Embarazo ectópico tubárico seis años después de una histerectomía supracervical. Reporte de caso / Tubal ectopic pregnancy six years after supracervical hysterectomy. A case report

Resumen El embarazo ectópico en pacientes histerectomizadas es un evento poco común y rara vez se considera en el diagnóstico diferencial en mujeres con esa condición. Se comunica el caso de una paciente de 30 años con antecedentes de histerectomía realizada hacía 6 años, que se presentó en el servicio de urgencias con evolución de tres días de dolor abdominal bajo. La ecografía mostró un saco gestacional con embrión y presencia de líquido libre en el fondo de saco Douglas. El examen histológico de la muestra operatoria reveló vellosidades coriónicas y un embrión dentro de la trompa uterina.

Abstract Ectopic pregnancy in hysterectomized patients is an uncommon event and it is rarely considered in the differential diagnosis. We present the case of a 30-year-old patient with hysterectomy performed 6 years before who presented to the emergency service with a 3-day evolution of lower abdominal pain. Ultrasonography showed a gestational sac with embryo and the presence of free fluid in the Douglas sac. Histological examination of the surgical piece revealed chorionic villi and an embryo within the uterine tube.

Improving Immunohistochemistry Capability for Pediatric Cancer Care in the Central American and Caribbean Region: A Report From the AHOPCA Pathology Working Group.

Accessibility to immunohistochemistry (IHC) is invaluable to proper diagnosis and treatment of pediatric patients with malignant neoplasms. Whereas IHC is widely available in anatomic pathology laboratories in high-income countries, access to it in anatomic pathology laboratories of low- and middle-income countries remains a struggle, with many limitations. To advance the quality of the pathology service offered to children with cancer in areas with limited resources, a 5-day pathology training workshop was offered to pathologists and histotechnologists from various countries of the Central American and Caribbean region. An initial assessment of the workshop participants' current laboratory capacities was performed, and a regional training center was selected. Didactic and hands-on activities were offered, and review and evaluation of the IHC slides produced during the training course were compared with original slides from the participants' sites. This model of intensive 5-day training appears to be effective and can potentially be used in other budget-constrained regions. Moreover, it can serve as a continuing education activity for pathologists and histotechnologists, and as part of validations and quality improvement projects to build capacity and develop IHC assay proficiency in low- and middle-income countries.

Leiomiosarcoma asociado a embarazo / Uterine leiomyosarcoma associated with pregnancy

Los leiomiosarcomas uterinos son tumores malignos poco frecuentes que generalmente se presentan con síntomas inespecíficos, por lo que su diagnóstico suele ser incidental. Los casos más frecuentes se presentan en mujeres posmenopáusicas a quienes se les interviene quirúrgicamente por leiomiomas. La asociación de los leiomiosarcomas uterinos con la gestación es rara; solo existen doce casos reportados hasta la actualidad. Se presenta un caso de leiomiosarcoma uterino en una paciente gestante a quien se le realizó histerectomía por atonía uterina.

Uterine leiomyosarcomas are rare malignant tumors that usually present with nonspecific symptoms. The diagnosis is usually incidental; especially in postmenopausal women who are surgically intervened by uterine leiomyomas. Its association with pregnancy is rare, and there are only twelve cases reported to date. We present a case of uterine leiomyosarcoma in a pregnant patient who underwent hysterectomy due to uterine atony.

Cost-effectiveness analysis of EGFR mutation testing in patients with non-small cell lung cancer (NSCLC) with gefitinib or carboplatin-paclitaxel.

OBJECTIVE: Assess the cost-effectiveness of an EGFR-mutation testing strategy for advanced NSCLC in first-line therapy with either gefitinib or carboplatin-paclitaxel in Mexican institutions. METHODS: Cost-effectiveness analysis using a discrete event simulation (DES) model to simulate two therapeutic strategies in patients with advanced NSCLC. Strategy one included patients tested for EGFR-mutation and therapy given accordingly. Strategy two included chemotherapy for all patients without testing. All results are presented in 2014 US dollars. The analysis was made with data from the Mexican frequency of EGFR-mutation. A univariate sensitivity analysis was conducted on EGFR prevalence. Progression-free survival (PFS) transition probabilities were estimated on data from the IPASS and simulated with a Weibull distribution, run with parallel trials to calculate a probabilistic sensitivity analysis. RESULTS: PFS of patients in the testing strategy was 6.76 months (95 % CI 6.10-7.44) vs 5.85 months (95 % CI 5.43-6.29) in the non-testing group. The one-way sensitivity analysis showed that PFS has a direct relationship with EGFR-mutation prevalence, while the ICER and testing cost have an inverse relationship with EGFR-mutation prevalence. The probabilistic sensitivity analysis showed that all iterations had incremental costs and incremental PFS for strategy 1 in comparison with strategy 2. CONCLUSION: There is a direct relationship between the ICER and the cost of EGFR testing, with an inverse relationship with the prevalence of EGFR-mutation. When prevalence is >10 % ICER remains constant. This study could impact Mexican and Latin American health policies regarding mutation detection testing and treatment for advanced NSCLC.

A double-blind, double-dummy, randomized, placebo-controlled trial to evaluate the effect of statin therapy on triglyceride levels in Mexican hypertriglyceridemic patients.

OBJECTIVE: The most prevalent dyslipidemias in Mexico are low high-density lipoprotein (HDL) and high triglyceride (TG) levels. Hypertriglyceridemia (HTG) has been considered an independent risk factor for cardiovascular disease (CVD). The aim of this study was to evaluate the efficacy of rosuvastatin (RSV) in reducing TG levels in Mexican patients. METHODS: A randomized, double-blind, double-dummy, parallel-group, placebo-controlled, multicenter, phase IV study was conducted. Patients were of both genders, ≥ 18 years old, with basal TG levels between 200 and 800 mg/dl, LDL levels ≤ 190 mg/dl. Patients were randomized to receive rosuvastatin 10 mg (Group 1), 20 mg (Group 2) or placebo (Group 3) once daily for 8 weeks. Primary efficacy was TG level; secondary efficacy was non-HDL; HDL, low-density lipoprotein (LDL), total cholesterol (TC), Apo (apolipoprotein) A1, and ApoB. Safety data were evaluated up to 30 days after the last dose of medication. The Mann-Whitney U-test was performed to contrast each RSV groups against placebo; p < 0.05 was considered significant. Trial registry number is NCT00473655. RESULTS: A total of 334 patients were randomized: Group 1 = 111, Group 2 = 112, and Group 3 = 111. Basal TG median value levels were 278 mg/dl, 266 mg/dl, 279 mg/dl with median reduction (MdR) at 8 weeks of 26.6%, 32.19% and 7.58%, respectively, (Group 1 vs. Group 3 p = 0.002, and Group 2 vs. Group 3 p < 0.0001). Basal non-HDL values were 179 mg/dl, 180 mg/dl and 179 mg/dl with a MdR of 27%, 32% and 8%, respectively (Group 1 vs. Group 3 p < 0.0001, and Group 2 vs. Group 3 p < 0.0001); basal LDL vales were 130 mg/dl, 130 mg/dl and 127 mg/dl with MdR 35%, 44% and -4% (Group 1 vs. Group 3 p < 0.0001, Group 2 vs. Group 3 p < 0.0001); basal ApoB values were 114 mg/dl, 115 mg/dl and 110.5 mg/dl with MdR 25%, 33% and -0.5% (Group 1 vs. Group 3 p < 0.0001, Group 2 vs. Group 3 p < 0.001). CONCLUSION: Rosuvastatin 10 and 20 mg/day significantly reduced triglycerides and improved atherogenic lipid profile in HTG Mexican patients. The main limitation was the short follow-up time period.

Impacto de las publicaciones médicas / The impact of medical publications

El impacto y el aprovechamiento de las publicaciones médicas no es fácil de determinar. Con la finalidad de evaluar el conocimiento sobre las revistas médicas se aplicó una encuesta a los participantes del curso cómo escribir un artículo médico, encontrando que el 79//no lee el editorial y no conocen quienes componen el comité editorial, 54//que recordó el último artículo leído, sólo el 38//recordó los autores. Las revistas nacionales de mayor circulación son Rev Med Dom (85//), Arch Dom Ped (79//) y Acta Médica Dominicana (50//). Las dos ultimas son leídas en igual proporción y frecuencia. Publicacioones médicas. Redacción escrito médico

Ruptura uterina en gestantes en el Hospital de Apoyo Cayetano Heredia entre los años 1970-1985 / Uterine rupture in pregnants in the Hospital de Apoyo Cayetano Heredia during 1970-1985

Se estudiaron 61 casos de ruptura uterina, ocurridas en el Hospital de Apoyo Cayetano Heredia, desde enero de 1970 hasta diciembre de 1985, siendo la incidencia de 1 ruptura por cada 677 partos. Se estudiaron las siguientes variables: procedencia, grado de instrucción, edad, pariedad, control prenatal, antecedentes obstétricos, tiempo gestacional, trabajo de parto, vía y tipo de parto, tipo y sitio anatómico de ruptura, cuadro clínico y tratamiento, así como la morbimortalidad materna y fetal. Se hizo su clasificación de acuerdo a su etiología los resultados obtenidos fueron comparados con trabajos realizados a nivel nacional y mundial. De las variables enunciadas, antenido relevancia el elevado número de casos de ruptura uterina a edades y paridades bajas pero en úteros con cicatriz previa, así como la elevada frecuencia en pacientes sin asistencia prenatal. Sin embargo, el diagnóstico precoz y el tratamiento adecuado permitieron una sobrevivencia fetal del 67 por ciento, con una mortalidad materna del 0.0 por ciento