improved with the combination of fluid-induced shear stress and bioactive factors.

Neocartilage tissue engineering aims to address the shortcomings of current clinical treatments for articular cartilage indications. However, advancement is required toward neocartilage functionality (mechanical and biochemical properties) and translatability (construct size, gross morphology, passage number, cell source, and cell type). Using fluid-induced shear (FIS) stress, a potent mechanical stimulus, over four phases, this work investigates FIS stress' efficacy toward creating large neocartilage derived from highly passaged minipig costal chondrocytes, a species relevant to the preclinical regulatory process. In Phase I, FIS stress application timing was investigated in bovine articular chondrocytes and found to improve the aggregate modulus of neocartilage by 151% over unstimulated controls when stimulated during the maturation stage. In Phase II, FIS stress stimulation was translated from bovine articular chondrocytes to expanded minipig costal chondrocytes, yielding a 46% improvement in aggregate modulus over nonstimulated controls. In Phase III, bioactive factors were combined with FIS stress to improve the shear modulus by 115% over bioactive factor-only controls. The translatability of neocartilage was improved in Phase IV by utilizing highly passaged cells to form constructs more than 9-times larger in the area (11 × 17 mm), yielding an improved aggregate modulus by 134% and a flat morphology compared to free-floating, bioactive factor-only controls. Overall, this study represents a significant step toward generating mechanically robust, large constructs necessary for animal studies, and eventually, human clinical studies.

Oxigenación apnéica para extracción de cuerpo extraño en vía aérea / Apneic oxygenation for extracting a foreign body in the airway

La oxigenación apnéica consiste en la administración de flujos altos de oxígeno a través de algún dispositivo supraglótico mientras el paciente se mantiene en apnea. Se explica por qué el alveolo desnitrogenizado con una composición en su mayor parte de oxígeno, permite la difusión alveolo capilar y genera una presión subatmosférica capaz de arrastrar el flujo de oxigeno existente en el árbol traqueobronquial hasta el mismo alveolo, siempre y cuando no hubiera obstrucción mecánica de la vía aérea. El tiempo aumenta considerablemente hasta que la saturación de oxígeno disminuya, lo que se conoce como tiempo de apnea segura. Se presenta la experiencia de emplear esta técnica en un escolar de 5 años sin antecedentes patológicos, que ingirió un cuerpo extraño (semilla de girasol), la cual se localizaba en vía aérea bronquio principal derecho. Este se extrajo por fibrobroncoscopía bajo anestesia total intravenosa, priorizando la ventilación espontánea hasta localizarlo, y luego, debido a la dificultad que presentó su extracción, se empleó relajación muscular y apnea para optimizar las condiciones de la extracción. Durante este periodo, se empleó la técnica de oxigenación apnéica, la cual se mantuvo durante 12 min. La saturación pulsátil de oxigeno fue mayor al 92 por ciento, tiempo suficiente para culminar la extracción con éxito y sin complicaciones(AU)

Apneic oxygenation consists in the administration of high flows of oxygen through a supraglottic device while the patient remains in apnea. It is explained because the alveolus with low nitrogen concertation/accumulation, with a composition mostly of oxygen, allows capillary alveolus to diffuse, as well as it generates a subatmospheric pressure capable of dragging the oxygen flow existing in the tracheobronchial tree to the alveolus itself, as long as there is no mechanical airway obstruction. The time increases considerably until oxygen saturation decreases, which is known as the safe apnea time. The experience of using this technique is presented is it was used with a five-year-old boy with no pathological history and who swallowed a foreign body (sunflower seed), which was located in the airway, specifically the right main bronchus. The foreign body was extracted by fiberoptic bronchoscopy under total intravenous anesthesia, prioritizing spontaneous ventilation until it was located; and then, due to the difficulty for its extraction, muscle relaxation and apnea were used to optimize the extraction conditions. During this period, the apneic oxygenation technique was used and maintained for twelve minutes. Pulsatile oxygen saturation was greater than 92 percent, enough time to complete the extraction successfully and without complications(AU)

Red blood cells and their releasates compromise bone marrow-derived human mesenchymal stem/stromal cell survival in vitro.

PURPOSE: The use of bone marrow aspirate (BMA) and bone marrow aspirate concentrate (BMC) in the treatment of inflammatory orthopedic conditions has become a common practice. The therapeutic effect of BMA/BMC is thought to revolve primarily around the mesenchymal stem/stromal cell (MSC) population residing within the nucleated cell fraction. MSCs have the unique ability to respond to site of injury via the secretion of immunomodulating factors, resolving inflammation in diseased joints. Recently, the importance of hematocrit (HCT) in BMC has been debated, as the potential impact on MSC function is unknown. In the present study, we investigate MSC health over a short time-course following exposure to a range of HCT and red blood cell releasate (RBCrel) conditions. METHODS: Bone marrow-derived human MSCs in early passage were grown under conditions of 0%, 2.5%, 5%, 10%, 20% and 40% HCT and RBCrel conditions for 3 days. At each day, the percentage of viable, apoptotic and necrotic MSCs was determined via flow cytometry. Relative viable MSC counts in each condition was determined to account for dynamic changes in overall MSC densities over the time-course. Statistical analysis was performed using a one-way ANOVA comparing test conditions to the control followed by a Dunnett's multiple comparison test. RESULTS: Significant reductions in viable MSCs concurrent with an increase in necrotic MSCs in high HCT and RBCrel conditions was observed within 24 h. At each successive timepoint, the percent and relative number of viable MSCs were reduced, becoming significant in multiple HCT and RBCrel conditions by Day 3. Necrosis appears to be the initial mode of MSC death following exposure to HCT and RBCrel, followed by apoptosis in surviving MSC fractions. CONCLUSION: Various levels of HCT and RBCrel severely compromise MSC health within 3 days and HCT should be controlled in the preparation of BMC products. Further, HCT of BMCs should be routinely recorded and tracked with patient outcomes along with routine metrics (e.g. nucleated cell counts, fibroblast-colony forming units). Differences in HCT may account for the inconsistencies in the efficacy of BMC reported when treating orthopedic conditions.

Soluble factors differ in platelets derived from separate niches: a pilot study comparing the secretome of peripheral blood and bone marrow platelets.

BACKGROUND AIMS: Platelet-rich plasma (PRP) and bone marrow aspirate are commonly used in orthobiologics for their anti-inflammatory, anabolic/regenerative and immunomodulatory characteristics via platelet degranulation and cell secretions. Although platelets are derived from megakaryocytes in the bone marrow, no attention has been paid to the potential benefits of bone marrow platelets and whether their contents differ from aging platelets in peripheral blood. METHODS: In the present study, leukocyte-poor peripheral blood-derived platelets in plasma (LPP) and leukocyte-poor bone marrow platelets in plasma (BMP) were prepared from six donors, activated with calcium chloride, incubated and sampled at day 0, day 3 and day 6. LPP and BMP are platelet preparations intended to evaluate the respective platelet secretomes but are not classified as conventional PRPs, as they are not concentrated to the extent necessary to meet the qualifying criteria. At each time point, 15 growth and immunomodulatory factors were quantitated in LPP and BMP: platelet-derived growth factor AA, basic fibroblast growth factor/fibroblast growth factor 2, granulocyte-macrophage colony-stimulating factor, hepatocyte growth factor, macrophage colony-stimulating factor, stem cell factor, vascular endothelial growth factor, tumor necrosis factor alpha, IL-1ß, interferon gamma, IL-4, IL-10, IL-1 receptor antagonist protein, IL-12p40 and arginase-1. RESULTS: The results illustrate that platelets derived from bone marrow have a unique secretome profile compared with those derived from peripheral blood, with significant differences in anti-inflammatory cytokines, which are associated with monocyte polarization. CONCLUSIONS: Ultimately, bone marrow-derived platelets may be useful as a stand-alone orthobiologic or as an effective adjuvant to autologous cell therapies where anti-inflammatory and anabolic processes are desired, especially with respect to monocyte function.

Cutaneous manifestations in COVID 19 infection: Bibliographic Review / Manifestaciones cutáneas en la infección de COVID 19: Revisión Bibliográfica

Introduction: In December 2019, they reported cases of unexplained pneumonia in Wuhan, China. The pathogen, a new coronavirus called severe acute respiratory syndrome (SARSCoV2), was named COVID-19 (coronavirus disease 2019). By February 15, COVID-19 spread across China and around the world, until a pandemic condition was announced on March 11. In Ecuador on February 20 the first case was identified. With the current literature on skin manifestations in COVID-19, in this review, we will focus on the analysis of the description of the skin manifestations presented in infected patients. Objective: to provide an updated descriptive analysis of a sample of patients with unexplained skin manifestations and a diagnosis of COVID-19. Method: it is a non-systematic bibliographic review based on article search using the criteria "skin manifestations and COVID-19" and "skin and COVID 19" in the search engines: PUBMed, ScieLo, Intramed and Psycinfo. Results: In this review, 20 scientific articles were collected, of which 16 were selected for the study, and only 12 met the inclusion criteria. Discussion: dermatological patterns are identified in this collection of articles: erythematous rash, gallbladder lesions, millimeter purpuric macules in flexures, purpuric plaques, urticaria, morbilliform exanthema, ischemic acral lesions, "androgenetic alopecia", these patterns could serve as diagnostic aid and also for research of alternative therapies. Conclusion: Considering all the current information collected on skin manifestations in patients with COVID-19, it is determined that there are not enough cases described to relate both pathologies, but if the number of the sample is increased, these would serve as diagnostic and research support. of possible therapeutic alternatives.

Introducción: En diciembre de 2019, informaron casos de neumonía sin explicación en Wuhan, China. El patógeno, un nuevo coronavirus llamado síndrome respiratorio agudo severo (SARSCoV-2), se denominó COVID-19 (enfermedad por coronavirus 2019). Para el 15 de febrero, COVID-19 se extendió por toda China y todo el mundo, hasta que se anunció una condición pandémica el 11 de marzo. En Ecuador el 20 de febrero se identificó el primer caso. Con la literatura actual sobre las manifestaciones cutáneas en COVID-19, en esta revisión, nos centramos en el análisis de la descripción de las manifestaciones cutáneas presentadas en pacientes infectados.Objetivo: brindar un análisis actualizado descriptivo de una muestra de pacientes con manifestaciones cutáneas inexplicables y diagnóstico de COVID-19. Método: es una revisión bibliográfica no sistemática basada en la búsqueda de artículos utilizando el criterio "manifestaciones cutáneas y COVID-19" y "piel y COVID 19" en los motores de búsqueda: PUBMed, ScieLo, Intramed y PsycInfo. Resultados: En esta revisión se recolectó 20 artículos, de los cuales 16 fueron seleccionados para el estudio, y solo 12 cumplieron con los criterios de inclusión.Discusión: en esta recopilación de artículos se identifica patrones dermatológicos: erupción eritematosa, lesiones vesículares, máculas purpúricas milimétricas en flexuras, placas purpúricas, urticaria, exantema morbiliforme, lesiones isquémicas acrales, "alopecia androgénica", these patrones poden servir como ayuda diagnostóstica y también para investigación de terapias alternativas. Conclusión: Considerando toda la información recogida actual de manifestaciones cutáneas en pacientes con COVID-19, se determina que no hay suficientes casos descritos para relacionar ambas patologías, pero si se aumenta el número de la muestra estas nos servirían como apoyo diagnóstico y en la investigación de posibles alternativas terapéuticas.

Relación del Bienestar Subjetivo de los trabajadores con su Compromiso hacia la organización / The relationship of the Subjective Wellbeing of the Workers with their Commitment towards the Organization

Resumen El compromiso organizacional (CO) de los trabajadores es entendido como una actitud o estado de ánimo que deriva en comportamientos como la intención de permanecer en la organización, la identificación con sus valores y la percepción de tener una deuda moral con la misma por los beneficios recibidos. Estudios previos muestran que el CO impacta positivamente el bienestar subjetivo de los trabajadores (BS), entendido este último como la evaluación cognitiva y afectiva que hacen las personas de la satisfacción sobre su propia vida. Otros estudios afirman que es el BS el que predice el CO. El objetivo del presente estudio fue especificar la dirección de esta relación, para lo cual se aplicó el Instrumento de Compromiso Organizacional para evaluar el CO y el módulo básico del Bienestar Autorreportado (BIARE) para evaluar el BS, a 230 trabajadores de una organización educativa pública de nivel superior en México. Mediante modelos de ecuaciones estructurales se contrastaron las hipótesis de relaciones en uno y otro sentido entre ambas variables con una tercera hipótesis con relaciones recíprocas entre ambas. Se identificó como mejor modelo el que presenta relaciones recíprocas y positivas entre el CO y el BS (Chi2=21.16; gl=16; p=0.172; RMR=.043; GFI=.976; CFI=.991; RMSEA=0.03 [IC 90%= 0.00, 0.07]). Se concluye que un incremento en el CO genera un incremento en el BS de los trabajadores, y la relación positiva entre ambas variables es recíproca. Se discuten las implicaciones de estos resultados para la relación de los trabajadores con su contexto laboral.

Abstract The organizational employee commitment conceptualizes the intention to remain in the work place, as the identification of corporative values and the moral sense of engagement due to the benefits received, under the name of organizational commitment (OC). Previous studies show that OC positively affects the subjective well-being of workers (SW), understood as the cognitive and affective assessment that people make of their own life satisfaction. Other studies state that the effect goes from SW to OC. This study aimed to specify the direction of this relationship, for this purpose OC and SW instruments were applied to 230 workers of a higher education public organization in Mexico. Using structural equation models, the hypothesis of relations in both directions between the two variables was contrasted with a third hypothesis of reciprocal relationships between both. The best model was identified as having positive and reciprocal relationships between CO and BS (Chi2 = 65,627, df = 18, p = 0.000, RMR = .074, RMSEA = .111 [CI 90%= .083, .141]; GFI = .931; CFI = .915). It is concluded that increases in OC strengthen SW, and positive relationship between both variables is reciprocal. The implications of the findings on workers´ relationships in the work place are discussed.

Caso Clínico: Histoplasmosis Cutánea Diseminada en un Paciente Inmunocomprometido / Case Report: Cutaneous Histoplasmosis Disseminated in an Immunocompromised Patient

INTRODUCCIÓN: La histoplasmosis es una micosis sistémica frecuente en pacientes inmunocomprometidos. La clínica es variable y se considera la micosis respiratoria más frecuente a nivel mundial, presentando mayor prevalencia en zonas tropicales incluida Sur América. Se estima que existen cuarenta millones de enfermos, calculándose doscientos mil nuevos casos anualmente. En Ecuador se desconoce la epidemiología de la enfermedad pero se calcula que el 11.1 % de pacientes con SIDA tienen histoplasmosis. CASO CLÍNICO: Paciente masculino de 23 años, procedente del Oro - Ecuador, con antecedentes de SIDA diagnosticado hace cuatro años, con mala adherencia al tratamiento antirretroviral y tuberculosis pulmonar, es ingresado por presentar fiebre de dos semanas de evolución, astenia, tos productiva, pérdida de peso, pápulas eritemato-violáceas costrosas diseminadas en todo el tegumento, con afectación mucosa. Los factores de riesgo que presentó el paciente para histoplasmosis la falta de cumplimiento al tratamiento antirretroviral y vivir en un área rural con exposición a excrementos de aves de corral. EVOLUCIÓN: El paciente fue hospitalizado con diagnóstico de histoplasmosis cutánea diseminada, SIDA, tuberculosis pulmonar, candidiasis oral y herpes anal. Se continuó con el tratamiento antirretroviral, antituberculoso e inició Anfotericina-B e Itraconazol; posteriormente el paciente fue dado de alta con mejoría clínica. CONCLUSIÓN: Las dermatosis juegan un papel importante para realizar el diagnóstico precoz de histoplasmosis. Cuando existen comorbilidades asociadas a la enfermedad, como el SIDA y tuberculosis pulmonar, es necesario replantear el tratamiento, por la interacción medicamentosa que puede existir entre el Itraconazol y la Rifampicina. El paciente recibió Anfotericina­B hasta presentar mejoría clínica. Para la prevención de enfermedades oportunistas una correcta adhesión al tratamiento antirretroviral, evitar el hábitat del hongo como criaderos de aves o cuevas y ante el riesgo de exposición, el uso adecuado de mascarilla.

BACKGROUND: Histoplasmosis is a frequent systemic mycosis in immunocompromised patients. The clinic is variable and is considered the most common respiratory mycosis worldwide, presenting a higher prevalence in tropical areas including South America. It is estimated that there are forty million patients, calculating two hundred thousand new cases annually. In Ecuador, the epidemiology of the disease is unknown, but it is estimated that 11.1% of patients with AIDS have histoplasmosis. CASE REPORT: Male patient of 23 years old, from Oro - Ecuador, with a history of AIDS diagnosed four years ago, with poor adherence to antiretroviral treatment and pulmonary tuberculosis, is admitted for presenting fever of two weeks evolution, asthenia, productive cough, weight loss, scaly erythematous-violaceous papules spread throughout the integument, with mucosal involvement. The risk factors presented by the patient for histoplasmosis were the lack of compliance with antiretroviral treatment and living in a rural area with exposure to poultry excrement. EVOLUTION: The patient was hospitalized with diagnosis of disseminated cutaneous histoplasmosis, AIDS, pulmonary tuberculosis, oral candidiasis and anal herpes. Antiretroviral, antituberculous treatment was continued and Amphotericin-B and itraconazole were started; later the patient was discharged with clinical improvement. CONCLUSION: Dermatoses play an important role in the early diagnosis of histoplasmosis. When there are comorbidities associated with the disease, such as AIDS and pulmonary tuberculosis. It is necessary to rethink the treatment, due to the drug interaction that may exist between Itraconazole and Rifampicin. The patient received Amphotericin-B until clinical improvement. For the prevention of opportunistic diseases, a correct adherence to the antiretroviral treatment, avoid the habitat of the fungus as bird or cave farms and before the risk of exposure, the adequate use of a mask.

Energy drink exposures reported to Texas poison centers: Analysis of adverse incidents in relation to total sales, 2010-2014.

The ill-defined term "energy drink" includes a disparate group of products (beverages, shots, concentrates, and workout powders) having large differences in caffeine content and concentration and intended use. Hence, inaccurate conclusions may be drawn when describing adverse events associated with "energy drinks". The FDA is considering new regulation of these products but product specificity is needed to evaluate safety. To help address this, we queried Texas Poison Center Network data for single substance exposures to "energy drinks" from 2010 to 2014, then analyzed adverse events by product type. We specifically compared energy beverage exposures with sales data for the same time period to evaluate the safety profile of this category of energy drinks. Among 855 documented "energy drink" exposures, poison center-determined outcome severity revealed 291 with no/minimal effects, 417 judged nontoxic or minor/not followed, 64 moderate and 4 major effects, and no deaths. Serious complications included 2 seizures and 1 episode of ventricular tachycardia. Outcome severity by category for beverages: 11 moderate/1 major effects (none in children <17 years); shots: 19 moderate/2 major; non-liquids: 16 moderate/1 major; concentrates: 7 moderate; unknown: 10 moderate. Call incidence to poison centers for beverage type exposures was 0.58 (for moderate effects) and 0.053 (for major) per hundred million units sold. Small volume and concentrated products were associated with a greater number of adverse effects than beverage versions of "energy drinks".

Caso Clínico: Esteatocistoma Múltiple / Case Report: Multiple Steatocystoma

INTRODUCCIÓN: El Esteatocistoma Múltiple (EM), también denominado bocistomatosis o enfermedad poliquística epidérmica, es una patología cutánea poco frecuente con alta carga genética, que se caracteriza por la aparición de múltiples quistes, los mismos que son consecuencia de una alteración de los conductos de las glándulas sebáceas. Estos quistes pueden llegar a medir desde 1-2 milímetros hasta varios centímetros de diámetro. Es importante diferenciar el esteatocistoma múltiple con otras patologías como quistes eruptivos vellosos, quistes epidérmicos o lipomas para descartar síndromes cutáneos asociados a estas patologías. A nivel mundial no existen datos epidemiológicos del EM; se han reportado treinta casos en familias y varios casos esporádicos a nivel mundial. Generalmente se presenta entre la primera y segunda década de vida, con una mayor prevalencia en hombres. CASO CLÍNICO: Paciente femenina, de 26 años de edad, afrodescendiente, sin antecedentes personales o familiares de relevancia. Acudió a consulta externa de dermatología por presentar desde hace aproximadamente siete años, nódulos blanquecinos a nivel de axilas, cuello e hipogastrio, levemente pruriginosos, que aumentan en número y tamaño de manera progresiva. EVOLUCIÓN: La paciente fue sometida a biopsia de lesión en región axilar derecha, con reporte de anatomía patológica compatible con esteatocistoma múltiple, los cuales fueron extirpados quirúrgicamente. CONCLUSIONES: El esteatocistoma es una patología infrecuente, de la cual existen muy pocos estudios. Aunque se conoce su benignidad, es importante su diagnóstico diferencial, por su posible asociación a paquioniquia congénita, acné nódulo quístico, hipotricosis, hipertricosis, hidrosadenitis supurativa y poliposis gastrointestinal. Además se debe sospechar de esta enfermedad cuando exista un cuadro clínico con nódulos quísticos

BACKGROUND: Multiple Steatocystoma (MS), also called bocistomatosis or epidermal polycystic disease, is rare skin pathology with high genetic load, which is characterized by the appearance of multiple cysts, which are the result of an alteration of the ducts of the sebaceous glands. These cysts can measure from 1 - 2 millimeters to several centimeters in diameter. It is important to differentiate multiple steatocystoma with other pathologies such as villous eruptive cysts, epidermal cysts or lipomas to rule out cutaneous syndromes associated with these pathologies. There are no clear data about the epidemiology of MS; thirty cases have been reported in families and several sporadic cases worldwide. It usually occurs between the first and second decade of life, with a higher prevalence in men. CASE REPORT:A 26-year-old, female patient of African descent; without personal or family history. She came to the consult of dermatology for presenting approximately since seven years, whitish nodules at the level of armpits, neck and hypogastrium, slightly pruritic, increasing in number and size progressively. EVOLUTION:The patient underwent a biopsy of the lesion in the right axillary region, with a pathology report compatible with multiple steatocystoma, which were surgically excised. CONCLUSIONS:Steatocystoma is an infrequent pathology, of which there are very few studies. Although it is benignity is known, it is important to realize the differential diagnosis, for possible association with pachyonychia congenita, acne nodule cystic, hypotrichosis, hypertrichosis, hidradenitis suppurativa and gastrointestinal polyposis. In addition, this disease should be suspected when there is a clinical picture with cystic nodules

Phase II Trial of Sorafenib in Patients with Chemotherapy Refractory Metastatic Esophageal and Gastroesophageal (GE) Junction Cancer.

PURPOSE: Vascular endothelial growth factor receptor (VEGFR2) directed therapies result in a modest survival benefit for patients with advanced esophageal and gastroesophageal (GE) junction cancer. Platelet-derived growth factor receptor (PDGFR) may contribute to escape from VEGFR2 inhibition. We evaluated the efficacy of sorafenib, a broad spectrum tyrosine kinase inhibitor targeting VEGFR2 and PDGFR as well as RET and RAF1, in patients with metastatic chemotherapy refractory esophageal and GE junction cancer. PATIENTS AND METHODS: This phase II trial of sorafenib 400 mg twice daily enrolled chemotherapy refractory patients with metastatic esophageal and GE junction cancer with primary endpoint of progression-free survival (PFS) rate at two months. Secondary endpoints included overall survival, objective response rate and toxicity. RESULTS: Among 34 patients, 8 week Kaplan-Meier estimated PFS was 61% (90%CI 45 to 73%). Median PFS is 3.6 months (95% CI 1.8 to 3.9 months), with median overall survival OS 9.7 months (95% CI 5.9 to 11.6 months). Grade 3 toxicities were uncommon and included hand foot skin reaction, rash, dehydration and fatigue. One patient (3%) with ongoing complete response and remains on trial for over 5 years. Whole exome sequencing of this tumor revealed mutations in many cancer-associated genes including ARID1A, PIK3CA, and TP53, and focal amplifications of HMGA2 and MET. CONCLUSION: Sorafenib therapy results in disease stabilization and encouraging PFS in patients with refractory esophageal and GE junction cancer. TRIAL REGISTRATION: ClinicalTrials.gov NCT00917462.

The global burden of neglected tropical diseases

The neglected tropical diseases (NTDs) consist of a group of chronic, debilitating, and poverty-promoting parasitic, bacterial, and viral and fungal infections that are widespread among people in poor rural or peri-urban communities living in tropical or subtropical areas. However, due to population mobility, diseases such as Chagas disease can be diagnosed anywhere on the globe. The NTDs are disabling, disfiguring and deadly diseases impacting more than one billion people worldwide. They also impair physical and cognitive development, cause adverse pregnancy outcomes, and limit adult productivity in the workforce. The global burden of disease associated with the NTDs is comparable to other infectious diseases such as that of malaria or tuberculosis. Controlling or eliminating NTDs represents an affordable opportunity to improve the health of poor communities, which may ultimately promote social development.

Adherencia al tratamiento farmacológico en pacientes hipertensos atendidos en un hospital general / Adherence to pharmacotherapy in hypertensive outpatients attended at general hospital

La falta de adherencia es un hecho recurrente y un problema global, que impide que la morbi-mortalidad asociada a enfermedades crónicas que pueda ser evitada. Objetivo: Determinar la adherencia al tratamiento farmacológico en pacientes hipertensos atendidos en un hospital general. Material y Métodos: Se realizó un estudio observacional, descriptivo, prospectivo, transversal en el que se entrevistó a pacientes atendidos en consultorios externos del Hospital Nacional Cayetano Heredia utilizando el Test de Morisky-Green para determinar su adherencia al tratamiento farmacológico y se determinó el nivel de presión arterial. Resultados: 69,9% eran mujeres, 77,7% tenía un tiempo de enfermedad mayor de tres años. El 52,4% tenían educación primaria, 68% eran casados, 62,1% tenían su presión arterial controlada. La adherencia al tratamiento farmacológico fue 37,9%. Se halló asociación entre adherencia con el estado civil viudo y entre adherencia y presión arterial controlada (p<0,05). Conclusión: La adherencia al tratamiento farmacológico fue 37,9%.

Lack of adherence is a common and global problem that avoid in patients with chronic diseases obtain benefit from treatments that can prevent morbidity and mortality. Objective: To determine adherence to drug treatment in chronic hypertensive patients treated in a general hospital. Material and Methods: An observational, descriptive, prospective, cross-sectional study was performed in patients attending to the outpatient clinic of the Hospital Nacional Cayetano Heredia using the Morisky-Green Test to determine their adherence to drug treatment and determine the blood pressure control. Results: 69.9% were women, 77.7% had disease duration longer than three years. 52.4% had primary education level, 68% were married, 62.1% had their blood pressure under control. Adherence to drug treatment was 37.9%. Association between adherence with the widower status and blood pressure control (p<0.05) were found. Conclusion: Adherence to drug treatment was 37.9%.