Psychosocial risk factors identification in Mexican workers and RGIII validation.

BACKGROUND: Since 2018, NOM-035-STPS-2018 has been applied in Mexico, focused on measuring psychosocial risk factors (PRFs) in workers and the Reference Guide III (RGIII) has been presented, however, research focused on its validation has been scarce, in very specific sectors and with small samples. OBJECTIVE: Determine the levels of PRFs of five work centers and reliability and validity aspects of RGIII. METHOD: The RGIII was applied to 1458 workers (806 women and 652 men) from five workplace in the industrial sector of Ensenada (Mexico), and the level of risk of the PRFs was analyzed, as well as their reliability and validity through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). RESULTS: The PRFs with medium, high and very high-risk levels are Workload, Lack of control over work and Workday. The RGIII presents adequate reliability with Cronbach's α, Alpha ordinal RHO and Omega of 0.93, 0.95 and 0.95, respectively. The EFA shows all five subscales maintain factor loadings greater than 0.43, although Leadership and relationships at work has better saturation values, and Work environment ended with only three items. The CFA indicates Leadership and work relationships with a Root Mean Square Error of Approximation (RMSEA) goodness of fit index of 0.072. CONCLUSION: The RGIII allows the identification and evaluation of the level of risk of PRFs. It complies with sufficient internal consistency. It does not have a clear factorial structure, because it does not meet the minimum values of goodness-of-fit indexes that would allow confirming the structure proposed in RGIII.

Individuals in Collaborative Governance for Environmental Management.

Analyzing the effect of individual participants on collaborative governance processes in environmental management has been elusive due to lack of theoretical frameworks and data limitations. This study uses pattern matching to contrast identity theory with original data from 7 individuals participating in waste management and urban agriculture collaboration in Florianópolis, Brazil. What started as a self-organized initiative to manage an environmental problem, due to precarious waste management services, was scaled up to a citywide policy. Findings demonstrate that as the collaboration evolved over time, individual participants in municipal government transitioned between roles, organizations, and departments which affected their influence on the collaboration according to two transition styles: integrators (overlapping different roles) and segmenters (aligning roles with contexts without ambiguity). While the integrator-style participants were key to increasing sectoral diversity during the activation stage of the collaboration to produce innovative actions, segmenters contributed to formalizing the collaboration with appropriate institutional designs. However, the success of the collaboration after the institutionalization stage depended on the individual transition style and the power of municipal agents to have agency for influencing the collaboration. These findings have implications for adapting collaborative settings to respond to contextual changes that involve urban environmental issues.

Temperature Asymmetry Analysis between Left and Right Wrist with Sensory and Infrared Thermography.

This article reports a thermal analysis of the wrists to analyze the behavior and recovery of skin temperature after 20 min when performing a highly repetitive movement, and two thermography methods (sensory and infrared) and research groups were compared. The tests were carried out with 44 participants who performed a repetitive task for 10 min and integrated into two groups, of which 22 were trained workers from a maquiladora company and were analyzed with sensory thermography, and the other 22 were in the laboratory with infrared thermography with undergraduate students. The study area is the left and right hand, specifically the wrists. The proposed hypothesis is that people with some musculoskeletal problems have a decrease in temperature when starting repetitive tasks and thermal asymmetries, which measurements were recorded at 0, 10, 15, and 20 min after the task was finished. Findings indicate that the temperatures in both wrists behave similarly. The workers reached higher temperatures, and the centigrade degrees of asymmetry difference were also higher. The variable with influence on the temperature was fractured in the arm. After thermally analyzing the temperature behavior between the wrists of both hands, it is concluded that there is an increase in temperature after finishing a repetitive task, and it does not stabilize after 20 min. Both thermography methods observed that the asymmetries are greater than 0.5 °C, detecting the possible pathology of carpal tunnel syndrome.

Factor structure and measurement invariance of the psychosocial risk factors inventory of NOM-035-STPS-2018.

The primary objective of this study was to analyze the psychometric properties of the Inventory for the Identification and Analysis of Psychosocial Risk Factors (IIA-PRF) of Reference Guide III proposed in NOM-035-STPS-2018. A total of 2,149 workers in Baja California, Mexico's industrial and education-government sectors, were administered an online inventory version. Preliminary analyses were performed, as well as a Confirmatory Factor Analysis (CFA) based on two models proposed by the standard itself: an eight-factor model (8-FM) and a four-factor model (4-FM). Likewise, based on the results and with the recommendations of the specialists, a threefactor model (3-FM) was proposed. In addition, nested model sequencing methods were subsequently applied to validate the invariance between the origin of the activity. The dimensionality of 3-FM was found to have adequate fit values according to a-priori established criteria. It is concluded that the IIAPRF does not have the reliability and validity parameters necessary to support interpretations, uses and consequences based on the theoretical structure established by NOM-035-STPS-2018 and that, although the 3-FM presents better reliability and validity indices, it is not invariant in terms of the origin of the activity. Finally, we discuss the implications and recommend reviewing and adjusting the design of the IIAPRF items to extend the measurement of invariance to other groups of relevance for decision making in the improvement of the work environment.

A Trypanosoma cruzi strain from southern Mexico is more virulent for male mice in part by blocking the immune response.

INTRODUCTION: Chagas disease is a neglected disease in the American continent. The southern Mexican state of Chiapas has the highest incidence rate of Chagas disease in the country. The disease, mainly caused by Tripanosoma cruzi in Mexico, is more prevalent in males than in females but the scientific basis for the sex-related tropism is not completely understood. The objective of this study was to evaluate the pathogenicity of a T. cruzi strain in mice of both sexes and to assess certain elements of the immune response in the infected animals. METHODOLOGY: Triatomines bugs were searched at Los Mezcales, Chiapas, Mexico and T. cruzi was identified by PCR and sequencing. A T. cruzi strain was isolated from the feces of triatomines bugs. Mice were infected with the strain and the virulence of the T. cruzi strain as well as the immune response against the infection was compared in male versus female mice. RESULTS: T. dimidiata was identified in all dwellings. 42.9% of the bugs were infected with T. cruzi lineage TcI. Male mice exhibited higher parasitemia than females, and developed leukopenia and lower levels of anti-T. cruzi antibodies compared to female mice. CONCLUSIONS: The identification of the T. cruzi strain in this endemic region of Mexico revealed that male mice are prone to this infectious protozoo, in addition to manifesting a deficient immune response against infection. These findings may explain the greater number of cases of Chagas disease among men in this endemic region of Latin America.

[Hematopoietic stem cells transplant in patients with common variable immunodeficiency. Is a therapeutic option?] / Trasplante de médula ósea en pacientes con inmunodeficiencia común variable, ¿es una opción terapéutica?

BACKGROUND: Patients with common variable immunodeficiency show higher incidence of sinopulmonary and gastrointestinal infections, as well as lymphoproliferative and autoimmune diseases. The treatment of choice is replacement therapy with human gamma-globulin. Hematopoietic stem cell transplantation is a non-conventional therapeutic modality. CASE REPORT: Twenty-six-year old woman with no family or hereditary history of primary immune deficiencies or consanguinity, with repeated episodes of otitis, sinusitis, gastroenteritis and bronchitis since childhood. At adolescence, she was diagnosed with common variable immunodeficiency; she was prescribed intravenous gamma-globulin, broad-spectrum antimicrobials and macrolides. At 22 years of age, she underwent hematopoietic stem cell transplantation owing to continued severe infections. At 4 months, post-transplantation she was diagnosed with hypothyroidism and ovarian insufficiency. During the following 3 years, she had no infections, but at 25 years of age she had immune thrombocytopenic purpura diagnosed, which persists together with Raynaud's disease and upper respiratory tract persistent infections. At the moment of this report she is being treated with intravenous gamma-globulin and receiving prophylaxis with clarithromycin, without steroids or danazol. CONCLUSIONS: Given the high rate of morbidity and mortality associated and immune reconstitution failure, hematopoietic stem cell transplantation should be carefully evaluated in patients with treatment-unresponsive infections or lymphoproliferative disorders.

Antecedentes: Los pacientes con inmunodeficiencia común variable presentan mayor incidencia de infecciones sinopulmonares y gastrointestinales, así como de enfermedades linfoproliferativas y autoinmunes. El tratamiento de elección es el reemplazo con gammaglobulina humana. El trasplante de células progenitoras hematopoyéticas es una modalidad terapéutica no convencional. Caso clínico: Mujer de 26 años de edad sin antecedentes heredofamiliares de inmunodeficiencias primarias ni consanguinidad, con procesos repetidos de otitis, sinusitis, gastroenteritis y bronquitis desde la infancia. En la adolescencia fue diagnosticada con inmunodeficiencia común variable; se le prescribió gammaglobulina intravenosa, antimicrobianos de amplio espectro y macrólidos. A los 22 años se le realizó trasplante de células progenitoras hematopoyéticas por continuar con infecciones severas. A los 4 meses del trasplante se le diagnosticó hipotiroidismo e insuficiencia ovárica. Durante los siguientes 3 años no presentó infecciones, pero a los 25 años manifestó púrpura trombocitopénica inmune, que persistía al momento de este informe con enfermedad de Raynaud e infecciones reincidentes de vías respiratorias altas. Es tratada con gammaglobulina intravenosa y profilaxis con claritromicina, sin esteroides ni danazol. Conclusiones: Dada la alta tasa de morbimortalidad asociada y falla en la reconstitución inmunológica, el trasplante de células progenitoras hematopoyéticas deberá ser cuidadosamente evaluado en pacientes con infecciones sin respuesta al tratamiento o con enfermedades linfoproliferativas.

[Clinic of humoral primary immunodeficiencies in adults. Experience in a tertiary hospital]. / Clínica de inmunodeficiencias primarias en adultos. Experiencia en un hospital de tercer nivel.

BACKGROUND: Primary immunodeficiencies (PID) are characterized by alteration of the components of the immune system. Humoral deficiencies represent 50%. The most common are selective IgA deficiency, Bruton agammaglobulinemia, and common variable immunodeficiency (CVID). OBJECTIVE: To describe the epidemiological and clinical characteristics of adults with humoral PID, cared for in a Primary Humoral Immunodeficiencies Clinic. METHODS: A descriptive cross-sectional study that included a year of analysis, including 35 patients with humoral PID, 31 with CVID, and 4 with Bruton agammaglobulinemia. Data were analyzed with descriptive statistics. RESULTS: Of 35 patients studied, 31 had CVID (88.5%) and 4 (11.5%) Bruton agammaglobulinemia; 21 were men and 14 women. The age at onset of symptoms was 22.7 years, and the delay in diagnosis was 7.2 years. 11.4% of CVID patients died during the study; 4 had malignancies, 22.8% autoimmune diseases, and 48.5% gastrointestinal disorders. Patients with Bruton agammaglobulinemia presented no comorbidities. CONCLUSIONS: Unlike reports in the literature, in the study group, CVID was the most common cause of humoral PID, predominantly in men; the most common gastrointestinal disorder was intestinal functional disorder.

Antecedentes: Las inmunodeficiencias primarias (IDP) son trastornos de los componentes del sistema inmune. Las deficiencias humorales representan el 50%. Las más comunes son el déficit selectivo de IgA, agammaglobulinemia de Bruton y la inmunodeficiencia común variable (IDCV). Objetivo: Describir las características epidemiológicas y clínicas de adultos con IDP humorales, atendidos en una Clínica de Inmunodeficiencias Primarias Humorales. Métodos: Estudio descriptivo trasversal que abarcó un año de análisis, en el que se incluyeron 35 pacientes con IDP humoral. Los datos se analizaron con estadística descriptiva. Resultados: De 35 pacientes estudiados, 31 tuvieron IDCV (88.5%) y 4 (11.5%) agammaglobulinemia de Bruton; 21 fueron hombres y 14 mujeres. La edad al inicio de los síntomas fue de 22.7 años y el tiempo de retraso en el diagnóstico fue de 7.2 años; 11.4% de los pacientes con IDCV fallecieron durante el estudio; 4 padecieron neoplasias, 22.8% enfermedades autoinmunes y 48.5% alteraciones gastrointestinales. Los pacientes con agammaglobulinemia de Bruton no presentaron comorbilidades. Conclusiones: A diferencia de lo informado en la literatura, la IDCV fue la causa más común de IDP humoral en el grupo estudiado, con predominio en hombres; la alteración gastrointestinal más común fue el trastorno funcional intestinal.

[Use of intravenous immunoglobulin in pregnancy. Report of a patient with common variable immunodeficiency]. / Uso de inmunoglobulina intravenosa en el embarazo. Reporte de una paciente con inmunodeficiencia común variable.

BACKGROUND: Common variable immunodeficiency is the most commonly-diagnosed primary immunodeficiency in adults; it is characterized by recurrent sinopulmonary and gastrointestinal infections, and increased incidence of malignancy and autoimmune processes. Many patients begin to have clinical manifestations during reproductive age. CASE REPORT: A 34-year-old woman with 12 weeks of gestation who was diagnosed with common variable immunodeficiency after recurrent episodes of rhinosinusitis, pharyngoamygdalitis, and pneumonia. 0.6 g/kg of IVIG was prescribed every 21 days during the second trimester; the patient only presented one episode of pharyngoamygdalitis, with adequate response to treatment with antibiotics. During the third trimester the dose was adjusted to every 14 days. The patient ended the pregnancy at term without complications, with a child without defects and with proper weight and size. CONCLUSIONS: The administration of immunoglobulin is the main treatment to control common variable immunodeficiency. While the recommended starting dose is 400-800 mg/kg intravenously every 3 to 4 weeks, there is no consensus on the dose to be used in pregnant women. The recommendation is to perform serum level controls before infusion to determine and adjust it.

Antecedentes: La inmunodeficiencia común variable es la inmunodeficiencia primaria más diagnosticada en los adultos; se caracteriza por infecciones sinopulmonares y gastrointestinales de repetición y mayor incidencia de procesos autoinmunes y malignidad. Numerosos pacientes inician con las manifestaciones clínicas durante la edad reproductiva. Caso clínico: Mujer de 34 años de edad con 12 semanas de gestación, en quien se diagnosticó inmunodeficiencia común variable después de cuadros recurrentes de rinosinusitis, faringoadmidalitis y neumonías. Durante el segundo trimestre se prescribió 0.6 g/kg de inmunoglobulina intravenosa cada 21 días; la paciente solo presentó un episodio de faringoamigdalitis, con adecuada respuesta al tratamiento con antibióticos. Durante el tercer trimestre se ajustó la dosis a cada 14 días. La paciente concluyó el embarazo a término sin complicaciones, con producto sin malformaciones y con peso y talla adecuados. Conclusiones: La administración de inmunoglobulina es el principal tratamiento para controlar la inmunodeficiencia común variable. Si bien la dosis inicial recomendada es de 400-800 mg/kg en forma intravenosa cada 3 a 4 semanas, no existe un consenso sobre la dosis que debe emplearse en la mujer que cursa con embarazo. La recomendación es realizar controles de niveles séricos antes de la infusión para determinarla y ajustarla.

[Long-term efficacy of aspirin desensitization in aspirin-exacerbated respiratory disease. Review of two clinical cases]. / Eficacia a largo plazo de la desensibilización a aspirina en enfermedad respiratoria exacerbada por aspirina. Revisión de 2 casos clínicos.

BACKGROUND: The aspirin exacerbated respiratory disease (AERD) shows a prevalence of 7% among asthmatics and increases to 14% in patients with difficult to control asthma. Treatment includes the use of inhibitors of leukotriene receptor (), intranasal steroids, polypectomy, asthma management according to the severity and avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs). In some patients it is necessary desensitization protocol to it. CLINICAL CASES: Two patients diagnosed with respiratory disease exacerbated by aspirin, with poor asthma control and need for multiple polypectomies, despite optimal pharmacological management, carrying out protocol desensitization to aspirin (AAS) successful, now after 4 years of having carried out, they have adequate asthma control without need for polypectomies with a maintenance dose of aspirin 150 mg/day.

Antecedentes: la prevalencia de enfermedad respiratoria exacerbada por aspirina es de 7% en pacientes asmáticos y se incrementa, incluso, a 14% en pacientes con asma de difícil control. El tratamiento incluye la prescripción de inhibidores de los receptores de leucotrienos, esteroides intranasales, polipectomías, tratamiento del asma según su severidad y evitar los antiinflamatorios no esteroides. En algunos pacientes es necesario realizar el protocolo de desensibilización a la aspirina. Casos clínicos: se describen 2 mujeres con diagnóstico de enfermedad respiratoria exacerbada por la administración de aspirina, con escaso control de los cuadros de asma y a quienes fue necesario realizar múltiples polipectomías, a pesar del manejo farmacológico óptimo. Se llevó a cabo protocolo de desensibilización a aspirina (AAS); la respuesta fue positiva. Después de cuatro años, las pacientes presentan adecuado control del asma, con una dosis de mantenimiento de AAS de 150 mg/ día y no han requerido polipectomías.

Intoxicación por uso recreativo de ‘floripondio’, reporte de caso / Poisoning by a flower

Hombre de 21 años, con cuadro de envenenamiento por exposición intencionada a planta del género Brugmansia. Ingresó al servicio de urgencias por síntomas neurológicos y neuropsiquiátricos luego de ingesta con fines recreativos de infusión de flores de “floripondio”, comúnmente conocido como ‘trompeta de ángel’. Requirió observación médica por 48 horas, con buena evolución clínica, y fue dado de alta sin ninguna complicación o secuelaneurológica...

Organización, mantenimiento y preservación de la Colección de Cultivos Bacterianos del Instituto de Ciencias Biológicas de la Universidad de Ciencias y Artes de Chiapas (UNICACH), México / Organization, maintenance, and preservation of the Bacterial Culture Collection of the Biological Sciences Institute, University of Science and Arts of Chiapas (UNICACH), Mexico

Los ceparios o colecciones de microorganismos son fuentes de recursos genéticos cuyo propósito es la preservación de la diversidad biológica, garantizando su disponibilidad para actividades de docencia, investigación y comerciales. En este trabajo se verificó la viabilidad, pureza y características biológicas de las bacterias que conforman el cepario del Instituto de Ciencias Biológicas de la Universidad de Ciencias y Artes de Chiapas, y se organizó y estructuró la información obtenida en un portal virtual, para propiciar la cooperación académica. El cepario cuenta con 33 microorganismos, la mayoría del género Streptococcus y Escherichia (45,1 y 21,2%, respectivamente). Del primer género, se confirmó la identificación de S. pyogenes (40%), exhibiendo la mayoría genes que codifican para DNAsas. Con respecto al segundo género, un 58,3% de las bacterias fueron confirmadas taxonómicamente como E. coli. De esta especie, la colección cuenta con las cepas prototipo causantes de diarrea y que han preservado sus rasgos genéticos por más de cinco años. Dicho acervo ha impulsado actividades de docencia e investigación, a nivel local e internacional. Es importante que los ceparios sean fuentes sustentables de recursos biológicos, para la adquisición y suministro de especies bacterianas, con la finalidad de fomentar la interacción con la comunidad académica.

Strain collections or bacterial culture collections are genetic resources whose purpose is the preservation of biological diversity, ensuring their availability for teaching, research and trade activities. In this work viability, purity and biological characteristics of bacteria from the bacterial collection of the Institute of Biological Sciences, University of Science and Arts of Chiapas were studied. Information was structured and organized in a virtual site, to promote academic cooperation. The strain bank includes 33 microorganisms, most of the genus Streptococcus and Escherichia (45.1 and 21.2%, respectively). For Streptococcus, the identification of S. pyogenes (40%) was confirmed, by determination of most DNAses encoding genes. For Escherichia 58.3% were taxonomically confirmed as E. coli. For this species, the collection includes typical strains that produce diarrhea and their genetic traits have been preserved for more than five years. This bacterial culture collection has stimulated teaching and research activities at local and international levels. Strain collections are important sources of biological material which can provide bacterial species, in order to encourage interaction with the academic community.

Tratamiento de los tumores de plexos coroideos en el Hospital Infantil Niño Jesús de Madrid: nuestra experiencia en las últimas tres décadas / Choroid plexus tumour treatment at Hospital Infantil Niño Jesús in Madrid: Our experience over the last three decades

Objetivo: Realizar una revisión de los pacientes en edad infantil con tumores de plexos coroideos (TPC) intervenidos en el Hospital Infantil Niño Jesús de Madrid desde enero de 1981 hasta septiembre de 2014. Material y método: Los casos registrados fueron analizados en base a la epidemiología, el grado tumoral, las características clínicas, la localización, las características de la diseminación, la actitud terapéutica, el pronóstico y las complicaciones. Resultados: Se registraron 17 pacientes con TPC en edad infantil. Los casos se distribuyeron de modo que 9 casos fueron diagnosticados como papiloma de plexos coroideos (PPC) (52,9%), 2 casos como PPC atípicos (11,7%) y 6 casos como carcinoma de plexos coroideos (CPC) (35,2%). La edad al diagnóstico fue menor de 2 años en 14 de los 17 pacientes (82,3%) y la incidencia fue mayor en los varones (82,3% de los casos). Se realizó resección completa en 16 pacientes (94,1%). Recibieron tratamiento complementario 6 pacientes (todos diagnosticados de CPC) (35,2%). Dos de los 17 pacientes fallecieron (11,7%), mostrando una densidad de incidencia de 0,01 muertes/año. Conclusiones : Nuestra serie de casos es concordante con series previas publicadas en la literatura científica en cuanto a epidemiología, grado tumoral, presentación clínica, características radiológicas y actitud terapéutica. El patrón oro en el tratamiento de los TPC es la resección quirúrgica completa. La quimioterapia y radioterapia deben reservarse para el tratamiento complementario de CPC y recidiva o resto tumoral de PPC atípico

Objective: To review childhood patients with choroid plexus tumors (CPT) who underwent surgery at Hospital Infantil Niño Jesús of Madrid since January 1981 to September 2014. Material and methods: Registered charts were analyzed based on the epidemiology, tumor grade, clinical profile, location, dissemination characteristics, therapy, prognosis and complications. Results: Seventeen childhood patients were recorded with CPT. Cases were distributed so that 9 cases were choroid plexus-papilloma (CPP) (52.9%), 2 cases atypical CPP (11.7%) and 6 cases choroid plexus-carcinoma (CPC) (35.2%). Age at diagnosis was less than 2 years in 14 of the 17 patients (82.3%) and the incidence was higher in males (82.3% of the cases). Gross total resection was performed in 16 patients (94.1%). Adjuvant treatment was used in 6 patients (all this cases with CPC) (35.2%). Two of the 17 patients died (11.7%), showing an incidence density of 0.01 deaths/year. Conclusions: Our case series is consistent with previous published in scientific literature regarding epidemiology, tumor grade, clinical presentation, radiological features and therapeutic approach. Gross total resection is considered the therapeutic gold standard for choroid plexus tumors. Chemotherapy and radiotherapy should be used as adjuvant treatment in CPC and recurrent or remaining atypical CPP

[Desensitization to darunavir in a pediatric patient]. / Desensibilización a darunavir en un paciente pediátrico.

Treatment of HIV infection requires the combination of multiple antiretroviral drugs, known as highly active antiretroviral therapy (HAART); however, up to 84% of patients experience adverse drug effects that lead to discontinuation within first months of treatment. Skin manifestations are reported to 22% of patients. The severity of these is variable, such as erythema multiforme, rash, hives and severe skin reactions at less than 2%. Mild rashes, usually transient and self-limiting, while severe reactions require immediately remove the drug involved to prevent progression of the reaction. Only in those cases where the offending drug does not have another alternative and documented the reaction is mediated type I hypersensitivity mechanisms, can be performed desensitization protocol.

El tratamiento para infección por VIH requiere la combinación de múltiples fármacos antirretrovirales, conocida como Terapia Antirretroviral Altamente Activa (TARAA), sin embargo hasta el 84% de los pacientes presentan efectos adversos a los fármacos, que los llevan a suspender el tratamiento dentro de los primeros meses de tratamiento. Las manifestaciones cutáneas se reportan hasta el 22.1% de los pacientes. La severidad de éstas es variable, como eritema multiforme, exantema, urticaria y reacciones cutáneas severas en menos del 2%. Los exantemas leves, suelen ser transitorios y autolimitados, mientras que las reacciones severas requieren retirar el fármaco implicado inmediatamente para prevenir la progresión de la reacción. Solamente en aquellos casos que el fármaco responsable no cuente con otra alternativa y se documente que la reacción este mediada por mecanismos de hipersensibilidad tipo I, se puede realizar protocolo de desensibilización.

[Orofacial clinical manifestations in adult patients with variable common immunodeficiency]. / Manifestaciones clínicas orofaciales en pacientes adultos con inmunodeficiencia común variable.

BACKGROUND: Common variable immunodeficiency is the primary immunodeficiency (CVID) frequently found in adults. Its prevalence is estimated from 1:25,000 to 75,000 alive newborns; there are variations by ethnic groups, it is estimated about 50-70% in Caucasian patients. Oral cavity lesions are rarely found in adult patients with CVID, there are reports about lesions on pediatric patients mostly caused by infections. OBJECTIVE: To describe the orofacial lesions (oral, maxillofacial and neck area) affecting adults with CVID. MATERIAL AND METHOD: A transversal, prospective study was done in patients with CVID attended at Specialties Hospital, CMN SXXI, Mexico City. Patients where examined by the oral and maxillofacial surgeon and clinical findings were reported, then the descriptive analysis of the lesions was done. RESULTS: We evaluated 26 patients, 16 female and 10 males, average age of 38.6 years. In 18/26 patients we found oral lesions on 7 different types. The most frequent was minor salivary glands hiperplasia (19/26),petechiae (12/26) and herpetic ulcers (7/26). In head and neck, we found 4 different lesions, the most common was lymphadenopathy <2cm (4/26). CONCLUSIONS: The immunologic alterations associated to CVID favors the development of lesions mainly of infectious and probably autoinmune origin that affects the oral cavity and head and neck area.

Antecedentes: la inmunodeficiencia común variable es la inmunodeficienci primaria más común en adultos. Su prevalencia se estima en 1 por cada 25,000 a 75,000 recién nacidos vivos; existen variaciones por grupos étnicos, se estima en 50 a 70% en pacientes de raza caucásica. Las lesiones de la cavidad oral raramente se describen en pacientes adultos con inmunodeficiencia común variable, en niños con esta enfermedad existen informes de lesiones principalmente de origen infeccioso. Objetivo: describir las lesiones orofaciales (cavidad oral, macizo facial y cuello) en pacientes adultos con inmunodeficiencia común variable. Material y método: estudio transversal, prospectivo, efectuado en todos los adultos con inmunodeficiencia común variable adscritos a la Clínica de inmunodeficiencias primarias, del Hospital de Especialidades, Centro Médico Nacional Siglo XXI, que fueron examinados por un cirujano maxilofacial; se realizó el reporte de hallazgos en lista de cotejo y, posteriormente, el análisis descriptivo de las lesiones. Resultados: se incluyeron 26 pacientes, 16 mujeres y 10 hombres, con edad promedio de 38.6 años. En 18 de 26 pacientes estudiados se observaron lesiones orales, con siete lesiones diferentes y predominio en el sexo femenino 2:1. Las lesiones más frecuentes fueron: hiperplasia de glándulas salivales menores (19/26), petequias (12/26) y úlceras herpetiformes (7/26). En la cara y el cuello se observaron cuatro lesiones distintas, las adenopatías < 2 cm (4/26) fueron las más comunes. Conclusiones: las alteraciones inmunológicas asociadas con la inmunodeficiencia común variable favorecen la aparición de lesiones de origen infeccioso y probablemente autoinmunitario que afectan la cavidad oral, la cara y el cuello.

[Structural and functional heart diseases in adult patients with common variable immunodeficiency]. / Cardiopatías estructurales y funcionales en pacientes adultos con inmunodeficiencia común variable.

BACKGROUND: Common variable immunodeficiency (CVID) is the primary immunodeficiency with the largest number of comorbidities in adulthood. It has been associated with bronchiectasis between 17%-76%, and these with the presence of cardiovascular complications such as pulmonary hypertension and heart failure. The new image methods of diagnosis, to assess the cardiovascular structural and functional conformation of adult patients with bronchiectasis, help to establish more efficient and timely diagnoses. OBJECTIVE: To define the presence of structural and functional heart disease in CVID patients by transthoracic echocardiography. MATERIAL AND METHOD: A cross-sectional study was done in a cohort of 26 adult patients diagnosed with CVID and replacement therapy with intravenous immunoglobulin (IVIG), belonging to the Immunodeficiency Clinic. All patients underwent transthoracic echocardiography and tissue ECO doopler; the results were evaluated by a echocardiographer physician. RESULTS: We evaluated 26 patients, of whom 10 patients were male, with a mean age of 35.7 ± 13.7 years. The results of thoracic echocardiography of the left cardiac cavities found the following functional changes: 17 patients presented with mitral insufficiency and only 2 had aortic insufficiency, none symptoms. Regarding the structural alterations of the right cavities: 8 adults with CVID had right cavities growth and 5 of them, hypermobile atrial septum was reported; respect to functional alterations, 24 patients had tricuspid insufficiency; in 20 it was mild and only in 3 is was moderate. Up to 12 had pulmonary valve insufficiency, and 8 had pulmonary arterial hypertension (PAH); of which, in 2 it was mild and in one it was moderate; and 4 patients had PSAP in high limit values. CONCLUSIONS: Patients with CVID, despite having a high incidence of bronchiectasis, had low incidence of PAH, but a significant number of patients had PSAP in high cutoff level, so, these patients should be monitored annually, because probably they will evolve to PAH in the future. Also, they have a high incidence of mild valvular regurgitation due to mild degenerative changes with valvular sclerosis, therefore, they also require regular monitoring.

Antecedentes: la inmunodeficiencia común variable es la inmunodeficiencia primaria con mayor cantidad de comorbilidades en la vida adulta. Se ha asociado con bronquiectasias en 17 a 76%, y éstas, con complicaciones cardiovasculares, como hipertensión arterial pulmonar e insuficiencia cardiaca. Los nuevos métodos diagnósticos de imagen permiten evaluar la conformación estructural y funcional cardiovascular de los pacientes adultos con bronquiectasias y, de esta manera, establecer diagnósticos más eficientes y oportunos. Objetivo: determinar las cardiopatías estructurales y funcionales en pacientes con inmunodeficiencia común variable mediante ecocardiografía transtorácica. Material y método: estudio transversal, descriptivo, efectuado en una cohorte de 26 pacientes adultos con diagnóstico de inmunodeficiencia común variable y tratamiento sustitutivo con inmunoglobulina intravenosa (IgIV), pertenecientes a la Clínica de Inmunodeficiencias. A todos los pacientes se les realizó ecocardiografía transtorácica con ecocardiograma doppler y tisular; los resultados fueron evaluados por un médico cardiólogo ecocardiografista. Resultados: evaluamos a 26 pacientes; de ellos, 10 fueron del género masculino, con media de edad de 35.7 ± 13.7 años. Los resultados de la ecocargiografia torácica en las cavidades cardiacas izquierdas reportaron las siguientes alteraciones funcionales: 17 de 26 pacientes tuvieron insuficiencia mitral y sólo 2 tuvieron insuficiencia aórtica; ninguno de ellos con síntomas. Respecto de las alteraciones estructurales de las cavidades derechas: 8 pacientes adultos con inmunodeficiencia común variable tuvieron crecimiento de las cavidades derechas y en 5 pacientes se encontró tabique interauricular delgado e hipermóvil; respecto de las alteraciones funcionales, 24 pacientes tuvieron insuficiencia tricuspídea, en 21 de ellos fue leve y sólo en 3 fue moderada. Además, 12 pacientes tuvieron insuficiencia de la válvula pulmonar y 6 pacientes tuvieron hipertensión arterial pulmonar; de ellos, en 2 sujetos fue leve y en 2, moderada y 4 pacientes tuvieron presión sistólica de la arteria pulmonar con valores límites altos. Conclusiones: los pacientes con inmunodeficiencia común variable, a pesar de tener alta incidencia de bronquiectasias, tienen baja incidencia de hipertensión arterial pulmonar; pero un número importante de pacientes tiene presión sistólica de la arteria pulmonar con valor límite alto, por lo que estos pacientes deben tener un seguimiento anual, debido a que probablemente evolucionarán a hipertensión arterial pulmonar. Además, tienen alta incidencia de insuficiencias valvulares leves debido a cambios degenerativos con esclerosis valvular, por lo que también requieren vigilancia periódica.

[Occupational asthma]. / Asma ocupacional.

The occupational asthma is the most common form of lung disease caused by factors that are attributed to a specific working environment in industrialized countries. It causes variable limitation of airflow and/or hyper-responsiveness of the airway due to contact with specific agents present in an atmosphere of work and not to stimuli found out of this place. It is recognized more and more frequently, and many agents are capable of causing occupational asthma by different pathophysiological mechanisms. More than 400 agents causing occupational asthma are known and every year new triggers are detected. Numerous factors contribute to the pathogenesis of occupational asthma induced chemically, including immunological, non-immunological mechanisms of epithelial damage, airway remodeling, oxidative stress, neurogenic inflammation as well as genetic factors. The most important risk factors for occupational asthma include: atopy, smoking and genetic factors. The diagnosis is based on the clinical history, skin tests, immunological tests and functional studies. The fundamental treatment is removing the worker from exposure as soon as possible. The advance in the knowledge of the pathogenesis of occupational asthma will importantly influence in the prevention and the management of this disease.

El asma ocupacional es la forma más común de enfermedad pulmonar causada por factores que se atribuyen a un ambiente laboral específico en países industrializados. Causa limitación variable del flujo aéreo e hiperrespuesta de las vías aéreas debido al contacto con agentes específicos presentes en un ambiente de trabajo y no a estímulos encontrados fuera de este lugar. Se reconoce cada vez con más frecuencia y muchos agentes son capaces de causar asma ocupacional por diferentes mecanismos fisiopatológicos. Se conocen más de 400 agentes causantes de asma ocupacional y cada año se detectan nuevos desencadenantes. Numerosos factores contribuyen a la patogénesis de asma ocupacional inducida químicamente, incluidos mecanismos inmunológicos, no inmunológicos, de daño epitelial, remodelación de las vías aéreas, estrés oxidativo, inflamación neurogénica y factores genéticos. Entre los factores de riesgo de asma ocupacional están: la atopia, el tabaquismo y factores genéticos. El diagnóstico se basa en la historia clínica del paciente, pruebas cutáneas, inmunológicas y estudios funcionales. El tratamiento principal es la remoción del trabajador del sitio de exposición tan pronto como sea posible. El avance en el conocimiento de la patogénesis del asma ocupacional influirá de manera importante en la prevención y el tratamiento de esta enfermedad.

[Choroid plexus tumour treatment at Hospital Infantil Niño Jesús in Madrid: Our experience over the last three decades]. / Tratamiento de los tumores de plexos coroideos en el Hospital Infantil Niño Jesús de Madrid: nuestra experiencia en las últimas tres décadas.

OBJECTIVE: To review childhood patients with choroid plexus tumors (CPT) who underwent surgery at Hospital Infantil Niño Jesús of Madrid since January 1981 to September 2014. MATERIAL AND METHODS: Registered charts were analyzed based on the epidemiology, tumor grade, clinical profile, location, dissemination characteristics, therapy, prognosis and complications. RESULTS: Seventeen childhood patients were recorded with CPT. Cases were distributed so that 9 cases were choroid plexus-papilloma (CPP) (52.9%), 2 cases atypical CPP (11.7%) and 6 cases choroid plexus-carcinoma (CPC) (35.2%). Age at diagnosis was less than 2 years in 14 of the 17 patients (82.3%) and the incidence was higher in males (82.3% of the cases). Gross total resection was performed in 16 patients (94.1%). Adjuvant treatment was used in 6 patients (all this cases with CPC) (35.2%). Two of the 17 patients died (11.7%), showing an incidence density of 0.01 deaths/year. CONCLUSIONS: Our case series is consistent with previous published in scientific literature regarding epidemiology, tumor grade, clinical presentation, radiological features and therapeutic approach. Gross total resection is considered the therapeutic gold standard for choroid plexus tumors. Chemotherapy and radiotherapy should be used as adjuvant treatment in CPC and recurrent or remaining atypical CPP.

Delírium en pacientes mayores de 60 años en un hospital público de tercer nivel en la ciudad de Pereira (Colombia ): subdiagnóstico y subregistro / Delirium in Patients Over 60 Years of Age in a Tertiary Level Public Hospital in the City of Pereira (Colombia ): Under-Diagnosed and Under-Recorded

Introducción: El delírium es un trastorno común entre la población geriátrica hospitalizada y es de gran importancia por sus repercusiones en la evolución clínica de los pacientes, pero a menudo su diagnóstico no se realiza. Objetivo: Clarificar el estado del registro y el diagnóstico del delírium en un hospital público de tercer nivel en la ciudad de Pereira. Métodos: Se realizó un estudio descriptivo de corte transversal, en el cual se consultaron las bases de datos de pacientes hospitalizados entre 2010 y 2011 mayores de 60 años, utilizando como filtro la clasificación CIE-10 y verificando los criterios diagnósticos del DSM-IV en las historias clínicas. Resultados: En los años 2010 y 2011, estuvieron hospitalizados 5.325 pacientes mayores de 60 años (19,3 %); según registros de estadística oficiales, el 0,08 % de ellos con diagnóstico de delírium no especificado (F059 ). En la consulta por historias clínicas, se encontró que 455 pacientes tenían esos mismos criterios (40,2 %); el 90,1 % de ellos sufrían delírium y se clasificó con el código F059 sólo al 29,5 %. Conclusiones: Se produce subregistro y subdiagnóstico de delírium de los pacientes mayores de 60 años, lo que se evidencia por la incongruencia en la información oficialmente reportada y la información real obtenida de las historias clínicas respectivas; este hecho incrementa el riesgo y la vulnerabilidad de los pacientes con delírium no diagnosticado o diagnosticado y no reportado en las fuentes estadísticas hospitalarias. La psiquiatría de enlace es una necesidad en las instituciones de tercer nivel, al igual que la formación continua del personal de salud sobre los criterios de prevención, diagnóstico y manejo del delírium.

Introduction: Delirium is a common disorder in the hospitalized geriatric population and it has a great importance on the clinical outcome of inpatients; however, delirium is not diagnosed properly. Objective: To clarify the state of delirium diagnosis and records in a tertiary level public hospital in the city of Pereira. Methods: A cross-sectional descriptive study was performed by searching the clinical records of hospitalized patients older than 60 years 2010 and 2011, using the ICD-10 classification as a filter, and verifying the diagnostic criteria of DSM-IV in the clinical records. Results: In the years 2010 and 2011, 5325 patients older than 60 years were hospitalized (19.3 %). According to the official statistical records; 0.08 % of them were reported with an unspecified diagnosis of delirium (F059 ). In the clinical records search 455 additional delirium patients were found using the same criteria (40.2 %), of which 90.1 % had delirium, and only 29.5 % were classified with the code F059. Conclusions: The diagnoses and recording of delirium patients over 60 years old patients are underestimated, which is demonstrated by the incongruence of the data obtained from the official records and those obtained from the clinical records. This fact increases the risk and vulnerability of patients with undetected delirium or diagnosed but not reported delirium in hospital statistical sources. Liaison psychiatry is a necessity in third level health institutions, as well as a program of continued education for the health staff about prevention, diagnosis criteria and treatment of delirium.

Nuevos agentes relajantes musculares / New muscular relaxing agents

Desde los primeros extractos naturales curarinicos, hasta los analogos sinteticos aparecidos posteriormente, distintos farmacos han sido descritos como capaces de bloquear la transmision muscular. Aparte de la eficacia, todos estos farmacos presentan como denominador cumun efectos colaterales, generalmente como interferencia con el sistema nervioso autonomo, ademas de la desventaja de ser dependientes del higado y rinones para su metabolismo y eliminacion. Esto ha motivado a investigadores de la ultima decada, a realizar innovaciones en la estructura de los agentes bloqueadores no despolarizantes, tratando de obviar los inconvenientes que presentan los agentes ya conocidos, y poder brindar un manejo mas adecuado y seguro a los pacientes que requieren este tipo de medicacion..