Chemotherapy-induced tubulopathy: a case report series.

Acquired tubulopathies are frequently underdiagnosed. They can be characterized by the renal loss of specific electrolytes or organic solutes, suggesting the location of dysfunction. These tubulopathies phenotypically can resemble Bartter or Gitelman syndrome). These syndromes are infrequent, they may present salt loss resembling the effect of thiazides (Gitelman) or loop diuretics (Bartter). They are characterized by potentially severe hypokalemia, associated with metabolic alkalosis, secondary hyperaldosteronism, and often hypomagnesemia. Tubular dysfunction has been described as nephrotoxic effects of platinum-based chemotherapy. We present 4 cases with biochemical signs of tubular dysfunction (Bartter-like/Gitelman-like phenotype) related to chemotherapy.

Ewing sarcoma of the cervix: an unusual site of presentation.

Ewing sarcoma is an exceedingly rare form of cancer that affects the cervix. It falls within the spectrum of neoplastic diseases known as Ewing's family of tumours, typically observed in osseous tissues. A woman in her 40s, experiencing symptoms of leucorrhoea and transvaginal bleeding that commenced 3 months before her consultation, was referred to our gynaecological oncology clinic with a preliminary diagnosis of ovarian teratoma. A colposcopy procedure was conducted unveiling a complete loss of cervical anatomy with friable and malodorous tissue. Pelvic ultrasound identified a lesion of uncertain origin in the cervix, suggestive of malignancy. Histopathological assessment of cervical biopsy specimens confirmed the presence of a small, round, blue cell neoplasm consistent with Ewing sarcoma. She underwent chemotherapy and pelvic radiotherapy, achieving complete remission 9 months after diagnosis, without experiencing any systemic adverse effects or sequelae.

Scleromyositis: A Novel Entity Beyond Systemic Sclerosis and Autoimmune Myositis.

Scleromyositis is a new clinical entity, which not only has clinical and histopathological components of systemic sclerosis and inflammatory myopathy but is also characterized by presenting unique characteristics, which may not be in the previously mentioned diseases. Up until now, there are no specific classification criteria proposed by the American College of Rheumatology or the European League Against Rheumatism (ACR/EULAR). This paper presents a case report of a female patient in her 60s who was admitted to our institution due to muscle weakness in her legs and dysphagia. Within her diagnosis approach, clinical characteristics compatible with autoimmune myopathy were found; however, she presented with anti-PM/Scl75 antibody-positive results. In this paper, we emphasized the clinical characteristics and forms of presentation of scleromyositis, additionally discussing the available treatment for this entity.

Diagnostic Usefulness of Antibodies Against M-type Phospholipase A2 Receptor (aPLA2R) in Primary Membranous Nephropathy in the Mexican Population.

OBJECTIVE: This study aimed to determine the frequency and diagnostic performance of antibodies against M-type phospholipase A2 receptors (aPLA2R) in subjects with idiopathic membranous nephropathy (IMN). MATERIALS AND METHODS: A diagnostic test study was conducted in a cohort of 160 patients from the nephrology outpatient clinic over a period of eight years. Serum samples were taken and analyzed from patients with a histological diagnosis of IMN with proteinuria greater than and less than 1 g in 24 hours and other glomerular diseases other than IMN with aPLA2R measurement by enzyme-linked immunosorbent assay (ELISA) (Euroimmun, Luebeck, Germany). RESULTS: In 22 of 160 patients, an aPLA2R concentration >9 RU/mL was found, and all these cases had IMN. The prevalence of seropositivity in cases with active IMN was 78% (21/27). All these correlations were statistically significant with a p<0.001. The area under the receiver operating characteristic (ROC) curve (AB-ROC) of aPLA2R was 0.87 (95%, CI: 78-0.96). CONCLUSIONS: The aPLA2R has adequate diagnostic usefulness to diagnose IMN in the selected population, especially in subjects with proteinuria greater than 1 gr/day, with a sensitivity of 78% and a specificity of 99%.

Advances in the Physiology of Transvascular Exchange and A New Look At Rational Fluid Prescription.

The Starling principle is a model that explains the transvascular distribution of fluids essentially governed by hydrostatic and oncotic forces, which dynamically allow vascular refilling according to the characteristics of the blood vessel. However, careful analysis of fluid physiology has shown that the principle, while correct, is not complete. The revised Starling principle (Michel-Weinbaum model) provides relevant information on fluid kinetics. Special emphasis has been placed on the endothelial glycocalyx, whose subendothelial area allows a restricted oncotic pressure that limits the reabsorption of fluid from the interstitial space, so that transvascular refilling occurs mainly from the lymphatic vessels. The close correlation between pathological states of the endothelium (eg: sepsis, acute inflammation, or chronic kidney disease) and the prescription of fluids forces the physician to understand the dynamics of fluids in the organism; this will allow rational fluid prescriptions. A theory that integrates the physiology of exchange and transvascular refilling is the "microconstant model", whose variables include dynamic mechanisms that can explain edematous states, management of acute resuscitation, and type of fluids for common clinical conditions. The clinical-physiological integration of the concepts will be the hinges that allow a rational and dynamic prescription of fluids.

Cirrhosis etiology trends in developing countries: Transition from infectious to metabolic conditions. Report from a multicentric cohort in central Mexico.

Background: Cirrhosis is a public health threat associated with high mortality. Alcoholic Liver Disease (ALD) is the leading cause in Latin America and Metabolic Associated Fatty Liver Disease (MAFLD) in western countries. In Mexico, ALD and chronic Hepatitis C Virus infection (HCV) were the most frequent aetiologies during the past decades. We aimed to describe the trends in the aetiologies of cirrhosis in a middle-income country. Methods: We performed a retrospective cohort study including patients diagnosed with cirrhosis between 2000 and 2019 from six different tertiary care hospitals in central Mexico. We collected information regarding cirrhosis etiology, year of diagnosis, hepatocellular carcinoma development, liver transplantation, and death. We illustrated the change in the tendencies of cirrhosis aetiologies by displaying the proportional incidence of each etiology over time stratified by age and gender, and we compared these proportions over time using chi square tests. Findings: Overall, 4,584 patients were included. In 2019, MAFLD was the most frequent cirrhosis etiology (30%), followed by ALD (24%) and HCV (23%). During the study period, MAFLD became the leading etiology, ALD remained second, and HCV passed from first to fourth. When analysed by gender, ALD was the leading etiology for men and MAFLD for women. The annual incidence of HCC was 3·84 cases/100 persons-year, the median survival after diagnosis was 12·1 years, and seven percent underwent LT. Interpretation: Increased alcohol consumption and the obesity epidemic have caused a transition in the aetiologies of cirrhosis in Mexico. Public health policies must be tailored accordingly to mitigate the burden of alcohol and metabolic conditions in developing countries. Funding: None.

Visual marking in mammals first proved by manipulations of brown bear tree debarking.

The rather limited human ability to understand animal vision and visual signalling has frequently clouded our expectations concerning the visual abilities of other animals. But there are multiple reasons to suspect that visual signalling is more widely employed by animals than previously thought. Because visibility of visual marks depends on the background in which they are seen, species spending most of their time living in dark conditions (e.g., in forests and/or having crepuscular and nocturnal habits) may rely on bright signals to enhance visual display. Here, as a result of experimental manipulations, we present, for the first time ever, evidence supporting the use of a new channel of intraspecific communication by a mammal species, i.e., brown bear Ursus arctos adult males relying on visual marks during mating. Bear reactions to our manipulation suggest that visual signalling could represent a widely overlooked mechanism in mammal communication, which may be more broadly employed than was previously thought.

Comparing the success of active and passive restoration in a tropical cloud forest landscape: A multi-taxa fauna approach.

Tropical forest restoration initiatives are becoming more frequent worldwide in an effort to mitigate biodiversity loss and ecosystems degradation. However, there is little consensus on whether an active or a passive restoration strategy is more successful for recovering biodiversity because few studies make adequate comparisons. Furthermore, studies on animal responses to restoration are scarce compared to those on plants, and those that assess faunal recovery often focus on a single taxon, limiting the generalization of results. We assessed the success of active (native mixed-species plantations) and passive (natural regeneration) tropical cloud forest restoration strategies based on the responses of three animal taxa: amphibians, ants, and dung beetles. We compared community attributes of these three taxa in a 23-year-old active restoration forest, a 23-year-old passive restoration forest, a cattle pasture, and a mature forest, with emphasis on forest-specialist species. We also evaluated the relationship between faunal recovery and environmental variables. For all taxa, we found that recovery of species richness and composition were similar in active and passive restoration sites. However, recovery of forest specialists was enhanced through active restoration. For both forests under restoration, similarity in species composition of all faunal groups was 60-70% with respect to the reference ecosystem due to a replacement of generalist species by forest-specialist species. The recovery of faunal communities was mainly associated with canopy and leaf litter covers. We recommend implementing active restoration using mixed plantations of native tree species and, whenever possible, selecting sites close to mature forest to accelerate the recovery of tropical cloud forest biodiversity. As active restoration is more expensive than passive restoration, both strategies might be used in a complementary manner at the landscape level to compensate for high implementation costs.

Dieta de la rana de hojarasca Craugastor rhodopis (Anura: Craugastoridae): una especie abundante en la región montañosa del este de México / Diet of the leaf litter frog Craugastor rhodopis (Anura: Craugastoridae): an abundant species in the mountainous region of the east Mexico

Resumen La composición de la dieta en anfibios puede ser influenciada por diversos factores que causan su variación intraespecífica, como pueden ser la distribución geográfica, ontogenia, estacionalidad, y el sexo de los organismos. El objetivo de este estudio fue analizar la composición de la dieta en adultos de la Craugastor rhodopis (rana hojarasquera común) en la región montañosa del centro de Veracruz, México. Un total de 77 individuos adultos fueron colectados durante la época de lluvias de 2012, de los cuales 66 tuvieron contenido estomacal. Se realizó un análisis de la variación intersexual en la diversidad de la dieta, y el volumen, número de presas, y número de categorías de presa consumidas. La dieta de C. rhodopis estuvo compuesta por 20 categorías, de las cuales predominó Orthoptera en cuanto a número, volumen, frecuencia de ocurrencia e importancia relativa. Los machos consumieron presas de menor tamaño en relación a las hembras. Aunque ambos sexos consumieron similar número de presas, se encontró un efecto significativo de la interacción del sexo y el tamaño de las ranas sobre esta variable de la dieta, en la cual las hembras pequeñas consumen más presas que las grandes, y los machos grandes consumen más presas que los pequeños. El alto consumo de ortópteros (al menos en cuanto a volumen) es un fenómeno común dentro de la familia Craugastoridae y posiblemente está relacionado con el éxito de algunas especies en los ecosistemas donde habitan. A pesar de que la composición de la dieta fue similar entre sexos en C. rhodopis, se sugiere que la competencia intersexual por los recursos tróficos es mínima, dadas las diferencias en el tamaño de presas consumidas por machos y hembras.(AU)

Abstract Dietary composition in amphibians may be influenced by several factors that cause their intraspecific variation, such as geographic distribution, ontogeny, seasonality, and sex of organisms. The objective of this study was to analyze the composition of the diet in adults of the Polymorphic Robber Frog Craugastor rhodopis in the mountainous region of central Veracruz, Mexico. A total of 77 adult individuals were collected during the rainy season of 2012, of which 66 had stomach contents. We performed an analysis of the intersexual variation in diet diversity, volume, number of prey, and number of prey categories consumed. The diet of C. rhodopis was composed by 20 categories. Orthoptera predominated in terms of number, volume, frequency of occurrence, and relative importance. Males consumed smaller prey items relative to females. Although both sexes consumed similar numbers of prey, we found a significant effect of interaction of sex and size of frogs on this variable, with small females consuming more prey than the large ones, whereas in males the opposite occurred. High consumption of orthopterans (at least in volume) is a common phenomenon within Craugastoridae and is possibly related to the success of some species in the ecosystems where they live. Although the composition of the diet was similar between sexes in C. rhodopis, we suggest that intersexual competition for trophic resources is minimal, given differences in prey size consumed by males and females.(AU)

Deferasirox nephrotoxicity-the knowns and unknowns.

In 2005, the oral iron chelator deferasirox was approved by the FDA for clinical use as a first-line therapy for blood-transfusion-related iron overload. Nephrotoxicity is the most serious and frequent adverse effect of deferasirox treatment. This nephrotoxicity can present as an acute or chronic decrease in glomerular filtration rate (GFR). Features of proximal tubular dysfunction might also be present. In clinical trials and observational studies, GFR is decreased in 30-100% of patients treated with deferasirox, depending on dose, method of assessment and population studied. Nephrotoxicity is usually nonprogressive and/or reversible and rapid iron depletion is one of several risk factors. Scarce data are available on the molecular mechanisms of nephrotoxicity and the reasons for the specific proximal tubular sensitivity to the drug. Although deferasirox promotes apoptosis of cultured proximal tubular cells, the trigger has not been well characterized. Observational studies are required to track current trends in deferasirox prescription, assess the epidemiology of deferasirox nephrotoxicity in routine clinical practice, explore the effect on outcomes of various monitoring and dose-adjustment protocols and elucidate the long-term consequences of the different features of nephrotoxicity. Deferasirox nephrotoxicity can be more common in the elderly; thus, specific efforts should be dedicated to investigate the effect of deferasirox use in this group of patients.

Seroepidemiology of Toxoplasma gondii infection in pregnant women in a public hospital in northern Mexico.

BACKGROUND: Toxoplasma gondii (T. gondii) infection in pregnant women represents a risk for congenital disease. There is scarce information about the epidemiology of T. gondii infection in pregnant women in Mexico. Therefore, we sought to determine the prevalence of T. gondii infection and associated socio-demographic, clinical and behavioural characteristics in a population of pregnant women of Durango City, Mexico. METHODS: Three hundred and forty three women seeking prenatal care in a public hospital of Durango City in Mexico were examined for T. gondii infection. All women were tested for anti-T. gondii IgM and IgG antibodies by using IMx Toxo IgM and IMx Toxo IgG 2.0 kits (Abbott Laboratories, Abbott Park, IL, USA), respectively. Socio-demographic, clinical and behavioural characteristics from each participant were also obtained. RESULTS: Twenty one out of the 343 (6.1%) women had IgG anti-T. gondii antibodies. None of the 343 women had IgM anti-T. gondii antibodies. Multivariate analysis using logic regression showed that T. gondii infection was associated with living in a house with soil floor (adjusted OR = 7.16; 95% CI: 1.39-36.84), residing outside of Durango State (adjusted OR = 4.25; 95% CI: 1.72-10.49), and turkey meat consumption (adjusted OR = 3.85; 95% CI: 1.30-11.44). Other characteristics as cat contact, gardening, and food preferences did not show any association with T. gondii infection. CONCLUSION: The prevalence of T. gondii infection in pregnant women of Durango City is low as compared with those reported in other regions of Mexico and the majority of other countries. Poor housing conditions as soil floors, residing in other Mexican States, and turkey meat consumption might contribute to acquire T. gondii infection.

Neumonia por anaerobios: a propósito de un caso: Hospital Central de San Cristóbal 1996 / Anaerobes by pneumoniae: a purpose of a case: Hospital Central of San Cristobal 1996

The main cause of pulmonary infection due to anaerobes is aspiration. There are many risk factors including: depressed consciousness level, seizures, CNS illnesses, etc. Weight loss, sickness and stinking sputum productive cough are the clinical findings. The radiographics, clinical findings and pulmonary aspirate Gram's stained are diagnosis supportive and confirmated by microorganism culture. The treatment includes proper drainage, necrotic tissues debridement, and antibiotc therapy against aeroes and anaerobes. A school age male, seven years old, with a curse of four month with lengthy pneumony history treated 10 days as a a outpatient and 35 dyas inside the hospital is the case shown. He was admited again due to foul smelling vomit and bad conditions. He was treated with therapy against anaerobes. Culture and biopsy were carried out with a sample of vomit resulted: Peptococus, Peptostreptococcus and Acynetobacter calcoaceticus in the first and necrotic pulmonary tissue in the second. His curse at hospital was slow but satisfactory