Strengthening Pathology Capacity to Deliver Quality Cancer Care in Cities in LMICs.

Diagnostic pathology services for oncology health systems are essential; yet, surveys, observations, and hard data from across low- and middle-income countries have revealed that these services are almost always lacking adequate quality and often missing completely. The City Cancer Challenge Foundation (C/Can), the American Society for Clinical Pathology, and C/Can partner cities undertook intense analysis of their existing pathology services as part of a year-long assessment process including the specific formation of a pathology-focused team. Internal and external expert assessments identified sustainable solutions adapted to the local context and level of resources and created specific local implementation projects. Through local leadership, capacity development, and collaboration, services were improved city-wide in three cities: Cali, Colombia; Asunción, Paraguay; and Yangon, Myanmar. Common problems identified across cities included deficiencies in personnel training, equipment, reagents, processes, quality, and coordination. Specific solutions included quality training, standard process development and regulation, implementation of new services, and public-private collaboration. As the first cities joining the C/Can initiative, Cali, Asunción, and Yangon demonstrate the success of the approach and the value of local expertise in identifying problems and solutions. The additional value of international partners' expertise created opportunities for growth through mentorship and technical support. Importantly, the power of healthcare programs with strong political support is emphasized.

The SARS-CoV-2 (COVID-19) coronavirus pandemic: current situation and implications for Mexico.

The Coronavirus pandemic (COVID-19) is one of the most devastating in this century. It originated in China in December 2019 caused by the SARS-Cov-2 virus, and in less than a month it had been classified as an "International Public Health Emergency". To date there are nearly 3 million people infected and more than 250,000 deaths caused by the disease worldwide. Initially it affects the respiratory tract with atypical pneumonia and in severe cases it produces systemic inflammation with cytokine storm that can cause rapid deterioration with circulatory and respiratory failure, coagulopathy and a lethality rate of approximately 7%. In Mexico, the first case was detected in February 2020, and to date there are 26,616 confirmed cases and 2,961 deaths throughout the country. The low number of diagnostic tests conducted in our country clearly underestimates the real incidence and impact of the disease. The most affected groups are those with risk factors such as age over 60, presence of hypertension, diabetes or cardiovascular disease. Of the confirmed cases, 15% are healthcare workers. There is no specific treatment or vaccine yet, so it is important to have hygiene, social isolation and personal protection measures. Health, social and economic consequences could have great impact in the near future.

La pandemia del Coronavirus (COVID-19) es una de las más devastadoras de este siglo. Originada en China en diciembre de 2019 y causada por el virus SARS-CoV-2, en menos de 1 mes ya había sido catalogada como "Emergencia de Salud Pública de Alcance Internacional". A la fecha hay cerca de 3 millones de personas con infección confirmada y ha provocado más de 250,000 fallecimientos en el mundo. Inicialmente afecta las vías respiratorias con neumonías atípica y en casos graves provoca inflamación sistémica con liberación de citoquinas que pueden provocar un rápido deterioro, insuficiencia circulatoria, respiratoria y alteraciones de coagulación con una letalidad cercana al 7%. En México, el primer caso se detectó en febrero del 2020, y a la fecha de esta publicación se cuenta con 29,616 casos confirmados y 2,961 fallecimientos en toda la extensión de país. La baja tasa de muestreo diagnóstico en nuestro país claramente subestima la incidencia e impacto de esta enfermedad. Los grupos mas afectados son aquéllos con factores de riesgo como lo son la edad mayor a 60 años, hipertensión, diabetes o historia de enfermedad cardiovascular. De los casos confirmados, 15% son trabajadores del sector salud. No existe hasta ahora un tratamiento específico o vacuna, de tal manera que es importante contar con las medidas de higiene, aislamiento social y protección personal. Las consecuencias en salud, sociales y económicas podrían ser de gran impacto en los tiempos por venir.

La pandemia de Coronavirus SARS-CoV-2 (COVID-19): Situación actual e implicaciones para México / The SARS-CoV-2 (COVID-19) coronavirus pandemic: current situation and implications for Mexico

Resumen La pandemia del Coronavirus (COVID-19) es una de las más devastadoras de este siglo. Originada en China en diciembre de 2019 y causada por el virus SARS-CoV-2, en menos de 1 mes ya había sido catalogada como "Emergencia de Salud Pública de Alcance Internacional". A la fecha hay cerca de 3 millones de personas con infección confirmada y ha provocado más de 250,000 fallecimientos en el mundo. Inicialmente afecta las vías respiratorias con neumonías atípica y en casos graves provoca inflamación sistémica con liberación de citoquinas que pueden provocar un rápido deterioro, insuficiencia circulatoria, respiratoria y alteraciones de coagulación con una letalidad cercana al 7%. En México, el primer caso se detectó en febrero del 2020, y a la fecha de esta publicación se cuenta con 29,616 casos confirmados y 2,961 fallecimientos en toda la extensión de país. La baja tasa de muestreo diagnóstico en nuestro país claramente subestima la incidencia e impacto de esta enfermedad. Los grupos mas afectados son aquéllos con factores de riesgo como lo son la edad mayor a 60 años, hipertensión, diabetes o historia de enfermedad cardiovascular. De los casos confirmados, 15% son trabajadores del sector salud. No existe hasta ahora un tratamiento específico o vacuna, de tal manera que es importante contar con las medidas de higiene, aislamiento social y protección personal. Las consecuencias en salud, sociales y económicas podrían ser de gran impacto en los tiempos por venir.

Abstract The Coronavirus pandemic (COVID-19) is one of the most devastating in this century. It originated in China in December 2019 caused by the SARS-Cov-2 virus, and in less than a month it had been classified as an "International Public Health Emergency". To date there are nearly 3 million people infected and more than 250,000 deaths caused by the disease worldwide. Initially it affects the respiratory tract with atypical pneumonia and in severe cases it produces systemic inflammation with cytokine storm that can cause rapid deterioration with circulatory and respiratory failure, coagulopathy and a lethality rate of approximately 7%. In Mexico, the first case was detected in February 2020, and to date there are 26,616 confirmed cases and 2,961 deaths throughout the country. The low number of diagnostic tests conducted in our country clearly underestimates the real incidence and impact of the disease. The most affected groups are those with risk factors such as age over 60, presence of hypertension, diabetes or cardiovascular disease. Of the confirmed cases, 15% are healthcare workers. There is no specific treatment or vaccine yet, so it is important to have hygiene, social isolation and personal protection measures. Health, social and economic consequences could have great impact in the near future.

Improving Anatomic Pathology in Sub-Saharan Africa to Support Cancer Care.

OBJECTIVES: Cancer care requires both accurate pathologic diagnosis as well as pathologic cancer staging. We evaluated three approaches to training pathologists in sub-Saharan Africa to perform pathologic cancer staging of breast, cervix, prostate, and colorectal cancers. METHODS: One of three training methods was used at each workshop: didactic, case-based testing (CBT), or a blended approach. The project involved 52 participants from 16 pathology departments in 11 countries in East, Central, and Southern Africa. Evaluation of each method included pre- and postworkshop knowledge assessments, online pre- and postworkshop surveys of practice changes at the individual and institutional levels, and selected site visits. RESULTS: While CBT resulted in the highest overall average postassessment individual scores, both CBT and blended approaches resulted in 19% increases in average scores from pre- to postworkshop assessments. Institutions that participated in the blended workshop had increased changes in practice as indicated by the institutional survey. CONCLUSIONS: Both CBT and a blended approach are effective methods for training pathologists in pathologic cancer staging. Both are superior to traditional lectures alone.

Histopathologic improvement with lymphedema management, Léogâne, Haiti.

In countries where bancroftian filariasis is endemic, lymphedema of the leg is a public health problem, particularly for women, who are disproportionately affected. We investigated the effect of basic lymphedema management (hygiene, skin care, and lower limb movement and elevation) on the histologic features of lymphedema. A total of 118 skin-punch biopsy specimens were collected from the legs of 91 patients enrolled in a lymphedema treatment clinic in Léogâne, Haiti. Follow-up biopsy specimens were collected from 27 patients succeeds, equals 12 months later. Keratinocyte hyperproliferation, condensed dermal collagen, and mononuclear perivascular infiltrate increased with lymphedema stage, which suggested progressive chronic inflammation and fibrosis. Follow-up biopsies showed reductions in perivascular mononuclear infiltrate in the superficial dermis (41% decrease in prevalence), perivascular fibrosis in the deep dermis (58% decrease), and periadnexal mononuclear infiltrate (53% decrease). These data suggest that the clinical improvement commonly observed with basic lymphedema management has a histologic basis.

Intestinal intussusception associated with adenovirus infection in Mexican children.

Formalin-fixed intestinal tissue specimens from 12 Mexican pediatric patients with intussusception were examined for the presence of adenovirus. Four patients (33%) had detectable adenovirus antigen in epithelial cells as determined by using immunohistochemical analysis. Two of the patients with positive immunohistochemical results had antigens in dendritic and mononuclear inflammatory cells, and 3 patients had positive results for species C adenovirus by in situ hybridization using adenovirus species-specific probes (A-F). A real-time polymerase chain reaction assay specific for species C (nonenteric) adenoviruses was used to confirm immunohistochemical results and to amplify adenovirus DNA for sequencing. A sequence similar to that for adenovirus serotype 1 was found in 1 patient, serotype 2 in another, and serotype 6 in a third; in the fourth patient, the sequence was indeterminate between serotypes 2 and 6. The assays used in this study proved useful for the identification of species C adenoviruses in formalin-fixed specimens from Mexican pediatric patients with intussusception.

[High frequency of precancerous lesions of gastric cancer associated with Helicobacter pylori and response to treatment, in Chiapas, Mexico]. / Alta frecuencia de lesiones precursoras de cáncer gástrico asociadas a Helicobacter pylori y respuesta al tratamiento, en Chiapas, México.

Stomach cancer is the second cause of death in Mexico in patients with malignant tumors. This disease represents a public health problem. A strong association has been described between chronic infection with Helicobacter pylori and gastric cancer. This malignancy is preceded by a series of preneoplastic conditions, including chronic atrophic gastritis (CAG), intestinal metaplasia (IM), and dysplasia. The objective of this study was to establish the prevalence of preneoplastic conditions associated with infection of Helicobacter pylori in the state of Chiapas and its eradication with antibiotics. Persons infected with Helicobacter pylori and with CAG were identified by serology against CagA protein and serologic levels of gastrin. An endoscopy with biopsy was performed at the beginning of the study, and at 6 weeks and 1 year thereafter. A total of 281 people were enrolled and randomly assigned to treatment or placebo group. CAG was found in 59%, IM in 51%, and dysplasia in 13%. In intent-to-treat and per-protocol analysis, Helicobacter pylori was eliminated in 70 and 76%, respectively. These results indicate high frequency of preneoplastic conditions associated with Helicobacter pylori and an excellent eradication rate. They also offer a possible alternative for preventing gastric cancer.

Eradication rate of Helicobacter pylori in a Mexican population at high risk for gastric cancer and use of serology to assess cure.

OBJECTIVES: Helicobacter pylori causes gastric adenocarcinoma. We assessed the success of H. pylori eradication therapy in a medically underserved population in Chiapas, Mexico, that is at high risk for gastric cancer risk. METHODS: Healthy volunteers with both antibodies to CagA and gastrin levels > or = 25 ng/ml were randomly assigned to receive either a combination of omeprazole, amoxicillin, and clarithromycin or matched placebo for 1 wk. Endoscopy with seven biopsies was performed at baseline, at 6 wk, and 1 yr after treatment. Treatment success was defined as loss of H. pylori by histological analysis. Cure was assessed using change in serology based on the standardized absorbance of a H. pylori ELISA. RESULTS: H. pylori eradication rates were high (intent-to-treat analysis: 76.3% [95% CI = 68.7-84.0%] after 6 wk and 76.1% [95% CI = 67.7-84.6%] after 1 yr; per protocol analysis: 77.8% [95% CI = 70.1-85.4%] after 6 wk and 75.2% [95% CI = 66.5-84.0%] after 1 yr). Nine subjects on active treatment and one subject on placebo who were without H. pylori at 6 wk were infected at 1 yr (recurrence rates 10.7% and 33.3%, respectively, p = 0.31). Median changes in standardized absorbance at 1 yr were 47% and 1% for successfully and unsuccessfully treated patients, respectively. A 10% decline in standardized absorbance after 1 yr had 84% sensitivity and 100% specificity for H. pylori eradication. CONCLUSIONS: Even with a short course of treatment against H. pylori, a high rate of eradication rate can be achieved in populations at high risk for stomach cancer. Serum antibodies are useful in assessing efficacy of therapy.

La asociación entre Helicobacter pylori y neoplasias gástricas: evidencia epidemiológica / Association between Helicobacter pylori and gastric neoplasias: epidemiological evidence

Helicobacter pylori (HP) produce gastritis crónica y, junto con los antiinflamatorios no esteroideos, se considera el agente etiológico de la mayoría de las úlceras pépticas, debido a que existen numerosos estudios epidemiológicos y de patogénesis que apoyan la asociación entre infección por HP y neoplasias gástricas, la Organización Mundial de la Salud declaró, en 1994, que la infección por HP representa un carcinógeno del grupo I (una causa definitiva de cáncer en humanos, semejante al tabaco). En este trabajo, se revisan las evidencias epidemiológicas que han establecido al HP como posible agente causal de dos neoplasias gástricas: el adenocarcinoma de estómago y el linfoma de células B asociado a mucosa (MALT). Así mismo, se presentan resultados preliminares de un proyecto realizado en los altos de Chiapas, México, donde se estudió la disminución de lesiones preneoplásicas del adenocarcinoma gástrico un año después de haber tratado la infección por HP

Zidovudina más didanosina en pacientes asintomáticos infectados por VIH previamente tratados con zidovudina / Zidovudine plus didanosine in the treatment of VIH asymptomatic patients previously treated with zidovudine

Objetivo. Conocer la eficacia en marcadores subrogados así como la tolerabilidad de la combinación AZT/ddl en pacientes tratados previamente con AZT como monoterapia por un mínimo de seis meses. Métodos. Se estudió una cohorte de 269 pacientes VIH positivos, asintomáticos que habían recibido AZT por un mínimo de seis meses y con cuenta de linfocitos T-CD4+ entre 200 y 500 cels/µl. Recibieron AZT 500 mg/d y ddl 400 mg/d. Como eventos finales se usaron la progresión a SIDA, la muerte o la toxicidad severa. Resultados. El tiempo promedio de tratamiento previo con AZT fue de 20 meses. Al inicio de la terapia combinada, la mediana de linfocitos T-CD4+ fue de 339 células/µL, observándose un incremento al tercer mes de 451 células/µL, y una disminución progresiva a los 6, 12 y 18 meses de seguimiento (medianas de 392, 360, 307 células/µL respectivamente). Cinco pacientes progresaron a sida; seis desarrollaron toxicidad importante (mielosupresión, hepatitis o pancreatitis) y 26 tuvieron efectos secundarios menores necesitando reducción de la dosis. Conclusiones. La introducción de trapia combinada AZT + ddl en pacientes con monoterapia prolongada con AZT puede ser útil. La cuenta de células T-CD4+ mostró un incremento significativo a los tres meses de terapia combinada y una disminución gradual subsecuente. Los efectos adversos a la combinación fueron frecuentes, pero no ameritaron suspender el tratamiento en la mayoría de los pacientes

CA 15.3 in breast cancer: Comparison of two assays and validation in a mexican population

Ca 15.3 is a tumor marker used for breat carcinoma, since one epitope is an antigen present in milk fat globules. Serum from 171 patients withbreast cancer upon initial presentation was studied for Ca 15.3. In the first 72 cases, the authors compared RIA vs. ELISA using a simple linear regression. On the following 99, only ELISA was performed. With all 171 patients, a clinical association between Ca 15.3 mesurement and age, stage and hormone receptors was carried out. Correlation coefficient between RIA and ELISA was 0.85. Of 104 patients below 50 years of age, 88 had normal Ca 15.3 and 16, elevated; 67 were older than 50 years, 46 had normal Ca 15.3 and 21, elevated (p=0.022). Ca 15.3 was elevated in 11 percent of patients with clinical stages I/II, and 89 percent in stages III/IV (p=0.0001). The association of Ca 15.3 with hormone receptors was not significant. In conclusion, ELISA and RIA measure Ca 15.3 with comparable results, the first method has the advantage of not using radioactivity. The authors found higher probability of elevated Ca 15.3 in older patients and in those with advanced disease

Frequency of intestinal parasites in adult cancer patients in Mexico

Approximately 28 percent of the Mexican population has intestinal parasites. Oncologic patients receiving chemotherapy should have a coproparasitoscopic study to avoid disseminated parasitic infections. The frequency of intestinal parasites, including Cryptosporidium and Isospora, was evaluated in 100 diarrheic (DS) and 100 formed stools (FS) from adult patients recently diagnosed with cancer, using wet mount stained with Kinyoun, saccharose and ZnSO4 procedures stained with Lugol's iodine. Seven patients with DS and three with FS had more than one parasite. Pathogenic intestinal parasites were seen in 26 percent of DS and 15 percent of FS. Of the frequent parasites, Entamoeba histolytica was found in 12 DS and in 2 FS (p=0.01), giardia lamblia in three DS and six FS and Hymenolepsis nana in eight DS and 10 FS. Other pathogenic parasites were found only in DS: Cyptosporidium sp. in five patients, Ascaris lumbricoides in two, Strongyloides stercoralis in two and Isospora sp. in one. Cryptosporidium and Isospora were only identified by wet mount stained with Kinyoun while other parasites were identified by flotation procedures. Since six (3 percent) of our patients had coccidia, the laboratory must perform special techniques for their detection. In epidemiology settings where there is a high prevalence of intestinal parasitic infections the coproparasitoscopic studies should be performed and antiparasitic treatment provided before starting chemotherapy

Chronic myelocytic leukemia in accelerated phase with i(17) (q10) and loss p53 gene. Case report

Chronic myelogenous leukemia (CML) is a clonal disorder that presents with a stable period followed by an accelarated phase. The most frequent chromosomal abnormality described is t(9;22). Alterations of chromosome 17, where p53 is located, have been described during transformation. We studied a 23-year-old male who presented with chronic myelogenous leukemia. The karyotype demonstrated 46,XY,t(9;22) (q34;qll) in 12 percent of mitoses and hyperdiploidy in 43 percent. Forty six months later the patient suffered a blast crisis characterized by absolute basophilia; the cytogenetic study demonstrated 48,XY,+8,t(9;22(q34;qll), +der(22)t(9;22)(q34;qll),+i(17)(q10) in 18 percent of the mitoses, 46,XY,t(9;22) (q34;qll) in 34 percent and hyperdiploidy in 23 percent. Since there was i(17)(q10) during this stage, a retrospective DNA study of the biopsy material before and after the transformacition was performed. In the chronic phase, p53 was present in normal amounts, during transformation there was loss of genetic material from the p53 region. The protein product of suppressor gene p53 normally works holding the proliferation of cells. When there is the formation of an isochromosome, genetic material is lost; thus, in this patient, p53 was delted upon the observation of i(17). Lastly, this case shows how DNA can be extracted from slides; this technique is novel and can be used for retrospective studies when parafin block or fresh tissue are not available

Comparación de dos métodos para medir antígeno prostático específico, antígeno carcinoembrionario y alfafetoproteína / Comparison of two methods to measeure prostate specific antigen, carcinoembrionic antigen and alpha fetoprotein

Variaciones en los niveles de marcadores tumorales pueden atribuirse a cambios de reactivos o ténica. En este estudio comparamos dos métodos de cuantificación, ensayo inmunoenzimático de micropartículas (IMx, Abbott) e inmunofluorescencia indirecta en placas (Stratus DaDe), para antígeno prostático específico, antígeno carcinoembrionario y alfafetoproteína. Método: Se analizaron sueros de 100 pacientes con solicitud para antígeno carcinoembrionario, 97 para alfafetoproteína y 98 para antígeno prostático específico. Se revisaron expedientes para corroborar diagnósticos; se obtuvo sensibilidad y especificidad y se realizan curvas de correlación lineal. Resultados: La sensibilidad para los tres marcadores fue superior a 97 por ciento; la especificidad para alfafetoproteína fue del 100 por ciento, para antígeno carcinoembrionario de 95 por ciento y para antígeno prostático específico de 84 por ciento. Los valores predictivos positivos y negativos estuvieron arriba del 92 por ciento. Los coeficientes de correlación fueron 0.97 para antígeno carcinoembrionario, 0.86 para alfafetoproteína y 0.66 para antígeno prostático específico. Existieron casos discrepantes; uno para alfafetoproteína, dos para antígeno carcinoembrionario y seis para antígeno prostático específico. Conclusiones: Basados en los coeficientes de correlación, los métodos son sustituibles para antígeno carcinoembrionario, pero no para antígeno prostático específico y alfafetoproteína. Con estos resultados se prueba que no es conveniente cambiar metodología cuando se sigue a pacientes oncológicos, ya que las variaciones pueden deberse a cambios en el método de medición y no al proceso maligno

Simplificación en el conteo de linfocitos T CD4 positivos en personas con infección por VIH/SIDA en México / A simplified CD4 T-lymphocyte cell count in patients with HIV/AIDS in Mexico

Objetivo. Correlacionar el conteo de células CD4 positivas y linfocitos totales (LT), así como disminuir el costo de la prueba. Material y métodos. En 175 pacientes infectados por VIH se determinó la cuenta de CD4 mediante citometría de flujo, siguiendo las recomendaciones actuales (positividad dual para CD3 y CD4). Se analizó la diferencia entre el porcentaje de células CD3/CD4 dualmente positivas y aquéllas únicamente positivas para CD4. Además, mediante regresión lineal se correlacionaron prospectivamente los valores de LT y células CD4 positivas en 500 personas infectadas con VIH, y se estudió el número de casos discrepantes para cuentas menores de 200 células CD4 positivas, en relación con cuentas de LT menores de 1 500 y 2 000 células/µl. Resultados. En los primeros 175 casos se encontró que la media para la subpoblación CD3/Cd4 positiva fue de 13.8 por ciento, y para CD4 total de 14.2 por ciento, diferencia que no fue estadísticamente significativa. La diferencia entre ambas mediciones varió de 0 a 4.8 por ciento, con una media de 0.4 y una mediana de 0.2 por ciento. La correlación lineal entre LT y CD4 de los 500 pacientes restantes fue de 0.59; la media de LT fue 1 700 células/µl, y de los CD4 219 células/l. Conclusiones. La correlación entre LT y CD4 es muy pobre, por lo que no es posible predecir las cuentas de CD4 a partir de la cuenta de linfocitos obtenida de una biometría hemática. La diferencia entre medir dualmente CD3/CD4 y sólo CD4, no fue significativa. Estos datos sugieren que medir únicamente CD4 disminuye costos y es una alternativa clínicamente útil

Objective. To study the correlation between ALC and CD4 cell counts and to find alternative ways of counting CD4+ T-lymphocytes. Material and methods. The double positivity for CD3/CD4 antibodies was measured in 175 consecutive HIV-positive patients using flow cytometry; in these cases a difference was made between counting cells that were positive for both antibodies vs those that were positive only to CD4. ALC and CD4 counts were also compared among 500 subjects infected with HIV, using linear regression analysis and comparing the number of dissimilar cases for counts below 200 cells/µl and ALC counts lower than 1 500 and 2000 cells/µl. Results. In the 175 cases measured by the CD3/CD4 antibody combination the mean percent was 13.8% and for total CD4 cells 14.2% (p= NS); the mean difference was 0.4% and the median 0.2%. For the 500 patients the mean ALC was 1 700 cells/µl and the mean CD4 count was 219 cells/µl; the correlation coefficient was 0.59. Conclusions. These data suggest a poor correlation of ALC and CD4 cell counts, thus it is impossible to predict CD4 on the basis of ALC. This is the reason why it is necessary to measure CD4 cells separately. The difference between measuring double positive CD3/CD4 cells vs only CD4 positive cells was not significant. Our data suggest that the use of a single CD4 antibody may cut costs and still produce clinically useful information.

Valoración de alfa fetoproteína y gonadotropina coriónica en el diagnóstico de 290 tumores germinales testiculares / Evaluation of alpha-fetoprotein and chorionic-gonadotropin in the diagnosis of 290 testicular germinal tumors

Desde el punto de vista terapéutico y pronóstico, los tumores germinales de testículo se dividen en seminoma puro y no seminoma. El diagnóstico definitivo toma en cuenta la histología, la presentación clínica, y los niveles séricos de alfa fetoproteína (AFP) y fracción beta de gonadotropina coriónica humana (HGC). Objetivo: Correlacionar los valores de AFP y HGC con la variedad histológica y etapa clínica para determinar si cambia el diagnóstico final del tumor. Material y métodos: Se tomó suero en la valoración inicial de 290 pacientes con tumores germinales testiculares determinando niveles de AFP y HGC (ELISA, Quantum II de Abbott). Se revisaron los expedientes para conocer estirpe histológica y estadio clínico. Se consideraron seminomas los tumores con histología de seminoma puro sin elevación de AFP y HGC menor de 500 mUI/ml; los tumores germinales no seminomatosos de testículo (TGNST) presentaron histología de no seminoma o de seminoma con elevación de AFP o HGC mayor de 500 mUI/ml. Resultados: Histológicamente se encontraron 120 seminomas puros y 170 TG-NST. Se reclasificó a 13 casos de seminomas como TGNST ya que 10 presentaron elevación de AFP (tres AFP únicamente y siete AFP más HGC) y tres casos tuvieron elevación de HGC > 500 mUI/ml. La distribución final fue de 107 seminomas y 83 seminomas. Conclusiones: Al analizar los niveles séricos de AFP y HGC con la histopatología se obtiene el diagnóstico definitivo de la estirpe tumoral testicular mejorando la selección del tratamiento

Productividad antes y después de instalar un sistema de cómputo en un laboratorio clínico / Laboratory productivity before and after installing a computer system

En enero de 1991 se instaló un sistema de información de laboratorio clínico en el Instituto Nacional de Cancerología. La meta principal gue agilizar la carga de trabajo administrativa y organizar integralmente el laboratorio. Este estudio, retrospectivo y comparativo, pretende evaluar la productividad del laboratorio clínico adecuando los parámetros del College of American Pathologists (CAP) y utilizando las estadísticas antes (1990) y después de la instalación del sistema de cómputo (1992). En 1990 se recibieron 30,764 pacientes a los que se les realizaron 191,070 exámenes de laboratorio, de tal forma que se procesaron 131 pruebas/secretaria/día y 21 pacientes/secretaria/día. En 1992 se recibieron 43,679 pacientes a los que se les realizaron 245,280 pruebas, para obtener 168 pruebas/secretaria/día y 30 pacientes/secretaria/día. Los índices de productividad muestran un incremento en el número de pacientes atendidos del 41 por ciento y de pruebas realizadas del 28 por ciento. A su vez, han aumentado las actividades de docencia e investigación, ya que existen por lo menos tres protocolos de investigación de químicos que están realizando tesis en el laboratorio clínico a partir de 1992 (en 1991 no se realizaban estas actividades) y se presentaron tres trabajos libres en congresos nacionales e internacionales con personal del laboratorio como primer autor probablemente como consecuencia de la instalación del sistema. En conclusión, el sistema de información del laboratorio permitió incrementar la carga de trabajo sin aumentar el número de secretarias debido a disminución del tiempo de transcripción (hombres, números, resultados) y a las interfases con instrumentos que permiten una organización más eficiente de la carga de trabajo. A su vez, ha sido posible realizar mayor número de protocolos de investigación que anteriormente no habían podido establecerse debido a carga de trabajo no redituable