Enfermedad de Células Falciformes y Embarazo

La enfermedad por células falciformes (ECF) es una patología en aumento en el mundo y en nuestro país. Debido a los avances en el tratamiento y la mejor expectativa de vida hay más mujeres con ECF que tienen embarazos.En estos casos, los riesgos para la madre y el hijo son mayores que para la población general. Por este motivo que se requiere de un equipo multidisciplinario que trabaje en forma protocolizada, para lograr los mejores resultados.  En este documento presentamos los principios generales para el manejo de la mujer con ECF durante el embarazo y puntualizamos la necesidad de más estudios para fortalecer la evidencia científica en esta población. (provisto por Infomedic International)

Sickle cell disease (SCD) is a growing pathology in the world and in our country. Due to advances in treatment and improved life expectancy, more women with SCD are having pregnancies. In these cases, the risks for mother and child are higher than for the general population. For this reason, a multidisciplinary team working in a protocolized way is required to achieve the best results. In this document we present the general principles for the management of women with SCD during pregnancy and point out the need for more studies to strengthen the scientific evidence in this population. (provided by Infomedic International)

Menor aerolización con bloqueo del nervio laríngeo superior comparado con lidocaína intravenosa a la extubación / Less aerolization with superior laryngeal nerve block compared to intravenous lidocaine at extubation

Resumen: Introducción: La tos es una respuesta fisiológica de protección de la vía aérea, produce aerosoles que se identifican por imagen y alcanza una velocidad de hasta ocho metros por segundo. La extubación produce tos, hipertensión, taquicardia, apnea y laringoespasmo, existen métodos para minimizar su aparición. Debido a la pandemia de COVID-19 se han utilizado como profilaxis del reflejo tusígeno, la lidocaína intravenosa y el bloqueo del nervio laríngeo superior. El objetivo fue compararlos en la inhibición de la tos. Material y métodos: Se seleccionaron pacientes entre 18-60 años, cirugía electiva con anestesia general balanceada, ASA 1-3, con intubación menor a tres horas. Se aleatorizó un total de 90 pacientes, 45 en cada grupo, se eliminó un total de 10 pacientes por presentar inestabilidad hemodinámica al final de la cirugía o por no administrar dosis intravenosa de lidocaína en el tiempo establecido. Resultados: No hubo diferencia estadísticamente significativa en el número de pacientes que presentaron tos en ambos grupos (13 vs 10, p = 0.4684), de éstos se obtuvo una diferencia estadísticamente significativa en el número de decibeles a favor del grupo de bloqueo (75.6 vs 67, p < 0.001). Conclusiones: El bloqueo (selectivo) presenta menos aerolización que la lidocaína intravenosa en la extubación.

Abstract: Introduction: Coughing is a physiological response to protect the airway, it produces aerosols that are identified by imaging reaching a speed of up to 8 meters per second. Extubation produces cough, hypertension, tachycardia, apnea and laryngospasm, there are methods to minimize its occurrence. Due to the COVID-19 pandemic, intravenous lidocaine and superior laryngeal nerve block have been used as cough reflex prophylaxis. The aim was to compare them in cough inhibition. Material and methods: Patients aged 18-60 years, elective surgery with balanced general anesthesia, ASA 1-3, with intubation less than 3 hours, were selected. A total of 90 patients were randomized, 45 in each group. A total of 10 patients were eliminated because they presented hemodynamic instability at the end of surgery, and because the intravenous dose of lidocaine was not administered within the established time. Results: There was no statistically significant difference in the number of patients who presented cough in both groups (13 vs 10, p = 0.4684), of these there was a statistically significant difference in the number of decibels in favor of the block group (75.6 vs 67, p < 0.001). Conclusions: Block presents less aerolization than intravenous lidocaine in extubation.

Características poblacionales y placentarias asociadas a óbito en infección asintomática por SARS-CoV-2 / Population characteristics and placental findings associated with stillbirth in asymptomatic SARS-CoV-2 infection

Resumen Objetivo: Comparar características poblacionales y hallazgos placentarios asociados a óbito, en mujeres con infección asintomática por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) al momento de la resolución del embarazo. Material y métodos: Estudio transversal analítico, mujeres con diagnóstico de óbito e infección asintomática por SARS-CoV-2. Se excluyeron pacientes con patología ginecológica y aquellas con más de una prueba RT-PCR. Resultados: No hay diferencia estadísticamente significativa entre las pacientes con infección asintomática por SARS-CoV-2 comparadas con pacientes sin infección para las características poblacionales como edad materna, antecedentes obstétricos, edad gestacional, escolaridad, estado civil, hábito tabáquico y enfermedades crónico-degenerativas. Tampoco hubo diferencia en los hallazgos placentarios de corioamnionitis, vasculitis, deciduitis, trombosis, aterosis aguda y necrosis fibrinoide. Conclusiones: No hay diferencia estadísticamente significativa en las características poblacionales y placentarias en embarazadas con diagnóstico de óbito, con y sin infección asintomática por SARS-CoV-2. Tenemos datos insuficientes para afirmar alguna característica asociada a óbito en pacientes con infección por SARS-CoV-2 asintomática.

Abstract Objective: To compare population characteristics and placental findings associated with stillbirth, in women with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at the time of delivery. Materials and methods: Analytical cross-sectional study women with a diagnosis of stillbirth and with asymptomatic SARS-CoV-2 infection. Patients with gynecological pathology and those with more than one RT-PCR test were excluded. Results: There is no statistically significant difference between patients with asymptomatic SARS-CoV-2 infection compared to patients without infection for population characteristics such as maternal age, obstetric history, gestational age, education, marital status, smoking habit, chronic-degenerative diseases. There was no difference in placental findings of chorioamnionitis, vasculitis, deciduitis, thrombosis, acute atherosis, and fibrinoid necrosis. Conclusions: There is no statistically significant difference in the population and placental characteristics, in pregnant women diagnosed with stillbirth with and without confirmed asymptomatic SARS-CoV-2 infection. For the moment, we have insufficient data to affirm any population characteristic associated with stillbirth in patients with asymptomatic SARS-CoV-2 infection.

First record of Triatoma longipennis, Usinger, 1939 (Hemiptera: Reduviidae: Triatominae) in Tecozautla, Hidalgo

ABSTRACT Background: We report the presence of Triatoma longipennis for the first time in two localities in Hidalgo, Mexico. Methods: This study was conducted at Tecozautla municipality, Hidalgo. Collection was performed in April 2022. Results: We collected eight triatomines from Guadalupe: two fourth-instar nymphs, three fifth-instar nymphs, one female, and two males. In San Miguel Caltepantla, a female was collected inside a dwelling. One sample tested positive for Trypanosoma cruzi. Conclusions: These findings suggest the need to investigate the dynamics of this species with respect to the inhabitants of the study area.

Reporte de caso: Bloqueo del erector de la espina en resección transuretral de próstata / Case report: Erector spine block for transuretral prostatic resection

The Erector Spinae Plane (ESP) block, described in 2016 by Dr. Forero et al, was used to treat neuropathic pain and postoperative acute pain. It was described as an interfascial block in the erector spinae plane, where it manages to block both ventral and dorsal branches of the spinal nerve. Due to scarce literature on its applicability in urological endoscopic surgeries, we formulate the hypothesis that it would be an effective opioid-sparing analgesic alternative in patients undergoing TULIP. Therefore, bilateral ESP was performed in a 69-year-old patient, who underwent transurethral prostatectomy guided by laser induced (TULIP) for benign prostatic hyperplasia. The patient did not require rescue medication, reported a maximum VAS of 4/10. At 72 hours postoperatively, the patient kept a VAS of 0/10, without nausea and vomiting, with a Likert satisfaction level of 1

El bloqueo del plano erector de la espina (ESP) fue descrito en 2016 por el Dr. Forero et al., con el afán de tratar el dolor neuropático y el dolor agudo posoperatorio. Consiste en un bloqueo interfascial en el plano del erector de la espina, en el cual se logra el bloqueo tanto de ramas ventrales como dorsales de los nervios espinales. Debido a la falta de literatura sobre su indicación en cirugías endoscópicas urológicas se formula la hipótesis de que podría considerarse como una alternativa analgésica efectiva ahorradora de opioides en pacientes sometidos a RTU-P. Por lo anterior se realizó el bloqueo ESP de manera bilateral a un paciente de 69 años, el cual fue sometido a prostatectomía transuretral guiado por láser inducido (TULIP) por hiperplasia prostática benigna. El paciente no requirió opioides de rescate, con EVA 0/10 en posoperatorio, valor que se mantuvo de la misma manera por 72 h, tanto en reposo como en movimiento, sin la presencia de náuseas o vómitos y una escala de satisfacción de Likert de 1.

Circulating miR-146a as a possible candidate biomarker in the indeterminate phase of Chagas disease

BACKGROUND: Chagas disease is considered important and presents intense inflammatory and fibrotic processes induced by the perpetuation of the parasite in the affected tissues and organs. Therefore, it is necessary to inquire about the host defense and attack mechanisms to have a more detailed knowledge about Chagas disease. Micro-RNAs are found in blood, tissues and extracellular vesicles. These small regulators of gene expression are involved in physiological and pathological processes in both mammals and parasites. Several microRNAs have deregulated expression in chagasic heart disease, although little is known about their extracellular expression. Our main objective was to evaluate the involvement of miR-21, miR-146a and miR-155 in several samples from mice infected with the TcI Ninoa strain from the acute and indeterminate phases. We also explored a potential functional association of the selected microRNAs using STRING software. This software identified 23 pathways associated with Trypanosoma cruzi infection. In addition, eleven genes were identified through bioinformatics analysis, and we found that SMAD family member 5 was downregulated in both phases. This gene serves as a mediator in the TGF-ß signaling pathway. Thus, forty female mice of the CD1 strain were distributed into 4 groups and the expression levels of miR-21, miR-146a and miR-155 were measured in samples of heart tissue, total plasma and plasma extracellular vesicles by quantitative real-time polymerase chain reaction. RESULTS: Overexpression of miR-21, miR-146a and miR-155 was observed in heart and plasma in both phases. Moreover, in extracellular vesicles miR-21 and miR-146a were also overexpressed in the acute phase, whereas in the indeterminate chronic phase we found only miR-146a up-regulated. CONCLUSIONS: The expression of inflammatory microRNAs miR-21, miR-146a and miR-155 were up-regulated in each of the samples from acutely and chronically infected mice. The relevant finding was that miR-146a was up-regulated in each sample in both phases; therefore, this miRNA could be a possible candidate biomarker in Chagas disease.

Abordaje retrosigmoideo para clipaje de aneurisma distal de la AICA / Retrosigmoid approach for clipping a distal aneurysm of the AICA

Introducción: Los aneurismas cerebrales de la circulación posterior, representan solo del 8 al 10 % del total de los aneurismas cerebrales, y de estos los de la arteria cerebelosa anteroinferior (AICA) son muy poco frecuentes, por lo que no hay algoritmo de manejo para estas lesiones, se requieren conocimientos anatómicos de vascular y de base de cráneo para el tratamiento de estos, hablando del abordaje quirúrgico, podemos mencionar, el extremo lateral, retrosigmoideo, orbitozigomatico y presigmoideo, que depende del tamaño y localización del aneurisma, ya sea distal o proximal. Presentamos este caso, que tratamos mediante un abordaje retrosigmoideo convencional, el cual nos ofreció un corredor quirúrgico suficiente, sin necesidad de un abordaje mas amplio, en este caso fue un aneurisma distal de la AICA, localizado en el segmento meatal, que se encontró en el complejo neurovascular medio del ángulo pontocerebeloso, muy próximo a los nervios craneales V, VII y VIII. Objetivos: Demostrar que los aneurismas distales de la AICA se pueden manejar mediante un abordaje retrosigmodeo convencional con éxito. Materiales y métodos: El paciente se colocó en posición park bench, bajo fijación esquelética de 3 puntos, con el asterion como punto mas elevado. Se realizo una incisión en forma de C en la mastoides y se realizo un abordaje dirigido hacia el ángulo pontocerebeloso. Resultados: Se logró realizar el clipaje del aneurisma de forma satisfactoria, con un buen resultado clínico del paciente, quien fue egresada a los 4 días sin déficit neurológico. Conclusión: El abordaje retrosigmoideo es una opción terapéutica para el manejo de los aneurismas ubicados en el ángulo pontocerebeloso, específicamente del AICA distal y también se puede usar incluso para los aneurismas distales del PICA.

Background: Cerebral aneurysms of the posterior circulation, representing only 8 to 10% of the total cerebral aneurysms, but the aneurysms of the anteroinferior cerebellar artery (AICA) are very rare, so there is no management algorithm for these lesions, anatomical knowledge of vascular and skull base are known for the treatment of these lesions, in relation of the surgical approach, we can identify, the far lateral, retrosigmoid, orbitozigmatic or presigmoid approaches, which depends on the size and location of aneurysm, either distal or proximal. We present this case, which we treated through a conventional retrosigmoid approach, which offers us a sufficient surgical corridor, without the need for a broader approach, in this case it was a distal AICA aneurysm, located in the meatal segment, which was found in the middle neurovascular complex of the pontocerebellar angle, very close to the cranial nerves V, VII and VIII. Objective: Demonstrate that distal aneurysms of AICA can be managed using a successful conventional retrosigmoid approach. Results: The clipping of the aneurysm was achieved satisfactorily, with a good clinical result of the patient, who was discharged at 4 days without neurological deficit. Conclusion: The retrosigmoid approach is a therapeutic option for the management of aneurysms located in the pontocerebellar angle, specifically of the distal AICA and can also be used even for distal aneurysms of the PICA.

New report of Eratyrus cuspidatus Stål, 1859 (Hemiptera: Reduviidae: Triatominae) in the State of Campeche, Mexico

Abstract INTRODUCTION: Triatomine bugs are vectors of Trypanosoma cruzi, the etiological agent of Chagas disease. METHODS: Triatomine bugs were collected and identified following established protocols. In addition, infection with T. cruzi was detected by microscopic and molecular analysis. RESULTS: We captured an adult male specimen of the Eratyrus cuspidatus species that has not been reported in the state of Campeche. CONCLUSIONS: This finding provides new information on the distribution of E. cuspidatus in Mexico. However, more studies are needed to determine their epidemiological significance.

Ameloblastoma sólido multiquístico en mandibula y reconstrucción con placa de titanio / Solid multicystic ameloblastoma in jaw and reconstruction with titanium plate

El ameloblastoma sólido multiquístico es una neoplasia odontogénica rara, representa el 1% de los tumoresmaxilares, es de crecimiento lento y muestra un comportamiento agresivo local; en estado avanzado es capaz de generar deformidad facial, dolor, infección de la lesión, ulceración de la mucosa, pérdida dentaria, parestesia y puede alterar la masticación y la fonética. Objetivo: determinar las características clínicas, imagenológicas e histológicas del ameloblastoma para realizar el diagnóstico correcto y tratamiento oportuno. Presentación de caso clínico: p aciente femenina de 66 años, tratada en el servicio de cirugía oral y maxilofacial del Hospital Escuela Universitario, por presentar lesión de aspecto tumoral en cavidad bucal y región mandibular izquierda de 4 años de evolución. Los resultados deexámenes complementarios confirmaron que se trataba de un ameloblastoma sólido multiquístico. Se extirpó el tumor con amplios márgenes de seguridad mediante hemimandibulectomía y reconstrucción posterior con placa de titanio 2.4 W Lorenz. Conclusión: Los ameloblastomas son neoplasias benignas que presentan comportamientos clínicos similares con debe establecer un diagnóstico diferencial exhaustivo, auxiliándose de los exámenes complementarios pertinentes para iniciar el tratamiento adecuado y oportuno...(AU)

Seroprevalence of human Trypanosoma cruzi infection in the North of Estado de Mexico

Abstract INTRODUCTION: Chagas disease is a neglected public health problem in Mexico; however, detailed studies to determine the seroprevalence in some states have not been performed. METHODS: A total 1,504 human serum from thirteen communities in Estado de Mexico, were analyzed with three diagnostics techniques. RESULTS: The overall seroprevalence was 9.1%, with high prevalence among people aged 51-60 years, while people aged 0-29 years were seronegative against T. cruzi. CONCLUSIONS: Our data demonstrated the seroprevalence of T. cruzi in the North of the Estado de Mexico, an area considered as non-endemic; however, epidemiological conditions necessary for natural transmission were found.

Controladores del tiempo y el envejecimiento: núcleo supraquiasmático y glándula pineal / Aging process entrainment: suprachiasmatic nucleus and pineal gland

El núcleo supraquiasmático (NSQ) es el principal reloj biológico de los mamíferos y sincroniza la actividad de la glándula pineal al ciclo luz-oscuridad a través de una vía polisináptica. El efecto de asa de retroalimentación neuroendocrina se lleva a cabo por la melatonina. El presente trabajo pretende demostrar que la glándula pineal modula la sensibilidad a la luz en el NSQ. Se utilizaron ratas Wistar, y se asignaron a 3 grupos: grupo A (falsa pinealectomía -sham-, sin luz), grupo B (falsa pinealectomía -sham- + luz) y grupo C al cual se le realizó la pinealectomía + luz, después de la manipulación se sacrifican para realizar inmunohistoquímica para c-Fos y al final conteo celular por técnica de estereología. Se obtuvo una reducción del 46,8% del promedio de células inmunorreactivas a c-Fos en el grupo C en comparación del grupo B. Este trabajo muestra que la sensibilidad a la luz está modulada por la actividad de la glándula pineal.

The suprachiasmatic nucleus (SCN) is the main and major biological clock in mammals and is responsible for the synchronization of the pineal gland to the light/darkness cycle through a polysynaptic pathway. The neuroendocrine feedback loop effect is carried out by melatonin. This study was carried out to demonstrate that the pineal gland adjusts the sensibility to light in the suprachiasmatic nucleus. Wistar rats were allocated in 3 groups: Group A (sham pinalectomy, without light), group B (sham pinealectomy + light) and group C which underwent real pinalectomy + light. After the intervention the animals were slain to perform immunohistochemistry for c-Fos and cell counting by stereology technique. A 46.8% average reduction in c-Fos immunoreactive cells was achieved in-group C as compared with group B. The present work shows that sensibility to the light is modulate by the activity of the pineal gland.

Biological and genetic aspects of crosses between species of the genus Meccus (Hemiptera: Reduviidae Triatominae)

The degree of reproductive isolation between Meccus phyllosomus and the remaining five species of the genus Meccus, as well as between Meccus bassolsae and Meccus pallidipennis, Meccus longipennis and Meccus picturatus, was examined. Fertility and the segregation of morphological characteristics were examined in two generations of hybrids from crosses between these species. The percentage of couples with offspring (fertile) was high in the vast majority of sets of crosses, with the exception of that between ♀M. phyllosomus and ♂Meccus mazzottii. In sets of crosses involving M. bassolsae specimens, no first-generation (F1) individuals were morphologically similar to M. bassolsae, but instead shared the morphology of the other parental species. A similar phenomenon was observed in most sets of crosses involving M. phyllosomus. These results indicated that different degrees of reproductive isolation exist among the species of Meccus involved in this study. The biological evidence obtained in this study does not support the proposal that M. bassolsae is a full species. It could indicate that, on the contrary, it should be considered a subspecies of a single polytypic species. The biological evidence does support the proposal that M. phyllosomus is a full species.

Impacto del tratamiento con bezafibrato en pacientes con hiperfibrinogenemia e infarto agudo del miocardio con elevación del ST / Impact of bezafibrate treatment in patients with hyperfibrinogenemia and ST-elevation acute myocardial infarction: a randomized clinical trial

Introducción: La hiperfibrinogenemia se considera predictora de eventos cardiovasculares en sujetos sanos y pacientes con cardiopatía isquémica. Como medida de prevención primaria, el bezafibrato disminuye el fibrinógeno sanguíneo y los eventos cardiovasculares, pero su efecto en el síndrome coronario agudo aún no se conoce. Material y métodos: Ensayo clínico, aleatorizado, controlado con tratamiento convencional. Se incluyeron pacientes con infarto agudo del miocardio con elevación del segmento ST y concentraciones de fibrinógeno > 500 mg/dl a las 72 horas de evolución. Se asignaron a recibir 400 mg de bezafibrato (grupo I) o tratamiento convencional (grupo II). Punto primario de evaluación: concentraciones de fibrinógeno; puntos secundarios: recurrencia de angina o infarto, falla ventricular izquierda y puntos finales combinados durante la estancia hospitalaria. Resultados: Se incluyeron 25 pacientes por grupo. Las concentraciones de fibrinógeno al egreso hospitalario fueron significativamente menores en el grupo I (532.42 ± 129.6 versus 889 ± 127.32 mg/dl del grupo II, p < 0.0001). Los puntos secundarios se presentaron con mayor frecuencia en el grupo II que en el grupo I: angina (56 versus 4%, riesgo relativo 0.071 [0.010-0.503], p < 0.0001), falla ventricular (24 versus 4%, riesgo relativo 0.167 [0.022-1.286], p = 0.049) y puntos finales combinados (76 versus 8%, riesgo relativo 0.105 [0.027- 0.405], p < 0.001). Conclusiones: El tratamiento con bezafibrato fue seguro y logró reducir el fibrinógeno en pacientes con infarto agudo. Esta reducción se asoció con menor frecuencia de eventos cardiovasculares a corto plazo.

BACKGROUND: Hyperfibrinogenemia is a predictor of cardiovascular events in healthy subjects and in patients with chronic ischemic heart disease. Bezafibrate decreases fibrinogen levels and also the incidence of major cardiovascular events in primary prevention, but its effects in acute coronary syndrome are unknown. METHODS: This is a randomized, controlled clinical trial with conventional therapy. We included patients with Acute ST Elevation Myocardial Infarction (STEAMI) and fibrinogen concentration >500 mg/dl at 72 h of evolution. We randomized subjects into two groups: bezafibrate 400 mg (group I) and conventional therapy (group II). Primary end point was decrease of fibrinogen concentrations. Secondary end points were recurrence of angina or infarction, left ventricular failure and combined end points during hospitalization. RESULTS: We included 25 patients in each group. Fibrinogen concentrations were lower at hospital discharge in Group I than in Group II (532.42 +/- 129.6 vs. 889 +/- 127.32 mg/dl in group II, p <0.0001). Secondary end points were more frequent in Group II than in Group I: angina (56% vs. 4%, RR 0.071 [0.010-0.503], p <0.0001), left ventricular failure (24% vs. 4%, RR 0.167 [0.022-1.286], p = 0.049) and combined end points (76% vs. 8%, RR 0.105 [0.027-0.405], p <0.001). CONCLUSIONS: Bezafibrate treatment was a safe treatment and reduced fibrinogen levels in patients with STEAMI and hyperfibrinogenemia. In the short term, this reduction was associated with a lower incidence of major cardiovascular events.

Síndrome metabólico, impacto clínico y angiográfico en pacientes con síndrome coronario agudo / Metabolic syndrome: clinical and angiographic impact on patients with acute coronary syndrome

Introducción: El síndrome metabólico agrupa diferentes factores de riesgo y es uno de los principales problemas de salud pública del siglo XXI. El objetivo de este estudio fue establecer su repercusión en pacientes con síndrome coronario agudo (SICA). Material y métodos: Se incluyeron pacientes con SICA, con y sin elevación del segmento ST. Se formaron dos grupos: A, pacientes que reunían los criterios para síndrome metabólico; B, pacientes sin criterios para síndrome metabólico. Se comparó la incidencia de eventos cardiovasculares mayores, severidad de la enfermedad coronaria, necesidad de revascularización y mortalidad intrahospitalaria. Resultados: De 971 pacientes con SICA, 421 (43.4 %) tuvieron síndrome metabólico. La edad fue de 63.37 ± 9.95 años versus 61.77 ± 12.2 años; 66.7 % versus 72.8 % hombres; 70.3 % versus 33.3 % diabéticos; 87.6 % versus 40.5 % hipertensos y dislipidemia 70.5 % versus 26.9 %, respectivamente para los grupos A y B. El diagnóstico de SICA con elevación del ST fue más frecuente en el grupo A, así como mayor severidad en el grado de enfermedad arterial coronaria y mayor incidencia de eventos cardiovasculares mayores. En el análisis multivariado se encontró que la hiperfibrinogenemia, la hiperglucemia y el síndrome metabólico, eran predictores independientes de insuficiencia cardiaca y puntos finales combinados. Conclusiones: La frecuencia de síndrome metabólico en pacientes con SICA es alta, con mayor comorbilidad y edad, lo que se asocia con peor pronóstico intrahospitalario. Probablemente la respuesta inflamatoria y protrombótica, aunada a mayor severidad de la enfermedad arterial coronaria de estos pacientes, sea la que incrementa la incidencia de eventos cardiovasculares.

BACKGROUND: Metabolic syndrome (MetS) is represented by a cluster of various risk factors and is one of the most important public health problems of the 21st century. The aim of this study was to identify the impact of this syndrome in patients with acute coronary syndrome (ACS). METHODS: We included patients with ST and non-ST segment elevation ACS. We divided patients into two groups: A) patients with MetS criteria and B) patients without MetS criteria. We compared the incidence of major cardiovascular events, severity of coronary artery disease (CAD), need for urgent revascularization and in-hospital mortality between groups. RESULTS: Among 917 patients with ACS, 421 (43.4%) fulfilled criteria of MetS. Age of patients in this group was 63.37 +/- 9.95 years (compared with 61.77 +/- 12.20 years in group B), 66.7% vs. 72.8% males, diabetes 70.3% vs. 33.3%, hypertension 87.6% vs. 40.5% and dyslipidemia 70.5% vs. 26.9%, respectively. ST-elevation ACS was more frequent in group A. We observed more severe CAD, and major cardiovascular events were more frequent in group A. Multivariate analysis demonstrated that hyperfibrinogenemia, hyperglycemia and MetS were independent predictors of heart failure and combined end point. CONCLUSIONS: Incidence of MetS was high in patients with ACS, presented with more comorbidities and older patients, and was associated with poorer in-hospital outcome. It may be probable that the high inflammatory and prothrombotic response and more severe CAD in these patients increase the incidence of major cardiovascular events.

Biological and genetic aspects of experimental hybrids from species of the Phyllosoma complex (Hemiptera: Reduviidae: Triatominae)

The present work is a thorough investigation of the degree of reproductive isolation between Meccus mazzottii and Meccus longipennis, Meccus picturatus, Meccus pallidipennis and Meccus bassolsae, as well as between M. longipennis and M. picturatus. We examined fertility and segregation of morphological characteristics in two generations of hybrids derived from crosses between these species. The percentage of pairs with (fertile) offspring was highest in the set of crosses between M. longipennis and M. picturatus, and lowest between M. mazzottii and M. picturatus. Most first-generation (F1) individuals from crosses involving M. mazzottii were morphologically similar to this species, while only F1 x F1 progeny of parental crosses between M. mazzottii and M. longipennis had offspring second generation that looked like M. mazzottii. The results indicate that different degrees of reproductive isolation apparently exist among the species of the Phyllosoma complex examined in this study. The biological evidence obtained in this study does not support the proposal that M. longipennis and M. picturatus are full species. It could indicate on the contrary, that both could be considered as subspecies of a single polytypic species. On the other hand, biological evidence supports the proposal that M. mazzottii is a full species.

Biology of three species of North American Triatominae (Hemiptera: Reduviidae: Triatominae) fed on rabbits

Aspects related to hatching, lifetime, number of blood meals for molting, mortality, feeding time, and postfeeding defecation delay were evaluated and compared in each instar of three North American Triatominae: Triatoma gerstaeckeri, Triatoma lecticularia and Triatoma protracta, all of them fed on rabbits. No significant differences (p > 0.05) were found among the three species regarding mean hatching rate, which was close to 20 days. Egg-to-adult development times were significantly shorter (p < 0.05) for T. lecticularia. Number of blood meals for molting to next instar ranged from one to five for T. protracta, and from one to six for T. gerstaeckeri and T. lecticularia. Mortality rates were higher in younger nymphs of T. lecticularia and T. protracta, while rates in T. gerstaeckeri were higher in fifth-instar nymphs. Mean feeding time was longest in T. gerstaeckeri, followed by T. lecticularia. More than twice the number of T. gerstaeckeri nymphs completed the development process, if compared to the nymphs from the other two species. Defecation delay was less than 10 min for T. lecticularia, T. protracta and the youngest nymphs of T. gerstaeckeri. Results point out that these three species may be important potential vectors of Trypanosoma cruzi for human populations, in areas of Mexico where these species are currently present.

Programa de donación de órganos y tejidos de individuos con muerte cerebral en San Luis Potosí: impacto de los aspectos médico-legales en los resultados de 1999-2002 / Program of organ and tissue donation in subjects with cerebral death in the State of San Luis Potosí between 1999-2002: legal implications and study results

Introducción: Los programas de transplante de órganos de donador fallecido requieren una estructura compleja desde el punto de vista médico, logístico y cultural. Material y métodos: Se analizó la detección de posibles donadores en el estado de San Luis Potosí, del 21 de agosto de 1999 al 30 de agosto de 2002; se estudiaron las principales causas de muerte cerebral, su conversión a donadores, las implicaciones médicolegales y las causas de donación y no donación. Resultados: 71.42% de donadores y 64.15% de los no donadores tuvieron implicaciones médico-legales. La principal causa de muerte cerebral fue el traumatismo craneoencefálico (66.97%). La tasa de donantes por millón de habitantes fue de 8.3. Conclusiones: El manejo adecuado de los aspectos médico-legales influye en la tasa de donadores fallecidos lograda. Esto, aunado a la coordinación y efectividad del Consejo Estatal de Trasplantes, permitió obtener la tasa más alta de donación de este tipo en México.

INTRODUCTION: The transplantation program of organs obtained from deceased donors requires a complex structural organization. Medical, logistic, and cultural aspects must be taken into account. MATERIAL AND METHODS: We analyzed the detection of possible organ donors in San Luis Potosí, Mexico, from August 21, 1999 to August 30, 2002. We studied the main causes of brain death, donor conversion, legal implications, reasons for donation and refusal to donate. RESULTS: 71.42% of donors and 64.15% of non donors required legal intervention. The main cause of brain death was brain traumatic injury (66.97%). The donation rate per one million inhabitants was 8.3. CONCLUSIONS: Adequate forensic management has a positive influence on achieved deceased donors. An effective team work and coordination with the State Council of Transplants has allowed the State of San Luis Potosí to have the highest rate of organ donation in Mexico.

Biology of three species of the Meccus phyllosomus complex (Hemiptera: Reduviidae: Triatominae) fed on blood of hens and rabbits

Aspects related to hatching, life time, number of blood meals to molt, mortality, feeding time and postfeed defecation delay for each instar of Meccus phyllosomus, M. mazzottii, and M. bassolsae, life-cycle were evaluated and compared in two cohorts of each of those three species, fed on hens or rabbits. No significant (p > 0.05) differences were recorded among cohorts fed on hens respect to cohorts fed on rabbits in M. phyllosomus and M. mazzottii and the average time of hatching was 21.5 days for cohorts fed on hens and 22.5 for cohorts fed on rabbits. Average egg-to-adult development times were no significant (p > 0.05) different between both cohorts of M. phyllosomus and M. mazzotti, independent of the blood meal source. The average span in days for each instar fed on hens was not significantly different to the average span for each instar fed on rabbits, when comparisons were made by species. The number of blood meals at each nymphal instar varied from 1 to 6 in both cohorts of each species. The mortality rates were higher on older nymphs, in both cohorts of M. phyllosomus and M. bassolsae, whereas they were higher on first instar nymphs on M. mazzottii. Mean feeding time was no significant (p > 0.05) different in triatomines fed on hens or fed on rabbits, when each species were compared separately. A similar number of nymphs of each cohort, completed the cycle. Defecation delay was no significant (p > 0.05) different when cohorts fed on hens and fed on rabbits were compared by species. Most of the studied parameters showed no significant (p > 0.05) differences among those cohorts fed on hens and for fed on rabbits, which could mean a high degree of association of those species with birds as much as mammals, under wild conditions, increasing their capacity to colonize human dwellings.