Mortalidad por enfermedad renal crónica y su relación con la diabetes en México / Chronic kidney disease mortality and its relation to diabetes in Mexico

Resumen OBJETIVO Analizar el efecto en México de la mortalidad producida por la enfermedad renal crónica secundaria a la diabetes mellitus. MATERIAL Y MÉTODO Estudio observacional efectuado de 1998 a 2014, en el que se tomó como base un registro nacional correspondiente a un lapso relativamente prolongado de 17 años, reconociendo a esta enfermedad en tanto entidad nosológica diferenciada, utilizando como metodología de análisis la minería de datos, y evitando en lo posible las ambigüedades o limitaciones detectadas en los estudios previamente publicados. RESULTADOS En las dos últimas décadas se han duplicado la prevalencia y las tasas de mortalidad por enfermedad renal crónica en la República Mexicana, lo que supone un elevado costo humano y financiero, además de que esta enfermedad reduce significativamente la calidad y la esperanza de vida de la población adulta mexicana. CONCLUSIONES Es necesario optimizar las estrategias de atención del paciente con enfermedad renal crónica sin descartar el uso de estrategias de prevención eficaces, dirigidas a la población general.

Abstract OBJECTIVE To analyze the impact in Mexico of the mortality produced by chronic renal failure secondary to diabetes mellitus. MATERIAL AND METHOD An observational study was done from 1998 to 2014 on the basis of a national registry corresponding to a relatively long period of 17 years, recognizing this pathology as a differentiated nosological entity, using the data mining as methodology of analysis, and avoiding as far as possible the ambiguities or limitations detected in previously published studies. RESULTS In the last two decades, the prevalence and mortality rates for chronic renal failure has doubled in Mexico, which means a high human and financial cost, in addition to the fact that this disease significantly reduces the quality of life and the life expectancy of the Mexican adult population. CONCLUSION It is necessary to optimize the care strategies for patients with chronic renal failure, without ruling out the use of effective prevention strategies focused on the general population.

Morphology of alpaca (Vicugna pacos) embryos in the first third of pregnancy.

The breeding of South American camelids is the main economic activity of the high Andean region of South America and it, is potentially, the most profitable resource in of the Puna environmental conditions of the Puna. The duration of the gestation in alpaca is 339.7 ± 12 days. The objective of the present work was to macroscopically and microscopically describe the ontogenic development of the splanchnic cavities of the alpaca and to determine the gestational time in which the post-cranial ossification centers are observed in the embryos/fetuses of this species, from day 21 to 107 of gestation. The documentation of normal ontogenic development, which is vacant for this period, is of the utmost importance to understand the consequences of the alterations at the different gestational times, as well as for the estimation of the gestational age in the case of abortions. Forty-seven alpaca specimens of both sexes, at different times of their gestational development, collected during slaughter at local slaughterhouses of the Department of Huancavelica, Peru, were evaluated. Specimens were assigned to seven groups according to their morphological characteristics. The embryogenesis in the alpaca was characterized by a series of changes comparable to those occurring in other mammals with similar gestational periods. Despite these similarities, species differences were found in some organs as stomach, which are observed too in adult individuals.

Cannabinoides para el tratamiento del trastorno por abuso de cannabis / Cannabinoids for the treatment of cannabis abuse disorder

Resumen INTRODUCCIÓN: El cannabis se erige como la droga ilícita más consumida en el mundo. Actualmente no existen alternativas farmacológicas específicas para el tratamiento de su adicción, por lo que se ha postulado la utilidad del uso de cannabinoides como herramienta terapéutica. Ellos actuarían principalmente a través de la disminución de síntomas de abstinencia y craving (deseo o compulsión por consumir), pero su efectividad aún no está clara. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos siete revisiones sistemáticas que en conjunto incluyeron 15 estudios primarios, de los cuales cuatro corresponden a ensayos aleatorizados. Concluimos que el uso de cannabinoides podría resultar en poco o nulo aumento en la abstinencia al finalizar el tratamiento, y probablemente aumenta los efectos adversos.

Abstract INTRODUCTION: Cannabis stands as the most used illegal drug in the world. Currently there are no pharmacologic alternatives to treat its addiction, so the use of Cannabinoids has been postulated as a therapeutic tool. They would act mainly through decrease in abstinence and craving symptoms but its effectiveness remains unclear. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified seven systematic reviews including 15 studies, of which four were randomized trials. We concluded the use of cannabinoids might result in little or no increase in abstinence at the end of treatment, and it probably increases adverse effects.

Development of the Liver in Alpaca (Vicugna pacos): A Microscopic and Macroscopic Description.

South American camelids have several biological, morphological and behavioural adaptations that allow them to live in geographical areas dominated by high altitudes. The liver has hematopoietic functions during the prenatal life, which could be modified in response to the unfavorable habitat. However, there are no previous data on the prenatal development of the liver in these species. In the present work, a study on the macroscopic and microscopic morphology of the liver of the alpaca during ontogeny was performed. Forty-one animals ranging in age from 20 days of embryonic development to adults were studied. Macroscopic and microscopic observations were performed on samples subjected to different techniques. Less than 7-g specimens were studied with stereoscopic magnifying glass. The general characteristics of the prenatal liver are similar to those of other mammals, and the structures related to hematopoietic function follow an ontogenic pattern similar to that of previously studied precocial species. However, there are differences in morphology when compared to descriptions for the Old World camelids, including the absence of relation between the caudate lobe and the right kidney and the lack of interlobular connective tissue.

Efecto citotóxico selectivo in vitro de muricin H (acetogenina de Annona muricata) en cultivos celulares de cáncer de pulmón / Selective in vitro cytotoxic effect of muricin H (Annona muricata acetogenenin) in lung cancer cell cultures

Objetivos: Determinar la actividad citotóxica selectiva de muricin H en la línea celular H460 (cáncer de pulmón de células grandes). Materiales y métodos: Las líneas H460 y 3T3 (fibroblastos normales de ratón), fueron expuestas a seis concentraciones de muricin H (62,5, 15,6, 3,9, 0,98, 0,24, 0,06 ªÌg/mL), e iguales concentraciones de 5-fluorouracilo(5-FU) usado como control positivo. Se hallaron los porcentajes de crecimiento en 48 horas, luego se determinó laconcentración inhibitoria de crecimiento 50 (CI50) mediante análisis de regresión linear y se obtuvieron los coeficientesde correlación de Pearson. Finalmente se calculó el índice de selectividad de cada muestra. Resultados: Los CI50en ªÌg/mL de muricin H fueron <0,06 (r = -0,96; p<0,005) para H460; y 6,16 (r = -0,96; p<0,025) para 3T3. Los CI50de 5-fluorouracilo fueron 0,46 (r = -0,95; p<0,005) para H460 y 0,29 (r = -0,88; p =0,01) para 3T3. Los índices de selectividad para muricin H y 5-FU fueron: >102,6 y 0,63 respectivamente. Conclusiones: Se demostró la acción citotóxica selectiva in vitro del muricin H, porque tuvo mayor efecto citotóxico para la línea H460, y menor para la línea3T3 en relación con el 5-fluorouracilo.

Objectives: To determine the selective cytotoxic activity of muricin H on a H460 cell line (non-small cell lung cancer). Materials and methods: H460 and 3T3 cell lines (normal murine fibroblasts) were exposed to six concentrations of muricin H (62,5; 15,6; 3,9; 0,98; 0,24; 0,06 µg/mL) and to equal concentrations of 5-fluorouracil (5-FU) used as a positive control. Growth percentages at 48 hours were measured, and then the half-maximal inhibitory concentration (IC50) was determined using linear regression analysis, and Pearson correlation coefficients were calculated. Finally, the selectivity index for each sample was calculated. Results: IC50 values for muricin H, expressed in µg/mL were as follows: <0,06 (r= -0,96; p<0,05) for the H5460 cell line, and 6,16 (r= -0,96; p<0,025) for the 3T3 cell line. IC50 with 5-FU were 0,46 (r= 0,95; p<0,005) for H460, and 0,29 (r= -0,88 P= 0,01) for 3T3. Selectivity indexes for muricin H and 5-FU were <102,6 and 0,63, respectively. Conclusions: In vitro selective cytotoxic activity of muricin H was proven, since it had a greater cytotoxic effect for H460 cell line, and lesser effect upon the 3T3 cell line when compared to 5-FU.

Las Rickettsias del grupo de las fiebres manchadas: respuesta inmune y sus proteínas inmunodominantes / Spotted fever Rickettsiae: their immunodominant proteins and immune response

The organisms of Rickettsia species are Gram (-) bacteria that cause severe illnesses in humans and are an important health problem in several countries around the world, including Mexico. The presence of different antigens between species and also in different strains of the same specie is an obstacle for vaccine development and serological diagnosis. There are important advances in the knowledge of the rickettsial antigenic structure and the resulting immune response in infected hosts, including humans. This review covers these topics and provides an overview about the development of vaccines and accessible diagnostic methods for diseases caused by Rickettsia (Rev Méd Chile 2004; 132: 381-7).

[Reasons for fresh frozen plasma transfusion in a general hospital]. / Motivos de transfusión de plasma fresco congelado en un hospital general.

OBJECTIVE: To assess the fresh-frozen plasma (FFP) transfusion indications in a Mexican hospital. SETTING: A general hospital for federal government employees located in the city of Morelia, State of Michoacan, Mexico. MATERIAL AND METHODS: We evaluated all FFP transfusions between February and August, 1998 classifying them as appropriate or inappropriate according to the recent FFP-transfusion guidelines: correction of known coagulation factor deficiencies with bleeding and correction of microvascular bleeding when prothrombin and activated partial thromboplastin time are > 1.6 times normal (coagulation index o CI), urgent reversal of warfarin therapy, antithrombin III deficiency, thrombotic thrombocytopenic purpura treatment, liver transplant and acute disseminated intravascular coagulation. RESULTS: 78 patients with 292 FFP units transfused were analyzed: in 20 patients the indication was clotting support, 16 with CI < 1.5 and four with CI > 1.6, one with blood loss and one with surgical procedure; hypoalbuminemia in 10; hypovolemia in eight; unidentified reason in 33 and others in seven patients. Eleven units (3.76%) were considered properly transfused whereas 281 (96.23%) were inadequately indicated.

Mothers at risk of alloimmunization to the Rh (D) antigen and availability of gamma-globulin at the Mexican Institute of Social Security.

Hemolytic disease of the newborn develops mainly when an Rh negative (D-) mother becomes sensitized and produces anti-Rh positive (anti-D) antibodies capable of hemolysing D+ fetal erythrocytes. Maternal alloimmunization can be prevented by the administration of anti-D gamma-globulin immediately after the birth of each Rh positive child. In order to identify the frequency of prevention of alloimmunization at the Instituto Mexicano del Seguro Social (IMSS), the amount of mothers at risk of sensitization from 1985 to 1995 was estimated from Rh and ABO blood group frequencies and with the number of deliveries and abortions at the Medical Institutions. Also, information in regard to the dose of gamma-globulin units purchased by the Institute of Social Security from 1985 to 1993 was obtained. The number of mothers at risk steadily increased from 16,616 in 1985 to 21,071 in 1995, amounting to a total of 203,203 in the 10-year period, while only 120,800 gamma-globulin units were purchased in that same period. The findings in this study suggest the need to define reasonable policies for the acquisition of gamma-globulin lots to prevent alloisoimmunization of mothers at risk.

[Simultaneous pancreas-kidney transplantation. First cases in Chile]. / Trasplante simultáneo páncreas riñón. Primeros casos en Chile.

We report two insulin dependent diabetic patients with a past history of 21 and 30 years complicated with retinopathy, neuropathy and nephropathy with arterial hypertension and kidney failure. Simultaneous pancreas-kidney transplantation was done 8 and 18 months after starting hemodialysis, performing a double intraperitoneal implant with pancreato-duodeno-vesical anastomosis and contralateral kidney grafting with uretero vesical anastomosis using antireflux techniques. In the second case, a second kidney transplant from the same donor was needed, due to a thrombosis of renal vein. There was one rejection episode in each case but renal or pancreatic function was not impaired. Other observed complications were metabolic acidosis and hyperkalemia due to urine loss of bicarbonate, moderate arterial hypertension and bacterial and fungal infections. There was a graft dysfunction due to the association of vancomycin and cyclosporin. In conclusion, in the two presented patients, simultaneous pancreas-kidney transplantations were successful and they remain free of insulin or dialytic therapy 4 and 9 months after the operation.

[False high levels glycosylated hemoglobin in 2 diabetic patients with persistence of fetal hemoglobin]. / Concentraciones falsamente elevadas de hemoglobina glicosilada en 2 pacientes diabéticos con hemoglobina fetal persistente.

Two diabetic patients with unusual high levels of glycosylated hemoglobin measured by ion exchange chromatography are described. Further studies revealed a persistence of fetal hemoglobin in both cases. This condition produces falsely high levels of glycosylated hemoglobin, when ion exchange chromatography is used. These cases may be overtreated with risk of hypoglycemia. Patients with inappropriate levels of glycosylated hemoglobin should be investigated for hemoglobinopathies.

[Evidence of genetic and environmental factors in manual laterality. Study of 120 Mexican families]. / Evidencia de componentes genéticos y ambientales en la lateralización manual. Estudio en 120 familias mexicanas.

Environmental factors as well as different modes of inheritance has been suggested to explain the etiology of left-handedness. In order to improve knowledge of this problem, manual skill (MS) of parents (n = 234), siblings (n = 506) and children (n = 126) of 60 right-handed (RHI) and 60 left-handed (LHI) index cases (IC), born in Mexico City, were studied. Parents and siblings of both IC had similar frequencies of left-handedness. Quite the contrary, 36.7% of children of LHI were left-handed, while 7.3% children of RHI happen to be left-handed (P < 0.00025). No differences were found in the appearance of perinatal environmental factors. These findings are explained in part according to the pressure exerted by parents and/or teachers for dextrality. The impact of this influence modifies the effect of several unknown genes (multifactorial inheritance). The understanding of the above mechanisms in the etiology of MS is relevant not only for academic purposes, but for the educational sphere as well.

Production and characterization of monoclonal antibodies to human Pneumocystis carinii for the diagnosis of P. carinii pneumonia.

OBJECTIVES: Monoclonal antibodies against human Pneumocystis carinii were produced by fusion of myeloma cells (X63-AG8.653) with splenocytes from Biozzi mice that had been immunized against P. carinii cysts isolated from infected human lung. The aim of this study was to evaluate the usefulness of these monoclonal antibodies for the diagnosis of P. carinii pneumonia by indirect immunofluorescence in comparison with a modified silver stain method and commercial kits. METHODS: One hundred fifty-seven specimens from 87 patients, infected or non-infected with human immunodeficiency virus, were examined for the presence of P. carinii. Specimens were either induced sputum samples or bronchoalveolar lavage fluids. Indirect immunofluorescence was performed with six stable clones obtained by limiting dilution. Four of the monoclonal antibodies were IgG1 isotypes, one was an IgG3 and one was an IgM. Their isoelectric points varied from 6.5 to 8.3. Tests were also performed with silver methenamine staining and with two commercially available monoclonal antibodies (Monofluo kit from Diagnostics Pasteur and MAb from Dako). RESULTS: The 6 antibodies all recognized P. carinii cysts in indirect immunofluorescence. No cross reactivity was observed with yeast or host cells. P. carinii antigens could not be identified with western immunoblotting suggesting that the monoclonal antibodies recognized native antigens. This result was confirmed by dot blot analysis. Spots were observed with native but not with denatured antigens. Inhibition studies showed that these 6 antibodies recognized the same or overlapping sites. The sensitivities of detection of P. carinii in sputum were 87% by silver stain and from 93.5 to 96.7% by immunofluorescence. The sensitivities of detection in bronchoalveolar lavage were 67.3% by silver stain and from 75.7% to 76.8% by immunofluorescence. CONCLUSION: Immunofluorescence was more sensitive than silver staining and the best results were obtained with E5-8 and A8-13 monoclonal antibodies and with Monofluo kit.

Lack of in vitro interference between SA-11 rotavirus and attenuated poliovirus type 1.

To determine if rotavirus interferes with the multiplication of poliovirus, and hence the efficiency of the polio vaccine, the effect of timing and concentration of Simian rotavirus (SSA-11) on polio-1 infection in MA-104 cells was studied in vitro by evaluating the cytopathic effect, the reduction of the infectivity titers and the visualization of viral particles by electron microscopy. We found that poliovirus 1 was able to replicate when the challenge dose was administered within the first 8 h following SA-11 infection and with titers ten times lower than those of rotavirus. Hence, non-interference effect was observed in this in vitro model.

Isolated congenital heart defects in first degree relatives of 185 affected children. Prospective study in Mexico City.

Parents (n = 355) and siblings (n = 313) of 185 index cases (IC) with congenital heart disease (CHD) were cardiologically evaluated. In the consecutive sample (2 years) Mendelian and chromosome syndromes were excluded. Four patients and nine siblings had CHD. The frequency of affection in siblings was 2.6% (8 in 313 siblings). All affected relatives are under medical care at the Centro Médico Nacional Siglo XXI, IMSS. In 10 of the 12 affected relatives found, the type of CHD was discordant from that of the IC. Discordance was found also in 9 of 36 IC with two or more CHD. An interpretation is given: if the mutated gene(s) has its effect in early embryological stages, affected relatives may have any type of CHD, but if the alteration occurs later, concordance is expected to be found. This model contributes also in explaining the remarkable genetic heterogeneity that exists in CHD.

Incongruent parenthood in a Mexican mestizo population as determined by HLA typing.

The incidence of incongruent parenthood was determined by confronting the declared familial relationship of 98 father-mother-son/daughter trinomials (drawn from the Centro Médico Nacional-IMSS (CMN-IMSS) Kidney Transplant Program) with their HLA-A and B antigens. Fourteen (14.3%) discrepant cases were found: three each with the putative father (3.1%) or with the putative mother (3.1%), two with either father or mother (though impossible to determine precisely with whom) (2.0%), and six with both parents (6.1%). Several possible explanations of these findings were considered, such as out-of-wedlock pregnancies, complex known or unknown, declared or undeclared social circumstances frequently related to the population studied (i.e. imminent kidney transplantation) and technical pitfalls. These data underscore the level of possible "noise" and imprecision in population genetics; genetic-epidemiology and transplantation programs.

[Histocompatibility antigens and acute vascular purpura]. / Antígenos de histocompatibilidad y púrpura vascular aguda.

INTRODUCTION: Some kidney diseases are associated to HLA antigens. Nyulassy found an increase in HLA-B35 in patients with Henoch-Schönlein's purpura suffering nephritis (HSP-N). Our study searched for associations of HLA antigens and anaphylactoid purpura nephritis in Mexican mestizo patients. MATERIAL AND METHODS: HLA-A,B, and C antigens were detected by two-step microcytotoxicity in 22 patients with HSP-N and compared to those of 665 healthy subjects of the same ethnic background. RESULTS: A significant association was found between HSP-N and HLA-Aw19 single (pc less than 0.05) or in haplotype form (Aw19-B35) (pc less than 0.005). HLA B35 alone was associated to HSP-N but only at non corrected level (pc less than 0.05). DISCUSSION: The significant association between HLA-Aw19 and Aw19-B35 and HSP-N may indicate a risk factor in Mexican mestizo patients to develop this case.

[Lymphangiomas or cystic hygromas of the oral cavity]. / Linfangiomas o higromas quísticos en cavidad oral.

Limphangioma or cystic higroms is a benign tumour constituted by capillar or cavernous limpha channels, which are uncommon in oral cavity. A worldwide bibliographic revision was done to unified opinions and a case which was treated at Specialities Hospital of Medical Center la Raza, Mexican Social Security Institute, is shown in this article.