Embolia pulmonar tumoral: un reto diagnóstico / Pulmonary tumour embolism: a diagnostic challenge

Resumen Se publica el caso de una paciente de 27 años, quien consultó al Servicio de Urgencias del Hospital Hernando Moncaleano Perdomo, por cuadro clínico de tos seca persistente que posteriormente se acompañó de disnea, dolor pleurítico y hemoptisis, de aproximadamente cuatro meses de evolución. Tenía antecedentes quirúrgicos de lipoescultura y abdominoplastia cuatro meses previos al ingreso e histerectomía hace un año (por hemorragia uterina). Mediante correlación clínico-patológica se llegó al diagnóstico de embolia pulmonar de origen tumoral, entidad aún de diagnóstico difícil dada la presentación clínica inespecífica. Para la diferenciación diagnóstica los estudios radiológicos no son precisos, a menos que se lleven a cabo procedimientos invasivos para llegar a un diagnóstico certero, como ocurrió con la paciente. Se presenta el caso y se hace una revisión sobre embolia pulmonar y sus otras causas como coriocarcinoma; adicionalmente se abarcan aspectos relevantes sobre incidencia, cuadro clínico, tratamiento y pronóstico, de una patología cuyo diagnóstico sigue siendo en su mayoría tardío.

Abstract The case is presented of a 27 year-old patient who was seen in the Emergency Department of the Hospital Hernando Moncaleano Perdomo, due to a clinical picture of a persistent dry cough that was later accompanied by dyspnoea, pleural pain, and haemoptysis, of approximately four months onset. She had a surgical history of liposculpture and abdominoplasty four months prior to the admission, and a hysterectomy a year ago (uterine haemorrhage). Using clinical-pathological correlation, the diagnosis was made of a pulmonary embolism of tumour origin, a condition still difficult to diagnose given the unspecific clinical picture. Radiological studies are not accurate for the differential diagnosis, unless invasive procedures are used to reach an accurate diagnosis, as in the case of this patient. As well as the case, a review is presented on pulmonary embolism and its other causes such as choriocarcinoma. Furthermore, relevant aspects are included on its incidence, clinical symptoms, treatment and prognosis, in a disease for which the majority of diagnoses continue to be delayed.

Participación en el sector no agropecuario en el México rural: una perspectiva de género / Participação no setor não agrícola no México rural: uma perspectiva de gênero / Participation in the non-agricultural sector in rural Mexico: a gender perspective

Los hogares rurales diversifican sus ingresos como estrategia para minimizar los riesgos, reducir la variabilidad y asegurar un nivel mínimo de ingreso. Con información panel de la Encuesta Nacional a Hogares Rurales de México, el presente estudio examina, bajo una perspectiva de género, los factores que determinan la participación en el sector no agropecuario. Los resultados señalan que en las ocupaciones asalariadas no agropecuarias, los hombres participan con menores niveles de escolaridad y la condición de indígena limita la incorporación de ambos géneros. En actividades no agropecuarias por cuenta propia son esenciales la riqueza acumulada del hogar y los servicios financieros, de comunicación y transporte.

As famílias rurais diversificam sua renda como estratégia para minimizar o risco, reduzir a variabilidade e garantir um nível mínimo de renda. Com informações da Encuesta Nacional a Hogares Rurales de México, o presente estudo examinou, sob uma perspectiva de gênero, os fatores que determinam a participação no setor não agrícola. Os resultados indicam que, nas ocupações assalariadas não agrícolas, os homens participam com baixos níveis de escolaridade e a situação indígena limita a incorporação de ambos os sexos. Em atividades de autoemprego não agrícola, são essenciais a riqueza acumulada das famílias e serviços financeiros, de comunicação e transporte.

Rural households diversify their income as a strategy to minimize risk, reduce variability and ensure a minimum level of income. With information panel of the National Rural Household Survey of Mexico, this study examined under a gender perspective, the factors that determine participation in the non-agricultural sector. The results indicate that employed in non-agricultural occupations, men participate with lower levels of education and indigenous status limits the incorporation of both genders. In non-agricultural self-employment activities are essential household accumulated wealth and financial services, communication and transportation.

Asociación de la tuberculosis pulmonar con los antígenos del sistema HLA en el Noreste de México / Association of pulmonar tuberculosis with HLA system antigens in Northeastern Mexico

Antecedentes: La susceptibilidad genética a tuberculosis pulmonar (TbP) ha sido asociada al sistema HLA (antígenos de los leucocitos humanos) del MHC (complejo mayor de histocompatibilidad), principalmente con los antígenos HLA-DR y -DQ. Dado lo anterior, el objetivo de este estudio caso-control no pareado, fue determinar la asociación de TbP con los antígenos HLA-DR y -DQ en pacientes que asistían a una unidad médica del IMSS. Métodos: Los fenotipos del sistema HLA de casos (n=50) y controles (n=417), se definieron serológicamente por la técnica de microlinfocitotoxicidad dependiente de complemento. Los linfocitos B fueron obtenidos utilizando inmunoperlas. Las frecuencias alélicas y haplotípicas, equilibrio de Hardy-Weinberg y el desequilibrio de ligamiento, se determinaron mediante el programa computacional Arlequín versión 3.01, y el riesgo relativo (RR) mediante el programa Epimax Table Calculator. Resultados: Los alelos HLA-DR11(5), -DR16(2) y -DQ7(3) y los haplotipos /DR11(5)-DQ7(3), /DR14(6)-DQ5(1) y /DR16(2)-DQ7(3) fueron más frecuentes en casos que en controles (RR>1, p<0.05). Los alelos HLA-DR17(3) y DQ8(3) y los haplotipos /DR17(3)-DQ2 y /DR4-DQ8(3) fueron más frecuentes en controles que en casos (RR<1, p<0.05). Conclusiones: Estos resultados sugieren asociación entre TbP y HLA-DR y -DQ en esta población mestiza mexicana y son similares a los encontrados en otros estudios caso-control no pareados a nivel mundial.

BACKGROUND: Genetic susceptibility to pulmonary tuberculosis (PTb) has been associated with the HLA (Antigens of the Human Leukocytes) system of the MHC (Major Histocompatibility Complex), mainly with HLA-DR and-DQ antigens. Based on this assumption we carried out a case control study to determine the association of PTb with the HLA-DR and-DQ antigens among a sample of patients attending a medical unit belonging to the Mexican Social Security System (IMSS). METHODS: HLA system phenotypes from cases (n=50) and controls (n=417), were defined serologically using a complement dependent microlymphocytotoxic assay. B lymphocytes were obtained using immunobeads. The allele and haplotype frequencies were determined using the Arlequin version 3.01 computer software. Relative risk (RR) was calculated with the Epimax Table Calculator. RESULTS: The alelles HLA-DR11(5), -DR16(2) and -DQ7(3) and haplotypes /DR11(5)-DQ7(3), /DR14(6)-DQS(1) and /DR16(2)-DQ7(3) had a higher frequency in cases than in controls (RR>1, p<0.05). The HLA-DR17(3) and DQ8(3) alelles and /DR17(3)-DQ2 and /DR4-DQ8(3) haplotypes had a higher frequency among controls than among cases (RR<1, p<.05). CONCLUSIONS: These results indicate an association between PTb with the HLA-DR and -DQ antigens in a Mexican sample. Our results are similar to those found in the international literature.

Citogenética y citoquímica de pacientes con leucemias en dos hospitales neotropicales / Citogenetics and citochemistry of leukemia patients in two neotropical hospitals

A cytogenetic and/or cytochemical study was performed in 166 individuals with leukemia or related disorders, in two major Costa Rican hospitals. In those patients treated at an adult`s (14 years old and over), acute leukemias represented 66 porcent of all cases. In that hospital the most frequent types of disorders were, in decreasing order: ANLL(>M1), ALL, CML (all of them showed the Ph chromosome) and MDS. In the cases fron a children`s hospital (<14 years old) acute leukemias were 98 porcent. Among them the order of frequency was: ALL (70 porcent): ALL-1(84 porcent), ALL-2(16 porcent) and ANLL (27 porcent): M5a>M3>M4>M5b. In ALL 85 porcent were type B and occurred mostly in women while 15 porcent of them were type T and more frequent in males. There was 5.6 porcent infant leukemia, which presented a similar number of acute lymphoids and myeloids. The cytogenetic pattern was similar among Costa Rica and other tropical and temperate countries. Key words: Leukemia cytogenetics, acute lymphocytic leukemia, acute nonlymphocitic leukemia, chronic granulocytic leukemia

Mutagenic activity of diazepan evaluated by in vivo cytogenetic tests

Background. Diazepam, one of the benzodiazepine group of tranquilizers, in used as an adjunctive drug for sedation and for relief of anxiety in the treatment of epilepsy. Suspicion has been aroused of a possible mutagenic and teratogenic effect of this drug, thus the potential for cancer development. Methods. To analyze the mutagenic effect of diazepam, the micronuclei and sister chromatid exchange (SCE) tests were performed by in vivo techniques in the bone marrow of Balb-C mice after intraperitoneal drug administration. Sixty mice, 30 males and 30 females, were classified as negative control (n=12), positive control (n=12), and three groups were treated with diazepam (n=36). All groups were matched by sex, and each mouse received a single intraperitoneal injection. Negative control group was injected with physiological saline, positive control group with mitomycin-C at a dose of 0.5 mg/kg of body weight. Treated groups received diazepam, one at 0.1, the other at 0.2, and the last, at 0.4 mg/kg. Results. The results showed a significant increase in the frequency of micronucleated polychromatic erythrocites at all doses tested for whole population in relation to negative control. The polychromatic/normochromatic erythrocyte ratio showed a significante decrease at doses of 0.1 and 0.4 mg/kg in relation to negative control, the male mice being those affected. Conclusions. It is concluded that diazepam showed mutagenic and genotoxic effects on bone marrow cells of mice and that it might represent a human health risk

Activity satellite association and polymorphismo of Ag stained nucleolus organizer regions (Ag+ NORs) in lymphocytes from women with cervical uterine cancer

Thirty five female patients with different stages of neoplastic lesions: cervical intraepithelial neoplasia (CIN) or dysplasia (CIN I and CIN II), in situ carcinoma (CIS), and adenocarcinoma, and 27 healthy women (controls) wee studied to determine the activity, satellite association, and jpolymorphism of Ag stained nucleolus organizer regions (Ag+NORs) in acrocentric chromosomes in metaphases obtained from peripheral blood lymphocytes. For each person, 25 to 50 metaphases stained with ammoniacal silver technique were scored. The average number of Ag+ NORs was higher in women with adenocarcinoma (7.66 ñ 0.72) than in controls (6.65 ñ 0.74). Non-associated chromosomes showing Ag+ NORs were found more frequently in patients (5.85 ñ 0.88) than in controls (4.81 ñ 0.67). Patients aged 30-39 and 60 or more had an increase of Ag+ NORs (7.99 ñ 1.04, and 7.81 ñ0.71) with respect to their controls (6.36 ñ 0.052 and 6.17 ñ 0.88), but the frequency of satellite association showed lower values in 50 -59 year-old patients (0.75 ñ 0.08) than in controls (1.02 ñ 0.19). The most frequent association in patients was the large type (patients = 38.96 perecent, controls 30.49 ). The partial association showed higher values (6.49 percent) than controls (2.44 percent). Otherwise, the spherical association was more frequent for controls (37.80 percent) than for patients (28.57 percent). All these differences were statistically significant (p<0.05). The frequency of Ag+ NORs and the type of polymorphism of satellite association could be related to the neoplastic process, while the frequency of satellite association and of polymorphism of Ag+ NORs seems to be irrelevant

Risk estimation of ABO and Rho(D) incompatibility in persons with mono- and polyphyletic surnames in Monterrey, Mexico: comparison with other Mexican population

ABO and Rho(D) blood groups were determined in 3813 males and females affiliated with the Instituto Mexicano del Seguro Social (IMSS) who are residents of the Monterrey Metropolitan Area (MMA) in northeastern Mexico. They were selected by their monophyletic or polyphyletic surnames. The ABO and Rho(D) blood group phenotypes and gene frequencies were determined and based upon these, the risk of incompatibilities was estimated for both marriages (MI) and maternal-fetal incompatibility (MFI). These were compared with those estimated for other populations of residents in the MMA, and in other locations in Mexico, as well as with the two most important ancestral populations, Spanish and Tlaxcaltecan Mexican Indians, with the hypothesis that the percent of risk ABO and Rho(D) MI and MFI are greater in the population with monophyletic surnames than those with polyphyletic surnames. It was found that for persons with nomophyletic and polyphyletic surnames, as well as for the other populations in the MMA and other places in Mexico, their ABO and Rho(D) MI and MFI percent of risk are intermediate to the ones estimated for their ancestry. The percentages of MI and MFI are higher for the persons with monophyletic than for the ones with polyphyletic surnames, other populations from the MMA and those from other locations in Mexico. The risks are higher when the similarity with Spanish increases and are lower when their similarities with the mexican Indians increase

Algunos factores epidemiológicos en el cáncer cervicouterino / Certain epidemiologic factors of cervico-uterine cancer

Colateralmente a un estudio citogenético se entrevisto a un grupo de 44 pacientes que acudían por primera vez a la consulta de oncología del Hospital Regional de Especialidades No. 23 "Dr. Ignacio Morones Prieto", Monterrey, N.L., del Instituto Mexicano del Seguro Social, las cuales presentaban alguna alteración neoplásica cervicouterina, y a 45 mujeres sin ningún padecimiento neoplásico que fueron consideradas como grupo control, a las que se les interrogó sobre algunos antecedentes ginecoobstétricos y además se les determinaron los grupos sanguíneos y Rh (D). Los resultado obtenidos indicaron que el cáncer invasor en estadio II es el padecimiento neoplásico cervicouterino más común (25 por ciento), siendo la cuarta década de la vida la etapa en la que mayormente se diagnosticó y tiende a presentarse en mujeres que inicaron relaciones sexuales a edad temprana. Se manifiesta también con más frecuencia en multigestas, en mujeres que presentan antecedentes de uno o más abortos, y en aquéllas que hayan utilizado anticonceptivos orales o dispositivo intrauterino (DIU) como mecanismo de control de la natalidad

Valores hemotológicos de referencia en niños escolares costarricenses / Haemathologic reference values in CostaRican scholar children

Se determinaron los ámbitos de referencia normal para hemoglobina (Hb), hematocrito (Hto), concentración de Hb corpuscular media (CHCM), hierro sérico (FeS), capacidad total de fijación de FeS (CTFFeS), índice de saturación (IS) y protoporfina libre unida a zinc (Prt-Zn) en niños escolares del Cantón Central de San José. Se estudiaron un total de 475 niños con edades comprendidas entre los 6 a 9 años y 11 a 14 años, demostrándose estadísticamente que no existe diferencia en los valores hematológicos estudidados por sexo, pero si por grupo de edad (p<0,05) en el caso de la Hb, Hto, CHCM y CTFFeS. Se utilizó para determinar los ámbitos de referencia normal el u+-2D. E. (promedio +- dos desviaciones estándar)

Ferritina sérica y protoporfirina eritrocitaria como indicadores de deficiencia de hierro en niños lactantes / Serum ferritin and erythrocyte protoporphyrin as iron deficiency indicators in infants

A nueve niños con anemia por deficiencia de hierro se les determinó el índice protoporfina eritrocitaria/hemoglobina (PPE:Hb) y los niveles de ferritina sérica antes, a los 15 y a los 30 días de administración de 2 mg de hierro/kg de peso/ día. Todos presentaron niveles anormales altos de protoporfirina y anormalmente bajos de ferritina, que descendieron y aumentaron respectivamente al administrarles el hierro. Estos cambios fueron estadísticamente significativos (p<0.05 ó mejor), aunque los valores no llegaron a igualar en ese tiempo los correspondientes a los niños controles a quienes también se les administró hierro. Por lo tanto, ambos indicadores resultaron muy sensibles para detectar la deficiencia de hierro y la respuesta al tratamiento. No obstante, el índice PPE:Hb, no logró identificar la deficiencia de hierro de reserva, pero es una prueba práctica, rápida y de bajo costo, en contraste con el radioinmunoensayo para ferritina sérica. Los valores de protoporfirina eritrocitaria fueron normales en estos niños, lo cual indica que este no es un buen indicador para detectar la deficiencia prelatente de hierro