Aplicabilidad de los criterios de alto riesgo hemorrágico del Academic Research Consortium al síndrome coronario agudo sometido a intervención coronaria percutánea / Applicability of the Academic Research Consortium for High Bleeding Risk in acute coronary syndrome undergoing percutaneous coronary intervention

Introducción y objetivos: La reciente propuesta del Academic Research Consortium for High Bleeding Risk (ARC-HBR), por consenso, no considera el síndrome coronario agudo (SCA) un criterio de hemorragia per se a pesar de tratarse de una situación de alto riesgo hemorrágico (ARH). En este artículo, se investiga la aplicabilidad de la clasificación y los criterios del ARC-HBR a los pacientes con SCA. Métodos: Se clasificó retrospectivamente a los pacientes con SCA sometidos a implante de stent coronario entre 2012 y 2018 en un hospital terciario como ARH si cumplían al menos 1 criterio mayor o 2 o más criterios menores del ARC-HBR. El objetivo primario fue la incidencia acumulada a 1 año de hemorragias de grado Bleeding Academic Research Consortium (BARC) 3-5. Resultados: De los 4.412 pacientes incluidos, el 29,5% estaba en ARH. La incidencia de hemorragias fue mayor en el grupo con ARH que en el de no ARH (el 9,4 frente al 1,3%; p < 0,01). Las tasas de hemorragias hospitalarias periprocedimiento y tras el alta también fueron mayores en el grupo con ARH (el 4,3 frente al 0,5% y el 5,3 frente al 0,9% respectivamente; p < 0,01). El riesgo hemorrágico se incrementó gradualmente a medida que aumentaban los criterios ARC-HBR: el 1,8, el 5,0, el 9,4, el 16,8, el 25,2 y el 25,9% con, respectivamente: solo 1 criterio menor, 2 o más criterios solo menores, 1 criterio mayor (solo o sumado a 1 criterio menor), 1 criterio mayor con 2 o más criterios menores, 2 o más criterios mayores (solos o sumados a 1 criterio menor) y 2 o más criterios mayores con 2 o más criterios menores. De los 20 criterios del ARC-HBR, 16 (80%) cumplieron los cortes predefinidos del riesgo hemorrágico BARC 3-5. Conclusiones: Este estudio respalda la aplicación de la clasificación y los criterios del ARC-HBR en el contexto del SCA. La clasificación ARC-HBR proporciona una estimación precisa del riesgo de hemorragia mayor y parece adecuada para la identificación y el tratamiento de los pacientes con ARH (AU)

Introduction and objectives: The recent Academic Research Consortium for High Bleeding Risk (ARC-HBR) proposal did not consider acute coronary syndrome (ACS), by consensus, a bleeding criterion per se despite being a high bleeding risk (HBR) scenario. We investigated the applicability of the ARC-HBR classification and criteria in ACS patients. Methods: Patients with ACS undergoing coronary stenting between 2012 and 2018 at a tertiary hospital were retrospectively classified as being at HBR if they met ≥ 1 major or ≥ 2 minor ARC-HBR criteria. The primary endpoint was the 1-year cumulative incidence of Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding.Results: Among 4412 patients, 29.5% were at HBR. The incidence of bleeding was higher in the HBR group than in the non-HBR group (9.4% vs 1.3%; P < .01). The rates of in-hospital periprocedural and postdischarge bleeding were also higher in the HBR group (4.3% vs 0.5% and 5.3% vs 0.9%, respectively; P < .01). Bleeding risk gradually increased with increasing ARC-HBR criteria: 1.8%, 5.0%, 9.4%, 16.8%, 25.2%, and 25.9% for 1 isolated minor criterion, ≥ 2 isolated minor criteria, 1 major criterion (isolated or plus 1 minor criterion), 1 major plus ≥ 2 minor criteria, ≥ 2 major criteria (isolated or plus 1 minor criterion), and ≥ 2 major plus ≥ 2 minor criteria, respectively. Sixteen (80%) out of 20 ARC-HBR criteria satisfied the ARC-HBR predefined cutoffs for BARC 3 or 5 bleeding risk. Conclusions: This study supports the use of the ARC-HBR classification and criteria in the ACS setting. The ARC-HBR classification provides an accurate major bleeding risk estimate and it seems suitable for the identification and management of patients at HBR (AU)

Sequence analysis of five exons of SLC6A4 gene in Mexican patients with anorexia nervosa and bulimia nervosa.

BACKGROUND: Accumulating evidence indicates that alterations in the serotonin system are related to changes in eating behavior. The serotonin transporter is encoded by the SLC6A4 gene and has been an interesting candidate for anorexia nervosa- restrictive type (AN-R) and bulimia nervosa (BN). Interestingly, functional variants have been identified in the coding region that could contribute to understand the role of this gene in eating disorders. The aim was to identify genetic variants in five exons of SLC6A4 gene using Sanger-sequencing in anorexia nervosa-restrictive and bulimia nervosa patients, and a control group. METHOD: The sample consisted of 86 patients and 50 control subjects. We obtained DNA samples from all subjects and performed Sanger-sequence analysis of the 1, 2, 3, 8 and 9 exons. The sequences were compared with the reference sequence of the SLC6A4 gene. RESULTS: The sequence analysis of the five exons of the gene identified several variants. In the AN-R, we observed two novel variants (g.130delA and c.1740G > A), three synonymous variants (rs57172732, rs55908624, rs74478645) and a missense variant (L90F) reporting a probably deleterious and damaging variant. In BN, we identified two novel variants (g.295C > G and c.1725G > A), and the non-synonymous (rs28914832/I425V), reported as benign. Interestingly, we observed the 425V variant in three patients in the BN, variant that previously was reported in patients with a spectrum obsessive-compulsive disorder. CONCLUSION: The results of our study suggest that variants of the SLC6A4 gene are related with a possible damaging or gain-of-function and may be involved in the susceptibility to AN-R and BN patients. However, the present findings should be considered as preliminary until replicated in large samples.

Review of the scientific evidence and technical opinion on noncaloric sweetener consumption in gastrointestinal diseases. / Revisión de la evidencia científica y opinión técnica sobre el consumo de edulcorantes no calóricos en enfermedades gastrointestinales.

The present review of noncaloric sweeteners (NCSs) by the Asociación Mexicana de Gastroenterología was carried out to analyze and answer some of the most frequent questions and concerns about NCS consumption in patients with gastrointestinal disorders, through a thorough review of the medical literature. A group of gastroenterologists and experts on nutrition, toxicology, microbiology, and endocrinology reviewed and analyzed the published literature on the topic. The working group formulated conclusions, based on the scientific evidence published, to give an opinion with respect to NCS ingestion. Current evidence does not confirm the carcinogenic potential of NCSs. However, the studies analyzed showed that saccharin could have a proinflammatory effect and that polyols can cause gastrointestinal symptoms and manifestations, depending on the dose and type of compound. The ingestion of xylitol, erythritol, sucralose, aspartame, acesulfame K, and saccharin could increase the secretion of the gastrointestinal hormones that regulate intestinal motility, and stevia and its derivatives could have a favorable effect on the percentage of liver fat. Caution should be taken in recommending aspartame consumption in patients with chronic liver disease because it reduces the ratio of branched-chain amino acids to aromatic amino acids. In addition, NCS ingestion could modify the composition of the intestinal microbiota, having an effect on gastrointestinal symptoms and manifestations. It is important to continue conducting causality studies on humans to be able to establish recommendations on NSC consumption.

Ophthalmic features of spinocerebellar ataxia type 7.

PurposeTo analyze the relation between ophthalmologic and motor changes in spinocerebellar ataxia type 7 (SCA7).Patients and methodsThis was a case series study. Sixteen SCA7 patients underwent a comprehensive ophthalmic examination, including ocular extrinsic motility testing, color vision test, and optical coherence tomography of the optic nerve and macula. Changes in the corneal endothelium, electroretinographic patterns, and a complete neurologic evaluation using the Scale for the Assessment and Rating of Ataxia (SARA) were evaluated. Correlations of endothelial cell density (ECD) with number of CAG repetitions and the SARA scores were estimated.ResultsAll patients showed various degrees of visual impairment mainly due to macular deterioration. Notably, they also presented decreased ECD. Pairwise correlations of ECD with number of CAG repeats and severity of motor symptoms quantified with the SARA scores were inverse (r=-0.46, P=0.083 and r=-0.64, P=0.009, respectively). Further analyses indicated an average ECD decrease of 48 cells/mm2 (P=0.006) per unit of change on the number of CAG repeats, and of 75 cells/mm2 (P=0.001) per unit of change on the SARA scores.ConclusionsThe results agree with previous ophthalmological findings regarding the widespread effect of SCA7 mutation on the patient's visual system. However, the results also show a significant negative correlation of decreased ECD with both CAG repetitions and SARA scores. This suggests that motor systems could degenerate in parallel with visual systems, although more research is needed to determine whether the degeneration is caused by the same mechanisms.

Carcinoma de células pequeñas en la unión gastroesofágica / Gastroesophageal junction small cell carcinoma

Resumen Los tumores de células pequeñas extrapulmonares pueden aparecer en múltiples órganos y forman una rara afección clínico-patológica de tumores neuroendocrinos, con gran proliferación epitelial y con comportamiento biológico agresivo. El tubo gastrointestinal es la fuente más común de tumores de células pequeñas extrapulmonares. Nuestro caso clínico describe un paciente con carcinoma de células pequeñas en la unión gastroesofágica, que fue diagnosticado en el contexto de sangrado de tubo digestivo alto. Se excluyó un tumor pulmonar primario; el paciente recibió quimioterapia, quimiorradioterapia y radioterapia cerebral profiláctica, con buena evolución clínica. Nuestro caso se trata de una rara afección clínica, lo que evidencia la importancia de diagnosticar enferemedades poco frecuentes. Existe poca evidencia en la bibliografía de cómo deben tratarse estos pacientes.

Abstract Extrapulmonary small cell carcinomas (EPSCC) can arise in multiple organ sites and form a rare clinicopathological entity of high proliferative epithelial neuroendocrine tumors with aggressive biological behavior. Gastrointestinal is the most common source of EPSCC. We report a case of gastroesophageal junction small cell carcinoma, which was diagnosed in the context of upper gastrointestinal bleeding. A primary small cell lung carcinoma was excluded. Chemotherapy, neoadjuvant chemoradiotherapy and prophylactic cranial radiotherapy were given, with good clinical outcome. Our case of a very rare condition highlights the importance of recognizing atypical pathologic diagnoses. More research needs to be conducted with EPSCC patients in order to better characterize disease pathogenesis, and an optimal disease management.

Rehabilitación oral integral en un niño con secuela de cirugía de linfangioma de piso de boca y lengua / Integral oral rehabilitation in a child with lymphangioma sequel surgery on floor of the mouth and tongue

Los linfangiomas son malformaciones del desarrollo caracterizadas por una proliferación benigna de los vasos linfáticos y representan hamartomas de los linfáticos malformados y tienen una marcada predilección por la región de la cabeza y el cuello. La localización más frecuente en la boca es el dorso de la lengua, seguido por los labios, la mucosa bucal, el paladar blando y el piso de la boca. Se presenta un caso clínico de una paciente con secuela de cirugías de linfangioma de piso de boca y lengua, con pérdida prematura de piezas dentarias y caries de aparición temprana, y su rehabilitación completa con restauraciones de resina, coronas de celuloide y mantenedores de espacio tipo prótesis parcial superior e inferior...

Lymphangiomas are developmental malformations wich are characterized by a benign proliferation of lymphatic vessels. They represent hamartomas of malformed lymphatics and have a strong predilection for the region of the head and neck. The most common location in the mouth is the dorsum of the tongue, followed by the lips, buccal mucosa, soft palate and fIoor of the mouth. The following case report is of a patient with lymphangioma sequel surgerie on fIoor of mouth and tongue, with premature loss of teeth and early childhood caries, and her complete rehabilitation with resin restorations, strip crowns, and removable space maintainers with artificial tooth...

[Leonine facies in carcinoid syndrome]. / Facies leonina en el síndrome carcinoide.

Carcinoid syndrome is a rare disorder caused when elevated levels of vasoactive substances secreted by a carcinoid tumor fail to be metabolized by the liver. This can occur for a variety of reasons including metastatic invasion of the organ. Carcinoid syndrome results in elevated levels of 5-hydroxyindoleacetic acid in the urine. Clinical manifestations include: flushing, diarrhea, bronchospasm, and heart failure. We describe a patient with carcinoid syndrome and hepatic metastases, in whom the key symptom of persistent facial edema resulted in conspicuous leonine facies; there was a partial response to treatment with oral isotretinoin and intramuscular lanreotide. Differential diagnosis was made with other conditions causing facial edema. A review is performed of the various skin manifestations of carcinoid syndrome, highlighting their role in the early diagnosis and treatment of the disorder.

Facies leonina en el síndrome carcinoide / Leonine Facies in Carcinoid Syndrome

El síndrome carcinoide es un proceso infrecuente que se produce por la presencia en el organismo de niveles elevados de sustancias vasoactivas secretadas por un tumor carcinoide y no metabolizadas por el hígado, debido a diversas circunstancias, entre ellas la invasión metastásica del mismo. Se traduce en una elevación del 5-hidroxi-indol-acético en orina. Clínicamente cursa con síntomas cutáneos (episodios de rubefacción-flushing), digestivos (diarrea), respiratorios (broncoespasmo) y cardiovasculares (insuficiencia cardiaca). Describimos el caso de un paciente con síndrome carcinoide con metástasis hepáticas cuyo síntoma guía fue el edema facial, que se hizo persistente otorgándole una facies leonina muy llamativa, que respondió parcialmente al tratamiento con isotretinoína por vía oral y lanreótida intramuscular. Realizamos diagnóstico diferencial con otros cuadros que cursan con edema facial y revisamos las diversas manifestaciones cutáneas que pueden surgir en el síndrome carcinoide, destacando su importancia para realizar un diagnóstico y tratamiento precoces del proceso (AU)

Carcinoid syndrome is a rare disorder caused when elevated levels of vasoactive substances secreted by a carcinoid tumor fail to be metabolized by the liver. This can occur for a variety of reasons including metastatic invasion of the organ. Carcinoid syndrome results in elevated levels of 5-hydroxyindoleacetic acid in the urine. Clinical manifestations include: flushing, diarrhea, bronchospasm, and heart failure. We describe a patient with carcinoid syndrome and hepatic metastases, in whom the key symptom of persistent facial edema resulted in conspicuous leonine facies; there was a partial response to treatment with oral isotretinoin and intramuscular lanreotide. Differential diagnosis was made with other conditions causing facial edema. A review is performed of the various skin manifestations of carcinoid syndrome, highlighting their role in the early diagnosis and treatment of the disorder (AU)

Primary cutaneous T-cell lymphoproliferative disorder of donor origin after allogeneic haematopoietic stem-cell transplantation.

A 56-year-old male patient had a history of mantle-cell lymphoma, which was treated with polychemotherapy and reduced-intensity conditioning allogeneic haematopoietic stem cell transplantation (ASCT) from his healthy sister with an identical human leucocyte antigen profile. Six years after transplantation, the patient developed asymptomatic eczema-like cutaneous lesions. Histologically the lesions contained a dense superficial lichenoid infiltrate, mainly consisting of CD4+ atypical medium to large lymphocytes showing indented hyperchromatic nuclei. In situ hybridization for Epstein-Barr virus was negative. PCR amplification of the T-cell receptor-gamma chain gene from several lesions revealed a monoclonal rearrangement without clonal variation. Two-colour fluorescence in situ hybridization (X and Y chromosomes) and microsatellite genotyping were used to compare samples from the patient (transplant recipient), his sister (donor) and the skin biopsy sample, which confirmed that the origin of the neoplastic cells was the donor graft. To our knowledge, this is the first case of post-transplant primary cutaneous T-cell lymphoproliferative disorder after ASCT.

[Antibiotic prophylaxis in dermatologic surgery]. / Profilaxis antibiótica en cirugía dermatológica.

This article discusses factors to take into consideration for the rational use of antibiotics to prevent postoperative infection in dermatologic surgery. The treatment of choice is described.

Profilaxis antibiótica en cirugía dermatológica / Antibiotic prophylaxis in dermatologic surgery

Se analizan los factores a considerar en el uso racional de los antibióticos en la cirugía dermatológica con el objeto de evitar la infección postoperatoria. Se describe el tratamiento de elección (AU)

This article discusses factors to take into consideration for the rational use of antibiotics to prevent postoperative infection in dermatologic surgery. The treatment of choice is described (AU)

[Evaluation of motor disorders in animal models of Parkinson's disease]. / Evaluación de alteraciones motoras en modelos animales de enfermedad de Parkinson.

INTRODUCTION: The diagnosis of Parkinson's disease is essentially clinical, that is to say, it is based on the observation of the motor alterations displayed by patients, and for this reason it is considered to be a simple matter. Yet, only 75% of the diagnoses that are carried out clinically are later confirmed in the autopsy. Animal models can be generated by systemic or intracerebral application of neurotoxins, like 6-hydroxydopamine (6-OHDA) for rats or 1-methyl-4-phenyl-1,2, 3,6-tetrahydropyridine (MPTP) for mice and non-human primates, which induce damage in the nigrostriatal dopaminergic system. This gives rise to a variety of motor symptoms such as akinesia, bradykinesia, rigidity, tremor, gait disorders and abnormal postures, which is what makes the evaluation of the changes in the signs of Parkinsonism in animal models such a challenge to researchers today. DEVELOPMENT: The paper reviews the variety of paradigms available for evaluating these symptoms in mouse, rat and non-human primate models, which have been used to measure the differences brought about by applying neurotoxins and, in some cases, the improvements produced by different treatments for the Parkinsonian syndromes that were induced. CONCLUSIONS: Both the general findings of these works and the factors that influence the trials are discussed, together with the potential problems and benefits that the experimental procedures may have.

Evaluación de alteraciones motoras en modelos animales de enfermedad de Parkinson / Evaluation of motor disorder in animal models of parkinson’s disease

El diagnóstico de la enfermedad de Parkinson es básicamente clínico, es decir, se basa en la observaciónde las alteraciones motoras de los pacientes, por este motivo se considera sencillo; sin embargo, sólo un 75% de los diagnósticos realizados clínicamente se confirma en la autopsia. Los modelos animales generados mediante la aplicación sistémica o intracerebral de neurotoxinas como 6-hidroxidopamina (6-OHDA) para ratas o 1-metil-4-fenil-1,2,3,6-tetrahidropiridina(MPTP) para ratones y primates no humanos, induce un daño en el sistema dopaminérgico nigroestriatal. Esto da como resultado una variedad de síntomas motores como acinesia, bradicinesia, rigidez, temblor, alteraciones en la marcha y posturas anormales; por este motivo es un reto evaluar los cambios de los signos parkinsonianos en los modelos animales.Desarrollo. Se revisa la variedad de paradigmas para valorar estos síntomas en los modelos de ratones, ratas y primates no humanos, los cuales se han utilizado para medir las diferencias que se generan con la aplicación de las neurotoxinas y, en algunos casos, las mejorías de los diferentes tratamientos para los síndromes parkinsonianos inducidos. Conclusiones. Se comentanlos resultados generales de estos trabajos y se discuten los factores que influyen en las pruebas, y los potenciales problemas y beneficios que pueden tener los procedimientos experimentales

The diagnosis of Parkinson’s disease is essentially clinical, that is to say, it is based on theobservation of the motor alterations displayed by patients, and for this reason it is considered to be a simple matter. Yet, only 75% of the diagnoses that are carried out clinically are later confirmed in the autopsy. Animal models can be generated bysystemic or intracerebral application of neurotoxins, like 6-hydroxydopamine (6-OHDA) for rats or 1-methyl-4-phenyl-1,2, 3,6-tetrahydropyridine (MPTP) for mice and non-human primates, which induce damage in the nigrostriatal dopaminergic system. This gives rise to a variety of motor symptoms such as akinesia, bradykinesia, rigidity, tremor, gait disorders andabnormal postures, which is what makes the evaluation of the changes in the signs of Parkinsonism in animal models such a challenge to researchers today. Development. The paper reviews the variety of paradigms available for evaluating these symptoms in mouse, rat and non-human primate models, which have been used to measure the differences brought about byapplying neurotoxins and, in some cases, the improvements produced by different treatments for the Parkinsonian syndromes that were induced. Conclusions. Both the general findings of these works and the factors that influence the trials are discussed, together with the potential problems and benefits that the experimental procedures may have

La búsqueda de creencias alimentarias a inicios del siglo XXI / In search of nutritional beliefs at the beginning of the century

En este estudio se identificaron creencias alimentarias, en usuarios de dos centros de salud de la Comuna Pedro Aguirre Cerda de la Región Metropolitana.Se demostró que algunas creencias han logrado ser transmitidas por la red primaria y secundaria, de tal manera que aún tienen vigencia en la población. En tanto, han surgido otras creencias relacionadas con los problemas actuales de salud (enfermedades crónicas no transmisibles), que contrastan con algunas existentes hace más de 50 años, relacionadas con problemas de salud prevalentes en esa época (enfermedades parasitarias). No es posible hacer generalizaciones dado las características de la muestra.

In this study we identified nutritional beliefs associated with health, the participants were two Health Departmnet of Pedro Aguirre Cedra located in the Metropolitan Area. It shows that some of them had been transmitted by the primary and secondary red, which at any rate still valid in the population, meanwhile others beliefs has been created related with actual problems of health (chronic sickness non transmissible), they contract with some in existence 50 years ago that related to health issues, more prevalent in that period( parasitic sickness).It is not possible to generalize, giving the characteristic of the sample.

Study of genetic expression of intrauterine growth factors IGF-I and EGFR in placental tissue from pregnancies with intrauterine growth retardation.

To investigate the possibility of altered gene expression of growth factors in prenatal growth retardation, we assessed expression of the genes for insulin-like growth factor-I (IGF-I) and epidermal growth factor receptor (EGFR) by RT-PCR from human placentas at term delivery in two groups: appropriate for gestational age (AGA) and pregnancies complicated with IUGR. The placentas from IUGR gestations showed reduced IGF-I expression with a significance of p = 0.008, whereas we did not find any significant differences in EGFR gene expression.

Intrauterine growth retardation: study of placental apoptosis.

We studied the rate of apoptosis in the placental tissue of pregnancies complicated with intrauterine growth retardation (IUGR) and compared it with the results obtained in normal placentas. Our results clearly demonstrate a strongly increased rate of apoptosis in placentas of children born with IUGR, suggesting severe placental dysfunction. The significance of these findings needs further study.

Validity of the Eating Attitudes Test: a study of Mexican eating disorders patients.

OBJECTIVE: To evaluate the psychometric properties of the Mexican version of the Eating Attitudes Test (EAT-40) in clinical and control populations in Mexico City. METHOD: 276 female patients with eating disorders [52 with anorexia nervosa (AN), 102 with bulimia nervosa (BN) and 122 with eating disorders not otherwise specified (EDNOS)] and a comparison group of 280 normal control female subjects completed the EAT. RESULTS: The EAT had an adequate level of internal consistency in the clinical sample (Cronbach's alpha=0.90). Total score was significantly correlated with criterion group membership (r=0.77, p< or =0.0001), suggesting a high level of concurrent validity. There was a small overlap in the frequency distribution of the 2 groups (eating disorders and control) and only 6% of the normal controls scored as high as lowest anorexic and bulimic patients. The factorial analysis yielded five factors accounting for 46.6% of total variance: 1) Dietary restraint, 2) Bulimia, 3) Drive of thinness, 4) Food preoccupation and 5) Perceived social pressure. CONCLUSIONS: This study provides evidence that the Mexican version of the EAT is an economical, reliable and potentially useful instrument for research in this field.