Expression and Association of Hsp70, Hsp90 and p53 Thermal Shock Proteins in Breast Cancer

Introducción: En México, el cáncer de mama es la primera causa de muerte en mujeres. En el desarrollo del cáncer de mama, participan las proteínas de estrés térmico (Hsp); En particular la Hsp27, Hsp70 y Hsp90 que aseguran la sobrevida de las células cancerosas, y en algunos casos de cáncer de mama, se forman complejos de Hsp70 y Hsp90 con p53. P53 interviene en la regulación del ciclo celular y en la apoptosis, donde más del 50% de los tumores humanos contiene mutaciones de este gen, permitiendo que las células anormales proliferen dando como resultado cáncer. Objetivo: Analizar en muestras de cáncer de mama, la expresión y asociación de las proteínas Hsp70, Hsp90 y P53. Material y métodos: Se obtuvieron 15 muestras de tejido mamario mediante biopsia y/o cirugía (11 con cáncer de mama, 3 alteraciones de la mama y 1 control negativo), donde se analizó la expresión y asociación de las proteínas Hsp70, 90 y p53 mediante inmunoprecipitación, Western Blot-ECL. Resultados: Las proteínas Hsp70, Hsp90 y p53 se expresaron en todas las muestras de tejido mamario canceroso, siendo mayor la expresión de Hsp70 seguido de p53 y en menor cantidad la Hsp90, y al analizar su asociación, se encontró a la Hsp70 con Hsp90 y p53, en 6 muestras. Así mismo, en alteraciones de la glándula mamaria, se encontró una mayor expresión de Hsp70. Conclusiones: Las proteínas Hsp70, Hsp90 y p53 se sobreexpresan en tejido canceroso, y se asocian entre ellas en 66.6% de las muestras analizadas

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

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

Gradientes de idoneidad para impulsar la mejora continua de campos clínicos utilizados en programas de Especialidades Médicas en México

Resumen: Objetivo: Desarrollar una metodología de evaluación de campos clínicos mediante la percepción de los médicos residentes. Material y métodos: Se identificaron 20 variables, que se agruparon en cuatro categorías: 1) profesor tutor; 2) organización hospitalaria; 3) complementos educativos, y 4) opinión global. Resultados: Se diseñó y validó una herramienta y escala de gradientes de idoneidad, encontrando el nivel de idoneidad aceptable en el 55% de los campos clínicos, en contraste con un 45% ubicado en el nivel no aceptable. Conclusión: Esta herramienta permitió medir y comparar por gradientes la calidad de los campos clínicos para entrenamiento de los médicos residentes. Abstract: Objective: To develop a method for the evaluation of clinical sites through the perspective of medical residents. Material and method: A set of 20 variables were selected and grouped into the following categories: (i) teaching staff; (ii) hospital organisation; (iii) educational program, and (iv) overall opinion. Results: A gradient scale of the suitability of the clinical site was designed, and validated, with 55% of the clinical sites being at an acceptable level and 45% being unacceptable below. Conclusion: This tool permitted the quality of the clinical sites used by the medical residents to be measured using a gradient scale. Palabras clave: Campos clínicos, Gestión educativa, Médicos residentes, Programas de residencia médica, Keywords: Clinical sites, Education administration, Medical residents, Medical residency program

Expresión y asociación de las proteínas de estrés térmico hsp70, hsp90 y p53 en cáncer mamario

Introduction: In Mexico, breast cancer is the leading cause of death in women. In the development of breast cancer, thermal shock proteins (HSPs) are involved. In particular Hsp27, Hsp70 and Hsp90 ensure the survival of cancer cells, and in some cases breast cancer complexes form between Hsp70 and Hsp90 with p53. P53 is involved in cell cycle regulation and apoptosis, where more than 50% of human tumors contain mutations of this gene, allowing abnormal cells to proliferate resulting in cancer. Objective: To analyze the expression and association of Hsp70, Hsp90 and P53 in breast cancer samples. Material and methods: 15 samples of breast tissue were obtained by biopsy and / or surgery (11 with breast cancer, 3 breast alterations and 1 negative control), where the expression and association of the Hsp70, 90 and p53 proteins by immunoprecipitation, Western Blot-ECL. Results: The presence of Hsp70, Hsp90 and p53 was found in all samples of cancerous mammary tissue, where the expression of Hsp70 followed by p53 was higher, and Hsp90 was less abundant, and association analyzing, found the Hsp70 with Hsp90 and p53, it was found in 6 samples. Likewise, in alterations of the mammary gland a greater expression of the Hsp70 was found. Conclusions: A higher presence of Hsp70, Hsp90 and p53 proteins was observed in cancerous tissue, and association among them in 66.6% samples analyzed.Introducción: En México, el cáncer de mama es la primera causa de muerte en mujeres. En el desarrollo del cáncer de mama, participan las proteínas de estrés térmico (Hsp); En particular la Hsp27, Hsp70 y Hsp90 que aseguran la sobrevida de las células cancerosas, y en algunos casos de cáncer de mama, se forman complejos de Hsp70 y Hsp90 con p53. P53 interviene en la regulación del ciclo celular y en la apoptosis, donde más del 50% de los tumores humanos contiene mutaciones de este gen, permitiendo que las células anormales proliferen dando como resultado cáncer. Objetivo: Analizar en muestras de cáncer de mama, la expresión y asociación de las proteínas Hsp70, Hsp90 y P53. Material y métodos: Se obtuvieron 15 muestras de tejido mamario mediante biopsia y/o cirugía (11 con cáncer de mama, 3 alteraciones de la mama y 1 control negativo), donde se analizó la expresión y asociación de las proteínas Hsp70, 90 y p53 mediante inmunoprecipitación, Western Blot-ECL. Resultados: Las proteínas Hsp70, Hsp90 y p53 se expresaron en todas las muestras de tejido mamario canceroso, siendo mayor la expresión de Hsp70 seguido de p53 y en menor cantidad la Hsp90, y al analizar su asociación, se encontró a la Hsp70 con Hsp90 y p53, en 6 muestras. Así mismo, en alteraciones de la glándula mamaria, se encontró una mayor expresión de Hsp70. Conclusiones: Las proteínas Hsp70, Hsp90 y p53 se sobreexpresan en tejido canceroso, y se asocian entre ellas en 66.6% de las muestras analizadas

Mis casos Clínicos de Odontopediatría y Ortodoncia

Libro que conjunta casos en el área de Odontopediatría y OrtodonciaEs para los integrantes de la Red de Investigación en Estomatología (RIE) una enorme alegría presentar el tercer libro del 2021, sobre casos clínicos, revisiones de la literatura e investigaciones. La RIE está integrada por cuerpos académicos de la UAEH, UAEM, UAC y UdeG

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN