Perceptions of aging and ageism among Mexican physicians-in-training.

INTRODUCTION: Attributing negative stereotypes to older adults (ageism) may lead to undertreatment, but little is known about the prevalence of ageism among physicians treating patients with cancer in Ibero-America. We studied stereotypes of aging among Mexican physicians-in-training. MATERIALS AND METHODS: Physicians-in-training attending an oncology meeting answered the "Negative Attributes and Positive Potential in Old Age" survey. Ten questions assessed positive characteristics of aging (PPOA; score 1-4, higher scores represent a positive perception), and four assessed negative characteristics (NAOA; score 1-4, higher score representing a negative perception). Descriptive statistics were used to analyze the questionnaires. Participants completed the "Image-of-Aging" question by writing five words describing older adults and young individuals. Each word was rated from - 5 (negative) to + 5 (positive), and presented as word clouds. RESULTS: One hundred physicians-in-training (median age 28.5) were included. For the PPOA scale, the mean score was 2.9 (SD 0.4), while for the NAOA scale it was 2.1 (SD 0.4). Perceptions of aging were better among women and trainees enrolled in geriatrics and/or oncology-related programs. In the "Image-of-Aging" questions, median rating of words describing older adults was - 2, compared to + 3 for young individuals (p < 0.001). Among words used to describe older adults, the most frequent was "frail/frailty" (n = 45), while "health" (n = 46) was the most frequent for younger individuals. CONCLUSIONS: Mexican physicians-in-training showed mostly negative perceptions of aging, exemplified by the use of negative terms to describe older adults. Creating educational initiatives aimed at decreasing ageism among oncology trainees is necessary across Ibero-America.

AGEP sistémico, un diagnóstico oculto en una falsa psoriasis paradójica por anti-TNF / Systemic AGEP, a hidden diagnosis in a false psoriasis paradoxical by anti-TNF

La pustulosis exantemática generalizada aguda (AGEP, en inglés) es una enfermedad poco frecuente, causada por drogas, caracterizada por aparición aguda de numerosas pústulas estériles en una base eritematosa, asociada en ocasiones a fiebre y leucocitosis, en algunos casos puede causar un compromiso de piel severo pero que resuelve rápidamente con la suspensión del fármaco sin tratamiento especial requerido. Puede confundirse con otras entidades como la psoriasis pustular e inusualmente produce compromiso sistémico. Presentamos un caso de AGEP secundario a terapia anti-TNF con compromiso sistémico.

The acute generalized exanthematous pustulosis (AGEP, in english)is a rare disease caused by drugs, characterized by acute onsetof numerous sterile pustules on an erythematous base, sometimesassociated with fever and leukocytosis, in some cases may causea severe skin involvement reaction but solved quickly with the drugsuspension without special treatment required. It can be confusedwith other entities such as pustular psoriasis and unusually producesystemic involvement. We present a case of secondary to anti-TNFtherapy AGEP systemic involvement.

Deficiencia congénita del factor V / Congenital deficiency of factor V

El factor V de la coagulación es encontrado en el plasma y en las plaquetas y tiene un profundo impacto sobre la generación de la trombina. La deficiencia de este factor puede ser congénita o adquirida y se caracteriza por un amplio espectro de signos, que van desde sangrado mucocutáneo hasta compromiso del sistema nervioso central. A continuación se presenta el caso de una paciente de 33 años de edad con hemorragia uterina anormal de varios años de evolución, sin evidenciar mejoría en el manejo instaurado en consultas previas, realizándose paraclínicos que concluyen deficiencia congénita del factor V.

Blood coagulation factor V (FV) plays a pivotal role in blood coagulation. It is found in both plasma and in platelets and has a profound impact on thrombin generation. Deficiency of this clotting factor due to inherited or acquired conditions results in a broad spectrum of bleeding symptoms. ranging from mucocutaneous bleeding to central nervous system bleeding. We present a case of a 33-year-old woman with abnormal uterine bleeding for several years, not improvement with the management in previous consultations, concluding after several tests a congenital Leiden V factor deficiency.

Durable complete response induced by paclitaxel-nimotuzumab-methotrexate chemotherapy in a patient with metastatic head and neck squamous cell carcinoma.

A 61-year-old male patient with metastatic poorly differentiated squamous cell carcinoma of the larynx to lymph nodes and lung was treated with a third-line chemotherapy regimen of paclitaxel, nimotuzumab and low-dose methotrexate, receiving a total of 30 cycles. The response was complete and maintained at 16 months. Nimotuzumab is a humanized monoclonal antibody used to treat squamous cell carcinomas of the head and neck. This third-line chemotherapy combination with paclitaxel-nimotuzumab-methotrexate seems to be an active combination and needs further evaluation in clinical trials to validate its use in heavily treated patients.

Comparison of organochlorine pesticide levels in human adipose tissue of inhabitants from Veracruz and Puebla, Mexico.

Since the discovery of insecticide properties of DDT (1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane) and HCH (hexachlorocyclohexane), they have provided great benefits to humans in sanitary actions to combat the spread of infection-borne disease vectors. Public Health Programs in Mexico used DDT and HCH until 1999 as the insecticides of choice to control disease-transmitting organisms. Because of their persistence and accumulative properties, organochlorine pesticides bioconcentrate in lipids of the human body, reflecting the rate of environmental exposure. Eighty human abdominal adipose tissue samples from Veracruz and 80 samples from Puebla were analyzed and the obtained results were compared among both populations. The results from Veracruz showed higher contamination levels (mg/kg on lipid base) compared to Puebla: beta-HCH, 0.072 vs. 0.029; pp'DDE (Dichlorodiphenyldichloroethylene), 2.364 vs. 0.726; op'DDT, 0.022 vs. 0.025; pp'DDT, 0.192 vs. 0.061; and Sigma-DDT, 2.589 vs. 0.806. The population from Veracruz and from Puebla divided by sex, origin, and cause of death presented no statistical differences. The comparison between sexes (women and men groups) at Veracruz and Puebla indicated significantly higher levels in Veracruz and statistical significant differences. Calculating possible risks (odds ratios, OR), pp'DDE (OR = 5.04) and op'DDT (OR = 2.93) revealed significantly higher risk for the Veracruz population. The study indicated prolonged DDT exposure of Mexicans caused by the past sanitary use and persistence of its residues in soils and air.

[Erythropoietin and transfusions in patients with anemia of chronic renal failure origin : an update view]. / Eritropoietina y transfusiones en la anemia del insuficiente renal crónico: visión actualizada.

Aiming to know the factors that influenced the use of erythropoietin (EPO) in chronic hemodialysis patients, we retrospectively studied 82 patients (41 male), of whom 15 received EPO. No differences, between patients receiving or not receiving EPO, were found in age (46.9 +/- 25 and 57 +/- 13 years respectively), male/female ratio (9/6 and 32/35 respectively), time on dialysis (36.4 +/- 25.6 and 36.8 +/- 31.8 months respectively), dialysis hours (3.19 +/- 0.6 and 3.33 +/- 0.39 h respectively) and proportion of diabetics (6.6 and 20.8% respectively). Prior to EPO use and compared to untreated patients, treated patients were transfused with a higher frequency (60 vs 22%) and with more units/patients/years (0.12 vs 0.08). Hemoglobin levels at the start of the treatment was similar in treated and untreated patients (8.4 +/- 1.46 vs 8.78 +/- 1.97 g/dl). EPO was indicated in 11 patients due to general symptomatology associated to anemia and in 4 due to cardiac failure or angina. We conclude that EPO treatment is indicated in approximately 18% of patients in dialysis. An adequate dialytic treatment may achieve optimal hemoglobin levels with minimal transfusion requirements and without need of EPO, thus reducing costs.

Insuficiencia renal y respiratoria en una embarazada con esclerosis sistémica progresiva: caso anatomo-clínico / Renal and respiratory failure in a pregnant woman with progressive systemic sclerosis: anatomical clinical case

Pregnancy in patients with systemic sclerosis may predispose to a fast progression of the disease. We report a woman with systemic sclerosis and a multiple visceral involvement that during the third trimester of pregnancy developed a respiratory failure caused by interstitial fibrosis complicated with alveolar hemorrhage, bronchopneumonia and respiratory distress syndrome and a renal failure. On admission, she was subjected to a cesarean section, delivering a 1205 g newborn. In spite of intensive care support, the multisystemic failure became unmanageable and the patient died 15 days after admission. Literature review, although sometimes controversial, indicates that pregnancy is a situation with definitive death risk for patients with systemic sclerosis, that requires a close follow up

[A comparative study of insulin and glyburide versus glyburide or insulin in the chronic control of patients with type-2 diabetes]. / Estudio comparativo de insulina y gliburida contra gliburida o insulina, en el control crónico de pacientes con diabetes tipo II.

In order to know the usefulness of a combined treatment with gliburide and NPH insulin 25 patients with well controlled type II diabetes mellitus were studied. The patients were randomly divided in to three groups: Group I just received gliburide, Group II only insulin and Group III gliburide and insulin. Glucose in fast, glycosylated haemoglobin and C peptide levels were determined over five months. For the statistical data processing variance analysis was performed. The initial and final glucose determinations were: Group I, 169.3 mg% and 139.0 mg% respectively (p > 0.05); Group II, 202.1 mg% and 177 mg% (p > 0.05); Group III, 157.8 mg% and 158.8 mg% (p > 0.1) for the glycosylated haemoglobin the determinations were: Group I, 7.2% and 5.1% (p > 0.05); Group II, 6.2% and 5.1% (p > 0.05) and Group III, 5.7% and 4.7% (p > 0.05). For the C peptide were 2.5 and 4.5 for Group I (p > 0.05), 2 and 4.1 for Group II (p > 0.05) and 3.2 and 5.3 for Group III (p > 0.05) with no significant statistical differences. It is concluded that the combined treatment showed to be effective, but not superior, in order to control diabetic patients and it can be a useful therapeutic alternative in well selected patients.

Tracheal reconstruction.

Between 1983 and 1990 the authors treated 193 patients with laryngo-tracheal stenoses of diverse etiology. In 119 cases the stenoses was in the trachea. In 36 the stenoses extended to the subglottic region and in 1 case the carina was involved. The surgical procedure used in the tracheal stenosis was resection of the stenotic segment followed by end to end anastomosis. In most cases up to 6 cm of trachea could be resected. Two patients required a silastic prosthesis because the length of the stenotic area, 9 and 11 cm. The patient with the carinal involvement was treated by the insertion of a long Montgomery T tube. When the lesion included the subglottic area a partial resection of the cricoid cartilage and the damaged trachea was used. Associated surgical procedures had to be performed in order to close tracheo-esophageal fistulas, 2 cases, fixation of one of the vocal cords, 9 cases. Tracheal stenoses were cured in 90% of the cases with one surgical procedure, when the stenoses extended to the subglottic region, the cure rate was only 88.6%.

Enfermedad de Hodgkin en el niño: tratamiento combinado COPP modificado y radioterapia en estadios avanzados / Hodgkin's disease in children: modified COPP combined treatment and radiotherapy in advanced stages

Veintidós pacientes de la X Región menores de 15 años,con enfermedad de Hodgkin en estadios avanzados (8 III-A, 6 III-B y 8 IV-B), fueron tratados en el hospital de Valdivia en el decenio 1976-1985 con quimioterapia (esquema COPP modificado) y radioterapia. La sobrevida fue de 77,3% y la remisión completa mantida de 64,5% con un período de observación entre 3 y 13 años (mediana de observación 70 meses).Cinco pacientes fallecieron dentro de los dos primeros años y uno sofrió recidiva en el décimo año del seguimiento, pero volvió a presentar remisión completa. El tipo histológico depleción linfocitaria (5 casos) tuvo una sobrevida de 20,0%, mientras que la celularidad mixta (14 casos) tuvo una sobrevida de 92,9% (p = menor de 0,01). No se observaron en este grupo casos de segunda neoplasias atribuibles a la quimioterapia y radioterapia