Implementing precision oncology in Latin America to improve patient outcomes: the status quo and a call to action for key stakeholders and decision-makers.

Background: The advent of precision oncology (PO) has revolutionised diagnostic and follow up strategies and improved clinical outcomes for cancer patients. However, socio-economic inequalities in the level of implementation of PO in different countries is a prevailing issue. To improve this situation, the Latin America Patients Academy has gathered the recommendations of healthcare professionals and social civil members experienced in cancer management from Mexico, Guatemala, Costa Rica, Dominican Republic, Panama, Colombia, Chile, Ecuador, Peru and Argentina regarding the areas that need to be prioritised to improve the access to PO in Latin American (LATAM) countries. Methods: This manuscript is the culmination of a series of educational campaigns and panel discussion aimed at improving the implementations of PO in LATAM that took place from June 2021 to January 2022. The status of PO in Latin America: the level of PO implementation is generally low with some exceptions. The number of clinical trials and articles published with keywords related to PO from LATAM countries is drastically lower than in Europe and the United States. Despite sharing many complex challenges, progress is taking place in some countries in the region. Focus areas defined by the expert panel: The expert panel determined the areas of PO that should be improved by LATAM countries to improve its implementation through cancer care plans, educational programs and collaborative strategies. These initiatives should increase awareness about PO in the region and eventually improve cancer control in the region.

Renal replacement therapy in Latin American end-stage renal disease.

The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r2 0.86; P < 0.05) and life expectancy at birth (r2 0.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (r2 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The prevalence of RRT continues to increase, particularly in countries with 100% public health or insurance coverage for RRT, where it approaches rates comparable to those displayed by developed countries with a better GNI. The incidence also continues to increase in both countries that have not yet extended its coverage to 100% of the population as well as in those that have an adequate program for timely detection and treatment of chronic kidney disease (CKD) and its associated risk factors. PD is still an underutilized strategy for RRT in the region. Even though renal Tx is feasible, its growth rate is still not as fast as it should be in order to compensate for the increased prevalence of patients on waiting lists. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost-effective forms of RRT are needed in the region. Regional cooperation among Latin American countries, allowing the more developed to guide and train others in starting registries and CKD programs, may be one of the key initiatives to address this deficit.

Síndrome de Charles Bonnet: reporte de caso y revisión del tema / Charles Bonnet syndrome: case report and subject revision

Se presenta el caso de una paciente femenina de 77 años, viuda, procedente de área urbana, con antecedentes de hipertensión arterial, con tratamiento regular de enalapril 20 mg. diarios, con déficit visual secundario a degeneración macular asociada a la edad, con pérdida progresiva de la agudeza visual, presentó alucinaciones visuales complejas de tres años de evolución y luego de ser estudiada por Psiquiatría, Oftalmología y Medicina Interna se estableció el diagnóstico de síndrome de Charles Bonnet, entidad que tiende a ser subdiagnosticada en el ámbito de la salud, dada su rareza y desconocimiento por parte del personal médico. Se describen las principales características clínicas del síndrome, fisiopatología, factores de riesgo, diagnóstico y tratamiento (AU)

The case of 77 years feminine patient appears, widow, coming from urban area, with hypertension antecedents, having regular treatment with enalapril 20 mg. everyday, with secondary visual deficit to age-related macular degeneration (ARMD), with progressive loss of visual acuity, she presented complex visual hallucinations in three years of evolution and after being studied by Psychiatry, Ophtalmology and Internal Medicine it was established the diagnosis of Charles Bonnet syndrome. This entity tends to be subdiagnosed in the scope of the health, given to its peculiarity and ignorance on the part of the medical personnel. It shows the main clinical characteristics of the syndrome, physiopathology, risk factors, diagnosis and treatment (AU)

Embolia de líquido amniótico que debuta como asistolia durante el trabajo de parto / Amniotic fluid embolism manifesting as asystole during labor

La embolia de líquido amniótico (ELA) constituye una entidad infrecuente en el embarazo o posparto, pero sus consecuencias pueden ser devastadoras tanto para la madre como para el feto. Presentamos el caso de una paciente primípara de 35 años que súbitamente durante el trabajo de parto presenta una parada cardiaca, iniciándose maniobras de RCP avanzada y cesárea peri-mortem. La evolución es mala, con múltiples complicaciones cardiovasculares y coagulopatía importante que precisa de histerectomía. Desenlace fatal a los 8 días de la madre y a los 5 días del recién nacido. La incidencia de la ELA, según los más recientes estudios realizados sobre bases poblacionales extensas, se sitúa entre 1/15.000 y 1/50.000 partos, con una mortalidad que clásicamente se sitúa entorno al 60-80%. La terapéutica se basa en gran parte en medidas de sostén y tratamiento sintomático. Las principales complicaciones son hemorrágicas, cardiovasculares y respiratorias. Se instauran medidas de soporte vital avanzado tan pronto como sea posible, dirigidas al mantenimiento de la oxigenación, la circulación y la coagulopatía(AU)

Amniotic fluid embolism (AFE) is infrequent in pregnancy or the postpartum, but the consequences can be devastating for both the mother and the fetus. We report the case of a 35-year-old primipara with sudden cardiac arrest during labor. Advanced cardiopulmonary resuscitation and peri-mortem cesarean section were performed. The clinical course was poor with multiple cardiovascular complications and severe coagulopathy, requiring hysterectomy. The patient died at 8 days and the neonate at 5 days. According to the most recent broad population-based studies, the incidence of AFE is between 1/15000 and 1/50000 childbirths, with mortality that is classically around 60-80%. Treatment is largely based on support measures and symptomatic treatment. The principal complications are hemorrhagic, cardiovascular and respiratory. Advanced life support measures should be started as soon as possible, aiming to maintain oxygen supply and circulation and arrest coagulopathy(AU)

Differential gene expression in lymphocytes from malnourished children.

Malnutrition, which is widespread in developing countries, may be particularly devastating during childhood, when tissue development is occurring and nutrient requirements are great. Since protein-energy malnutrition potentially involves many cellular alterations, we have evaluated gene expression changes in lymphocytes from malnourished children using differential hybridization cloning. A cDNA library was generated from well-nourished children and differential screenings were performed with cDNAs obtained from well-nourished and malnourished children who presented with bacterial gastrointestinal infections. Differential expression was detected for genes involved in cell development and differentiation, and for genes involved in lymphocyte and mitochondrial functions. The genes detected in the present study suggest mechanisms for the changes in cell growth and immune function that are associated with protein-energy malnutrition. Two down-regulated genes in malnourished children may represent mechanisms of protection against immunosuppression. This finding clearly merits further investigation.

Stabilization energies of the hydrogen-bonded and stacked structures of nucleic acid base pairs in the crystal geometries of CG, AT, and AC DNA steps and in the NMR geometry of the 5'-d(GCGAAGC)-3' hairpin: Complete basis set calculations at the MP2 and CCSD(T) levels.

Stabilization energies of the H-bonded and stacked structures of a DNA base pair were studied in the crystal structures of adenine-thymine, cytosine-guanine, and adenine-cytosine steps as well as in the 5'-d(GCGAAGC)-3' hairpin (utilizing the NMR geometry). Stabilization energies were determined as the sum of the complete basis set (CBS) limit of MP2 stabilization energies and the Delta E(CCSD(T)) - Delta E(MP2) correction term evaluated with the 6-31G*(0.25) basis set. The CBS limit was determined by a two-point extrapolation using the aug-cc-pVXZ basis sets for X = D and T. While the H-bonding energies are comparable to those of base pairs in a crystal and a vacuum, the stacking energies are considerably smaller in a crystal. Despite this, the stacking is still important and accounts for a significant part of the overall stabilization. It contributes equally to the stability of DNA as does H-bonding for AT-rich DNAs, while in the case of GC-rich DNAs it forms about one-third of the total stabilization. Interstrand stacking reaches surprisingly large values, well comparable to the intrastrand ones, and thus contributes significantly to the overall stabilization. The hairpin structure is characterized by significant stacking, and both guanine...cytosine pairs possess stacking energies larger than 11.5 kcal/mol. A high portion of stabilization in the studied hairpin comes from stacking (similar to that found for AT-rich DNAs) despite the fact that it contains two GC Watson-Crick pairs having very large H-bonding stabilization. The DFT/B3LYP/6-31G** method yields satisfactory values of interaction energies for H-bonded structures, while it fails completely for stacking.

Cáncer cervicouterino y edad / Cervicouterine cancer and age

Se presenta el estudio de 182 casos de carcinoma cervicouterino infiltrante y 113 casos de carcinoma cervicouterino in situ, comprobados histopatologicamente y su relación con la edad al diagnóstico, vistos entre 1985 y 1994 en el Hospital Regional de Rio Blanco (S.S.A.), Veracruz. Se encontró que el cáncer cervicouterino invasor se presentó a una edad promedio de 50.2 años y que la edad promedio es diferente para cada una de las etapas clínicas, etapa I 45.1 años; etapa II 48.6 años, etapa III 54.9 años y etapa IV 57.4 años, hallazgo no reportado previamente y que puede tener importancia clínica. La edad promedio del carcinoma in situ fue de 43.9 años, tardía en relación a lo encontrado en la literatura se hacen consideraciones sobre las estrategias a seguir en la campaña de detección oportuna de esta neoplasia

Cáncer de vesícula biliar durante colecistectomías en el Hospital Regional <> de Veracruz / Gallbladder cancer during cholescystectomy at the regional Hospital of ®Río Blanco¼ in Veracruz

En México la incidencia de cáncer de vesícula bibliar es desconocida. En Estados Unidos de América ocupa el quinto lugar entre los carcinomas de tubo digestivo y tiene una tasa de incidencia anual de 3.5 por 100,000 habitantes. Existen diferencias en la incidencia de esta neoplasia de acuerdo a la región geográfica, el grupo étnico y la población de estudio. En el oeste del estado de Veracruz, recientemente se ha observado un incremento en el número de caso con carcinoma de vesícula biliar. En este trabajo, se analizan de manera retroprospectiva los hallazgos clínicos y demográficos de pacientes con carcinoma de vesícula biliar que acudieron al Hospital Regional ®Río Blanco¼ de la Secretaría de Salud durante el periódo 1986-1987. De un total de 127 pacientes que fueron sometidos a intervención quirúrgica de vesícula y vías biliares, se detectaron 12 pacientes con carcinoma de vesícula biliar. La frecuencia con respecto al total de procedimientos quirúrgicos fue de 9.4 por ciento. La edad promedio de los pacientes fue de 63 años (extremos 41-87 años); predominó en mujeres con razón 5:1. La presentación clínica más frecuente fue dolor e ictericia, aislados o asociados, en el 67 por ciento. La descripción de estos casos intenta estimular el desarrollo de estudios epidemiológicos para identificar los factores de riesgo asociados a esta neoplasia en el estado de Veracruz

Morbilidad ambulatoria en el adulto: Servicio Salud Metropolitano Norte / Ambulatory morbidity in adult: Health Service Metropolitano Norte

Con el objetivo de poder describir las características de la demanda de atenciones primarias de salud hecha por adultos al Servicio de Salud Metropolitano Norte (Santiago-Norte), se analiza una muestra de las consultas atendidas durante 1982. Los resultados muestran una disminución de la demanda a medida que la edad de los cunsultantes avanza, hasta los 44 años. A partir de los 45 años, la demanda aumenta nuevamente. Los grupos de causas más frequentes, entre 16 y 10%, corresponden a enfermedades respiratorias, circulatorias, digestivas, osteomusculares y mentales. Como diagnósticos específicos aparecen la hipertensión arterial, las neurosis y la diabetes. En general, el 60% de la demanda se concentra en 13 diagnósticos. Se establecen algunas diferencias entre las 15 causas más frecuentes, según el Centro de atenciones primarias de salud estudiado: una proporción diferente sobre el total; una diferencia en el orden de importancia de los diagnósticos habituales; una alta proporción de neurosis en "Til-Til" (rural); una demanda de atención por causa de alcoholismo en "Lucas Sierra" (urbano); una apreciable frecuencia de la hipertensión arterial en "Quinta Buin" (urbana); la aparición de damanda de atenciones por sarna en "Pincoya" (urbana pobre); la obesidad en "Quinta Buin" (urbana) u las anemias en el "Consultorio N-2" (urbano). En cuanto a la importancia relativa de ciertos diagnósticos por secciones de edad, la mayor parte de los grupos varía, ya sea aumentando o disminuyendo. Entre las que disminuyem con la edad se encuentran la fiebre tifoidea, la sarna, la tuberculosis, las parasitosis intestinales, la epilepsia, la infección urinaria y los accidentes. Entre las que aumentan con la edad se encuentran la diabetes, la hipertensión arterial, las cardiopatías, la bronquitis crónica, las artritis y las artrosis. Otros diagnósticos son observados con mayor frecuencia entre los sectores de edad media, tales como las neurosis, la patología biliar, la úlcera péptica y el lumbago