Consenso Mexicano para el Tratamiento de la Hepatitis C / The Mexican consensus on the treatment of Hepatitis C

El objetivo del Consenso Mexicano para el Tratamiento de la Hepatitis C fue el de desarrollar un documento como guía en la práctica clínica con aplicabilidad en México. Se tomó en cuenta la opinión de expertos en el tema con especialidad en: gastroenterología, infectología y hepatología. Se realizó una revisión de la bibliografía en MEDLINE, EMBASE y CENTRAL mediante palabras claves referentes al tratamiento de la hepatitis C. Posteriormente se evaluó la calidad de la evidencia mediante el sistema GRADE y se redactaron enunciados, los cuales fueron sometidos a voto mediante un sistema modificado Delphi, y posteriormente se realizó revisión y corrección de los enunciados por un panel de 34 votantes. Finalmente se clasificó el nivel de acuerdo para cada oración. Esta guía busca dar recomendaciones con énfasis en los nuevos antivirales de acción directa y de esta manera facilitar su uso en la práctica clínica. Cada caso debe ser individualizado según sus comorbilidades y el manejo de estos pacientes siempre debe ser multidisciplinario.

The aim of the Mexican Consensus on the Treatment of Hepatitis C was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitis C treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

Dirofilariasis palpebral causada por Dirofilaria repens: un caso importado / Human dirofilariasis in the eyelid caused by Dirofilaria repens: An imported case

Caso clínico: Mujer de 33 años, ucraniana, acude a urgencias asegurando tener alojado en el párpado un gusano que se mueve y le muerde. La exploración reveló un cuerpo extraño subcutáneo, filiforme, que reptaba bajo la piel. Fue extirpado quirúrgicamente extrayéndose un parásito vivo identificado por PCR como Dirofilaria repens. Discusión: Los humanos son huéspedes accidentales en el ciclo de las dirofilarias. En España apenas se han publicado 8 casos de afectación subcutánea. Ante el calentamiento global D. repens se ha convertido en un agente infeccioso emergente en países de Centroeuropa como el originario de la paciente. Exponemos nuestras conclusiones (AU)

Clinical case: The case concerns a 33-year-old Ukrainian woman, who came to the Ophthalmology Emergency Service, stating that she had a «worm» under the skin of her upper left eyelid that wriggled at night and bit her. A complete examination revealed a subcutaneous foreign body, which showed a filarial appearance and seemed to crawl under the skin. It was surgically removed to discover a live parasite, PCR-identified as Dirofilaria repens. Discussion: Humans are accidental hosts in the cycle of Dirofilaria. There are only 8 reported cases of subcutaneous infection in Spain. Due to global warming, D. repens has become an emerging infectious agent in Central Europe countries such as Ukraine. The findings in this case are discussed (AU)

Classical markers like ER and ki-67, but also survivin and pERK, could be involved in the pathological response to gemcitabine, adriamycin and paclitaxel (GAT) in locally advanced breast cancer patients: results from the GEICAM/2002-01 phase II study

INTRODUCTION: The identification and validation of biomarkers of chemotherapy sensitivity is critical in order to individualise therapy in breast cancer. We evaluated pathological complete response (pCR) to GAT, and its correlation with tumour biomarkers before and after neoadjuvant chemotherapy. MATERIALS AND METHODS: Stage III (and stage II with T≥5 cm) breast cancer patients were included. Treatment consisted of adriamycin (40 mg/m(2)) day 1, and paclitaxel (150 mg/ m(2)) followed by gemcitabine (2000 mg/m(2)) day 2, every 14 days for six cycles. Tissue from pre-treatment biopsy and surgery was evaluated for biologic markers by immunohistochemistry. Two XPD single nucleotide polymorphisms (SNP) were also analysed. RESULTS: Forty-six patients entered the trial. Median age was 49.5 years (range 31-72); 25 patients (54%) were pre-menopausal; 12 (26%) were ER-PgR-negative; pCR was observed in 17% (95% CI: 6.4-28.4) of patients. Significant differences in marker expression (mean±SD) in correlation to pathological response were only found in Ki- 67. After treatment, tumours showed lower Ki-67-, surviving- and pERK-positive cells. No correlation between XPD polymorphisms and pCR was found. The overall response rate was 89% (95% CI: 80.1-98.1). Fifteen patients (33%) underwent breast-conserving surgery. The most frequent grade 3 or 4 toxicities were neutropenia (with one febrile neutropenia) and asthenia. CONCLUSION: These results show an effective regimen with acceptable tolerability. Our data suggest that not only classical markers (ER, Ki-67), but also survivin and pERK could be involved in the response to GAT, which may contribute to therapy individualisation in future study designs (AU)

The place of targeted therapies in the management of non-small cell bronchial carcinoma. Molecular markers as predictors of tumor response and survival in lung cancer.

This review highlights the numerous molecular biology findings in the field of lung cancer with potential therapeutic impact in both the near and distant future. Abundant pre-clinical and clinical data indicate that BRCA1 mRNA expression is a differential modulator of chemotherapy sensitivity. Low levels predict cisplatin sensitivity and antimicrotubule drug resistance, and the opposite occurs with high levels. The main core of recent research has centered on epidermal growth factor receptor (EGFR) mutations and gene copy numbers. For the first time, EGFR mutations have been shown to predict dramatic responses in metastatic lung adenocarcinomas, with a threefold increase in time to progression and survival in patients receiving EGFR tyrosine-kinase inhibitors. Evidence has also been accumulated on the crosstalk between estrogen and EGFR receptor pathways, paving the way for clinical trials of EGFR tyrosine-kinase inhibitors plus aromatase inhibitors. Understanding the relevance of these findings can help to change the clinical practice in oncology towards customizing chemotherapy and targeted therapies, leading to improvement both in survival and in cost-effectiveness.

Implicaciones de la modulación autonómica en las valvulopatías / Role of automatic nervous system on valvular heart disease

Estudios experimentales y clínicos han mostrado la relevancia de la actividad nerviosa autónoma en la historia natural de las valvulopatías. A modo de ejemplo, en la insuficiencia mitral crónica un aumento compensatorio de las catecolaminas ha demostrado ser un factor deletéreo a nivel miocárdico. Asociado a esto, la hiperactividad adrenérgica ha sido involucrada en la generación de arritmias tanto en la valvulopatía mitral como aórtica. La aplicación de este conocimiento, utilizando métodos no invasivos para evaluar la función autonómica, puede contribuir a identificar en forma más precisa a pacientes valvulópatas con un mayor riesgo de mortalidad (AU)

Leaves of Berberidaceae (Berberis and Mahonia) from Oligocene sediments, near Tepexi de Rodríguez, Puebla.

From the Oligocene Los Ahuehuetes locality, near Tepexi de Rodríguez, Puebla, Mexico, five new plant species are described based on their leaf architecture. The presence of brochidodromous or acrodromous venation, and secondary veins forming angular (versus rounded) arcs, are well defined characters in the fossil material that relate it to Berberidaceae. Comparison with the leaves and leaflets of extant and fossil plants allow the recognition of one Mahonia and four Berberis new species. The lack of detailed information on leaf architecture in Berberidaceae limits the evaluation of the taxonomic relationships that can be suggested between fossil and extant plants. However, from a biogeographic point of view the presence of these new fossil plants supports the hypothesis of a North American origin of the Orientalis Groups of Mahonia, to which a lineage of Berberis may be added. Furthermore, two of the new species suggest the dispersal, some time during the Tertiary, of a lineage that today forms the Australis Group of Berberis from low latitude North America to South America. The movement of the Chortis Block is proposed as an alternative to explain the dispersal of a growing list of plants from north to south in the Americas. Only through future geological and palaeobotanical work can this hypothesis be corroborated.

Reconstruction of the Leaves of Two New Species of Pseudosmodingium (Anacardiaceae) from Oligocene Strata of Puebla, Mexico.

Leaves of two new plants are reconstructed from their isolated leaflets collected from the Oligocene Los Ahuehuetes locality near Tepexi de Rodríguez in Puebla, Mexico. The leaves of Pseudosmodingium mirandae Ramírez-Garduño et al. are compound imparipinnate with leaflets of variable morphology. The leaflets of five leaf morphotypes vary from narrow elliptic to lanceolate or lorate; they are symmetrical to slightly asymmetrical, with acute to attenuate apex, acute to cuneate base, and entire to serrate margin. Venation is simple pinnate craspedodromous, with secondary veins slightly curved near their base; secondary veins may dichotomize near the margin to become tertiary veins, and intersecondary veins are small and oblique to the secondary veins. A small number of leaflets assigned to Pseudosmodingium terrazasiae Ramírez-Garduño et al. are distinguished from P. mirandae by the leaflet shape, length&rcolon;width ratio, base shape, and apex angle. Morphological comparison of the fossil leaves with leaves of extant species of Anacardiaceae based on numerical analyses indicates a close similarity between P. mirandae and Pseudosmodingium multifolium Rose, while P. terrazasiae is more similar to Pseudosmodingium perniciosum (HBK) Engl. The presence of fossil species with extant relatives that are endemic to Mexico, along with previous reports, indicates that by the Oligocene, some lineages were already in place, although today they form part of the more xeric communities in southern North America.

Leaves of Salicaceae (Salix and Populus) from Oligocene Sediments Near Tepexi de Rodríguez, Puebla, Mexico.

Eleven new salicaceous taxa based on fossil leaves, seven Salix and four Populus species, are described from the Oligocene Los Ahuehuetes locality, Pie de Vaca Formation, near Tepexi de Rodríguez in Puebla, Mexico. They are characterized by the presence of typical salicoid teeth, camptodromous secondary venation, and elliptic or lanceolate shape. Morphological differences between these new fossil plants and those reported previously from the United States and elsewhere indicate that diversification among these taxa occurred early during their differentiation. Furthermore, the limited morphological similarities of the fossil and extant plants growing naturally in Mexico also indicate a high rate of evolution. Documenting the expansion of high-latitude North American taxa into lower latitudes at the time of deposition of the Pie de Vaca Formation confirms that at least some of the typical boreal taxa were part of dry tropical communities in low-latitude North America and underscores the need to reevaluate the origin of this southern vegetation.