Prevention of chemotherapy-induced nausea and vomiting in the real-world setting in Spain.

PURPOSE: Proper monitoring and management of chemotherapy-induced nausea and vomiting (CINV) with antiemetics is crucial for cancer patients. This study aimed to evaluate the use of antiemetics for the treatment of highly emetogenic chemotherapy (HEC) including carboplatin in the real-world setting in Spain. METHODS: A representative panel of cancer specialists was asked to collect information about the antiemetic treatments provided to patients receiving chemotherapy. Records formed part of the Global Oncology Monitor© database (Ipsos Healthcare, London, UK). Chemotherapy data were extrapolated using Ipsos Healthcare's projection methodology. RESULTS: A total of 73 experts were finally included. Data from 9519 patients, estimated to be representative of 202,084 patients, were collected. HEC (and carboplatin-based chemotherapy) was administered to 73,118 (36%) patients, cisplatin-based therapy being the most frequent treatment (n = 34,649, 47.38%). Neurokinin-1 receptor antagonists (NK1RAs) alone or in combination were used as prophylaxis for CINV in 14,762 (20%) patients, while the combination of NK1RA with 5-hydroxytryptamine-3 receptor antagonist (5-HT3RAs) and dexamethasone as recommended by the international guidelines was used in 5849 (8%) patients only. No antiemetic prophylaxis was administered to 8.46% of the patients receiving HEC (n = 6189). Physicians classified cisplatin-, anthracycline-cyclophosphamide (AC-), and carboplatin-based regimens as HEC in 63%, 22% and 4% of the cases, respectively. CONCLUSIONS: The use of NK1RA-containing regimens for CINV prevention in patients treated with HEC was less than expected, suggesting poor adherence to international antiemetic guidelines.

SEOM clinical guidelines for anaemia treatment in cancer patients (2020).

Anaemia is defined by the presence of haemoglobin (Hb) levels < 13 g/dL in men and 12 g/dL in women. Up to 39% of cancer patients present it at the time of diagnosis and up to 40% have iron deficiency. Anaemia causes fatigue, functional deterioration and a reduction in the quality of life; it has also been associated with a poorer response to anti-tumour treatment and lower survival. Basic diagnostic tests for anaemia are simple and should be a routine part of clinical practice. These guidelines review the available evidence on the use of different therapies for treating anaemia: erythropoiesis-stimulating agents, iron supplements, and transfusion of blood products.

Breakthrough cancer pain: review and calls to action to improve its management.

In this paper, we review the current state of breakthrough cancer pain (BTcP) management. BTcP is a heterogeneous condition and a global problem for cancer patients. It is often managed suboptimally, which results in a negative outcome for patients, healthcare providers, and healthcare systems. Several barriers to the appropriate management of BTcP have been identified. These include, among others, an incomplete definition of BTcP, poor training of healthcare providers and patients alike, a lack of a multidisciplinary approach and the absence of specific protocols and tools. We provide some actions to help physicians and patients improve their approach to BTcP, including specific training, the design of easy-to-use tools for BTcP identification and assessment (such as checklists and pocket-sized cards), individualized treatment, and the use of multidisciplinary teams.

Serological and molecular study of Hepatitis E virus in pediatric patients in Mexico.

INTRODUCTION AND OBJECTIVES: Cases of viral hepatitis reported in Mexico are typically identified as hepatitis A, B and C. However, unspecified cases are reported annually. Hepatitis E virus (HEV) is an emergent agent that causes a self-limiting infection that can evolve to chronic in immunosuppressed individuals. In Mexico, HEV genotype 2 is considered endemic, though it's the prevalence is not well known. Therefore, the present study was designed to determine the prevalence of HEV among patients at the "Hospital Infantil de Mexico Federico Gomez". MATERIALS AND METHODS: The study included 99 patients, anti-HEV antibody (IgG and IgM) were detected by indirect ELISA and viral genome was identified using RT-PCR technique. Two PCR products of positive cases were sequenced. RESULTS: ELISA results were positive in 3% and 6%, for IgG and IgM respectively, 54.5% prevalence was found by PCR. Low lymphocyte count (p<0.05) and malnutrition (p<0.005) were significant factors for high PCR prevalence and could increase the possibility of infection. Two samples were sequenced and confirmed the presence of HEV genotype 3. CONCLUSIONS: This report reveals the incidence of HEV in pediatric patients in Mexico. Moreover, the identification of HEV genotype 3 in human samples suggests a potential zoonotic risk that requires further research.

Study of macro and microelements in fish from the Cienfuegos Bay. Relationship with its content in sediments.

Thirteen microelements (Al, As, Cd, Co, Cr, Cu, Fe, Li, Mn, Ni, Ti, V, and Zn) and four macroelements (Ca, K, Mg, and Na) were determined in the edible muscle tissue of fish in Cienfuegos Bay. Eight species, Albula vulpes, Diapterus rhombeus, Gerres cinereus, Haemulon carbonarium, Haemulon sciurus, Micropogonias furnieri, Kyphosus sectatrix, and Lutjanus cyanopterus were studied. The total concentrations and extracted concentrations using HCl were also determined in sediments. The quality of the analysis was guaranteed by validating the used analytical methods with certified reference materials of fish and sediments. The high content of macroelements confirmed the importance of fish as a valuable source of food for the local population. New information is provided on bioaccumulation of toxic elements As, Cd, Cu, Zn, and Cr in fish of the bay, with concentrations that overcame the local or international maximum allowable levels for human consumption in most samples analyzed. A high correlation between the content of toxic elements As, Cd, Zn, and macroelement K in fish and its concentration extracted from sediments using the HCl extraction method was observed.

Accreditation and certification of hospital quality: different or similar? / Acreditación y certificación de calidad hospitalaria ¿diferentes o similares? / Acreditação e certificação da qualidade hospitalar ¿diferentes ou similares?

The external evaluation and management of hospital quality are two intimately related aspects of the same phenomenon: the need to improve the quality of health services and provide confidence of this quality to all stakeholders. The objective of this study is to analyze the hospital accreditation programs and ISO 9001 quality management and certification schemes of health institutions, as well as to identify the benefits of each of them, their similarities and differences. Hospital accreditations and ISO 9001 certifications are important instruments to improve the health service quality and to give confidence to the society about the health care provider. Both guide management strategies to improve service quality and patient safety. They differ in some aspects: accreditation is based on the best practices of the quality of the medical assistance and have a more technical character. The ISO 9001 standard is more process oriented and constitutes a suitable framework for incorporating the requirements of hospital accreditation programs and existing international methodologies for risk management in health institutions.

La evaluación externa y la gestión de la calidad hospitalaria son dos aspectos íntimamente relacionados del mismo fenómeno: la necesidad de mejorar la calidad de los servicios de salud y brindar confianza de esta calidad a todas las partes interesadas. El objetivo de este estudio es analizar los programas de acreditación hospitalaria y los sistemas de gestión y certificación de calidad ISO 9001 de las instituciones sanitarias, así como identificar los beneficios de cada uno de ellos, sus similitudes y diferencias. Las acreditaciones hospitalarias y las certificaciones ISO 9001 son instrumentos importantes para mejorar la calidad del servicio de salud y para dar confianza a la sociedad sobre el proveedor de atención médica. Ambos guían las estrategias de gestión para mejorar la calidad del servicio y la seguridad del paciente. Difieren en algunos aspectos: la acreditación se basa en las mejores prácticas de la calidad de la asistencia médica y tiene un carácter más técnico. La norma ISO 9001 está más orientada al proceso y constituye un marco adecuado para incorporar los requisitos de los programas de acreditación hospitalaria y las metodologías internacionales existentes para la gestión del riesgo en las instituciones de salud.

A avaliação externa e a gestão da qualidade hospitalar são dois aspectos intimamente relacionados do mesmo fenómeno: a necessidade de melhorar a qualidade dos serviços de saúde e brindar confiança desta qualidade a todas as partes interessadas. O objetivo deste estudo é analisar os programas de acreditação hospitalar e os sistemas de gestão e certificação de qualidade ISO 9001 das instituições sanitárias, bem como identificar os benefícios da cada um deles, seus similitudes e diferenças. As acreditações hospitalares e as certificações ISO 9001 são instrumentos importantes para melhorar a qualidade do serviço de saúde e para dar confiança à sociedade sobre o provedor de atenção médica. Ambos guiam as estratégias de gestão para melhorar a qualidade do serviço e a segurança do paciente. Diferem em alguns aspectos: a acreditação baseia-se nas melhores práticas da qualidade da assistência médica e tem um carácter mais técnico. A norma ISO 9001 está mais orientada ao processo e constitui um marco adequado para incorporar os requisitos dos programas de acreditação hospitalar e as metodologias internacionais existentes para a gestão do risco nas instituições de saúde.

Despistaje de infecciones de transmisión vertical durante el embarazo: Toxoplasmosis, VIH, Hepatitis B y C, Sífilis / Screening vertical transmission of infections during pregnancy: Toxoplasmosis, HIV, Hepatitis B and C, Syphilis

El despistaje de infecciones mediante pruebas de laboratorio permite disminuir el riesgo de morbimortalidad perinatales y maternas. El objetivo del estudio fue identificar la presencia de infecciones de transmisión vertical: toxoplasmosis, VIH, sífilis, Hepatitis B y C, durante el periodo noviembre 2013 a mayo 2014. Estudio descriptivo, muestra conformada por 175 embarazadas entre 14 a 43 años, a las cuales se les descarto Toxoplasmosis, Anticuerpos Reagínicos por VDRL cualitativa, VIH, hepatitis B (Anti-HBsAg, HBsAg, anti-Core); hepatitis C (Anticuerpos totales), a través de ultramicroELISA (UMELISA). Los resultados arrojaron Anticuerpos Anti Toxoplasma gondii positivas en 27,4%, donde el 31,2% de estas embarazadas presentaron títulos de anticuerpos de 1/512. Los Anticuerpos Anti-VIH resultaron positivos en 0,6%. El 99,4% mostraron un VDRL No Reactivo. El 38,9% tuvo un resultado positivo para anticuerpos contra el antígeno de superficie de la hepatitis B, los marcadores HBsAg y Anti-Core resultaron negativos en un 100%; el 1,7% fue positivo para anticuerpos totales contra el virus de la Hepatitis C. Se concluye que el despistaje de enfermedades infecciosas que representan factores de riesgo de transmisión vertical en embarazadas, constituye uno de los medios más oportuno para diagnosticar estas patologías y prevenir la morbimortalidad materna e infantil.

The screening for infection diseases in pregnancy by laboratory tests can reduce the risk of perinatal and maternal morbidity and mortality. The objective of this study was to identify the presence of vertically transmitted infections: toxoplasmosis, HIV, syphilis, hepatitis B and C, for the period November 2013 to May 2014. Descriptive study, the sample consisted of 175 pregnant women between 14 to 43 years, women who were discarded for Toxoplasmosis, Reaginic Antibodies by qualitative VDRL, HIV, hepatitis B (Anti-HBsAg Anti-HBsAg, anti-Core); hepatitis C (Total antibodies), through ultramicroELISA (UMELISA). The results showed 27.4% positive for Anti- Toxoplasma gondii antibodies, with 31.2% of these pregnant women having antibody titers of 1/512. Anti-HIV antibodies were positive by 0.6%. 99.4% showed Nonreactive VDRL. 38.9% were positive for antibodies against the hepatitis B surface antigen, the markers HBsAg and anti-Core were negative by 100%; 1.7% were positive for total antibodies against Hepatitis C. It is concluded that the screening of infectious diseases that represent risk factors for vertically transmission infections during pregnancy, is one of the most appropriate tools to diagnose these diseases and prevent maternal and infant morbidity and mortality.

SEOM guide to antiemetic prophylaxis in cancer patients treated with chemotherapy 2013.

Chemotherapy-induced emesis (CIE) both in the form of nausea and vomiting is one of the adverse effects most feared by patients who receive treatment, and one of the factors that most affect their quality of life and limit their functional capacity for everyday activities. Chemotherapy-induced emesis can result from many factors, depending on the treatment and the patients themselves. The best treatment for CIE is prevention, based on the use of drugs aimed at inhibiting the signal of certain neurotransmitters involved in the process. Antiemetic prophylaxis for chemotherapy of high-emetogenous potential lasting 1 day includes a combination of anti-5-HT3, neurokinin-1 inhibitors and dexamethasone. Antiemetic prophylaxis for chemotherapy of moderate-emetogenous potential lasting 1 day includes a combination of palonosetron and dexamethasone. Prophylaxis is not recommended for chemotherapy with minimal emetogenous potential. In the case of unforeseen or refractory emesis the use of olanzapine, metoclopramide or phenothiazine should be considered.

[Perinatal infection by rubella virus in breast-fed babies with congenital heart disease]. / Infección perinatal por el virus de la rubéola en lactantes con cardiopatía congénita.

BACKGROUND: seroepidemiological surveys suggest that approximately 20 % of women of childbearing age are susceptible to rubella. It is necessary to detect congenital rubella cases. Our objective was to determine the frequency of perinatal infection by rubella virus (RV) in infants with congenital heart disease. METHODS: prospective, cross-sectional study. We studied hospitalized and outpatients from September 2007 to December 2008. Neonates and infants under one year of age with congenital heart disease were included. A blood sample of 3 mL was taken from mother-child binomial and micro-ELISA for IgG and IgM against rubella were performed. RESULTS: 80 patients were studied, 56 % were female, with a median age of 3 months. More frequent congenital heart disease was ventricular septal defect (28.5 %), followed by atrial septal defect (17.5 %). Median maternal age was 28 years old. A history of febrile illness and rash during pregnancy was positive in 1.25 %. 7 cases of perinatal infection by RV were detected, three met the criteria for congenital rubella syndrome, and four had only congenital heart disease. CONCLUSIONS: the search for cases of congenital rubella syndrome in newborns and infants with heart disease could be used as a strategy to detect non-obvious cases.

Introducción: las encuestas seroepidemiológicas sugieren que 20 % de las mujeres en edad fértil es susceptible a la rubéola. El objetivo de esta investigación fue determinar la frecuencia de infección perinatal por el virus de la rubéola en lactantes con cardiopatía congénita. Métodos: estudio prospectivo y transversal de niños menores de un año de edad con diagnóstico de cardiopatía congénita. Se tomaron 3 mL de sangre al binomio madre-hijo y se realizó ELISA de micropartículas para anticuerpos IgG e IgM contra la rubéola. Resultados: se estudiaron 80 pacientes con edad de tres meses; 56 % era del sexo femenino. Las cardiopatías congénitas más frecuentes fueron las comunicaciones interventricular (28.5 %) y la interauricular (17.5 %). La mediana de la edad materna fue de 28 años; 1.25 % de las madres tuvo antecedente de enfermedad febril y exantema durante el embarazo. Se detectaron siete casos (8.75 %) de infección perinatal por el virus de la rubéola, tres cumplieron el criterio de síndrome de rubéola congénita y cuatro de cardiopatía. Conclusiones: se sugiere buscar rubéola congénita en los recién nacidos y lactantes con cardiopatías, como una estrategia para detectar los casos no obvios.

MiR-146a polymorphism is associated with asthma but not with systemic lupus erythematosus and juvenile rheumatoid arthritis in Mexican patients.

Extensive research has shown that aberrant expression of microRNAs (miRNAs) plays an important role in innate and adaptive immune responses. The rs2910164 polymorphism has been identified as a functional variant, which affects the transcription and expression level of miR-146a and, thereby, contributes to the pathogenesis of several inflammatory and autoimmune diseases. To investigate whether the rs2910164 G/C polymorphism was associated with asthma, systemic lupus erythematosus (SLE) or juvenile rheumatoid arthritis (JRA), we performed an association study in a pediatric Mexican cohort. We included 979 pediatric patients (asthma: 402, SLE: 367 and JRA: 210) and 531 control subjects without inflammatory or immune diseases. Genotyping was performed using the 5' exonuclease technique. The genotype distribution of the rs2910164 polymorphism was in Hardy-Weinberg equilibrium in each group. No significant differences were detected in the distribution of this polymorphism between cases and controls (P = 0.108, 0.609 and 0.553 for subjects with asthma, JRA and SLE, respectively). However, stratification by gender showed a statistically significant difference between asthmatic and control females, where the C allele was significantly associated with protection to asthma (odds ratio = 0.694, 95% confidence interval 0.519-0.929, P = 0.0138). Our results provide evidence that rs2910164 may play a role in the susceptibility to childhood-onset asthma, but not SLE or JRA in Mexicans. Further association studies may contribute to determining the role of miR-146a single-nucleotide polymorphisms in immune-mediated diseases.

Vertical distribution and inventories of (239+240)Pu and mercury in Sagua la Grande estuary, Cuba.

The vertical activity distribution and inventories of (239+240)Pu profile and Hg were determined in Sagua la Grande estuary, Cuba. The shape of the (239+240)Pu profile in the core column resembled very closely the history of atmospheric nuclear weapons' testing, and the maximum deposition in 1963 was recorded in the sediment core history. The (239+240)Pu activity concentrations in the surface layer sediments varied from 0.163 to 0.611 mBq g(-1). The inventory of (239+240)Pu was 42 ± 5.6 Bq m(-2), a value close to that expected from direct global fallout. Using the (239+240)Pu as a chronomarker the mass sedimentation rate in the area for the last 60 years was calculated, reaching values of 0.173 g cm(-2) y(-1). The mercury profile reflects the history of anthropogenic pollution in the estuary and perfectly describes the operation of the mercury-cell chlor-alkali plant, for production of NaOH, which began operations in 1980. The inventory of Hg was 2.42 ± 0.19 µg cm(-2). These results contribute to the scarce regional database for pollutants and anthropogenic radionuclides in the Caribbean marine environment, particularly in relation to (239+240)Pu.

Membrane cycling after the excess retrieval mode of rapid endocytosis in mouse chromaffin cells.

AIM: After exocytosis, neuroendocrine cells and neurones keep constant the plasma membrane and the releasable vesicle pools by performing endocytosis and vesicular cycling. Patch-clamp capacitance measurements on chromaffin cells showed that strong Ca(+2) entry activates excess retrieval: a rapid endocytosis process that retrieves more membrane than the one fused by preceding exocytosis. The main purpose of the present experiments was to study the recycling pathway that follows excess retrieval, which is unknown. METHODS: Membrane recycling after exocytosis-endocytosis can be studied by fluorescence imaging assays with FM1-43 (Perez Bay et al. Am J Physiol Cell Physiol 2007; 293, C1509). In this work, we used this assay in combination with fluorescent dextrans and specific organelle-targeted antibodies to study the membrane recycling after excess retrieval in mouse chromaffin cells. RESULTS: Excess retrieval was observed after the application of high-K(+) or cholinergic agonists during 15 or 30 s in the presence of FM1-43. We found that the excess retrieval membrane pool (defined as endocytosis-exocytosis) was associated with the generation of a non-releasable fraction of membrane (up to 30% of plasma membrane surface) colocalizing with the lysosomal compartment. The excess retrieval membrane pool followed a saturable cytosolic Ca(2+) dependency, and it was suppressed by inhibitors of L-type Ca(2+) channels, endoplasmic reticulum Ca(2+) release and PKC. CONCLUSION: Excess retrieval is not associated with the cycling of releasable vesicles, but it is related to the formation of non-releasable endosomes. This process is activated by a concerted contribution of Ca(2+) entry through L-channels and Ca(2+) release from endoplasmic reticulum.

Cancer survival in Cuba, 1994-1995.

The population-based cancer registry in Cuba is a national cancer registry established in 1964; cancer registration is entirely done by passive methods. Data on survival from 13 cancer sites or types registered during 1994-1995 are reported. Follow-up has been carried out predominantly by passive methods, with median follow-up ranging from 13-54 months. The proportion with histologically verified diagnosis for various cancers ranged between 34-100%; death certificates only (DCOs) comprised 8-50%; 50-89% of total registered cases were included for the survival analysis. The 5-year age-standardized relative survival for selected cancers were breast (69%), colon (41%), cervix (56%), urinary bladder (64%), rectum (48%) and non-Hodgkin lymphoma (49%). The 5-year relative survival by age group showed no distinct pattern or trend, and was fluctuating. A decreasing survival with increasing clinical extent of disease was noted for all cancers studied. The data on survival trend revealed that the 5-year relative survival of most cancers diagnosed in 1994-1995 was greater than that in 1988-1989.

[Rapid immune response against hepatitis B using an accelerated intradermal vaccination schedule]. / Respuesta inmune rápida contra la hepatitis B mediante esquema acelerado de vacunación intradérmica.

OBJECTIVE: To analyze the prescription of antiviral and antibiotic agents in children with upper airway infection (UAI) during Influenza H1N1 epidemic. METHODS: A cross-section study (01/04/2009 to 31/03/2010) was performed. We analyzed the antiviral and antibiotic agents' prescription and its relation with the presence of the triad of symptom of suspicion (migraine, fever and cough) and the cost for attention (medicines and screening test). RESULTS: 838 children were attendance for UAI, 40.3% with the suspicion triad. In 733 patients, the screening test were done with 155 positive results (120 had the triad). All patient with a positive result received oseltamivir. During the first five months of the epidemic, the medical prescriptions were: antibiotics 60-85%, 0-7% anti-viral and 20-30% symptomatic drugs. At the 6th at 8th months (peak of outbreak) antibiotics 35-70%, anti-virals 20-25% and 10-30% symptomatic drugs. At final months (9th to 11th) antimicrobials 65-80%, anti-virals 20-30% and symptomatic 0-10%. The cost for URI attention increased a 27%. CONCLUSIONS: Medical prescription changed during the epidemic, with an increased in the anti-virals, especially for patients with high suspicion for influenza and positive screening test.

Psicopatología y complejidad / Psychopathology and complexity

El paradigma de la complejidad plantea que la realidad posee una dinámica caótica, ambigua, borrosa, paradójica, y que no sigue los valores de orden, armonía y perfección que tienden a simpli¬ficarla; sin embargo, dicho caos es una forma de organización y orden. El comportamiento humano abordado por este paradigma reivindica así el papel representativo de lo irregular y lo contra¬dictorio del comportamiento al lado de lo lineal y predecible. La presente revisión de tema tiene como propósito describir algunos conceptos y supuestos en los que el enfoque de la complejidad basa su visión de lo complejo en el comportamiento, en particular, del psicopatológico en el individuo. Se establecen algunas com¬paraciones con conceptos asociados a lo complejo en enfoques científicos de la psicología, tales como el conductismo contextual, el conductismo paradigmático y el interconductismo desde su perspectiva, todo ello, destacando la muticausalidad recíproca, el aprendizaje complejo y jerárquico, lo histórico y contextual en la comprensión de la conducta, y buscando hacer algunas extrapola¬ciones al comportamiento psicopatológico. Esta aproximación se considera útil y necesaria para comprender e intervenir entidades nosológicas que plantean desafíos clínicos.

The paradigm of complexity states that reality conveys a chaotic dynamics, ambiguous, blurred, and paradoxical, and that it does not fulfill the values of order, harmony nor perfection. However, such a chaos represents a specific way of organization and order. Human behavior explained by this paradigm vindicates on this way the outstanding role of contradiction and irregularity aside of what is linear and predictable. The purpose of this review has the primary aim to describe some concepts and assumptions that give support to the approach to complexity in behavior, especially concerning the psychopathological behavior of an individual. Some comparisons with concepts associated to complexity in scientific approaches to psychology (contextual and paradigmatical behaviorism and interbehaviorism from its own persepctive) are stablished. All these elements are developed underlining the concepts of reciprocal multicausality, complex and hierarchical learning, historical and contextual factors in the comprehension of behavior, and trying to make some extrapolations on the psychopathological behavior. This approach is hence considered appropriate and necessary to understand gnosiological entities and to intervene them in their role of clinical challenges.

One century sedimentary record of Hg and Pb pollution in the Sagua estuary (Cuba) derived from 210Pb and 137Cs chronology.

The vertical distribution of Hg and Pb were determined in a sediment core collected from the Sagua estuary (North Cuba) that receives input from the Sagua river, one of the most polluted rivers discharging into the Cuban coastal environment. Depth profiles of metal concentrations were converted to time-based profiles using the (210)Pb dating method and confirmed with the (137)Cs fallout peak. The mean mass accumulation rate was estimated to be 0.17+/-0.04 g cm(-2)y(-1) (mean sediment accumulation rate 0.52+/-0.13 cm y(-1)) and the core bottom was estimated to date back about 130 years. The historical sedimentary record showed a strong enrichment of mercury concentrations in the past decades, caused by the incomplete treatment of industrial wastes from a chlor-alkali plant with mercury-cell technology in the Sagua river basin. Lead fluxes to sediments showed a gradual increase from the 1920s to present, which agrees with a population increase in Sagua la Grande City. Fluxes of both metals have increased the past 25 years, with values reaching a maximum of 0.5 and 3.9 microg cm(-2)y(-1) for Hg and Pb, respectively.

[Is there a shift in the epidemiology of hepatitis A in Mexican children?]. / Existe transición en el patrón endémico de la hepatitis A en población infantil mexicana?

INTRODUCTION: Twenty years ago, prevalence of Hepatitis A in Mexican children was 90%. OBJECTIVE: To describe a shift in the prevalence of Hepatitis A virus (HAV) infection and to demonstrate an increment in the age at the first contact with HAV, in a sample of Mexican children. MATERIAL AND METHODS: Reports of antiviral serologic studies collected from 1991 to 2005 from patients attending a pediatric hospital, were reviewed, and those with IgM anti-HAV positive in serum were selected. Age at the moment of acute infection was analyzed. Additionally, a serological survey searching IgG anti-HAV was made in a group of HAV unvaccinated children. RESULTS: From 1708 determinations of IgM, 221 were positive (13%). According to the year of report, five groups were constituted. Mean age by group was: 1991-1993 of 6.4 years, 1994-1996 of 8.0, 1997-1999 of 8.4, 2000-2002 of 8.0 and from 2003-2005 of 10.1 years. In a cohort of 259 unvaccinated children (mean of age 8.59 years), IgG antibodies were detected in 51%. CONCLUSION: In the infantile population studied a Hepatitis A epidemiology shift is suggested.

BCR-ABL, ETV6-RUNX1 and E2A-PBX1: prevalence of the most common acute lymphoblastic leukemia fusion genes in Mexican patients.

This study was conducted to determine the frequency of the most common fusion genes in Mexican pediatric patients with acute lymphoblastic leukemia (ALL). Molecular analysis using RT-PCR was carried out in 53-blood samples: 52 patients with de novo ALL and one with relapsed ALL. The ETV6-RUNX1 fusion was found in 7 cases (13.5%), BCR-ABL fusion was detected in 2 cases (3.8%), and 6 patients (11.5%) expressed the chimeric gene E2A-PBX1. The prevalence of E2A-PBX1 is one of the highest that has been described thus far in childhood ALL. Furthermore, we detected both the BCR-ABL, and E2A-PBX1 fusion in the relapsed patient. With regards to the immunophenotype, ETV6-RUNX1 was expressed in both pre-B and T-cell cases, while the presence of E2A-PBX1 and BCR-ABL was associated with the pre-B ALL phenotype. The prevalence of E2A-PBX1 in Mexican pediatric cases supports the existence of ethnic differences in the frequency of molecular markers of ALL.

Spectrum of RB1 gene mutations and loss of heterozygosity in Mexican patients with retinoblastoma: identification of six novel mutations.

RB1 mutation detection has greatly improved the clinical management of retinoblastoma and provides critical information to predict the risk of inheriting the disease. We screened for RB1 gene sequence alterations in both peripheral blood and tumor specimens from a total of 48 Mexican retinoblastoma patients using an SSCP-based screening approach followed by sequencing. Overall, 21 (43.8%) cases were bilateral and 27 (56.2%) were unilateral. Interestingly, 51.8% of unilateral patients developed the tumor before age 1 year and 10 of which (71.4%) were diagnosed before the age of 6 months. Thirteen different oncogenic mutations were detected in 14/48 (29.2%) patients, 9 of which were germline (64.3%). Six of these mutations are novel (IVS3-1G>T, 125X, 389X, 610X, 750X and -149G>T). The most frequent types of mutation were frameshift and nonsense (30.8% each). Moreover, 5 intronic variants were identified, two of which are novel (g.41908 C/A and g.161976del6T). Loss of heterozygosity of the RB1 gene as assessed by intron1/BamHI and intron17/XbaI intragenic markers was 50.0% (18 of 36 informative cases), being higher in tumors with known mutations (76.9% vs 34.8%). This low mutation detection rate and the earlier age at diagnosis in unilateral retinoblastoma cases suggest that other RB1 inactivating mechanisms could be present in the retinoblastoma development. In this study, mutation analysis was not helpful to distinguish sporadic and hereditary retinoblastoma, so, other approaches are needed to improve the molecular diagnosis of retinoblastoma and supports further investigations of Mexican retinoblastoma patients.