Navigating HER2-Low Testing in Invasive Breast Cancer: Update Recommendations for Pathologists.

The article discusses the importance of accurately distinguishing HER2-low from HER2-negative breast cancer, as novel ADCs have demonstrated activity in a large population of patients with HER2-low-expressing BC. While current guidelines recommend a dichotomous classification of HER2 as either positive or negative, the emergence of the HER2-low concept calls for standardization of HER2 testing in breast cancer, using currently available assays to better discriminate HER2 levels. This review covers the evolution and latest updates of the ASCO/CAP guidelines relevant to this important biomarker in breast cancer, including still-evolving concepts such as HER2 low, HER2 heterogeneity, and HER2 evolution. Our group presents the latest Mexican recommendations for HER2 status evaluation in breast cancer, considering the ASCO/CAP guidelines and introducing the HER2-low concept. In the era of personalized medicine, accurate HER2 status assessment remains one of the most important biomarkers in breast cancer, and the commitment of Mexican pathologists to theragnostic biomarker quality is crucial for providing the most efficient care in oncology.

Larval chaetotaxy and morphometry of Megasternini: Cercyon (Paracercyon) Seidlitz, Cryptopleurum Mulsant and Pelosoma Mulsant (Coleoptera: Hydrophilidae).

The chaetotaxy of the head capsule and head appendages of all the larval instars of Cercyon (Paracercyon) analis and the first and third instars of Cryptopleurum minutum and Pelosoma sp. is described and illustrated for the first time. Morphometric characters derived from the head capsule and mouthparts are also included, together with detailed illustrations of all characters. The morphology and chaetotaxy of these larvae are compared to that of other Megasternini with described larvae. The larval morphology of Megasternini has proven to be very similar, however we provided a group of chaetotaxic characters useful to separate genera. Most of the differences were found in the sensilla of the head capsule, maxilla, and labium, both in size and arrangement, while the chaetotaxy of the antennae and mandibles was strongly conserved.

Moral reasoning and moral competence as predictors of cooperative behavior in a social dilemma.

The level of moral development may be crucial to understand behavior when people have to choose between prioritizing individual gains or pursuing general social benefits. This study evaluated whether two different psychological constructs, moral reasoning and moral competence, are associated with cooperative behavior in the context of the prisoner's dilemma game, a two-person social dilemma where individuals choose between cooperation or defection. One hundred and eighty-nine Mexican university students completed the Defining Issues Test (DIT-2; measuring moral reasoning) and the Moral Competence Test (MCT) and played an online version of the prisoner's dilemma game, once against each participant in a group of 6-10 players. Our results indicate that cooperative behavior is strongly affected by the outcomes in previous rounds: Except when both participants cooperated, the probability of cooperation with other participants in subsequent rounds decreased. Both the DIT-2 and MCT independently moderated this effect of previous experiences, particularly in the case of sucker-outcomes. Individuals with high scores on both tests were not affected when in previous rounds the other player defected while they cooperated. Our findings suggest that more sophisticated moral reasoning and moral competence promote the maintenance of cooperative behaviors despite facing adverse situations.

A characterization of cross-border use of health services in a transborder population at the Mexico-Guatemala border, September-November 2021.

BACKGROUND: Cross-border use of health services is an important aspect of life in border regions. Little is known about the cross-border use of health services in neighboring low- and middle-income countries. Understanding use of health services in contexts of high cross-border mobility, such as at the Mexico-Guatemala border, is crucial for national health systems planning. This article aims to describe the characteristics of the cross-border use of health care services by transborder populations at the Mexico-Guatemala border, as well as the sociodemographic and health-related variables associated with use. METHODS: Between September-November 2021, we conducted a cross-sectional survey using a probability (time-venue) sampling design at the Mexico-Guatemala border. We conducted a descriptive analysis of cross-border use of health services and assessed the association of use with sociodemographic and mobility characteristics by means of logistic regressions. RESULTS: A total of 6,991 participants were included in this analysis; 82.9% were Guatemalans living in Guatemala, 9.2% were Guatemalans living in Mexico, 7.8% were Mexicans living in Mexico, and 0.16% were Mexicans living in Guatemala. 2.6% of all participants reported having a health problem in the past two weeks, of whom 58.1% received care. Guatemalans living in Guatemala were the only group reporting cross-border use of health services. In multivariate analyses, Guatemalans living in Guatemala working in Mexico (compared to not working in Mexico) (OR 3.45; 95% CI 1.02,11.65), and working in agriculture/cattle, industry, or construction while in Mexico (compared to working in other sectors) (OR 26.67; 95% CI 1.97,360.85), were associated with cross-border use. CONCLUSIONS: Cross-border use of health services in this region is related to transborder work (i.e., circumstantial use of cross-border health services). This points to the importance of considering the health needs of migrant workers in Mexican health policies and developing strategies to facilitate and increase their access to health services.

Using artificial intelligence to risk stratify COVID-19 patients based on chest X-ray findings.

BACKGROUND: Deep learning-based radiological image analysis could facilitate use of chest x-rays as a triaging tool for COVID-19 diagnosis in resource-limited settings. This study sought to determine whether a modified commercially available deep learning algorithm (M-qXR) could risk stratify patients with suspected COVID-19 infections. METHODS: A dual track clinical validation study was designed to assess the clinical accuracy of M-qXR. The algorithm evaluated all Chest-X-rays (CXRs) performed during the study period for abnormal findings and assigned a COVID-19 risk score. Four independent radiologists served as radiological ground truth. The M-qXR algorithm output was compared against radiological ground truth and summary statistics for prediction accuracy were calculated. In addition, patients who underwent both PCR testing and CXR for suspected COVID-19 infection were included in a co-occurrence matrix to assess the sensitivity and specificity of the M-qXR algorithm. RESULTS: 625 CXRs were included in the clinical validation study. 98% of total interpretations made by M-qXR agreed with ground truth (p = 0.25). M-qXR correctly identified the presence or absence of pulmonary opacities in 94% of CXR interpretations. M-qXR's sensitivity, specificity, PPV, and NPV for detecting pulmonary opacities were 94%, 95%, 99%, and 88% respectively. M-qXR correctly identified the presence or absence of pulmonary consolidation in 88% of CXR interpretations (p = 0.48). M-qXR's sensitivity, specificity, PPV, and NPV for detecting pulmonary consolidation were 91%, 84%, 89%, and 86% respectively. Furthermore, 113 PCR-confirmed COVID-19 cases were used to create a co-occurrence matrix between M-qXR's COVID-19 risk score and COVID-19 PCR test results. The PPV and NPV of a medium to high COVID-19 risk score assigned by M-qXR yielding a positive COVID-19 PCR test result was estimated to be 89.7% and 80.4% respectively. CONCLUSION: M-qXR was found to have comparable accuracy to radiological ground truth in detecting radiographic abnormalities on CXR suggestive of COVID-19.

Síndrome de hiperestimulación ovárica espontáneo en un embarazo con una mola invasiva: reporte de un caso / Spontaneous hyperstimulation ovarian syndrome in gestational trophoblastic disease: case report

ANTECEDENTES: El Síndrome de Hiperestimulación Ovárica (SHO) ocurre cuando los ovarios se hiperestimulan y se agrandan con la presencia de múltiples quistes foliculares y extravasación aguda de líquido desde el espacio intravascular hacias los compartimentos del tercer espacio. La presentación espontánea es infrecuente, de aparición más tardía y dentro de su patogénesis implica distinos factores, tales como genéticos y/o valores hormonales suprafisiológicos. CASO CLÍNICO: Paciente de 18 años, acude al servicio de urgencias por presentar embarazo de 14 semanas, acompañándose de dolor abdominal y sangrado transvaginal. Se mide fracción beta de la hormona Gonadotropina Coriónica humana (hCG), la cual se reporta en 3,932,600 mUI/ml. Vitalidad no se observa por ultransonido vaginal. Se procede a realizar evacuación uterina por aspiración manual endouterina y se inicia quimioprofilaxis con metotrexate / ácido folínico. Se documenta derrame pleural bilateral, derrame pericárdico. Se realiza ventana pericárdica y el derrame pleural se envía a patología y posteriormente se recaban resultados de patología con diagnóstico definitivo de embarazo molar completo / enfermedad trofoblástica metastásica. CONCLUSIÓN: Síndrome extremadamente raro de manera endógena. La evacuación del contenido intrauterino es la piedra angular del tratamiento. El inicio clínico de los síntomas masivos en las pacientes ocurre cuando la hCG empieza a declinar, iniciando edema periferico masivo, taquicardia y pulso paradójico. Lo anterior puede explicarse, en parte, por la liberación de sustancias vasoactivas en la placenta durante la evacuación. Por lo tanto, pacientes con SHO espontáneo y la posterior finalización del embarazo deben de tener un seguimiento estrecho

BACKGROUND: Ovarian hyperstimulation syndrome develops with bilateral ovarian enlargement and the present of fluid at the third space in the body compartments, the spontaneous manifestation is quite uncommon the late onset of the syndrome is related to several factors among them, pathological hormonal measurements and genetic factors. Clinical case: 18 years female with abnormal vaginal bleeding and pregnancy presenting at the emergency room, the pregnancy was diagnosticated as a miscarriage at 14 weeks and the levels of beta fraction of human chorionic hormone showed a nearly 4 million mUi/ml. no embryonic activity was observed by endovaginal ultrasound The uterine contents were aspirated and metrotexate as a chemotherapeutic drug was initiated. A pericardial effusion was drained and sent to pathological analysis. The diagnosis reported was a metastatic trophoblastic gestational disease. CONCLUSION: Extremely rare syndrome endogenously. Evacuation of intrauterine contents is the cornerstone of treatment. The clinical onset of massive symptoms in patients occurs when hCG begins to decline, initiating massive peripheral edema, tachycardia, and a paradoxical pulse. This can be explained, in part, by the release of vasoactive substances in the placenta during evacuation. Therefore, patients with spontaneous OHSS and subsequent termination of pregnancy should be closely followed

Gangrena de Fournier. Reporte de caso / Fournier's Gangrene. A Case Report

Resumen La gangrena de Fournier es una fascitis necrotizante tipo II que produce trombosis de los pequeños vasos subcutáneos, lo que genera que se propague a través de la piel del periné, área perianal y región genital. La mayoría de los casos tienen un foco perianal o colorectal en la mayoría de los casos y en una menor proporción se origina del tracto urogenital. La tasa de mortalidad varía entre el 7.8 y 50%1-3, únicamente el diagnóstico oportuno disminuye la morbilidad y mortalidad de este padecimiento. El tratamiento incluye desbridamiento quirúrgico de todo el tejido necrótico y el uso de antibióticos de amplio espectro.

Abstract Fournier's Gangrene is a type II necrotizing fascitis that leads to thrombosis of small subcutaneous vessels and spreads through the perianal and genital regions and the skin of the perineal. Most cases have a perianal or colorectal focus and in a smaller proportion it originates from the urogenital tract. The mortality rate varies between 7.8 and 50%1-3, only timely diagnosis decreases the morbidity and mortality of this condition. Treatment includes surgical debridement of all necrotic tissue and the use of broad-spectrum antibiotics.

Characterization and mapping of sensilla on the head appendages of noterid larvae (Coleoptera: Noteridae), and development of a preliminary biometric method for taxa delimitation.

Larvae of the burrowing water beetle family Noteridae are distributed worldwide and are often abundant in a broad range of aquatic habitats, playing an important role in structuring freshwater communities, yet they have remained among the most poorly studied groups of aquatic beetles. Studies on sensillar equipment of aquatic insect larvae are largely lacking, despite their potential use in phylogeny and biometric identification methods. In this article, the external morphology and distribution of sensilla on the head appendages of first instar larvae of selected genera of Noteridae were examined using scanning electron microscopy. Seven main types were distinguished based on their morphological structure: basiconica (3 subtypes), campaniformia (2 subtypes), chaetica (7 subtypes), coeloconica (6 subtypes), coniform complex (2 subtypes), placodea, and styloconica (3 subtypes). The apex of the labial palpus was found to be the most variable and informative region in regard to the number, relative position, and topology of sensilla. Fingerprint models were, therefore, generated for this region in each of the studied genera, allowing their identification.

Chaetotaxy and morphometry of the head capsule and head appendages of the genus Derallus Sharp (Coleoptera: Hydrophilidae).

The primary and secondary chaetotaxy of the head capsule and head appendages of the three larval instars of the water scavenger beetle genus Derallus Sharp are described for the first time based on two species: D. angustus Sharp and D. paranensis Oliva. Morphometric characters derived from the head capsule and mouthparts are included, together with detailed illustrations of all characters. Chaetotaxy of these larvae is compared with that of Regimbartia attenuata (Fabricius), another species belonging to the Derallus-clade of Berosini.

Isquemia intestinal por trombosis mesentérica en paciente geriátrico, resuelta por intervencionismo. Reporte de caso / Intestinal Ischemia Due to Mesenteric Thrombosis in a Geriatric Patient, Solved by Intervention. Case Report

Resumen: La trombosis mesentérica representa una urgencia vascular condicionada por la interrupción abrupta del flujo sanguíneo, ya sea arterial o venoso; el cuadro clínico puede ser inespecífico, lo cual puede representar un reto diagnóstico. De acuerdo con su etiología vascular, se requiere un enfoque terapéutico diferente. Si hay sospecha clínica o signos de peritonitis, el diagnóstico por imagen puede apoyar a identificar la patología presentada. En esta ocasión, se presenta caso clínico de una paciente de 84 años que acude al servicio de urgencias por dolor abdominal generalizado, que condujo a la realización de un estudio de imagen diagnóstico para confirmar tal hallazgo.

Abstract: Mesenteric thrombosis represents a vascular urgency caused by the abrupt interruption of blood flow, whether arterial or venous; clinical presentation can be nonspecific, which can represent a diagnostic challenge. According to its vascular etiology, a different therapeutic approach is required. If there is clinical suspicion or signs of peritonitis, the imaging diagnosis can support to identify the presented pathology. On this occasion, there is a clinical case of an 84-year-old patient who goes to the emergency department for generalized abdominal pain, which led to a diagnostic imaging study, to confirm this finding.

Adenoma pleomorfo de la glándula submandibular: reporte de un caso y revisión de la literatura / Pleomorphic adenoma of the submandibular gland: report of a case and review of literature

Los tumores de las glándulas salivales constituyen alrededor de 5% de las neoplasias de cabeza y cuello. El adenoma pleomorfo es el tumor benigno más frecuente de las glándulas salivales, representa aproximadamente 60% de todas las neoplasias salivales, está compuesto fundamentalmente por una proliferación de células mioepiteliales y por un amplio espectro de componentes de tejido epitelial y mesenquimal, rodeado por una nítida cápsula fibrosa. Alrededor de 80% de los adenomas pleomorfos aparecen en la parótida, 10% en la glándula submandibular y 10% en las glándulas salivales menores de la cavidad oral. La edad media de presentación es a los 46 años, pero la edad oscila entre la tercera y la quinta década de la vida. No obstante, ha sido encontrado en individuos de todas las edades, presentando una ligera predilección por el sexo femenino. Respecto a su sitio de origen, el adenoma pleomorfo es asintomático, de crecimiento lento y consistencia firme. La tomografía axial computarizada (TAC) y la resonancia magnética nuclear (RMN) son de gran utilidad para evaluar la extensión de la lesión, así como el compromiso de estructuras importantes. La biopsia por aspiración con aguja fina (BAAF) es un método útil para el diagnóstico de este tipo de neoplasias. El tratamiento de este tipo de lesiones consiste en la remoción quirúrgica de la tumoración junto con la glándula afectada. Menos de 1% de los casos de adenomas pleomorfos sufren transformación maligna, especialmente los que han presentado múltiples recidivas (AU)

The tumors of the salivary glands constitute about 5% of the neoplasms of the head and neck. The pleomorphic adenoma is the most frequent benign tumor of the salivary glands, represents approximately 60% of all salivary neoplasms, is composed mainly of a proliferation of myoepithelial cells and a wide spectrum of components of epithelial and mesenchymal tissue, surrounded by a sharp fibrous capsule. About 80% of pleomorphic adenomas appear in the parotid, 10% in the submandibular gland and 10% in the minor salivary glands of the oral cavity. The average age of presentation is 46 years, but age ranges between the third and fifth decade of life. However, it has been found in individuals of all ages, presenting a slight female predilection. Regarding its site of origin, the pleomorphic adenoma is asymptomatic, slow growing and firm consistency. Computed tomography (CT) and nuclear magnetic resonance (NMR) are very useful to evaluate the extent of the injury as well as the commitment of important structures. Fine needle aspiration biopsy (FNAB) is a useful method for the diagnosis of this type of neoplasm. The treatment of this type of injuries consists in the surgical removal of the tumor together with the affected gland. Less than 1% of cases of pleomorphic adenomas suffer malignant transformation, especially those that have presented multiple recurrences (AU)

Larval morphology and analysis of primary chaetotaxy in the genus Suphis Aubé, 1836 (Coleoptera: Noteridae).

The three larval instars of Suphis cimicoides Aubé, 1837 are described and illustrated, including morphometric and chaetotaxic analyses of the cephalic capsule, head appendages, legs, last abdominal segment and urogomphus. A preliminary ground plan of primary chaetotaxy for noterid larvae is presented for the first time, based on the species described herein and examination of larvae of the genera Hydrocanthus Say, 1823 and Suphisellus Crotch, 1873. This ground plan is compared with previous systems proposed for other adephagan families. Larvae of Noteridae can be distinguished from those of other families of Hydradephaga by the following combination of characters: (1) antennomere 3 with a rugged area on distal portion; (2) abdominal segment VIII with a U-shaped wavy membranous area ventrally; (3) absence of pore FRd; and (4) presence of seta AB16. Several sensilla present in noterid larvae (notably setae TR2 and TA1 and pores PAl, PAm, COd, TRb and FEb) are absent in larvae of Meruidae. On the contrary, parietal seta PA5 is present in Meruidae but absent in Noteridae. The presence of pore COc in Noteridae may indicate that this family has retained the ancestral condition found only in Carabidae. On the other hand, the absence of setae FE7, FE8, FE9 and FE10 in Noteridae is similar to the condition found in Carabidae, Gyrinidae and Meruidae.

Evolución histórica del proceso de atención al neonato quirúrgico en Cirugía Pediátrica / Historical evolution of the caring process to the surgical newborn in Pediatric Surgery

RESUMEN Introducción: la evolución histórica del proceso de atención al neonato quirúrgico en Cirugía Pediátrica se realizó teniendo como hito la creación de la Unidad de Cuidados Intensivos Neonatales por primera vez en Cuba, lo que significó un cambio en la calidad de la atención al recién nacido. Objetivo: determinar las características que definieron la evolución histórica del proceso de atención al neonato quirúrgico en Cirugía Pediátrica desde 1970 hasta la actualidad. Método: se utilizaron los métodos histórico lógico y enfoque sistémico para el estudio y la caracterización de las etapas del proceso de atención. Resultados: a partir de la década de 1970 se identificaron cuatro etapas del proceso de atención al neonato quirúrgico en Cuba: inicio (1970), fortalecimiento (1980), nuevas estrategias (1990), así como actualidad y proyecciones desde el año 2000, además se determinó el movimiento tendencial del mismo. Conclusiones: las etapas propuestas caracterizan el proceso de atención al neonato quirúrgico en Cirugía Pediátrica en Cuba y son: I Etapa: 1970 a 1979. Inicio de la atención médica al neonato quirúrgico, II Etapa: 1980 a 1989. Fortalecimiento de la atención médica al neonato quirúrgico. III Etapa: 1990 a 1999. Nuevas estrategias en la atención médica al neonato quirúrgico y IV Etapa: 2000 - 2018. Actualidad y proyecciones en la atención médica al neonato quirúrgico.

ABSTRACT Introduction: in Cuba, surgical newborn intensive care evolution has come up with the creation of Neonatal Intensive Care Unit. For the first time, newborns´ quality care has made a meaningful change in our health service quality. Objective: to figure out historical evolution characteristics of newborns´ surgical attention in Pediatric Surgery, since 1970 until nowadays. Method: we used the logical historical method, sistemic approach and stages of neonatal caring process. Results: in Cuba, since the 1970's four surgical newborn caring process stages were identified: beginning (1970), strenghening (1980), new strategics (1990). Since 2000, the updates and visualizations also determined this trend. Conclusions: previous stages define the surgical process newborns´ medical care inside Pediatric Surgery, in Cuba. We identified the following: Stage 1: 1970-1979 Beginning, stage 2: 1980-1989 Strenghening of medical attention to surgical newborn. Stage 3: 1990-1999 new medical attention strategics to the surgical newborn. Stage 4: 2000-2018 Current proyections of medical attention to the surgical newborn.

La supervivencia en neonatos con afecciones complejas en Cirugía Pediátrica / Neonates' survival from complex conditions after Pediatric Surgery

RESUMEN Introducción: el análisis de supervivencia es uno de los métodos estadísticos más empleado en los estudios clínicos. Objetivo: determinar la influencia de factores de riesgo en la supervivencia de los neonatos con afecciones complejas en Cirugía Pediátrica. Método: en este trabajo se estudiaron los pacientes atendidos en el Centro Regional de Cirugía Neonatal de Holguín, desde el 1ro de enero de 1994 hasta el 31 de diciembre del 2015. El universo estuvo constituido por 382 niños y la muestra por 295, con un tiempo de seguimiento de hasta 28 días. Se analizaron las variables como: peso al nacer, edad gestacional y anomalías asociadas; según los factores de riesgo como: bajo peso al nacer, neonato pretérmino y anomalías asociadas; así como su influencia en la supervivencia. Con la ayuda del paquete estadístico SPSS versión 15 sobre Windows XP, se efectuó el análisis de las curvas de supervivencia por el método Kaplan-Meier, y los factores de riesgo por el método Log-Rank. Resultados: del total de la muestra (n=295), se obtienen 66 neonatos con nacimiento pretérmino (22,4%), 82 con bajo peso al nacer (27,8%) y 154 con anomalías asociadas (52,2%); siendo este el factor de riesgo predominante. En dichos pacientes, se aprecia un alto número de eventos con influencia en su supervivencia, durante el seguimiento del período neonatal. El evento final ocurrió en 61 neonatos (20,7%). La media en el tiempo de supervivencia de los neonatos con afecciones complejas en Cirugía Pediátrica fue de 23 días. Conclusiones: en la supervivencia de los pacientes influyeron los factores de riesgo estudiados. La sepsis severa fue la causa directa de muerte que predominó.

ABSTRACT Introduction: survival study is one of the most used statistical methods in the clinical field. Objective: to determine the influence of risk factors over neonates´ survival form complex conditions after Pediatric Surgery. Method: in this work we studied patients attended in the Regional Center of Neonatal Surgery of Holguín, from January 1st, 1994 to December 31st, 2015. Universe was 382 neonates and the sample was 295, monitored during 28 days. Analyzed variables were: birth weight, gestational age and associated anomalies; according to its risk factors like: low birth weight, preterm neonates and associated anomalies, as well as their influence on neonates 'survival. By the use of statistical package SPSS version 15 on Windows XP, survival curves were analyzed by the Kaplan-Meier method and the risk factors by Log-Rank. Results: of the total sample (n=295) 66 neonates were preterm births (22.4%); 82 low birth weight (27.8%) and 154 showed associated anomalies (52.2%) as the main risk factor. Patients studied showed high numbers of events and their influence on survival during neonatal period. The final event occurred to 61 neonates (20.7%). Conclusions: risk factors studied were influenced by patients´ survival and the direct cause of death was severe sepsis.

Apendagitis aguda. Presentación de un caso / Acute appendagitis. Presentation of a case

Resumen La apendagitis aguda es una causa de dolor abdominal subdiagnosticada, ya que puede simular un cuadro de diverticulitis o apendicitis. Se debe a una torsión o trombosis del pedículo vascular de un apéndice epiploico que resulta en isquemia e infarto. El diagnóstico suele ser un hallazgo radiológico; sin embargo, tiene un curso autolimitado con resolución espontánea de 5 a 7 días.

Abstract Acute appendagitis is a cause of undiagnosed abdominal pain, as it may mimic diverticulitis or appendicitis. Torsion or thrombosis of the vascular pedicle of an epiploic appendage resulting in ischemia and infarction is due. The diagnosis is usually a radiological finding; however it has a self-limited course with spontaneous resolution of 5 to 7 days.