[COVID-19 in transplant recipients: Multicentric report of Mexican experience]. / COVID-19 en receptores de trasplante: reporte multicéntrico de la experiencia mexicana.

Background: Solid Organ Transplant recipients (SOTR) appear to be at particular high risk for critical COVID-19 due to immunosuppressive drugs and comorbidities. We report the first description of clinical course and short-term outcomes of kidney and liver transplant recipients with confirmed COVID-19 in Mexico. The objective of this paper was evaluate the clinical course of transplant patients with COVID-19 infection. Material and methods: We retrospectively evaluated SOTR (kidney and liver) over 18 years of age with confirmed diagnosis of COVID-19 from tertiary care centers in Mexico. Results: Data from 45 kidney transplant recipients were recorded. Median (IQR) age was 43 (IQR 25-70) years. Admission to hospital was required in 37 (75.5 %) patients, of which 8 (16.3%) were hospitalized at Intensive Care Unit (ICU). Acute kidney injury (AKI) stage was documented in 33 (67%) patients. The time of hospitalization was 8 (IQR 6-12) days. Six patients died (12.2%). Additionally, data from 10 liver transplant recipients were included. During their evolution, 5 / 10 required hospital admission and there were no deaths in this group. Conclusions: Transplant recipients show a higher fatality rate and complications from SARS-CoV-2 infection; more studies are needed to identify prognostic factors and effective anti-SARS-CoV-2 therapies.

Antecedentes: Los receptores de trasplante de órgano sólido (RTOS) parecen estar en un riesgo particularmente alto de cuadros severos de infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) debido al uso crónico de medicamentos inmunosupresores y sus comorbilidades. Reportamos la primera descripción del curso clínico y desenlaces a corto plazo de los receptores de trasplante con enfermedad por coronavirus 2019 (COVID-19) confirmada en México. El objetivo de este trabajo es evaluar el curso clínico de estos pacientes. Material y métodos: Evaluamos de manera retrospectiva los RTOS (riñón e hígado) mayores de 18 años de edad, con diagnóstico confirmado de infección por SARS-CoV-2 provenientes de cinco centros de tercer nivel en México. Resultados: Se incluyeron 45 receptores de trasplante renal con una edad de 43 (intervalo intercuartílico [IQR]: 25-70) años. El ingreso hospitalario se requirió en 37 (75.5%) pacientes, de los cuales ocho (16.3%) fueron hospitalizados en la unidad de terapia intensiva. Se documentó lesión renal aguda en 33 (67%) pacientes. El tiempo de hospitalización fue de 8 (IQR: 6-12) días. Seis pacientes fallecieron (12.2%). Adicionalmente, 10 receptores de trasplante hepático fueron incluidos. Durante su evolución, 5 / 10 requirieron ingreso hospitalario; no se presentaron fallecimientos en este grupo de pacientes. Conclusiones: Los receptores de trasplante mostraron una alta tasa de mortalidad y complicaciones por la infección por SARS-CoV-2. Son necesarios más estudios para identificar los factores pronósticos y modalidades de tratamiento eficaces.

Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department.

The Colombian program to end trachoma implements the component F of the SAFE strategy in the Vaupés department of the Amazon rainforest. Cultural, linguistic, and geographical barriers and the coexistence of an ancestral medical system demand the technical and sociocultural adaptation of this component. A cross-sectional survey combined with focus-group discussions to understand the knowledge, attitudes, and practices of the indigenous population related to trachoma was conducted in 2015. Of the 357 heads of households that participated, 45.1% associated trachoma with a lack of hygiene, and 94.7% associated the concept of hygiene with taking one or more body baths per day, using commercial or handcrafted soap. In total, 93% reported cleaning their children's faces and eyes more often when they have conjunctivitis, but 66.1% also did this with clothes or towels in use, and 52.7% of people shared towels; in total, 32.8% indicated that they would use ancestral medicine to prevent and treat trachoma. The SAFE strategy in Vaupés requires an intercultural approach to facilitate stakeholder support and participation to promote general and facial hygiene, washing clothes with soap, and not sharing towels and clothes to dry and clean children's faces for effective and sustainable elimination of trachoma as a public health problem. This qualitative assessment facilitated an intercultural approach locally and in other Amazonian locations.

Caracterización de la tuberculosis multidrogorresistente y resistente a rifampicina en Colombia / Characterization of rifampin-resistant/multidrug-resistant tuberculosis in Colombia

RESUMEN Objetivo Caracterizar la población afectada por tuberculosis multidrogorresistente y resistente a rifampicina (TB-MDR/RR) en Colombia. Métodos Estudio transversal a partir de la información nominal de los pacientes con TB-MDR/RR tratados y reportados en Colombia desde 2009 hasta 2020, usando la totalidad de las fuentes de información oficiales. Se compararon, además, las tasas de TB-MDR/RR de diferentes grupos de riesgo con la de la población general y se evaluaron variables asociadas a la TB-MDR/RR extrapulmonar y a resistencias medicamentosas. Resultados La TB-MDR/RR ha aumentado progresivamente durante la última década y se ha concentrado en hombres (64% vs. 36%, p<0,001), edades medias (mediana: 39,5 años; RIC: 27) y zonas de mayor densidad poblacional (59% de los casos en Antioquia, Valle del Cauca y Santiago de Cali). Además, al compararlas con las poblaciones de referencia que aplicaran, se evidenciaron tasas 2, 10 y 200 veces mayores en población indígena (9,45/1 000 000 vs. 4,31/1 000 000; p=0,02), prisioneros (169/1 000 000 vs. 16,9/1 000 000; p<0,001) y habitantes de calle (21/100000 vs. 0,1/100 000; p<0,001), respectivamente. Conclusiones El aumento en los casos de TB-MDR/RR y sus grupos de riesgo deben tenerse en cuenta para la planeación de políticas, distribución de recursos y atención clínica.

ABSTRACT Objective To describe the population affected by rifampin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) in Colombia. Methods Cross-sectional study on all the patients treated for RR/MDR-TB in Colombia between 2009 and 2020, using all the official sources of information. In addition, a comparison was made between the rates of RR/MDR-TB in some higher-risk groups and average population. Finally, the variables associated to pulmonary versus extrapulmonary RR/MDR-TB and those associated to resistance to other drugs were evaluated. Results RR/MDR-TB cases have progressively increased during the last decade. These cases were concentrated in men (64% vs. 36%, p<0.001), middle aged adults (median: 39.5 years old; IQR: 27), and in geographic regions with higher population density (59% of cases in Antioquia, Valle del Cauca and Santiago de Cali). Also, the rate of RR/MDR-TB was 2, 10 and 200 times higher in indigenous (9.45/1 000 000 vs. 4.31/1 000 000; p=0.02), prisoners (169/1 000 000 vs. 16.9/1 000 000; p<0.001), and homeless population (21/100 000 vs. 0.1/100 000; p<0.001), respectively. Conclusions The increase in RR/MDR-TB cases and their concentration in higher-risk groups must be kept in mind to make better policies, a more efficient distribution of resources, and better patient care.

[Short-term cardiovascular impact and change in the natural history of the disease after high-quality dialysis therapy]. / Impacto cardiovascular a corto plazo y cambio de la historia natural de la enfermedad tras terapia dialítica de alta calidad.

Se trata de hombre de 28 años de edad conocido previamente sano. Inició su cuadro con presencia de náuseas, vómitos y ataque al estado general. Durante la valoración se documentó nitrógeno ureico en sangre (BUN) 142 mg/dl y creatinina 12.8 mg/dl. Por recursos económicos limitados no fue posible inicio inmediato de terapia dialítica y solo se inició manejo médico. Tras progresión de la sintomatología, se inició terapia dialítica 10 meses después, recibiendo solamente dos sesiones por semana.

Linfomas de estirpe B: bases para su entendimiento / Line B lymphomas: understanding their bases

Propósito de la revisión: el objetivo de la revisión es delinear la fisiopatología de los linfomas de estirpe B.Buscamos reportes endonde se incluyela descripción del origen de los Linfomas B para una mejor comprensión de esta patología, a la luz de los avances en las diferentes áreas. Recientes hallazgos: El Grupo Euroflow ha publicado una lista de paneles de Expresión de Antígenos de Superficie en Linfoma no Hodgkin, cuya lista se presenta en este artículo. Extracto: Las neoplasias hematológicas han tenido grandes avances en los últimos años en varios campos, evolucionando desde la identificación citológica, pasando por su caracterización inmunofenotípica por medio de la Citometría de Flujo e Inmunohistoquímica y llegando a la caracterización molecular, iniciando por Técnicas de Cariotipo Convencional, continuando por técnicas de Inmunohibridación in situ y actualmente con la identificación molecular por medio de la Secuenciación de Nueva Generación. Esta es la razón por la que los sistemas de estadificación han ido evolucionando también, siendo el que está al momento en vigencia el propuesto por la Organización Mundial de la Salud en el año 2016.Los linfomas constituyen un grupo heterogéneo de neoplasias hematológicas con un amplio espectro de presentación clínica, cuyo origen se encuentra en los precursores de linfoides y que afectan a los diversos órganos linfoides. De estos, los linfomas dela línea B son los más comunes, motivo de esta revisión

Purpose of the review: the objective of the review is to delineate the pathophysiology of B-line lymphomas. We are looking for reports that include a description of the origin of B-lymphomas for a better understanding of this pathology, in light of advances in the different areas. Recent Findings: The Euroflow Group has published a list of Surface Antigen Expression panels in Non-Hodgkin Lymphoma, the list of which is presented in this article. Extract: Hematological neoplasms have had great advances in recent years in several fields, evolving from cytological identification, passing through their immunophenotypic characterization through Flow Cytometry and Immunohistochemistry and reaching molecular characterization, starting with Conventional Karyotype Techniques , continuing with in situ Immunohybridization techniques and currently with molecular identification through New Generation Sequencing. This is the reason why staging systems have also evolved, the one currently in force being the one proposed by the World Health Organization in 2016. Lymphomas constitute a heterogeneous group of hematological neoplasms with a wide spectrum of clinical presentation, originating from lymphoid precursors and affecting the various lymphoid organs. Of these, line B lymphomas are the most common, which is the reason for this review

Prevalence of trachoma and associated factors in the rural area of the department of Vaupés, Colombia.

OBJECTIVES: The objectives of the study were to estimate the prevalence of different clinical signs of trachoma and identify possible factors associated with TF. METHODOLOGY: Following the approval of the study protocol by the ethics committee, a cross-sectional study was conducted in Vaupés, a department of the Colombian Amazon, between the years 2012 and 2013 in two districts. Based on the records obtained from a standardized format for the clinical evaluation of the participants and the factors associated with follicular trachoma, an excel database was built and debugged, which was analyzed using IBM SPSS, Statistics Version 23 and Stata STATA (Version 14, 2015, StataCorp LLC, Texas, USA). RESULTS: The records of 13,091 individuals was collected from 216 rural indigenous communities, of which 12,080 were examined (92.3%); 7,274 in the Western and 4,806 in the Eastern districts. A prevalence of trachomatous inflammation-follicular (TF) of 21.7% (n = 599; 95% CI 20.2-23.3) in the Western and 24.9% (n = 483; 95% CI 23.1-26.9) in the Eastern district was found in children aged 1 to 9 years. Regarding trachomatous trichiasis (TT), 77 cases were found, of which 14 belonged to the Western district (prevalence 0.3%, CI 95% 0.2-0.5) and 63 to the Eastern district (1.8%, CI 95% 1.4-2.4). Children aged between 1 to 9 years were significantly more likely to have TF when there was the presence of secretions on the face (OR: 3.2; 95% CI: 2.6-3.9). CONCLUSIONS: Trachoma is a public health problem in Vaupés that requires the implementation of the SAFE strategy (S = Surgery, A = Antibiotics, F = Face Washing, E = Environment) in the Eastern and Western districts, for at least 3 consecutive years, in accordance with WHO recommendations.

Blue carbon of Mexico, carbon stocks and fluxes: a systematic review.

Mexico has more than 750,000 ha of mangroves and more than 400,000 ha of seagrasses. However, approximately 200,000 ha of mangroves and an unknown area of seagrass have been lost due to coastal development associated with urban, industrial and tourist purposes. In 2018, the approved reforms to the General Law on Climate Change (LGCC) aligned the Mexican law with the international objectives established in the 2nd Article of the Paris Agreement. This action proves Mexico's commitment to contributing to the global target of stabilizing the greenhouse gas emissions concentration in the planet. Thus, restoring and conserving mangrove and seagrass habitats could contribute to fulfilling this commitment. Therefore, as a first step in establishing a mitigation and adaptation plan against climate change with respect to conservation and restoration actions of these ecosystems, we evaluated Mexican blue carbon ecosystems through a systematic review of the carbon stock using the standardized method of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We used the data from 126 eligible studies for both ecosystems (n = 1220). The results indicated that information is missing at the regional level. However, the average above and below ground organic carbon stocks from mangroves in Mexico is 113.6 ± 5.5 (95% CI [99.3-118.4]) Mg Corg ha-1 and 385.1 ± 22 (95% CI [344.5-431.9]) Mg Corg ha-1, respectively. The variability in the Corg stocks for both blue carbon ecosystems in Mexico is related to variations in climate, hydrology and geomorphology observed along the country's coasts in addition to the size and number of plots evaluated with respect to the spatial cover. The highest values for mangroves were related to humid climate conditions, although in the case of seagrasses, they were related to low levels of hydrodynamic stress. Based on the official extent of mangrove and seagrass area in Mexico, we estimate a total carbon stock of 237.7 Tg Corg from mangroves and 48.1 Tg Corg from seagrasses. However, mangroves and seagrasses are still being lost due to land use change despite Mexican laws meant to incorporate environmental compensation. Such losses are largely due to loopholes in the legal framework that dilute the laws' effectiveness and thus ability to protect the ecosystem. The estimated emissions from land use change under a conservative approach in mangroves of Mexico were approximately 24 Tg CO2e in the last 20 years. Therefore, the incorporation of blue carbon into the carbon market as a viable source of supplemental finance for mangrove and seagrass protection is an attractive win-win opportunity.

The prognostic significance of serum XCL1 concentration in patients with acute lymphoblastic leukemia: a pilot study.

There is no information about XCL1 in patients with acute lymphoblastic leukemia (ALL). The objective of this study was to correlate the serum levels of XCL1 and survival in ALL patients. Only ALL patients older than 12 months were considered to participate. Serum XCL1 was measured at diagnosis, end of remission induction, and end of consolidation. Thirty-three ALL patients with median age of 21 years (1-78) were included. Higher XCL1 level (above 50 pg/mL) at ALL diagnosis correlated with higher survival (p = 0.038), whereas XCL1 level at end of induction and consolidation had no significant correlation. Concerning the behavior of serum XCL1 during treatment, higher survival at 5 years was observed in the group with progressively decreased levels of XCL1 (70%) than those with progressively increasing (29%) or no detectable XCL1 (14%). In conclusion, higher serum XCL1 levels at diagnosis and their progressive decline throughout chemotherapy could be correlated with higher survival.

Prevalence and Clinical Significance of FLT3 Mutation Status in Acute Myeloid Leukemia Patients: A Multicenter Study.

BACKGROUND AND AIMS: FLT3-ITD mutations in acute myeloid leukemia (AML) are associated with a poor prognosis. In Latin America, little epidemiological data exist about these mutations and their influence on clinical evolution and prognosis. Standardization and well-established clinical correlation make FLT3 mutational analysis by molecular methods an invaluable tool to decide among treatment options and to determine AML prognosis. METHODS: We assessed the prevalence of FLT3-ITD mutations in 138 patients with AML at four hematology referral centers from Mexico and Colombia. Molecular methods based on polymerase chain reaction (PCR) were employed for determining FLT3-ITD status. RESULTS: Mutations were present in 28 patients indicating a prevalence of 20.28%. Median age was 47 years (5-96). The FLT3 mutation positive group was older, had higher WBC and hemoglobin values and lower platelet counts but without statistical significance. A not previously described mutation in the FLT3 gene was found in one patient involving a nucleotide exchange of timine for cytosine at the 66608 position. A high mortality was found in the FLT3-mutated group, 67.8 vs. 42.72% in the non-mutated group and median survival was 4.9 months vs. 20.4 months, p = 0.009. A mutated FLT3 did not confer poor prognosis to those with M3 AML. The mutated FLT3 population had poor overall survival (OS) despite hematoprogenitor stem cell transplantation (HSCT). CONCLUSION: Prevalence of FLT3-ITD mutation in AML was present in a proportion comparable to other populations and, when present, was associated with a very poor prognosis.

Análisis de conocimiento, actitudes y prácticas sobre aborto incompleto en una muestra de proveedores de salud en obstetricia de Ecuador / Analysis of knowledge, attitudes and practices about incomplete abortion in a sample of obstetrics health providers in Ecuador

Objetivos: analizar el nivel de conocimientos, actitudes y prácticas que tiene una muestra voluntaria de proveedores de salud en obstetricia asistentes al XXI Congreso Nacional de Ginecología y Obstetricia del Ecuador sobre muerte materna, leyes nacionales y tratamientos relacionados al aborto incompleto. Material y Métodos: Se realizó una intervención investigativa transversal...

Objectives: To examine the level of knowledge, attitudes and practices which has voluntary sample of health care providers at obstetrician tending the 21st National Congress of Gynecology and Obstetrics of Ecuador on maternal death, national laws and treatment related to incomplete abortion. Material and Methods: a descriptive and analytical cross - sectional investigative intervention through suvery...

Conocimientos, actitudes y prácticas sobre aborto en una muestra de médicos gineco-obstetras de Ecuador / Knowledge, attitudes and practices regarding abortion in a sample of obstetrician-gynecologists from Ecuador

Objetivos: Determinar el nivel de conocimientos, actitudes y prácticas en una muestra intencionada de médicos gineco-obstetras líderes provinciales de la Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO) sobre el aborto inducido. Diseño: Estudio transversal, correlacional, de corte prospectivo y analítico. Institución: Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO). Participantes: Médicos gineco-obstetras líderes provinciales de FESGO. Metodología: En una muestra intencionada de 33 médicos gineco-obstetras se aplicó una encuesta estructurada validada y basada en experiencias de la región, acerca de datos generales y sociodemográficos del encuestado, conocimientos teóricos sobre la epidemiología del aborto y la muerte materna, actitudes con relación del manejo del aborto inseguro, y la práctica de prescripción de misoprostol y tratamiento quirúrgico por aspiración. Principales medidas de resultados: Nivel de conocimientos, actitudes y prácticas. Resultados: La población encuestada tenía promedio de edad de 49 años, 16 años de práctica, con relación estable, hijos y religión declarada. Consideraron de alta prioridad la muerte materna por aborto, pues atendían pacientes públicas y privadas con intención de aborto inducido frecuente y uso de misoprostol previo. Consideraron la ampliación de motivos para aborto con la proyección de reducción de mortalidad, aunque los casos aumentaran. En su mayoría consideraron suficientes sus conocimientos de derechos reproductivos, se sentían solventes respecto a la consejería en misoprostol, aunque la satisfacción alta respecto a consejería de aborto inducido fue apenas en 51%. Conclusiones: Los líderes provinciales de esta muestra intencionada conocían la temática del aborto y su atención integral. Los conocimientos fueron altos, aunque las actitudes y prácticas resultaron diversas, con respuestas que sugieren mayor sensibilización y capacitación. Nuevos estudios necesitan ser realizados en una población más amplia de gineco-obstetras federados, así como intervenciones educativas y de sensibilización para mejorar la calidad de atención del aborto.

Objectives: To determine knowledge, attitudes and practices regarding abortion in an intentioned sample of obstetrician/gynecologists who are provincial leaders of the Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO). Design: Prospective, correlational, cross-sectional, and analytical survey. Setting: Federación de Sociedades de Ginecología y Obstetricia del Ecuador (FESGO). Participants: FESGO obstetrician/gynecologists provincial leaders. Methods: A structured and validated survey was applied to an intentional sample of 33 obstetrician/gynecologists. The survey was based on experiences in the region, general and demographic information of the respondent, theoretical knowledge about the epidemiology of abortion and maternal death, attitudes about the management of unsafe abortion, and practice on misoprostol prescription and surgical aspiration. Main outcome measures: Knowledge, attitude and practices. Results: The survey respondents were 49 years old average, had 16 years of medical practice, and stable family relations, with declared children and religion. They considered maternal death due to abortion of high priority be-cause they attended public and private patients with frequent history of induced abortion and use of misoprostol. They also considered the expansion of reasons for abortion in the light of a potential reduction in mortality, even if the number of cases increased. Most considered sufficient their knowledge on reproductive rights and felt proficient with respect to counseling on misoprostol, although high satisfaction on induced abortion counseling was just 51%. Conclusions: Provincial leaders of this sample knew about abortion and its comprehensive care. Knowledge was high, but attitude and practices were diverse and require more awareness and training. Further studies are needed in a b broader federated population of obstetrician/ gynecologists. Educational and sensitizing interventions are needed to improve the quality of abortion care.

Impact of outpatient non-myeloablative haematopoietic stem cell transplantation in quality of life vs. conventional therapy.

The role of outpatient hematopoietic stem cell transplantation (HSCT) as a therapeutic tool has been strengthened significantly because of the increasing number of patients undergoing this treatment. Due the very nature of this procedure, one of the aspects that should not be overlooked is the quality of life (QOL) of patients undergoing HSCT. Thus, one must consider not only health status after treatment, but also, the psychosocial implications for the patient. This is an observational, longitudinal, and prospective study to assess QOL in patients undergoing outpatient HSCT vs. similar patients receiving medical treatment (MxTx). By applying the COOP/WONKA charts on five occasions (pre-HSCT/initial, post-HSCT/first month, and at 3, 6, and 9 months), thirty-eight patients were analysed, 19 with HSCT and 19 with MxTx with no differences in age, gender or diagnosis. The initial survey found significant differences only in pain perception, which was higher in the HSCT group (p = .08); at the first month, there was a greater tendency for feelings of depression or anxiety in the HSCT group (p = .016), with more limitations in social (p = .003) and daily (p = .044) activities. From 3 months post-HSCT, the results were very similar. The differences persisted only in the area of social activities. Four patients developed graft-versus-host disease with no significant difference in the scores obtained compared to other transplant patients at 3, 6, and 9 months (p = .26) of follow-up.

Cultural factors related to adherence to imatinib in CML: a Mexican perspective.

INTRODUCTION: The advent of imatinib as a therapeutic option of chronic myeloid leukemia (CML) has transformed this previously highly resistant disease into one that is susceptible to management with oral drugs that now offer high long-term survival rates. However, achieving an adequate adherence to treatment regimes is of critical importance. The characteristics of treatment compliance in Mexican patients have not been determined. METHODS: We evaluated 38 CML patients, members of the Glivec(®) International Patient Assistance Program (GIPAP). A bimonthly simplified medication adherence questionnaire was applied and the adherence rate was calculated by direct tablet counting. RESULTS: Two groups, one of local patients and another of out-of-town patients, were studied using an 85% adherence rate as a cut-off. The overall adherence rate was 85.9%. Fifteen patients were considered non-adherent (39.5%). The group of out-of-town patients presented a higher adherence rate of 92.8% in contrast with 76.3% in the local population (P = 0.021). The probability of achieving a complete cytogenetic response at some point of evolution after 8 years of follow-up was 93% in the adherent group vs. 58% in the group with an adherence rate <85% (P = 0.008). In patients with imatinib failure, the adherence rate was 75.8% compared to 95.5% (P = 0.008) in the optimal response group. CONCLUSIONS: In Mexican patients with CML, non-adherence to treatment is a cause of the failure to achieve remission or the subsequent loss of a complete cytogenetic and major molecular response.

Mantenedor fixo estético-funcional como tratamento para perda precoce de dentes decíduos anteriores / Aesthetic-functional fixed appliance as treatment of premature of primary anterior teeth

A perda precoce de dentes decíduos pode acarretar dano à oclusão e outras sequelas estético-funcionais indesejáveis. Nesses casos, tão importante quanto a reabilitação do paciente, é a escolha adequada do tipo de aparelho mantenedor de espaço. Este trabalho é um relato de caso clínico no qual uma criança de três anos de idade apresentou perda precoce dos incisivos superiores decíduos onde foi instalado um aparelho mantenedor estético-funcional fixo. Em um período inicial de quatro meses de acompanhamento a mãe relatou boa aceitação quanto à adaptação e higienização do aparelho. Consultas de proservação do caso serão feitas mensalmente até o início da erupção dos incisivos permanentes.

The premature loss of primary teeth can cause damage to occlusion and other undesirable aesthetic-functional sequelaes. ln such cases, as important as the rehabilitation of the patient, is the accurate choice of space maintenance appliance. This work is a case report in which a child of three years old showed premature loss of deciduous incisors and a aesthetic-functional fixed appliance was installed. ln an initial follow-up of 4 months, the mother reported good acceptance on the adjustment and cleaning of the device. The clinical visits of proservation of the case will be scheduled monthly until the eruption of the permanent incisors.

Pigmented Eccrine Poroma in abdominal region, a rare presentation / Poroma Ecrino Pigmentado en región abdominal, una rara presentación

The eccrine poroma or Hidracanthoma Simplex is a rare benign adnexal tumor of ephitelial cells, with an incidence of 0.001 to 0.008%¹. In two-thirds of the patients it appears on the soles and lateral borders of the feet. We report the case of a patient with pigmented eccrine poroma in abdominal skin, of a rare entity presentation with a single report in the literature in that location.

El poroma ecrino o hidroacantoma simple, es una tumoración anexial benigna de células epiteliales, de rara presentación, con una incidencia de 0.001 a 0.008%1. En dos tercios partes de los pacientes se presenta en la planta y bordes laterales de los pies. Reportamos el caso de una paciente con Poroma ecrino pigmentado en piel abdominal, entidad de rara presentación con un sólo reporte en la literatura en esa ubicación.

Pigmented Eccrine Poroma in abdominal region, a rare presentation.

The eccrine poroma or Hidracanthoma Simplex is a rare benign adnexal tumor of ephitelial cells, with an incidence of 0.001 to 0.008%1. In two-thirds of the patients it appears on the soles and lateral borders of the feet. We report the case of a patient with pigmented eccrine poroma in abdominal skin, of a rare entity presentation with a single report in the literature in that location.

El poroma ecrino o hidroacantoma simple, es una tumoración anexial benigna de células epiteliales, de rara presentación, con una incidencia de 0.001 a 0.008%1. En dos tercios partes de los pacientes se presenta en la planta y bordes laterales de los pies. Reportamos el caso de una paciente con Poroma ecrino pigmentado en piel abdominal, entidad de rara presentación con un sólo reporte en la literatura en esa ubicación.

Is there a benefit to adding rituximab to CHOP in the overall survival of patients with B-cell non-Hodgkin's lymphoma in a developing country?

Rituximab (R) has changed the prognosis of patients with non-Hodgkin's lymphoma (NHL) in developed countries, but its role has not been analyzed in underprivileged circumstances. One hundred and two patients with NHL treated in a developing country were analyzed: 28 patients with follicular lymphoma (FL) and 74 with diffuse large B-cell lymphoma (DLCL). Patients were treated upfront with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or R-CHOP; the decision to employ R depending solely on the ability of patients to defray it. In DLCL, 42 were given CHOP and 32 R-CHOP, whereas in FL, 19 were given CHOP and 9 R-CHOP. The impact of the addition of R was found to be clearer in FL than in DLCL. In patients with DLCL, the overall survival (OS) was 87% at 80 months for those treated with R-CHOP and 84% at 145 months for those treated with CHOP (not significant). In patients with FL, the OS was 89% at 88 months for those treated with R-CHOP and 71% at 92 months for those treated with CHOP (P = 0··05). In a multivariate analysis, other variables which were identified to be associated with the OS were IPI and number of cycles in DLCL. It is concluded that R produced a mild positive impact in the OS of patients with FL, but not in those with DLCL. Since the addition of R results in a 36-fold increase in treatment costs, these observations may be important to decide therapeutic approaches in NHL patients living in underprivileged circumstances.