Health-Related Quality of Life and Satisfaction With Health Care: Relation to Clinical Stage in Mexican Patients With Multiple Myeloma.

Multiple myeloma (MM) is characterized by bone pain, pathologic fractures, bone destruction, and secondary hypercalcemia, all these conditions impact on health-related quality of life of patients. The objective was to evaluate the global health state and health-related quality of life in a group of patients with MM who attended a tertiary health-care center of the Instituto Mexicano del Seguro Social in Mexico, through the questionnaires designed by European Organization for Research and Treatment of Cancer (EORTC) quality of life group. Exploratory cross-sectional study in patients with MM treated in a Department of Hematology in a High-Specialty Medical Unit was conducted. Patients older than 18 years of age, men and women, were selected, and their informed written consent was obtained. We included all consecutive cases treated from January 2012 to December 2014. Questionnaires EORTC QLQ-C30, EORTC QLQ-MY20, and EORTC IN-PATSAT-32 were used. We studied 37 patients, 19 (51%) men and 18 women. The mean age was 61.9 years. Twenty-two (59.46%) patients presented with clinical stage III. The mean time for diagnosis was 33.11 months. The most used first-line treatment schedule was melphalan/prednisone/thalidomide (15; 40%). The global health median was 66.67, and symptoms showed a median score of 22.22. Treatment side effects score was 16.67; for general satisfaction, the median score was 75. In conclusion, the patients showed an advanced clinical stage and poor prognosis but had scores higher than 50 in functional scales and lower than 50 for symptom scales. The scores for symptom scales were related to age, renal failure, and disease-free survival. Identification of quality of life and satisfaction of care markers allow for early therapeutic intervention and efficiency and enable a change in quality of life and perception of care in Health Services.

The Inhibitory Mechanism of the ζ Subunit of the F1FO-ATPase Nanomotor of Paracoccus denitrificans and Related α-Proteobacteria.

The ζ subunit is a novel inhibitor of the F1FO-ATPase of Paracoccus denitrificans and related α-proteobacteria. It is different from the bacterial (ϵ) and mitochondrial (IF1) inhibitors. The N terminus of ζ blocks rotation of the γ subunit of the F1-ATPase of P. denitrificans (Zarco-Zavala, M., Morales-Ríos, E., Mendoza-Hernández, G., Ramírez-Silva, L., Pérez-Hernández, G., and García-Trejo, J. J. (2014) FASEB J. 24, 599-608) by a hitherto unknown quaternary structure that was first modeled here by structural homology and protein docking. The F1-ATPase and F1-ζ models of P. denitrificans were supported by cross-linking, limited proteolysis, mass spectrometry, and functional data. The final models show that ζ enters into F1-ATPase at the open catalytic αE/ßE interface, and two partial γ rotations lock the N terminus of ζ in an "inhibition-general core region," blocking further γ rotation, while the ζ globular domain anchors it to the closed αDP/ßDP interface. Heterologous inhibition of the F1-ATPase of P. denitrificans by the mitochondrial IF1 supported both the modeled ζ binding site at the αDP/ßDP/γ interface and the endosymbiotic α-proteobacterial origin of mitochondria. In summary, the ζ subunit blocks the intrinsic rotation of the nanomotor by inserting its N-terminal inhibitory domain at the same rotor/stator interface where the mitochondrial IF1 or the bacterial ϵ binds. The proposed pawl mechanism is coupled to the rotation of the central γ subunit working as a ratchet but with structural differences that make it a unique control mechanism of the nanomotor to favor the ATP synthase activity over the ATPase turnover in the α-proteobacteria.

Rabies in chozna 'Potus flavus': a warning of a potential threat to public and animal health.

We reported an outbreak of wild rabies in Potus flavus (choznas), a carnivorous mammal associated with insectivorous bats in Kosñipata, Cusco, Peru, from February 2021 to October 2022. Eight human exposures were reported, with aggressive attacks resulting in injuries. The outbreak prompted a public health response and raised concerns about zoonotic diseases due to habitat fragmentation and urbanization. The study involved antigenic and genetic characterization of the virus in the affected animals, revealing similarities with variants in non-hematophagous bats. This outbreak marked the first time rabies had been reported in choznas in the region, highlighting the need for early intervention programs and wildlife protection. Pre-exposure rabies vaccinations were administered to residents, and community surveillance was established to control the outbreak. The study emphasizes the importance of continuous surveillance and education to prevent rabies transmission from choznas to humans and other animals, as their role as potential secondary transmitters of the virus warrants further investigation.

The prothrombotic state in cancer.

Neoplasms result from changes in the mechanisms of growth, differentiation, and cellular death. Cancers are of high clinical relevance due to their prevalence and associated morbidity and mortality. The clinical and biological diversity of cancer depends mainly on cellular origin and degree of differentiation. These changes result from alterations in molecular expression that generate a complex clinical, biochemical, and morphologic phenotype. Although cancer is associated with a hypercoagulable state, few cancers result in a thrombotic event. Many factors influence thrombotic incidence, such as advanced disease, central catheter placement, chemotherapy, neoplasia, and surgery. The pro-coagulant state is associated with anomalies in the vascular wall, blood flow, blood constituents (tissue factor, thrombin), coagulation state, and cell growth factors. Tumor cells perpetuate this phenomenon by releasing tissue factor, inflammatory cytokines, and growth factors. These changes favor cellular activation that gives rise to actions involving coagulation, inflammation, thrombosis, tumor growth, angiogenesis, and tumor metastases. These, in turn, are closely linked to treatment response, tumor aggressiveness, and host survival. Activation of the coagulation cascade is related to these phenomena through molecules that interact in these processes. As such, it is necessary to identify these mediators to facilitate treatment and improve outcomes.

New biomarkers in non-Hodgkin lymphoma and acute leukemias.

Biomarkers play a critical role in the medical care of patients with cancer, including in early detection of the disease, diagnostic accuracy, risk stratification, treatment, and follow-up. Biomarkers in hematological malignancies can support the redefinition of the diagnosis and adjustments in the treatment plan. Biomarkers can be classified into 4 categories: (1) protein antigens, (2) cytogenetic abnormalities, (3) genetic polymorphisms, and (4) gene expression. Efforts in genomics, proteomics, and metabolomics to observe new biomarkers that contribute to the development of clinical medicine with greater precision in the strategies that improve prevention, diagnosis, and treatment of patients with malignant hematological disease. New biomarkers should accomplish several issues such as the biological plausibility, methodology used, analytical validation, intellectual property registry, and legal framework of application. This knowledge should be transferred to health professionals who can carry out the process of its implementation in clinical practice.

Sleeve Gastrectomy Outcomes in Patients with BMI Between 30 and 35-3 Years of Follow-Up.

INTRODUCTION AND PURPOSE: Laparoscopic sleeve gastrectomy (LSG) in patients with a BMI between 30 and 35 kg/m2 plus comorbidities has shown to be safe and effective. The purpose of this study is to describe our outcomes in this group of patients after 3 years of follow-up. MATERIALS AND METHODS: Retrospective descriptive analysis of patients with initial BMI between 30 and 35 kg/m2 plus comorbidities were submitted to LSG between 2006 and 2013. We analyzed gender, age, comorbidities, BMI, total weight loss (%TWL), excess weight loss (%EWL), comorbidity resolution, morbidity, and mortality. Postoperative success was defined as %TWL over 20% and EWL% over 50% maintained for at least 1 year and comorbidity remission with no need of medication. RESULTS: Of the patients, 477 underwent a LSG in the above period and 252 met inclusion criteria; 188 (75%) were female and 64 (25%) were male. Median age was 39 years (15-70). Three-year follow-up was 43.9% (111 patients). Median preoperative BMI was 32.3 kg/m2 (30-34.3). Median postoperative %TWL was 12.9, 23.2, 28.2, 24.3, and 22.1% at 1, 6, 12, 24, and 36 months, respectively. %EWL was 42.88, 77.44, 98.42, 83.2, and 75.8%. Median surgical time was 86.9 min (40-120). There was comorbidity remission at 36 months. Insulin resistance was remitted in 89.4%, dyslipidemia 52%, non-alcoholic fatty liver disease 84.6%, hypertension 75%, and GERD 65%. T2DM had 60% of complete remission and 40% improvement. There were morbidity in six patients (2.4%), two reoperations, no leaks, and no mortality. CONCLUSIONS: Performing LSG in patients with grade I obesity is safe and effective. BMI should not be the only indicator to consider bariatric and metabolic surgery. We still require further studies and longer follow-up.

Obesity, Thrombotic Risk, and Inflammation in Cancer.

Neoplasms exhibits a high incidence and mortality rates due to their complex and commonly overlapping clinical, biochemical, and morphologic profiles influenced by acquired or inherited molecular abnormalities, cell of origin, and level of differentiation. Obesity appears related to ~20% of cancers including endometrial, esophageal, colorectal, postmenopausal breast, prostate, and renal. Several factors other than obesity, i.e., insulin, insulin-like growth factor, sexual hormones, and adipokines may play a potential role in neoplasia. Cancer-associated hypercoagulable and thrombotic states are influenced by abnormalities in the vascular wall and susceptibility to invasion, interference in blood flow and increase in circulating tissue factor and thrombin, activation of cell growth factors, the presence of a central catheter, chemotherapies, neoplasm type, and surgery. In cancer, thromboembolic complications are the second most frequent cause of death with pulmonary thromboembolism in ~50% of cases postmortem. Thrombosis worsens prognosis as demonstrated with a survival rate as low as 12% per year vs 36% in nonthrombic patients. Deep vein thrombosis is the most frequent thromboembolic complication in cancer. It is usually detected at diagnosis and within the first 3 months of chemotherapy. The underlining mechanisms of this association should be further studied to identify patients at higher risk and develop adequate prevention, diagnostic, and treatment measures. The D-dimer test can be successfully used to assess the fibrinolytic phase of coagulation and as such is routinely used in suspected cases of deep vein thrombosis and pulmonary thromboembolism. In addition, significant advances have been made in understanding the composition and functional capabilities of the gut microbiota in the inflammatory process, obesity, and its roles in cancer; however, the intricate balance that exists within the microbiota may not only affect the host directly, it can also disrupt the entire microbial community. CONCLUSIONS: Cancer is a prothrombotic and inflammatory state in which the activation of coagulation is related to tumor growth, angiogenesis, and metastasis. It is important to identify the relationship between body mass index with these processes and clarify their importance in cancer prognosis. Future research should answer the question if manipulation of resident microbial communities could potentially improve prognosis and treatment outcome.

Percepción del Ambiente Familiar y su Relación con el Consumo de Sustancias Legales e Ilegales en Estudiantes de Yucatan / Perception of the Family Environment and its Relationship with the Consumption of Legal and Illegal Substances in Students of Yucatan

El objetivo de este trabajo es determinar la percepción del ambiente familiar y su relación con la incidencia de consumo de tabaco, alcohol y sustancias ilegales en universitarios (N=300), con un rango de edad de 16 a 24 años, a quienes se les administró una escala de consumo de drogas y otra de ambiente familiar. Los resultados evidencian que, a mayor percepción de hostilidad y rechazo familiar mayor incidencia de consumo de diversas sustancias entre ellas alcohol, tabaco y marihuana, así como drogas sintéticas, en tanto que la percepción de apoyo familiar y comunicación con padres, se relaciona con menor consumo. Asimismo, se evidencia que los hombres consumen más tabaco y las mujeres más analgésicos.

The objective of this work is to determine the perception of the family environment and its relationship with the incidence of tobacco, alcohol and illegal substances consumption in university students with an age range of 16 to 24 years, who were administered a scale of drug consumption and another of family environment. The results show that the higher the perception of hostility and family rejection, the higher the incidence of consumption of various substances, including alcohol, tobacco, and marijuana, as well as synthetic drugs, while the perception of family support and communication with parents is related to lower consumption Also, it is evident that men consume more tobacco and women more analgesic.

[Appendiceal orifice inflammation in distal ulcerative colitis. Report of a case and review of the literature]. / Inflamación del Orificio Apendicular en Colitis Ulcerativa Distal.

We report the case of a 45-year-old female patient with an 18 month diagnosis of distal ulcerative colitis (proctosigmoiditis) of 18 months, who presented initially with allergy to salicylates, for which the disease was managed with corticosteroids and azathioprine and subsequently with Infliximab infusions, entering in remission. When she was about to receive her fifth Infliximab infusion she presented an exacerbation of her underlying disease with frequent stools with mucus, blood and tenesmus. Given that her initial diagnosis was made with a sigmoidoscopy we scheduled a total colonoscopy showing marked inflammation, erythema and friability limited to the recto-sigmoid mucosa, like at the disease onset, and when we reached the cecum an erythematous area circumscribed to the appendiceal orifice was observed, with a mucosal aspect identical to the described for the recto-sigmoid mucosa. The biopsies taken from that area were compatible with ulcerative colitis. We herein describe the details of the case and review the literature.

[Coexistence of Celiac Disease and autoimmune hepatitis case study and literature review]. / Coexistencia de enfermedad celíaca y hepatitis autoinmune. Reporte de un caso y revisión de la literatura.

The case of a patient who was initially diagnosed with Systemic Lupus Erythematosus, with subsequent documentation of Celiac Disease histologically and serologically is reported. The patient presented elevation of the aminotransferases, upon detection of the Celiac Disease which was initially attributed to the underlying disease. However, despite the complete resolution of her articular symptoms with a gluten-free diet, the liver chemistry abnormalities persisted. This led to consider an autoimmune hepatitis as the cause which was documented with a liver biopsy three months after the diagnosis of the celiac disease and under a strict gluten-free diet. Treatment with prednisone and azathioprine was initiated with complete normalization of aminotransferase levels. We present the sequence of events with the results and a review of the literature.

Inflamación del orificio apendicular en colitis ulcerativa distal / Appendiceal orifice inflammation in distal ulcerative colitis

Reportamos el caso de una paciente mujer de 45 años con diagnostico de colitis ulcerativa distal (procto-sigmoiditis) desde hace 18 meses, quien en su debut presenta alergia a salicilatospor lo cual la enfermedad fue manejada con corticoides y azatioprina y mas adelante con infusiones de Infliximab entrando en remisión. Estando próxima a su quinta infusión de Infliximab presenta exacerbación de su enfermedad de fondo caracterizada por deposiciones frecuentes con moco, sangre y pujo. Dado que su diagnostico inicial fue realizado con un examen limitado al sigmoides en esta oportunidad se programa una colonoscopía total. En dicho exámen se evidenció una marcada inflamación, eritema y friabilidad limitado a la mucosa recto-sigmoidea como al inicio de su enfermedad, y al llegar al ciego llamó la atención un eritema circunscrito al orificio apendicular, cuya mucosa tenía un aspecto endoscópico idéntico al observado en recto-sigmoides. Las biopsias tomadas de dicha zona también corresponden a cambios compatibles con colitis ulcerativa activa. Reportamos aquí los detalles del caso y hacemos una revisión de la literatura.

We report the case of a 45-year-old female patient with an 18 month diagnosis of distal ulcerative colitis (proctosigmoiditis) of 18 months, who presented initially with allergy to salicylates, for which the disease was managed with corticosteroids and azathioprine and subsequently with Infliximab infusions, entering in remission. When she was about to receive her fifth Infliximab infusion she presented an exacerbation of her underlying disease with frequent stools with mucus, blood and tenesmus. Given that her initial diagnosis was made with a sigmoidoscopy we scheduled a total colonoscopy showing marked inflammation, erythema and friability limited to the recto-sigmoid mucosa, like at the disease onset, and when we reached the cecum an erythematous area circumscribed to the appendiceal orifice was observed, with a mucosal aspect identical to the described for the recto-sigmoid mucosa. The biopsies taken from that area were compatible with ulcerative colitis. We herein describe the details of the case and review the literature.

Coexistencia de enfermedad celíaca y hepatitis autoinmune. Reporte de un caso y revisión de la literatura / Coexistence of celiac disease and autoimmune hepatitis. Case study and literature review

Reportamos el caso de una paciente en quien se hizo inicialmente un diagnóstico de Lupus Eritematoso sistémico documentándose posteriormente enfermedad Celíaca serológica e histológicamente. La paciente presentó elevación de aminotransferasas que una vez detectada la enfermedad celíaca se pensó que podían ser atribuíbles a su enfermedad de fondo. Sin embargo si bien los transtornos articulares desaparecieron por completo con la dieta libre de gluten, las anomalías de bioquímica hepática persistieron. Esto llevó a la consideración de hepatitis autoinmune que se documentó mediante biopsia hepática a los tres meses del diagnóstico de enfermedad celíaca y estricta dieta libre de gluten. Se inició tratamiento con Prednosona y Azatioprina con lo cual las aminotransferasas se normalizaron completamente. Presentamos aquí la secuencia de hechos con sus resultados y una revisión de la literatura.

The case of a patient who was initially diagnosed with Systemic Lupus Erythematosus, with subsequent documentation of Celiac Disease histologically and serologically isreported. The patient presented elevation of the aminotransferases, upon detection of the Celiac Disease which was initially attributed to the underlying disease. However, despite the complete resolution of her articular symptoms with a gluten-free diet, the liver chemistry abnormalities persisted. This led to consider an autoimmune hepatitis as the cause which was documented with a liver biopsy three months after the diagnosis of the celiac disease and under a strict gluten-free diet. Treatment with prednisone and azathioprine was initiated with complete normalization of aminotransferase levels. We present the sequence of events with the results and a review of the literature.

Dime qué comes y te diré cómo está tu salud bucal / Tell me what do you eat and I will tell you how is your oral health

Para un estado óptimo de salud se requiere de un buen equilibrio de la condición oral. Una dieta balanceada comprende alimentos saludables y diversos, lo cual es clave para mantener un buen estado de salud bucodental, debería tomarse en consideración ellimitar el exceso de carbohidratos en las comidas. La dieta afecta la salud oral de muchas maneras como la generación de caries dental, defectos en el desarrollo del esmalte, erosión dental y enfermedad periodontal y esta situación podría afectar la salud general dando como resultado la aparición de enfermedades cardiovasculares o infecciosas, entre otras.

For an optimal health a good oral equilibrium is required. A balanced diet comprising of diverse and healthy foods is key to promoting good oral health, limitation of high carbohydrates intake should be taken into consideration. Diet affects oral health in many ways such as diet include dental caries, developmental defects of enamel, dental erosion and periodontal disease and this situation could affect general health in many ways like cardiovascular and infectious diseases.

Diagnóstico prenatal en 350 amniocentesis / Prenatal diagnosis in 350 amniocentesis

Se realizaron 350 amniocentesis entre marzo de 1988 y marzo de 1991, como parte del programa de diagnóstico prenatal del Instituto Nacional de Perinatología. El diagnóstico citogenético se obtuvo en 348 casos (99.4%), de los cuales 10 (2.9%), fueron cromosómicamente anormales: Síndrome de Down, Síndrome de Edwards, (2) Síndrome de Turner, (1) Síndrome de Klinefelter (1) e inestabilidad cromosómica. (1) además se identificó un feto portador de translocación robertsoniana, dos portadores de translocaciones recíprocas balanceadas y tres más presentaron mosaicismo verdadero. En el grupo de pacientes estudiadas por indicación diferente de riesgo para cromosopatía, se observó un feto femenino afectado por hiperplasia suprarrenal congénita. En dos casos se observó pérdida fetal posiblemente atribuible al procedimiento por lo que la tasa de aborto fue de 0.57%.(au)

Sensibilidad bacteriana a las cefalosporinas de tercera y cuarta generación en diferentes áreas hospitalarias: estudio multicéntrico / Study multicéntric: bacterial sensitivity to third and fourth generation cephalosporins in differents areas hospitable

Se presenta un estudio prospectivo de corte transversal, de vigilancia epidemiológica, para determinar la sensibilidad bacteriana, por Servicio Hospitalario, a cefalosporinas de tercera y cuarta generación (ceftriaxona, cefotaxina, ceftazidima, cefoperazona y cefepime) mediante la prueba de disco de Kirby Bauer. Se incluyeron muestras bacteriológicas de 13 centros: 10 de Lima, dos de Arequipa y uno de Chiclayo. La sensibilidad más alta de Staphylococcus aureus se encontró en los servicios ambulatorios (Consulta Externa y Urgencia), situación que disminuyó casi a la mitad en los servicios de hospitalización (Medicina Interna, Cirugía y Cuidados Críticos). La sensibilidad de E.coli no mostró variación entre los servicios, a excepción de ser de menor grado en la Unidad de Cuidados Críticos. Las cepas de klebsiella pneumoniae y Enterobacter aerogenes aisladas en Consulta Externa, mostraron ser más sensibles que las procedentes de áreas de hospitalización, sobre todo Medicina Interna y Cirugía. La sensibilidad de Pseudomonas aeruginosa fue más alta en las muestras obtenidas en los servicios ambulatorios. Klebsiella, Enterobacter y Pseudomonas fueron más sensibles a cefepime que a ceftazidima. Se concluye que, según el Servicio de referencia de la muestra, hay variación en la sensibilidad bacteriana a cefalosporinas de tercera y cuarta generación

Vigilancia epidemiológica de susceptibilidad bacteriana a las cefalosporinas de tercera y cuarta generación. Estudio multicéntrico / Epidemiologic surveillance of bacterial susceptibility to the cephalosporines of third and fourth generation: multicenter study

Objetivo: Determinar la susceptibilidad bacteriana a cefalosporinas de tercera y cuarta generación en centros hospitalarios en Perú. Métodos: Estudio prospectivo de corte transversal, de vigilancia epidemiológica. Se incluyeron muestras bacteriológicas de 13 centros, 10 de Lima, 2 de Arequipa y uno de Chiclayo, las que fueron tipificadas de acuerdo a los criterios del NCCLS. Se determinó la susceptibilidad para ceftriaxone, cefotaxime, ceftazidime, cefoperazone y cefepime, mediante el método de disco de Kirby Bauer.Resultados: La sensibilidad de las bacterias grampositivas fue de 79 por ciento a cefepime, de 72 por ciento a cefoperazone, de 71 por ciento a cefotaxime y de 71 por ciento a ceftriaxone. La susceptibilidad de Staphylococcus aureus para cefepime fue de 74 por ciento, para cefotaxime de 67 por ciento, seguido de las otras cefalosporinas. La susceptibilidad de 77 cepas de Streptococcus pneumoniae fue igual o mayor al 90 por ciento para todas las cefalosporinas. De 1,645 bacterias gramnegativas, el 93 por ciento fue susceptible a cefepime, el 87 por ciento a ceftazidime, seguidas por ceftriaxone, cefoperazone y cefotaxime. La susceptibilidad para E. coli estuvo encima del 90 por ciento para todas las cefalosporinas. El 93 por ciento de las cepas de Klebsiella pneumoniae fue susceptible a cefepime, el 81 por ciento a ceftazidime, seguidas por las otras sefalosporinas. De forma similar la susceptibilidad de Enterobacter cloacae fue mayor para cefepime (89 por ciento) y ceftazidime (80 por ciento). La susceptibilidad para Pseudomona aeruginosa fue de 83 por ciento para cefepime y de 81 por ciento para ceftazidime. Conclusiones: En el estudio se encuentra que la resistencia bacteriana a cefalosporinas de tercera generación está presente en los centros hospitalarios del Ministerio de Salud, IPSS, clínicas privadas y Hospital Militar, manteniéndose un buen nivel de susceptibilidad para cefalosporinas de cuarta generación.