Sacubitril/Valsartan Versus Enalapril in Chronic Chagas Cardiomyopathy: Rationale and Design of the PARACHUTE-HF Trial.

Chronic Chagas cardiomyopathy (CCC) has unique pathogenic and clinical features with worse prognosis than other causes of heart failure (HF), despite the fact that patients with CCC are often younger and have fewer comorbidities. Patients with CCC were not adequately represented in any of the landmark HF studies that support current treatment guidelines. PARACHUTE-HF (Prevention And Reduction of Adverse outcomes in Chagasic Heart failUre Trial Evaluation) is an active-controlled, randomized, phase IV trial designed to evaluate the effect of sacubitril/valsartan 200 mg twice daily vs enalapril 10 mg twice daily added to standard of care treatment for HF. The study aims to enroll approximately 900 patients with CCC and reduced ejection fraction at around 100 sites in Latin America. The primary outcome is a hierarchical composite of time from randomization to cardiovascular death, first HF hospitalization, or relative change from baseline to week 12 in NT-proBNP levels. PARACHUTE-HF will provide new data on the treatment of this high-risk population. (Efficacy and Safety of Sacubitril/Valsartan Compared With Enalapril on Morbidity, Mortality, and NT-proBNP Change in Patients With CCC [PARACHUTE-HF]; NCT04023227).

Vulnerable period in heart failure: a window of opportunity for the optimization of treatment - a statement by Mexican experts.

Acute heart failure (HF) is associated with poor prognosis. After the acute event, there is a vulnerable period during which the patient has a marked risk of readmission or death. Therefore, early optimization of treatment is mandatory during the vulnerable period. The objective of this article is to provide recommendations to address the management of patients with HF during the vulnerable period from a practical point of view. A group of Mexican experts met to prepare a consensus document. The vulnerable period, with a duration of up to 6 months after the acute event - either hospitalization, visit to the emergency department or the outpatient clinic/day hospital - represents a real window of opportunity to improve outcomes for these patients. To best individualize the recommendations, the management strategies were divided into three periods (early, intermediate and late vulnerable period), including not only therapeutic options but also evaluation and education. Importantly, the recommendations are addressed to the entire cardiology team, including physicians and nurses, but also other specialists implicated in the management of these patients. In conclusion, this document represents an opportunity to improve the management of this population at high risk, with the aim of reducing the burden of HF.

Espacios cardioprotegidos en México: acciones para prevenir la muerte súbita cardiaca. Una postura de profesionales de la salud.

La muerte súbita cardiaca es un problema de salud pública a nivel mundial. Aunque su incidencia no es conocida, se estima que causa hasta 50% de la mortalidad de origen cardíaco y hasta 20% de la mortalidad total en los adultos. En México, estimaciones previas sugieren que causa en promedio 33 000 muertes al año; sin embargo, los datos no son precisos. La  mitad de los eventos por muerte súbita cardiaca se deben a un paro cardiaco súbito extrahospitalario que, de no ser atendido oportunamente, deriva en una muerte súbita cardiaca. Por tanto, la capacidad de responder pronta y adecuadamente a estos eventos con las maniobras y equipos necesarios mejora la sobrevida de las víctimas. Para atender este problema, en algunos estados del país se han creado espacios cardioprotegidos que permiten realizar maniobras de reanimación cardiopulmonar y desfibrilación cardiaca de acceso público oportunamente. Como objetivo, los profesionales de la salud establecen la importancia de implementar espacios cardioprotegidos y crear políticas públicas al respecto en todo el país.

Rhino-orbital mucormycosis in a Mexican patient with COVID-19: Case report.

BACKGROUND: A variety of bacterial and fungal co-infections may be attributed to the coronavirus disease 2019 (COVID-19), particularly in people who already have a medical condition such diabetes mellitus or those who received large dosages of steroids. CASE REPORT: We described a 52-year-old diabetic man who was receiving high doses of dexamethasone and antibiotics while receiving ambulatory care for COVID-19 pneumonia. His anterior rhinoscopy revealed a necrotic scab, and a sample confirmed Mucor spp. He underwent surgery and was given amphotericin as a result of the severity of the condition, palpebral ptosis, and right ocular palsy he was experiencing. The patien ́s progression was satisfactory. CONCLUSIONS: pre-existing diabetes mellitus, previous steroid and antimicrobial use, as well as SARS-CoV-2 infection are some of the risk factors associated with Mucor spp. infection. Prompt detection of mucormycosis is important in the management of these affected patients.

ANTECEDENTES: A la enfermedad por coronavirus (COVID-19) se le han atribuido diversas coinfecciones bacterianas y fúngicas, especialmente en sujetos con enfermedades preexistentes (diabetes mellitus) o en quienes han recibido altas dosis de corticosteroides. REPORTE DE CASO: Paciente masculino de 52 años, con antecedente de diabetes mellitus, quien recibió altas dosis de dexametasona y antibióticos mientras recibía atención ambulatoria por neumonía secundaria a COVID-19. La rinoscopia anterior reveló una costra necrótica, y una muestra de exudado confirmó la coexistencia de Mucor spp. Debido a la complicación del cuadro clínico, ptosis palpebral y parálisis ocular derecha, se le administró anfotericina B y fue intervenido quirúrgicamente. La evolución del paciente fue satisfactoria. CONCLUSIONES: La diabetes mellitus preexistente, el consumo de corticosteroides y antimicrobianos, además de la infección por SARS-CoV-2 son factores de riesgo asociados con la infección por Mucor spp. Es importante la detección oportuna de mucormicosis en el tratamiento de estos pacientes.

The impact of the COVID-19 pandemic on heart failure management: Global experience of the OPTIMIZE Heart Failure Care network.

During the COVID-19 pandemic, reductions in heart failure (HF) hospitalizations have been widely reported, and there is an urgent need to understand how HF care has been reorganized in countries with different infection levels, vaccination rates and healthcare services. The OPTIMIZE Heart Failure Care program has a global network of investigators in 42 countries, with first-hand experience of the impact of the pandemic on HF management in different care settings. The national coordinators were surveyed to assess: 1) the challenges of the COVID-19 pandemic for continuity of HF care, from both a hospital and patient perspective; 2) the organizational changes enacted to ensure continued HF care; and 3) lessons learned for the future of HF care. Contributions were obtained from 37 national coordinators in 29 countries. We summarize their input, highlighting the issues raised and using the example of three very different settings (Italy, Brazil, and Taiwan) to illustrate the similarities and differences across the OPTIMIZE program.

Effect of Melatonin Administration on Mitochondrial Activity and Oxidative Stress Markers in Patients with Parkinson's Disease.

Mitochondrial dysfunction and oxidative stress are extensively linked to Parkinson's disease (PD) pathogenesis. Melatonin is a pleiotropic molecule with antioxidant and neuroprotective effects. The aim of this study was to evaluate the effect of melatonin on oxidative stress markers, mitochondrial complex 1 activity, and mitochondrial respiratory control ratio in patients with PD. A double-blind, cross-over, placebo-controlled randomized clinical trial study was conducted in 26 patients who received either 25 mg of melatonin or placebo at noon and 30 min before bedtime for three months. At the end of the trial, in patients who received melatonin, we detected a significant diminution of lipoperoxides, nitric oxide metabolites, and carbonyl groups in plasma samples from PD patients compared with the placebo group. Conversely, catalase activity was increased significantly in comparison with the placebo group. Compared with the placebo group, the melatonin group showed significant increases of mitochondrial complex 1 activity and respiratory control ratio. The fluidity of the membranes was similar in the melatonin group and the placebo group at baseline and after three months of treatment. In conclusion, melatonin administration was effective in reducing the levels of oxidative stress markers and restoring the rate of complex I activity and respiratory control ratio without modifying membrane fluidity. This suggests that melatonin could play a role in the treatment of PD.

Numerical Study Using Microstructure Based Finite Element Modeling of the Onset of Convective Heat Transfer in Closed-Cell Polymeric Foam.

The thermal performance of closed-cell foams as an insulation device depends on the thermal conductivity. In these systems, the heat transfer mode associated with the convective contribution is generally ignored, and studies are based on the thermo-physical properties that emerge from the conductive contribution, while others include a term for radiative transport. The criterion found in the literature for disregarding convective heat flux is the cell diameter; however, the cell size for which convection is effectively suppressed has not been clearly disclosed, and it is variously quoted in the range 3-10 mm. In practice, changes in thermal conductivity are also attributed to the convection heat transfer mode; hence, natural convection in porous materials is worthy of research. This work extends the field of study of conjugate heat transfer (convection and conduction) in cellular materials using microstructure-based finite element analysis. For air-based insulating materials, the criteria to consider natural convection (Ra=103) is met by cavities with sizes of 9.06 mm; however, convection is developed into several cavities despite their sizes being lower than 9.06 mm, hence, the average pore size that can effectively suppress the convective heat transfer is 6.0 mm. The amount of heat transported by convection is about 20% of the heat transported by conduction within the foam in a Ra=103, which, in turn, produces an increasing average of the conductivity of about 4.5%, with respect to a constant value.

[Pulmonary arterial hypertension from the risk assessment to combined treatment]. / Hipertensión arterial pulmonar desde la evaluación del riesgo al tratamiento combinado.

This paper shows the importance of the guideline clinical practice as well as the centers for comprehensive care of pulmonary arterial hypertension. The current treatment of pulmonary arterial hypertension is analyzed according to its severity, stratified through the evaluation of the multiple parameters of risk and its mortality to 1 year. The prognosis of the disease is considered and the place of the combined treatment indicated in sequential manner or from the beginning.

En este trabajo se señala la importancia de las guías de actuación clínica, así como de los centros de atención integral de la hipertensión arterial pulmonar. Se analiza el tratamiento actual de la hipertensión arterial pulmonar de acuerdo a su severidad, estratificado a través de la evaluación de parámetros múltiples de riesgo y su mortalidad a 1 año. Además, se considera el pronóstico de la enfermedad y el lugar que tiene el tratamiento combinado indicado en forma secuencial o desde un inicio.

[Obesity hypoventilation syndrome and pulmonary hypertension. An association little-known in Mexico]. / El síndrome de hipoventilación del obeso y la hipertensión pulmonar. Una asociación poco conocida en México.

The obesity hypoventilation syndrome (OHS) refers to the combination of obesity, daytime hypercapnia and sleep-disordered breathing. Obesity has risen to epidemic proportions in the last three decades in the United States, Mexico and Europe. The OHS is associated with obstructive sleep apnea syndrome in 30%. Without treatment, mortality is 46% at 50 months. So in this paper we analyze the OHS, obesity and pulmonary hypertension, the pathophysiology, clinical presentation and diagnosis as well as the treatment, which is aimed at the correction of sleep-disordered breathing and hypoxemia; although there is little experience with the use of specific pulmonary vasodilator drugs.

El síndrome de hipoventilación del obeso (SHO) se refiere a la combinación de obesidad, hipercapnia diurna y trastornos respiratorios del sueño. La obesidad ha aumentado con características epidémicas en las últimas tres décadas en Estados Unidos, México y Europa. El SHO se asocia al síndrome de apnea obstructiva del sueño hasta en el 30%. Sin tratamiento, la mortalidad es de 46% a 50 meses. Por lo que en este trabajo se analizan el SHO, la obesidad y la hipertensión pulmonar, la fisiopatología, la presentación clínica y el diagnóstico, además del tratamiento, el cual está orientado a la corrección de los trastornos respiratorios del sueño y la hipoxemia; aún hay poca experiencia con el uso de medicamentos vasodilatadores pulmonares específicos.

[The pulmonary hypertension of the chronic kidney disease]. / La hipertensión pulmonar de la enfermedad renal crónica.

Pulmonary hypertension in chronic kidney disease is included in the group 5 of the pulmonary hypertension classification of the World Health Organization. Its mechanism is multifactorial and little known. Its importance has increased due to its impact on survival according to whether they received a kidney transplant, the greater risk of early renal graft loss and major hospital stays. In this review, we analyze the panorama of chronic renal disease in Mexico and Latin America, the epidemiology, pathophysiological mechanisms, the diagnostic process and the treatment of pulmonary hypertension in chronic kidney disease.

La hipertensión pulmonar de la enfermedad renal crónica está contemplada en el grupo 5 de la clasificación de hipertensión pulmonar de la Organización Mundial de la Salud. Su mecanismo es multifactorial y poco conocido. Su importancia ha incrementado debido a su impacto en la supervivencia de acuerdo a si el paciente recibió un trasplante renal, al mayor riesgo de pérdida temprana del injerto renal y a las estancias hospitalarias mayores. En esta revisión, se analiza el panorama de la enfermedad renal crónica en México y Latinoamérica, la epidemiología, los mecanismos fisiopatológicos, el proceso diagnóstico y el tratamiento de la hipertensión pulmonar en la enfermedad renal crónica.

[Consensus on Systemic Arterial Hypertension In México]. / Consenso de Hipertensión Arterial Sistémica en México.

This Consenso Nacional de Hipertensión Arterial Sistémica (National Consensus on Systemic Arterial Hypertension) brings together experiences and joint work of 79 specialists who have been in contact with the patient affected by systemic arterial hypertension. All concepts here presented were outlined on the basis of the real world practice of Mexican hypertensive population. The consensus was developed under strict methodological guidelines. The Delphi technique was applied in two rounds for the development of an appropriate statistical analysis of the concepts exposed by all the specialists, who posed key questions, later developed by the panel of experts of the Hospital de Cardiología, and specialists from the Centro Médico Nacional. Several angles of this illness are shown: detection, diagnosis, pathophysiology, classification, treatment and prevention. The evidence analysis was carried out using PRISMA method. More than 600 articles were reviewed, leaving only the most representative in the references. This document concludes with practical and useful recommendations for the three levels of health care of our country.

Este Consenso Nacional de Hipertensión Arterial Sistémica reúne las experiencias y el trabajo conjunto de 79 especialistas que han estado en contacto con el paciente que padece hipertensión arterial sistémica. Todos los conceptos aquí presentados se plantearon con base en la práctica del mundo real de la población hipertensa de México. El consenso se desarrolló bajo lineamientos metodológicos estrictos. La técnica de Delphi se aplicó en dos vueltas para el desarrollo de un análisis estadístico apropiado de los conceptos vertidos por todos los especialistas con preguntas clave que desarrolló el panel de expertos del Hospital de Cardiología y especialistas del Centro Médico Nacional. Se presentan los aspectos de detección, diagnóstico, fisiopatología, clasificación, tratamiento y prevención. El análisis de la evidencia en la literatura se hizo utilizando el método de PRISMA para análisis de evidencia. Se revisaron más de 600 artículos y se dejaron en la bibliografía solo los más representativos. Este documento concluye con recomendaciones prácticas y de utilidad para los tres niveles de atención en salud de nuestro país.

[Methodology for superiority versus equivalence and non-inferior clinical studies. A practical review]. / Metodología para los estudios clínicos de superioridad frente a los de equivalencia y estudios de no inferioridad. Una revisión aplicada.

Physicians should always remember that a negative result in a superiority trial never would prove that the therapies under research are equivalent; more often, there may be a risk of type 2 (false negative) error. Equivalence and not inferiority studies demand high standards to provide reliable results. Physicians should take into account above all that the equivalence margins tend to be too large to be clinically significant and that the claim of equivalence can be misleading if a study has not been conducted at a sufficiently high level. In addition, physicians must be a bit skeptical of judgments that do not include the basic requirements of information, including the definition and justification of the equivalence margin, the calculation of the size of the sample bearing in mind this margin, the presentation of both analysis (intention-to-treat and by protocol), and provide confidence intervals for the results. Equivalence and inferiority studies are not indicated in certain areas. If one follows the required strict adherence to the specific methodology, such studies can provide new and important knowledge.

Los médicos deben recordar siempre que un resultado negativo en una prueba de superioridad nunca probará que las terapias investigadas son equivalentes; más a menudo puede haber un gran riesgo de error de tipo 2 (resultado falso negativo). Los estudios de equivalencia y de no inferioridad exigen altos estándares para proporcionar resultados confiables. Los médicos deben tener en cuenta sobre todo que los márgenes de equivalencia suelen ser demasiado grandes como para ser clínicamente significativos y que la reclamación de esta puede ser engañosa si un estudio no se ha llevado a cabo a un nivel suficientemente elevado. Además, los médicos deben ser un poco escépticos de análisis que no incluyan los requisitos básicos de información, incluida la definición y la justificación del margen de equivalencia, el cálculo del tamaño de la muestra (deben tomar en cuenta este margen), la presentación de ambos tipos de análisis (por intención de tratar y por protocolo), así como los intervalos de confianza para los resultados. Los estudios de equivalencia y de no inferioridad se indican en ciertas áreas. Si se sigue la estricta adherencia necesaria a la metodología específica, tales estudios pueden proporcionar nuevos e importantes conocimientos.

[Heart failure with preserved ejection fraction (HFPEF). Impact of change in the paradigm of isolated diastolic dysfunction]. / Insuficiencia cardiaca con fraccion de expulsion preservada (ICFEP). Impacto del cambio en el paradigma de la disfunción diastólica aislada.

Heart failure with preserved ejection fraction is a significant and growing public health problem, since it currently represents half of all patients with heart failure. Despite improvements in the understanding of the disease, there is no benefit form treatments tested at all. Advances in diagnostic imaging and invasive evaluation algorithms will allow a more accurate and early diagnosis so that treatment of earliest forms in the progression of the disease are applied since the potential for benefit may be higher. Although important progress has been made in our understanding of the pathophysiology, cardiac catheterization, and cellular of diastolic failure mechanisms and not diastolic mechanisms of disease, further research is required promptly to determine how best to address these anomalies to reduce the significant burden of morbidity and mortality in this form of heart failure, which is reaching pandemic proportions.

Concordancia entre la gasometría arterial y venosa central en sujetos postoperados de cirugía de revascularización miocárdica en condición estable / Concordance between central venous and arterial blood gases in post-surgical myocardial revascularization patients in stable condition

Objetivo: La concordancia entre los parámetros de la gasometría arterial y venosa central no se ha definido aún, por lo cual estudiamos la concordancia entre ambas en sujetos postoperados de cirugía de revascularización miocárdica en condición estable. Métodos: Se estudiaron sujetos de manera consecutiva con un diseño transversal. Se les determinó la posición del catéter venoso central y al mismo tiempo se obtuvo la muestra arterial y venosa central previa a su egreso de la terapia intensiva. Los datos se expresaron según el método estadístico de Bland-Altman y al coeficiente de correlación intraclase. El resultado estadístico aceptó una p < 0.05. Resultados: Se estudiaron 206 muestras de 103 sujetos postoperados, el pH y el lactato tuvieron una diferencia media (límites de acuerdo) de 0.029 ± 0.048 (−0.018, 0.077) y −0.12 ± 0.22 (−0.57, 0.33) respectivamente; la magnitud del coeficiente de correlación intraclase respectiva fue de 0.904 y 0.943; las relativas a la presión de oxígeno 27.86 ± 6.08 (15.9, 39.8) y la saturación de oxígeno 33.02 ± 6.13 (21, 45), magnitud 0.258 y 0.418. Conclusión: Los parámetros con mejor concordancia arterial y venosa central fueron el pH y el lactato.

Objective: The concordance between the parameters of arterial and central venous blood gases has not been defined yet. We studied the concordance between both parameters in post-surgical myocardial revascularization patients in stable condition. Methods: Consecutive subjects were studied in a cross-sectional design. The position of the central venous catheter was performed and simultaneously we obtained arterial and central venous blood samples prior to discharge from the intensive care unit. Data are expressed according to Bland-Altman statistical method and the intraclass correlation coefficient. Statistical result was accepted at P < .05. Results: Two hundred and six samples were studied of 103 post-surgical patients, pH and lactate had a mean difference (limits of agreement) 0.029 ± 0.048 (−0018, 0.077) and −0.12 ± 0.22 (−0.57, 0.33) respectively. The magnitude of the intraclass correlation coefficient was 0.904 and 0.943 respectively. The values related to oxygen pressure were 27.86 ± 6.08 (15.9, 39.8) and oxygen saturation 33.02 ± 6.13 (21, 45), with magnitude of 0.258 and 0.418 respectively. Conclusion: The best matching parameters between arterial and central venous blood samples were pH and lactate.

[Concordance between central venous and arterial blood gases in post-surgical myocardial revascularization patients in stable condition]. / Concordancia entre la gasometría arterial y venosa central en sujetos postoperados de cirugía de revascularización miocárdica en condición estable.

OBJECTIVE: The concordance between the parameters of arterial and central venous blood gases has not been defined yet. We studied the concordance between both parameters in post-surgical myocardial revascularization patients in stable condition. METHODS: Consecutive subjects were studied in a cross-sectional design. The position of the central venous catheter was performed and simultaneously we obtained arterial and central venous blood samples prior to discharge from the intensive care unit. Data are expressed according to Bland-Altman statistical method and the intraclass correlation coefficient. Statistical result was accepted at P<.05. RESULTS: Two hundred and six samples were studied of 103 post-surgical patients, pH and lactate had a mean difference (limits of agreement) 0.029±0.048 (-0018, 0.077) and -0.12±0.22 (-0.57, 0.33) respectively. The magnitude of the intraclass correlation coefficient was 0.904 and 0.943 respectively. The values related to oxygen pressure were 27.86±6.08 (15.9, 39.8) and oxygen saturation 33.02±6.13 (21, 45), with magnitude of 0.258 and 0.418 respectively. CONCLUSION: The best matching parameters between arterial and central venous blood samples were pH and lactate.

Condiciones de cultivo que fomentan la producción de sustancias antimicrobianas en actinomicetos patógenos y del suelo / Culture conditions that enhance the production of antimicrobial substances from pathogenic and soil actinomycetes

En el presente estudio fueron evaluadas 300 cepas de actinomicetos (140 de origen clínico y 160 del suelo). La producción de sustancias antimicrobianas del total de las cepas de actinomicetos fue evaluada utilizando los siguientes caldos: Bennett (M1), (M2), y el caldo levadura extracto de malta-dextrosa YMD (M3). Se ajustaron las condiciones óptimas de cultivo para lograr altas concentraciones de los metabolitos bioactivos. El proceso de fermentación fue utilizado en tiempos de incubación que variaron entre 5 hasta 10 días. La mayor producción de metabolitos bioactivos se obtuvo cuando se utilizó el medio de producción M2. La actividad antimicrobiana se vio favorecida con la adición de dextrosa, peptona proteosada y extracto de levadura y fosfato de potasio (K2P04), sulfato de magnesio (MgSO4) x 7H2O y carbonato de calcio (CaCO3). Se relacionaron los patrones de crecimiento, la actividad antimicrobiana y la producción de biomasa en las cepas de actinomicetos en los tres medios de cultivo utilizados. Las cepas que presentaron fuerte actividad antimicrobiana contra la mayoría de las bacterias grampositivas, gramnegativas y hongos, fueron seleccionadas para futuros estudios donde se realizará la extracción, purificación y caracterización de los metabolitos bioactivos producidos.

The present study evaluated 300 actinomyces strains (140 from clinical samples and 160 from soil samples). The production of antimicrobial substances by the total actinomyces strains was evaluated using the following broths: Bennet (M1), (M2), and malt-dextrose yeast extract broth YMD (M3). Cultures were adjusted to optimal conditions in order to obtain high bioactive metabolite concentrations. The fermentation process was used with incubation periods which varied between 5 and 10 days. The highest bioactive metabolite production was obtained when the M2 medium was used. Antimicrobial activity was favored with the addition of dextrose, proteose peptone, yeast extract, potassium phosphate (K2PO4), magnesium sulfate (MgSO4) x 7H2O and calcium carbonate (CaCO2). Growth patterns, antimicrobial activity, and biomass production of the actinomyces were related to the three culture media used. The strains which showed strong antimicrobial activity against most gram positive and gram negative bacteria and fungi were selected for future studies where the bioactive metabolites produced will be extracted, purified, and characterized.

Ping pong fractures: treatment using a new medical device.

PURPOSE: The aim of this study was to assess the use of a new medical device to elevate depressed skull fractures (DSFs) in newborns and minor infants. METHODS: Nine patients (ranging from 1 day to 9 months of age) with simple DSF underwent skull elevation by a new elevator medical device. This medical device comprises two elements: a pediatric resuscitator (CPR mask) connected to a 50-ml syringe. Pediatric CPR face mask is placed on the depressed region and negative pressure is generated through syringe plunger elevation until fracture reduction is observed. RESULTS: Fracture reduction was confirmed in eight of nine patients by computed tomography scan without underlying brain damage and associated complications. Skull asymmetry was eliminated recovering normal shape. Up to now, there are no neurological concerns. Another treatment was chosen to be applied for one patient who did not respond to manipulation. CONCLUSION: The new device is a safe, affordable, and effective choice in the treatment of simple depressed skull fractures in newborns and minor infants.

[Intracranial tumor behavior of plasma cell neoplasms. Report of 2 cases and literature review]. / Comportamiento tumoral de neoplasias intracraneales de células plasmáticas. Reporte de 2 casos y revisión de la bibliografía.

BACKGROUND: Multiple myeloma is a plasmatic cell neoplasm that is characterized by skeletal destruction, renal failure, anemia and hypercalcemia. The skull plasmacytomas represent less than 1% of the head and neck tumors, they can be the primary lesion or occur as a secondary manifestation of multiple myeloma in 20-30% of the patients, or they can even manifest several years later after the diagnosis of plasmacytoma. Although some of the lesions may be surgically accessible, the aggressive natural behavior will complicate the evolution of the patients. We present two cases of Mexican women with intracranial plasmacytomas, one of them associated with multiple myeloma. CLINICAL CASES: The first case was a 24 year-old woman diagnosed with a multiple myeloma with plasmacytic-plasmablastic bone infiltration that was removed in 90%. She presented a local recurrence that required a second intervention for removal. The second case was a 62 year-old female with a malignant intracranial tumor of plasma cells that was totally resected. Both patients received adjuvant treatment based on chemotherapy and radiation therapy with favorable results. The patients died at 5 and 1.5 years respectively due to renal failure secondary to systemic disease. CONCLUSIONS: We propose chemotherapy and radiation therapy as an essential part of treatment for this condition, as the aggressive behavior of the neoplasms can complicate the evolution, despite being surgically accessible.

Antecedentes: el mieloma múltiple es una neoplasia de células plasmáticas caracterizada por destrucción ósea, insuficiencia renal, anemia e hipercalcemia. Los plasmacitomas de los huesos del cráneo representan menos de 1% de los tumores de cabeza y cuello. Se manifiestan como lesión primaria o secundaria a mieloma múltiple en 20-30%, incluso pueden aparecer varios años después del diagnóstico. Los autores comunicamos dos casos de pacientes mexicanas con lesiones plasmocíticas intracraneales, asociadas con mieloma múltiple.Casos clínicos: el primer caso es el de una paciente de 24 años de edad, con diagnóstico de mieloma múltiple e infiltración ósea que fue extirpado en 90%. Experimentó una recidiva local que requirió otra intervención para su remoción. El segundo caso es el de una mujer de 62 años de edad con un tumor intracraneal de células plasmáticas que se resecó en su totalidad. Ambas recibieron terapia adyuvante con quimio y radioterapia con resultados favorables. Las pacientes fallecieron a los 5 y 1.5 años, respectivamente, por insuficiencia renal como consecuencia de la enfermedad sistémica. Conclusiones: se propone a la quimioterapia y radioterapia como parte esencial del tratamiento de este tumor porque su comportamiento natural agresivo puede complicar la evolución, a pesar de ser accesibles quirúrgicamente.