Consensus on complementary feeding from the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition: COCO 2023.

Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.

Intraoperative irradiation in breast cancer: preliminary results in 80 patients as partial breast irradiation or anticipated boost prior to hypo-fractionated whole breast irradiation.

PURPOSE: To present the first results of intraoperative irradiation (IORT) in breast cancer with a low-energy photon system used as partial breast irradiation (PBI) or as an anticipated boost before whole breast hypo-fractionated irradiation (IORT + WBI), concerning tolerance, side effects, quality of life, and patient-reported outcomes. MATERIALS AND METHODS: Eighty patients treated with an Intrabeam® system of 50 kV X-rays received a 20 Gy dose intraoperatively were included. Moderate daily hypofractionation of 2.7 Gy in 15 fractions up to 40.5 Gy was administered if high-risk factors were present. Acute post-operative toxicity, surgery complications, chronic toxicity, patient-reported cosmesis and Breast-Q questionnaire were performed at follow-up visits. RESULTS: Thirty-one patients were treated as PBI and the remaining 49 as IORT + WBI. Only the IORT + WBI group presented acute toxicity, mainly mild acute dermatitis (11 patients) and one subacute mastitis. A total of 20 patients presented fibrosis (18 patients grade I, 2 patients grade II), 15 (30.5%) patients in the IORT + WBI group and 3 (9.6%) patients in the group of PBI. The cosmesis evaluation in 73 patients resulted poor, fair, good or excellent in 2, 7, 38 and 26 patients, respectively. In PBI group Breast-Q scored higher, especially in terms of their psychosocial well-being (78 vs 65) and satisfaction with radiation-induced toxicity (77 vs 72, respectively) compared to IORT + WBI group. CONCLUSION: IORT is a well-tolerated procedure with low toxicity, good cosmesis and favorable patient-reported outcomes mainly when administered as PBI.

Quantitative assessments of late radiation-induced skin and soft tissue toxicity and correlation with RTOG scales and biological equivalent dose in breast cancer.

PURPOSE: Radiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer. METHODS: Patients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration. RESULTS: In 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts (p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well (p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade (p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased (p < 0.001, p = 0.016, p = 0.005, respectively). CONCLUSIONS: The multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT.

Long-term results of a randomized partial irradiation trial compared to whole breast irradiation in the early stage and low-risk breast cancer patients after conservative surgery.

PURPOSE: To report long-term results of a randomized trial comparing accelerated partial breast irradiation (APBI) to whole-breast irradiation (WBI) in terms of efficacy, toxicity, and cosmesis. METHODS AND MATERIALS: WBI group was treated with 3D conformal external irradiation, 2 Gy daily/fraction, 5 fractions/week, to a total dose of 50 Gy. APBI group was treated with 3D conformal external irradiation 3.75 Gy/fraction, twice a day, 5 fractions/week, to a total dose of 37.5 Gy in the APBI group. Patients were followed up every 6 months up to 5 years and yearly thereafter. During follow-up visits, the clinician evaluated chronic toxicity and scored cosmetic results with a four-scale system. RESULTS: After a median follow-up of 10.3 years, 43 patients in each group (84%) are alive without disease. One patient died after disease progression in the APBI arm, and there was no death in the WBI arm. The rest of the patients died from another disease different than breast cancer, similarly between groups. There was greater fibrosis in the APBI group (9 patients grade 1 and one grade 2) compared to WBI (3 patients grade 1 and one grade 2); p = 0.18. Regarding cosmesis, in APBI group, 19 and 21 (43.2 and 47%) patients had excellent or good results, similar to the WBI group with 18 patients (40.9%) in each cosmesis outcome. The WBI group did not have any patient with poor cosmesis but the APBI had 3 (6.8%; p = 0.24). CONCLUSION: After a follow-up of 10 years, there were no differences in efficacy between the 2 treatment arms. Despite slight greater toxicity in the APBI group, the cosmesis was similar and satisfactory in both groups.

[Model of care for the treatment of patients with osteoarthritis from the first to the third level]. / Modelo de atención para el tratamiento de pacientes con osteoartritis del primer al tercer nivel.

INTRODUCTION: Osteoarthritis in Mexico is one of the ten most frequent causes of disability. Early diagnosis and detection of risk factors are determinant for treatment. The institutional organization establishes therapeutic guidelines according to each level of care, but effective management is not achieved. MATERIAL AND METHODS: A prospective, pilot, interventional, clinical study was conducted, which included patients diagnosed with different degrees of knee osteoarthritis in the first, second and third level of care, with an integrative model that includes a group of professionals for the intervention of nutritional, physiotherapeutic, social and psychological evaluation from the first level. RESULTS: The intervention of a multidisciplinary care group allows a correct evaluation and assignment of the level of care, optimizing human and material resources. The participation of different disciplines in nutrition, psychology, social work, physiotherapy and rehabilitation modifies the global lifestyle by involving the patients themselves in their treatment. The intervention group had improvements in the visual analog pain scale, mobility arcs, low body mass index and improvement in the psychological aspect. CONCLUSIONS: The proposed model of care demonstrates that implementation in the institution and in each clinical care unit should be considered to improve outcomes.

INTRODUCCIÓN: La osteoartritis en México es una de las 10 causas más frecuentes de discapacidad. El diagnóstico temprano y la detección de factores de riesgo son determinantes para el tratamiento. La organización institucional establece las pautas terapéuticas de acuerdo con cada nivel de atención, pero no se logra un manejo efectivo. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, piloto, de intervención, clínico conformado por pacientes diagnosticados con diferentes grados de osteoartritis de rodilla en el primer, segundo y tercer nivel de atención, con un modelo integrador que incluyó un grupo de profesionales para la intervención de la evaluación nutricional, fisioterapéutica, social y sicológica desde el primer nivel. RESULTADOS: La intervención de un grupo de atención multidisciplinaria permite una correcta evaluación y asignación del nivel de atención optimizando los recursos humanos y materiales. La participación de diferentes disciplinas en nutrición, sicología, trabajo social, fisioterapia y rehabilitación modifica el estilo de vida global al involucrar a los propios pacientes en su tratamiento. El grupo de intervención tuvo mejoras en la escala de dolor análogo visual, arcos de movilidad, bajo índice de masa corporal y mejoría en el aspecto sicológico. CONCLUSIONES: El modelo de atención propuesto demuestra que la implementación en la institución y en cada unidad clínica de atención debe considerarse para mejorar los resultados.

Weekly radiotherapy in elderly breast cancer patients: a comparison between two hypofractionation schedules.

PURPOSE: Weekly irradiation in breast cancer in elderly patients is a treatment option, whose tolerance may be influenced by the fractionation used. The objective of this study is to compare the tolerance and long-term side effects of two different fractionations. MATERIALS AND METHODS: 47 elderly patients were recruited after conservative or radical treatment that also received irradiation with a dose per fraction of 6.25 Gy or 5 Gy for one session per week, 6 sessions in total. The long-term tolerance results are compared by assessing toxicity using CTCAE version 5.0 scales for dermatitis, telangectasia, fibrosis and pain of the irradiated breast. In addition, objective parameters of skin status (erythema, hyperpigmentation, elasticity and hydration) by a multi-probe MultiSkin Test-Center system were obtained and compared between groups. RESULTS: After an average follow-up of 5 years, all patients were free of disease and with complete local control. A total of 20 patients with 6.25 Gy fractionation and 27 patients with 5 Gy fractionation have been included. Patients treated with lower fractionation had a lower incidence of dermatitis, telangectasia, fibrosis, or local pain. The decrease in elasticity measured by the multi-probe system was smaller with the fractionation of 5 Gy. No differences were observed in the other objective parameters. CONCLUSION: Weekly irradiation with 5 Gy fractionation is better tolerated than with higher fractionation.

Genomic profiling in oncology clinical practice.

The development of high-throughput technologies such as next-generation sequencing for DNA sequencing together with the decrease in their cost has led to the progressive introduction of genomic profiling in our daily practice in oncology. Nowadays, genomic profiling is part of genetic counseling, cancer diagnosis, molecular characterization, and as a biomarker of prognosis and response to treatment. Furthermore, germline or somatic genomic characterization of the tumor may provide new treatment opportunities for patients with cancer. In this review, we will summarize the clinical applications and limitations of genomic profiling in oncology clinical practice, focusing on next-generation sequencing.

ΔNp73 status in peritoneal and ovarian dissemination of appendicular adenocarcinoids (goblet cells).

INTRODUCTION: Goblet cell carcinoma (GCC) is an appendicular neoplasia representing less than 5% of all appendicular tumors, found in 0.3-0.9% of the appendectomies, 35-58% of all appendicular neoplasms, and less than 14% of malign appendix tumors. The most frequent clinical presentation is abdominal pain associated with a picture of acute appendicitis. MATERIALS AND METHODS: We present 3 clinical cases of appendix GCC, 2 subjected to cytoreductory surgery plus intraperitoneal hyperthermic chemotherapy and a third, who is currently receiving neoadjuvant treatment with a good response to chemotherapy and who will be offered the same treatment as the first two patients. Given the unpredictable behavior of these tumors, the use of molecular markers could help us to predict their behavior and prognosis. In this context, the TP73 gene would make an interesting putative marker. ∆Np73 has been described as overexpressed in a great variety of tumor types including colon cancer and this up-regulation is associated with a poor prognosis. To evidence its role in this malignancy, we evaluate here the status of ∆Np73 in the primary tumor and normal counterpart tissues, in the metastatic implants and in healthy areas of the peritoneum from the appendicular GCC patients. In addition, we checked the expression levels of this p73 variant in the tumor and normal tissue of 26 patients with colon cancer. RESULTS: Remarkably, 2 patients showed significant ∆Np73 down-regulation in both the primary tumor and the implants. Case 1 presented a fourfold decrease of levels in the primary tumor and 20-fold decrease in the implants. Case 2 showed a seven- and fourfold down-regulation in the primary tumor and implants, respectively. However, Case 3 showed an up-regulation of 53- and threefold in the primary tumor and implants, respectively. CONCLUSION: Goblet cell carcinoma of the appendix is very rate. It tends to seed throughout the peritoneum, making aggressive surgical cytoreduction and chemotherapy viable treatment options. Investigation into the molecular basis of these tumors may improve the diagnosis, prognosis and therapeutic decisions regarding these patients. ∆Np73 seems a good candidate for further analysis in longer series.

Nutritional evaluation and productivity of supplemented sheep grazing in semiarid rangeland of northeastern Brazil.

Sheep production systems in Brazilian caatinga rangelands require supplementation adapted to changes in floristic and chemical composition as dry seasons progress. Meeting sheep nutritional needs in extensive semiarid systems is challenging because of sheep dietary preferences and habits. The objective of this trial was to evaluate the substitutive effect of concentrate supplementation on grazing sheep in the Brazilian caatinga rangeland and its consequences on performance in different seasons. The trial was conducted from March to August 2013 at Embrapa Goat and Sheep in Sobral, Ceará State, Brazil. Thirty-two Brazilian Somali multiparous ewes were submitted to estrus synchronization and controlled breeding. At the start of the trial, ewes averaged 30.45 + 2.60 kg body weight (BW). Ewes were divided into four groups and individually offered 0, 200, 350, or 500 g supplement head-1 day-1. Intake prediction and digestibility trials were evaluated at three periods: rainy season (April), transition rainy-dry (June), and dry season (August). Sheep weights were taken every 14 days to measure their performance from late gestation until weaning. Ewe BW and body condition score changes were determined too. Lamb BW changes were also measured every 14 days from birth through weaning. A completely randomized design with split plot arrangement using eight replications was used for intake and digestibility measurements. The differences between supplement offered (0, 200, 350, and 500 g sheep-1) and season (rainy, transition rainy-dry, and dry) were submitted to analyses of variance and multiple means were separated, where differences were detected, using the Tukey's test. During lactation up through weaning, ewes supplemented at 500 g day-1 had greater BW than ewes without supplement. Ewes supplemented with 200 g concentrate head-1 day-1 had 9.1% greater (P ≤ 0.05) BW at weaning and their lambs had 19.7% greater birth and 16.6% heavier wean BW despite lower dry matter intake compared to unsupplemented animals. Supplementation with 200 g concentrate increased carrying capacity by 28.8% during the dry season and by 20.5% during the rainy season. This study confirmed that in the dry season, when quality of rangeland forages decreases, supplementation contributes to greater DMI, improves postpartum and lactation BW recovery of ewes, and contributes to greater lamb birth and wean weights. Moreover, supplementation leads to feed substitution effects that may increase rangeland resilience by mitigating overgrazing. Supplementation with 200 g concentrate can also prevent negative energy balance for grazing animals, improving longer postnatal recovery, longer intervals between parturitions, fewer double and is necessary to ensure a better BW at birth to lambs.

Genetic Polymorphisms in Cytokine Genes in Colombian Patients with Ocular Toxoplasmosis.

Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii, which has the capacity to infect all warm-blooded animals worldwide. Toxoplasmosis is a major cause of visual defects in the Colombian population; however, the association between genetic polymorphisms in cytokine genes and susceptibility to ocular toxoplasmosis has not been studied in this population. This work evaluates the associations between polymorphisms in genes coding for the cytokines tumor necrosis factor alpha (TNF-α) (rs1799964, rs1800629, rs1799724, rs1800630, and rs361525), interleukin 1ß (IL-1ß) (rs16944, rs1143634, and rs1143627), IL-1α (rs1800587), gamma interferon (IFN-γ) (rs2430561), and IL-10 (rs1800896 and rs1800871) and the presence of ocular toxoplasmosis (OT) in a sample of a Colombian population (61 patients with OT and 116 healthy controls). Genotyping was performed with the "dideoxynucleotide (ddNTP) primer extension" technique. Functional-effect predictions of single nucleotide polymorphisms (SNPs) were done by using FuncPred. A polymorphism in the IL-10 gene promoter (-1082G/A) was significantly more prevalent in OT patients than in controls (P = 1.93e-08; odds ratio [OR] = 5.27e+03; 95% confidence interval [CI] = 3.18 to 8.739; Bonferroni correction [BONF] = 3.48e-07). In contrast, haplotype "AG" of the IL-10 gene promoter polymorphisms (rs1800896 and rs1800871) was present at a lower frequency in OT patients (P = 7e-04; OR = 0.10; 95% CI = 0.03 to 0.35). The +874A/T polymorphism of IFN-γ was associated with OT (P = 3.37e-05; OR = 4.2; 95% CI = 2.478 to 7.12; BONF = 6.07e-04). Haplotype "GAG" of the IL-1ß gene promoter polymorphisms (rs1143634, rs1143627, and rs16944) appeared to be significantly associated with OT (P = 0.0494). The IL-10, IFN-γ, and IL-1ß polymorphisms influence the development of OT in the Colombian population.

Effects of 6% Tetrastarch and Lactated Ringer's Solution on Extravascular Lung Water and Markers of Acute Renal Injury in Hemorrhaged, Isoflurane-Anesthetized Healthy Dogs.

BACKGROUND: Tetrastarch can cause acute kidney injury (AKI) in humans with sepsis, but less likely to result in tissue edema than lactated Ringer's solution (LRS). OBJECTIVES: Compare effects of volume replacement (VR) with LRS and 6% tetrastarch solution (TS) on extravascular lung water (EVLW) and markers of AKI in hemorrhaged dogs. ANIMALS: Six healthy English Pointer dogs (19.7-35.3 kg). METHODS: Prospective crossover study. Animals underwent anesthesia without hemorrhage (Control). Two weeks later, dogs hemorrhaged under anesthesia on 2 occasions (8-week washout intervals) and randomly received VR with LRS or TS at 3 : 1 or 1 : 1 of shed blood, respectively. Anesthesia was maintained until 4 hour after VR for EVLW measurements derived from transpulmonary thermodilution cardiac output. Neutrophil gelatinase-associated lipocalin (NGAL) and creatinine concentrations in plasma and urine were measured until 72 hour after VR. RESULTS: The EVLW index (mL/kg) was lower at 1 hour after TS (10.0 ± 1.9) in comparison with controls (11.9 ± 3.4, P = 0.04), and at 4 hour after TS (9.7 ± 1.9) in comparison with LRS (11.8 ± 2.7, P = 0.03). Arterial oxygen partial pressure-to-inspired oxygen fraction ratio did not differ among treatments from 0.5 to 4 hour after VR. Urine NGAL/creatinine ratio did not differ among treatments and remained below threshold for AKI (120,000 pg/mg). CONCLUSIONS AND CLINICAL IMPORTANCE: Although TS causes less EVLW accumulation than LRS, neither fluid produced evidence of lung edema (impaired oxygenation). Both fluids appear not to cause AKI when used for VR after hemorrhage in healthy nonseptic dogs.

Clinical implications of the deregulated TP73 isoforms expression in cancer.

TP73 is a member of the TP53 family whose expression has been observed altered in most human cancers and associated with the prognosis. TP73 translates into a complex number of isoforms with both oncogenic and tumour-suppressor functions and presents a complex cross-talk with other members of the family (TP53 and TP63). In this revision, we focus on the evidence that may support TP73 variants as prognostic markers in cancer. Nowadays, most publications in this topic highlight the association between overexpression of the oncogenic variants and failure to respond to chemotherapy and/or shorter survival. In addition, we comment on the putative possibilities that the detection through a liquid biopsy of TP73 variants may provide, and finally, the significance of determining the value of the combined alteration of the TP53 family members in the clinical setting.

Inocuidade micotoxicológica e viabilidade de Aspergillus spp com potencial probiótico provenientes do trato digestório bovino / Mycotoxicological safety and viability of Aspergillus spp with probiotic potential from the bovine digestive tract]

Objetivou-se, com a presente pesquisa, avaliar a viabilidade de Aspergillus spp. com potencial probiótico durante o armazenamento e diante da pressão da microbiota autóctone, bem como a tolerância aos principais ácidos graxos da fermentação ruminal. Verificou-se também a inocuidade micotoxicológica desses isolados fúngicos cultivados em meio de cultivo sólido. Foram avaliados 20 isolados de Aspergillus spp., provenientes do trato gastrointestinal de bovinos criados em Urochloa decumbens lignificada. Esses fungos foram identificados por análise de sequências do DNAr e foram selecionados por apresentarem expressivo potencial celulolítico. O método vapor de amônia foi utilizado para detecção de cepas produtoras de micotoxinas. Os isolados foram avaliados quanto à viabilidade de crescimento em fluido ruminal por até 96 horas e estocagem em condições ambientais. Observou-se que os fungos avaliados não produziram aflatoxinas e que 95% dos isolados apresentaram resistência aos ácidos ruminais. Dois isolados, selecionados a partir das análises anteriores, apresentaram viabilidade sob a pressão da microbiota autóctone e de metabólitos do ecossistema ruminal e permanecem viáveis por, no mínimo, dois anos. Conclui-se que os isolados do gênero Aspergillus selecionados nesta pesquisa apresentam características fisiológicas para serem utilizados com aditivos microbianos ou probióticos para o ambiente ruminal.(AU)

The aims in this study were to evaluate the viability of Aspergillus spp. with probiotic potential during storage, pressure of autochthonous microbiota and tolerance to the main fatty acids of ruminal fermentation. The mycotoxicological safety was also verified. Twenty isolates from the gastrointestinal tract of cattle raised in lignified Urochloa decumbens were identified by rDNA sequence analysis and were previously selected because they showed significant cellulolytic potential. The ammonia vapor method was used to detect the production of mycotoxins. The isolates were evaluated for viability of ruminal fluid growth for up to 96 hours and storage under environmental conditions. The evaluated fungi did not produce aflatoxins, and 95% of them had resistance to ruminal acids. Two isolates, selected according these tests, presented viability on autochthonous microbiota pressure and metabolites from the ruminal ecosystem and remain viable for at least two years. In this research, the selected Aspergillus spp. isolates present physiological characteristics to be used with microbial additives or probiotic.(AU)

Inocuidade micotoxicológica e viabilidade de Aspergillus spp com potencial probiótico provenientes do trato digestório bovino / Mycotoxicological safety and viability of Aspergillus spp with probiotic potential from the bovine digestive tract]

Objetivou-se, com a presente pesquisa, avaliar a viabilidade de Aspergillus spp. com potencial probiótico durante o armazenamento e diante da pressão da microbiota autóctone, bem como a tolerância aos principais ácidos graxos da fermentação ruminal. Verificou-se também a inocuidade micotoxicológica desses isolados fúngicos cultivados em meio de cultivo sólido. Foram avaliados 20 isolados de Aspergillus spp., provenientes do trato gastrointestinal de bovinos criados em Urochloa decumbens lignificada. Esses fungos foram identificados por análise de sequências do DNAr e foram selecionados por apresentarem expressivo potencial celulolítico. O método vapor de amônia foi utilizado para detecção de cepas produtoras de micotoxinas. Os isolados foram avaliados quanto à viabilidade de crescimento em fluido ruminal por até 96 horas e estocagem em condições ambientais. Observou-se que os fungos avaliados não produziram aflatoxinas e que 95% dos isolados apresentaram resistência aos ácidos ruminais. Dois isolados, selecionados a partir das análises anteriores, apresentaram viabilidade sob a pressão da microbiota autóctone e de metabólitos do ecossistema ruminal e permanecem viáveis por, no mínimo, dois anos. Conclui-se que os isolados do gênero Aspergillus selecionados nesta pesquisa apresentam características fisiológicas para serem utilizados com aditivos microbianos ou probióticos para o ambiente ruminal.(AU)

The aims in this study were to evaluate the viability of Aspergillus spp. with probiotic potential during storage, pressure of autochthonous microbiota and tolerance to the main fatty acids of ruminal fermentation. The mycotoxicological safety was also verified. Twenty isolates from the gastrointestinal tract of cattle raised in lignified Urochloa decumbens were identified by rDNA sequence analysis and were previously selected because they showed significant cellulolytic potential. The ammonia vapor method was used to detect the production of mycotoxins. The isolates were evaluated for viability of ruminal fluid growth for up to 96 hours and storage under environmental conditions. The evaluated fungi did not produce aflatoxins, and 95% of them had resistance to ruminal acids. Two isolates, selected according these tests, presented viability on autochthonous microbiota pressure and metabolites from the ruminal ecosystem and remain viable for at least two years. In this research, the selected Aspergillus spp. isolates present physiological characteristics to be used with microbial additives or probiotic.(AU)

Frecuencia y factores asociados a la histerectomía obstétrica en un hospital de segundo nivel en México / Frequency and factors associated with obstetric hysterectomy in a second level hospital in México

INTRODUCCION La histerectomía obstétrica es procedimiento de urgencia para resolver una situación grave, su incidencia es de 5 a 15 por cada 1000 eventos obstétricos OBJETIVO GENERAL Determinar la frecuencia y factores asociados a la histerectomía obstétrica en un hospital de segundo nivel en México. METODOLOGIA Estudio descriptivo, transversal y retrospectivo en el periodo de Enero de 2014 a Diciembre del 2016, se incluyeron todos los casos de histerectomía posterior a un evento obstétrico, se estudiaron: edad, paridad, vía de interrupción del embarazo, antecedente de cesárea previa, indicaciones y complicaciones de la histerectomía, ingreso al servicio de terapia intensiva y mortalidad, el análisis se realizó con estadística descriptiva. RESULTADOS Durante el periodo de estudio, se atendieron 37 308 eventos obstétricos, efectuándose histerectomía obstétrica a 153 pacientes que representan el 0.57%, es decir, una HO por cada 243 embarazos. La edad promedio de quienes se les efectuó la histerectomía fue de 34 años de edad, siendo más frecuente en el grupo de mayores de 35 años, que habían tenido dos o tres embarazos previos. El antecedente de cesárea previa fue del 69.2%. La vía de interrupción del embarazo actual fue de cesárea en el 72.1%. La principal indicación fue la atonía uterina en 51 casos (33.3%). La complicación más frecuente fue la anemia aguda en el 83%. Hubo 1 muerte materna (0.6%). CONCLUSIONES La Histerectomía obstétrica es una cirugía de urgencia, por lo que se deben de identificar durante el control prenatal los factores asociados a las principales indicaciones de esta complicación.

INTRODUCTION Obstetric Hysterectomy (OH) is an emergency procedure to solve a life threatening condition, and its incidence is 5 to 15 per 1000 obstetric events. GENERAL OBJETIVE To determine the frequency and factors related with obstetric hysterectomy at a secondary hospital in Mexico. METHODOLOGY Descriptive, cross-sectional and retrospective study from January 2014 to December 2016 including all hysterectomy cases due to an obstetric event. Factors such as Age, number of deliveries, abortions, and previous cesarean sections, admission to the Intensive care unit, surgical indications, complications and mortality because of hysterectomy were analyzed thru descriptive statistics. RESULTS 37 308 obstetric events were registered and 153 were treated with Obstetric Hysterectomy representing 0.57% of the total, meaning one OH per every 243 pregnancies. The average age of those who had a hysterectomy was 28.5 years, and the procedure had its peak at the group of age older than 35 years who had had two or more pregnancies. The history of previous cesarean section was 39.2%. In 72.1% the pregnancy was terminated with a cesarean section. The main indication for hysterectomy was Uterine Atony in 33.3% (51 cases). The most frequent complication was acute anemia in 83%. There was a maternal death (0.6%). CONCLUSIONS Obstetric Hysterectomy is an emergency surgery, there are related factors that must be identified during the prenatal control to avoid this complication.

Lipid bodies accumulation in Leishmania infantum-infected C57BL/6 macrophages.

Lipid bodies (LBs) are intracellular accumulations of neutral lipids surrounded by a single membrane. These organelles are involved in the production of eicosanoids, which modulate immunity by either promoting or dampening inflammatory responses. Leishmania infantum, the etiological agent of visceral leishmaniasis in Brazil, is an intracellular parasite that causes disease by suppressing macrophage microbicidal responses. C57BL/6 mouse bone marrow-derived macrophages infected with L. infantum strain LcJ had higher numbers of LB+ cells (P<.0001) and total LBs than noninfected cultures. Large (>3 µm) LBs were present inside parasitophorous vacuoles (PVs). These results contrast with those of L. infantum-infected BALB/c macrophages, in which the only LBs are derived from parasite, not macrophage origin. Increased LBs in C57BL/6 macrophages in close association with parasites would position host LBs where they could modulate L. infantum infection. These results imply a potential influence of the host genetics on the role of LBs in host-pathogen interactions. Overall, our data support a model in which the expression, and the role of LBs upon infection, ultimately depends on the specific combination of host-pathogen interactions.

Influence of incidental radiation dose in the subventricular zone on survival in patients with glioblastoma multiforme treated with surgery, radiotherapy, and temozolomide.

PURPOSE: To determine if there is an association between the incidental radiation dose to the subventricular zone and survival in patients with glioblastoma multiforme treated with surgery, radiotherapy and temozolomide. METHODS AND MATERIALS: Sixty-five patients, treated between 2006 and 2015, were included in this retrospective study. The doses (75th percentile; p75) administered to the ipsilateral, contralateral and bilateral subventricular zone were compared to overall survival and progression-free survival using Cox proportional hazards models. Covariates included: age, sex, surgery, tumor location, and concomitant and adjuvant temozolomide. RESULTS: Median progression-free survival and overall survival were 11.5 ± 9.96 and 18.8 ± 18.5 months, respectively. The p75 doses to the ipsilateral, contralateral and bilateral subventrivular zone were, respectively, 57.30, 48.8, and 52.7 Gy. Patients who received a dose ≥48.8 Gy in the contralateral subventricular zone had better progression-free survival than those who received lower doses (HR 0.46; 95% CI 0.23-0.91 P = 0.028). This association was not found for overall survival (HR 0.60; 95% CI 0.30-1.22 P = 0.16). Administration of adjuvant temozolomide was significantly associated with improved progression-free survival (HR 0.19; 95% CI 0.09-0.41 P < 0.0001) and overall survival (HR 0.11; 95% CI 0.05-0.24 P = 0.001). In the subgroup of 46 patients whose O6-methylguanine-DNA methyltransferase gene promoter status was known, the methylation had no effect on either progression-free survival (P = 0.491) or overall survival (P = 0.203). CONCLUSION: High-dose radiation in the contralateral subventricular zone was associated with a significant improvement in progression-free survival but not overall survival in patients treated for glioblastoma multiforme.