Subpopulation treatment effect pattern plot analysis: a prognostic model for distant recurrence-free survival to estimate delayed adjuvant chemotherapy initiation effect in triple-negative breast cancer.

Introduction: Triple-negative breast cancer (TNBC) is a heterogeneous disease associated with a poor prognosis. Delaying in time to start adjuvant chemotherapy (TTC) has been related to an increased risk of distant recurrence-free survival (DRFS). We aimed to develop a prognostic model to estimate the effects of delayed TTC among TNBC risk subgroups. Materials and methods: We analyzed 687 TNBC patients who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). Database was randomly divided to create a discovery set (n=344) and a validation set (n=343). Univariate and multivariate Cox regression models were performed to identify prognostic factors for DRFS. Risk stratification was implemented through two models developed based on proportional hazard ratios from significant clinicopathological characteristics. Subpopulation treatment effect pattern plot (STEPP) analysis was performed to determine the best prognostic cut-off points for stratifying TNBC subgroups according to risk scores and estimate Kaplan-Meier differences in 10-year DRFS comparing TTC (≤30 vs.>30 days). Results: In univariate analysis, patients aged ≥70 years (HR=4.65; 95% CI: 2.32-9.34; p=<0.001), those at stages pT3-T4 (HR=3.28; 95% CI: 1.57-6.83; p=0.002), and pN2-N3 (HR=3.00; 95% CI: 1.90-4.76; p=<0.001) were notably associated with higher risk. STEPP analysis defined three risk subgroups for each model. Model N°01 categorized patients into low (score: 0-31), intermediate (score:32-64), and high-risk (score: 65-100) cohorts; meanwhile, Model N°02: low (score: 0-26), intermediate (score: 27-55), and high (score: 56-100). Kaplan-Meier plots showed that in the discovery set, patients with TTC>30 days experienced a 17.5% decrease in 10-year DRFS rate (95%CI=6.7-28.3), and the impact was more remarkable in patients who belong to the high-risk subgroup (53.3% decrease in 10 years-DRFS rate). Similar results were found in the validation set. Conclusions: We developed two prognostic models based on age, pT, and pN to select the best one to classify TNBC. For Model N°02, delayed adjuvant chemotherapy conferred a higher risk of relapse in patients ≥70 years and who were characterized by pT3/T4 and pN2/N3. Thus, more efforts should be considered to avoid delayed TTC in TNBC patients, especially those in high-risk subgroups.

Breast cancer subtype and clinical characteristics in women from Peru.

Introduction: Breast cancer is a heterogeneous disease, and the distribution of the different subtypes varies by race/ethnic category in the United States and by country. Established breast cancer-associated factors impact subtype-specific risk; however, these included limited or no representation of Latin American diversity. To address this gap in knowledge, we report a description of demographic, reproductive, and lifestyle breast cancer-associated factors by age at diagnosis and disease subtype for The Peruvian Genetics and Genomics of Breast Cancer (PEGEN-BC) study. Methods: The PEGEN-BC study is a hospital-based breast cancer cohort that includes 1943 patients diagnosed at the Instituto Nacional de Enfermedades Neoplásicas in Lima, Peru. Demographic and reproductive information, as well as lifestyle exposures, were collected with a questionnaire. Clinical data, including tumor Hormone Receptor (HR) status and Human Epidermal Growth Factor Receptor 2 (HER2) status, were abstracted from electronic medical records. Differences in proportions and mean values were tested using Chi-squared and one-way ANOVA tests, respectively. Multinomial logistic regression models were used for multivariate association analyses. Results: The distribution of subtypes was 52% HR+HER2-, 19% HR+HER2+, 16% HR-HER2-, and 13% HR-HER2+. Indigenous American (IA) genetic ancestry was higher, and height was lower among individuals with the HR-HER2+ subtype (80% IA vs. 76% overall, p=0.007; 152 cm vs. 153 cm overall, p=0.032, respectively). In multivariate models, IA ancestry was associated with HR-HER2+ subtype (OR=1.38,95%CI=1.06-1.79, p=0.017) and parous women showed increased risk for HR-HER2+ (OR=2.7,95%CI=1.5-4.8, p<0.001) and HR-HER2- tumors (OR=2.4,95%CI=1.5-4.0, p<0.001) compared to nulliparous women. Multiple patient and tumor characteristics differed by age at diagnosis (<50 vs. >=50), including ancestry, region of residence, family history, height, BMI, breastfeeding, parity, and stage at diagnosis (p<0.02 for all variables). Discussion: The characteristics of the PEGEN-BC study participants do not suggest heterogeneity by tumor subtype except for IA genetic ancestry proportion, which has been previously reported. Differences by age at diagnosis were apparent and concordant with what is known about pre- and post-menopausal-specific disease risk factors. Additional studies in Peru should be developed to further understand the main contributors to the specific age of onset and molecular disease subtypes in this population and develop population-appropriate predictive models for prevention.

Experimental evaluation of low-displacement compression ignited engines operating with hydroxy gas as a supplementary gaseous fuel.

A large proportion of annual production of worldwide greenhouses gases results from the use of internal combustion engines. This experimental work evaluates the influence of dual-fuel operation on the overall emissions of a low-displacement compression-ignition engine based on operational conditions such as torque, rotational speed, and load. Hydroxy gas is used as a supplementary gaseous fuel while using pure diespel or palm oil biodiesel as baseline fuels. The CO, CO2, NOx, and HC emissions levels were carefully characterized through experimental measurements and statistical analysis. The influence of hydroxy enrichment was also examined on the engine's fuel consumption. The study incorporates an in-house hydroxy generator to store and supply the gas in the intake air system using an electrolyzer. The results demonstrated that the ANOVA analysis provides accurate predictions compared to experimental measurements with less than 5% relative error. The use of hydroxy reduces the SFC by up to 25%, which represents an economic advantage of dual-fuel operation, additionally it decreases CO, HC, and CO2 emissions. However, with hydroxy enrichment, NOx emissions levels escalate at medium and high loads. Overall, hydroxy enrichment demonstrates to be a robust alternative from an environmental and economic perspective. Future research will be focused on evaluating the biodiesel - hydroxy dual operation, broadening the spectrum of biodiesel concentration percentages, and selecting different raw materials for biofuel production.

Association between Ancestry-Specific 6q25 Variants and Breast Cancer Subtypes in Peruvian Women.

BACKGROUND: Breast cancer incidence in the United States is lower in Hispanic/Latina (H/L) compared with African American/Black or Non-Hispanic White women. An Indigenous American breast cancer-protective germline variant (rs140068132) has been reported near the estrogen receptor 1 gene. This study tests the association of rs140068132 and other polymorphisms in the 6q25 region with subtype-specific breast cancer risk in H/Ls of high Indigenous American ancestry. METHODS: Genotypes were obtained for 5,094 Peruvian women with (1,755) and without (3,337) breast cancer. Associations between genotype and overall and subtype-specific risk for the protective variant were tested using logistic regression models and conditional analyses, including other risk-associated polymorphisms in the region. RESULTS: We replicated the reported association between rs140068132 and breast cancer risk overall [odds ratio (OR), 0.53; 95% confidence interval (CI), 0.47-0.59], as well as the lower odds of developing hormone receptor negative (HR-) versus HR+ disease (OR, 0.77; 95% CI, 0.61-0.97). Models, including HER2, showed further heterogeneity with reduced odds for HR+HER2+ (OR, 0.68; 95% CI, 0.51-0.92), HR-HER2+ (OR, 0.63; 95% CI, 0.44-0.90) and HR-HER2- (OR, 0.77; 95% CI, 0.56-1.05) compared with HR+HER2-. Inclusion of other risk-associated variants did not change these observations. CONCLUSIONS: The rs140068132 polymorphism is associated with decreased risk of breast cancer in Peruvians and is more protective against HR- and HER2+ diseases independently of other breast cancer-associated variants in the 6q25 region. IMPACT: These results could inform functional analyses to understand the mechanism by which rs140068132-G reduces risk of breast cancer development in a subtype-specific manner. They also illustrate the importance of including diverse individuals in genetic studies.

Immunotherapy in triple-negative breast cancer: A literature review and new advances.

Triple-negative breast cancer (TNBC) is a highly complex, heterogeneous disease and historically has limited treatment options. It has a high probability of disease recurrence and rapid disease progression despite adequate systemic treatment. Immunotherapy has emerged as an important alternative in the management of this malignancy, showing an impact on progression-free survival and overall survival in selected populations. In this review we focused on immunotherapy and its current relevance in the management of TNBC, including various scenarios (metastatic and early -neoadjuvant, adjuvant-), new advances in this subtype and the research of potential predictive biomarkers of response to treatment.

Últimos avances en el tratamiento neoadyuvante de cáncer de vejiga / Latest advances in neoadjuvant therapy for bladder cancer

RESUMEN La quimioterapia neoadyuvante basada en cisplatino ha demostrado un claro beneficio en cáncer de vejiga músculo invasivo (MIBC) EC II o IIIA, logrando un impacto en la sobrevida libre de progresión y sobrevida global. Esta revisión actualizada se centra en el tratamiento neoadyuvante del MIBC, incluyendo las recomendaciones actuales de las guías de práctica clínica internacionales y/o locales, así como el estudio de nuevos agentes terapéuticos (inmunoterapia, terapias dirigidas) además de la investigación de potenciales biomarcadores predictivos de respuesta a inmunoterapia.

ABSTRACT Cisplatin-based neoadjuvant therapy has shown clear benefits in clinical stage II or IIIA muscle invasive bladder cancer (MIBC), achieving an impact in progression-free survival and overall survival. This updated review focuses on neoadjuvant therapy for MIBC, including the current recommendations from international and/or local practice guidelines, as well as studies of new therapeutic agents (immunotherapy, targeted therapy), on top of research on potential biomarkers that may predict response to immunotherapy.

PIK3CA mutation in non-metastatic triple-negative breast cancer as a potential biomarker of early relapse: A case report.

BACKGROUND: Currently, the detection of PIK3CA mutations is of special interest in personalized medicine because it is frequently found in triple-negative breast cancer (TNBC). The PI3KCA mutation is an independent negative prognostic factor for survival in metastatic breast cancer, and its prognostic value in liquid biopsy as a biomarker of treatment and early relapse is under investigation, both for metastatic disease and neoadjuvant scenario with curative intent. CASE SUMMARY: A 54-year-old female patient with TNBC clinical stage IIIA, who, after receiving neoadjuvant chemotherapy (based on anthracyclines and taxanes), surgery, radiotherapy, and adjuvant capecitabine, was detected with a PI3KCA mutation in tissue and peripheral blood (ctDNA in liquid biopsy). After 10 mo, the patient had disease relapse of left cervical node disease. CONCLUSION: The detection of PIK3CA mutation in TNBC after neoadjuvant treatment might be associated with early relapse or rapid disease progression.

Renal liposarcoma: case report and review of systemic treatment.

Liposarcomas are malignant mesenchymal tumours usually located in the retroperitoneum, rarely occurring as a single lesion in the kidney. We present a case of a 59-year-old male patient with a left renal mass detected by computed tomography scan. He underwent radical nephrectomy and the histopathological study reported a primary undifferentiated liposarcoma of the kidney without nodal involvement. After 15 months of surgery, he remained asymptomatic and without evidence of disease recurrence. The objective of this report is to present a case and literature review with current evidence of treatment options and prognostic factors for survival.

Adaptation of international coronavirus disease 2019 and breast cancer guidelines to local context.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (a novel coronavirus), which was first identified amid an outbreak of respiratory illness cases in Wuhan, China and declared a global health emergency, is currently considered an additional challenge in the management of patients with breast cancer (BC). Cancer patients are more vulnerable to becoming infected with severe acute respiratory syndrome coronavirus 2 and are more likely to suffer additional complications that can increase mortality. Identifying those BC patients who require more urgent therapy than others in the current situation is essential. These recommendations are based on and have been adapted from those similarly published by international scientific societies for BC management. They are divided mainly by clinical stage (early, advanced), subtype [luminal, human epidermal growth factor receptor 2 (HER2), triple-negative], or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes are similar, whereas in luminal subtype there are various options of management. The objective is to adapt guidelines to local context through relevant decision-makers, avoiding duplication of efforts and optimizing use or resources. We hope that these recommendations will help medical oncologists provide the best quality care to BC patients during the COVID-19 pandemic with information tailored to our healthcare system. AIM: To establish and adapt recommendations from those published by international scientific societies for BC management. METHODS: The Peruvian Society of Medical Oncology developed a consensus and propose here a manuscript with recommendations for oncological medical treatment of BC during the COVID-19 pandemic. The Peruvian Society of Medical Oncology invited a panel of experts and opinion leaders on BC working in major health care systems around Peru. Panel experts selected three international clinical practice guidelines (National Comprehensive Cancer Network, European Society for Medical Oncology, Spanish Foundation Research Group in Breast Cancer), considering that these are more representative in COVID-19 management. Also, the panel agreed to include at least one European and American clinical practice guideline. RESULTS: Recommendations about BC management during the COVID-19 pandemic were divided mainly by clinical stage (early, advanced), subtype (luminal, HER2, triple-negative), or type of medical treatment and setting (neoadjuvant, adjuvant, metastatic). Recommendations for HER2 and triple-negative subtypes were similar between clinical practice guidelines, whereas in luminal subtype there were various options of management. One hundred twelve recommendations were reviewed, adapted, and voted. A consensus was made in order to provide best decisions of management, avoid duplication of efforts, and optimize medical resources, considering health care system reality. These recommendations are not intended to replace clinical judgment. CONCLUSION: Most of recommendations are similar, mainly in high-risk subtypes (HER2, triple-negative). Certain societies adapt them to deal with different situations involving the best decision in the management of BC patients.

Frecuencia y factores asociados a la apnea obstructiva del sueño en adultos. Cali-Colombia 2014-2016 / Frequency and Factors Associated with Obstructive Sleep Apnea in Adults. Cali-Colombia 2014-2016

Introducción: La apnea obstructiva del sueño (AOS) es una entidad frecuente, presente en un 9% a 38%, pero con un subregistro importante del 85%1. Clásicamente, se observa en hombres de edad mediana, obesos y somnolientos, relacionándose estrechamente con múltiples comorbilidades de tipo cardiovascular, respiratorio y metabólico, que genera un alto costos en los sistemas de salud. El objetivo de este estudio fue determinar la frecuencia e identificar los factores clínicos asociados a la apnea obstructiva del sueño, en la población adulta de un centro especializado de Cali, Colombia. Materiales y Métodos: Estudio observacional, analítico de casos y controles anidado en una cohorte. Se analizaron registros de polisomnografías de primera vez en adultos con sospecha clínica de AOS en un centro especializado. A través de estadística descriptiva, se resumieron las características de la población de estudio. Las asociaciones se determinaron a través de OR, IC95% y se tomó como significante valores de p ≤ 0,05 para las pruebas estadísticas. A través de una regresión logística multivariada se identificó un modelo de 6 variables que explican de manera independiente el evento. Resultados: Se analizaron 566 polisomnografías, la prevalencia de la AOS fue 85.3% (483 de 566; IC95%82, 4-88.35%), la edad media fue 51.80 ± 13.73 años, el 50% fueron hombres. El modelo final incluyo sexo masculino (OR 4.46 IC95% 2.04-8.04, p < 0.000), hipertensión (OR 3.78 IC95% 2.48-8.04, p < 0,000), Mallampati grado IV (OR 4.14, IC95% 2.41-7.10, p < 0.000) y somnolencia excesiva (OR 5.70 IC95% 1.66-19.53, p < 0.006) y peso normal (OR 0.48 IC95% 0.24-0.97, p < 0.043). Conclusión: La probabilidad predictiva demostró que ser hombre, hipertenso con Mallampati grado IV y somnolencia excesiva, se asocian de manera independiente a la AOS, mientras que el peso normal disminuyó el riesgo

Frequency and Factors Associated with Obstructive Sleep Apnea in Adults. Cali-Colombia 2014-2016 / Frecuencia y factores asociados a la apnea obstructiva del sueño en adultos. Cali-Colombia 2014-2016

Introduction: Obstructive sleep apnea (OSA) is a common entity present in 9% to 38%, but with an important underreporting of 85%. Classically, it is observed in middle-aged, obese and sleepy men, closely related to multiple comorbidities of cardiovascular, respiratory and metabolic and is associated with increased mortality. Recent studies indicate that majority of people with type 2 diabetes also has OSA. The aim of this study was to assess the prevalence and severity of OSA and risk factors contributing to it among people with chronic and severe type 2 diabetes. Methods A total of 203 people with type 2 diabetes (mean age: 54 ± 8 years, 145 males, 58 females, HbA1c ≥ 7% [53mmol/mol] types, generating high costs of health systems.10 The purpose of this study was to determine the frequency and identify the clinical factors associated with obstructive sleep apnea within the adult population of a specialized center in Cali, Colombia. Materials and Methods: Observational, analytical case-control study nested within a cohort. First-time polysomnography records were analyzed in adults with clinical suspicion of OSA in a specialized center. The characteristics of the study population were summarized through descriptive statistics. Associations were determined through OR, 95% CI and values of p ≤ 0.05 taken as significant for the statistical tests. Through multivariate logistic regression, a 6-variable model was identified, where the 6 variables independently explain the event. Results: We analyzed 566 polysomnographies, where the prevalence of OSA was 85.3% (483 of 566, 95% CI 82.4-88.35%), the mean age was 51.80 ± 13.73 years and 50% were men The final model included male gender (OR 4.46 95% CI 2.04-8.04, p <0.000), hypertension (OR 3.78 95% CI 2.48-8.04, p <0.000), Mallampati grade IV (OR 4.14, 95% CI 2.41-7.10, p <0.000) and excessive sleepiness (OR 5.70 95% CI 1.66-19.53, p <0.006) and normal weight (OR 0.48 95% CI 0.24-0.97, p <0.043). Conclusion: The predictive probability showed that being male, hypertensive with Mallampati grade IV and excessive sleepiness are associated independently with OSA, while normal weight decreased the risk

Multiobjective Optimization of a Plate Heat Exchanger in a Waste Heat Recovery Organic Rankine Cycle System for Natural Gas Engines.

A multiobjective optimization of an organic Rankine cycle (ORC) evaporator, operating with toluene as the working fluid, is presented in this paper for waste heat recovery (WHR) from the exhaust gases of a 2 MW Jenbacher JMS 612 GS-N.L. gas internal combustion engine. Indirect evaporation between the exhaust gas and the organic fluid in the parallel plate heat exchanger (ITC2) implied irreversible heat transfer and high investment costs, which were considered as objective functions to be minimized. Energy and exergy balances were applied to the system components, in addition to the phenomenological equations in the ITC2, to calculate global energy indicators, such as the thermal efficiency of the configuration, the heat recovery efficiency, the overall energy conversion efficiency, the absolute increase of engine thermal efficiency, and the reduction of the break-specific fuel consumption of the system, of the system integrated with the gas engine. The results allowed calculation of the plate spacing, plate height, plate width, and chevron angle that minimized the investment cost and entropy generation of the equipment, reaching 22.04 m2 in the heat transfer area, 693.87 kW in the energy transfer by heat recovery from the exhaust gas, and 41.6% in the overall thermal efficiency of the ORC as a bottoming cycle for the engine. This type of result contributes to the inclusion of this technology in the industrial sector as a consequence of the improvement in thermal efficiency and economic viability.

[Anemia as a prognostic factor in cancer patients]. / Anemia como factor pronóstico en pacientes con cáncer.

OBJECTIVE.: To determine the frequency and prognostic value of anemia in cancer patients receiving care at the National Institute of Neoplastic Diseases (Instituto Nacional de Enfermedades Neoplásicas - INEN) between January and April of 2010. MATERIALS AND METHODS.: Anemia was considered for men with hemoglobin levels at <13 g/dL; and for women, at <12 g/dL. Associations between qualitative features were assessed with a Chi-square test. Kaplan-Meier estimator was used for the analysis of the survival curves, and differences between the curves were performed with the log-rank test. RESULTS.: 772 patients were included; 584 (75.7%) had solid tumors and 188 (24.3%) had hematologic malignancies. Anemia was diagnosed in 359 patients (46.5%); hematologic malignancies in 127 patients (67.6%); and solid neoplasms in 235 (40.2%). Hematologic malignancies with the highest frequency of anemia were chronic myeloid leukemia, acute leukemias, and multiple myeloma (100%, 92.5% and 60%, respectively); and were cancer of gastrointestinal, gynecological, and urological origin were in the group of solid neoplasms (62%, 52.1% and 45%, respectively). Two hundred and four (204) patients (26.4%) were transfused. In 762 patients, a significant difference in overall survival was found between groups with and without anemia, estimated at 5 years in 62% and 47% respectively (p <0.001). In the solid tumor subgroup (p = 0.002), and the hematological malignancies subgroup (p = 0.007), such association was also found. CONCLUSIONS.: Anemia is common in cancer patients, and its presence determines an independent prognostic factor in overall survival.

OBJETIVOS.: Determinar la frecuencia y el valor pronóstico de la anemia en pacientes con cáncer atendidos en el Instituto Nacional de Enfermedades Neoplásicas (INEN) entre enero y abril del 2010. MATERIALES Y MÉTODOS.: Se consideró anemia en varones cuando la hemoglobina fue <13 g/dL, y en mujeres cuando fue <12 g/dL. Para determinar asociaciones se usó la prueba Chi-cuadrado. Para el análisis de las curvas de sobrevida se usó el estimador de Kaplan-Meier y log rank test. RESULTADOS.: 772 pacientes fueron incluidos; 584 (75,7%) tuvieron tumores sólidos y 188 (24,3%) neoplasias hematológicas. Se diagnóstico anemia en 359 (46,5%) pacientes, en 124 (66,0%) neoplasias hematológicas, y en 235 (40,2%) neoplasias sólidas. Las neoplasias hematológicas con mayor frecuencia de anemia fueron la leucemia mieloide crónica, las leucemias agudas, y el mieloma múltiple (100%, 92,5% y 60%; respectivamente) y en el grupo de neoplasias sólidas fueron los cánceres de origen: gastrointestinal, ginecológico, y urológico (62%, 52,1% y 45%; respectivamente). Recibieron transfusiones 204 pacientes (26,4%). En 762 pacientes se encontró una diferencia en la sobrevida global entre los grupos sin y con presencia de anemia, estimándose a los cinco años en 62% y 47% respectivamente (p<0,001), además se encontraron diferencias en la sobrevida global para el subgrupo de tumores sólidos (p=0,002) y neoplasias hematológicas (p=0,007). CONCLUSIONES.: La anemia es frecuente en pacientes con cáncer y su presencia determina un factor pronóstico independiente en la sobrevida global.

Anemia como factor pronóstico en pacientes con cáncer / Anemia as a prognostic factor in cancer patients

RESUMEN Objetivos. Determinar la frecuencia y el valor pronóstico de la anemia en pacientes con cáncer atendidos en el Instituto Nacional de Enfermedades Neoplásicas (INEN) entre enero y abril del 2010. Materiales y métodos. Se consideró anemia en varones cuando la hemoglobina fue <13 g/dL, y en mujeres cuando fue <12 g/dL. Para determinar asociaciones se usó la prueba Chi-cuadrado. Para el análisis de las curvas de sobrevida se usó el estimador de Kaplan-Meier y log rank test. Resultados. 772 pacientes fueron incluidos; 584 (75,7%) tuvieron tumores sólidos y 188 (24,3%) neoplasias hematológicas. Se diagnóstico anemia en 359 (46,5%) pacientes, en 124 (66,0%) neoplasias hematológicas, y en 235 (40,2%) neoplasias sólidas. Las neoplasias hematológicas con mayor frecuencia de anemia fueron la leucemia mieloide crónica, las leucemias agudas, y el mieloma múltiple (100%, 92,5% y 60%; respectivamente) y en el grupo de neoplasias sólidas fueron los cánceres de origen: gastrointestinal, ginecológico, y urológico (62%, 52,1% y 45%; respectivamente). Recibieron transfusiones 204 pacientes (26,4%). En 762 pacientes se encontró una diferencia en la sobrevida global entre los grupos sin y con presencia de anemia, estimándose a los cinco años en 62% y 47% respectivamente (p<0,001), además se encontraron diferencias en la sobrevida global para el subgrupo de tumores sólidos (p=0,002) y neoplasias hematológicas (p=0,007). Conclusiones. La anemia es frecuente en pacientes con cáncer y su presencia determina un factor pronóstico independiente en la sobrevida global.

ABSTRACT Objective. To determine the frequency and prognostic value of anemia in cancer patients receiving care at the National Institute of Neoplastic Diseases (Instituto Nacional de Enfermedades Neoplásicas - INEN) between January and April of 2010. Materials and Methods. Anemia was considered for men with hemoglobin levels at <13 g/dL; and for women, at <12 g/dL. Associations between qualitative features were assessed with a Chi-square test. Kaplan-Meier estimator was used for the analysis of the survival curves, and differences between the curves were performed with the log-rank test. Results. 772 patients were included; 584 (75.7%) had solid tumors and 188 (24.3%) had hematologic malignancies. Anemia was diagnosed in 359 patients (46.5%); hematologic malignancies in 127 patients (67.6%); and solid neoplasms in 235 (40.2%). Hematologic malignancies with the highest frequency of anemia were chronic myeloid leukemia, acute leukemias, and multiple myeloma (100%, 92.5% and 60%, respectively); and were cancer of gastrointestinal, gynecological, and urological origin were in the group of solid neoplasms (62%, 52.1% and 45%, respectively). Two hundred and four (204) patients (26.4%) were transfused. In 762 patients, a significant difference in overall survival was found between groups with and without anemia, estimated at 5 years in 62% and 47% respectively (p <0.001). In the solid tumor subgroup (p = 0.002), and the hematological malignancies subgroup (p = 0.007), such association was also found. Conclusions. Anemia is common in cancer patients, and its presence determines an independent prognostic factor in overall survival.

Evidence of the anti-Helicobacter pylori, gastroprotective and anti-inflammatory activities of Cuphea aequipetala infusion.

ETHNOPHARMACOLOGICAL RELEVANCE: Cuphea aequipetala (Lythraceae) is a medicinal plant highly appreciated in Mexico to treat stomach ailments such as pain and burning sensation, stomach infections, ulcers, diarrhea, dysentery, and different types of tumors and bruises. In this work, the infusion of aerial parts of this plant (CAI) was investigated for its polypharmacological potential. MATERIALS AND METHODS: In vitro anti-Helicobacter pylori activity was assessed by broth dilution method. Pharmacological studies included acute toxicity in mice using Lorke´s model, anti-inflammatory activity by xylene and TPA induced ear edema assay, as well as gastroprotection with ethanol-induced gastric ulcer model. DPPH and ABTS assays were used to determine antioxidant capacity. Polyphenols and flavonoid contents were determined by Folin-Ciocalteu method and AlCl3 reaction, respectively. RESULTS: CAI showed good anti-Helicobacter pylori activity with a MIC of 125µg/mL. The infusion was not toxic according to Lorke's model with a LD50 greater than 5g/kg. CAI exhibited low anti-edematogenic action in the models assayed. Oral administration of 300mg/kg CAI significantly reduced gastric lesions by 87.9%. The effect was reversed only by indomethacin and N-ethylmaleimide demonstrating the role of endogenous prostaglandins and sulfhydryl compounds in gastroprotection. Total phenolic and flavonoid contents of CAI were 109.9mg GAE/g DW and 28.1mg QE/g DW, respectively, and the infusion exhibited a good antioxidant activity that is thought to play a role in its biological activity. The analysis of a preliminary fractionation of the infusion indicates that the complete extract conserves all its pharmacological activities in contrast to fractionated extracts. CONCLUSIONS: Cuphea aequipetala is a promising native herb in an integral therapy for the treatment of bacterial or non-bacterial gastric ulcer because it possesses some anti-inflammatory properties, as well as exhibits good gastroprotective and antibacterial effects. It represents an important source for the isolation of anti-Helicobacter pylori compounds. This work provides ethnopharmacological evidence that supports the traditional use of this species.

Hantavirus y embarazo: aspectos hemodinámicos y respiratorios / Hanta virus and pregnancy: hemodynamic and respiratory aspects

The disease by Hanta virus has a recent diagnose in our country. 218 cases have been reported to date and given its high mortality of 44 percent, a great epidemiological campaign has been implemented, for its isolation and control. The most severe form of this disease, Hanta virus, is the cardio pulmonary syndrome which present characterics that difference it from other similar disorders. The more frequent hemodynamics patrons to find are low cardiac indexes (CI) with pulmonary vascular resistences and elevated (RVS) systemic. On the other hand, the respiratory disorders correspond to a pulmonary edema non cardiogenic, similar to acute respiratory distress syndrome (SDRA). There are few reports of Hanta in pregnant patients described in literature and case present a high rate of fetal and maternal mortality and there is not a clear description of the hemodynamic compromise, or certitude if there is vertical transmission of the virus from the infected mother to the fetus. We described the clinical case of a 12 weeks pregnant patient with cardio pulmonary syndrome due to Hanta virus (SCPH) which shws a different hemodynamics patron than which has been published and who survives both she as well as her child and do not present virus transmission to the fetus

Eficacia y seguridad de la fexofenadina y la cetirizina en el tratamiento de la rinitis alérgica / Efficacy and safety of fexofenadine compared with cetirizine in the treatment of allergic rhinitis

Antecedentes: la rinitis alérgica afecta a 20 millones de personas en Estados Unidos y a un número muy superior en el resto del mundo. Objetivo: evaluar la eficacia y la seguridad de la fexofenadina en comparación con la cetirizina en el tratamiento de la rinitis alérgica. Material y método: se realizó un estudio prospectivo, doble ciego, comparativo, al azar y multicéntrico en pacientes con rinitis alérgica con edades comprendidas entre los 12 y 65 años. En la primera fase se administró placebo durante tres días a todos los pacientes y posteriormente se asignaron por azar para recibir fexofenadina a la dosis de 120 mg o 10 mg de cetirizina en dosis única al día durante 14 días. Al inicio y al final del estu dio se realizaron pruebas de laboratorio y gabinete que sirvieron como parámetros para conocer la inocuidad, eficacia y evaluación global por parte del investigador. Resultados: se incluyeron 176 pacientes, 63.6 por ciento de ellos eran mujeres. La edad promedio fue 27.8 años (ñ 12.0). El 47.7 por ciento de la muestra recibió fexofenadina y 52.2 por ciento cetirizina. No se encontró una diferencia significativa ni en parámetros de eficacia ni en la inocuidad. Conclusión: los resultados de este estudio permiten corroborar la eficacia e inocuidad de la fexofenadina.

Golpe de calor provocado durante el tratamiento con atropina en un paciente con intoxicación por organofosforado / Heat stroke due to atropine treatment in a patient poisoned with organophosphate

El golpe de calor es una entidad clínica que se clasifica dentro de los síndromes hipertérmicos. La hipertermia es el aumento de la temperatura corporal secundaria a un incremento en la producción de calor o a una disminución en su disipación. Presentamos el caso de un hombre joven intoxicado con insecticida organofosforado, que estando en tratamiento con atropina hace hipertermia severa con compromiso de conciencia y disfunción multiorgánica

Estapedectomía de revisión / Revision stapedectomy

El fracaso en la corrección de la hipoacusia de conducción en la Otoesclerosis posterior a una estapedectomía o la reaparición de un nuevo foco son indicaciones para la realización de una Estapedectomía de Revisión. El análisis de estos casos implica la selección del paciente, los factores relacionados al cirujano y la evolución postoperatoria. En el presente estudio se presentan 22 casos de estapedectomía de revisión en un lapso de siete años, analizando los hallazgos quirúrgicos de la cirugía de revisión y la evolución posterior. Los hallazgos quirúrgicos más importantes fueron la presencia de nuevo foco de otoesclerosis y la presencia de bridas entre la cadena osicular y las paredes de la caja timpánica. En ninguno de los pacientes se encontró fístula perilinfática. La mitad de los pacientes (50 por ciento) refirió ganancia auditiva posterior a la revisión, con cierre de la diferencia aéreo-ósea en 10 dB; en 27.3 por ciento no hubo cambios y en 22.7 por ciento aumentó la hipoacusia. Se concluye que la selección adecuada de los pacientes permite disminuir la incidencia de estapedectomías de revisión, la cual tendrá un éxito menor que la estapedectomía primaria.