Hiperplasia Nodular Focal, Hallazgo Incidental en Colecistectomía Laparoscópica Electiva. Reporte de Caso

Focal Nodular Hyperplasia (FNH) is a benign tumor, the second most frequent of its type, usually asymptomatic. In this case report, we present the clinical scenario of a 29-year-old woman with chronic cholelithiasis, who, upon elective surgical treatment by laparoscopy, a liver-dependent tumor was found in segment V, whose histopathological result was focal nodular hyperplasia. The objective of this article is to carry out a brief bibliographic review of this rare pathology, as well as to share the approach and surgical resolution that was performed.La Hiperplasia Nodular Focal (HNF) es un tumor benigno, el segundo más frecuente de su tipo normalmente asintomático. En este reporte presentamos el caso de una mujer de 29 años con colelitiasis crónica, que al darle tratamiento quirúrgico electivo por laparoscopia, se encuentra una tumoración dependiente de hígado en segmento V, cuyo resultado histopatológico fue hiperplasia nodular focal. El objetivo de este artículo es realizar una breve revisión bibliográfica de esta rara patología, así como compartir el abordaje y resolución quirúrgica que se realizó

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Primary explants of the postnatal thymus allow the expansion of clonogenic thymic epithelial cells that constitute thymospheres

Abstract Background Thymic epithelial cells (TECs) are responsible for shaping the repertoires of T cells, where their postnatal regeneration depends on a subset of clonogenic TECs. Despite the implications for regenerative medicine, their cultivation and expansion remain challenging. Primary explant cell culture is a technique that allows the seeding and expansion of difficult-to-culture cells. Here, we report a reliable and simple culture system to obtain functional TECs and thymic interstitial cells (TICs). Methods To establish primary thymic explants, we harvested 1 mm cleaned fragments of thymus from 5-week-old C57/BL6 mice. Tissue fragments of a complete thymic lobe were placed in the center of a Petri dish with 1 mL of DMEM/F-12 medium supplemented with 20% fetal bovine serum (FBS) and 1% penicillin‒streptomycin. To compare, thymic explants were also cultivated by using serum-free DMEM/F-12 medium supplemented with 10% KnockOut™. Results We obtained high numbers of functional clonogenic TECs and TICs from primary thymic explants cultivated with DMEM/F-12 with 20% FBS. These cells exhibited a highly proliferative and migration profile and were able to constitute thymospheres. Furthermore, all the subtypes of medullary TECs were identified in this system. They express functional markers to shape T-cell and type 2 innate lymphoid cells repertoires, such as Aire, IL25, CCL21 and CD80. Finally, we also found that ≥ 70% of lineage negative TICs expressed high amounts of Aire and IL25. Conclusion Thymic explants are an efficient method to obtain functional clonogenic TECs, all mTEC subsets and different TICs Aire+IL25+ with high regenerative capacity

Surveillance of Diarrheagenic Escherichia coli strains isolated from diarrhea cases from children, adults and elderly at northwest of Mexico

Diarrheagenic Escherichia coli (DEC) strains are a main cause of gastrointestinal disease in developing countries. In this study we report the epidemiologic surveillance in a four-year period (January 2011 to December 2014) of DEC strains causing acute diarrhea throughout the Sinaloa State, Mexico. DEC strains were isolated from outpatients of all ages with acute diarrhea (N=1,037). Specific DEC pathotypes were identified by PCR-amplification of genes encoding virulence factors. The adhesion phenotype and antibiotic resistance were also investigated. DEC strains were detected in 23.3% (242/1037) of cases. The most frequently DEC strain isolated was EAEC (12.2%), 126/242 followed by EPEC (5.1%), 53/242, ETEC (4.3%), 43/242 DAEC (1.4%), 15/242, STEC (0.3%), 3/242 and EIEC (0.2%), 2/242. EHEC strains were not detected. Overall DEC strains were more prevalent in children ≤ 2 years of age with EPEC strains the most common of DEC pathotypes. While 65% of EAEC strains were classified as typical variant based on the aggregative adherence to in vitro cultures of HEp-2 cells, a high proportion of EPEC strains was classified as atypical strains. EAEC, EPEC, ETEC and DAEC strains were distributed in the north, central and south regions of Sinaloa state. Among all DEC strains, >90% were resistant to at least one commonly prescribed antibiotic. Strains were commonly resistant to first-line antibiotics such as tetracycline, ampicillin and sulfamethoxazole-trimethoprim. Furthermore, more than 80% of DEC isolates were multi-drug resistant and EPEC and DAEC were the categories with major proportion of this feature. In conclusion, in nearly one out of four cases of acute diarrhea in Northwestern Mexico a multi-drug resistant DEC strain was isolated, in these cases EAEC was the most prevalent (52%) pathotype

Seminario Integrador 2 - ME169 - 202102

Curso de la especialidad de la carrera de medicina, de carácter teórico del ciclo 9, en el que los estudiantes al realizar la revisión y análisis de casos, elaboran los diagnósticos, los planes de trabajo y terapéuticos pertinentes para el caso clínico respectivo. El curso de seminario integrador 2 busca desarrollar las competencias generales de: comunicación oral (nivel 3) 1y las competencias específicas de práctica clínica-promoción, prevención y tratamiento (nivel 3) y profesionalismo- aprendizaje autonómo y desarrollo profesional (nivel 3). El curso de seminario integrador 2 les permitirá a los estudiantes tomar decisiones ante los diferentes retos diagnósticos del paciente adulto con un problema médico o quirúrgico como miembro de un equipo interprofesional en su futura vida profesional

Memoria del primer foro sobre logros, problemas y propuestas de los cuerpos académicos de educación y humanidades de la Universidad Autónoma del Estado de México

Motivados por el interés de dialogar nuestras preocupaciones cotidianas en torno al quehacer académico en la Universidad, e impulsados por la inquietud de compartir puntos de vista y apreciaciones acerca de la forma en que organizamos colectivamente el trabajo académico (en especial, de investigación) en los diferentes espacios de especialización disciplinaria e interdisciplinaria en los campos de las Ciencias de la Educación y las Humanidades, asistimos a la convocatoria para reflexionar qué tanto hemos avanzado como verdaderos equipos de trabajo (sobre todo en lo relativo a la investigación) y cuánto aún nos queda por hacer, a fin de coordinar esfuerzos individuales y sumar capacidades en proyectos y actividades comunes a cada cuerpo académico