Malignancies after renal transplantation: experience of a Mexican referral center.

OBJECTIVE: To report the incidence of cancer after renal transplantation at a referral center in a developing country. MATERIALS AND METHODS: Consecutive patients receiving renal transplantations during a 48-year period at Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran were analyzed. The standardized incidence ratio (SIR) was calculated based on data from GLOBOCAN 2012. RESULTS: From 1257 patients, 98 (8%) developed 143 malignancies. The SIR of all the cohort was 4.1 (95% CI 3.2-5.1). The relative risks of male and female transplant recipients were 4.6 and 3.5 times greater than the risk of cancer of the general population, respectively. The most common malignancy was non-melanoma skin cancer (52%). The malignancy that associated with the greater relative risk was Kaposi sarcoma (SIR: 200), followed by lymphomas (SIR: 30). A multivariate analysis comparing patients with cancer and controls confirmed that receiving a three-drug regimen as final treatment, prolonged immunosuppression, and patients undergoing a second renal transplantation were factors associated with increased cancer development. CONCLUSION: To date, there is paucity of data from developing countries. We reported the results from a National Health Institute in Mexico including a large cohort with a long follow-up, demonstrating differences within frequencies and risks compared to other regions of the world.

Correlation of T Cell Subsets and Hypercholesterolemia of the Donor and Its Association with Acute Graft-versus-Host Disease.

Background: Acute graft-versus-host disease (aGVHD) is an important cause of death following allogeneic hematopoietic stem cell transplantation (allo-HSCT). The association between cholesterol and aGVHD was previously described potentially, resulting from pro-inflammatory responses associated with hypercholesterolemia. The aim of this study was to correlate T cell subsets in donor bone marrow (BM) samples with their levels of cholesterol and associate these results with recipients who developed aGVHD and those who did not. Materials and Methods: A prospective study was performed in 39 donor samples. T cell subsets were analyzed by flow cytometry. Results: Eleven (28%) donors had hypercholesterolemia. Donor samples with hypercholesterolemia had less Tregs compared to donors with normal levels of cholesterol (22.69 (IQR=30.6) cells/µL vs 52.62 (IQR=44.68) cells/µL, p=0.04). Among all individuals in the cohort, aGVHD was observed in 21%: 36% from donors with hypercholesterolemia versus 14% from donors with normal levels of cholesterol. Conclusion: As we described the association between hypercholesterolemia and diminished Tregs, our results might suggest that normalizing the levels of total cholesterol in the donor, prior performing allo-HSCT, might be an effective approach to diminish the risk of the receptor to develop aGVHD.

Breast self-exam and patient interval associate with advanced breast cancer and treatment delay in Mexican women.

PURPOSE: The objective of this study was to compare treatment intervals in breast cancer patients according to the detection method (breast self-exam vs screening). PATIENTS AND METHODS: We conducted a retrospective analysis including 291 breast cancer patients at a Mexican tertiary referral hospital. RESULTS: Breast cancer detection method was mostly breast self-exam (60%). The median patient interval was 60.5 days, and was associated with marital status and socioeconomic level. Differences between the two groups were statistically significant for global interval, p = 0.002; however, health system interval was not statistically different. CONCLUSION: In our country, breast cancer screening is opportunistic, with several weaknesses within its management and quality systems. Our study showed that even in specialized health care centers, breast cancer is detected by self-exam in up to 2/3 of patients, which can explain the advanced stages at diagnosis in our country. In developing countries, the immediate health care access for breast cancer patients should be prioritized as an initial step to reduce the global treatment initiation interval in order to reduce mortality.

Neumonía por mycoplasma: cuatro años de estudio / Mycoplasma pneumonia: four years study

Mycoplasma pneumoniae constituye una de las causas, cada vez mas frecuente, de neumonias en la infancia. Objetivos: estudiar 105 casos de neumonias por Mycoplasma pneumoniae habidos en nuestro hospital en los ultimos cuatro anos. Material y metodos: durante dicho tiempo se diagnosticaron en el Servicio de Urgencias de nuestro hospital, un total de 452 neumonias ambulatorias, 132 de ellas causadas por Mycoplasma pneumonlae, lo que significa un porcentaje de casi 30 por ciento; todas fueron seguidas mediante un protocolo de neumonias, recogiendose datos epidemiológicos, clínicos, analíticos y microbiológicos, analizándose sus resultados según un programa estadístico. Resultados: edad media de presentación de 6.38 anos, 38.6 por ciento menores de cinco arlos. No encontramos ningun predominio de sexos en su distribución, aunque si una mayor distribución de los casos entre los meses de enero y julio con 83 por ciento de los casos. Epidemiológicamente encontramos la aparición de casos familiares similares en 37 por ciento de los casos, por 52 por ciento de casos en donde no se encontraron casos similares en el entorno, se hallaron factores de riesgo en 36 por ciento de los casos (enfermedades del tracto respiratorio inferior). La clinica consistió fundamentalmente en fiebre superior a 38§C, tos seca y buen estado general, acompanandose de sintomatologia catarral en los pacientes mas pequenos. A la exploración ffsica encontramos estertores a la auscultación pulmonar en 75 pacientes y una auscultación normal en 23 casos, cinco pacientes cursaron con derrame pleural de leve a moderado. La afectación faringo-amigdalar estaba presente en 74 casos y 14 pacientes cursaron con afectación dermatológica, sólo cuatro de los pacientes precisaron ingreso hospitalario. El tratamiento consistió en batalactamicos y macrólidos, evolucionando a su total curación al mes de iniciado el estudio 93 por ciento de los casos