Effectiveness of decentralizing outpatient acute malnutrition treatment with community health workers and a simplified combined protocol: a cluster randomized controlled trial in emergency settings of Mali.

Background: Outpatient treatment of acute malnutrition is usually centralized in health centers and separated into different programs according to case severity. This complicates case detection, care delivery, and supply chain management, making it difficult for families to access treatment. This study assessed the impact of treating severe and moderate cases in the same program using a simplified protocol and decentralizing treatment outside health centers through community health workers (CHWs). Methods: A three-armed cluster randomized controlled trial under a non-inferiority hypothesis was conducted in the Gao region of Mali involving 2,038 children between 6 and 59 months of age with non-complicated acute malnutrition. The control arm consisted of 549 children receiving standard treatment in health centers from nursing staff. The first intervention arm consisted of 800 children treated using the standard protocol with CHWs added as treatment providers. The second intervention arm consisted of 689 children treated by nurses and CHWs under the ComPAS simplified protocol, considering mid-upper arm circumference as the sole anthropometric criterion for admission and discharge and providing a fixed dose of therapeutic food for severe and moderate cases. Coverage was assessed through cross-sectional surveys using the sampling evaluation of access and coverage (SLEAC) methodology for a wide area involving several service delivery units. Results: The recovery rates were 76.3% in the control group, 81.8% in the group that included CHWs with the standard protocol, and 92.9% in the group that applied the simplified protocol, confirming non-inferiority and revealing a significant risk difference among the groups. No significant differences were found in the time to recovery (6 weeks) or in anthropometric gain, whereas the therapeutic food expenditure was significantly lower with the simplified combined program in severe cases (43 sachets fewer than the control). In moderate cases, an average of 35 sachets of therapeutic food were used. With the simplified protocol, the CHWs had 6% discharge errors compared with 19% with the standard protocol. The treatment coverage increased significantly with the simplified combined program (SAM +42.5%, MAM +13.8%). Implications: Implementing a simplified combined treatment program and adding CHWs as treatment providers can improve coverage while maintaining non-inferior effectiveness, reducing the expenditure on nutritional intrants, and ensuring the continuum of care for the most vulnerable children.

Impact of a simplified treatment protocol for moderate acute malnutrition with a decentralized treatment approach in emergency settings of Niger.

Introduction: Of the 45.4 million children under five affected by acute malnutrition in the world, the majority (31.8 million) are affected by moderate acute malnutrition (MAM). Its treatment is particularly complex in emergency settings such as the Diffa region in Niger. This study aims to evaluate the effectiveness and coverage of a simplified treatment protocol with Community Health Workers (CHWs) as treatment providers. Methods: This study is a non-randomized controlled trial. The control group (n = 181) received the standard protocol currently used in country, delivered by nursing staff only in health centres and health posts, while the intervention group (n = 483) received the simplified protocol which included nursing at health centres and CHWs at health post as treatment providers. Results: The recovery rate was higher in the simplified protocol group (99.6% vs. 79.56%, p < 0.001) recording lower time to recover and higher anthropometric gain. Treatment coverage in the intervention group increased from 28.8% to 84.9% and reduced in the control group (25.3% to 13.6%). No differences were found in the recovery rate of children treated by CHWs and nursing staff. Conclusion: The outcomes using the simplified protocol exceeded humanitarian requirements and demonstrated improvements compared to the standard protocol showing that the simplified protocol could be safely provided by CHWs in an emergency context. Further research in other contexts is needed to scale up this intervention.

Effectiveness and Coverage of Severe Acute Malnutrition Treatment with a Simplified Protocol in a Humanitarian Context in Diffa, Niger.

BACKGROUND: the aim of this study is to evaluate the effectiveness and coverage of a simplified protocol that is implemented in health centers (HCs) and health posts (HPs) for children who are suffering from severe acute malnutrition (SAM) in the humanitarian context of Diffa. METHODS: We conducted a non-randomized community-controlled trial. The control group received outpatient treatment for SAM, without medical complications, at HCs and HPs with the standard protocol of community management of acute malnutrition (CMAM). Meanwhile, with respect to the intervention group, the children with SAM received treatment at the HCs and HPs through a simplified protocol wherein the mid-upper arm circumference (MUAC) and the presence of edema were used as the admission criteria, and the children with SAM were administered doses of fixed ready-to-use therapeutic food (RUTF). RESULTS: A total of 508 children, who were all under 5 years and had SAM, were admitted into the study. The cured proportion was 87.4% in the control group versus 96.6% in the intervention group (p value = 0.001). There was no difference between the groups in the length of stay, which was 35 days, but the intervention group used a lower quantity of RUTF-70 sachets versus 90 sachets, per child cured. Coverage increases were observed in both groups. DISCUSSION: the simplified protocol used at the HCs and HPs did not result in worse recovery and resulted in fewer discharge errors compared to the standard protocol.

Leishmania (Leishmania) mexicana Infection in Wild Rodents from an Emergent Focus of Cutaneous Leishmaniasis in Yucatan, Mexico.

In 2015, emergent cases of localized cutaneous leishmaniasis (LCL) were reported in Tinum, Yucatan, Mexico. As part of an eco-epidemiological study to characterize the elements that trigger Leishmania infection in that area, we conducted a field study to investigate the occurrence of Leishmania infection in wild rodents. From November 2019 to February 2020, rodents were caught from three sites located in the municipality of Tinum, Yucatan. For each specimen, clinical signs suggestive of Leishmania infection were recorded. Samples from the tail, liver, and spleen were taken for the identification of Leishmania DNA by PCR. Twenty rodents belonging to two species were caught including Heteromys gaumeri (55%, 11/20) and Ototylomys phyllotis (45%, 9/20). Fifty-five percent of the animals presented white spots on the tail, 15% had splenomegaly, and 5% had hepatomegaly. Fifty-five percent (11/20) of the animals were found infected by Leishmania. Heteromys gaumeri was caught in all trapping sites and was the most infected species (63.6%, 7/11). The percentage of infection for O. phyllotis was 44.4% (4/9). Leishmania (Leishmania) mexicana was identified as the infecting species in two H. gaumeri. This study provides, for the first time, evidence of Leishmania infection in wild rodents from the Yucatan state. Heteromys gaumeri and O. phyllotis may be involved in the transmission cycle of L. mexicana in this emergent focus; however, further longitudinal studies are needed to confirm their role as primary reservoirs.

Low prevalence of chewing lice (Phthiraptera) in wintering populations of the reed bunting Emberiza schoeniclus (Aves: Passeriformes: Emberizidae) in the Iberian Peninsula.

The reed bunting is a passerine bird of the Palearctic region, some subspecies suffer a decline in their populations. Four species of lice have been cited in reed bunting, but lice studies have not been carried out in the Iberian Peninsula. Between 2018 and 2020 a wintering population of the reed bunting is sampled in the center of the Iberian Peninsula through mist nets. Lice were collected directly from birds by a visual body examination. Of the 208 reed buntings sampled, only four individuals were parasitized. We find two species: Menacanthus chrysophaeus, which is the first record in Iberian lice, and Brueelia blagovescenskyi. Lice are not associated with the sex or age of the birds. The prevalence obtained is low compared to other European populations. This difference can be explained by the phenology of the subspecies, the migratory populations have a lower load of lice than sedentary populations.

Genetic variation patterns of ß-thalassemia in Western Andalusia (Spain) reveal a structure of specific mutations within the Iberian Peninsula.

BACKGROUND: Analyses of the genomic variation in the western Mediterranean population are being used to reveal its evolutionary history and to understand the molecular basis of particular diseases. AIM: To observe the ß-thalassemia mutational spectrum in western Andalusia, Spain, in the context of the Mediterranean. In addition, associations between disease and neutral gene variants within the ß-globin gene (HBB) were also evaluated. SUBJECTS AND METHODS: This study included 63 unrelated individuals diagnosed with ß-thalassemia. In addition, 97 unrelated, healthy subjects of the same territory were also analysed as proxies of the normal genetic background. Allele associations and population genetic structure analyses were performed using different methodologies. RESULTS: Data have revealed a rather restricted spectrum of ß-thalassemia mutations in the analysed sample. Although the detected variants fit well with the Mediterranean pattern, certain singularities support a structure of some specific ß-thalassemia alleles. The IVSI-1 (G > A) shows a strong regionalisation. The spatial correlogram revealed a typically narrow wave structure, presumably linked to genetic isolation and genetic drift. CONCLUSIONS: The long history of endemic malaria in the study territory, the rather high consanguinity rates among its autochthonous population, and other demographic features have been used here to understand the western Andalusian ß-thalassemia molecular portrait.

Human Genomic Diversity Where the Mediterranean Joins the Atlantic.

Throughout the past few years, a lively debate emerged about the timing and magnitude of the human migrations between the Iberian Peninsula and the Maghreb. Several pieces of evidence, including archaeological, anthropological, historical, and genetic data, have pointed to a complex and intermingled evolutionary history in the western Mediterranean area. To study to what extent connections across the Strait of Gibraltar and surrounding areas have shaped the present-day genomic diversity of its populations, we have performed a screening of 2.5 million single-nucleotide polymorphisms in 142 samples from southern Spain, southern Portugal, and Morocco. We built comprehensive data sets of the studied area and we implemented multistep bioinformatic approaches to assess population structure, demographic histories, and admixture dynamics. Both local and global ancestry inference showed an internal substructure in the Iberian Peninsula, mainly linked to a differential African ancestry. Western Iberia, from southern Portugal to Galicia, constituted an independent cluster within Iberia characterized by an enriched African genomic input. Migration time modeling showed recent historic dates for the admixture events occurring both in Iberia and in the North of Africa. However, an integrative vision of both paleogenomic and modern DNA data allowed us to detect chronological transitions and population turnovers that could be the result of transcontinental migrations dating back from Neolithic times. The present contribution aimed to fill the gaps in the modern human genomic record of a key geographic area, where the Mediterranean and the Atlantic come together.

Paternal lineages in southern Iberia provide time frames for gene flow from mainland Europe and the Mediterranean world.

BACKGROUND: The geography of southern Iberia and an abundant archaeological record of human occupation are ideal conditions for a full understanding of scenarios of genetic history in the area. Recent advances in the phylogeography of Y-chromosome lineages offer the opportunity to set upper bounds for the appearance of different genetic components. AIM: To provide a global knowledge on the Y haplogroups observed in Andalusia with their Y microsatellite variation. Preferential attention is given to the vehement debate about the age, origin and expansion of R1b-M269 clade and sub-lineages. SUBJECT AND METHODS: Four hundred and fourteen male DNA samples from western and eastern autochthonous Andalusians were genotyped for a set of Y-SNPs and Y-STRs. Gene diversity, potential population genetic structures and coalescent times were assessed. RESULTS: Most of the analysed samples belong to the European haplogroup R1b1a1a2-M269, whereas haplogroups E, J, I, G and T show lower frequencies. A phylogenetic dissection of the R1b-M269 was performed and younger time frames than those previously reported in the literature were obtained for its sub-lineages. CONCLUSION: The particular Andalusian R1b-M269 assemblage confirms the shallow topology of the clade. Moreover, the sharing of lineages with the rest of Europe indicates the impact in Iberia of an amount of pre-existing diversity, with the possible exception of R1b-DF27. Lineages such as J2-M172 and G-M201 highlight the importance of maritime travels of early farmers who reached the Iberian Peninsula.

Population Genetics of Plasmodium vivax in the Peruvian Amazon.

BACKGROUND: Characterizing the parasite dynamics and population structure provides useful information to understand the dynamic of transmission and to better target control interventions. Despite considerable efforts for its control, vivax malaria remains a major health problem in Peru. In this study, we have explored the population genetics of Plasmodium vivax isolates from Iquitos, the main city in the Peruvian Amazon, and 25 neighbouring peri-urban as well as rural villages along the Iquitos-Nauta Road. METHODOLOGY/ RESULTS: From April to December 2008, 292 P. vivax isolates were collected and successfully genotyped using 14 neutral microsatellites. Analysis of the molecular data revealed a similar proportion of monoclonal and polyclonal infections in urban areas, while in rural areas monoclonal infections were predominant (p = 0.002). Multiplicity of infection was higher in urban (MOI = 1.5-2) compared to rural areas (MOI = 1) (p = 0.003). The level of genetic diversity was similar in all areas (He = 0.66-0.76, p = 0.32) though genetic differentiation between areas was substantial (PHIPT = 0.17, p<0.0001). Principal coordinate analysis showed a marked differentiation between parasites from urban and rural areas. Linkage disequilibrium was detected in all the areas ([Formula: see text] = 0.08-0.49, for all p<0.0001). Gene flow among the areas was stablished through Bayesian analysis of migration models. Recent bottleneck events were detected in 4 areas and a recent parasite expansion in one of the isolated areas. In total, 87 unique haplotypes grouped in 2 or 3 genetic clusters described a sub-structured parasite population. CONCLUSION/SIGNIFICANCE: Our study shows a sub-structured parasite population with clonal propagation, with most of its components recently affected by bottleneck events. Iquitos city is the main source of parasite spreading for all the peripheral study areas. The routes of transmission and gene flow and the reduction of the parasite population described are important from the public health perspective as well for the formulation of future control policies.

[Idiopathic scrotal elephantiasis. A case report]. / Elefantiasis escrotal idiopática. Reporte de un caso.

BACKGROUND: Penoscrotal lymphedema (scrotal elephantiasis) is a condition that has been described in areas in which filariasis is endemic. CASE REPORT: This paper presents a case of a 45-year-old man with idiopathic lymphedema isolated to the scrotum. After acquired causes of lymphedema were ruled out, the patient was treated with scrotectomy and penoscrotal reconstruction. Currently, the patient is receiving follow-up care without evidence of recurrence. CONCLUSIONS: Penoscrotal lymphedema may cause symptoms of weakness, immobility and emotional disturbance. Surgery procedure provides a satisfactory cosmetical and functional outcome.

Introducción: el linfedema penoescrotal (también conocido como elefantiasis penoescrotal) es una condición que históricamente se ha descrito en áreas en las que la filariasis es endémica. Caso clínico: presentamos el caso de un hombre de 45 años de edad con linfedema escrotal. Después de descartar las causas adquiridas de linfedema, el paciente fue sometido a escrotectomía, prepuciectomía y reconstrucción escrotal y peneana. Actualmente el paciente se encuentra en seguimiento, sin datos de recidiva. Conclusión: el linfedema penoescrotal puede causar síntomas de debilidad e inmovilidad, así como problemas psicológicos. La cirugía otorga resultados cosméticos y funcionales aceptables.

[Rosai-Dorfman disease presented with involvement of the adrenal gland. A clinical case reported]. / Enfermedad de Rosai-Dorfman en glándula suprarrenal. Informe de un caso clínico.

BACKGROUND: Adrenal gland involvement is a very rare extranodal presentation of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease). Its pathogenesis still remains unknown with many theories about its probable cause. Symptoms and signs of adrenal involvement presentation are uncertain. Although, it is a disease with a good prognosis and a favorable clinical course in most cases, the low index of suspicion and difficulty in radiological differential diagnosis lead to radical treatment. CLINICAL CASE: We present a case of Rosai-Dorfman disease with right adrenal plus left infrahiliar nodal involvement. It was treated with adrenalectomy and node exeresis. The infrahilial involvement evolution was appropriate. CONCLUSIONS: Rosai-Dorfman disease is a rare disease and the extra-nodal presentation is even more rare. The incidence and evolution of this disease in the adrenal gland is unknown. The presence of this pathology should be considered if the patient shows adrenal gland affected and lymph node growth, in order to consider the individualized treatment, which may vary (treatment with corticosteroids, chemotherapy and/or radiotherapy).

INTRODUCCIÓN: la afectación extranodal de la glándula suprarrenal es una forma infrecuente de la histiocitosis sinusal con linfadenopatía masiva o enfermedad de Rosai-Dorfman. Aún se desconoce la etiopatogenia de esta enfermedad. Los síntomas y signos de presentación en la afectación adrenal son inciertos. Aunque es una enfermedad de buen pronóstico y curso clínico favorable, el bajo índice de sospecha y el difícil diagnóstico radiológico diferencial llevan a tratamiento radical en la mayoría de los casos. CASO CLÍNICO: se describe el caso de una paciente con enfermedad de Rosai-Dorfman en quien se identificó tumor adrenal derecho de 97 × 99 × 68 mm y tumor nodal infrahiliar izquierdo de 61 × 58 × 57 mm. El tratamiento incluyó adrenalectomía y vigilancia activa del tumor infrahilial mediante tomografía y gammagrama renal. La evolución de la paciente fue adecuada. CONCLUSIONES: la enfermedad de Rosai-Dorfman es una patología poco común y su presentación extranodal es todavía más extraña. La incidencia y evolución de la enfermedad en glándula suprarrenal se desconocen. Esta patología debe ser considerada en glándula suprarrenal cuando hay afección adrenal y crecimiento nodal, para plantear el tratamiento individualizado que puede variar entre vigilancia activa, tratamiento con corticosteroides, quimioterapia y radioterapia.

[Clinical practice guideline. Traumatic urethral stenosis in males]. / Guía de práctica clínica. La estenosis de uretra postraumática en el hombre.

The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid.

En México no está documentada la incidencia de la estenosis de uretra en forma consistente. En 2010, en el Centro Médico Nacional La Raza se reportaron 629 pacientes en consulta externa, 85 % de uretra anterior y 15 % de uretra posterior. La estenosis uretral es una enfermedad crónica, de etiología variada y manejo controvertido, con gran impacto negativo para los pacientes y recurrencia hasta de 85 %. El tratamiento puede ser instrumentado (dilataciones, cirugía endoscópica) y por cirugía abierta (uretroplastia). La Organización Mundial de la Salud y Alianza Mundial la consideran un reto de la atención de la salud. El objetivo de la siguiente guía es ofrecer al profesional de la salud, una herramienta clínica para la toma de decisiones en la atención de la estenosis uretral masculina, basada en la mejor evidencia identificada mediante la búsqueda bibliográfica sistematizada en las bases de datos Tripdatabase, PubMed, Guideline Clearinghouse, Cochrane Library y Ovid.

[Prostate-specific antigen. The role in the prostate cancer diagnosis]. / El antígeno prostático específico. Su papel en el diagnóstico del cáncer de próstata.

Prostate cancer (PC) is a common malignant neoplasia in males over 50 years. The serum level of prostate specific antigen (PSA) is a tool in the diagnosis of PC and benign prostatic hyperplasia patients that improves the efficiency obtained with the digital rectal examination. The use of PSA increases the detection rates of organ-confined PC. The PSA must be requested by the primary care physician in male population over 45 years and if the result is above the normal levels, the patient must be send to an urologist.

El cáncer de próstata es el tumor maligno más frecuente del varón mayor de 50 años. El nivel del antígeno prostático específico es una herramienta indispensable en el diagnóstico del cáncer de próstata y mejora sustancialmente la eficacia del tacto rectal. Si bien la elevación de este antígeno también sucede ante hiperplasia benigna, la cuantificación de sus niveles aumenta las tasas de detección del cáncer de próstata que tiene mayor probabilidad de estar limitado a la glándula.

Lesión ureteral yatrógena por cirugía ginecológica y obstétrica: Experiencia de 10 años en el Hospital de Especialidades del Centro Médico Nacional "La Raza" / Iatrogenic ureteral lesion by gynecologic and obstetric surgery: experience of 10 years in the Hospital de Especialidades del Centro Médico Nacional \"La Raza\"

La lesión quirúrgica del uréter es un importante problema que confrontan el urólogo y el ginecólogo. Los autores comunican su experiencia durante 10 años (junio de 1986 a junio de 1996) con los casos de 93 pacientes que experimentaron lesiones de uréter por cirugía ginecoobstétrica. Se encontraron un total de 108 lesiones de uréter: 46 por ciento de uréter izquierdo, 31.1 por ciento de uréter derecho y 16.1 por ciento bilaterales. Estas lesiones se advirtieron durante el procedimiento sólo en 13 por ciento de los casos con reparación inmediata. En la proporción restante de 86 por ciento la lñesión de diagnósticó en el periodo posoperatorio inmediato, y en un pequeño poercentaje se diagnosticó en forma tardía (3.2 por ciento). Los estudios realizados fueron urografía excretora, ultrasonido renal y pielografía escendente. Una vez establecido el diagnóstico, la reparación del uréter se realizó de inmediato, y el procedimiento de reparación que se utilizó en la mayoría de los casos fue la reimplantación ureteral

Riñón en herradura con doble sistema colector y compresión de la unión ureteropiélica inferior por vena renal accesoria. Caso clínico / Horseshoe kidney with dual collector system and compression of inferior ureteropyelic junction by an accesory renal vein. report of a case

Las alteraciones de la fusión renal se presentan frecuentemente asociadas a otras malformaciones renales, Se presenta en este artículo el caso de una paciente de 26 años de edad, asintomática durante la infancia, que inició su padecimiento con un cuadro de pielonefritis aguda con infección ulterior recurrente de vías urinarias; durante la protocolización del estudio se encontró un riñón en herradura con doble sistema colector completo e hidonefrosis del superior. Se sometió a lumbotomía exploradora y se realizó polectomía, y se identificó compresión extrínseca de la unión ureteropiélica izquierda por una vena renal accesoria

Oncocitoma en riñón funcionalmente único / Oncocytoma in unique functioning kidney

El oncocitoma se ha reconocido como un tumor de comportamiento benigno. Se considera que, en los casos en que se logra obtener un diagnóstico preciso antes de operar, el procedimiento deberá ser conservador, pero dado que en la mayoría de los casos el diagnóstico preoperatorio no es digno de confianza, en la actualidad es más segura la nefrectomía radical a menos que se encuentre una contraindicación, como lo sería el riñón único

Ferritina sérica: uso como marcador tumoral para el adenocarcinoma renal: informe preliminar / Serum ferritin: its use as tumor marker for renal adenocarcinoma: preliminary report

Se estudiaron 20 pacientes portadores de adenocarcinoma renal en diversas etapas clínicas, a los cuales se efectuaron determinaciones de ferritina sérica antes del tratamiento efectuado, después del mismo y bimestralmente, durante su seguimiento para investigar su empleo como potencial marcador tumoral. La ferritina sérica se halló elevada en los pacientes con cáncer renal en comparación con el grupo testigo; existió un incremento de la misma al aumentar la etapa clínica así como una disminución en los pacientes con regresión y estabilización de la neoplasia. En los pacientes con progresión aparecieron pruebas de persistencia de la elevación de la ferritina sérica. Según los resultados obtenidos, se justifica considerar a la ferritina sérica como un potencial marcador tumoral para el adenocarcinoma renal

Inmunoterapia del carcinoma renal estadio "d" con interferón alfa 2B: seguimiento a 12 meses / Immunotherapy of \"d\" stage renal carcinoma with alpha 2B interferon

El carcinoma de células renales es un tumor relativamente raro, con una frecuencia de 3 por ciento en los procesos malignos del adulto. Es una neoplasia que ocupa el cuarto lugar de las consultas del servicio de urología del Hospital de Especialidades del Centro Médico "La Raza". Los diversos tratamientos empleados en el carcinoma renal avanzado no ofrecen un adecuado porcentaje de supervivencia. Dada la importancia de encontrar un tratamiento que brinde un buen porcentaje de supervivencia, se efectúa este estudio en forma longitudinal, a futuro, descriptiva y comparativa en un periodo comprendido de diciembre de 1993 a diciembre de 1994. Se estudió a 12 pacientes con confirmación diagnóstica de carcinoma renal metastásico, a los que se les aplicaron 10 millones de UI de interferón alfa 2B, en 12 dosis cada semana. Se llevó a cabo seguimiento por espacio de 12 meses, se evaluó la reacción parcial y la total, la progresión de la enfermedad y la suspensión del tratamiento. Se encontró reacción completa en dos pacientes (16.6 por ciento); reacción parcial en cuatro (33.3 por ciento), y progresión en seis (50 por ciento). Por lo anterior, se llegó a la conclusión de que los resultados obtenidos se hallan dentro de lo informado en la bibliografía mundial, que deberá aumentar el número de pacientes y llevarse a cabo seguimiento por un tiempo prolongado. Por último, se concluyó que el interferón es una alternativa en el tratamiento del carcimona renal metastásico para brindar un mayor porcentaje de supervivencia en dicha patología

Ectomesenquimoma maligno; informe de un caso / Malignant ectomesen chimoma: report of a case

Se informan los hallazgos clínicos y patológicos de un ectomesenquimoma maligno de partes blandas. Los ectomesenquimomas malignos son tumores compuestos por derivados de la cresta neural y uno o más elementos mesenquimatosos malignos, por lo general rabdomiosarcoma, condrosarcoma, angiosarcoma y liposarcoma maligno y liposarcoma. En esta neoplasia, el tratamiento más adecuado es el quirúrgico, pues la quimioterapia y la radioterapia no parecen modifiar el curso de la enfermedad. En este caso el tratamiento fue quirúrgico, sin datos de actividad tumoral a los 16 meses subsecuentes a la operación.