Computer System for the Capture and Preparation of Cytopathological Reports for Cervical Cancer Detection and His Utility in Training for Health Personnel.

Health information systems and training are tools that support process management. The current study describes the results of the implementation of technological innovation in the process of the capture and preparation of cytopathological reports. The electronic system was structured based on national standards regarding cervical cancer control. PHP was used to design the software and MYSQL was used for the structure of the database. The total number of health personnel assigned to the cytology department participated, along with a pathologist, who made the records of the patients who came for cervical cytology to a university health center in San Luis Potosi, Mexico. The system was evaluated based on the indicators of structure, process, and results. Structure: comply with the official Mexican regulations for the registration of cervical cancer and electronic health information systems. Process: all records were legible and accurate, with varying percentages of completeness in the patient identification sections (46%) and alternate contact data (80%). Result: percentages above 80% were obtained in the satisfaction of the professionals who used the system. The system was effective as it yielded readable and accurate data that made the process of information capture and delivery of cervical screening results more efficient and faster.

Influence of Prebiotic Activity of Agave salmiana Fructans on Mucus Production and Morphology Changes in Colonic Epithelium Cell of Healthy Wistar Rats.

The beneficial health of evaluating prebiotic effect by the consumption of Agave salmiana fructans (A. salmiana fructans) was assessed in the epithelium of the cecum and proximal colon of Wistar rats fed at different doses for 35 days with regards to mucus production, morphological cell changes, and the serum concentration of tumor necrosis factor-α (TNF-α). Results showed a significant increase in mucus-secreting cells (P < 0.05) and a normal structure with preserved crypts, without morphological damage to colonic cells for a dose of 12.5% (w/w) with respect to the control and the other doses evaluated. The concentration of pro-inflammatory cytokine TNF-α was decreased significantly (P < 0.05) in the groups with doses of 10 and 12.5% (w/w) at 7 and 35 days, respectively. This effect was positively correlated with the reduction of inflammation in epithelial cells. This study provides direct evidence of the effects of the A. salmiana fructans on the colonic epithelium, demonstrating that a diet supplemented with 12.5% of fructans for 35 days exerts health benefits through the strengthening of the mucosa layer, which favors the adherence of the bacterial population and suppresses inflammation.

Evaluation of vascular tone and cardiac contractility in response to silver nanoparticles, using Langendorff rat heart preparation.

Silver nanoparticles (AgNPs) have been widely used because of their antimicrobial properties. However, several reports suggest that AgNPs exposure promote cardiac effects that involve nitric oxide (NO) and oxidative stress (OS). Nevertheless, there are no studies related to AgNPs-induced effects in cardiac physiology. The aim of this study was to evaluate the AgNPs direct actions on coronary vascular tone and cardiac contractility using Langendorff rat heart preparation. Low concentrations of AgNPs (0.1 and 1 µg/mL) increased NO derived from inducible NO-synthase (iNOS), without modifying cardiac parameters. Meanwhile, high concentrations (10 and 100 µg/mL) promoted a sustained vasoconstriction and increased cardiac contractility related to OS, leading to rhabdomyolysis. Furthermore, AgNPs were internalized in the cardiac muscle, hindering classic actions induced by phenylephrine (Phe) and acetylcholine (ACh). These data suggest that AgNPs affect cardiac physiology in function of the concentration and in part of the NO generation, NOS expression and OS.

Impact of Applying a Learning Strategy to Improve the Sample Quality in Cervical Screening in Nursing Staff in Social Service.

OBJECTIVES: The study sought to assess the impact of applying a learning strategy to improve the quality of sample collection during cervical screening by students from the Nursing Degree Program doing social service. METHODS: This was a longitudinal, quasi-experimental study with the participation of 23 interns from the Nursing Degree Program at a public university from San Luis Potosí, Mexico. The work assessed knowledge of practical skills in taking cervical cytology tests and the quality of samples before and after applying a learning strategy that included 10 h of theoretical training and 22 h of practices on themes related to sample collection in cervical screening. RESULTS: A statistically significant difference was obtained in improved knowledge (t = -12.8 p<0.001) and practical skills (t = -8.86 p<0.001) after the intervention. The increased percentage of suitable samples from 30.43% to 82.60% was attributed to the application of the learning strategy in the pre- and post-intervention phases (p<0.001). CONCLUSIONS: Training is effective to improve knowledge and practical skills to collect samples in cervical screening, as well as the quality of the samples for their interpretation.

Effect of prebiotics of Agave salmiana fed to healthy Wistar rats.

BACKGROUND: Inulin and other fructans are synthesized and stored in mezcal agave (Agave salmiana). Fructans provide several health benefits and have excellent technological properties, but only few data report their physiological effect when added in the diet. RESULTS: Here, we studied the physiological effects of fructans obtained from A. salmiana when added in the diet of Wistar rats. Results showed favorable changes on Wistar rats when the fructans was added to their diet, including the decrease of the pH in the feces and the increase of the number of lactic acid bacteria (CFU g-1 ) (Lactobacillus spp. and Bifidobacterium spp.), even these changes were enhanced with the synbiotic diet (fructans plus B. animalis subsp. lactis). Synbiotic diet, developed changes in the reduction of cholesterol and triglycerides concentrations in serum, with statistical differences (P < 0.05). Histological analysis of colon sections showed that synbiotic diet promoted colon cells growth suggesting that fructans from A. salmiana confer beneficial health effects through gut microbiota modulation. CONCLUSION: Our data underline the advantage of targeting the gut microbiota by colonic nutrients like specific structure of fructans from A. salmiana, with their beneficial effects. More studies are necessary to define the role of fructans to develop more solid therapeutic solutions in humans. © 2016 Society of Chemical Industry.

IgG4 deposits in pure and combined membranous lupus nephritis.

The aim of this study is to determine the frequency and prognosis of IgG4 deposits in renal biopsy of patients with membranous lupus nephritis (MLN). This is a retrospective cohort study in which we included patients with class V alone or combined (III/V or IV/V) of lupus nephritis according to the 2004 ISN/RPS. All the patients included must have availability of renal tissue for immunohistochemistry analyses. We excluded other classes of lupus nephritis. The renal tissue was examined by a nephro-pathologist. We included 65 patients with MLN; of these, 24 (37 %) were class V, and the other had proliferative concomitant with membranous patterns. Seven renal specimens had IgG4 deposits (10 %). Patients with IgG4 deposits had higher levels of eosinophils in serum. All of the patients with IgG4 had renal involvement as first manifestations of systemic lupus erythematosus. The rate of renal failure was 42 and 43 % in IgG4 positive and negative, respectively, 28 % of IgG4 required renal replacement therapy. From a histological view, 42 % of IgG4 had evidence of arteriolar vasculitis in renal biopsies. Lupus patients with IgG4 deposits were more likely to have renal involvement as a first manifestation of systemic lupus erythematosus, and they course with a worse prognosis since they required more dialysis. Also, they have more probability of vascular inflammation on the renal biopsy.

[Allopurinol hypersensitivity syndrome. A report of two cases]. / Síndrome de hipersensibilidad por alopurinol. Informe de dos casos clínicos.

Patients in treatment with allopurinol are in risk of having life threatening adverse reactions particularly at the beginning of the treatment. Two percent of the patients prescribed with this drug have associated severe cutaneous adverse reactions. We present two cases of allopurinol hypersensitivity syndrome in mexican patients in which asymptomatic hyperuricemia was the indication to its use. The general physician and the specialist must be alert of this syndrome that causes elevate morbidity and mortality.

Los pacientes bajo tratamiento con alopurinol pueden presentar reacciones adversas potencialmente mortales, particularmente al inicio del tratamiento. Las reacciones cutáneas adversas por alopurinol tienen una prevalencia aproximada del 2 %. Presentamos dos casos de síndrome de hipersensibilidad por alopurinol en pacientes mexicanos en quienes la hiperuricemia asintomática fue la indicación para su uso. El médico general y el especialista deben estar alerta ante este síndrome que ocasiona alta morbilidad y mortalidad.

Metastatic Calcinosis Cutis: A Case in a Child with Acute Pre-B Cell Lymphoblastic Leukemia.

Hypercalcemia in children with malignancy is an uncommon condition. It has been described in leukemia patients with impaired renal excretion of calcium or osteolytic lesions. Metastatic calcinosis cutis (MCC) may develop if hypercalcemia persists. We report the case of a 5-year-old girl with an atypical dermatosis and unspecific gastrointestinal symptoms. Considered clinical diagnoses were xanthomas, histiocytosis, molluscum contagiosum, and nongenital warts. Cutaneous histological analysis showed amorphous basophilic deposits in the dermis suggestive of calcium deposits. Laboratory tests confirmed serum hypercalcemia. Extensive investigations such as bone marrow biopsy established the diagnosis of an acute pre-B cell lymphoblastic leukemia. Hypercalcemia in hematopoietic malignancies is unusual, especially as initial manifestation of the disease. Careful review of the literature fails to reveal previous reports of these peculiar cutaneous lesions of MCC in children with leukemia.

[Video-assisted thoracic surgery diagnosis of mucinous (colloid) lung adenocarcinoma: Case report]. / Diagnóstico de adenocarcinoma mucinoso (coloide) pulmonar por cirugía torácica asistida por video. Reporte de caso.

BACKGROUND: Mucinous colloid lung adenocarcinoma is an uncommon variant of lung carcinomas with similar features to tumours seen in the gastrointestinal tract. To distinguish between these tumours and other mucinous lung tumours, such as mucinous bronchioloalveolar cell carcinomas and metastatic mucinous lesions could be difficult with small biopsy specimens from fine needle aspiration. CLINICAL CASE: The case is described of a 49-year-old female with history of dyspnoea and cough with bloody sputum and weight lose. Thorax axial computed tomography demonstrated a right lower lobe spiculated mass with calcifications. Transthoracic computed tomography- guided fine needle biopsy reported negative results, and the biopsy obtained with video-assisted thoracic surgery was useful for an adequate cytology report of a colloid variant of mucinous lung adenocarcinoma. CONCLUSION: Video-assisted thoracic surgery is an appropriate option for obtaining a larger specimen in those cases where small biopsies are inconclusive for the diagnosis of thoracic pathologies such as malignant tumours.

[Calciphylaxis, renal failure and gout. A patient with hyperuricemia as a risk factor for death]. / Calcifilaxis, insuficiencia renal y gota. Un paciente con hiperuricemia como factor de riesgo para morir.

BACKGROUND: gout is an inflammatory arthritis that frequently is associated with obesity, alcohol consumption, hypertension and hypertriglyceridemia. The calciphylaxis is characterized by metastatic calcification to small and medium vessels. Both are associated independently with high mortality. When hyperuricemia and the calciphylaxis are present, the death risk is 80 %. CLINICAL CASE: a 51 year old man presented with clinical history of alcoholism and systemic arterial hypertension, and he developed limb ulcers, edema and uremic syndrome. Three week later, the patient died as a consequence of sepsis from Staphylococcus aureus. We emphasize the diagnostic approach of calciphylaxis, metabolic syndrome and comorbidities, cardiovascular and renal failure risk factors. CONCLUSIONS: the hyperuricemia is included in the metabolic syndrome, as the result of genetic and behavioral factors. It is recognized as a cardiovascular risk. For this reason we must consider it in the clinical practice guidelines for the prevention and treatment of diseases with high mortality.

Introducción: la gota es una artropatía inflamatoria que frecuentemente se asocia con obesidad, consumo de alcohol, hipertensión e hipertrigliceridemia. La calcifilaxis se caracteriza por la calcificación metastásica de los vasos de mediano y pequeño calibre. En forma independiente ambas se asocian con mortalidad elevada. Cuando la hiperuricemia y la calcifilaxis están presentes, el riesgo de muerte es de 80%. Caso clínico: hombre de 51 años de edad, con antecedentes de alcoholismo e hipertensión arterial sistémica, quien desarrolló úlceras en extremidades, edema generalizado y síndrome urémico. Tres semanas después de su ingreso falleció debido a sepsis ocasionada por Staphylococcus aureus. El diagnóstico fue calcifilaxis asociada con síndrome metabólico, comorbilidades, factores de riesgo cardiovascular y de insuficiencia renal. Conclusiones: la hiperuricemia es parte del complejo que conforma el síndrome metabólico, resultante de factores genéticos y ambientales. Se reconoce que es un factor asociado con la mortalidad cardiovascular, lo que obliga a considerar a la hiperuricemia en las guías de práctica clínica en la prevención y tratamiento de enfermedades con alta mortalidad debido a las complicaciones que se presentan.

Primary monophasic synovial sarcoma of the tonsil: immunohistochemical and molecular study of a case and review of the literature.

Synovial sarcoma (SS) arises primarily in the lower extremities with a predilection for sites in proximity to large joints, such as the knee. It rarely occurs in the head and neck region, and the tonsil is an unusual site for the tumor, with only eight previously published cases in this anatomical site. We present a case of a primary monophasic SS arising in the right tonsil in a 63-year-old male. His medical history was noncontributory. Immunohistochemistry showed that cytokeratin OSCAR, EMA, Bcl-2, vimentin, PGP 9.5, and TLE1 were diffusely positive. A molecular analysis using RT-PCR indicated that the patient was positive for the SYT/SSX1 fusion transcript. A diagnosis of monophasic synovial sarcoma of the tonsil was made.

Varón con enfermedad cavitaria pulmonar / A male patient with cavitary pulmonary disease

Paciente masculino de 44 años, con diagnóstico de granulomatosis con poliangeítis (Wegener) (GPA) y recaída 6 años después, con el signo de la media luna creciente en la tomografía. Siete años después del diagnóstico, el paciente presentó otro episodio con empeoramiento de la enfermedad cavitaria pulmonar y altos niveles de anticuerpos antiproteinasa 3, lo que sugirió actividad de la enfermedad; adicionalmente, la biopsia transbronquial informó tuberculosis pulmonar (Tb). La asociación entre Tb y GPA es rara, aunque estas 2 enfermedades tienen características clínicas similares y se acompañan de anticuerpos antiproteinasa 3 que se han asociado a tratamiento antifímico (AU)

Granulomatosis with polyangiitis (Wegener) (GPA) was diagnosed in a 44 year-old-man who had a relapse 6 years after diagnosis with the “air crescent” sign on chest CT. Seven years after his diagnosis the patient presented a new relapse with cavitary lung disease, and high levels of anti-proteinase 3 antibodies, suggesting disease activity; however, a transbronchial biopsy showed histological findings of tuberculosis (TB). The association between TB and GPA is rarely informed; moreover TB and GPA have similar findings including both clinical and anti-proteinase 3 antibodies (AU)

Topical niacinamide 4% and desonide 0.05% for treatment of axillary hyperpigmentation: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Axillary hyperpigmentation is a frequent cause of cosmetic consultations in dark-skinned women from tropical areas, including Latin America. Currently, there is no widely accepted treatment for the disorder, but it is usually treated with bleaching agents because it is considered a variant of inflammatory hyperpigmentation. The purpose of this study was to assess the efficacy of niacinamide 4% and desonide 0.05% emulsions compared with placebo in the treatment of axillary hyperpigmentation. METHODS: Twenty-four women aged 19-27 years with hyperpigmented axillae (phototype III-V) were randomly assigned to receive the study treatments in the axillary region. Improvement was assessed at baseline, then clinically and by colorimetry 9 weeks later. Quantitative evaluation including melanin, inflammatory infiltrates, NKI/Beteb, CD1a, CD68, and collagen type IV content was performed by histochemistry and immunohistochemistry, assisted by computerized morphometric analysis. RESULTS: Both niacinamide and desonide induced significant colorimetric improvement compared with placebo; however, desonide showed a better depigmenting effect than niacinamide. A good to excellent response was achieved in 24% of cases for niacinamide, 30% for desonide, and 6% for placebo. We observed a marked disruption of the basal membrane in axillary hyperpigmentation and an inflammatory infiltrate that improved after treatment. Decreased pigmentation in the desonide-treated axillae was associated with recovery of disruption at the basal membrane. CONCLUSION: Niacinamide and desonide showed depigmenting properties in women with axillary hyperpigmentation. These findings may be explained by their antimelanogenic and anti-inflammatory properties, respectively.

A male patient with cavitary pulmonary disease.

Granulomatosis with polyangiitis (Wegener) (GPA) was diagnosed in a 44 year-old-man who had a relapse 6 years after diagnosis with the "air crescent" sign on chest CT. Seven years after his diagnosis the patient presented a new relapse with cavitary lung disease, and high levels of anti-proteinase 3 antibodies, suggesting disease activity; however, a transbronchial biopsy showed histological findings of tuberculosis (TB). The association between TB and GPA is rarely informed; moreover TB and GPA have similar findings including both clinical and anti-proteinase 3 antibodies.

Noninvasive estimation of chronological and photoinduced skin damage using Raman spectroscopy and principal component analysis.

BACKGROUND: Skin aging can be attributed to endogenous and exogenous factors which modify the hydration and protein structure of the skin which can be measured using Raman spectroscopy. METHOD: This study included 21 healthy adult volunteers, aged 32-81 years, Raman spectra were obtained from sun-protected and sun-exposed skin, also three millimeter punch biopsies of sun-exposed skin were collected and analyzed. The Raman spectra were analyzed using principal component analysis and the results were correlated with clinical and histological findings. RESULTS: The principal component analysis of the Raman spectra shows that the first principal component (PC1) obtained from the sun-protected skin is related to the age of the subject, which can be taken as a measure of chronological aging, the second (PC2) and fourth (PC4) principal components obtained from Raman spectra of sun-exposed skin are related to the amount of solar elastosis and collagen, respectively. CONCLUSION: In this work a relationship was found between histological properties of photoaged skin and noninvasive measurements based on Raman and principal components analysis (PCA). These relationships can be used to assess noninvasively the photoinduced damage and chronological characteristics of skin.

A Double-Blind, Randomized Clinical Trial of Niacinamide 4% versus Hydroquinone 4% in the Treatment of Melasma.

Background. Multiple modalities have been used in the treatment of melasma with variable success. Niacinamide has anti-inflammatory properties and is able to decrease the transfer of melanosomes. Objective. To evaluate the therapeutic effect of topical niacinamide versus hydroquinone (HQ) in melasma patients. Patients and Methods. Twenty-seven melasma patients were randomized to receive for eight weeks 4% niacinamide cream on one side of the face, and 4% HQ cream on the other. Sunscreen was applied along the observation period. They were assessed by noninvasive techniques for the evaluation of skin color, as well as subjective scales and histological sections initially and after the treatment with niacinamide. Results. All patients showed pigment improvement with both treatments. Colorimetric measures did not show statistical differences between both sides. However, good to excellent improvement was observed with niacinamide in 44% of patients, compared to 55% with HQ. Niacinamide reduced importantly the mast cell infiltrate and showed improvement of solar elastosis in melasma skin. Side effects were present in 18% with niacinamide versus 29% with HQ. Conclusion. Niacinamide induces a decrease in pigmentation, inflammatory infiltrate, and solar elastosis. Niacinamide is a safe and effective therapeutic agent for this condition.

Histochemical and immunohistochemical study in melasma: evidence of damage in the basal membrane.

The pathogenesis of melasma has not been clearly elucidated. Using Fontana Masson; diastase-resistant periodic acid-Schiff stains; and immunohistochemistry to stem cell factor (SCF), its receptor c-kit, anti-mast cell tryptase, and anti-collagen type IV antibody, we evaluated melasma lesions and compared them with perilesional skin and photoprotected skin. Samples were taken from lesional and photoprotected nonlesional skin in 24 patients. In other 24 patients, we took biopsies of lesional and perilesional skin. With Fontana Masson, we observed many pigmented basal cells protruding into the dermis of the melasma skin. Periodic acid-Schiff stain and anti-collagen type IV showed damage on the basal membrane in 95.5% and 83%, respectively, in melasma lesion. The immunoreactivity of SCF and the prevalence of mast cells were increased in the dermis of melasma compared with perilesional dermis. The expression of c-kit was significantly increased at lesional epidermis; a frequent protrusion of c-kit-positive basal cells into the dermis was evident in 70% versus that in 29% of perilesional skin. The expression of c-kit was increased at lesional dermis of melasma compared with perilesional skin. We found a low correlation between c-kit expression and prevalence of mast cells; these were increased in melasma skin. The results may suggest a role of SCF, c-kit, and mast cells in the pathogenesis of melasma. We were surprised by the unexpected evidence of damage to basal membrane (BM), which could facilitate the fall or the migration of active melanocytes and melanin into the dermis allowing the constant hyperpigmentation in melasma.

Heterotopic neuroglial tissue associated with bilateral palatine cleft.

Isolated heterotopic lesions of neuroglial tissue may rarely present in the head and neck, or they may be associated with other congenital deviations. In this article we present the case of a 7-month-old patient with a central lesion that emerged through the anterior part of a bilateral palatine fissure.

[Primary renal angiosarcoma]. / Angiosarcoma renal primario.

The twenty-fourth case of primary renal angiosarcoma is described, according to the available international literature, this present in a 71-year-old male, a mechanic by trade, without carcinogenic antecedents. Hematuria, pain in flank, and left-side tumoral mass of approximately 20 cm in diameter located in kidney by computerized axial tomography (CT) constituted manifestations. A left nefrectomy was performed. No metastasis was found. The tumor replaced 4/5 of the organ and weighed 1145 g. It showed angiomatous structure with atypical proliferation of endothelial cells in a sinusoldal trauma and anastomosatic vascular channels that invaded neighboring parenchymal and capsule. Tymorous cells were positive for CD31 and CD34 and negative for cytokeratins, S100 and HMB 45 proteins. The patient was subjected to treatment with chemotherapy and radiotherapy (lineal accelerator), but 12 months after surgery he presented retroperitonal tumoral relapse and hepatic metastasis. Diagnostic differentiation with benign vascular tumors is pointed out, as well as carcinomas and sarcomas that showed an outstanding angiomatous component, both primary and/or secondary. Primary renal angiosarcoma exposes the multiplicity of localizations that it is capable of with a tumor of this type, as well as renal parenquimatous capacity to be the seat of a great variety of neoplasias.

Identification of patients with high-risk lymph node-negative colorectal cancer and potential benefit from adjuvant chemotherapy.

BACKGROUND: Adjuvant chemotherapy is not indicated in lymph node-negative colorectal adenocarcinoma (CRC), even though some cases will present recurrent disease. It is important to identify a subgroup of patients with the highest risk of relapse because of the potential benefit of adjuvant chemotherapy. The objective of this study is to define the prognostic factors and describe a method for the selection of this subgroup. METHODS: A retrospective cohort of 124 patients with lymph node-negative CRC with complete surgical resection was studied. Cox's proportional hazards model was used to define the prognostic factors associated with CRC-related survival and to develop a method for prediction of recurrence probability. RESULTS: The cohort included 62 women and 62 men with mean age 55.8 years. The mean follow-up period was 11.7 years. T classification of the primary tumor, differentiation grade, carcinoembryonic antigen level, gender and the presence of neural invasion were significant prognostic factors according to the multivariate analysis (final model P=0.00001). Using risk ratios for these prognostic factors, we defined a high-risk group of 78 patients and a low-risk group of 46 patients with 24 and 5 recurrences, respectively (recurrence rates of 30.8% and 10.9% respectively, P=0.011). CONCLUSIONS: Using these factors, a prognostic scale was developed to predict high risk of recurrence in cases of completely resected CRC and to identify them as a subgroup of patients with potential benefit of adjuvant chemotherapy.