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.

Maternal diet in pregnancy and acute leukemia in infants: a case-control study in Mexico City.

Introduction: Epidemiological studies around the world on acute leukemia (AL) and risk factors in infants are scarce. Infant AL has been proposed to originate in utero, which facilitates its study by establishing a short exposure time in pregnant women to environmental and dietary factors that could contribute to the risk of or protection against leukemia. We hypothesized that maternal diet during pregnancy may be an important factor involved in AL in offspring. Methods: We conducted a hospital-based case-control study from 2010 to 2019 on maternal diet during pregnancy in nine high-specialty public hospitals of different health institutions that diagnose and offer treatment to children with AL in Mexico City. Cases (n=109) were children ≤24 months of age with de novo diagnosis of AL, and controls (n=252) were children obtained in hospitals from second-level medical care matched for age, sex, and health institution. Maternal diet during pregnancy was obtained by a semiquantitative food frequency questionnaire. Unconditional logistic regression models were used to assess the association between food groups and infant AL. Potential confounders were assessed by constructing directed acyclic graphs (DAGs) with Dagitty software in which adjusted options were identified for the construction of unconditional logistic regression models. Results: Cases were slightly predominantly female (52.3%). The years of education of the mother in cases and controls was 0-9 on average, and those who reported smoking cigarettes and consuming alcohol during pregnancy did so at a low frequency. Regarding the mother's diet, the main findings were that the consumption of allium vegetables during pregnancy was inversely associated with AL for medium and high consumption (OR=0.26, 95% CI 0.14-0.46; P-trend< 0.001). In contrast, the high consumption of high-fat dairy products had a positive association with AL (OR=2.37, 95% CI 1.30-4.34; P-trend<0.001). No association was found between consumption of topoisomerase II inhibitor foods during pregnancy and AL. Conclusion: The results suggest that maternal intake during pregnancy of allium vegetables, specifically garlic, is inversely associated with the development of AL in children ≤24 months old. On the other hand, consumption of high-fat dairy products is positively associated with AL in children ≤24 months old.

Association Analysis Between the Functional Single Nucleotide Variants in miR-146a, miR-196a-2, miR-499a, and miR-612 With Acute Lymphoblastic Leukemia.

BACKGROUND: Acute lymphoblastic leukemia (ALL) is characterized by an abnormal proliferation of immature lymphocytes, in whose development involves both environmental and genetic factors. It is well known that single nucleotide polymorphisms (SNPs) in coding and noncoding genes contribute to the susceptibility to ALL. This study aims to determine whether SNPs in miR-146a, miR-196a-2, miR-499a, and miR-612 genes are associated with the risk to ALL in pediatric Mexican population. METHODS: A multicenter case-control study was carried out including patients with de novo diagnosis of ALL and healthy subjects as control group. The DNA samples were obtained from saliva and peripheral blood, and the genotyping of rs2910164, rs12803915, rs11614913, and rs3746444 was performed using the 5'exonuclease technique. Gene-gene interaction was evaluated by the multifactor dimensionality reduction (MDR) software. RESULTS: miR-499a rs3746444 showed significant differences among cases and controls. The rs3746444G allele was found as a risk factor to ALL (OR, 1.6 [95% CI, 1.05-2.5]; p = 0.028). The homozygous GG genotype of rs3746444 confers higher risk to ALL than the AA genotype (OR, 5.3 [95% CI, 1.23-23.4]; p = 0.01). Moreover, GG genotype highly increases the risk to ALL in male group (OR, 17.6 [95% CI, 1.04-298.9]; p = 0.00393). In addition, an association in a gender-dependent manner among SNPs located in miR-146a and miR-196a-2 genes and ALL susceptibility was found. CONCLUSION: Our findings suggest that SNP located in miR-499a, miR-146a, and miR-196a-2 genes confer risk to ALL in Mexican children. Experimental analysis to decipher the role of these SNPs in human hematopoiesis could improve our understanding of the molecular mechanism underlying the development of ALL.

Genotype-Environment Interaction Analysis of NQO1, CYP2E1, and NAT2 Polymorphisms and the Risk of Childhood Acute Lymphoblastic Leukemia: A Report From the Mexican Interinstitutional Group for the Identification of the Causes of Childhood Leukemia.

Background: Acute lymphoblastic leukemia (ALL) is the main type of cancer in children. In Mexico and other Hispanic populations, the incidence of this neoplasm is one of the highest reported worldwide. Functional polymorphisms of various enzymes involved in the metabolism of xenobiotics have been associated with an increased risk of developing ALL, and the risk is different by ethnicity. The aims of the present study were to identify whether NQO1, CYP2E1, and NAT2 polymorphisms or some genotype-environmental interactions were associated with ALL risk in Mexican children. Methods: We conducted a case-control study including 478 pediatric patients diagnosed with ALL and 284 controls (children without leukemia). Ancestry composition of a subset of cases and controls was assessed using 32 ancestry informative markers. Genetic-environmental interactions for the exposure to hydrocarbons were assessed by logistic regression analysis. Results: The polymorphisms rs1801280 (OR 1.54, 95% CI 1.21-1.93), rs1799929 (OR 1.96, 95% CI 1.55-2.49), and rs1208 (OR 1.44, 95% CI 1.14-1.81) were found to increase the risk of ALL; being the risks higher under a recessive model (OR 2.20, 95% CI 1.30-1.71, OR 3.87, 95% CI 2.20-6.80, and OR 2.26, 95% CI 1.32-3.87, respectively). Gene-environment interaction analysis showed that NAT2 rs1799929 TT genotype confers high risk to ALL under exposure to fertilizers, insecticides, hydrocarbon derivatives, and parental tobacco smoking. No associations among NQO1, CYP2E1, and ALL were observed. Conclusion: Our study provides evidence for the association between NAT2 polymorphisms/gene-environment interactions, and the risk of childhood ALL in Mexican children.

Utilidad de la interleucina-6 y de la proteína C reactiva ultrasensible como marcadores pronósticos en pacientes ambulatorios con insuficiencia cardíaca y fracción de eyección reducida / Usefulness of Interleukin-6 and High-sensitivity C-reactive Protein as Prognostic Markers in Outpatients with Heart Failure and Reduced Ejection Fraction

RESUMEN Objetivo: Evaluar si la interleucina-6 (IL-6) y la proteína C reactiva ultrasensible (PCRus) asociadas al péptido natriurético tipo B (BNP) son marcadores independientes de eventos en pacientes ambulatorios con insuficiencia cardíaca con fracción de eyección reducida (IC-FEr). Materiales y Métodos: Se incluyeron en forma prospectiva pacientes mayores de 65 años con IC-FEr controlados en forma ambulatoria. Se realizó la medición basal del BNP, la IL-6 y la PCRus. Se excluyeron los pacientes con IC posinfarto de miocardio reciente (<6 meses), con internación reciente (<3 meses) por un cuadro que pudiera aumentar los marcadores inflamatorios. Se consideró el punto final combinado de mortalidad de cualquier causa e internación por insuficiencia cardíaca descompensada (ICD). Resultados: Se incluyeron 130 pacientes de 75 ± 5 años, con FE de 33 ± 11%. Con un seguimiento de 450 ± 210 días, el punto final combinado se observó en el 31,5% (n = 41). En el análisis multivariado, el BNP elevado (>442 pg/ml) y la IL-6 elevada (>7,2 pg/ml) fueron predictores independientes del punto primario (HR 2,60 (IC95%: 1,14-5,9), p = 0,02 y HR 2,49 (IC95%: 1,08-5,7), p = 0,03, respectivamente), no así la PCRus (>6,9 mg/l), con p = 0,2. La IL-6 presentó un área bajo la curva (ABC) de 0,70, el BNP, de 0,73 y la PCRus de 0,63, sin diferencias significativas entre ellas. Conclusiones: El BNP y la IL-6 fueron marcadores independientes del punto final combinado, no así la PCRus. La capacidad de discriminación de la IL-6 y el BNP fue moderada.

ABSTRACT Purpose: The aim of this study was to assess whether interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) associated with B-type natriuretic peptide (BNP) are independent markers of adverse events in outpatients with heart failure and reduced ejection fraction (HFrEF). Methods: Patients older than 65 years of age with HFrEF who were followed-up on an outpatient basis were prospectively included. Baseline BNP, IL-6 and hsCRP levels were assessed. Patients with HF after recent myocardial infarction (<6 months), and recent hospitalization (<3 months) due to a condition that could increase inflammatory markers were excluded from the analysis. The composite endpoint was all-cause mortality and hospitalization for decompensated heart failure (DHF). Results: A total of 130 patients aged 75 ± 5 years and with EF of 33 ± 11% were included in the study. The composite endpoint was observed in 31.5% (n=41) of patients during a follow-up period of 450 ± 210 days. In the multivariate analysis, elevated BNP (>442 pg/ml) and elevated IL-6 (>7.2 pg/ml) were independent predictors of the primary endpoint [HR 2.60 (95% CI 1.14-5.9), p=0.02 and HR 2.49 (95% CI 1.08-5.7), p=0.03, respectively], but not hsCRP >6.9 mg/l, p=0.2. IL-6 presented an area under the ROC curve (AUC) of 0.70, BNP 0.73 and hsPCR 0.63, without significant differences between them. Conclusions: BNP and IL-6 were independent markers of the composite endpoint, but not CRP. The discrimination ability of IL-6 and BNP was moderate.

Persistent Facial Oedema and Erythema in a Woman, An Uncommon Manifestation of Chronic Cutaneous Lupus Erythematosus.

Manifestations of chronic cutaneous lupus erythematosus are variable. Periorbital and facial swelling occurs in dermatomyositis and systemic lupus, but it has been rarely reported as a manifestation of exclusively cutaneous lupus. A 48-year-old woman presented with a 16-year history of asymptomatic, bilateral swelling and erythema of her face with marked worsening after sun exposure. No systemic symptoms were associated. A complete evaluation did not reveal other findings. Cutaneous biopsy showed features of lupus erythematosus. She was treated with photoprotection, topical tacrolimus, hydroxychloroquine and azathioprine with a partial response. Facial swelling with erythema represents quite an unusual manifestation of chronic cutaneous lupus erythematosus. Dermatomyositis, systemic lupus and Morbihan disease are the main differential diagnoses. LEARNING POINTS: Periorbital and facial swelling with erythema are clinical manifestations of dermatomyositis and systemic lupus erythematosus. However, these manifestations represent quite an unusual presentation of chronic cutaneous lupus erythematosus.The periorbital area is most frequently affected, while extensive facial involvement is much more unusual.A complete evaluation and cutaneous biopsy are essential to make the diagnosis and to rule out other disorders such as dermatomyositis, systemic lupus erythematosus and Morbihan disease.

Asociación entre el volumen plaquetario medio y la resistencia a aspirina e inhibidores del receptor p2y12 en pacientes ancianos con síndrome coronario agudo / Association between Mean Platelet Volume and Resistance to Aspirin and P2Y12 Receptor Inhibitors in Elderly Patients with Acute Coronary Syndrome

RESUMEN Introducción: La resistencia a antiagregantes y el volumen plaquetario medio (VPM) son predictores de eventos en el síndrome coronario agudo (SCA). La asociación entre ambos ha sido poco estudiada. Objetivos: Evaluar si existe asociación entre la resistencia a la aspirina (AAS) e inhibidores del receptor P2Y12 (iP2Y12) y el VPM en pacientes mayores de 65 años con SCA. Material y métodos: Se incluyeron pacientes mayores de 65 años con diagnóstico de SCA. Se dividieron en: grupo 1 (resistencia a ambos antiagregantes), grupo 2 (a uno de los antiagregantes) y grupo 3 (a ningún antiagregante). Se midió la agregación plaquetaria entre las 12 y 24 horas poscarga (por light transmission aggregometry). Se consideró resistencia a iP2Y12 a un porcentaje máximo de agregación (PMA) con ADP > 60% y a la AAS a un PMA con ARA > 20%. En el seguimiento se consi-deró el punto final combinado de muerte global y reinternación cardiovascular. Resultados: Se incluyeron 195 pacientes que recibieron AAS e iP2y12 (120 recibieron clopidogrel y 75 ticagrelor); grupo 1 (19%), grupo 2 (34,4%) y grupo 3 (46,6%). El VPM se asoció a la resistencia a ambos antiagregantes (OR 1,02 (IC 95% 1,01-1,05), p = 0,03. A su vez, el VPM y el GRACE fueron predictores independientes del punto combinado (HR 1,03 (IC 95% 1,01-1,07), p = 0,04 y HR 1,02 (IC 95% 1,01-1,04), p = 0,02), respectivamente. Conclusiones: El VPM se asoció a la presencia de resistencia a ambos antiagregantes. En el seguimiento el VPM y el score GRACE fueron predictores del punto combinado.

ABSTRACT Background: Antiplatelet resistance and mean platelet volume (MPV) are event predictors in acute coronary syndrome (ACS). However, the association between both has been poorly studied. Objective: The aim of this study was to evaluate the association between MPV and resistance to aspirin (ASA) and P2Y12 receptor inhibitors (P2Y12i) in elderly patients with ACS. Methods: Patients over 65 years old with diagnosis of ACS were included in the study. They were divided into group 1 (re-sistance to both antiplatelet agents), group 2 (resistance to one antiplatelet agent) and group 3 (no resistance to antiplatelet agents). Platelet aggregation was measured between 12 and 24 hours postload (by light transmission aggregometry). Resis-tance to P2Y12i was considered as maximum percentage of aggregation (MPA) with adenosine diphosphate (ADP) >60% and resistance to ASA as MPA with arachidonic acid (ARA) >20%. The composite endpoint of global death and cardiovascular re-hospitalization was considered during follow-up. Results: One hundred and ninety five patients included in the study received ASA and P2Y12i (120 received clopidogrel and 75 ticagrelor). Nineteen percent of patients belonged to group 1, 34.4% to group 2 and 46.6% to group 3. Mean platelet volume was associated with resistance to both antiplatelet agents [OR 1.02 (95% CI 1.01-1.05), p=0.03], while MPV and the GRACE score were independent predictors of the composite endpoint [HR 1.03 (95% CI 1.01-1.07), p=0.04] and [HR 1.02 (95% CI 1.01-1.04), p=0.02], respectively. Conclusions: Mean platelet volume was associated with the presence of resistance to both antiplatelet agents. During follow-up, MPV and the GRACE score were predictors of the composite endpoint.

Pharmacotherapeutic Reports as Tools for Detecting Discrepancies in Continuity of Care.

BACKGROUND: The care transition is the time when more medication errors occur. The aim of this study is to analyze the usefulness of a pharmacotherapeutic report model at hospital discharge to prevent medication errors and to simplify pharmacotherapy during a patient's transition from the hospital to primary care. METHODS: Prospective study including patients diagnosed with chronic obstructive pulmonary disease who were admitted to a short-stay unit or an emergency room. Relevant variables were extracted from the patients' clinical history and SPSS software was used to carry out the statistical analysis. Direct costs were also calculated. RESULTS: 79.3% of patients were polymedicated, 15.5% of patients were identified as nonadherent to the treatment, 12.1% were users of alternative therapies, and 10.3% had been prescribed drugs that could be monitored. In 32.8% of the reports, reference was made to the primary care pharmacists with a view to resolve any pharmacotherapeutic discrepancies. A total of 132 discrepancies were identified, the majority being related to medicinal requirements (necessary/unnecessary medication). The major cause of drug-related problems (DRPs) were prescription errors. The drugs that were mainly involved in the onset of DRPs belonged to the R group, and the degree of simplification of the pharmacotherapy was 7.6%. The total cost avoided with the reconciliation was 200€/patient. CONCLUSION: A continuity program was implemented based on the drafting of a pharmacotherapeutic report, which allowed for detecting discrepancies and updating the patients' pharmacotherapeutic history, resulting in financial savings after its implementation.

Renal damage induced by the pesticide methyl parathion in male Wistar rats.

Little information is apparently available regarding the nephrotoxic effects induced by pesticides. The aim of this study was to examine the influence of low doses of methyl parathion (MP) on the structure and function of the kidney of male Wistar rats. A corn oil (vehicle) was administered to control rats, whereas treated rats received MP at 0.56 mg/kg orally (1/25 of LD50), every third day, for 8 weeks. At the end of each week following MP exposure, creatinine and glucose levels were measured in plasma, while glucose, inorganic phosphate, total proteins, albumin, and activity of γ-glutamyltranspeptidase (GGT) were determined in urine. Kidney histological study was also performed. Compared with control rats, MP significantly increased plasma glucose and creatinine levels accompanied by decreased urinary flow rate and elevated urinary excretion rates of glucose, phosphate, and albumin. Further, the activity of GGT in urine was increased significantly. The proximal cells exhibited cytoplasmic vacuolization, positive periodic acid Schiff inclusions, and brush border edge loss after 2 or 4 weeks following MP treatment. Finally, renal cortex samples were obtained at 2, 4, 6, and 8 weeks of MP treatment, and the concentrations of reduced glutathione (GSH) and glutathione peroxidase (GPx) activity were measured. The mRNA expression levels of BAX and tumor necrosis factor-α (TNF-α) were also determined (RT-PCR). MP significantly decreased renal GSH levels, increased GPx activity, as well as downregulated the mRNA expression of TNF-α and BAX. Densitometry analysis showed a significant reduction in TNF-α and BAX mRNA expression levels at 2 and 4 weeks following MP treatment. Low doses of MP produced structural and functional damage to the proximal tubules of male rat kidney.

Lepra neural pura. Aspectos diagnósticos en un caso clínico / Pure neural leprosy. Diagnostic aspects of a clinical case

Introducción. La lepra es una enfermedad infecciosa causada por la bacteria Mycobacterium leprae. Presenta especial avidez por la piel y los troncos nerviosos, y, de hecho, ambos se afectan en la mayor parte de los infectados. Se trasmite por exposición con enfermos y en ocasiones por reactivación. Una posibilidad inhabitual es la lepra neural pura, caracterizada por neuropatía, pero sin lesiones en la piel. Se describe un paciente con lepra neural pura y se revisan los aspectos diagnósticos. Caso clínico. Varón de 40 años, inmigrante, diagnosticado y tratado de lepra 20 años antes. Acudió por parestesias y disestesias dolorosas en las manos y las piernas sin lesiones en la piel. Se demostró mononeuritis múltiple aguda con principal afectación de cubitales. La enfermedad, tipificada como tuberculoide paucibacilar, se trató y en pocas semanas la mejoría fue evidente. Conclusiones. En este caso de lepra neural pura por reactivación, el diagnóstico temprano permitió un rápido tratamiento. Es recomendable la evaluación de la neuropatía integrada con criterios clínicos, electrofisiológicos y ecográficos. De este modo se consigue una alta sensibilidad y especialmente una precocidad en el diagnóstico y la instauración del tratamiento, y por consecuencia una mejor recuperación funcional (AU)

Introduction. Leprosy is an infectious disease caused by the bacteria Mycobacterium leprae. It is particularly prone to affect the skin and the nerve trunks and, in fact, both are compromised in most infected patients. It is transmitted by exposure to those with the disease and sometimes by reactivation. One uncommon possibility is pure neural leprosy, which is characterised by neuropathy, but without skin lesions. We report the case of a patient with pure neural leprosy and review the diagnostic aspects. Case report. A 40-year-old male, an immigrant who was diagnosed and treated for leprosy 20 earlier. The patient visited due to painful paraesthesias and dysesthesias in the hands and legs without the presence of any skin lesions. Acute multiple mononeuritis with mainly ulnar involvement was observed. The disease, typified as paucibacillary/tuberculoid, was treated and in a few weeks there was a clear improvement. Conclusions. In this case of pure neural leprosy due to reactivation, early diagnosis allowed timely treatment to be established. Evaluation of neuropathy together with clinical, electrophysiological and ultrasound criteria is recommended. By so doing, a high degree of sensitivity is achieved as well as allowing early diagnosis and treatment, and therefore a better functional recovery (AU)

Presence of Thrombus and spontaneous Contrast in the left atrium of Patients with atrial Fibrillation anticoagulated with dabigatran and acenocoumarol / Presencia de trombo y contraste espontáneo en la aurícula izquierda en pacientes con fibrilación auricular, anticoagulados con dabigatrán y acenocumarol

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Volumen plaquetario medio como marcador pronóstico en pacientes con síndrome coronario agudo / Mean Platelet Volume as Prognostic Marker in Patients with Acute Coronary Syndrome

El volumen plaquetario medio (VPM) se ha descripto como un predictor de eventos cardiovasculares en pacientes con síndrome coronario agudo. No obstante, la evidencia de su rol como marcador pronóstico en pacientes añosos es escasa. Objetivo: Evaluar si el VPM es un predictor independiente de eventos en el seguimiento en pacientes con síndrome coronario agudo mayores de 65 años. Material y métodos: Estudio prospectivo que incluyó pacientes mayores de 65 años con síndrome coronario agudo con y sin elevación del segmento ST. Se dividieron en dos grupos: VPM alto (≥ 10,9 fL - tercil 3) y VPM bajo (< 10,9 fL - terciles 1 y 2). Se analizaron diferentes variables clínicas y se calcularon los puntajes TIMI y GRACE. Se consideró el punto final combinado de mortalidad global y reinternación cardiovascular (por síndrome coronario agudo, insuficiencia cardíaca y accidente cerebrovascular) en el seguimiento. Resultados: Se incluyeron 250 pacientes con una edad promedio de 74 ± 7 años, el 44% eran mujeres. Presentaron VPM alto 85 pacientes y VPM bajo 165. La mediana de seguimiento fue de 302 días (rango intercuartil 130-558) y el punto final primario se observó en el 17,6% (44 pacientes). En el análisis multivariado por regresión de Cox, el VPM alto fue predictor independiente del punto final primario [HR 7,23 (IC 95% 2,47-11,6); p = 0,001], al igual que el TIMI riesgo alto [3,10 (IC 95% 1,46-6,59); p = 0,03] y el puntaje GRACE [1,02 (IC 95% 1,01-1,07); p = 0,002]. El VPM presentó un área bajo la curva de 0,71 (IC 95% 0,59-0,82); p = 0,001. Conclusiones: En nuestra población, el VPM se comportó como un predictor independiente del punto final combinado, ajustado por otras variables como los puntajes TIMI y GRACE.

Background: Mean platelet volume (MPV) has been described as a predictor of cardiovascular events in patients with acute coronary syndrome. However, there is limited evidence of its role as prognostic marker in elderly patients. Objective: The aim of this study was to evaluate whether MPV is an independent predictor of events during follow-up of patients over 65 years of age with acute coronary syndrome. Methods: This prospective study included patients over 65 years with ST segment elevation or non ST segment elevation acute coronary syndrome. They were divided into two groups: high MPV (≥10.9 fL - 3rd tertile) and low MPV (<10.9 fL - 1st and 2nd tertile). Different clinical variables were analyzed and the TIMI and GRACE scores were calculated. The primary endpoint was the composite of all-cause mortality and cardiovascular readmission (for acute coronary syndrome, heart failure and stroke) over the follow up period. Results: A total of 250 patients were included in the study. Mean age was 74±7 years and 44% were women. Eighty-five patients presented with high and 165 with low MPV. Median follow-up was 302 days (interquartile range 130-558) and the primary endpoint was observed in 17.6% of cases (44 patients). In the multivariate Cox regression analysis, high MPV [HR 7.23 (95% CI 2.47-11.6); p=0.001], and TIMI [HR 3.10 (95% CI 1.46-6.59); p=0.03] and GRACE [HR 1.02 (95% CI 1.01-1.07); p=0.002] high risk scores were independent predictors of the primary endpoint. The area under the curve for MPV was 0.71 (95% CI 0.59-0.82), p=0.001. Conclusions: In our population, MPV emerged as an independent predictor of the composite endpoint, adjusted for other variables as the TIMI and GRACE scores.

Manifestaciones clínicas de la toxicidad cutánea por telaprevir / Telaprevir-induced cutaneous lesions

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Embolia de líquido amniótico que debuta como asistolia durante el trabajo de parto / Amniotic fluid embolism manifesting as asystole during labor

La embolia de líquido amniótico (ELA) constituye una entidad infrecuente en el embarazo o posparto, pero sus consecuencias pueden ser devastadoras tanto para la madre como para el feto. Presentamos el caso de una paciente primípara de 35 años que súbitamente durante el trabajo de parto presenta una parada cardiaca, iniciándose maniobras de RCP avanzada y cesárea peri-mortem. La evolución es mala, con múltiples complicaciones cardiovasculares y coagulopatía importante que precisa de histerectomía. Desenlace fatal a los 8 días de la madre y a los 5 días del recién nacido. La incidencia de la ELA, según los más recientes estudios realizados sobre bases poblacionales extensas, se sitúa entre 1/15.000 y 1/50.000 partos, con una mortalidad que clásicamente se sitúa entorno al 60-80%. La terapéutica se basa en gran parte en medidas de sostén y tratamiento sintomático. Las principales complicaciones son hemorrágicas, cardiovasculares y respiratorias. Se instauran medidas de soporte vital avanzado tan pronto como sea posible, dirigidas al mantenimiento de la oxigenación, la circulación y la coagulopatía(AU)

Amniotic fluid embolism (AFE) is infrequent in pregnancy or the postpartum, but the consequences can be devastating for both the mother and the fetus. We report the case of a 35-year-old primipara with sudden cardiac arrest during labor. Advanced cardiopulmonary resuscitation and peri-mortem cesarean section were performed. The clinical course was poor with multiple cardiovascular complications and severe coagulopathy, requiring hysterectomy. The patient died at 8 days and the neonate at 5 days. According to the most recent broad population-based studies, the incidence of AFE is between 1/15000 and 1/50000 childbirths, with mortality that is classically around 60-80%. Treatment is largely based on support measures and symptomatic treatment. The principal complications are hemorrhagic, cardiovascular and respiratory. Advanced life support measures should be started as soon as possible, aiming to maintain oxygen supply and circulation and arrest coagulopathy(AU)