Progressive vision loss as the initial symptom of Prostate Cancer.

Althought it may vary between countries, since the prostate specific antigen screening era, metastasic prostate cancer at diagnosis accounts for approximately 10% of cases. Intracranial dural metastases are uncommon, but when present they may lead to an increase in intracranial pressure that can subsequently damage intracranial structures, such as the cranial nerves. Prolonged intracranial hypertension can cause optic nerve ischemia, leading to progressive and irreversible vision loss if untreated, hence the importance of anamnesis, complete physical examination, and clinical suspicion.

Management of complicated urinary tract infections in a referral center in Mexico.

BACKGROUND: Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40-70 %). In Mexico, there are ciprofloxacin resistance rates of 8-73 %, to trimethoprim/sulfamethoxazole 53-71 % and cephalosporins 5-18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard. OBJECTIVE: To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance. MATERIALS AND METHODS: The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed. RESULTS: One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %. DISCUSSION: There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role. CONCLUSIONS: Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done.

Relaciones intergeneracionales: implicaciones en procesos de formación política en jóvenes / Intergenerational Relationships: Implications in processes of political formation of young people

Las relaciones intergeneracionales, en siete experiencias de acción política con vinculación de jóvenes en Colombia, permiten señalar algunas tendencias frente a los procesos de socialización y formación política, a partir de las narrativas biográficas y colectivas en contextos diversos. Para tal fin abordaremos algunas que amplían la noción de formación política, tales como las implicaciones en las dimensiones histórica, identitaria e intercultural, especialmente, a partir de los procesos de auto-formación. Es muy importante anotar que en este texto no pretendemos establecer comparaciones entre las experiencias para hallar las comunes; al contrario, buscamos reconocer las distinciones y las diversidades en sus procesos y sentidos de socialización y en sus prácticas de formación política, relacionados directamente con los contextos culturales donde habitan.

Anti-tissue antibodies are related to lung function in chronic obstructive pulmonary disease.

RATIONALE: Chronic obstructive pulmonary disease (COPD) is a multicomponent disease. Autoimmunity can contribute to the pathogenesis of COPD. OBJECTIVES: This study investigates the prevalence of circulating antinuclear antibodies (ANA) and anti-tissue (AT) antibodies, two common markers of autoimmunity, in COPD and their relationship with several components of the disease. METHODS: We determined lung function, the serum titers of ANA and AT by immunofluorescence, and the serum levels of C-reactive protein (CRP) by high sensitivity nephelometry in 328 patients with clinically stable COPD and in 67 healthy controls recruited in the PAC-COPD study. Multiple linear and logistic regression analysis was used to analyze results. MEASUREMENTS AND MAIN RESULTS: The prevalence of abnormal ANA and AT titers was 34% and 26% in patients and 3% and 6% in controls, respectively. Levels of AT greater than or equal to 1:320 were seen in 21% of patients with COPD and were independently associated with the severity of airflow limitation and gas transfer impairment (P < 0.05). Neither ANA or AT titers was related to body mass index, current smoking status, use of inhaled steroids, the Charlson index, or serum C-reactive protein values. CONCLUSIONS: Between a quarter and a third of patients with clinically stable COPD present abnormal titers of circulating ANA and AT. The observed relationship between AT and lung function supports a role for autoimmunity in the pathogenesis of COPD.

Adaptación estructural del diafragma en pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC)

Introducción: La función de los músculosrespiratorios de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) está alterada, entre otros, por eventos mecánicos como la hiperinsuflación pulmonar, trastornos nutricionales (i.e., desnutrición) y cambios metabólicos (i.e., hipoxemia). Sin embargo, un estudio reciente postuló que el músculo puede compensar en alguna medida los efectos deletéreos de la hiperinsuflación. Objetivos: Describir los cambios ultraestructurales del diafragma humano en pacientes con EPOC y relacionarlos con el estado nutricional y la función pulmonar y muscular respectiva. Diseño: estudio observacional prospectivo y descriptivo (serie de casos). Pacientes y Métodos: Se estudiaron 22 pacientes llevados a toracotomía por neoplasia pulmonar localizada (estadio TMN I). Se evaluaron previos a la cirugía el estado nutricional, función pulmonar y mecánica del diafragma y de los demás músculos inspiratorios. Durante la intervención se tomaron muestras del diafragma costal que fueron procesadas para estudios histoquímicos y de microscopía electrónica. resultados: Los pacientes mostraron un volumen espiratorio en el primer segundo (FEV1) de 73+-16 por ciento pred; relación volumen residual/capacidad pulmonar total (RV/TLC), 43+-12 por ciento; y una presión transdiafragmática máxima de 93+-30 cmH2O. En las células musculares del diafragma se evidenciaron 56+-17 secciones mitocondriales por 100um2 (Nmit), una longitud sarcomérica (Lsar) de 2.15+-0.17um, y un área de depósitos de glicógeno (Agly) de 9.6+-4.4 por ciento del área celular total analizada. Se evidenciaron diferencias en elcontenido mitocondrial en asociación con el FEV1, ya que aquellos pacientes con el FEV1 menor de 75 porciento pred tenían mayor Nmit (63+-14 vs 46+-16 mit/100um2, p<0.05). El porcentaje FEV1 correlacionó en forma inversa con Nmit (r=0.53, p<0.01). Por otra parte, las muestras musculares de pacientes con una relación RV/TLC mayor de 35 por ciento mostraron mayores...