Transoperative intravitreal dexamethasone implantation in patients with proliferative vitreoretinopathy.

OBJECTIVE: To compare the anatomical results in patients with rhegmatogenous retinal detachment, at least grade B of proliferative vitreoretinopathy, and with a trans-surgical dexamethasone implant vs the control group. We also assessed the diminution of proliferative vitreoretinopathy and the final visual acuity (VA). METHOD: The patients were evaluated clinically and with optical coherence tomography for 10 months. Logistic regression analyses were performed to evaluate the effect of the dexamethasone implant on retinal detachment. Correlational analyses were explored depending on the variables' distribution, and an independent samples t-test was used to compare the VA in both groups. RESULTS: The study included 38 eyes of patients with proliferative vitreoretinopathy: 18 with the implant and 20 for the control group. The evaluation of the main objective showed significant differences (p < 0.05) in the anatomical success between the two groups (61.1% vs. 20%, treatment vs. control); odds ratio of 6.29; 95% confidence interval: 1.5- 26.8; p = 0.013; Nagelkerke's R2 = 0.225. The t-test showed a significant difference in the final VA of the patients (t = 2.047; df = 36; p = 0.048; Cohen's d = 0.66). CONCLUSIONS: Retinal redetachment was less frequent, and better VA was observed, in patients with the dexamethasone implant in comparison with the control group.

OBJETIVO: Comparar los resultados anatómicos en pacientes con desprendimiento de retina regmatógeno, vitreorretinopatía proliferativa a partir de grado B y aplicación de implante de dexametasona transquirúrgico frente a un grupo control. También se valoraron la disminución de la vitreorretinopatía proliferativa y la agudeza visual (AV) final. MÉTODO: Los pacientes se evaluaron clínicamente y con tomografía de coherencia óptica por 10 meses. Se realizaron análisis de regresión logística para evaluar el efecto del implante en el redesprendimiento de retina. Se exploraron análisis correlacionales dependiendo de la distribución de variables y se aplicó la prueba t de muestras independientes para comparar la AV en ambos grupos. RESULTADOS: Se incluyeron 38 ojos de pacientes con vitreorretinopatía proliferativa: 18 con el implante y 20 del grupo control. La evaluación del objetivo principal mostró diferencias significativas (p < 0.05) en el éxito anatómico entre ambos grupos (61.1% en los ojos con tratamiento frente a 20% en el grupo control); razón de momios de 6.29; intervalo de confianza del 95%: 1.5- 26.8; p = 0.013; R2 de Nagelkerke = 0.225. La prueba t mostró una diferencia significativa entre la AV final de los pacientes (t = 2.047; gl = 36; p = 0.048; d de Cohen = 0.66). CONCLUSIONES: Se observó menor redesprendimiento, así como mejor AV, en los pacientes con el implante de dexametasona en comparación con el grupo control.

Prevalence of kidney disease of unknown etiology in agricultural workers, Guatemala.

Objectives: To determine the prevalence of kidney disease of unknown etiology in banana, melon, and tomato workers in north-eastern Guatemala, and to evaluate the usefulness of a cystatin C blood test for early detection of renal disease. Methods: This was a cross-sectional, farm-based study of 462 agricultural workers conducted from June to September 2021. Epidemiological and demographic characteristics of the workers were collected through a self-administered questionnaire. Blood samples were obtained to determine glucose, creatinine and cystatin C levels. Anthropometric and clinical data were also recorded. Results: The prevalence of kidney disease of unknown etiology was 3.03% (95% confidence interval (CI): 1.36-4.70%) based on glomerular filtration rate (GFR-EPI) < 60 mL/min/1.73 m2, with a significantly higher prevalence in banana workers (5.67%; 95% CI: 2.16-9.18%) than melon workers (p = 0.009) and tomato workers (p = 0.044). Ten workers (2.16%) had reduced kidney function (GFR-EPI 60-90 mL/min/1.73 m2). The levels of cystatin C showed less variability (coefficient of variation 46.4%) than those of creatinine (coefficient of variation 67.0%), and cystatin C levels in cases with abnormal and reduced kidney function were significantly different from cases with normal kidney function (p < 0.001). Conclusions: Surveillance of the health of active farm workers and improvement of working conditions, such as sun protection, adequate hydration, and sufficient breaks, are recommended. The significant differences in cystatin C levels between cases with abnormal and reduced kidney function and those with normal kidney function suggest that cystatin C could be a useful measure for early detection of renal disease.

Prevalence of kidney disease of unknown etiology in agricultural workers, Guatemala

[ABSTRACT]. Objectives. To determine the prevalence of kidney disease of unknown etiology in banana, melon, and tomato workers in north-eastern Guatemala, and to evaluate the usefulness of a cystatin C blood test for early detec- tion of renal disease. Methods. This was a cross-sectional, farm-based study of 462 agricultural workers conducted from June to September 2021. Epidemiological and demographic characteristics of the workers were collected through a self-administered questionnaire. Blood samples were obtained to determine glucose, creatinine and cystatin C levels. Anthropometric and clinical data were also recorded. Results. The prevalence of kidney disease of unknown etiology was 3.03% (95% confidence interval (CI): 1.36–4.70%) based on glomerular filtration rate (GFR-EPI) < 60 mL/min/1.73 m2, with a significantly higher prevalence in banana workers (5.67%; 95% CI: 2.16–9.18%) than melon workers (p = 0.009) and tomato workers (p = 0.044). Ten workers (2.16%) had reduced kidney function (GFR-EPI 60–90 mL/min/1.73 m2). The levels of cystatin C showed less variability (coefficient of variation 46.4%) than those of creatinine (coefficient of variation 67.0%), and cystatin C levels in cases with abnormal and reduced kidney function were significantly different from cases with normal kidney function (p < 0.001). Conclusions. Surveillance of the health of active farm workers and improvement of working conditions, such as sun protection, adequate hydration, and sufficient breaks, are recommended. The significant differences in cystatin C levels between cases with abnormal and reduced kidney function and those with normal kidney function suggest that cystatin C could be a useful measure for early detection of renal disease.

[RESUMEN]. Objetivos. Determinar la prevalencia de la nefropatía de etiología desconocida en el personal de los sectores de la banana, el melón y el tomate en el noreste de Guatemala, así como la utilidad de un análisis de la cistatina C en sangre para su detección temprana. Métodos. Se llevó a cabo un estudio transversal en 462 personas que trabajan en establecimientos agrícolas entre junio y septiembre del 2021. Se utilizaron cuestionarios rellenados por las propias personas encuesta- das a fin de recopilar sus características epidemiológicas y demográficas. Se tomaron muestras de sangre para determinar las concentraciones de glucosa, creatinina y cistatina C. También se obtuvieron datos antro- pométricos y clínicos. Resultados. La prevalencia de la nefropatía de etiología desconocida, definida por una filtración glomerular (determinada con la fórmula GRF—EPI) <60 ml/min/1,73 m2, fue del 3,03% (intervalo de confianza [IC] del 95%: 1,36–4,70%); y la cifra fue significativamente mayor en el personal del sector de la banana (5,67%; IC 95%: 2,16–9,18%) que en el de los sectores del melón (p = 0,009) y del tomate (p = 0,044). Diez personas (2,16%) presentaron una reducción de la función renal (GRF—EPI 60—90 ml/min/1,73 m2). Se observó una menor variabilidad en las concentraciones de cistatina C (coeficiente de variación del 46,4%) que en las de creatinina (coeficiente de variación del 67,0%); asimismo, hubo una diferencia significativa (p <0,001) de las concentraciones de cistatina C entre las personas con un valor anormal o una reducción de la función y las que tenían una función renal normal. Conclusiones. Se recomienda la vigilancia de la salud del personal laboral del sector agrícola y la mejora de sus condiciones de trabajo, por ejemplo mediante la protección frente a la luz solar, una hidratación adecuada y un número suficiente de pausas en el trabajo. Las diferencias significativas en las concentraciones de cistatina C entre las personas con una función renal alterada o reducida y las personas con una función renal normal hacen pensar que la determinación de la cistatina C podría ser un parámetro útil para la detec- ción precoz de la nefropatía.

[RESUMO]. Objetivos. Determinar a prevalência de doença renal de etiologia desconhecida em trabalhadores que cultivam banana, melão e tomate no nordeste da Guatemala e avaliar a utilidade da dosagem sanguínea de cistatina C para detecção precoce de doença renal. Métodos. Estudo transversal realizado de junho a setembro de 2021 com 462 trabalhadores rurais em unidades produtoras agrícolas. As características epidemiológicas e demográficas dos trabalhadores foram coletadas por meio de um questionário autoadministrado. Foram obtidas amostras de sangue para dosagem de glicose, creatinina e cistatina C. Os dados antropométricos e clínicos também foram registrados. Resultados. A prevalência da doença renal de etiologia desconhecida foi de 3,03% (intervalo de confiança (IC) de 95%: 1,36-4,70%), com base em uma taxa de filtração glomerular (TFG-EPI) < 60 mL/min/1,73 m2. A prevalência foi significantemente maior em cultivadores de banana (5,67%; IC de 95%: 2,16-9,18%) do que em cultivadores de melão (p = 0,009) e de tomate (p = 0,044). Dez trabalhadores (2,16%) tinham função renal reduzida (TFG-EPI 60-90 mL/min/1,73 m2). Os níveis de cistatina C foram menos variáveis (coeficiente de variação: 46,4%) que os de creatinina (coeficiente de variação: 67,0%). Os níveis de cistatina C foram significantemente diferentes entre casos com função renal alterada ou reduzida e casos com função renal normal (p < 0,001). Conclusões. Recomenda-se a vigilância da saúde dos trabalhadores rurais ativos e a melhoria das condições de trabalho, como proteção contra o sol, hidratação adequada e intervalos de descanso suficientes. As diferenças significantes nos níveis de cistatina C entre trabalhadores com função renal alterada ou reduzida e trabalhadores com função renal normal sugerem que a cistatina C poderia ser uma medida útil para a detecção precoce da doença renal.

Prevalence of kidney disease of unknown etiology in agricultural workers, Guatemala / Prevalencia de la nefropatía de etiología desconocida en el personal del sector agrícola de Guatemala / Prevalência de doença renal de etiologia desconhecida em trabalhadores agrícolas na Guatemala

ABSTRACT Objectives. To determine the prevalence of kidney disease of unknown etiology in banana, melon, and tomato workers in north-eastern Guatemala, and to evaluate the usefulness of a cystatin C blood test for early detection of renal disease. Methods. This was a cross-sectional, farm-based study of 462 agricultural workers conducted from June to September 2021. Epidemiological and demographic characteristics of the workers were collected through a self-administered questionnaire. Blood samples were obtained to determine glucose, creatinine and cystatin C levels. Anthropometric and clinical data were also recorded. Results. The prevalence of kidney disease of unknown etiology was 3.03% (95% confidence interval (CI): 1.36-4.70%) based on glomerular filtration rate (GFR-EPI) < 60 mL/min/1.73 m2, with a significantly higher prevalence in banana workers (5.67%; 95% CI: 2.16-9.18%) than melon workers (p = 0.009) and tomato workers (p = 0.044). Ten workers (2.16%) had reduced kidney function (GFR-EPI 60-90 mL/min/1.73 m2). The levels of cystatin C showed less variability (coefficient of variation 46.4%) than those of creatinine (coefficient of variation 67.0%), and cystatin C levels in cases with abnormal and reduced kidney function were significantly different from cases with normal kidney function (p < 0.001). Conclusions. Surveillance of the health of active farm workers and improvement of working conditions, such as sun protection, adequate hydration, and sufficient breaks, are recommended. The significant differences in cystatin C levels between cases with abnormal and reduced kidney function and those with normal kidney function suggest that cystatin C could be a useful measure for early detection of renal disease.

RESUMEN Objetivos. Determinar la prevalencia de la nefropatía de etiología desconocida en el personal de los sectores de la banana, el melón y el tomate en el noreste de Guatemala, así como la utilidad de un análisis de la cistatina C en sangre para su detección temprana. Métodos. Se llevó a cabo un estudio transversal en 462 personas que trabajan en establecimientos agrícolas entre junio y septiembre del 2021. Se utilizaron cuestionarios rellenados por las propias personas encuestadas a fin de recopilar sus características epidemiológicas y demográficas. Se tomaron muestras de sangre para determinar las concentraciones de glucosa, creatinina y cistatina C. También se obtuvieron datos antropométricos y clínicos. Resultados. La prevalencia de la nefropatía de etiología desconocida, definida por una filtración glomerular (determinada con la fórmula GRF—EPI) <60 ml/min/1,73 m2, fue del 3,03% (intervalo de confianza [IC] del 95%: 1,36-4,70%); y la cifra fue significativamente mayor en el personal del sector de la banana (5,67%; IC 95%: 2,16-9,18%) que en el de los sectores del melón (p = 0,009) y del tomate (p = 0,044). Diez personas (2,16%) presentaron una reducción de la función renal (GRF—EPI 60—90 ml/min/1,73 m2). Se observó una menor variabilidad en las concentraciones de cistatina C (coeficiente de variación del 46,4%) que en las de creatinina (coeficiente de variación del 67,0%); asimismo, hubo una diferencia significativa (p <0,001) de las concentraciones de cistatina C entre las personas con un valor anormal o una reducción de la función y las que tenían una función renal normal. Conclusiones. Se recomienda la vigilancia de la salud del personal laboral del sector agrícola y la mejora de sus condiciones de trabajo, por ejemplo mediante la protección frente a la luz solar, una hidratación adecuada y un número suficiente de pausas en el trabajo. Las diferencias significativas en las concentraciones de cistatina C entre las personas con una función renal alterada o reducida y las personas con una función renal normal hacen pensar que la determinación de la cistatina C podría ser un parámetro útil para la detección precoz de la nefropatía.

RESUMO Objetivos. Determinar a prevalência de doença renal de etiologia desconhecida em trabalhadores que cultivam banana, melão e tomate no nordeste da Guatemala e avaliar a utilidade da dosagem sanguínea de cistatina C para detecção precoce de doença renal. Métodos. Estudo transversal realizado de junho a setembro de 2021 com 462 trabalhadores rurais em unidades produtoras agrícolas. As características epidemiológicas e demográficas dos trabalhadores foram coletadas por meio de um questionário autoadministrado. Foram obtidas amostras de sangue para dosagem de glicose, creatinina e cistatina C. Os dados antropométricos e clínicos também foram registrados. Resultados. A prevalência da doença renal de etiologia desconhecida foi de 3,03% (intervalo de confiança (IC) de 95%: 1,36-4,70%), com base em uma taxa de filtração glomerular (TFG-EPI) < 60 mL/min/1,73 m2. A prevalência foi significantemente maior em cultivadores de banana (5,67%; IC de 95%: 2,16-9,18%) do que em cultivadores de melão (p = 0,009) e de tomate (p = 0,044). Dez trabalhadores (2,16%) tinham função renal reduzida (TFG-EPI 60-90 mL/min/1,73 m2). Os níveis de cistatina C foram menos variáveis (coeficiente de variação: 46,4%) que os de creatinina (coeficiente de variação: 67,0%). Os níveis de cistatina C foram significantemente diferentes entre casos com função renal alterada ou reduzida e casos com função renal normal (p < 0,001). Conclusões. Recomenda-se a vigilância da saúde dos trabalhadores rurais ativos e a melhoria das condições de trabalho, como proteção contra o sol, hidratação adequada e intervalos de descanso suficientes. As diferenças significantes nos níveis de cistatina C entre trabalhadores com função renal alterada ou reduzida e trabalhadores com função renal normal sugerem que a cistatina C poderia ser uma medida útil para a detecção precoce da doença renal.

Melanoma del cuerpo ciliar en un adulto joven: reporte de caso / Ciliary body melanoma in a young adult: a case report

Resumen Reporte de un caso: Femenino de 29 años de edad sin comorbilidades, con baja visual progresiva en ojo derecho de 1 mes de evolución. A la exploración oftalmológica agudeza visual de ese ojo en 20/80, conjuntiva bulbar superior con vaso centinela, masa retroiridiana color naranja vascularizada que subluxa el cristalino hacia inferior. Por ultrabiomicroscopía se evidencia una masa en domo dependiente del cuerpo ciliar de 4.87x5.74mm con reflectividad interna media y regular. Se realiza primeramente BAAF reportando melanoma, después se hace enucleación con resultado histopatológico de melanoma amelanótico. Posterior, se realiza implante de prótesis cosmética y se encuentra en seguimiento por oncología sin presentar datos de actividad tumoral después de 4 años. Discusión: Los melanomas uveales son la causa más común de tumores malignos intraoculares primarios en adultos, localizados principalmente en coroides (90%), siendo extremadamente rara su aparición en el cuerpo ciliar (6%) e iris (4%). El abordaje de un tumor del cuerpo ciliar debe incluir una anamnesis y exploración física completa con estudios paraclínicos adecuados para poder discernir entre los diagnósticos diferenciales. El ultrasonido ocular es el estudio auxiliar más importante ya que brinda características típicas propias del tumor. El tratamiento continúa basado en el COMS con un pronóstico sombrío. Los factores de mal pronóstico son presencia de metástasis, tamaño del tumor, extensión extraocular y estirpe epitelioide. Limitaciones: No se contaban con todas las alternativas de tratamiento. Originalidad: Caso inusual en pacientes jóvenes y por su sitio.

Abstract: Case report: 29-year-old female with no comorbidities, with progressive vision loss in the right eye of 1 month's evolution. On ophthalmological examination, visual acuity was 20/80, superior bulbar conjunctiva with sentinel vessel, vascularised orange retroiridian mass generating a lens subluxation inferiorly. Ultrabiomicroscopy revealed a dome-shaped mass dependent on the ciliary body measuring 4.87x5.74mm with medium and regular internal reflectivity. A FNA was done and melanoma was reported, then enucleation was performed with histopathological findings of amelanotic melanoma. Subsequently, a cosmetic prosthesis was implanted and the patient has been followed up by oncology with no evidence of tumour activity after 4 years. Discussion: Uveal melanomas are the most common cause of primary intraocular malignant tumours in adults, mainly located in the choroid (90%), being extremely rare in the ciliary body (6%) and iris (4%). The approach to a ciliary body tumour should include a complete anamnesis and physical examination with appropriate paraclinical studies to be able to discern between differential diagnoses. Ocular ultrasound is the most important ancillary study as it provides typical features of the tumour. Treatment is still based on COMS and the prognosis remains poor. Poor prognostic factors are the presence of metastases, tumour size, extraocular extension and epithelioid lineage. Limitations: Not all treatment alternatives were available. Originality: Unusual case in young patients and because of its site.

Beyond words: From jaguar population trends to conservation and public policy in Mexico.

The jaguar (Panthera onca) is one of the most threatened carnivores in the Americas. Despite a long history of research on this charismatic species, to date there have been few systematic efforts to assess its population size and status in most countries across its distribution range. We present here the results of the two National Jaguar Surveys for Mexico, the first national censuses in any country within the species distribution. We estimated jaguar densities from field data collected at 13 localities in 2008-2010 (2010 hereafter) and 11 localities in 2016-2018 (2018 hereafter). We used the 2010 census results as the basis to develop a National Jaguar Conservation Strategy that identified critical issues for jaguar conservation in Mexico. We worked with the Mexican government to implement the conservation strategy and then evaluated its effectivity. To compare the 2010 and 2018 results, we estimated the amount of jaguar-suitable habitat in the entire country based on an ecological niche model for both periods. Suitable jaguar habitat covered ~267,063 km2 (13.9% of the country's territory) in 2010 and ~ 288,890 km2 (~14.8% of the country's territory) in 2018. Using the most conservative density values for each priority region, we estimated jaguar densities for both the high and low suitable habitats. The total jaguar population was estimated in ~4,000 individuals for 2010 census and ~4,800 for the 2018 census. The Yucatan Peninsula was the region with the largest population, around 2000 jaguars, in both censuses. Our promising results indicate that the actions we proposed in the National Jaguar Conservation Strategy, some of which have been implemented working together with the Federal Government, other NGO's, and land owners, are improving jaguar conservation in Mexico. The continuation of surveys and monitoring programs of the jaguar populations in Mexico will provide accurate information to design and implement effective, science-based conservation measures to try to ensure that robust jaguar populations remain a permanent fixture of Mexico's natural heritage.

[Inequalities in access to cancer screening programmes in Spain and how to reduce them: data from 2013 and 2020.] / Desigualdades de acceso a los programas de cribado del cáncer en España y cómo reducirlas: datos de 2013 y 2020.

OBJECTIVE: The European Commission recommends ensuring equity in cancer screening. The aim of this study was to find out if there were inequalities in access to cancer screening programmes in Spain. METHODS: A transversal study was carried out by means of a survey addressed to the people responsible for breast, colorectal (CRC) and cervical cancer screening programmes in the 19 Autonomous Communities (AC) of Spain in 2013 and 2020. Information was collected on organizational characteristics, inequalities in access and interventions to reduce them. A descriptive analysis was made by AC and time period, by calculating frequencies and percentages, depending on the type of programme (breast, CRC and cervix). RESULTS: In 2013, 14 ACs participated for the breast programme, 8 for the CRC and 7 for the cervical programme; and in 2020, 14, 13 and 11 ACs respectively. All breast programmes were population-based in both periods (14/14 in 2013 and 14/14 in 2020), as well as CRC ones (8/8 in 2013 and 13/13 in 2020), with an increase in cervical cancer programmes (0/7 en 2013 y 6/11 en 2020). In both periods, social groups not included in the target population and groups that were less involved were identified, with differences according to the type of programme. A total of 53 interventions were carried out to reduce inequalities in access (27 in breast, 22 in RCC and 4 in cervical), 66% of them aimed at specific social groups (35/53). CONCLUSIONS: Inequalities in access to cancer screening programmes in Spain are identified, as well as interventions to reduce them.

OBJETIVO: La Comisión Europea recomienda asegurar la equidad en el cribado del cáncer. El objetivo de este estudio fue conocer si existían desigualdades en el acceso a los programas de cribado del cáncer en España. METODOS: Se realizó un estudio transversal mediante encuesta dirigida a las personas responsables de los programas de cribado del cáncer de mama, colorrectal (CCR) y cérvix de las diecinueve Comunidades Autónomas (CCAA) del Estado Español en 2013 y 2020. Se recogió información sobre características organizativas, desigualdades de acceso e intervenciones para reducirlas. Se hizo un análisis descriptivo por CCAA y periodo temporal, mediante el cálculo de frecuencias y porcentajes, en función del tipo de programa (mama, CCR y cérvix). RESULTADOS: En 2013 participaron catorce CCAA para el programa de mama, ocho para el de CCR y siete para el de cérvix, y en 2020, catorce, trece y once CCAA, respectivamente. Todos los programas de mama eran poblacionales en ambos periodos (14/14 en 2013 y 14/14 en 2020), así como los de CCR (8/8 en 2013 y 13/13 en 2020), con un aumento en el caso de los programas de cribado del cáncer de cérvix (0/7 en 2013 y 6/11 en 2020). Se identificaron en ambos periodos grupos sociales no incluidos en la población diana y grupos que, estando incluidos, participaban menos, con diferencias según el tipo de programa. Se realizaron un total de cincuenta y tres intervenciones para reducir desigualdades en el acceso (veintisiete en mama, veintidós en CCR y cuatro en cérvix), el 66% de ellas dirigidas a grupos sociales específicos (35/53). CONCLUSIONES: Se identifican desigualdades de acceso a los programas de cribado del cáncer en España, así como intervenciones para reducirlas.

Gallbladder cancer in South America: epidemiology and prevention.

The incidence and the mortality of gallbladder cancer (GBC) show significant variation worldwide, with high age-standardized rates in western South America (SA). Due to the lack of effective measures for prevention, the late diagnosis and the small benefit of systemic treatment, GBC has an ominous prognosis and became an important public health problem in this part of the continent, where the most important risk factors are gallstone disease, female gender, age, ethnic groups, and low socioeconomic status. Many genetic abnormalities have been described in series from SA, some of them similar and others unique in comparison to gene alterations in GBC from other regions of the world. Prophylactic cholecystectomy (PC) is one of the strategies to decrease the mortality but its cost-effectiveness is questionable. A way to improve the performance of PC is to identify molecular risk factors that in combination with currently known ones detect patients with very high risk for developing GBC. Also, more research studies are required to better understand the epidemiology and molecular biology in order to improve the prevention and treatment of this lethal disease.

Potential uses of an infodemiology approach for health-care services for rheumatology.

OBJECTIVES: This is a demand-based infodemiology study using the Google Trends and AdWords tools to illustrate infodemiology's potential use in rheumatology. The study investigates three questions in North American countries: (1) What terms associated with "rheumatology" and "arthritis" do people search for on Google? (2) What is the search volume for disease-modifying antirheumatic drugs (DMARDs)? and (3) What is the search volume for the term "arthritis" compared with for "hepatitis C" and "breast cancer"? METHODS: We conducted independent searches by country and search term for 2015-2017. Seventeen DMARDs were searched for 2015 through May 2018, with the turmeric remedy included for comparison. Data were exported to Excel for further analysis, adjusted by country population, and expressed as searches per 100,000 inhabitants (SpTh). RESULTS: There were approximately 550 associated terms for "arthritis" in each country, and 5679 SpTh for DMARDs across the three countries. Searches for turmeric numbered slightly lower than for all DMARDs together in Canada and the USA, but were 70% higher in Mexico. Turmeric was also searched four times more than the most-searched biological DMARD in Canada and the USA, and 60 times more in Mexico. Arthritis was more commonly searched for in Canada than hepatitis C and breast cancer, but hepatitis C was highest in the USA and breast cancer in Mexico. Monthly trends did not show expected peaks associated with arthritis awareness campaigns. CONCLUSION: Infodemiology provides preliminary information that could help in generating hypotheses, assessing health-care interventions, or even in providing patient-centered care.

Coriorretinopatía esclopetaria manejada con vitrectomía pars plana temprana. Reporte de un caso / Chorioretinitis sclopetaria managed with early pars plana vitrectomy. Case report

Resumen Introducción La coriorretinopatía esclopetaria es una rara entidad resultante de un trauma por proyectil de alta velocidad que haya pasado adyacente o a través de la órbita, sin penetrar el globo ocular. Provoca daño coriorretiniano de espesor completo y pérdida visual. Objetivo Presentar un caso clínico de esta rara entidad, tratada de manera poco habitual, dados los hallazgos clínicos iniciales y con buen resultado final. Reporte de un caso Masculino de 42 años de edad, que refirió una fuerte detonación de arma de fuego cerca del globo ocular. Presentó baja visual los días posteriores y se diagnosticó hemovítreo; se realizó un ultrasonido ocular, el cual reportó desgarro retiniano, por lo que se realizó vitrectomía pars plana. Al final del seguimiento, se encontró con capacidad visual de cuenta dedos a 30 cm. Se realizaron estudios complementarios para documentar los hallazgos clínicos, presentando fractura coroidea con involucro macular. Se describe su seguimiento por cuatro semanas; se mantiene con estabilidad visual, sin complicaciones posteriores. Conclusiones Presentamos el caso de una coriorretinopatía esclopetaria, la cual está escasamente reportada. Hasta el momento, es el primer caso tratado con vitrectomía temprana sin complicaciones posteriores y estabilidad visual posterior.

Abstract Introduction Chorioretinitis sclopetaria is a rare entity resulting from trauma by a high-velocity projectile that passed adjacent or through the orbit without penetrating the eyeball. It causes full-thickness chorioretinal damage and visual loss. Objective To present a clinical case of the entity treated in an unusual way, with a good result. Case report 42 year-old male who mentioned a strong firearm detonation near the eyeball. Days later, he presented with visual loss, and hemovitreous was diagnosed. An ocular ultrasound was done, which reported retinal tear, so a pars plana vitrectomy was performed. At the end of the follow up, there was a visual ability to count fingers at 30 cm. Complementary studies were carried out to document the clinical findings, showing a choroidal fracture with macular involvement. Follow-up was carried up to four weeks after the intervention, without complications and with visual stability. Conclusions We present a case of chorioretinitis sclopetaria, which is scarcely reported; so far, this is the first case treated with early vitrectomy without later complications.

Diez pasos básicos para escribir y publicar un artículo científico / Ten basic steps to write and publish a scientific article

La elaboración de un manuscrito y su publicación en revistas indexadas, es la culminación de un proyecto de investigación, es la forma en que los investigadores comparten el nuevo conocimiento con sus pares y constituye el principal mecanismo de visibilidad personal e institucional, a nivel nacional e internacional. El presente ensayo tuvo como objetivo elaborar una guía básica de cómo preparar un manuscrito y brindar elementos prácticos para lograr su publicación. Se describen los 10 pasos básicos, que señalan el orden en que deben abordarse las secciones de un artículo científico, así como el contenido de las mismas. Finalmente se presenta una tabla que mediante preguntas e indicaciones, resume el contenido de cada una de las secciones del artículo. Se espera que con esta guía, los investigadores encuentren una herramienta útil que les ayude a escribir y publicar artículos científicos.

Preparing and publishing a scientific manuscript in peer reviewed journals, is the final phase of a research project, it represents the way of sharing new knowledge with other scientists, and is the principal mechanism for personal and institutional visibility at national and international level. The objective of this essay was to prepare a basic guide on how to write a manuscript and to provide practical elements to achieve its publication. Ten basic steps are described, which point out the order to approach the sections of a scientific paper, as well as the content of each section. Finally the paper presents a table which by using questions and indications provides tips for writing each section of a scientific paper. It is expected that this guide will help young scientists to write and publish scientific papers.

Effect of the Various Steps in the Processing of Human Milk in the Concentrations of IgA, IgM, and Lactoferrin.

INTRODUCTION: Human milk immune components are unique and important for the development of the newborn. Milk processing at the Human Milk Banks (HMB), however, causes partial destruction of immune proteins. The objective of this study was to determine the effects that heating during the milk processing procedure at the HMB had on the concentrations of IgA, IgM, and lactoferrin at three critical points in time. MATERIALS AND METHODS: Fifty milk samples (150 mL) were collected from voluntary donors at the HMB at the Hospital Nacional Pedro de Bethancourt, located in Antigua Guatemala. Samples from three critical points in time during the milk processing procedure were selected for analysis: freezing/thawing I, freezing/thawing II, and pasteurization. IgA, IgM, and lactoferrin concentrations were determined during each critical point and compared with a baseline concentration. RESULTS: After milk processing, IgA, IgM, and lactoferrin mean concentrations were reduced by 30.0%, 36.0%, and 70.0%, respectively (p < 0.001). Reduction of biological activity was mainly attributed to pasteurization for IgA and lactoferrin (p < 0.001); the first freezing/thawing processes before pasteurization showed no significant reduction difference between mean concentrations of IgA (p = 0.160) and lactoferrin (p = 0.345) but showed a significant effect on IgM concentration (p = 0.016), and the second freezing/thawing procedure only showed a significant effect on IgA (p < 0.001). CONCLUSIONS: The effects of milk processing on the immune proteins that were evaluated in this study demonstrated a significant reduction.

Presence of Antibodies to Leptospira spp. in Black-tailed Prairie Dogs ( Cynomys ludovicianus ) and Beavers ( Castor canadensis ) in Northwestern Mexico.

Leptospires are widespread spirochete bacteria that infect mammals, including rodents and humans. We investigated the presence of Leptospira antibodies in two species of rodents from San Pedro River Basin (SPRB) in northwestern Mexico as part of the black-tailed prairie dog ( Cynomys ludovicianus ) monitoring plan and the North American beaver ( Castor canadensis ) reintroduction program. We sampled a total of 26 black-tailed prairie dogs and three beavers during October-November 2015. We detected antibodies against Leptospira spp. by microagglutination test in 12 (46%) prairie dogs and in two (67%) beavers. The antibody titers for seropositive rodents varied from 1:100 to 1:200, but none of the animals showed clinical signs of disease. We found seven Leptospira spp. serogroups (Autumnalis, Australis, Bataviae, Canicola, Celledoni, Grippotyphosa, and Sejroe) circulating in rodent species in SPRB. We did not find any differences between sex and age concerning Leptospira-positive rodents. Our findings suggest the presence of endemic cycles and potential risks of Leptospira infection in both species from SPRB. Although the impact of this infection on threatened species remains unclear, human activities and environmental stress might facilitate the emergence or reemergence of leptospirosis disease as has been reported elsewhere.

Sobreexpresión de C-MET en carcinoma de vesícula y del tracto biliar: prevalencia y correlación clínico-molecular / Overexpression of C-MET in gallbladder and biliary tract carcinoma: prevalence and clinical-molecular correlation

El objetivo fue determinar la sobreexpresión de c-MET en pacientes con cáncer biliar y analizar asociaciones con parámetros clínicos. Este es un estudio descriptivo, longitudinal, retrospectivo y prospectivo. Se determinó la sobreexpresión por inmunohistoquímica en 58 pacientes con resultados: positivo fuerte, positivo débil y negativo. Se construyeron curvas de supervivencia global con el método de KaplanMeier en todos los pacientes y en subgrupos según estadío, género, origen tumoral y grado de diferenciación histológica. La diferencia en supervivencia global entre subgrupos se analizó por el método log-rank. La asociación entre sobreexpresión y grado de diferenciación se estudió por el método chi cuadrado. Las pruebas estadísticas se realizaron a dos colas con un valor de p 0.05. Veintinueve muestras (50%) fueron negativas, 24 (41%) positivas débiles y 5 (9%) positivas fuertes. La mediana de supervivencia fue 18.2, 11.3 y 11.7 meses en pacientes con sobreexpresión negativa, positiva débil y positiva fuerte, respectivamente. Sin embargo, la diferencia en supervivencia global entre pacientes c-MET negativos y positivos (fuerte y débil) no alcanzó significancia estadística (p 0.068). En los subgrupos los resultados fueron similares. La sobreexpresión se asoció al grado de diferenciación (p 0.015), mostrando una relación inversa; y no se correlacionó con tasa de respuesta a la quimioterapia y tiempo a la progresión. La sobreexpresión de c-MET es frecuente en cáncer biliar, se asocia al grado de diferenciación tumoral y podría tener valor pronóstico. Si la vía c-MET es importante, los fármacos inhibidores tendrían impacto en la supervivencia global (AU)

The objective was to determine the overexpression of c-MET in patients with biliary cancer and to analyze associations with clinical parameters. This is a descriptive, longitudinal, retrospective and prospective study. Overexpression was obtained by immunohistochemistry in 58 patients, with the following results: strong positive, weak positive and negative. Overall survival curves were constructed using the Kaplan-Meier method in all patients and in subgroups according to stage, gender, tumor origin and grade of histological differentiation. The difference in overall survival between groups was analyzed by the log-rank test. The association between overexpression and grade of differentiation was studied using the chisquare method. Statistical tests were two-tailed with a p value 0.05. Twenty nine samples (50%) were negative, 24 (41%) weak positive and 5 (9%) strong positive. Median survival was 18.2, 11.3 and 11.7 months in patients with negative, weak positive and strong positive overexpression, respectively. However, the difference in overall survival between negative and positive (strong and weak together) c-MET patients did not reach statistical significance (p 0.068). In the subgroup analyses the results were similar. Overexpression correlated with tumor grade (p 0.015), showing an inverse association; and was not associated neither with chemotherapy response rate nor with time to progression. Overexpression of c-MET is common in biliary cancer, is associated with grade of tumor differentiation and could have prognostic value. If the c-MET pathway is important, the inhibitory drugs would have an impact on overall survival (AU)

Gallbladder cancer: South American experience.

Large differences in terms of incidence and mortality due to gallbladder cancer (GBC) have been reported worldwide. Moreover, it seems that GBC has unique characteristics in South America. We surveyed the literature looking for information about the epidemiology, basic and translational research, and clinical trials performed in South America in order to critically analyze the magnitude of this health problem in the region. Compared to other geographic areas, age-standardized mortality rates (ASMR) for GBC in women are very high, particularly in many western areas of South America. Genetic, as well as dietary and environmental factors likely contribute to the pathogenesis of this disease in the area. Compared to other regions the profile of abnormalities of key genes such as KRAS and TP53 in GBC seems to slightly differ in South America, while the clinical behavior appears to be similar with a median overall survival (OS) of 6.5 to 8 months in advanced GBC. In contrast to Europe and USA, prophylactic cholecystectomy is a common practice in western areas of South America. GBC particularly affects women in South America, and represents a significant public health problem. It appears to have peculiarities that pose an urgent need for additional research aimed to discover risk factors, molecular events associated with its development and new treatment options for this lethal disease.

[Palliative treatment for locally advanced or metastatic gallbladder cancer: conclusions of the Latin American Consensus meeting for the management of gallbladder cancer]. / Manejo paliativo del cáncer de vesícula biliar irresecable o metastásico: conclusiones del Consenso Latinoamericano de Manejo del Cáncer de Vesícula Biliar.

Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: (1) Gallbladder cancer and cholangiocarcinoma--are they the same disease?; (2) Palliative chemotherapy: indications, drugs and schedules; (3) Palliative radiotherapy; (4) Palliative Surgery; (5) Management of malignant biliary obstruction.

Manejo paliativo del cáncer de vesícula biliar irresecable o metastásico: Conclusiones del Consenso Latinoamericano de Manejo del Cáncer de Vesícula Biliar / Palliative treatment for locally advanced or metastatic gallbladder cancer: conclusions of the Latin American Consensus meeting for the management of gallbladder cancer

Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: 1.- Gallbladder Cancer and Cholangiocarcinoma -are they the same disease?; 2. - Palliative Chemotherapy: Indications, Drugs and Schedules; 3. - Palliative Radiotherapy; 4.- Palliative Surgery; 5.-Management of Malignant Biliary Obstruction.

Incidencia y etiología de vaginitis infecciosa en mujeres Guatemaltecas / Incidence and etiology of infectious vaginitis Guatemalan women

La vaginitis es el proceso patológico que con mayor frecuencia afecta a mujeres en edad reproductiva y puede ser responsable, en algunos casos, de complicaciones y secuelas serias para la salud de la mujer. En Guatemala, no se tiene conocimiento preciso de la frecuencia de estos procesos, ni tampoco de los agentes que lo causan, razón por la cual se llevó a cabo esta investigación. Se realizó un estudio prospectivo en 594 pacientes que asistieron a la clínica de Papanicolaou de la Asociación Pro-bienestar de la familia (APROFAM) en la ciudad de Guatemala, las cuales fueron evaluadas clínicamente y mediante pruebas de laboratorio para determinar la presencia de microorganismos patógenos. Utilizando una metodología de laboratorio sencilla y estrictas definiciones de caso, se determinó que 305 pacientes (51.3%) padecían de vaginitis...