[Psychometric validation of a guideline for classifying the medical complexity of children and adolescents with special health care needs]. / Validación psicométrica de Pauta de Clasificación de Complejidad Médica de niños, niñas y adolescentes con Necesidades Especiales de Atención en Salud.

Children and youth with special health care needs (CYSHCN) present an intensive use of health services resources and demand a high level of coordination between these services, communities, and families. SOCHIPE, along with other experts, generated a Complexity Classification Guideline to allocate resources according to the need of the cases through the Health Care Network. OBJECTIVE: To perform a construct validation of the Complexity Classification Guideline. SUBJECTS AND METHOD: With a sample of 488 CYSHNC to whom the Classification Guideline was applied, an instrument reliability analysis was performed, in addition to an exploratory and confirmatory factor analysis. RESULTS: The Classification Guideline obtained a standardized Cronbach's Alpha of 0.87; however, the RMSEA, TLI, and CFI model fit statistics were lower than expected. The MI coefficient suggested the elimination of 9 items, from which a summary Guideline of 11 items and three dimensions was generated that presented an RMSEA of 0.60; TLI of 0.970, and CFI of 0.977. CONCLUSION: The study allows us to have a Summarized Complexity Classification Guideline for CYSHNC, with good psychometric properties, quick application, and easy interpretation, for application in the public health network.

Prevalencia de infección por Chlamydia trachomatis y relación con el perfil de conductas sexuales en adolescentes y mujeres jóvenes de la Provincia de Osorno, Chile / Prevalence of Chlamydia trachomatis infection and relationship with the profile of sexual behaviors in adolescents and young women in the Province of Osorno, Chile

INTRODUCCIÓN: La infección por Chlamydia trachomatis es la ITS bacteriana más frecuente del mundo. En el cervix se presenta mayormente de forma asintomática y afecta especialmente a mujeres jóvenes y adolescentes. Puede producir daño permanente en el tracto reproductor femenino, se asocia a parto prematuro, infecciones neonatales transmitidas vía vertical y mayor riesgo de adquirir otras ITS como VIH Y VPH. Por estos motivos se han establecido estrategias de tamizaje para detectar y tratar precozmente la infección asintomática por C. trachomatis en diferentes países. En nuestro país no contamos con un programa nacional de tamizaje. OBJETIVO: Determinar la prevalencia de infección asintomática por Chlamydia trachomatis en mujeres entre 12 y 21 años de la Provincia de Osorno, Región de Los Lagos, Chile. PACIENTES Y MÉTODOS: Se desarrolló un estudio de diseño transversal con una cohorte única de mujeres adolescentes y jóvenes consultantes en el Policlínico de Alto Riesgo Obstétrico y de Ginecología Infantil y Adolescente, del Hospital Base de Osorno, entre enero de 2019 y enero 2020. Se determinó el estado de infección asintomática mediante RPC en tiempo real para C. trachomatis. Se realizó una encuesta a fin de determinar características demográficas, hábitos y conductas sexuales de las pacientes estudiadas. RESULTADOS: Fueron reclutadas 124 mujeres entre 12 a 21 años de edad, de las cuales, 36 (29,3%) se encontraban embarazadas al momento del estudio. La prevalencia de infección asintomática por C. trachomatis fue de 14/124 (11,3%). En las mujeres gestantes se encontraron 6/36 (16,7%) casos positivos de infección por C. trachomatis y 8/88 (9,1%) en las no gestantes. Existe una mayor frecuencia de infección asintomática a menor edad de inicio de actividad sexual (33,3% en aquellas que inician entre 11-12 años vs. 16,2% en las que inician entre 1314 años, 7,4% entre 15-16 y 8% entre 17-21 años; p < 0,05). Esta tendencia no fue observada al comparar el estado de infección con el tiempo de vida sexual activa. Sólo 15,7% de las pacientes utilizó preservativo en todas sus relaciones sexuales. DISCUSIÓN: La infección asintomática por C. trachomatis es frecuente en las mujeres adolescentes y jóvenes sexualmente activas. Las pacientes con inicio más temprano de la actividad sexual coital (bajo 13 años de edad) podrían estar en mayor riesgo. Se requiere con urgencia establecer la frecuencia nacional de infección para desarrollar una estrategia sanitaria para su pesquisa y manejo oportuno en nuestro país.

BACKGROUND: Chlamydia trachomatis infection is the world most common bacterial STI. At uterine cervix it presents mostly asymptomatically and especially affects young women and adolescents. It can cause permanent damage to the female reproductive tract and is associated with premature birth, connatal infections and increased risk of acquiring other STIs such as HIV and HPV. For these reasons, other countries have established screening strategies to detect and treat asymptomatic C. trachomatis infection. Our country don't have a national screening program. AIM: To determine the prevalence of C. trachomatis asymptomatic infection in adolescent and young women in Osorno province, Los Lagos Region, Chile. METHODS: A crosssectional study was performed in adolescent and young women who consult at Hospital Base Osorno in the MaternoFetal and PediatricAdolescent Gynecology ambulatory clinics, between January 2019 and January 2020. The status of asymptomatic infection was determined by PCR for C. trachomatis. A survey was carried out to determine the demographic characteristics, habits and sexual behaviors. RESULTS: 124 women between 12 and 21 years of age were recruited, of which 36 (29,3%) were pregnant at the time of the study. The prevalence of asymptomatic infection by C. trachomatis was 11.3.%. In pregnant women, there were 6/36 (16.7%) positive cases for C. trachomatis and 8/88 (9.1%) in nonpregnant women. We found a higher frequency of asymptomatic infection at younger age of first sexual intercourse (33% in adolescents at 11-12 years old vs. 16.2% at 13-14, 7.4% at 15-16 and 8% at 17-21; p<0.05). Only 15.7% of the patients utilized condoms in all their intercourses. DISCUSSION: Asymptomatic C. trachomatis infection is common in adolescent and young women, with a higher risk in those who onset sexual activity at an early age (less than 13 years old). It is urgently required to determine the national frequency of asymptomatic C. trachomatis infection to develop a national strategy for screening and timely treatment.

Hybrid Methacrylated Gelatin and Hyaluronic Acid Hydrogel Scaffolds. Preparation and Systematic Characterization for Prospective Tissue Engineering Applications.

Hyaluronic acid (HA) and gelatin (Gel) are major components of the extracellular matrix of different tissues, and thus are largely appealing for the construction of hybrid hydrogels to combine the favorable characteristics of each biopolymer, such as the gel adhesiveness of Gel and the better mechanical strength of HA, respectively. However, despite previous studies conducted so far, the relationship between composition and scaffold structure and physico-chemical properties has not been completely and systematically established. In this work, pure and hybrid hydrogels of methacroyl-modified HA (HAMA) and Gel (GelMA) were prepared by UV photopolymerization and an extensive characterization was done to elucidate such correlations. Methacrylation degrees of ca. 40% and 11% for GelMA and HAMA, respectively, were obtained, which allows to improve the hydrogels' mechanical properties. Hybrid GelMA/HAMA hydrogels were stiffer, with elastic modulus up to ca. 30 kPa, and porous (up to 91%) compared with pure GelMA ones at similar GelMA concentrations thanks to the interaction between HAMA and GelMA chains in the polymeric matrix. The progressive presence of HAMA gave rise to scaffolds with more disorganized, stiffer, and less porous structures owing to the net increase of mass in the hydrogel compositions. HAMA also made hybrid hydrogels more swellable and resistant to collagenase biodegradation. Hence, the suitable choice of polymeric composition allows to regulate the hydrogels´ physical properties to look for the most optimal characteristics required for the intended tissue engineering application.

Hydrogeochemical baseline in a human-altered landscape of the central Pacific coast of Costa Rica.

Groundwater pollution in tropical and human-altered coastal landscapes is receiving novel attention due to decreasing in annual recharge as a consequence of recurrent droughts and overexploitation, whereby saline intrusion, point and diffuse source contamination, and water conflicts are common denominators. This study presents a detailed groundwater evaluation in a coastal aquifer within the central Pacific coast of Costa Rica. Three sampling campaigns including major ions, heavy metals, and fecal coliform analyses were conducted between July 2013 and March 2014 across 17 wells within the alluvial and fissured units of the Jacó aquifer. The groundwater system is classified as mixed HCO3--Ca2+-Mg2+ type. Coliforms presence was found in two wells, nearby Mona Creek headwaters and near the coastal line. Heavy metal concentrations were below quantification limits in most of the wells; however, chromium concentrations up to 6.56 µg/L were quantified within the coastal line and central portion of the alluvial aquifer in 20 out of the 48 samples. The spatial distribution of major ions (K+, Na+, Ca2+, Mg2+, Cl-, SO42-, and HCO3-) exhibited an increasing trend towards the central portion of the alluvial aquifer, which may be potentially associated with the large unregulated urban expansion, invoking a need of a continuous water quality monitoring program in this touristic hot spot. This study provides useful information for other similar coastal aquifers in Central America, whereby increasing population growth and unregulated touristic, industrial, and agricultural activities are posing a truly challenge to ensure water security and sustainability parallel to the economic development in a changing climate.

Paraffin Removal in the Synthesis of Novel Janus Carbon Nano-Onions.

Recent research has demonstrated that Janus nanoparticles provide a novel strategy to prepare catalysts and biomaterials. This is because of the versatility of being able to modify both sides of a particle with different properties. Carbon nano-onions are an excellent material as a support for different applications such as metal nanoparticles due to their unique structure and good conductivity. Because of their physical and chemical properties, carbon nano-onions are an ideal material to create Janus nanoparticles for further amphiphillic modifications. This article aims to show a preparatory process to ensure the removal of paraffin efficiently. The main method to be able to create these particles is employing the Pickering emulsion process. Paraffin wax is used as the hydrophobic part of this mixture and serves to block one side of the CNOs to facilitate their modification only on one side. Therefore, its removal is essential to obtain this catalytic nanoparticle.

Magnesium, zinc, arsenic, selenium and platinum urinary excretion from cancer patients of Antofagasta region, Chile: multi-metal approach.

OBJECTIVES: To evaluate the short-term 24 h urinary excretion of platinum, arsenic, selenium, magnesium and zinc in patients with lung cancer and with cancer other than lungs treated with cisplatin or/and carboplatin from Antofagasta, Chile. DESIGN: Urine measurements of Pt and Se were made by inductively coupled plasma optical emission spectrometry, As by hydride-generation atomic absorption spectrometry and Mg and Zn by means of flame furnace atomic absorption spectrometry. SETTING: All samples were provided by the Oncological Centre of Antofagasta Regional Hospital (Region of Antofagasta, Chile). PARTICIPANTS: Ninety 24-h urine samples from cancer patients after the infusion of Pt-base drugs and 10 24-h urine samples from cancer patients not treated with metal-base drugs. MAIN OUTCOME MEASURES: Concentrations of Pt, Se, As, Zn and Mg coming from 24-h urine samples. RESULTS: Pt excreted was not significantly different between patients with lung and other cancers treated with cisplatin. The excretion of Mg, Zn and Se was greater than As. Then, Pt favours the excretion of essential elements. For lung and other types of cancers treated with drugs without Pt, excretion of Mg, Zn and Se was also greater than that of As, suggesting antagonism Mg-Zn-Se-anti-cancer drug relationship. CONCLUSIONS: The amounts of Mg, Zn and Se excreted were greater than for As either with or without Pt-containing drugs, suggesting antagonist Mg-Zn-Se-anti-cancer drug relationships. The excretion of As, Mg, Zn and Se is induced by Pt. Knowledge obtained can contribute to understanding the arsenic cancer mechanism and the As-Mg-Zn-Se-Pt inter-element association for lung cancer and other types of cancer.

Thymoglobulin Induction Therapy in Deceased Donor Kidney Transplantation: Single-Center Experience in Mexico.

BACKGROUND: Induction therapy is used to reduce the incidence of graft rejection and delayed graft function. Thymoglobulin is the most used inductor agent in deceased donor kidney transplantation due to its lower rejection and delayed graft function rates. METHODS: Retrospective study of patients who underwent deceased donor kidney transplantation from 2011 to 2014. Efficacy and safety outcomes evaluated were primary graft nonfunction, delayed graft function, acute rejection episodes, the lowest leukocyte count during the induction, adverse effects, eGFR, and patient and graft survival. P < .05 was considered statistically significant. RESULTS: A total of 42 patients were registered. Of these, 51.7% were female, with a mean age of 36.4 ± 11.1 years. Mean dialysis time was 112.4 ± 365 months. Mean donor age was 33.7 ± 13.1 years. Of the registered patients, 14.3% were extended criteria donors and 23.8% high-risk. Mean thymoglobulin dose was 4.4 ± 0.8 mg/kg. Primary graft nonfunction was 2.4%. Nineteen percent presented with delayed graft function and 19% with acute rejection. Mean lowest leukocyte count was of 4.6 ± 1.5 × 10(3) cells/mm(3). Mean hospital stay was 11.3 ± 6.3 days. Adverse effects were seen in 59.5% of registered patients, whereas graft survival 1 year and 3 years after transplantation was 85.3% and 56.9%, respectively. Patient survival 1 year and 3 years after transplantation was 85.3% and 53.8%, respectively. Patients who received a higher dose (>4.4 mg/kg) had a shorter hospital stay (9.4 ± 4.6 and 8.1 ± 2.3) than those who received lower dose (13.6 ± 7.9 and 12.8 ± 7.4; P < .05). CONCLUSION: Thymoglobulin induction at doses near 5 mg/kg in deceased donor kidney transplant is efficient and secure at our center.

Induction Immunosuppressive Therapy Use in Deceased Donor Kidney Transplantation: 11-Year Experience in Veracruz, Mexico.

BACKGROUND: Induction therapy reduces the frequency of acute rejection and delayed graft function in renal transplantation. Basiliximab and Thymoglobulin are most commonly used agents for induction. METHODS: A retrospective study of two transplant centers in Veracruz, Mexico compared induction therapy in deceased donor renal transplantation from 2003 to 2014. Efficacy and safety outcomes evaluated were primary graft nonfunction, delayed graft function, acute rejection episodes and hospitalizations during first year, and patient and graft survival. P < .05 was considered statistically significant. RESULTS: Seventy deceased kidney donors (40 male) were studied. Mean donor age was 32.9 ± 14.3 years, mean donor BMI 25.6 ± 4.3 kg/m(2), and mean donor creatinine 1.13 ± 0.58 mg/dL. Main cause of death was trauma (62.9%). In total, 125 kidney transplantations were performed, with female predominance (53.6%) and mean age 33.8 ± 11.8 years. Of these, 66.4% used basiliximab and 33.6% Thymoglobulin. Thymoglobulin patients were significantly older, with lower weight and BMI, and were on dialysis longer than basiliximab patients. DGF was present in 19.3% of basiliximab patients vs 16.7% in Thymoglobulin patients, acute rejection occurred in 16.9% of basiliximab patients vs 19% Thymoglobulin patients. A total of 33.7% basiliximab patients were hospitalized during the first year vs 47.6% Thymoglobulin-induced patients (P > .05). Mean graft survival was 84.2 ± 5.3 months (73.8-94.7) basiliximab vs 32.4 ± 28.7 months (28.7-36.1) Thymoglobulin, Kaplan-Meier survival did not show statistically significant differences between groups (P = .276; CI 95%). CONCLUSION: Similar transplant outcomes were obtained using basiliximab or Thymoglobulin induction in our population.

Trace metal variability in coastal waters of San Jorge Bay, Antofagasta, Chile: An environmental evaluation and statistical approach to propose local background levels.

Between 2008 and 2011, twelve metals from 384 coastal waters samples from San Jorge Bay (Antofagasta, northern Chile) were collected and analyzed. The goal was to evaluate the quality of the bay's water bodies according to the current Chilean Quality Guideline and to establish background levels for these metals. The result suggests that the coastal waters of San Jorge Bay are of very good quality suitable for recreational activities involving human body contact. The natural background thresholds established for this bay were significantly lower than primary and secondary water quality guidelines. The distribution of Cu, Zn and Pb, along the bay's coastline provides evidence of the effects of industrial activity. Both situations suggest that the threshold indicated in the environmental guidelines of the Chilean legislation may be overestimated and do not represent pollution-free environments.

Collective optical Kerr effect exhibited by an integrated configuration of silicon quantum dots and gold nanoparticles embedded in ion-implanted silica.

The study of the third-order optical nonlinear response exhibited by a composite containing gold nanoparticles and silicon quantum dots nucleated by ion implantation in a high-purity silica matrix is presented. The nanocomposites were explored as an integrated configuration containing two different ion-implanted distributions. The time-resolved optical Kerr gate and z-scan techniques were conducted using 80 fs pulses at a 825 nm wavelength; while the nanosecond response was investigated by a vectorial two-wave mixing method at 532 nm with 1 ns pulses. An ultrafast purely electronic nonlinearity was associated to the optical Kerr effect for the femtosecond experiments, while a thermal effect was identified as the main mechanism responsible for the nonlinear optical refraction induced by nanosecond pulses. Comparative experimental tests for examining the contribution of the Au and Si distributions to the total third-order optical response were carried out. We consider that the additional defects generated by consecutive ion irradiations in the preparation of ion-implanted samples do not notably modify the off-resonance electronic optical nonlinearities; but they do result in an important change for near-resonant nanosecond third-order optical phenomena exhibited by the closely spaced nanoparticle distributions.

Electroconvulsive therapy as a treatment for refractory neuropsychiatric lupus with catatonia: three case studies and literature review.

Neuropsychiatric disorders associated with systemic lupus erythematosus are very common. Treatment generally consists of glucocorticoids and immunosuppressive therapy; however, some cases are unresponsive. Electroconvulsive therapy (ECT) is a recognized treatment modality in psychiatry and is an option for refractory cases of neuropsychiatric lupus. This report describes three cases of neuropsychiatric lupus that improved with ECT after failure of antipsychotics and immunosuppressive therapy. All cases met DSM-5 criteria for catatonia (case 1: agitation, stereotypies, and grimacing; case 2: stupor, mutism, and grimacing; case 3: agitation, mutism, and stereotypies); therefore, ECT was indicated. This case series shows that ECT can be a therapeutic option in patients with neuropsychiatric lupus, especially when associated with catatonia and unresponsive to conventional treatment.

Aplicaciones de la ultrasonografía en cadera / Ultrasound Applications on Hip

Ultrasonography (US) in the last decade has gained interest for the study of the hip, with its known advantages over other imaging techniques, although the acoustic window of this joint is small. It is useful to differentiate pathology intra of extra-articular, guide local corticosteroid infiltration and monitoring of the response to systemic or local treatment. It has application in patients with hip osteoarthritis, rheumatoid arthritis and spondyloarthritis, also the prosthetic hip.

La ultrasonografía (US) en la última década ha cobrado interés para el estudio de la cadera, con sus conocidas ventajas sobre otras técnicas de imagen, a pesar de que la ventana acústica de esta articulación sea pequeña. Es de gran utilidad para diferenciar patología intra de la extra articular, guiar la infiltración local de glucocorticoides y monitoreo de la respuesta a tratamiento sistémico o local. Tiene aplicación tanto en la cadera de pacientes con osteoartritis, artritis reumatoide y espondiloartritis como en la cadera protésica.

Actividad oscilatoria en banda gamma, un promisorio nuevo marcador electroencefalográfico de dolor con potencial utilidad en la monitorización intraoperatoria / Gamma band oscillatory activity, a promising new marker electroencephalographic of pain potential utility in monitoring intraoperative

Chronic pain is a highly prevalent condition in modern medicine. Is the main cause of consultation, the principal cause of disability worldwide and represent enormous costs for all health systems. In most cases, chronic pain is a consequence of long exposures to untreated or subtreated acute pain. Efforts should be done in situation where acute pain is expected in order to prevent its transformation into chronic pain. Surgery is one of those situations. Electroencephalography (EEG) is a powerful tool that has proved its utility for monitoring the brain under general anesthesia. Unfortunately most of the achievements have been developed in the study of unconsciousness and amnesia with little progress in the pain/nociception field. Today the electroencephalographic feature more commonly associated with pain perception is the variation in the amplitude of evoked-related potentials (ERPs). However, new date shows that the ERPs do not always reflect the stimulus intensity nor the amount of perceived pain. New data has shown strong and clear evidence that transient Gamma (30-100 Hz) oscillations are a constant electroencephalographic feature associated with pain perception. Gamma oscillations appear, then, as a promising EEG marker than has the potential to be used for monitoring pain/nociception in anesthesia...

Evaluation of Water Sanitation Health Education Programme: Working with the Knowledge of the Basic Sanitation Services in a Developing Community in Rural Haiti after the 2010 Earthquake.

OBJECTIVE: The aim of this study is to measure the knowledge regarding the new sanitation water system being implemented in Dessources, a rural community in the municipality of Croix-des-Bouquets in Haiti after a two-year intervention programme. DESIGN AND METHODS: A cross-sectional epidemiologic design was used to measure the knowledge of the people in the community using a semi-structured questionnaire. Data collection followed a face-to-face interview process in all houses of the community. The instrument content validity was performed by a panel of experts followed by Cronbach's alpha test to establish the reliability of knowledge scale. In addition, association measures were done using Stata 11.0 statistical package. RESULTS: Content validity test were performed with minimum changes and an alpha of 0.74 was obtained for the scale. Response rate was 65.57% (41/60 houses); non-participants were only those who did not meet the inclusion criteria. Most of the participants (77.5%) were 21-49 years old and 85% had been living in the community for more than 20 years. Bivariate analysis showed that the people of Dessources had adequate knowledge. Significant differences, however, were found among the zones that are not in use of the new sanitary systems and among families with more than seven members per house. CONCLUSIONS: Differences found can be explained based on the Rogers theoretical diffusion of innovation model. The evaluation shows that people of Dessources in Haiti have a high knowledge regarding the new water sanitation system and provided evidence of an adequate health education programme intervention.

[Cytokines and the nervous system: the relationship between seizures and epilepsy]. / Citocinas y sistema nervioso: relacion con crisis convulsivas y epilepsia.

INTRODUCTION. The immune system and the peripheral and central nervous system are in constant communication by means of messengers and signalling molecules released, such as cytokines, neuropeptides, neurohormones and neurotransmitters, among others. Seizures are defined as the transitory appearance of signs and symptoms that trigger an abnormally excessive neuronal activity in the brain. Following seizures the generation of a neuroinflammatory process has been observed to occur, with the consequent release of proinflammatory cytokines and inflammation-mediating molecules, which make the patient more prone to epilepsy. AIM. To offer evidence suggesting and supporting the role of cytokines in the appearance of seizures and in epilepsy, since these molecules have proven to have dual properties. DEVELOPMENT. The central nervous system, by means of the blood-brain barrier, restricts the flow of activated cells and inflammation mediators released from the peripheral system towards the brain parenchyma. Moreover, there is also another series of mechanisms that contributes to the 'selective and modified' immunity of the central nervous system. The purpose of all this series of events is to limit the responses of the immune system at central level, although it has been shown that in the central nervous system they are permanently under the control and regulation of the immune system. CONCLUSIONS. Cytokines in epilepsy play a dual role with pro- and anti-convulsive properties. Seizures do not induce the expression of cytokines only inside the brain, but also peripherally.

TITLE: Citocinas y sistema nervioso: relacion con crisis convulsivas y epilepsia.Introduccion. El sistema inmune y el sistema nervioso periferico y central se encuentran en constante comunicacion a traves de mensajeros y moleculas de señalizacion liberadas, como las citocinas, los neuropeptidos, las neurohormonas y los neurotransmisores, entre otros. Las convulsiones se definen como la aparicion transitoria de signos y sintomas que inducen una actividad neuronal excesiva anormal en el cerebro; despues de una crisis convulsiva, se ha observado la generacion de un proceso neuroinflamatorio, con la consecuente liberacion de citocinas proinflamatorias y de moleculas mediadoras de inflamacion, que predisponen a la epilepsia. Objetivo. Mostrar la evidencia que sugiere y apoya el papel de las citocinas en la aparicion de crisis convulsivas y en la epilepsia, ya que estas moleculas han demostrado propiedades duales. Desarrollo. El sistema nervioso central, a traves de la barrera hematoencefalica, restringe el flujo de celulas activadas y de mediadores de inflamacion liberados desde el sistema periferico hacia el parenquima cerebral; ademas, existe otra serie de mecanismos que contribuyen a la inmunidad 'selectiva y modificada' del sistema nervioso central. Toda esta serie de eventos tiene la finalidad de limitar respuestas del sistema inmune a nivel central, aunque se ha demostrado que en el sistema nervioso central se encuentran de manera permanente bajo el control y la regulacion del sistema inmune. Conclusiones. Las citocinas en la epilepsia muestran un papel dual con propiedades pro y anticonvulsionantes. Las convulsiones no solamente inducen la expresion de citocinas dentro del cerebro, sino tambien perifericamente.

Brachytherapy versus radical hysterectomy after external beam chemoradiation with gemcitabine plus cisplatin: a randomized, phase III study in IB2-IIB cervical cancer patients.

BACKGROUND: The aim of the present study was to demonstrate that radical hysterectomy (RH) leads to improved survival outcomes in FIGO stage IB2-IIB cervical cancer when compared with standard brachytherapy (BCT) after identical external beam chemoradiation (EBRT-CT). PATIENTS AND METHODS: EBRT-CT treatment consisted of six courses of cisplatin at 40 mg/m² and gemcitabine at 125 mg/m² per week concurrent with 50.4 Gy of radiation. In the BCT arm, EBRT-CT was followed by BCT to reach a point A dose of 85 Gy, whereas in the experimental arm, a type III RH with bilateral pelvic lymph node dissection and para-aortic lymph node sampling (RH) was carried out within 4-6 weeks after EBRT-CT. RESULTS: Between May 2004 and June 2009, 211 patients were enrolled (BCT, 100 and RH, 111). At a median follow-up time of 36 months (3-80), progression-free survival (PFS) and overall survival (OS) rates were similar in both the arms. PFS rates were 74.8% and 71.7% in the BCT and RH arms [HR 0.6516 (95% confidence interval (CI) 0.3504-1.2116)], P = 0.186. OS rates were 76.3% in the BCT versus 74.5% in the surgical arm [HR 0.6981 (95% CI 0.3106-1.3439)], P = 0.236. No differences were observed in the pattern of local and systemic failures. CONCLUSIONS: This study failed to demonstrate that RH after EBRT-CT is superior to standard BCT.

Late recurrence of cervical cancer: a report of 16 cases.

PURPOSE: To analyze the clinical characteristics and outcome of cervical cancer patients presenting late recurrence. MATERIALS AND METHODS: The medical records of 16 patients who were treated between 1974 and 1999 at the Institution and whose cancer recurred after a five-year disease-free interval were reviewed. RESULTS: Mean time from initial therapy to recurrence was 162.5 months (60-360 mean). Smear abnormalities, atypical genital bleeding, abdominal and lumbar pain, and respiratory findings were the most common symptoms and signs associated with late recurrence. Fourteen patients were diagnosed by physical examination. Three of the six patients with local recurrence who were re-irradiated developed a vesico-vaginal fistula. At a median follow-up time of 12.5 months (4-38 mean), 12 patients were alive and the median survival time was 30 months. CONCLUSIONS: Cervical cancer patients surviving free of disease after the fifth year post-treatment are still at risk for relapse and in most of them, the recurrence is suspected by clinical examination alone.

Associations of killer cell immunoglobulin- like receptor genes with rheumatoid arthritis.

OBJECTIVE: Rheumatoid Arthritis (RA) is an autoimmune and chronic inflammatory disease of unknown etiology. Killer cell immunoglobulin-like receptors are expressed on the surface of natural killer cells and CD28null T-cells, both present in synovial membrane of RA. Therefore we evaluated the associations of KIR genes with RA. METHODS: 16 KIR genes were genotyped in 100 healthy subjects (HS) and 100 RA patients from Western Mexico using PCR-SSP. Differences in KIR genotypes and gene frequencies were assessed using the X^{2} test. RESULTS: Gene frequency of KIR2DL3 was lower in RA than in HS (p= 0.0019), whereas KIR2DL2 and KIR2DS2 were higher in RA than HS (p =0.0004 and p = 0.0487, respectively). In addition were identified 38 genotypes (from G1-G38) in both studied groups, and the genotype frequencies of G1, G6 and G14 showed significant differences (p =0.0001, p =0.0208 and p =0.0300, respectively). CONCLUSIONS: The presence of KIR2DL2, KIR2DS2 and absence of KIR2DL3 are associated with RA. Moreover, two genotypes BX are associated with RA. These results suggest that KIRs can be involved in RA susceptibility.

Neuroblastoma torácico en la adolescencia: caso clínico / Thoracic neuroblastoma in adolescence: clinical case

Neuroblastoma is predominantly a tumor of early childhood, most cases occur in children under 5 years old. It originates in the adrenal gland and paravertebral ganglion cells (neural crest-derived), being the most common an extracranial solid tumor in children. It is characteristic a spontaneous regression, However in some cases it shows progression and dissemination to other organs. Objetive: To show a neuroblastoma in adolescence, with poor response to chemotherapy and radiotherapy, requiring surgery treatment. Clinical case: A 16 y.o. Female patient, previously asymptomatic, who after a body temperature rise up to 39 ° C, was found to have a tumor in the right hemithorax. Biopsy was compatible with neuroblastoma. Surgical removal of a large 20 x 19 cm tumor was achieved, the only complication presented 10 days postop was recurrent pneumothorax. Conclusion: Despite little or no response to standard treatment, surgical resection of this large tumor achieved complete remission for this patient.

El neuroblastoma es predominantemente un tumor de la infancia temprana que en la mayoría de los casos se presenta en menores de 5 años. Se origina en la glándula suprarrenal y células ganglionares paravertebrales (derivadas de la cresta neural), siendo el tumor sólido extracraneal más común en pediatría, presenta regresión espontánea en algunos casos y en otros progresión y diseminación a otros órganos. Objetivo: Analizar el caso de una adolescente portadora de un neuroblastoma resistente a quimioterapia y radioterapia, que requiere tratamiento quirúrgico. Caso clínico: Paciente asintomática, edad 16 años, que a raíz de alza febril se le detecta un tumor en hemitórax derecho. La biopsia fue compatible con un neuroblastoma. Se realizo la extirpación quirúrgica de un gran tumor con diámetro de 20 cm x 19 cm. A los 10 días se complica con neumotórax recidivante. Conclusión: A pesar de la poca o nula respuesta a las armas terapéuticas habituales: quimioterapia y radioterapia, la cirugía logró la resección del tumor torácico con remisión completa.