"Mi Familia Quiere Que Regrese": Retired Latiné Immigrants' Families' Expectations to Return to Their Country of Origin.

We conducted a quantitative, interdisciplinary study that investigated how financial concerns and varying family connections influence the retirement choices of Latiné immigrants in terms of returning to their country of origin. We hypothesized that being worried about one's finances for retirement, and having strong transnational ties, would lead to familial expectations to return to one's country of origin. Through data collected from a survey through Qualtrics, we found that higher levels of financial worry significantly affected greater familial expectations to return to their country of origin. The transnational ties that influenced the families' expectations to return to their country of origin was having children, friends, and family not residing in the U.S. Following our findings, we discuss potential future directions and implications relating to transnational ties, remittances, and older Latiné immigrants.

Effects of Supplemental Oxygen on Cardiovascular and Respiratory Interactions by Extended Partial Directed Coherence in Idiopathic Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a chronic and restrictive disease characterized by fibrosis and inflammatory changes in lung tissue producing a reduction in diffusion capacity and leading to exertional chronic arterial hypoxemia and dyspnea. Furthermore, clinically, supplemental oxygen (SupplO2) has been prescribed to IPF patients to improve symptoms. However, the evidence about the benefits or disadvantages of oxygen supplementation is not conclusive. In addition, the impact of SupplO2 on the autonomic nervous system (ANS) regulation in respiratory diseases needs to be evaluated. In this study the interactions between cardiovascular and respiratory systems in IPF patients, during ambient air (AA) and SupplO2 breathing, are compared to those from a matched healthy group. Interactions were estimated by time series of successive beat-to-beat intervals (BBI), respiratory amplitude (RESP) at BBI onset, arterial systolic (SYS) and diastolic (DIA) blood pressures. The paper explores the Granger causality (GC) between systems in the frequency domain by the extended partial directed coherence (ePDC), considering instantaneous effects. Also, traditional linear and nonlinear markers as power in low (LF) and high frequency (HF) bands, symbolic dynamic indices as well as arterial baroreflex, were calculated. The results showed that for IPF during AA phase: 1) mean BBI and power of BBI-HF band, as well as mean respiratory frequency were significantly lower (p < 0.05) and higher (p < 0.001), respectively, indicating a strong sympathetic influence, and 2) the RESP → SYS interaction was characterized by Mayer waves and diminished RESP → BBI, i.e., decreased respiratory sinus arrhythmia. In contrast, during short-term SupplO2 phase: 1) oxygen might produce a negative influence on the systolic blood pressure variability, 2) the arterial baroreflex reduced significantly (p < 0.01) and 3) reduction of RSA reflected by RESP → BBI with simultaneous increase of Traube-Hering waves in RESP → SYS (p < 0.001), reflected increased sympathetic modulation to the vessels. The results gathered in this study may be helpful in the management of the administration of SupplO2.

[Overview of the interstitial lung disease in the Southeast of Mexico]. / Panorama de la enfermedad pulmonar intersticial en el sureste de México.

Background: Interstitial lung disease (ILD) corresponds to a heterogeneous group of pathologies that differ in etiology with common clinical and radiological manifestations. In Latin America and Mexico, reports are scarce and the need for studies to understand the scenario is emphasized. Objective: To analyze a multidimensional profile in patients with interstitial lung disease in Yucatan. Method: This is an observational, prospective, analytic, descriptive study including consecutive patients diagnosed with ILD over a 4-year period. Demographic and clinical data, lung function tests, chest imaging, serum immunological profile, and echocardiographic findings were recorded. Differences between subgroups were analyzed performing a one-way analysis of variance (ANOVA). Results: 110 patients were included. The median age was 60 years and women were most affected. The main cause of ILD was related with connective tissue diseases (CTD). A group subanalysis revealed that Idiopathic pulmonary fibrosis (IPF) was common in males with a history of smoking and an imaging pattern of usual interstitial pneumonia. Lung function tests showed a moderate-to-severe pulmonary restriction (FVC 55%p) and mild hypoxemia (PaO2 79mmHg). Positive antinuclear antibodies are less likely in cases with IPF (20 vs. 65%; p = 0.006). Conclusion: In Southeastern Mexico, ILD occurs in women in their seventh decade of life; the most common cause is related with CTD. Our results support that ILD has a heterogeneous expression and is relevant the need for subsequent studies characterizing each ILD.

Introducción: La enfermedad pulmonar intersticial (EPI) corresponde a un grupo heterogéneo de patologías que difieren en su etiología pero tienen manifestaciones clínicas y radiológicas comunes. En Latinoamérica y México los reportes son escasos, enfatizando la necesidad de estudios que permitan conocer su escenario clínico-epidemiológico. Objetivo: Realizar un análisis multidimensional y contrastado de la EPI en la población de la Península de Yucatán. Método: Estudio observacional, prospectivo, analítico y descriptivo, que incluye la totalidad de pacientes diagnosticados de EPI en un período de 4 años. Se registraron datos demográficos y clínicos, pruebas de función pulmonar, imagenología del tórax, perfil inmunológico y ecocardiografía transtorácica. Se analizaron las diferencias según la etiología mediante análisis de la varianza de una sola vía (ANOVA). Resultados: Se incluyeron 110 pacientes con una mediana de edad de 60 años y predominio del sexo femenino. La causa principal de la EPI fue relacionada con enfermedad del tejido conectivo. El subanálisis de grupos mostró que la fibrosis pulmonar idiopática (FPI) es frecuente en los varones con antecedente de tabaquismo y patrón tomográfico de neumonía intersticial usual. Las pruebas de función pulmonar demostraron restricción pulmonar moderadamente grave (FVC 55%p) e hipoxemia leve (PaO2 79 mmHg). La positividad de anticuerpos antinucleares ocurre en menor proporción en la FPI (20 vs. 65%, p = 0.006). Conclusiones: En el sureste de México, la EPI ocurre en mujeres de la séptima década de la vida y se relaciona con enfermedad del tejido conectivo. Nuestros resultados respaldan que la EPI tiene expresión heterogénea y se requieren estudios subsecuentes sobre cada tipo de enfermedad.

Hemodynamic response to low-flow acute supplemental oxygen in idiopathic pulmonary fibrosis and elderly healthy subjects.

BACKGROUND: Hemodynamic response to supplemental oxygen in idiopathic pulmonary fibrosis (IPF) is still not well known. OBJECTIVE: To determine and compare the effect of low-flow acute supplemental oxygen on the hemodynamics of IPF patients and matched healthy subjects. METHODS: Descriptive and comparative study in 20 IPF-patients and 19 Control-subjects, (60-80 years old) breathing ambient air followed by acute nasal low-flow (3 L/min) supplemental oxygen. Non-invasive methods were used during the supine position to evaluate oxygen saturation, heart rate, stroke volume index, cardiac output index, total peripheral resistance and arterial blood pressure. RESULTS: Breathing ambient air, IPF (vs. Control) presented lower values in stroke volume index (38.7 [29.4-43.2] vs. 45.4 [38.4-50.9] mL•kg-1•m2; p=0.009) and cardiac output index (2.484 [2.268 - 2.946] vs. 2.857 [2.628 - 3.054] L•min-1•m-2; p=0.028), with higher total peripheral resistance (1644 [1559-2076] vs. 1505 [1366-1784] dyne•s•cm-5; p=0.017). During supplemental oxygen (vs. ambient air), both groups increased oxygen saturation above 94% (p<0.001) while heart rate decreased about 6 to 8% (p<0.001); stroke volume index increased around 7% in the Control-group (p=0.004) but only 1% in the IPF-group (p=0.017). In addition, IPF showed increments in total peripheral resistance (1644 [1559-2076] vs. 1706 [1554-2278] dyne•s•cm-5; p=0.017) with subsequent decrements in cardiac output index (2.484 [2.268 - 2.946] vs. 2.362 [2.139 - 2.664] L•min-1•m-2; p<0.001). CONCLUSION: Low-flow acute supplemental oxygen in IPF causes a meaningful decrement in cardiac output due to greater reduction in heart rate and increment in total peripheral resistance than matched healthy subjects. Knowing the hemodynamic profile of IPF patients may be helpful in determining their management with supplemental oxygen.

An Open-label Study With Pirfenidone on Chronic Hypersensitivity Pneumonitis / Estudio abierto con pirfenidona en neumonitis por hipersensibilidad crónica

BACKGROUND: Chronic hypersensitivity pneumonitis (cHP) represents a severe lung disease often evolving to fibrosis with the subsequent destruction of the lung parenchyma. There are no approved therapies with confirmed efficacy to deal with this disease. METHODS: We performed an open-label, proof of concept study, to evaluate the efficacy and safety of pirfenidone added to immunosuppressive drugs on the treatment of cHP. We included 22 patients assigned to two groups: Group 1, nine patients that received prednisone plus azathioprine and Group 2, thirteen patients, received prednisone plus azathioprine and pirfenidone (ClinicalTrials.gov identifier NCT02496182). There were no significant imbalances in clinically relevant baseline characteristics between two study groups. RESULTS: After 1 year of treatment, inclusion of pirfenidone was not associated with improved forced vital capacity (primary end-point). A not significant tendency to show higher improvement of diffusion capacity of the lung for carbon monoxide (DLCO) was observed in the group receiving pirfenidone (p = 0.06). Likewise, a significant improvement in the total score on the SGRQ was found in the group 2 (p = 0.02) without differences in other two questionnaires related to quality of life (ATAQ-IPF and EQ-5D-3L). HRCT showed a decrease of the ground glass attenuation without changes in the fibrotic lesions and without differences between both groups. CONCLUSIONS: These findings suggest that the addition of pirfenidone to the anti-inflammatory treatment in patients with chronic HP may improve the outcome with acceptable safety profile. However, prospective randomized double-blind, placebo-controlled trials in largest cohorts are needed to validate its efficacy

ANTECEDENTES: La neumonitis por hipersensibilidad crónica es una enfermedad pulmonar grave que con frecuencia evoluciona hacia fibrosis, con la ulterior destrucción del parénquima pulmonar. No existen tratamientos aprobados con eficacia confirmada para el manejo de esta enfermedad. MÉTODOS: Llevamos a cabo un estudio preliminar de eficacia, abierto, para evaluar la eficacia y la seguridad de la pirfenidona sumada a los fármacos inmunosupresores en el tratamiento de la neumonitis por hipersensibilidad crónica. Se incluyeron 22 pacientes, que se asignaron a dos grupos: grupo 1, 9 pacientes que recibieron prednisona y azatioprina; y grupo 2, 13 pacientes que recibieron prednisona, azatioprina y pirfenidona (identificador NCT02496182 en ClinicalTrials.gov). No se observaron alteraciones significativas en las características clínicamente relevantes iniciales entre ambos grupos. RESULTADOS: Tras un año de tratamiento, la inclusión de la pirfenidona no se asoció con una mejora de la capacidad vital forzada (objetivo principal). Se observó una tendencia no significativa a mostrar una mayor mejora en la capacidad de difusión de monóxido de carbono (DLCO) por el pulmón en el grupo que recibió pirfenidona (p = 0,06). Asimismo, se encontró una mejora significativa en la puntuación total del cuestionario SGRQ en el grupo 2 (p = 0,02) sin encontrarse diferencias en los otros dos cuestionarios relacionados con la calidad de vida de los pacientes (ATAQ-IPF y EQ-5D-3L). La TAC de alta resolución mostró una disminución de la atenuación en «vidrio deslustrado», sin cambios en las fibrosis y sin diferencias entre ambos grupos. CONCLUSIONES: Estos hallazgos sugieren que añadir pirfenidona al tratamiento antiinflamatorio en pacientes con neumonitis por hipersensibilidad crónica podría mejorar el pronóstico con un perfil de seguridad aceptable. Sin embargo, se necesitan ensayos prospectivos aleatorizados doble ciego y controlados con placebo para validar esta eficacia

An Open-label Study With Pirfenidone on Chronic Hypersensitivity Pneumonitis.

BACKGROUND: Chronic hypersensitivity pneumonitis (cHP) represents a severe lung disease often evolving to fibrosis with the subsequent destruction of the lung parenchyma. There are no approved therapies with confirmed efficacy to deal with this disease. METHODS: We performed an open-label, proof of concept study, to evaluate the efficacy and safety of pirfenidone added to immunosuppressive drugs on the treatment of cHP. We included 22 patients assigned to two groups: Group 1, nine patients that received prednisone plus azathioprine and Group 2, thirteen patients, received prednisone plus azathioprine and pirfenidone (ClinicalTrials.gov identifier NCT02496182). There were no significant imbalances in clinically relevant baseline characteristics between two study groups. RESULTS: After 1 year of treatment, inclusion of pirfenidone was not associated with improved forced vital capacity (primary end-point). A not significant tendency to show higher improvement of diffusion capacity of the lung for carbon monoxide (DLCO) was observed in the group receiving pirfenidone (p=0.06). Likewise, a significant improvement in the total score on the SGRQ was found in the group 2 (p=0.02) without differences in other two questionnaires related to quality of life (ATAQ-IPF and EQ-5D-3L). HRCT showed a decrease of the ground glass attenuation without changes in the fibrotic lesions and without differences between both groups. CONCLUSIONS: These findings suggest that the addition of pirfenidone to the anti-inflammatory treatment in patients with chronic HP may improve the outcome with acceptable safety profile. However, prospective randomized double-blind, placebo-controlled trials in largest cohorts are needed to validate its efficacy.

Estándares de protección del Derecho Humano a la salud en la Corte Interamericana de Derechos Humanos / Standards of Protection of the Human Right to Health in the Inter-American Court of Human Rights

Resumen El derecho a la salud ha sido objeto de análisis por parte de la Corte Interamericana de Derechos Humanos, a través de los casos contenciosos donde ha interpretado su contenido y alcance, emitiendo diferentes estándares de protección por medio de una conexión e interrelación entre los derechos humanos a la vida en condiciones de dignidad e integridad personal contenidos en la Convención Americana sobre Derechos Humanos, así mismo ha identificado diferentes espacios convencionales derivados de las obligaciones internacionales de los Estados Partes, como la posición de garante del Estado ante los grupos vulnerables, los derechos sexuales y reproductivos y la salud mental.

Abstract The right to health has been the subject of analysis by the Inter-American Court of Human rights, through the contentious cases where it has interpreted its content and scope, by emitting different standards of protection, by means of a connection and interrelation of human rights to life in conditions of dignity, and personal integrity, which are contained in the American Convention on Human Rights. Similarly, it has also identified different conventional spaces derived from international obligations from States parties, as the guarantor of the State before the vulnerable groups, sexual and reproductive rights, and mental health.

A Smartphone-Based System for Automated Bedside Detection of Crackle Sounds in Diffuse Interstitial Pneumonia Patients.

In this work, we present a mobile health system for the automated detection of crackle sounds comprised by an acoustical sensor, a smartphone device, and a mobile application (app) implemented in Android. Although pulmonary auscultation with traditional stethoscopes had been used for decades, it has limitations for detecting discontinuous adventitious respiratory sounds (crackles) that commonly occur in respiratory diseases. The proposed app allows the physician to record, store, reproduce, and analyze respiratory sounds directly on the smartphone. Furthermore, the algorithm for crackle detection was based on a time-varying autoregressive modeling. The performance of the automated detector was analyzed using: (1) synthetic fine and coarse crackle sounds randomly inserted to the basal respiratory sounds acquired from healthy subjects with different signal to noise ratios, and (2) real bedside acquired respiratory sounds from patients with interstitial diffuse pneumonia. In simulated scenarios, for fine crackles, an accuracy ranging from 84.86% to 89.16%, a sensitivity ranging from 93.45% to 97.65%, and a specificity ranging from 99.82% to 99.84% were found. The detection of coarse crackles was found to be a more challenging task in the simulated scenarios. In the case of real data, the results show the feasibility of using the developed mobile health system in clinical no controlled environment to help the expert in evaluating the pulmonary state of a subject.

A multichannel acoustic approach to define a pulmonary pathology as combined pulmonary fibrosis and emphysema syndrome.

Interstitial lung diseases (ILDs) have been increasing their relevance in loss of lives according to a recent world wide medical information. Idiopathic pulmonary fibrosis (IPF) and combined pulmonary fibrosis and emphysema syndrome (CPFES) belong to ILD class with the latter having a limited survival prognosis. In clinical environment high resolution computed tomography (HRCT) is used to detect CPFE; however, there is still controversy about the amount of emphysema observed in HRCT to declare CPFES. Consequently, to help in the diagnosis of CPFES to develop an alternative technique seems to be attractive. In this study, we propose a multichannel acoustic approach to discriminate between IPF and CPFES parameterizing the multichannel lung sounds information linearly and classifying it by neural networks (NN). The NN performance using different features provided values above 90% in the validation phase. Furthermore, to test the trained NN, the proposed approach was applied on new data from five patients 3 diagnosed by experts as CPFES and 2 with IPF. The univariate autoregressive model obtained the best classification followed by the feature vector formed by the percentile frequencies augmented by the total power of the acoustic information. Results indicate that multichannel acoustic analysis is promising to discern between these two ILDs.

Small airway dysfunction in chronic hypersensitivity pneumonitis.

BACKGROUND AND OBJECTIVE: Lung biopsies from patients with hypersensitivity pneumonitis (HP) have demonstrated small airway (SA) involvement, but there is no information concerning SA function in HP, and it is unknown whether pharmacological treatment could modify its function. SA function in patients with chronic HP using ultrasonic pneumography (UPG) and impulse oscillometry (IOS) was explored. We also compared initial results with those obtained after 4 weeks of standardized treatment with azathioprine and prednisone. METHODS: The study group consisted of adults with recent diagnoses of HP. All patients completed UPG, IOS, spirometry, body plethysmography, single-breath carbon monoxide diffusing capacity (DLCO ) and the 6-min walk test (6MWT). The fraction of exhaled nitric oxide (FENO ) was obtained to assess eosinophilic airway inflammation. Measurements were taken at diagnosis and after 4 weeks of treatment. RESULTS: A total of 20 consecutive patients (16 women) with chronic HP participated in the study. Median age was 50 years (interquartile range (IQR): 42-54). At diagnosis, the UPG phase 3 slope was abnormally high, consistent with maldistribution of ventilation. For IOS, all patients had low reactance at 5 Hz (X5) and elevated reactance area (AX) reflecting low compliance, and only eight (40%) patients had elevated R5 (resistance at 5 Hz (total)) and R5-20 (resistance at 5 Hz-resistance at 20 Hz (peripheral)) attributed to SA resistance. In contrast, FENO parameters were within normal limits. After treatment, forced vital capacity (FVC), the 6-min walk distance and the distribution of ventilation showed significant improvement, although DLCO did not. CONCLUSION: Patients with chronic HP have SA abnormalities that are partially revealed by the UPG and IOS tests. Lung volumes, but not gas exchange, improved after treatment with azathioprine and prednisone.

Seguridad del paciente en cuatro Empresas Sociales delEstado de segundo nivel del Departamento de Córdoba / Patient safety in four health institutions on the second-level of complexity from the State of Córdoba

Determinar el nivel de implementación de la política de seguridad del paciente eidentificar en la plataforma estratégica su articulación con la política institucional, encuatro instituciones de salud de segundo nivel de complejidad.MetodologíaEstudio de tipo descriptivo, cuantitativo, transversal, cuya información se recolectómediante la aplicación de lista de chequeo a los líderes de calidad y seguridad del pacientey la realización de una encuesta en línea, en las cuatro instituciones objeto de estudio.ResultadosTodas las instituciones cuentan con la política formalmente documentada y disponendel comité de seguridad del paciente, tienen definidas las funciones y los responsables,a quienes se han comunicado las responsabilidades asignadas de acuerdo con su perfil;tres instituciones disponen del referente de seguridad, realizan reuniones periódicas delcomité y hacen reporte de eventos adversos a través del aplicativo sugerido por la OPS yadoptado por el Ministerio de Salud; sólo dos instituciones cumplen con los lineamientosexigidos por la normatividad, han realizado capacitaciones y entrenamiento al personal.RecomendaciónEs necesario tener una política de seguridad del paciente formalmente documentadade acuerdo con los lineamientos exigidos por la normatividad, que permita mejorar ymantener la seguridad en el tiempo...

To determine the level of implementation of the patient safety policy and identify on thestrategic platform its articulation with the institutional policy in four health institutions onthe second level of complexity.MethodologyDescriptive study, quantitative, cross-sectional. Information was collected by applying achecklist to the leaders of quality and patient safety along with an online survey in the fourinstitutions subject to study.ResultsAll the institutions have the policy formally documented and also have the patient safetycommittee. Functions and responsible parties have been assigned and informed about theirduties according to their profiles. Three institutions count on the safety referent, conductregular committee meetings and report adverse events through the application suggestedby WHO and adopted by the Ministry of Health. Only two institutions meet the guidelinesrequired by the regulations, and have provided staff training.RecommendationIt is necessary to have a patient safety policy formally documented according to theguidelines required by the regulations that allows to improve and maintain safety in time...

Sarcoidosis: a single hospital-based study in a 24-year period.

BACKGROUND: Clinical presentation of sarcoidosis varies according to race and geographical area. We describe the clinical spectrum and outcome of sarcoidosis in Mexican patients compared with other populations. METHODS: We reviewed the medical charts of 21 patients with sarcoidosis seen at a referral hospital in 1989-2012; organ involvement was assessed using the ACCESS instrument. We compared our results with the ACCESS and Latin American studies. We used descriptive statistics and reported odd ratios with 95% CI. RESULTS AND CONCLUSION: Fifty-two percent were women; median age was 31 years; median time to diagnosis, 5.5 months. Frequency of organ involvement was: constitutional symptoms 62%, lungs 66.6%, skin 42.8%, bone marrow 23.4%, lymph node 19%, liver 19%, and eye 19%. After one year of follow-up, 47.5% of patients were asymptomatic without treatment, 38% asymptomatic on treatment, and 14.2% symptomatic on treatment. In our patients, pulmonary involvement was lower (66.6 vs. 94.9%; p = 0.001) and cutaneous (42.8 vs. 15.8%; p = 0.003) and bone marrow (23.4 vs. 4.7%; p = 0.001) were higher than in the ACCESS cohort. Data regarding Latin American populations was scarce. The clinical spectrum of sarcoidosis in our population differed from other studies, with a higher frequency of cutaneous sarcoidosis and less pulmonary involvement.

Expresión de moléculas de adhesión y subpoblaciones linfocitarias en lesiones de pacientes con Estomatitis Aftosa Recurrente

Introducción: La Estomatitis Aftosa Recurrente (EAR) es una condición muy común, caracterizada por la recurrencia de úlceras en la mucosa bucal no queratinizada. Actualmente las investigaciones dirigidas a determinar la etiología de la EAR, se enfocan hacia el componente inmunológico, la evidencia más relevante indica que los individuos afectados, presentan alteración de la respuesta inmunológica mediada por células. Adicionalmente, existe atención en destacar la importancia y participación de las moléculas de adhesión en el reclutamiento del infiltrado inflamatorio en esta condición. Objetivo: Determinar la expresión de las moléculas de adhesión ICAM-1, VCAM-1 y las subpoblaciones de linfocitos T CD4+ y CD8+, en lesiones de pacientes con EAR. Material y Método: Se incluyeron 19 pacientes de los cuales 15 presentaban EAR Menor y 4 tenían EAR Mayor. El grupo control incluyó muestras de encía de 10 pacientes sin historia de EAR. A los pacientes les fue realizada una biopsia de la lesión que fue procesada por inmunohistoquímica. Resultados y Conclusión: Se observó un marcado aumento en las subpoblaciones de linfocitos, especialmente de los CD8+, lo que sugiere la implicación de los linfocitos T, y de una respuesta inmune mediada por células activadas, en la patogénesis de esta entidad. La expresión de las moléculas de adhesión de los pacientes con EAR, fue mayor en comparación con el grupo control, siendo estas diferencias estadísticamente significativas. Con respecto a ICAM-1, se observó un fuerte marcaje en el corion-infiltrado seguido del corion-endotelio y epitelio, mientras que en relación a VCAM-1 fue similar en corion-infiltrado y corion-epitelio. Estos resultados implicarían a las moléculas de adhesión jugando un papel importante en las interacciones celulares y en el reclutamiento del infiltrado celular inflamatorio, pudiéndose convertir en blanco para el daño citotóxico y contribuyendo de esta forma, a la ruptura del tejido que ocurre en los sitios de ulceración.

Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease characterized by aphthous ulcerations in the oral mucosal. Actually the investigations have been directed to determine the etiology of the RAS with special attention to the cellular immune response. Aditionally, is very important to determine the rol of the adhesion molecules in this condition. The purpose of this work was to determine the of the adhesion molecules expression, ICAm-1, VCAM-1, CD4 and CD8 cell count in patients with RAS. We evaluated 19 patients, 15 with RAS minor and 4 with major RAS. The control group included oral health tissue of subjects without RAS. We observed a higher level of CD8 cell count that suggest the implication of T cells and cellular immune response in the pathogenesis of this entity. The adhesion molecules expression was higher than in the control group. These results suggest that the adhesion molecules may play an important role in the cell interactions that we observed in this entity.

Evaluación de oncógenes y moléculas de proliferación celular: en carcinoma escamoso de cavidad oral / Oncogenes and moleculas the evaluation of proliferative cells: in squamous carcinoma of oral cavity

El cáncer de la cavidad oral comprende el 30 por ciento de los cánceres de cabeza y cuello, de los cuales el 95 por ciento son carcinoma escamoso. Se han descrito numerosos factores de riesgo y en los últimos años han surgido una serie de moléculas de proliferación celular y de oncógenes en los cuales su expresión podría estar aumentada en los pacientes con cáncer escamoso de la cavidad oral. El objetivo de esta investigación es evaluar los marcadores de proliferación celular Ki-67 y PCNA y los oncógenes p53, p21 y c-erbB2, en pacientes con carcinoma escamoso localizado en la cavidad oral y correlacionarlo con los factores clínicos y patológicos en el grupo evaluado. A las biopsias de 52 pacientes con carcinoma escamoso de cavidad oral, vistos en el Hospital Oncológico “Padre Machado” entre 1995 y 1999, se les evaluó, con técnicas de inmunohistoquímica, las moléculas de proliferación celular PCNA y Ki-67 y los oncógenes p53, p21 y c-erbB2. La proporción de resultados positivos en inmunohistoquímica fue el siguiente: PCNA 90,4 por ciento, p21 63,5 por ciento, Ki-67 53,8 por ciento, p53 48,1 por ciento y el c-erbB2 con 3,8 por ciento. La permeación vascular y el grado de diferenciación fue significativo en este estudio en correlación con la presencia de p53, p21, c-erbB2, PCNA y Ki-67. El PCNA y p21, fueron los biomarcadores encontrados más frecuentemente. La permeación vascular, el grado histológico tienen relación estadísticamente significativa con todos los biomarcadores en estudio.

The oral cavity cancer account for 30 % of all of head and neck cancers, among which 95 % are squamous cell type carcinoma. There are described many risk factors involved, and in the last few years there is been a wide a series development of cell proliferation molecules and oncogenes, in which can be over expressed in the patients with squamous cell cancer of the oral cavity. The objective of this investigation is to evaluate the proliferation cells marker Ki-67 and PCNA and the p53, p21 oncogenes and the c-erbB2 in patients with squamous cell carcinoma, localized in oral cavity and his correlation with clinical and pathological factors in the evaluated group. To the biopsies of 52 patients with squamous cell carcinoma of oral cavity seen in the Oncology Hospital “Padre Machado” between 1995 and 1999 there were evaluated with immunohistochemestry techniques to determine Ki-67 and PCNA cell-proliferation markers and p53, p21, c-erbB2 oncogenes. The proportion of positive results found were: In the immunohistochemestry: 90.4 % PCNA, 63.5 % p21, 53.8 % Ki-67, 48.1 % p53 and 3.8 % in c-erbB2. In our study, the vascular permeability and the differentiation degree were significant in this study with the correlation of the presence of the p53, p21, c-erbB2, PCNA and Ki-67. The PCNA and p21 were the most common found biomarkers. The vascular permeability and the histological grade show a significant statistic relation with all study biomarkers.

Evaluación de las moléculas de fibrinógeno, del complemento C3, C4, C1q, y anticuerpos IgG, IgM e IgA por inmunofluorescencia directa, en pacientes con liquen plano bucal / Molecule fibrinogen evaluation of C3 C4 C10 complement and IGG IGM and IGA antibodies by direct inmunofluorescence in oral planus patient

El Liquen Plano (LPB) es una enfermedad crónica mucocutánea que frecuentemente involucra la mucosa bucal. El objetivo del presente estudio fue la evaluación de las Moléculas de Fibrinógeno, del Complemento C3, C4, C1q,  y Anticuerpos IgG, IgM e IgA  por Inmunofluorescencia directa, en pacientes con Liquen Plano Bucal En el presente estudio se evaluaron las muestras de lesiones de LPB de 20 pacientes y 10 muestras de mucosa sana de pacientes sin LPB que constituyeron el grupo control. Se aplicó como método de evaluación la inmunofluorescencia directa con anticuerpos policlonales fluoresceinados para  fibrinógeno, C1q, C3, C4, IgM , IgG e IgA. (Dako Corporation, Conpenhagen, Denmark). Los resultados demostraron que todas las muestras fueron positivas para fibrinógeno en los pacientes con Liquen Plano Bucal. La Evaluación de las moléculas del complemento C3, C4, C1q y de los anticuerpos IgM, IgG e IgA, demostraron  que al evaluar la presencia de inmunoglobulinas 16/20 (80 por ciento) de las muestras resultaron positivas para IgG. En relación a la presencia de anticuerpos de la clase IgM e IgA;  12/20 muestras  (60 por ciento) resultaron positivas para IgM solamente 1/20 muestras  (5 por ciento) resultó positiva para IgA. Referente a las moléculas de complemento 14/20 muestras (70 por ciento) resultaron positivas para las proteínas del complemento C3, y 8/20 (37.5 por ciento), para la presencia de C1q,  mientras que 4/20 (20 por ciento) muestras resultaron positivas para C4. A partir de nuestros resultados se podría inferir que la inmunoexpresión de complemento puede deberse a la presencia de un antígeno exógeno que desencadenaría la respuesta inmunológica en las lesiones de Liquen Plano Bucal

Lichen planus is a chronic inflammatory mucocutaneous disease that frequently involves the oral mucosa. The aim of this study was the evaluation of fibrinogen, C1q, C3, C4, IgG, IgM, IgA  by direct immunofluorescense in patients with oral lichen planus (OLP). We evaluated 20 patients with OLP and 10 patients withouth lesions. We used direct immunofluorescense with policlonals antibodies to fibrinogen, C1q C3, C4, IgM , IgG e IgA. (Dako Corporation, Conpenhagen, Denmark) Conpenhagen, Our results demonstrated that all the samples were positive for fibrinogen. Aditionally 16/20 (80 percent) of the patients were positive for IgG, 12/20 (60 percent) for IgM and only one patient was positive for IgA. Regarding complement, 14/20 samples (70 percent) were positives for C3, 8/20 (37.5 percent), for C1q, while 4/20 (20 percent) demonstrated positivity for C4. We may suggest that the  complement immunoexpresion could be posible for the presence of  an exogen antigen that stimulate the immune response in lesions of OLP

Determinación genómica de virus de epstein-barr: en tumores del tracto aerodigestivo superior / The genomic determination of ebstein-barr virus: in aerodigestive superior tract tumors

El virus de Epstein-Barr se encuentra en relación directa con algunas neoplasias como los linfomas y el carcinoma indiferenciado de nasofaringe. Más recientemente se han reportado la presencia del genoma viral en tumores similares a linfoepiteliomas de otras localizaciones como estómago, hígado, mama y pulmón. Fueron tomadas muestras en fresco de pacientes con tumores localizados en tracto aerodigestivo superior entre enero y junio de 2006. Se determinó el genoma viral. Dieciocho de 41 muestras eran positivas para virus, 23 negativas. Trece de los tumores malignos resultaron positivos para el genoma del virus mientras que el 48,1 por ciento restante resultaron negativos. La presencia del genoma viral fue encontrada en 8 muestras de laringe, 4 de nasofaringe, 2 de senos piriformes y en 1 de cada una de los siguientes sitios: fosas nasales, mucosa yugal, amígdala, y antro maxilar. A pesar del número limitado de muestras tomadas en algunas de las localizaciones mencionadas en este trabajo, pudimos encontrar el genoma viral en sitios como laringe, fosas nasales y cavidad oral. La mayor parte de los tumores malignos eran carcinomas escamosos, sólo 2 muestras correspondían a linfoepiteliomas. El genoma del virus puede ser identificado en muestras tomadas en fresco de tumores del tracto aerodigestivo superior tales como en carcinomas escamosos de laringe, fosas nasales, cavidad oral y faringe. Es necesario realizar más estudios para poder identificar la posible relación que existe entre este virus y dichos tumores.

The Epstein-Barr virus is been related with many malignancies as lymphoma and nasopharyngeal undifferentiated carcinoma. More recently, the presence of viral genome had been reported in some similar tumors how the lymphoepithelioma in other localizations for example the stomach, the liver, the breast and lung. From January to June 2006, we had taken fresh from the patient’s superior aero digestive tumors samples. The Epstein-Barr viral genome was determined by the Polymerasa Chain Reaction. From 41 samples of tumors, 18 were viruses positive and 23 of them were viruses negative. Thirteen malignant tumors were positive for the viruses genome and the rest ant other 48.1 % were negative. In eight larynxes, 4 nasopharyngeal, 2 piriform sinuses and some of this localization: nasal cavity, oral yugal mucosa, tonsil and maxillary sinus, and samples the viral genome of Epstein Barr was present. Although, we had a limited number of sample in some regions mentioned in these work, we could determine the viral genome of Epstein Barr in some sites how larynx, nasal and oral cavity. The majority of malignant tumors were squamous cell carcinoma, only two of them were correspondent to lymphoepithelioma. The Epstein-Barr viral genome may be identified in fresh superior aero digestive tumors samples, like in squamous cell carcinoma of the larynx, the oral cavity, nasal cavity and in the pharynx. Further studies are necessary to identify the probability relation between this virus and these tumors.

La placa dental como reservorio de Helicobacter pylori / Dental plaques as Helicobacter pylori reservoirs

Resumen La placa dental ha sido propuesta como un reservorio para Helicobacter pylori, sugiriéndose que el microambiente oral pueda ser un nicho permanente para la bacteria. El objetivo de este estudio fue determinar el papel que juega la placa dental como reservorio de esta especie, evaluando la presencia de ADN de H. pylori en la placa dental y biopsias gástricas, mediante la reacción en cadena de la polimerasa (PCR por sus siglas en inglés). Fueron evaluados 71 pacientes sintomáticos gastrointestinales referidos para examen endoscópico, provenientes del Servicio de Gastroenterología del Hospital Universitario de Caracas, Venezuela y 40 sujetos asintomáticos. Las muestras de placa dental fueron analizadas por PCR, basada en la secuencia del gen ure c. Se tomaron biopsias gástricas para análisis histopatológico y PCR. H. pylori. fue detectado en las biopsias gástricas de 48(68%) de los 71 pacientes, todos con gastritis crónica y en placa dental de 13(18%) de los 71 sujetos. En 8 (17%) de estos 48 pacientes, H. pylori fué también detectado en placa dental. De estos pacientes 4 presentaban adicionalmente displasia y 4 metaplasia. Tres pacientes del grupo control fueron positivos por PCR para H. pylori en placa dental. La placa dental puede ser un reservorio para la bacteria, y su presencia podría representar un factor de riesgo para la reinfección gastrointestinal, posterior al tratamiento de erradicación de la bacteria.

Abstract Dental plaques have been proposed as Helicobacter pylori reservoirs, suggesting that the oral microenvironment can be a permanent niche for the bacterium. The objective of this study was to determine the role played by the dental plaque as reservoir for this species, evaluating the presence of H. pylori DNA in dental plaques and gastric biopsies through the polymerase chain reaction (PCR). The evaluation included seventy-one gastro-intestinal symptomatic patients referred for endoscopic examination by the Gastroenterology Service of the Caracas University Hospital, as well as 40 asymptomatic subjects. The dental plaque samples were analyzed by PCR based on the ure c gene sequence. Gastric biopsies were taken for histopathological analysis and PCR. H. pylori was detected in 48 (68%) gastric biopsies from the 71 patients, all with chronic gastritis, and in the dental plaque of 13 (18%) of the same 71 patients. In 8 (17%) of these 48 patients H. pylori was also detected in dental plaque. Four of these patients also presented displasia and metaplasia. Three patients from the control group were PCR positive for H. pylori in dental plaque. Dental plaques can be a reservoir for these bacteria and their presence could represent a risk factor for gastrointestinal re-infection after treatment for eradicating this bacterium.

Prevalencia de iiabetes mellitus en pacientes con fibrosis pulmonar idiopática

La prevalencia de diabetes mellitus tipo 2 (DM2) en México es del 10%. Objetivo: Determinar la prevalencia de DM2 en pacientes con fibrosis pulmonar idiopática (FPI), neumonitis por hipersensibilidad (NH) y cáncer pulmonar (CP) en la ciudad de México. Casos: 136 pacientes con FPI; controles: 53 pacientes con NH y 263 con CP. El diagnóstico de DM2 se basó en dos glicemias en ayuno por arriba de 126mg/dL. Resultados: Veintinueve pacientes (21.3%) con FPI, 4 (7.5%) con NH y 25 (9.5%) con CP, tuvieron DM2, con una prevalencia significativamente mayor en la FPI en relación con la NH razón de momios 3.3 (intervalo de confianza 95% 1.1-9.6) p < 0.01 y con CP [razón de momios 2.5 (intervalo de confianza 95% 1.4-4.6) p<0.01]. No se observaron diferencias estadísticamente significativas en relación con el género, obesidad y nivel socioeconómico Conclusión: La prevalencia de DM2 en FPI, es mayor que en los controles y en la población general. La obesidad, género y nivel socioeconómico no influyeron en la DM2.

Prevalence of type 2 diabetes mellitus (DM2) in Mexico is 10%. Objective: to describe the prevalence of DM2 in Idiopathic pulmonary fibrosis (IPF), hypersensitivity pneumonitis (HP) and lung cancer patients (LC) in Mexico City. Cases: 136 patients with IPF. The control groups were 53 hypersensitivity pneumonitis patients (HP) and 263 lung cancer patients (LC). DM2 was determined by two preprandial serum glucose levels higher than 126 mg/dL. Results: 29 (21.3%) IPF patients, 4 (7.5%) HP patients and 25 (9.5%) LC patients had DM2, revealing a significantly higher prevalence of DM2 in IPF/HP [odds ratio 3.3 (95% CI 1.1-9.6) p<0.01] and IPF/LC [odds ratio 2.5 (95% CI 1.4-4.6) p<0.01]. No differences were seen when IPF patients were divided by gender, obesity and economic level. Conclusions: These results suggest that there is a higher prevalence of DM2 in IPF patients in comparison with HP, LC patients and the general population in Mexico City.

La importancia de la gammagrafía pulmonar en cirugía de resección pulmonar: caso clínico / Importance of lung gammagraphy in the resection lung surgery. a clinical case

La presentación de este caso clínico tiene por objeto resaltar la utilidad de la medicina nuclear en el protocolo de valoración prequirúrgica de resección de tejido pulmonar. Se trató de una paciente con una enfermedad pulmonar obstructiva crónica asociada a neoplasia pulmonar (tumor carcinoide), que evolucionó sin un diagnóstico preciso durante algunos años. Una vez realizado el diagnóstico de la enfermedad, se encontró con una alteración funcional importante que contraindicaba una resección pulmonar amplia. Sin embargo, la gammagrafía pulmonar ventilatoria-perfusoria permitió una adecuada conducta quirúrgica