Up to half of patients diagnosed with chronic lymphocytic leukemia in México may not require treatment.

Introduction: Although therapeutic choices for patients with chronic lymphocytic leukemia (CLL) were once limited, treatment of this disease has vastly improved in the last decades.Patients and methods: Consecutive CLL patients diagnosed in a single institution were analyzed. Treatment was withheld in persons with CLL Rai stage 0 or 1, until progression and in persons with stages 2-4, with a negative expression of ZAP-70 until progression. Between 1983 and 1991, patients were give chlorambucil and prednisone (CP); after 1991 fludarabine and cyclophosphamide (FC) and after 1998, rituximab and FC (FCR).Results: 98 patients with CLL were identified; 49 were followed for >3 months. 21 persons (43%) did not require treatment nor progressed; 14 received CP, 6 FC, 7 FCR and one rituximab. Median overall survival (OS) has not been reached, being above 247 months; median OS for patients given CP was 115 months, for FC above 132 months and for FCR above 136 months (p > 0.5).Conclusion: CLL seems to be less aggressive in Mexican mestizos than in Caucasians; 43% of patients do not need treatment at all.

Treatment of Persons with Multiple Myeloma in Underprivileged Circumstances: Real-World Data from a Single Institution.

BACKGROUND: The treatment of patients with multiple myeloma (MM) has evolved in recent years, and the disease-associated prognosis has improved substantially. This improvement has been driven largely by the approval of novel agents, many of which are expensive and not universally available. Less expensive but effective approaches would be of value globally. PATIENTS AND METHODS: All consecutive MM patients diagnosed in the Centro de Hematología y Medicina Interna de Puebla after 1993 were included in this study. Patients were given oral thalidomide (100 mg/day), oral dexamethasone (36-40 mg/week), and aspirin 100 mg/day. Bor-tezomib (1.75 mg s.c. every week) was administered to those who could afford it. After 4-6 weeks of treatment, patients were offered an outpatient-based hematopoietic cell transplant (HCT). After the recovery of granulocytes following HCT, patients continued indefinitely on thalidomide; those who failed to tolerate thalidomide were switched to lenalidomide (25 mg/day). RESULTS: The median overall survival (OS) for all patients has not been reached and is >157 months. Median follow-up of the patients lasted 14 months (range 1.3-157). The median OS of patients with and without HCT was similar. The response rate (complete remission or very good partial remission) was 72% for those given thalidomide plus dexamethasone versus 88% for those given bortezomib, thalidomide, and dexamethasone before HCT, but OS was not different. As post-HCT maintenance, 37 patients received thalidomide; 26 of those (70%) could be maintained indefinitely on thalidomide, whereas 11 were switched to lenalidomide after a median of 7 months; median OS of patients maintained on thalidomide or lenalidomide after HCT was not different. CONCLUSION: In this series, a regimen incorporating low-cost novel agents and outpatient HCT was associated with excellent long-term survival in the treatment of MM patients. This approach may be a model for MM treatment in underprivileged circumstances.

Nonalcoholic Fatty Liver Disease and Thrombocytopenia III: Its Association With Insulin Resistance.

Thrombocytopenia (less than 100 × 109/L platelets) presents in around one quarter of patients with nonalcoholic fatty liver disease (NAFLD), the hepatic component of insulin resistance (IR). It is unknown whether IR, by itself, associates with thrombocytopenia. Persons with NAFLD and/or IR were prospectively accrued in the study after February 2018. Insulin resistance was defined by assessing α hydroxybutyrate, lynoleoyl glycerolphosphocoline, oleic acid, and insulin (Quantose IR), whereas the presence of NAFLD was defined by serologic determinations (Fibromax) and liver transient elastography (Fibroscan). In 78 patients with NAFLD, thrombocytopenia was identified in 22 (28%), whereas in 19 persons with IR, 14 (73%) were found to have NAFLD. In persons with IR + NAFLD, thrombocytopenia presented in 9 (64%). In the subset of patients with IR, the prevalence of thrombocytopenia was 52%. There was only 1 patient with IR/without NAFLD who displayed thrombocytopenia. Significant statistical association between NAFLD and thrombocytopenia was found (odds ratio [OR]: = 13, confidence interval [CI]: 1.5-162, P = .05), whereas there was no association between IR and thrombocytopenia (OR = 0.38, CI: 0.06-2.3, P = .61). Insulin resistance, by itself, was not found to be associated with diminished platelet counts. The presence of NAFLD, one of the consequences of IR, seems to be required to lead into thrombocytopenia.

Timpanoplastia en otitis media crónica y su relación con la trompa de Eustaquio / Tympanoplasty in chronic otitis media and its relations to the Eustachian tube

Objetivo: identificar la relación de la función de la trompa de Eustaquio con los resultados anatómicos y funcionales de timpanoplastia efectuada a pacientes con otitis media crónica. Diseño: estudio prospectivo, longitudinal, clínico controlado, comparativo, no cegado. Material y métodos: se estudiaron 55 pacientes en el Departamento de Otorrinolaringología del Hospital General, Centro Médico Nacional La Raza. Se les practicó estudio audiométrico con logoaudiometría, valoración de la función de la trompa de Eusaquio mediante impedanciometría, y timpanoplastia retroauricular. Resultados: se trató de 19 pacientes masculinos y 36 femeninos, promedio de edad 32 años. La función posoperatoria de la trompa de Eustaquio cambió en 29.1 por ciento y se mantuvo igual en 69.1 por ciento. La integración del injerto se logró en 26 casos (96.3 por ciento) del grupo con buena función tubaria y en 28 (100 por ciento) del grupo con mala función tubaria. La movilidad del injerto fue normal en 80 por ciento y anormal en 18.2 por ciento. Se obtuvo ganancia auditiva en 89.1 por ciento (siendo mayor en frecuencias bajas sobre todo en 250 Hz), 9.1 por ciento sin ganancia y no hubo casos con pérdida autidiva. Conclusión: la función de la rompa de Eustauio no influye en el resultado de la timpanoplastia y es posible continuar con las intervenciones quirúrgicas en pacientes con mala función tubaria preoperatoria, ya que su condición no modifica los resultados

Quiste dermoide mastoideo, reporte de un caso / Dermoid cyst in the mastoid process. case report

Se reporta el caso de paciente femenino de 34 años de edad, con historia de otitis media crónica y cirugía mastoidea en su infancia que en su vida adulta presenta hipoacusia conductiva unilateral progresiva, sintomatología vestibular, acúfeno y otalgia ipsilateral de un año de evolución. Los hallazgos tanto en estudios de imagen como trans operatorio fueron de una neoformación que ocupaba y ampliaba antro y mastoides con un defecto óseo hacia fosa posterior. La lesión fue resecada vía transmastoidea. El reporte histopatológico señalaba quiste dermoide mastoideo