MYC directly transactivates CR2/CD21, the receptor of the Epstein-Barr virus, enhancing the viral infection of Burkitt lymphoma cells.

MYC is an oncogenic transcription factor dysregulated in about half of total human tumors. While transcriptomic studies reveal more than 1000 genes regulated by MYC, a much smaller fraction of genes is directly transactivated by MYC. Virtually all Burkitt lymphoma (BL) carry chromosomal translocations involving MYC oncogene. Most endemic BL and a fraction of sporadic BL are associated with Epstein-Barr virus (EBV) infection. The currently accepted mechanism is that EBV is the BL-causing agent inducing MYC translocation. Herein we show that the EBV receptor, CR2 (also called CD21), is a direct MYC target gene. This is based on several pieces of evidence: MYC induces CR2 expression in both proliferating and arrested cells and in the absence of protein synthesis, binds the CR2 promoter and transactivates CR2 in an E-box-dependent manner. Moreover, using mice with conditional MYC ablation we show that MYC induces CR2 in primary B cells. Importantly, modulation of MYC levels directly correlates with EBV's ability of infection in BL cells. Altogether, in contrast to the widely accepted hypothesis for the correlation between EBV and BL, we propose an alternative hypothesis in which MYC dysregulation could be the first event leading to the subsequent EBV infection.

A Possible Case of Centronuclear Myopathy: A Case Report.

Congenital myopathies (CMs) are a group of diseases that primarily affect the muscle fiber, especially the contractile apparatus and the different components that condition its normal functioning. They present as muscle weakness and hypotonia at birth or during the first year of life. Centronuclear CM is characterized by a high incidence of nuclei located centrally and internally in muscle fibers. Clinical case: a 22-year-old male patient with symptoms of muscle weakness since early childhood, with difficulty in performing physical activity according to his age, with the presence of a long face, a waddling gait, and a global decrease in muscle mass. Electromyography was performed, showing a neurogenic pattern and not the expected myopathic one, neuroconduction with reduced amplitude of the motor potential of the peroneal nerve and axonal and myelin damage of the posterior tibial nerves. The microscopic study of the studied striated muscle fragments stained with hematoxylin-eosin and Masson's trichrome showed the presence of fibers with central nuclei, diagnosing CM. The patient meets most of the description for CM, with involvement of all striated muscles, although it is important to note the neurogenic pattern present in this case, due to the denervation of damaged muscle fibers, which contain terminal axonal segments. Neuroconduction shows the involvement of motor nerves, but with normal sensory studies, axonal polyneuropathy is unlikely, due to normal sensory potentials. Different pathological findings have been described depending on the mutated gene in this disease, but all coincide with the presence of fibers with central nuclei for diagnosis by this means, which is so important in institutions where it is not possible to carry out genetic studies, and allowing early specific treatment, according to the stage through which the patient passes.

Linfoma no Hodgkin tipo MALT cerebral / Cerebral type MALT non Hodgkin lymphoma

Introducción: Los linfomas no Hodgkin tienen su origen generalmente en el sistema linfoide, existe una gran diversidad de ellos, que hace difícil su clasificación y diagnóstico anatomopatológico definitivo. También hay localizaciones extranodales, como en el cerebro, lo que la hace aún más interesante. Objetivo: Presentar un caso con linfoma marginal cerebral, de diagnóstico muy infrecuente. Caso clínico: Paciente femenina de 67 años de edad con antecedentes patológicos personales de hipertensión arterial y epilepsia, que comenzó a sentirse rígida, con movimientos involuntarios generalizados en el cuerpo, hasta perder la conciencia. Al recuperarse se encontraba somnolienta y con cefalea de moderada intensidad. Se diagnostica un linfoma no Hodgkin tipo MALT cerebral; se realiza tratamiento con el que se revierten los síntomas y se controla la enfermedad. Conclusiones: Es necesario un diagnóstico histopatológico oportuno y certero, con la utilización de los estudios inmunohistoquímicos. Esto permite aplicar un tratamiento precoz y el control de la enfermedad(AU)

Introduction: Non-Hodgkin's lymphomas generally have their origin in the lymphoid system, there is a great diversity of them, which makes their classification and definitive pathological diagnosis difficult. There are also extranodal locations, such as in the brain, which makes it even more interesting. Objective: To present a patient with marginal cerebral lymphoma, of a very infrequent diagnosis. Clinical case: A 67-year-old female patient with a personal pathological history of arterial hypertension and epilepsy, who began to feel rigid, with involuntary movements that generalized to the whole body, until she lost consciousness, when she recovered she was drowsy and with headache of moderate intensity. Brain MALT non-Hodgkin lymphoma is diagnosed, treatment is performed to reverse symptoms, and the disease is controlled. Conclusions: A timely and accurate histopathological diagnosis is necessary, with the use of immunohistochemical studies. This allows for early treatment and disease control(AU)

Neuromuscular blockade management and postoperative outcomes in enhanced recovery colorectal surgery: secondary analysis of POWER trial.

BACKGROUND: We evaluated the impact of neuromuscular blockade (NMB) management, monitoring and reversal on postoperative outcomes in colorectal surgical patients included in an enhanced recovery program. METHODS: We performed a predefined analysis in 2084 patients undergoing elective colorectal surgery who participated in POWER study. We analyzed them for complications, length of hospital stay and mortality. Two groups were defined: 1) monitoring + reversal of the neuromuscular blockade (M+R) group: all patients receiving neuromuscular blockade monitoring plus reversal of it with any drug (neostigmine or sugammadex) were included; and 2) no monitoring nor reversal (noM+noR) group. In this group all the patients who did not receive monitoring and reversal of the neuromuscular blockade were allocated. RESULTS: Multivariate analysis found no statistically significant differences in moderate-severe complications (174 [25.7%] vs. 124 [27.1%]; P=0.607), length of hospital stay (10.8±11.1 vs. 11.0 ±12.6 days; P=0.683) and mortality (6 [0.9%] vs. 5 [1.1%]; P=0.840) between the group receiving optimal neuromuscular management (M+R) and the one did not receive it (noM+noR). Univariate analysis showed patients reversed with neostigmine died more than those reversed with sugammadex (3 [2.7%] vs. 3 [0.5%]; P=0.048). CONCLUSIONS: Our data suggest optimal neuromuscular blockade management in colorectal surgery is not associated with less moderate-severe complications, length of hospital stay or death during postoperative period in an enhanced recovery program. Neostigmine reversal seems to be linked to higher rate of mortality than sugammadex.

Surgical treatment for colorectal cancer: analysis of the influence of an enhanced recovery programme on long-term oncological outcomes-a study protocol for a prospective, multicentre, observational cohort study.

INTRODUCTION: The evidence currently available from enhanced recovery after surgery (ERAS) programmes concerns their benefits in the immediate postoperative period, but there is still very little evidence as to whether their correct implementation benefits patients in the long term. The working hypothesis here is that, due to the lower response to surgical aggression and lower rates of postoperative complications, ERAS protocols can reduce colorectal cancer-related mortality. The main objective of this study is to analyse the impact of an ERAS programme for colorectal cancer on 5-year survival. As secondary objectives, we propose to analyse the weight of each of the predefined items in the oncological results as well as the quality of life. METHODS AND ANALYSIS: A multicentre prospective cohort study was conducted in patients older than 18 years of age who are scheduled to undergo surgery for colorectal cancer. The study involved 12 hospitals with an implemented enhanced recovery protocol according to the guidelines published by the Spanish National Health Service. The intervention group includes patients with a minimum implementation level of 70%, and the control group includes those who fail to reach this level. Compliance will be studied using 18 key performance indicators, and the results will be analysed using cancer survival indicators, including overall survival, cancer-specific survival and relapse-free survival. The time to recurrence, perioperative morbidity and mortality, hospital stay and quality of life will also be studied, the latter using the validated EuroQol Five questionnaire. The propensity index method will be used to create comparable treatment and control groups, and a multivariate regression will be used to study each variable. The Kaplan-Meier estimator will be used to estimate survival and the log-rank test to make comparisons. A p value of less than 0.05 (two-tailed) will be considered to be significant. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the Aragon Ethical Committee (C.P.-C.I. PI20/086) on 4 March 2020. The findings of this study will be submitted to peer-reviewed journals (BMJ Open, JAMA Surgery, Annals of Surgery, British Journal of Surgery). Abstracts will be submitted to relevant national and international meetings. TRIAL REGISTRATION NUMBER: NCT04305314.

Evaluación de la implantación de un protocolo de recuperación intensificada en cirugía electiva de colon y recto: un estudio cuasiexperimental / No disponible

INTRODUCCIÓN: Los protocolos de recuperación intensificada (PRI) en cirugía de colon y recto disminuyen la estancia hospitalaria y las complicaciones, pero son pocos los estudios acerca de si son coste-efectivos. MÉTODOS: Comparamos un grupo de 121 pacientes (grupo RICA) operados de forma consecutiva de cirugía electiva de colon y recto según un PRI, con una cohorte histórica de 135 pacientes (grupo preRICA) operados antes de la implantación del PRI de forma tradicional. Se realizó un análisis univariante para comparar los datos de estancia, complicaciones, reingresos y coste efectividad, y un análisis multivariante para comprobar si la realización de cirugía laparoscópica, el PRI, las complicaciones, el sexo y la edad influían de forma independiente en la estancia hospitalaria, los reingresos y los costes. RESULTADOS: Los dos grupos fueron homogéneos, realizándose más cirugía laparoscópica en el grupo RICA (27 (20%) vs 45 (37,2%), p = 0,006). En el grupo RICA se objetivó una disminución de la estancia hospitalaria de 1,2 días (11 ± 3,8 vs 9,8 ± 3,7, p = 0,018), sin aumentar la tasa de complicaciones (49 (36,3%) vs 38 (31,4%), p = 0,49), de reingresos a los 30 días tras el alta hospitalaria (15 (11,1%) vs 12 (9,9%), p = 0,756), la mortalidad (1 (0,7%) vs 2 (1,7%), p = 0,498) ni el gasto sanitario (1618,8 € ± 830,5 ± 1578,6 ± 491,1, p = 0,634). La laparoscopia redujo de forma independiente la estancia hospitalaria y la tasa de reingresos, mientras que la presencia de complicaciones severas lo aumentó. CONCLUSIONES: La aplicación de un PRI en cirugía electiva de colon y recto es coste-efectiva, pues mejora los resultados obtenidos sin incrementar el gasto sanitario

INTRODUCTION: ERAS (Enhanced Recovery After Surgery) protocols in colorectal surgery reduce hospital stay and com-plications, but there are few studies on whether they are cost-effective. METHODS: We compared a group of 121 patients (ERAS group) consecutively operated on elective colorectal surgery according to an ERAS protocol, with a historical cohort of 135 patients (preERAS group) operated prior to the implantation of the protocol in a traditional manner. A univariate analysis was performed to compare the data of stay, complications, readmissions and cost effectiveness, and a multivariate analysis to check whether laparoscopic surgery, the ERAS protocol, complications, sex and age had an independent influence hospital stay, readmissions rate and costs. RESULTS: The two groups were homogeneous, with more laparoscopic surgery performed in the ERAS group (27 (20%) vs 45 (37.2%), p = 0.006). In the ERAS group, a decrease in hospital stay was observed in 1,2 days (11 ± 3.8 vs 9.8 ± 3.7, p = 0.018), without increasing the complication rate (49 (36.3%) vs 38 (31.4%), p = 0.49), readmissions at 30 days after hospital discharge (15 (11.1%) vs 12 (9.9%), p = 0.756), mortality (1 (0.7%) vs 2 (1.7%), p = 0.498) and healthcare costs (1618.8 € ± 830.5 vs 1578.6 € ± 491.1, p = 0.634). Laparoscopic surgery independently reduced the hospital stay and the rate of readmissions, while the presence of severe complications increased them. CONCLUSIONS: The application of an ERAS protocol in elective colorectal surgery surgery is cost-effective, since it improves the results obtained without increasing healthcare costs

Implementation of an Enhanced Recovery After Surgery program in elective colorectal surgery: a prospective cohort study / Implantação de um programa de recuperação aprimorada após cirurgia colorretal eletiva: um estudo prospectivo de coorte

ABSTRACT Objective: To evaluate the results of an Enhanced Recovery After Surgery (ERAS) protocol in elective colorectal surgery compared to the historical cohort of this hospital with standard care, in terms of hospital Length Of Stay (LOS), 30 days readmissions rate and 3-5 Clavien-Dindo Complications (CDC). Methodology: Data were collected from consecutive patients during 2 time periods, before (135 patients from hospital database) and after implementation of an ERAS protocol (121 with prospective follow up). Multivariate lineal or logistic regressions were used to assess the impact of ERAS program, adjusting by gender, age, laparoscopy and 3-5 CDC. Results: The two groups were homogeneous in terms of demographic and surgery details, with the exception of the operative approach, with increased use of laparoscopy in the ERAS group. The ERAS protocol decreased LOS (9.8 ± 3.7 vs. 11 ± 3.8, p = 0.018) without increasing 30 days readmission rate or the number of severe CDC. In a multivariate analysis, age and 3-5 CDC were independently associated with a longer LOS while male gender, ERAS protocol and laparoscopic surgery with a decreased LOS. 3-5 CDC increased readmissions (OR = 3.5, 95% CI 1.2-10.2) while laparoscopic surgery decreased them (OR = 0.2, 95% CI 0.1-0.8). ERAS improved compliance with secondary variables in a statistically significant way: more laparoscopic surgery; more regional analgesia in the intraoperative period; earlier adherence to ambulation; faster onset of oral liquid diet and analgesia by mouth; and lower requirements of opioids. Conclusions: ERAS protocol and laparoscopic surgery decreased LOS without increasing 30 days readmission rate. Severe CDC increased LOS and readmissions.

RESUMO Objetivo: Avaliar os resultados de um protocolo de recuperação aprimorada após a cirurgia (enhanced recovery after surgery [ERAS]) em cirurgia colorretal eletiva em comparação com a coorte histórica deste hospital, que recebeu o tratamento padrão, em termos de hospitalização, taxa de readmissão de 30 dias e graus 3 a 5 na escala de complicações cirúrgicas de Clavien-Dindo (CCD). Metodologia: Os dados foram coletados de pacientes consecutivos em dois períodos de tempo: antes (135 pacientes do banco de dados do hospital) e depois da implementação de um protocolo ERAS (121 pacientes com acompanhamento prospectivo). Regressões lineares ou logísticas multivariadas foram usadas para avaliar o impacto do protocolo ERAS, ajustando por sexo, idade, uso de laparoscopia e graus 3 a 5 na escala CCD. Resultados: Os dois grupos foram homogêneos em termos de características demográficas e cirúrgicas, com exceção da abordagem operatória, com o aumento do uso de laparoscopia no grupo ERAS. O protocolo ERAS diminuiu o tempo de internação (9,8 ± 3,7 vs. 11 ± 3,8; p = 0,018) sem aumentar a taxa de readmissão de 30 dias ou a severidade na escala CCD. Na análise multivariada, a idade e os graus 3 a 5 na escala CCD foram independentemente associados a uma hospitalização mais longa, enquanto o sexo masculino, o protocolo ERAS e a cirurgia laparoscópica foram independentemente associados a uma hospitalização mais curta. Graus 3 a 5 na escala CCD foram associados a um aumento nas readmissões (OR = 3,5; IC 95%: 1,2-10,2), enquanto a cirurgia laparoscópica foi associada a uma diminuição nesse número (OR = 0,2; IC 95%: 0,1-0,8). O ERAS melhorou a adesão às variáveis secundárias de uma forma estatisticamente significativa: aumento no número de cirurgias laparoscópicas; maior uso de analgesia regional no período intraoperatório; adesão precoce à deambulação; início mais rápido da dieta líquida oral e analgesia por via oral; finalmente, menor uso de opioides. Conclusões: O protocolo ERAS e a cirurgia laparoscópica diminuíram o tempo de internação sem aumentar a taxa de readmissão de 30 dias. Um grau severo na escala CCD aumentou a hospitalização e readmissões.

Immunotherapeutic effects of intratumoral nanoplexed poly I:C.

Poly I:C is a powerful immune adjuvant as a result of its agonist activities on TLR-3, MDA5 and RIG-I. BO-112 is a nanoplexed formulation of Poly I:C complexed with polyethylenimine that causes tumor cell apoptosis showing immunogenic cell death features and which upon intratumoral release results in more prominent tumor infiltration by T lymphocytes. Intratumoral treatment with BO-112 of subcutaneous tumors derived from MC38, 4 T1 and B16-F10 leads to remarkable local disease control dependent on type-1 interferon and gamma-interferon. Some degree of control of non-injected tumor lesions following BO-112 intratumoral treatment was found in mice bearing bilateral B16-OVA melanomas, an activity which was enhanced with co-treatment with systemic anti-CD137 and anti-PD-L1 mAbs. More abundant CD8+ T lymphocytes were found in B16-OVA tumor-draining lymph nodes and in the tumor microenvironment following intratumoral BO-112 treatment, with enhanced numbers of tumor antigen-specific cytotoxic T lymphocytes. Genome-wide transcriptome analyses of injected tumor lesions were consistent with a marked upregulation of the type-I interferon pathway. Inspired by these data, intratumorally delivered BO-112 is being tested in cancer patients (NCT02828098).

Encuesta de satisfacción tras aplicación de un protocolo de recuperación intensificada ERAS (Enhanced Recovery After Surgery) en cirugía electiva colorrectal en mayores de 70 años / Satisfaction survey after an ERAS (Enhanced Recovery After Surgery) protocol in colorectal elective surgery in patients over 70 years of age

Abstract Introduction: Enhanced Recovery After Surgery (ERAS) programs have been shown to reduce hospital stay, without increasing the rate of complications or readmissions 30 days after discharge; however, there is limited information about patient satisfaction. Objective: To determine the satisfaction of our patients following the implementation of an ERAS protocol in elective colorectal surgery. Materials and methods: A period of 4 days after discharge, a telephone survey was conducted based on the enhanced recovery in abdominal surgery clinical survey of the first 55 patients aged 70 years or older, who underwent elective colorectal surgery according to an ERAS protocol at the Hospital Universitario de Guadalajara, Spain. This is a cross-sectional analytical study. Results: Most of our patients are very satisfied with the care and the way they were treated by the health staff during their hospitalization, and they would be willing to undergo surgery again following this protocol. Most of them consider that the information received in the pre-anesthesia and surgery consultation is very good, and they value this consultation as one of the most positive aspects of the protocol. More than half of the patients did not experience any nausea or vomiting and rated their pain as <3 (minimum 0 and maximum 10). Most considered the introduction of oral feeding and ambulation as on time or somewhat early. Conclusion: Elderly patients undergoing elective colorectal surgery according to an ERAS protocol are highly pleased with the care received. Standardized surveys are required to be able to contrast outcomes.

Resumen Introducción: los programas de recuperación intensificada postoperatoria (Enhanced Recovery After Surgery (ERAS)) reducen la estancia hospitalaria, sin aumentar la tasa de complicaciones ni de reingresos a los 30 días tras el alta, pero hay poca información acerca del grado de satisfacción de los pacientes. Objetivo: conocer la satisfacción de nuestros pacientes tras la aplicación de un protocolo ERAS en cirugía electiva colorrectal. Materiales y métodos: cuatro días tras el alta, se realizó una encuesta telefónica basada en la encuesta de la guía clínica RICA (Recuperación Intensificada en Cirugía Abdominal) a los 55 primeros pacientes con edad mayor o igual a 70 años operados de cirugía electiva colorrectal según un protocolo ERAS. Es un estudio analítico transversal. Resultados: la mayor parte de nuestros pacientes están muy satisfechos con la asistencia y con el trato recibido por el personal sanitario durante su ingreso hospitalario, y se volverían a operar siguiendo este protocolo. La mayoría consideran que la información recibida en la consulta de preanestesia y cirugía es muy buena, y valoran esta consulta como uno de los aspectos más positivos del protocolo. Más de la mitad de los pacientes no tuvieron náuseas ni vómitos y calificaron su dolor como <3 (mínimo 0 y máximo 10). La mayoría consideraron el inicio de tolerancia oral y deambulación como a tiempo o algo pronto. Conclusiones: Los pacientes ancianos operados de cirugía electiva colorrectal según un protocolo ERAS están muy satisfechos con la asistencia prestada. Se necesitan encuestas estandarizadas para poder comparar resultados.

Functional interplay between c-Myc and Max in B lymphocyte differentiation.

The Myc family of oncogenic transcription factors regulates myriad cellular functions. Myc proteins contain a basic region/helix-loop-helix/leucine zipper domain that mediates DNA binding and heterodimerization with its partner Max. Among the Myc proteins, c-Myc is the most widely expressed and relevant in primary B lymphocytes. There is evidence suggesting that c-Myc can perform some of its functions in the absence of Max in different cellular contexts. However, the functional in vivo interplay between c-Myc and Max during B lymphocyte differentiation is not well understood. Using in vivo and ex vivo models, we show that while c-Myc requires Max in primary B lymphocytes, several key biological processes, such as cell differentiation and DNA replication, can initially progress without the formation of c-Myc/Max heterodimers. We also describe that B lymphocytes lacking Myc, Max, or both show upregulation of signaling pathways associated with the B-cell receptor. These data suggest that c-Myc/Max heterodimers are not essential for the initiation of a subset of important biological processes in B lymphocytes, but are required for fine-tuning the initial response after activation.

C-reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study.

BACKGROUND: The aim of this study is to evaluate the effectiveness of an Enhanced Recovery After Surgery Protocol (ERAS) in relation to reduce the Systemic Inflammatory Response (SIR) to surgery using C-reactive protein (CRP) in the first (POD1), second (POD2) and third (POD3) postoperative day. METHODS: We enrolled 121 patients (ERAS group) that underwent elective colorectal surgery with ERAS, and compared them with 135 patients (preERAS group) that had undergone surgery prior to the implementation. We made a univariate analysis to compare the CRP values in POD1, POD2, and POD3 between preERAS/ERAS group, laparoscopic/open surgery and the presence or not of Clavien Dindo complications. Multivariable lineal regression was used to assess if the ERAS had a decreasing effect on the CRP in POD1, POD2, and POD3, and was adjusted by age, male sex, use of laparoscopy, and complications. RESULTS: The presence of complications was independently associated with an increase in CRP values ​​in POD1, POD2, and POD3. Laparoscopy in POD1 and POD2, and ERAS in POD2 was independently associated with a decrease in CRP values. CONCLUSION: The analysis shows an increase in SIR measured as a CRP value in those patients that had complications. The SIR decreased with laparoscopy in POD1 and POD2 and with ERAS in POD2.

Desarrollo natural del proceso aterosclerótico en arterias coronarias de niños fallecidos por muerte violenta. Patomorfometría / Natural development of the atherosclerotic process in coronary arteries of children dying a violent death. Pathomorphometry

En Cuba se han realizado disímiles estudios sobre la aterosclerosis, enfermedad esta muy antigua, que es causante de una gran morbilidad y mortalidad. El objetivo de este trabajo es proponernos describir el desarrollo del proceso aterosclerótico en edades tempranas de la vida (niños), para lo cual se estudiaron las arterias coronarias epicárdicas principales en 13 autopsias de niños fallecidos por muerte violenta, provenientes del Instituto de Medicina Legal, a las cuales se les aplicó el sistema aterométrico. En las diferentes edades se evidenció el desarrollo del proceso aterosclerótico, donde predominó la presencia de las estrías adiposas, aunque también se encontraron placas fibrosas. Se concluye que el proceso aterosclerótico comienza desde etapas muy tempranas de la vida, que se va intensificando con el paso de los años, y que la arteria coronaria más afectada de las estudiadas resultó ser la descendente anterior(AU)

Atherosclerosis has been the object of many studies in Cuba. This ancient disease is characterized by high morbidity and mortality rates. The purpose of this paper is to describe the atherosclerotic process in early ages (children). To achieve this end, a study based on the atherometric system was conducted of the main epicardial coronary arteries in 13 autopsies of children who had died a violent death, obtained from the Institute of Legal Medicine. The atherosclerotic process was observed at the various ages, with a predominance of adipose striae, though fibrous plates were also found. It is concluded that the atherosclerotic process starts at very early life stages and intensifies with the passing of time. The most affected coronary artery among those studied was the anterior descending coronary artery(AU)

Desarrollo natural del proceso aterosclerótico en arterias coronarias de niños fallecidos por muerte violenta. Patomorfometría / Natural development of the atherosclerotic process in coronary arteries of children dying a violent death. Pathomorphometry

En Cuba se han realizado disímiles estudios sobre la aterosclerosis, enfermedad esta muy antigua, que es causante de una gran morbilidad y mortalidad. El objetivo de este trabajo es proponernos describir el desarrollo del proceso aterosclerótico en edades tempranas de la vida (niños), para lo cual se estudiaron las arterias coronarias epicárdicas principales en 13 autopsias de niños fallecidos por muerte violenta, provenientes del Instituto de Medicina Legal, a las cuales se les aplicó el sistema aterométrico. En las diferentes edades se evidenció el desarrollo del proceso aterosclerótico, donde predominó la presencia de las estrías adiposas, aunque también se encontraron placas fibrosas. Se concluye que el proceso aterosclerótico comienza desde etapas muy tempranas de la vida, que se va intensificando con el paso de los años, y que la arteria coronaria más afectada de las estudiadas resultó ser la descendente anterior

Atherosclerosis has been the object of many studies in Cuba. This ancient disease is characterized by high morbidity and mortality rates. The purpose of this paper is to describe the atherosclerotic process in early ages (children). To achieve this end, a study based on the atherometric system was conducted of the main epicardial coronary arteries in 13 autopsies of children who had died a violent death, obtained from the Institute of Legal Medicine. The atherosclerotic process was observed at the various ages, with a predominance of adipose striae, though fibrous plates were also found. It is concluded that the atherosclerotic process starts at very early life stages and intensifies with the passing of time. The most affected coronary artery among those studied was the anterior descending coronary artery

Occupational allergic contact dermatitis from methyl aminolevulinate.

Photodynamic therapy (PDT) is used to treat certain types of nonmelanoma skin cancer. Metvix cream applied topically in PDT is composed of the active substance methyl aminolevulinate and 14 excipients composing the vehicle. One case of occupational allergic contact dermatitis from methyl aminolevulinate is reported. A 49-year-old nurse's aide working in a PDT unit in the dermatology department developed a dermatitis involving the eyelids and fingers. The lesions began a few months after she started working in that unit. Patch tests were performed with the standard series (Spanish Group for Research into Dermatitis and Skin Allergies [GEIDAC]), cosmetics series, Metvix cream "as is," the Metvix vehicle supplied by the manufacturer, and some of the excipients separately (methyl para-hydroxybenzoate [Nipagin M], propyl para-hydroxybenzoate [Nipasol M], isopropyl myristate, cetostearyl alcohol [Lanette N], and disodium edetate). After day-2, day-4, and day-7 readings, positive results were achieved only with Metvix cream "as is." Tests performed on a control group of 15 individuals were negative. Literature on cases of allergic contact dermatitis from methyl aminolevulinate is reviewed. It should be emphasized that the present case is the first occupational case reported so far.

Caracterización patomorfológica y morfométrica de la lesión aterosclerótica de arterias coronarias en autopsias de fallecidos por muerte violenta / Pathomorphological and morphometry characterization of atherosclerotic lesion of coronary arteries during necropsy of deceased persons due to violent death

OBJETIVO: caracterizar desde el punto de vista patomorfológico y morfométrico a la aterosclerosis coronaria en fallecidos por muerte violenta y clínica, teniendo en cuenta grupos de edad y sexo, mediante la aplicación del sistema aterométrico. MÉTODOS: se estudiaron los 3 vasos coronarios en una población de 108 fallecidos por muerte violenta, 397 necropsias clínicas consideradas como de alto nivel aterosclerótico y 89 casos clasificados como de bajo nivel aterosclerótico. Se aplicó el sistema aterométrico y se compararon los grupos. RESULTADOS: las placas fibrosas resultaron 15 veces más frecuentes en el grupo de muerte clínica, mientras que las placas graves lo fueron 20 veces más. La arteria más lesionada fue la descendente anterior, donde llegó a alcanzar hasta el 41,6 por ciento de placas fibrosas y graves en el grupo de muerte clínica. Con el aumento de la edad, en todos los grupos, aumentó la severidad del proceso aterosclerótico. En la mujer la aterosclerosis fue más severa, cuando se encontraba alrededor de los 50 años o más, mientras que a edades más tempranas, los hombres resultaron más afectados. CONCLUSIONES: se observa mayor desarrollo del proceso aterosclerótico en fallecidos por muerte clínica. De las 3 ramas coronarias estudiadas hay mayor severidad del proceso aterosclerótico en la arteria descendente anterior. El proceso aterosclerótico aumenta con la edad. La mujer es la más impactada por la aterosclerosis alrededor de los 50 años o más, mientras que a edades más tempranas, lo es el hombre(AU)

OBJECTIVE: to characterize from the point of view pathomorphological and morphometry the coronary atherosclerosis in deceased persons due to a violent and clinical death, taking into account the age and sex groups by implementation of atherometric system. METHODS: three coronary vessels were studied in 108 deceased persons due to violent death, 397 clinical necropsies considered as a high atherosclerotic level and 89 cases classified as of low atherosclerotic level. The atherometric system was applied and groups were compared. RESULTS: the fibrous plaques were 15 times more frequent in the group of clinical death, whereas the severe plaques were 20 times more frequent. The more injured artery was the minor descending one where it involved up to 41.6 percent of severe and fibrous plaques in the group of clinical death. Just as age increases in all groups the severity of atherosclerotic process also increases. In woman the atherosclerosis was more severe about 50 years old or more, whereas at more early ages, men were more involved. CONCLUSIONS: there is a greater development of atherosclerotic process in deceased persons due to clinical death. From the three coronary study branches the atherosclerotic process in the anterior descending artery was the more severe. The woman is more involved by atherosclerosis about 50 years old or more, whereas at earlier ages the man is the more involved one(AU)

Caracterización patomorfológica y morfométrica de la lesión aterosclerótica de arterias coronarias en autopsias de fallecidos por muerte violenta / Pathomorphological and morphometry characterization of atherosclerotic lesion of coronary arteries during necropsy of deceased persons due to violent death

OBJETIVO: caracterizar desde el punto de vista patomorfológico y morfométrico a la aterosclerosis coronaria en fallecidos por muerte violenta y clínica, teniendo en cuenta grupos de edad y sexo, mediante la aplicación del sistema aterométrico. MÉTODOS: se estudiaron los 3 vasos coronarios en una población de 108 fallecidos por muerte violenta, 397 necropsias clínicas consideradas como de alto nivel aterosclerótico y 89 casos clasificados como de bajo nivel aterosclerótico. Se aplicó el sistema aterométrico y se compararon los grupos. RESULTADOS: las placas fibrosas resultaron 15 veces más frecuentes en el grupo de muerte clínica, mientras que las placas graves lo fueron 20 veces más. La arteria más lesionada fue la descendente anterior, donde llegó a alcanzar hasta el 41,6 por ciento de placas fibrosas y graves en el grupo de muerte clínica. Con el aumento de la edad, en todos los grupos, aumentó la severidad del proceso aterosclerótico. En la mujer la aterosclerosis fue más severa, cuando se encontraba alrededor de los 50 años o más, mientras que a edades más tempranas, los hombres resultaron más afectados. CONCLUSIONES: se observa mayor desarrollo del proceso aterosclerótico en fallecidos por muerte clínica. De las 3 ramas coronarias estudiadas hay mayor severidad del proceso aterosclerótico en la arteria descendente anterior. El proceso aterosclerótico aumenta con la edad. La mujer es la más impactada por la aterosclerosis alrededor de los 50 años o más, mientras que a edades más tempranas, lo es el hombre

OBJECTIVE: to characterize from the point of view pathomorphological and morphometry the coronary atherosclerosis in deceased persons due to a violent and clinical death, taking into account the age and sex groups by implementation of atherometric system. METHODS: three coronary vessels were studied in 108 deceased persons due to violent death, 397 clinical necropsies considered as a high atherosclerotic level and 89 cases classified as of low atherosclerotic level. The atherometric system was applied and groups were compared. RESULTS: the fibrous plaques were 15 times more frequent in the group of clinical death, whereas the severe plaques were 20 times more frequent. The more injured artery was the minor descending one where it involved up to 41.6 percent of severe and fibrous plaques in the group of clinical death. Just as age increases in all groups the severity of atherosclerotic process also increases. In woman the atherosclerosis was more severe about 50 years old or more, whereas at more early ages, men were more involved. CONCLUSIONS: there is a greater development of atherosclerotic process in deceased persons due to clinical death. From the three coronary study branches the atherosclerotic process in the anterior descending artery was the more severe. The woman is more involved by atherosclerosis about 50 years old or more, whereas at earlier ages the man is the more involved one

Neumonía por Pneumocystis jirovecii / Pneumocystic jirovecii pneumonia

OBJETIVO: presentar un caso atípico de una paciente VIH negativo, fallecida por Pneumocystis jirovecii, más frecuente en personas infectadas por el virus del SIDA y postrasplantados. DESCRIPCIÓN: se presenta una paciente con antecedentes de alcoholismo, asma, con síntomas respiratorios y fiebre, VIH negativo, con evolución tórpida que fallece a los 11 días del ingreso. Pulmones: enfisema periférico, zonas dispersas de aspecto rojo carnoso entre mezclado con zonas poco aireadas, empastadas. INTERVENCIÓN: se realizó autopsia clínica encontrándose como causa directa de la muerte, neumonía por Pneumocystis jirovecii, diagnosticado con coloración de hematoxilina y eosina donde se observó presencia del edema espumoso característico. Se corroboró con coloración de plata metenamina donde se pudo observar el microorganismo. CONCLUSIONES: el caso presentó como causa directa de la muerte una neumonía por Pneumocystis jirovecii, patógeno oportunista reportado con frecuencia como causa de muerte en pacientes infectados por el VIH-SIDA y en inmunocomprometidos por otras causas, como los trasplantados.

OBJECTIVE: to present the atypical case of a HIV-negative patient, deceased from Pneumocystis jirovecii more frequent in persons infected with the AIDS virus and in those underwent transplantation. DESCRIPTION: a patient with a history of alcoholism, asthma, respiratory symptoms and fever, HIV-negative, with a torpid course deceased at 11 days after admission. Lung: peripheral emphysema, scattered zones of a fleshy red appearance mixed with not much aired zones and impasted. INTERVENTION: a clinical necropsy was carried out where the direct cause of death was from Pneumocystis jirovecii, diagnosed using hematoxylin-esosin stain proving the presence of a characteristic foamy edema. In the silver methenamine stain it was possible to corroborate the presence of the microorganism. CONCLUSIONS: in this case the leading cause of death was Pneumocystis jirovecii pneumonia, an opportunistic pathogen frequently reported a cause of death in HIV-AIDS patients and also in those immunocompromised due to other causes, e.g. those with transplantation.

Cistitis glandular / Glandular cystitis

Se presenta un caso de cistitis glandular, enfermedad rara, generalmente asintomática, que consiste en un desorden proliferativo de las glándulas que producen moco dentro de la mucosa y submucosa del epitelio urinario de la vejiga. La irritación crónica constituye el factor de riesgo de mayor importancia en su aparición. La evolución hacia la malignidad (adenocarcinoma) es excepcional y ocurre en caso de la persistencia del factor de predisposición. Para llegar a establecer el diagnóstico es necesario el examen clínico, radiológico e histológico. A este caso se le realizó ecografía vesical y se encontró tumoración pequeña de 3 cm en fondo vesical, que primeramente se le efectuó biopsia por cistoscopia y después se resecó totalmente. Confirmado el diagnóstico, el tratamiento fue esencialmente quirúrgico. La vigilancia anual por cistoscopia con biopsias de vejiga resulta necesaria en estos casos. La forma florida es mucho más rara e incapacitante pues precisa resección amplia de las lesiones(AU)

This is the case of glandular cystitis a uncommon disease generally asymptomatic consisted of a proliferative disorder of glands producing mucus within mucosa and submucosa of vesical urinary epithelium. Chronic irritation is the risk factor more significant in its appearance. Course to malignancy (adenocarcinoma) is exceptional and occur in case of persistence of the predisposition factor. To made diagnosis it is necessary the clinical, radiological and histological examination. This case undergoes a vesical echography noting a 3 cm small tumor in vesical fundus and a biopsy by cystoscopy after a total resection. Diagnosis was confirmed and treatment was essentially surgical. Annual surveillance by cystoscopy with vesical biopsies is necessary in these cases. The progressive way is rarer and incapacitant since a wide resection of lesions is essential(AU)

Cistitis glandular / Glandular cystitis

Se presenta un caso de cistitis glandular, enfermedad rara, generalmente asintomática, que consiste en un desorden proliferativo de las glándulas que producen moco dentro de la mucosa y submucosa del epitelio urinario de la vejiga. La irritación crónica constituye el factor de riesgo de mayor importancia en su aparición. La evolución hacia la malignidad (adenocarcinoma) es excepcional y ocurre en caso de la persistencia del factor de predisposición. Para llegar a establecer el diagnóstico es necesario el examen clínico, radiológico e histológico. A este caso se le realizó ecografía vesical y se encontró tumoración pequeña de 3 cm en fondo vesical, que primeramente se le efectuó biopsia por cistoscopia y después se resecó totalmente. Confirmado el diagnóstico, el tratamiento fue esencialmente quirúrgico. La vigilancia anual por cistoscopia con biopsias de vejiga resulta necesaria en estos casos. La forma florida es mucho más rara e incapacitante pues precisa resección amplia de las lesiones(AU)

This is the case of glandular cystitis a uncommon disease generally asymptomatic consisted of a proliferative disorder of glands producing mucus within mucosa and submucosa of vesical urinary epithelium. Chronic irritation is the risk factor more significant in its appearance. Course to malignancy (adenocarcinoma) is exceptional and occur in case of persistence of the predisposition factor. To made diagnosis it is necessary the clinical, radiological and histological examination. This case undergoes a vesical echography noting a 3 cm small tumor in vesical fundus and a biopsy by cystoscopy after a total resection. Diagnosis was confirmed and treatment was essentially surgical. Annual surveillance by cystoscopy with vesical biopsies is necessary in these cases. The progressive way is rarer and incapacitant since a wide resection of lesions is essential(AU)

Cistitis glandular / Glandular cystitis

Se presenta un caso de cistitis glandular, enfermedad rara, generalmente asintomática, que consiste en un desorden proliferativo de las glándulas que producen moco dentro de la mucosa y submucosa del epitelio urinario de la vejiga. La irritación crónica constituye el factor de riesgo de mayor importancia en su aparición. La evolución hacia la malignidad (adenocarcinoma) es excepcional y ocurre en caso de la persistencia del factor de predisposición. Para llegar a establecer el diagnóstico es necesario el examen clínico, radiológico e histológico. A este caso se le realizó ecografía vesical y se encontró tumoración pequeña de 3 cm en fondo vesical, que primeramente se le efectuó biopsia por cistoscopia y después se resecó totalmente. Confirmado el diagnóstico, el tratamiento fue esencialmente quirúrgico. La vigilancia anual por cistoscopia con biopsias de vejiga resulta necesaria en estos casos. La forma florida es mucho más rara e incapacitante pues precisa resección amplia de las lesiones

This is the case of glandular cystitis a uncommon disease generally asymptomatic consisted of a proliferative disorder of glands producing mucus within mucosa and submucosa of vesical urinary epithelium. Chronic irritation is the risk factor more significant in its appearance. Course to malignancy (adenocarcinoma) is exceptional and occur in case of persistence of the predisposition factor. To made diagnosis it is necessary the clinical, radiological and histological examination. This case undergoes a vesical echography noting a 3 cm small tumor in vesical fundus and a biopsy by cystoscopy after a total resection. Diagnosis was confirmed and treatment was essentially surgical. Annual surveillance by cystoscopy with vesical biopsies is necessary in these cases. The progressive way is rarer and incapacitant since a wide resection of lesions is essential