Brain metastasis risk prediction model in females with hormone receptor-positive breast cancer.

BACKGROUND: Breast cancer is a leading cause of cancer-related deaths in females, and the hormone receptor-positive subtype is the most frequent. Breast cancer is a common source of brain metastases; therefore, we aimed to generate a brain metastases prediction model in females with hormone receptor-positive breast cancer. METHODS: The primary cohort included 3,682 females with hormone receptor-positive breast cancer treated at a single center from May 2009 to May 2020. Patients were randomly divided into a training dataset (n = 2,455) and a validation dataset (n = 1,227). In the training dataset, simple logistic regression analyses were used to measure associations between variables and the diagnosis of brain metastases and to build multivariable models. The model with better calibration and discrimination capacity was tested in the validation dataset to measure its predictive performance. RESULTS: The variables incorporated in the model included age, tumor size, axillary lymph node status, clinical stage at diagnosis, HER2 expression, Ki-67 proliferation index, and the modified Scarff-Bloom-Richardson grade. The area under the curve was 0.81 (95 % CI 0.75-0.86), p < 0.001 in the validation dataset. The study presents a guide for the clinical use of the model. CONCLUSION: A brain metastases prediction model in females with hormone receptor-positive breast cancer helps assess the individual risk of brain metastases.

The Impact of the COVID-19 Pandemic in Postoperative Neurosurgical Infections at a Reference Center in México.

The COVID-19 pandemic has had a major global impact on the treatment of hospitalized surgical patients. Our study retrospectively evaluates the impact of the COVID-19 pandemic at a neurosurgical reference center in Mexico City. We compared the number of neurosurgeries, the rate and type of postoperative infections, the causative microorganisms and in-hospital mortality rates in a 4-year period, from the pre-pandemic year 2019 until 2022. A total of 4150 neurosurgical procedures were registered. In 2020 the total number of surgeries was reduced by 36% compared to 2019 OR = 0.689 (95% CI 0.566-0.834) p ≤ 0.001, transnasal/trans sphenoidal pituitary resections decreased by 53%, and spinal surgeries by 52%. The rate of neurosurgical infections increased from 3.5% in 2019 to 5.6% in 2020 (p = 0.002). Regarding the microorganisms that caused infections, gram positive cocci accounted for 43.5% of isolates, Klebsiella spp. and Pseudomonas spp. caused one third of the infections. No significant differences were found for in-hospital mortality nor patterns of resistance to antibiotics. The number of surgeries increased in the last two years, although the infection rate has returned to pre-pandemic levels. We observed a lower impact from subsequent waves of COVID-19 and despite an increase in the number of surgeries, the surgeries have not amounted to the full pre-pandemic levels.

The Real Practice Prescribing Antibiotics in Outpatients: A Failed Control Case Assessed through the Simulated Patient Method.

The first level of medical care provides the largest number of consultations for the most frequent diseases at the community level, including acute pharyngitis (AP), acute diarrhoea (AD) and uncomplicated acute urinary tract infections (UAUTIs). The inappropriate use of antibiotics in these diseases represents a high risk for the generation of antimicrobial resistance (AMR) in bacteria causing community infections. To evaluate the patterns of medical prescription for these diseases in medical offices adjacent to pharmacies, we used an adult simulated patient (SP) method representing the three diseases, AP, AD and UAUTI. Each person played a role in one of the three diseases, with the signs and symptoms described in the national clinical practice guidelines (CPGs). Diagnostic accuracy and therapeutic management were assessed. Information from 280 consultations in the Mexico City area was obtained. For the 101 AP consultations, in 90 cases (89.1%), one or more antibiotics or antivirals were prescribed; for the 127 AD, in 104 cases (81.8%), one or more antiparasitic drugs or intestinal antiseptics were prescribed; for the scenarios involving UAUTIs in adult women, in 51 of 52 cases (98.1%) one antibiotic was prescribed. The antibiotic group with the highest prescription pattern for AP, AD and UAUTIs was aminopenicillins and benzylpenicillins [27/90 (30%)], co-trimoxazole [35/104 (27.6%)] and quinolones [38/51 (73.1%)], respectively. Our findings reveal the highly inappropriate use of antibiotics for AP and AD in a sector of the first level of health care, which could be a widespread phenomenon at the regional and national level and highlights the urgent need to update antibiotic prescriptions for UAUTIs according to local resistance patterns. Supervision of adherence to the CPGs is needed, as well as raising awareness about the rational use of antibiotics and the threat posed by AMR at the first level of care.

Paleohistology of Caraguatypotherium munozi (Mammalia, Notoungulata, Mesotheriidae) from the early late Miocene of northern Chile: A preliminary ontogenetic approach.

The Miocene Caragua fossil fauna in northern Chile contains a considerable number (7) of articulated partial skeletons tentatively assigned to Caraguatypotherium munozi (Notoungulata, Mesotheriidae), which presents up to 40% body size difference. Since either inter- and intra- specific wide size range has been observed in the Mesotheriidae family in general, we wanted explore the ontogenic stage signature of the sample, by carrying out the first comprehensive paleohistological description of the appendicular system in Notoungulata. Results show that: 1) they can be classified as subadults and adults, based on the presence of bone tissues typical of ceased somatic growth; 2) there is a notorious inter-skeletal variation on bone growth rates (skeletal modularity), particularly, the humerus showed a slower diameter growth and less remodelling than the femur, resulting as a better element for ontogenetic analyses; 3) marked cyclical growth is observed, characterised by fast early ontogenic continuous growth, and subsequent fast/slow stratified bone tissue layering. In general, such growth pattern suggests that C. munozi had a similar ontogenetic growth process as other modern mammals, that it should also be influenced by other sex-related, ecological and environmental factors. Likely related to the presence of rapid climatic variations, due to orogenic uplift and concomitant re-organization of the drainage processes along the western tectonic front of the Central Andes at that time.

Endothelial Progenitor Cells May Be Related to Major Amputation after Angioplasty in Patients with Critical Limb Ischemia.

BACKGROUND: Critical limb ischemia represents an advanced stage of peripheral arterial disease. Angioplasty improves blood flow to the limb; however, some patients progress irreversibly to lower limb amputation. Few studies have explored the predictive potential of biomarkers during postangioplasty outcomes. AIM: To evaluate the behavior of endothelial progenitor cells in patients with critical limb ischemia, in relation to their postangioplasty outcome. METHODS: Twenty patients with critical limb ischemia, candidates for angioplasty, were enrolled. Flow-mediated dilation, as well as endothelial progenitor cells (subpopulations CD45+/CD34+/CD133+/CD184+ and CD45+/CD/34+/KDR[VEGFR-2]+ estimated by flow cytometry) from blood flow close to vascular damage, were evaluated before and after angioplasty. Association with lower limb amputation during a 30-day follow-up was analyzed. RESULTS: Endothelial progenitor cells were related with flow-mediated dilation. A higher number of baseline EPCs CD45+CD34+KDR+, as well as an impaired reactivity of endothelial progenitor cells CD45+CD34+CD133+CD184+ after angioplasty, were observed in cases further undergoing major limb amputation, with a significant discrimination ability and risk (0.75, specificity 0.83 and RR 4.5 p < 0.05). CONCLUSIONS: Endothelial progenitor cells were related with endothelial dysfunction, whereas a higher baseline number of the subpopulation CD45+CD34+KDR+, as well as an impaired reactivity of subpopulation CD45+CD34+CD133+CD184+ after angioplasty, showed a predictive ability for major limb amputation in patients with critical limb ischemia.

Limited Therapeutic Options in Mexico for the Treatment of Urinary Tract Infections.

The rise in antimicrobial resistance (AMR) has complicated the management of urinary tract infections (UTIs). The objective of this study was to evaluate the antimicrobial susceptibility patterns of Escherichia coli and Klebsiella pneumoniae. Design: prospective observational study. Bacteria were classified as susceptible or resistant to ampicillin-sulbactam, amikacin, gentamicin, ciprofloxacin, norfloxacin, nitrofurantoin, trimethoprim-sulfamethoxazole (TMP/SMZ), ertapenem, meropenem, and fosfomycin. The sensitivity to fosfomycin and chloramphenicol was evaluated by the disk diffusion method. Statistical analysis: the chi-square test and Fisher's exact test were used to compare differences between categories. A p value < 0.05 was considered statistically significant. Isolates were collected from January 2019 to November 2020 from 21 hospitals and laboratories. A total of 238 isolates were received: a total of 156 E. coli isolates and 82 K. pneumoniae isolates. The majority were community-acquired infections (64.1%). Resistance was >20% for beta-lactams, aminoglycosides, fluoroquinolones, and TMP/SMZ. For E. coli isolates, resistance was <20% for amikacin, fosfomycin, and nitrofurantoin; for K. pneumoniae, amikacin, fosfomycin, chloramphenicol, and norfloxacin. All were susceptible to carbapenems. K. pneumoniae isolates registered a higher proportion of extensively drug-resistant bacteria in comparison with E. coli (p = 0.0004). In total, multidrug-resistant bacteria represented 61% of all isolates. Isolates demonstrated high resistance to beta-lactams, fluoro-quinolones, and TMP/SMZ.

Paleobiological inferences on middle Eocene native ungulates from South America: Functional morphological analysis of Notostylops and Notopithecus.

Eocene early-diverging representatives of South American extinct notungulates are traditionally considered to have been "generalists" and "non-specialized" in terms of the appendicular skeleton and locomotor behavior, as is the case with the notostylopid Notostylops, a middle Eocene iconic taxon from Patagonia (Argentina). However, they are mainly known from dental remains, and associated cranial and postcranial elements are scarce. The discovery of a nearly complete specimen attributed to N. murinus allows us to: (1) increase the knowledge of the anatomy of its appendicular skeleton; (2) identify isolated bones from several collections and suggest different taxonomic interpretations for published specimens; (3) perform a biomechanical and functional study using functional morphological analysis to infer its paleoecological attributes (e.g. posture, locomotor habit, estimated speed, and body mass); and (4) establish morphofunctional comparisons, based on possible functional ranges, with other extinct early-diverging notoungulates from the middle Eocene, such as the Notopithecid Notopithecus. Our evidence suggests that Notostylops was a medium-sized mammal (8.5-20 kg), which could achieve a dynamic digitigrade posture that allowed a scansorial secondary locomotor habit and a speed of up to 50 km/h. However, Notopithecus was a small-sized mammal (0.6-1.4 kg) with a plantigrade posture both in a static and dynamic context, terrestrial habits, and a speed of up to 35 km/h. Therefore, we conclude that these Eocene notoungulates show different locomotor capabilities, which can be associated with early niche diversifications, clearly contrasting with the "all-generalists" paradigmatic view.

Why Is the Grass the Best Surface to Prevent Lameness? Integrative Analysis of Functional Ranges as a Key for Dairy Cows' Welfare.

Lameness is a painful clinical condition of the bovine locomotor system that results in alterations of movement. Together with mastitis and infertility, lameness is the main welfare, health, and production problem found in intensive dairy farms worldwide. The clinical assessment of lameness results in an imprecise diagnosis and delayed intervention. Hence, the current approach to the problem is palliative rather than preventive. The five main surfaces used in free housing systems in dairy farms are two natural (grass and sand) and three artificial (rubber, asphalt, and concrete). Each surface presents a different risk potential for lameness, with grass carrying the lowest threat. The aim of the present study is to evaluate the flooring type influences on cows' movement capabilities, using all the available information relating to kinematics, kinetics, behavior, and posture in free-housed dairy cows. Inspired by a refurbished movement ecology concept, we conducted a literature review, taking into account kinematics, kinetics, behavior, and posture parameters by reference to the main surfaces used in free housing systems for dairy cows. We built an integrative analysis of functional ranges (IAFuR), which provides a combined welfare status diagram for the optimal (i.e., within the upper and lower limit) functional ranges for movement (i.e., posture, kinematics, and kinetics), navigation (i.e., behavior), and recovery capacities (i.e., metabolic cost). Our analysis confirms grass' outstanding clinical performance, as well as for all of the movement parameters measured. Grass boosts pedal joint homeostasis; provides reliable, safe, and costless locomotion; promotes longer resting times. Sand is the best natural alternative surface, but it presents an elevated metabolic cost. Rubber is an acceptable artificial alternative surface, but it is important to consider the mechanical and design properties. Asphalt and concrete surfaces are the most harmful because of the high traffic abrasiveness and loading impact. Furthermore, IAFuR can be used to consider other qualitative and quantitative parameters and to provide recommendations on material properties and the design of any surface, so as to move towards a more grass-like feel. We also suggest the implementation of a decision-making pathway to facilitate the interpretation of movement data in a more comprehensive way, in order to promote consistent, adaptable, timely, and adequate management decisions.

Role of whole brain radiotherapy in the management of infratentorial metastases from lung and breast cancer.

BACKGROUND: Brain metastases (BM) occur in almost one third of patients with systemic malignancies. Only a small number of studies focus on infratentorial location and whole brain radiotherapy (WBRT) as the main non-surgical management. The aim of the study was to compare the prognosis of patients treated with WBRT among patients with supra- or infratentorial lesions. MATERIALS AND METHODS: At a single center, 263 patients with either breast (BC) or lung (LC) cancer, that had developed BM and received treatment with WBRT, were analyzed during an 8-year period. RESULTS: A total of 152 patients with BC and 111 with LC were analyzed, median age at the time of BM was 50.7 years, systemic activity other than BM was detected in 91%. Newly diagnosed BM were supratentorial in 40%, infratentorial in 10% and 51% in both locations. Median overall survival was 13 months (95% CI: 11.1-14.8 months), without significant difference between supra- or infratentorial location. WBRT alone was administered in 79% of patients, whereas WBRT with chemtoreapy was provided for 21%. CONCLUSION: In patients with BM from LC or BC that were not candidates for surgical resection, palliative WBRT appears to be equally effective in those with supra- or infratentorial locations.

Enlarged adipocytes from subcutaneous vs. visceral adipose tissue differentially contribute to metabolic dysfunction and atherogenic risk of patients with obesity.

Morphological characteristics and source of adipose tissue as well as adipokines may increase cardiometabolic risk. This study aimed to explore whether adipose tissue characteristics may impact metabolic and atherogenic risks. Subcutaneous Adipose Tissue (SAT), Visceral Adipose Tissue (VAT) and peripheral blood were obtained from obese patients submitted to bariatric surgery. Adipose tissue (morphometry), plasma adiponectin, TNF-α, resistin (multiplexing) and biochemical chemistry were analyzed; as well as endothelial dysfunction (Flow Mediated Dilation, FMD) and atherogenesis (Carotid Intima Media Thickness, CIMT). Subgroups divided by adipocyte size and source were compared; as well as correlation and multivariate analysis. Sixty patients 36.6% males, aged 44 years-old, BMI 46.7 kg/m2 were included. SAT's adipocytes showed a lower range of size expandability than VAT's adipocytes. Independent from their source, larger adipocytes were associated with higher glucose, lower adiponectin and higher CIMT. Particularly, larger adipocytes from SAT were associated with higher blood pressure, lower insulin and HDL-cholesterol; and showed positive correlation with glucose, HbA1c, systolic/diastolic values, and negatively correlated with insulin and adiponectin. VAT's larger adipocytes particularly associated with lower resistin and lower FMD values. Gender and Diabetes Mellitus significantly impacted the relation of adipocyte size/source with the metabolic and atherogenic risk. Multivariable analysis suggested hypertension-resistin-HbA1c interactions associated with SAT's larger adipocytes; whereas potential insulin-adiponectin associations were observed for VAT's larger adipocytes. Adipocyte morphology and source are differentially related with cardiometabolic and atherogenic risk in population with obesity, which are potentially affected by gender and Diabetes Mellitus.

COVID-19: Clouds Over the Antimicrobial Resistance Landscape.

In recent years, the increase in antimicrobial resistance (AMR) has been recognized as a real threat to human and animal health. It is a problem that has been given the highest priority, uniting nations in the fight against its causes and effects. Among the actions that have been implemented are: clinical and microbiological surveillance, promotion of rational and controlled use of antibiotics, AMR stewardship programs in hospitals, development of tools for rapid diagnosis of infectious diseases to establish prompt and adequate treatment, and radically improving vaccination strategies. The current COVID-19 pandemic has placed disproportionate demands on the healthcare infrastructure and economy worldwide, which will negatively impact on the availability of materials as well as the technical capacity for diagnosis, patient care, and treatment of both COVID-19 and non-COVID-19 patients. Disruptions to production and distribution chains will hamper the availability and usage of antibiotics, also interrupting several of the activities that have been implemented thus far to combat AMR, including detailed laboratory monitoring and reinforced vaccination programs. Here, we discuss the main aspects that should be considered with regard to AMR, that may be affected by the pandemic and propose some actions to counter them.

Identification of risk factors for central nervous system metastasis in patients with breast cancer with neurologic symptoms.

BACKGROUND: The current study was performed to identify factors that are present at the time of breast cancer (BC) diagnosis that are associated with a higher rate of central nervous system metastasis (CNSm). METHODS: The authors analyzed a database of patients with a confirmed diagnosis of BC who were referred for a neuro-oncology consultation at the National Cancer Institute in Mexico City, Mexico, from June 2009 to June 2017. Information was collected prospectively and included demographic, pathologic, and clinical data at the time of diagnosis of BC. Bivariate and multivariate logistic regression models were built to estimate the associations between the development of CNSm and the time after BC diagnosis. RESULTS: Among 970 patients with BC, 263 (27%) were diagnosed with CNSm. The median time from BC diagnosis to the development of CNSm was 33 months (interquartile range, 15-76 months). After multivariate analysis, age <50 years at the time of BC diagnosis (odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8-3.5 [P < .0001]), human epidermal growth factor receptor 2 (HER2)-positive status (HER2+) (OR, 3.6; 95% CI, 2.1-6.1 [P < .0001]), luminal B/HER2+ subtype (OR, 3.1; 95% CI, 1.9-5.3 [P < .001]), triple-negative subtype(OR, 2.4; 95% CI, 1.5-4 [P = .001]), and Karnofsky performance status ≤70 (OR, 6.6; 95% CI, 4.5-9.6 [P < .0001]) were associated with a higher frequency of CNSm. Brain parenchyma was the most common site of CNSm. The median overall survival after a diagnosis of CNSm was 12.2 months (95% CI, 9.3-15.1 months). CONCLUSIONS: CNSm is not uncommon among patients with BC, particularly in those with neurologic symptoms who require neuro-oncology evaluation and are aged <50 years at the time of diagnosis, have HER2+ or triple-negative subtypes, have a poor Karnofsky performance status, and/or have ≥2 non-CNS metastases.

Antimicrobial resistance and antibiotic consumption in Mexican hospitals / Resistencia antimicrobiana y consumo de antibióticos en hospitales mexicanos

Abstract: Objective: To establish the current situation of antimicrobial resistance and antibiotic consumption in Mexican hospitals. Materials and methods: Antimicrobial susceptibility data from blood and urine isolates were collected. Defined daily dose (DDD) of antibiotic consumption/100 occupied beds (OBD) was calculated. Results: Study period: 2016 and 2017. Of 4 382 blood isolates, E. coli and K. pneumoniae were most frequently reported, with antimicrobial resistance >30% for most drugs tested, only for carbapenems and amikacin resistance were <20%. A. baumannii had antimicrobial resistance >20% to all drugs. Resistance to oxacillin in S. aureus was 20%. From 12 151 urine isolates, 90% corresponded to E. coli; resistance to ciprofloxacin, cephalosporins and trimethoprim/sulfamethoxazole was >50%, with good susceptibility to nitrofurantoin, amikacin and carbapenems. Global median antimicrobial consumption was 57.2 DDD/100 OB. Conclusions: This report shows a high antimicrobial resistance level in Gram-negative bacilli and provides an insight into the seriousness of the problem of antibiotic consumption.

Resumen: Objetivo: Establecer la situación actual de la resistencia antimicrobiana y el consumo de antibióticos en hospitales mexicanos. Material y métodos:F Se colectaron datos de susceptibilidad antimicrobiana de aislamientos de sangre y orina. Se calculó la dosis diaria definida (DDD) del consumo de antibióticos/100 estancias. Resultados: Periodo de estudio de 2016 a 2017. De 4 382 aislamientos en sangre, E. coli y K. pneumoniae fueron las más frecuentes, con resistencia >30% a la mayoría de las drogas evaluadas; sólo para carbapenémicos y amikacina la resistencia fue <20%. A. baumannii tuvo resistencia >20% a todos los fármacos. La resistencia a oxacilina en S. aureus fue de 20%. De 12 151 aislamientos en urocultivos, 90% correspondió a E. coli; la resistencia a ciprofloxacina, cefalosporinas y trimetoprima/sulfametoxazol fue >50%, con buena susceptibilidad a nitrofurantoína, amikacina y carbapenémicos. La mediana del consumo global de antibióticos en DDD/100 estancias fue de 57.2. Conclusiones: Este reporte muestra el nivel elevado de resistencia en bacilos Gram-negativos y brinda una perspectiva de la gravedad del problema del consumo de antibióticos.

High Phenotypic and Genotypic Diversity of Enterococcus faecium from Clinical and Commensal Isolates in Third Level Hospital.

Background: The use of antimicrobials and myeloablative chemotherapy regimens has promoted multiresistant microorganisms to emerge as nosocomial pathogens, such as vancomycin-resistant Enterococcus faecium (VREfm). We described a polyclonal outbreak of bloodstream infection caused by Efm in a hemato-oncological ward in Mexico. Our aim was to describe the clonal complex (CC) of the Efm strains isolated in the outbreak in comparison with commensal and environmental isolates. Methodology: Sixty Efm clinical, environmental, and commensal strains were included. We constructed a cladogram and a phylogenetic tree using Vitek and Multilocus sequence typing data, respectively. Results: We reported 20 new sequence types (ST), among which 17/43 clinical isolates belonged to CC17. The predominant ST in the clinical strains were ST757, ST1304, ST412, and ST770. Neither environmental nor commensal isolates belonged to CC17. The phylogeny of our collection shows that the majority of the clinical isolates were different from the environmental and commensal isolates, and only a small group of clinical isolates was closely related with environmental and commensal isolates. The cladogram revealed a similar segregation to that of the phylogeny. Conclusions: We found a high diversity among clinical, environmental, and commensal strains in a group of samples in a single hospital. Highest diversity was found between commensal and environmental isolates.

Antimicrobial resistance and antibiotic consumption in Mexican hospitals.

OBJECTIVE: To establish the current situation of antimicrobial resistance and antibiotic consumption in Mexican hospitals. MATERIALS AND METHODS: Antimicrobial susceptibility data from blood and urine isolates were collected. Defined daily dose (DDD) of antibiotic consumption/100 occupied beds (OBD) was calculated. RESULTS: Study period: 2016 and 2017. Of 4 382 blood isolates, E. coli and K. pneumoniae were most frequently reported, with antimicrobial resistance >30% for most drugs tested, only for carbapenems and amikacin resistance were <20%. A. baumannii had antimicrobial resistance >20% to all drugs. Resistance to oxacillin in S. aureus was 20%. From 12 151 urine isolates, 90% corresponded to E. coli; resistance to ciprofloxacin, cephalosporins and trimethoprim/sulfamethoxazole was >50%, with good susceptibility to nitrofurantoin, amikacin and carbapenems. Global median antimicrobial consumption was 57.2 DDD/100 OB. CONCLUSIONS: s. This report shows a high antimicrobial resistance level in Gram-negative bacilli and provides an insight into the seriousness of the problem of antibiotic consumption.

OBJETIVO: Establecer la situación actual de la resistencia antimicrobiana y el consumo de antibióticos en hospitales mexicanos. MATERIAL Y MÉTODOS: Se colectaron datos de susceptibilidad antimicrobiana de aislamientos de sangre y orina. Se calculó la dosis diaria definida (DDD) del consumo de antibióticos/100 estancias. RESULTADOS: Periodo de estudio de 2016 a 2017. De 4 382 aislamientos en sangre, E. coli y K. pneumoniae fueron las más frecuentes, con resistencia >30% a la mayoría de las drogas evaluadas; sólo para carbapenémicos y amikacina la resistencia fue <20%. A. baumannii tuvo resistencia >20% a todos los fármacos. La resistencia a oxacilina en S. aureus fue de 20%. De 12 151 aislamientos en urocultivos, 90% correspondió a E. coli; la resistencia a ciprofloxacina, cefalosporinas y trimetoprima/sulfametoxazol fue >50%, con buena susceptibilidad a nitrofurantoína, amikacina y carbapenémicos. La mediana del consumo global de antibióticos en DDD/100 estancias fue de 57.2. CONCLUSIONES: Este reporte muestra el nivel elevado de resistencia en bacilos Gram-negativos y brinda una perspectiva de la gravedad del problema del consumo de antibióticos.

Carnivore Protoparvovirus 1 at the Wild-Domestic Carnivore Interface in Northwestern Mexico.

Eighty-three wild and domestic carnivores of nine species from Janos Biosphere Reserve (JBR), Mexico, were tested by serologic and molecular assays to determine exposure and infection rates of carnivore protoparvovirus 1. Overall, 50.8% (33/65) of the wild carnivores and 100% (18/18) of the domestic dogs tested were seropositive for Canine protoparvovirus 1 (CPV), while 23% (15/65) of the wild carnivores and 22.2% (4/18) of the domestic dogs were PCR positive for CPV. Phylogenetic analysis confirmed circulation of CVP-2 with residues 426 Asn (CPV2a = 1/19) and 426 Glu (CPV-2c = 18/19) among carnivores in JBR. The prevalence of both PCR positivity and antibodies to CPV varied significantly among wild host species. Of the six identified haplotypes, three were unique to kit foxes (Vulpes macrotis) (the species with higher haplotype richness) and two to striped skunks (Mephitis mephitis). The remaining haplotype was shared among all carnivore species including dogs suggesting non-host specificity and bidirectional and continuous viral transmission cycle in the JBR. The phylogenetic similarity of CPV strains from dogs and wild carnivores and the higher prevalence of CPV in wild carnivores captured near towns relative to those captured far from towns suggest that dogs might be an important source of CPV infection for wild carnivores in the JBR. We provide evidence that cross-species transmission occurs at the domestic-wildlife interface in JBR.

Vertigo in patients with cancer: Red flag symptoms.

INTRODUCTION: Vertigo is a common condition occurring in the general population and is usually self-limited. Reports studying vertigo in patients with brain metastasis (BM), are scarce. Therefore, the aim of this study was to analyze if the presence of vertigo in cancer patients is associated with the presence of BM. METHODS: This study was conducted in a cancer referral center, where patients with confirmed systemic cancer sent for a neuro-oncologic consultation from May 2012 to March 2018 were included for review. RESULTS: Of 3220 patients, 723 were diagnosed with BM, and 204 had vertigo. Of these patients, 22.5% of those who had vertigo were diagnosed to have BM and 6% of those with BM had vertigo as an initial symptom (odds ratio [OR] 0.9; p = 0.9). An additional symptom was present in 104 patients with vertigo. Bivariate regression analysis disclosed a higher risk of having BM in patients with vertigo accompanied by headache (OR18.6; p < 0.0001), ataxia (OR12.1; p < 0.0001), seizures (OR10.9; p = 0.04), visual symptoms (OR10.4; p < 0.0001), speech impairment (OR6.3; p = 0.01), altered mental status (OR7.4; p < 0.0001), and focal weakness (OR7.4; p = 0.001), or focal sensitive complaint (OR6.9; p = 0.003). Vertigo with headache or ataxia remained statistically significant after multivariate analysis. CONCLUSION: In this cohort, a higher risk of having BM was associated with the presence of vertigo coexistent with headache, ataxia, seizures, visual symptoms, speech impairment, altered mental status, focal weakness, or focal sensitive complaint. On the basis of these results, these accompanying symptoms must be considered as red flags in patients with systemic cancer.

[Relationship between the sensitization to shrimp and mites. Exploration of cross-reactivity due tropomyosin]. / Relación entre la sensibilización a camarón y ácaros. Exploración de la reactividad cruzada por tropomiosina.

BACKGROUND: Little is known out the sensitization to shrimp in patients with respiratory allergies who are sensitized to mites and about the clinical relevance of that sensitization in the tropical region. OBJECTIVES: To determine the prevalence of sensitization to shrimp in patients with rhinitis or asthma who are sensitized to mites, to explore the route of sensitization, its relevance, and the role of sensitization to tropomyosin. METHODS: A cross-sectional study in patients with asthma and rhinitis who are sensitized to mites. Through a survey, it was asked about the consumption of shrimp and the control of asthma or rhinitis. Oral provocation tests were carried out with shrimp on individuals who are sensitized to mites and shrimp without consumption, or consumption greater than six months before, without reaction history. In a subgroup, the sIgE was measured for shrimp, Der p and Lit v 1. The patients who are sensitized to mites and shrimp (cases) were compared to the patients who are sensitized only to mites (controls). RESULTS: Out of 229 patients, 48 (21%) were sensitized to shrimp. There wasn't a statistically significant difference in the intake of shrimp between cases (54.2%) and controls (49.7%); eight cases showed symptoms on contact with shrimp. No statistically significant differences were found in the sIgE for Der p, Lit v1 and shrimp between cases and controls. A medium change was observed in the size of the effect: 0.45, 0.44 and 0.41 respectively. CONCLUSIONS: Sensitization to shrimp in patients with asthma or allergic rhinitis caused by mites is high; in 25% it seems to be clinically relevant, mainly in those with asthma. Intake is not the main route of exposure to tropomyosin; cross-reactivity can explain the frequency of sensitization.

Antecedentes: Se conoce poco sobre la sensibilización a camarón en pacientes con alergias respiratorias sensibilizados a ácaros y la importancia clínica de dicha sensibilización en el trópico. Objetivos: Determinar la prevalencia de sensibilización a camarón en pacientes con rinitis o asma sensibilizados a ácaros, explorar la ruta de sensibilización, su relevancia y el papel de la sensibilización a tropomiosina. Métodos: Estudio de corte transversal en pacientes con asma y rinitis sensibilizados a ácaros. Mediante encuesta se indagó consumo de camarón y control del asma o rinitis. Se realizaron pruebas de provocación oral con camarón a los individuos sensibilizados a ácaros y camarón sin consumo, o con consumo mayor a seis meses, sin historia de reacción. En un subgrupo se midió la sIgE para camarón, Der p y Lit v 1. Se compararon los pacientes sensibilizados a ácaro y camarón (casos) y los sensibilizados solo a ácaros (controles). Resultados: De 229 pacientes, 48 (21 %) se encontraban sensibilizados a camarón. No hubo diferencia estadísticamente significativa en la ingesta de camarón entre casos (54.2 %) y controles (49.7 %); ocho casos presentaron síntomas al contacto con camarón. No se encontraron diferencias estadísticamente significativas en la sIgE para Der p, Lit v1 y camarón entre casos y controles. Se observó cambio mediano en la magnitud de efecto: 0.45, 0.44 y 0.41, respectivamente. Conclusiones: La sensibilización a camarón en pacientes con asma o rinitis alérgica por ácaros es alta, en 25 % parece ser clínicamente relevante, principalmente en aquellos con asma. La ingesta no es la principal vía de exposición a la tropomiosina; la reactividad cruzada puede explicar la frecuencia de sensibilización.

Chemotherapy-induced posterior reversible encephalopathy syndrome: Three case reports.

RATIONALE: Posterior reversible encephalopathy syndrome (PRES) has been associated with the use of several medications, including chemotherapeutic agents. PATIENT CONCERNS: A 65-year-old woman was diagnosed with adenocarcinoma of the ovary, after sixth-line treatment with topotecan, at the beginning of the fourth cycle, she was admitted to the emergency room for presenting tonic-clonic seizures, visual disturbance, and hypertension. A 66-year-old woman was diagnosed with bilateral breast cancer; due to disease progression, treatment with paclitaxel and gemcitabine was started, 1 month after the last dose of chemotherapy, she was admitted to the emergency room for suffering severe headache, altered mental status, tonic-clonic seizures, and hypertension. A 60-year-old patient diagnosed with breast cancer on the left side, underwent second-line chemotherapy with gemcitabine, carboplatin, and bevacizumab, and 1 month after the last dose of chemotherapy, she was also admitted to the emergency room due to altered mental status, vomiting, tonic-clonic seizures, and hypertension. DIAGNOSIS: They were diagnosed as PRES based on physical examination, laboratory findings, and imaging techniques that revealed diffuse lesions and edema within the parieto-occipital regions. INTERVENTIONS: They received support treatment with blood pressure (BP) control, seizures were controlled with a single anti-epileptic agent, and chemotherapeutic agents from the onset of PRES to its resolution were discontinued. OUTCOMES: All these patients improved after medical treatment was started. LESSONS: Medical personnel and therapeutic establishments need to be made aware about this chemotherapy-induced neurologic complication.

A late Pleistocene human footprint from the Pilauco archaeological site, northern Patagonia, Chile.

The present study describes the discovery of a singular sedimentary structure corresponding to an ichnite that was excavated at the paleo-archaeological site Pilauco (Osorno, Chile). The trace fossil is associated with megafauna bones, plant material and unifacial lithic tools. Here we present a detailed analysis of the Pilauco ichnite and associated sedimentary structures, as well as new radiocarbon data. The ichnological analysis confidently assigns the trace to the ichnospecies Hominipes modernus-a hominoid footprint usually related to Homo sapiens. Some particular characteristics of the Pilauco trace include an elongated distal hallux, lateral digit impressions obliterated by the collapsed sediment, and sediment lumps inside and around the trace. In order to evaluate the origin of the ichnite, trackmaking experiments are performed on re-hydrated fossil bed sediments. The results demonstrate that a human agent could easily generate a footprint morphology equivalent to the sedimentary structure when walking on a saturated substrate. Based on the evidence, we conclude that the trackmaker might well have been a bare-footed adult human. This finding, along with the presence of lithic artifacts in the same sedimentary levels, might represent further evidence for a pre-Clovis South American colonization of northern Patagonia, as originally proposed for the nearby Monte Verde site.