Maternal dietary patterns and acute leukemia in infants: results from a case control study in Mexico.

Background: Childhood cancer is the leading cause of disease-related mortality among children aged 5-14 years in Mexico, with acute leukemia being the most common cancer among infants. Examining the overall dietary patterns allows for a comprehensive assessment of food and nutrient consumption, providing a more predictive measure of disease risk than individual foods or nutrients. This study aims to evaluate the association between maternal dietary patterns during pregnancy and the risk of acute leukemia in Mexican infants. Methods: A hospital-based case-control study was conducted, comparing 109 confirmed acute leukemia cases with 152 age-matched controls. All participants (≤24 months) were identified at hospitals in Mexico City between 2010 and 2019. Data on a posteriori dietary patterns and other relevant variables were collected through structured interviews and dietary questionnaires. Multivariate logistic regression was employed to estimate the association between maternal dietary patterns during pregnancy and the risk of acute leukemia in infants. Results: The "Balanced & Vegetable-Rich" pattern, characterized by a balanced consumption of various food groups and higher vegetable intake, exhibited a negative association with acute leukemia when compared to the "High Dairy & Cereals" Pattern (adjusted odds ratio [OR] = 0.51; 95% confidence interval [CI]: 0.29, 0.90). We observed that mothers who gave birth to girls and adhered to a healthy dietary pattern during pregnancy exhibited significantly lower odds of their children developing AL compared to those who gave birth to boys [OR = 0.32 (95% CI 0.11, 0.97)]. Our results underscore the significance of maternal nutrition as a modifiable factor in disease prevention and the importance of prenatal health education.

A protective maternal nutrient concomitant intake associated with acute leukemia might be modified by sex, in children under 2 years.

Introduction: Maternal dietary consumption during pregnancy has been inconclusively associated with acute leukemia (AL) in infants, probably because epidemiological evidence has emerged mainly from the analysis of one-by-one nutrient, which is not a real-life scenario. Our objective was to evaluate the association between AL in Mexican children under 2 years of age and their mothers' nutrients concomitant intake during pregnancy, as well as to explore whether there are differences between girls and boys. Methods: We conducted a study of 110 cases of AL and 252 hospital-based controls in the Mexico City Metropolitan area from 2010 to 2019. We obtained information on maternal intake of 32 nutrients by a food frequency questionnaire and used weighted quantile sum regression to identify nutrient concomitant intakes. Results: We found a concomitant intake of nutrients negatively associated with AL (OR 0.17; CI95% 0.03,0.88) only among girls; and we did not find a nutrient concomitant intake positively associated with AL. Discussion: This is the first study that suggests nutrients that have been individually associated with AL are not necessarily the same in the presence of other nutrients (concomitant intake); as well as that maternal diet might reduce AL risk only in girls.

Valor pronóstico del cociente lactato/albúmina para la mortalidad en pacientes mayores de 65 años con infección urinaria complicada / Lactate/albumin ratio prognostic value for mortality in patients older than 65 years with complicated urinary tract infection

Antecedentes El cociente lactato/albúmina (LAR) es un biomarcador emergente de sepsis que se ha evaluado para determinar la mortalidad en pacientes con sepsis de distinto foco. Nuestro objetivo es evaluar el valor pronóstico de LAR en pacientes ingresados en el hospital por infecciones urinarias complicadas. Métodos Estudio observacional prospectivo de pacientes mayores de 65 años diagnosticados de ITU. Se calcularon y compararon el área bajo la curva ROC, la sensibilidad y la especificidad para predecir la mortalidad a 30 días para LAR, qSOFA y SOFA. Resultados Se analizaron 341 casos de ITU. La mortalidad a 30 días (20,2 frente a 6,7%, p<0,001) y la mayor estancia hospitalaria (5 [4-8] frente a 4 [3-7], p=0,018) se asociaron con LAR≥0,708. LAR no presenta diferencias estadísticamente significativas en comparación con qSOFA y SOFA para predecir la mortalidad a 30 días (AUROC 0,737 frente a 0,832 y 0,777, respectivamente, p=0,119 y 0,496). La sensibilidad de LAR fue similar a la de qSOFA y SOFA (60,8 frente a 84,4 y 82,2%, respectivamente, p=0,746 y 0,837). Sin embargo, su especificidad fue inferior a la del qSOFA (60,8 frente a 75%, p=0,003), pero similar a la del SOFA (60,8 frente a 57,8%, p=0,787). Conclusiones LAR no presenta diferencias significativas con otras puntuaciones bien establecidas en sepsis, como qSOFA y SOFA, para predecir la mortalidad a 30 días en pacientes con ITU complicada (AU)

Background Lactate to albumin ratio (LAR) is an emerging sepsis biomarker that has been tested for mortality in patients with sepsis of different focus. Our goal is to evaluate the prognostic value of LAR in patients admitted to the hospital due to complicated urinary tract infections. Methods Prospective observational study of patients older than 65 years diagnosed with UTI. Area under the ROC curve, sensibility, and specificity to predict 30-day mortality were calculated for LAR, qSOFA and SOFA. Results Three hundred and forty-one UTI cases were analyzed. Thirty-day mortality (20.2 vs. 6.7%, p<0.001) and longer hospital stay (5 [4–8] vs. 4 [3–7], p=0.018) were associated with LAR≥0.708. LAR has no statistically significant differences compared to qSOFA and SOFA for predicting 30-day mortality (AUROC 0.737 vs. 0.832 and 0.777, respectively, p=0.119 and 0.496). The sensitivity of LAR was similar to the sensitivity of qSOFA and SOFA (60.8 vs. 84.4 and 82.2%, respectively, p=0.746 and 0.837). However, its specificity was lower than the specificity of qSOFA (60.8 vs. 75%, p=0.003), but similar to the specificity of SOFA (60.8 vs. 57.8%, p=0.787). Conclusions LAR has no significant differences with other well-stablished scores in sepsis, such as qSOFA and SOFA, to predict 30-day mortality in patients with complicated UTI (AU)

Effect of liraglutide on physical performance in type 2 diabetes: Results of a randomized, double-blind, controlled trial (LIPER2).

AIMS: To assess the effect of the GLP-1 analogue liraglutide on measures of cardiac function and physical performance in patients with type 2 diabetes (T2D). METHODS: In this phase-IV randomized double-blind placebo-controlled parallel-group clinical trial at a tertiary hospital, T2D patients with HbA1c levels of 7-10% with oral agents and/or intermediate-/long-acting insulin were allocated (computer-generated randomization, ratio 1:1) to either liraglutide 1.8 mg/day or a placebo for 6 months. The primary endpoint was maximum oxygen consumption (VO2max) during cycle ergometry, while other procedures included a 6-min walk test, echocardiography, anthropometry and blood tests. Safety endpoints were also monitored, and an intention-to-treat analysis was performed. RESULTS: A total of 24 patients (15 women) aged 52 (11.7) years, with diabetes duration of 8.7 (5.8) years, BMI 34.98 (6.2) kg/m2 and HbA1c 8.2% (0.68%), were randomized to liraglutide 1.8 mg daily or placebo. There were no differences in VO2max [17.98 (4.8) vs. 15.90 (4.96) mL/kg/min; P > 0.10], VE/VCO2 slope [30.18 (4.8) vs. 32 (4.49)], left ventricular ejection fraction or 6-min walk test [530.7 (86) vs. 503.9 (84) m] at 6 months. HbA1c was lower (6.7% vs. 7.7%; P = 0.005), with a trend towards lower maximum systolic blood pressure during ergometry [171.7 (24.4) vs. 192.5 (25.6); P = 0.052] in the liraglutide group at the end of the study. There were no severe adverse events. CONCLUSION: In this trial, liraglutide improved glycaemic control in T2D, but had no significant effects on either physical performance or myocardial function.

Perfusión continúa de ropivacaína más fentanilo mediante bloqueo paravertebral torácico guiado con neuroestimulador para el manejo del dolor de un paciente con fracturas costales múltiples / No disponible

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[Brachial plexus block for minimally invasive parathyroidectomy: report of 3 cases]. / Bloqueo del plexo cervical en paratiroidectomía mínimamente invasiva. A propósito de tres casos.

The brachial plexus block, either deep or superficial, is one of the anesthetic techniques used in parathyroidectomy. The block is easy to perform and has few hemodynamic side effects. Surgery can be carried out in an awake patient. We describe 3 cases of patients with primary hyperparathyroidism (parathyroid adenoma) who underwent unilateral minimally invasive parathyroidectomy under regional anesthesia and sedation with 2 mg of midazolam plus remifentanil at dosages ranging from 0.6 to 0.1 microg kg(-1) min(-1). To provide a deep cervical block, we administered 15 mL of 0.75% ropivacaine. For a superficial block, 15 mL of 0.2% ropivacaine was used. The procedure could be completed in all 3 patients under regional anesthesia. The latency time for the block ranged from 21 to 30 minutes, and remifentanil dosages from 0.05 to 0.09 microg kg(-1) min(-1) were administered for procedures that lasted 30 to 45 minutes. No patient required postoperative opioids or antiemetics, although a local anesthetic had to be used at the moment of incision for 1 patient. All 3 patients were discharged the same day. We wish to underline the utility of the brachial plexus block for parathyroid surgery. The technique is easy to perform, safe, and effective; as a result, surgery can be carried out on an outpatient basis.

Bloqueo del plexo cervical en paratiroidectomia minimamente invasiva. A proposito de tres casos / Brachial plexus block for minimally invasive parathyroidectomy: report of 3 cases

El bloqueo del plexo cervical profundo y superficial,es una de las tecnicas anestesicas para el manejo depacientes sometidos a cirugia de paratiroides. Es facil derealizar, con pocos efectos hemodinamicos, y permite llevara cabo la cirugia con el paciente despierto. Presentamostres casos clinicos, en pacientes con hiperparatiroidismo(HPT) primario (adenoma de paratiroides) en losque se les practica una paratiroidectomia unilateral minimamenteinvasiva. Para ello, se realiza una anestesiaregional mas sedacion con midazolam 2 mg y remifentaniloen un rango de 0,06-0,1 ug kg-1min-1. Para el bloqueocervical profundo se administra ropivacaina 0,75% untotal de 15 mL, y para el bloqueo cervical superficial ropivacaina0,2%15 mL. En los tres pacientes se pudo realizarla tecnica quirurgica mediante anestesia regional, conun tiempo de latencia del bloqueo que oscilo entre 21-30min, y unas dosis de remifentanilo 0,05-0,09 ug kg-1min-1durante el tiempo que duro la cirugia (30-45 min). Ningun paciente preciso opioides ni antiemeticos postoperatorios,aunque uno requirio en el momento de la incision la infiltracio nde la piel con anestesico local. Los tres pacientesfueron dados de alta en el dia. Con estos casos clinicos queremos mostrar la utilidad del bloqueo del plexo cervicalpara la cirugia de paratiroides, que ademss de su facil realizacion, es seguro y efectivo, lo que permite queeste tipo de cirugia sea ambulatoria (AU)

The brachial plexus block, either deep or superficial,is one of the anesthetic techniques used inparathyroidectomy. The block is easy to perform andhas few hemodynamic side effects. Surgery can becarried out in an awake patient. We describe 3 cases ofpatients with primary hyperparathyroidism(parathyroid adenoma) who underwent unilateralminimally invasive parathyroidectomy under regionalanesthesia and sedation with 2 mg of midazolam plusremifentanil at dosages ranging from 0.6 to 0.1 ¦Ìg kg-1min-1.To provide a deep cervical block, we administered 15mL of 0.75% ropivacaine. For a superficial block, 15 mLof 0.2% ropivacaine was used. The procedure could becompleted in all 3 patients under regional anesthesia.The latency time for the block ranged from 21 to 30minutes, and remifentanil dosages from 0.05 to 0.09¦Ìg kg-1min-1 were administered for procedures that lasted30 to 45 minutes. No patient required postoperativeopioids or antiemetics, although a local anesthetic had tobe used at the moment of incision for 1 patient. All 3patients were discharged the same day. We wish tounderline the utility of the brachial plexus block forparathyroid surgery. The technique is easy to perform,safe, and effective; as a result, surgery can be carriedout on an outpatient basis (AU)

Tratamiento de hemorragia obstétrica masiva con factor VII recombinante activado en el contexto de un embolismo de líquido amniótico / No disponible

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[Acute myocardial infarction complicating radiofrequency catheter ablation in a girl]. / Infarto agudo de miocardio tras ablación por radiofrecuencia de vía cardiaca anómala en un niño.

Paroxysmal supraventricular tachycardia is the most common tachyarrhythmia in childhood and adolescence. The current treatment of choice for managing and preventing frequent recurrences is radiofrequency catheter ablation, which provides a definitive solution in most cases. This technique is very effective but not devoid of potential complications, particularly in children and adolescents. We report the case of a 3-year-old girl who suffered acute myocardial infarction after occlusion of the right coronary artery during this procedure. We describe intraoperative and postoperative management. Progress was good and the patient was discharged 14 days after ablation.

Infarto agudo de miocardio tras ablación por radiofrecuencia de vía cardiaca anómala en un niño / Acute myocardial infarction complicating radiofrequency catheter ablation in a girl

La taquicardia paroxística supraventricular es lataquiarritmia más frecuente en la infancia y adolescencia.Actualmente el tratamiento de elección para el controly prevención de las frecuentes recidivas es la ablacióntranscatéter por radiofrecuencia, logrando en lamayoría de los casos una solución definitiva del problema.Esta técnica es muy eficaz pero no está exenta deposibles complicaciones, sobre todo en niños y adolescentes.Presentamos el caso de una niña de tres años coninfarto agudo de miocardio tras oclusión de la arteriacoronaria derecha en el transcurso de la ablación transcatéterpor radiofrecuencia. Se muestra el manejo intraoperatorioy postoperatorio en reanimación. La niñaevolucionó favorablemente y pudo ser dada de alta hospitalariaa los 14 días del procedimiento (AU)

Paroxysmal supraventricular tachycardia is the most common tachyarrhythmia in childhood and adolescence. The current treatment of choice for managing and preventing frequent recurrences is radiofrequency catheter ablation, which provides a definitive solution in most cases. This technique is very effective but not devoid of potential complications, particularly in children and adolescents. We report the case of a 3-yearold girl who suffered acute myocardial infarction after occlusion of the right coronary artery during this procedure. We describe intraoperative and postoperative management. Progress was good and the patient was discharged 14 days after ablation (AU)

Remifentanilo en bolos para inducir apnea y bradicardia necesarias para la realización de coronariografía-tcmd en un paciente pediátrico / Remifentanil: bolus doses to induce apnea and bradycardia for coronary arteriography in a pediatric patient

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