Acute Seronegative Toxoplasma gondii Hepatitis Allergic to First-Line Treatment.

Toxoplasma gondii infects up to one-third of the world's population, making it the protozoan that most infects people worldwide. Among the forms of presentation of toxoplasmosis, hepatitis is probably the least frequent with only a few case reports in the world's medical literature. Despite the fact that the first diagnostic test is the serology using the ELISA technique because its sensitivity is close to 100% in our case, it was reported negative. The biopsy gave the definitive diagnosis, and we were able to start treatment immediately. Although the first line of treatment is sulfadiazine and pyrimethamine, our sulfate allergic patient received an alternative regimen of doxycycline, clindamycin, and azithromycin with a good response. This is the only case of Toxoplasma hepatitis reported in Mexico and the only one in the world with negative serology with a good response to second-line treatment.

[The Mexican Board of Pathology: microscopy examination before and after digital microscopy]. / Consejo Mexicano de Médicos Anatomopatólogos: su examen de microscopia, antes y después de su digitalización.

INTRODUCTION: The examination carried out by the COMMAP for the certification process assessed pathologist formed in dissimilar institutions. In 2007 COMMAP's governing body in turn, decided to digitize it. The purpose of this study is to investigate whether the conversion to virtual slides in the microscopy section, compared with the traditional have had an impact on the scores of the candidates. METHOD: The slides were scanned with high resolution. The virtual microscope is a standard computer screen where there is a program (Aperio Scope Image Viewer) that can display the scanned slides. The results of the microscopy section of the past nine years were compared; two groups were formed: 1) those without digitized examination, and 2) with it. The results were compared by Student t-test and Mann-Whitney. RESULTS: Of a 461 results 240 belonged to the first group and 221 to the second one. On a scale of 1-10, the average scores were 6.6 and 6.8, respectively (p > 0.6 and > 0.5).The minimum and maximum scores were also similar in each group. CONCLUSIONS: According to the results, the digitized exam in the COMMAP's certification process shows no difference between the digitized and the conventional versions.

[Heart transplant in Monterrey, Nuevo León]. / Trasplante cardiaco en Monterrey, Nuevo León.

Heart failure constantly increases its incidence and prevalence in our society, it was imperative to start a heart transplant program to improve the survival rates of patients with end stages of the disease. Legal issues made impossible to transplant patients out of Mexico City until recent years. Even with an acute hemodynamic and clinic improvement after the transplant, these patients frequently develop complications such as graft rejection or opportunistic infections due to the immunosuppressive schemes increasing the morbidity and mortality of the procedure. In the present article we report the experience acquired with 65 heart transplant patients from 4 transplant programs in Monterrey, Nuevo Leon, one of them from the socialized system and the other three from private hospitals. Our program not only has successfully transplanted patients with advanced age but, for the first time in Latin America we have transplanted patients assisted with the ambulatory Thoratec TLC II system. Even that we have faced obstacles like a newly started donation culture in our population and limited resources, our patient's survival rate push us to continue working with these very ill population.

[Obesity as risk factor for metabolic disorder in Mexican adolescents, 2005]. / Obesidad como Factor de Riesgo para Trastornos Metabólicos en Adolescentes Mexicanos, 2005.

OBJECTIVE: Determining the prevalence and estimating the risk of obesity for dyslipidemia and hyperinsulinemia in adolescents. The existence of a linear association betweenanthropometric measures, lipids and insulin was also evaluated. MATERIAL AND METHODS: A comparative study was carried out amongst obese (body mass index=BMI >95th percentile for age and gender; n=120) and non-obese adolescents (BMI <85th percentile for age and sex; n=120) aged 10-19. A structured questionnaire was used for collecting anthropometric and demographic data. Glucose, insulin and lipid profiles were obtained for each adolescent. RESULTS: Prevalence of at least one dyslipidemia was 56,6 % among obese adolescents and 20,8 % amongst non-obese ones (p<.001). The former registered 50 % prevalence of hyperinsulinemia, the latter 4 % (p<.001). Obesity increased hyperinsulinemia risk having a 23 odds ratio (8.3-68.9 95 % CI) and for at least one dyslipidemia (OR=5,0; 2,7-9,2 95 % CI). Insulin level significantly correlated with BMI (r=0,57), triglycerides (r=0,57), VLDL (r=0,57), HDL (-0,37), waist-hip circumference index (r=0,29), cholesterol (r=0,22), and LDL (r=0,13). CONCLUSIONS: Obesity can be considered to be a risk factor for developing metabolic disorders in adolescents. In fact, there was a linear relationship between anthropometric measurement, lipids and insulin. Prevention should focus on improving predisposing environments for obesity amongst families having children and teenagers. Emphasising life-styles and healthy behaviour is essential, as well as training and treatment options for complete care of individuals in this age-group.

Obesidad como Factor de Riesgo para Trastornos Metabólicos en Adolescentes Mexicanos, 2005 / Obesity as risk factor for metabolic disorder in Mexican adolescents, 2005

Objetivo: Determinar la prevalencia y estimar el riesgo de obesidad para dislipidemias e hiperinsulinemia en adolescentes. Asimismo, evaluar la asociación lineal de medidas antropométricas y lípidos con insulina. Material y Métodos: Se realizó un estudio transversal comparativo entre adolescentes obesos (índice de masa corporal=IMC>percentil 95 para edad y sexo; n=120) y no obesos (IMC< percentil 85 para edad y sexo; n=120) de 10-19 años. Se aplicó una encuesta estructurada con datos sociodemográficos y antropométricos y se determinaron glucosa, insulina y perfil de lípidos. Resultados: La prevalencia de una o más dislipidemias fue de 56,6 por ciento en adolescentes c/obesidad, en comparación con 20,8 por ciento en adolescentes s/obesidad (p<.001). La hiperinsulinemia se presentó en el 50 por ciento del primer grupo mientras que en el segundo, en 4 por ciento (p<.001). La obesidad incrementó el riesgo de hiperinsulinemia con una razón de momios de (RM) de 23 (IC 95 por ciento: 8,3-68,9) y de por lo menos una dislipidemia (RM=5,0; IC95 por ciento: 2,7-9,2). El nivel de insulina se correlacionó significativamente con IMC (r=0,57), triglicéridos (r=0,57), VLDL (r=0,57), HDL (-0,37), relación cintura cadera (r=0,29), colesterol (r=0,22), y LDL (r=0,13). Conclusiones: Se evidenció a la obesidad en adolescentes como factor predisponente para el desarrollo de trastornos metabólicos y la asociación lineal de medidas antropométricas y lípidos con insulina.

Objective: Determining the prevalence and estimating the risk of obesity for dyslipidemia and hyperinsulinemia in adolescents. The existence of a linear association betweenanthropometric measures, lipids and insulin was also evaluated. Material and Methods: A comparative study was carried out amongst obese (body mass index=BMI >95th percentile for age and gender; n=120) and non-obese adolescents (BMI <85th percentile for age and sex; n=120) aged 10-19. A structured questionnaire was used for collecting anthropometric and demographic data. Glucose, insulin and lipid profiles were obtained for each adolescent. Results: Prevalence of at least one dyslipidemia was 56,6 percent among obese adolescents and 20,8 percent amongst non-obese ones (p<.001). The former registered 50 percent prevalence of hyperinsulinemia, the latter 4 percent (p<.001). Obesity increased hyperinsulinemia risk having a 23 odds ratio (8.3-68.9 95 percent CI) and for at least one dyslipidemia (OR=5,0; 2,7-9,2 95 percent CI). Insulin level significantly correlated with BMI (r=0,57), triglycerides (r=0,57), VLDL (r=0,57), HDL (-0,37), waist-hip circumference index (r=0,29), cholesterol (r=0,22), and LDL (r=0,13). Conclusions: Obesity can be considered to be a risk factor for developing metabolic disorders in adolescents. In fact, there was a linear relationship between anthropometric measurement, lipids and insulin. Prevention should focus on improving predisposing environments for obesity amongst families having children and teenagers. Emphasising life-styles and healthy behaviour is essential, as well as training and treatment options for complete care of individuals in this age-group.

[Heart transplant in "Nuevo Leon": the first 33 cases]. / Estado actual del trasplante cardíaco en Nuevo León: primeros 33 casos.

Heart failure is one of the most important causes of death worldwide. Heart transplant is the last effective alternative when the medical and surgical treatments have failed in patients with end stage heart failure, giving them an 80% one year survival rate. Unfortunately, during the outcome, the heart transplant patients can develop complications such as graft rejection and opportunistic infections because of the use of immunosuppressive therapy. In the present article we report the experience with 33 heart transplant patients. Our program not only has successfully transplanted patients with advanced age but, for the first time in Latin America we have transplanted patients assisted with the ambulatory Thoratec TLC II system. Even with limited resources, we have managed the same complications than other heart transplant programs, our 82% one year survival rate is similar than reports in medical literature.

Estado actual del trasplante cardíaco en Nuevo León: primeros 33 casos / Heart transplant in Nuevo Leon: the first 33 cases

Heart failure is one of the most important causes of death worldwide. Heart transplant is the last effective alternative when the medical and surgical treatments have failed in patients with end stage heart failure, giving them an 80% one year survival rate. Unfortunately, during the outcome, the heart transplant patients can develop complications such as graft rejection and opportunistic infections because of the use of immunosuppressive therapy. In the present article we report the experience with 33 heart transplant patients. Our program not only has successfully transplanted patients with advanced age but, for the first time in Latin America we have transplanted patients assisted with the ambulatory Thoratec TLC II system. Even with limited resources, we have managed the same complications than other heart transplant programs, our 82% one year survival rate is similar than reports in medical literature.

Un caso de amiloidosis sistémica y deficiencia de factor X asociada con mieloma múltiple / A case of systemic amyloidosis and factor X deficiency associated with multiple myeloma

Se describe el caso de un paciente masculino de 50 años con síndrome de amiloidosis primaria y deficiencia adquirida de factor X asociada con mieloma múltiple. Las manifestaciones clínicas más importantes consistieron en infiltracion amiloide sistémica y hemorragia por mucosa gingival. El estudio integral del paciente se llevó a cabo a partir del hallazgo inicial de prolongación del tiempo de protrombina y del tiempo de tromboplastina activado. La reacción al tratamiento fue insatisfactoria, y el paciente falleció poco después de haberse logrado aparentemente la estabilización de sus complicaciones cardiovasculares y renales