Atypical Lemierre’s syndrome caused by Prevotella oris

Lemierre’s syndrome is a rare form of severe sepsis secondary to oropharyngeal infection characterized by septic thrombophlebitis of the internal jugular vein with disseminated infections, with the lungs being the most frequent target. We report the case of a previously healthy 15-year-old admitted to the intensive care unit because of septic shock, brain and lung abscesses, and a positive blood culture for Prevotella oris with a clinical presentation compatible with the diagnosis of Lemierre’s syndrome. Conclusion: This is an atypical presentation of Lemierre’s syndrome because of the isolated microorganism

Índice de saponificación de Cremas de leche y Cremas vegetales.

La cremade leche es una emulsión de grasa en agua, la sustitución por grasa vegetal y aditivos alimenticios genera un producto denominado crema vegetal.Por su delicioso sabor y textura, este alimento es un ingrediente fundamental en la cocina mexicana e internacional que imparte cremosidad y potencia el sabor de muchos platillos.Las características y calidad de la cremas regulares y vegetales, están vinculadas estrechamente al contenido de grasa.Siendo la crema un alimento rico en grasa, los criterios de calidad exigidos por la legislación mexicana para su comercialización, no consideran parámetros químicos como el pH y otras medidas de identidad propios de los materiales grasos como el Índice saponificación, entre otros.Esta investigación evaluó el Índice de saponificación de cremas regulares, light y vegetales utilizando un método a pequeña escala, basado en la Norma Mexicana NMX-F-174-S-1981con la finalidad de conocer el peso molecular promedio de los ácilglicéridos y ácidos grasos libres que poseen estos productos.Las muestras analizadas exhibieron valores por debajo delrango establecido en la literatura; éstos bajos Índices de saponificación señalan que tanto las cremas lácteas como las vegetales contienen una gran proporción de ácilglicéridos constituidos por ácidos grasos de cadena media y larga

Evaluación del índice de saponificación de 5 margarinas de mesa mediante un método a pequeña escala.

La margarina es una emulsión de aceite vegetal, grasas mixtas, agua, sólidos de leche y aditivos alimenticios. Es un ingrediente fundamental en todas las cocinas, especialmente en la panificación y repostería, confiriéndole un exquisito sabor a productos como los pasteles. Sin embargo, su consumo debe ser controlado por su alto valor calórico y grasas saturadas de difícil digestión. En esta investigación se evaluó el Índice de saponificación (IS) de cinco margarinas mediante el empleo de un método a pequeña escala, basado en la Norma Mexicana NMX-F-174-S-1981, a consecuencia de la falta de este parámetro de calidad en la legislación mexicana para margarinas. Las muestras analizadas exhibieron valores que se ubican dentro de los rangos establecidos en la literatura; éstos bajos Índices de saponificación señalan que las margarinas contienen una gran proporción de ácidos grasos de cadena media y larga. Este trabajo se adhiere a la propuesta de que la legislación mexicana considere la inclusión de micrométodos perfectamente validados para la determinación de parámetros químicos en margarinas

Índice de saponificación de mayonesas

La mayonesa es un sazonador empleado hoy en día en una gran variedad de platillos internacionales como acompañamiento, consiste de una emulsión aceite/agua cuya fase oleosa es generalmente un aceite vegetal ya sea de algodón, soya o maíz. En esta investigación, cinco mayonesas de mayor consumo entre la población neolonesa, fueron analizadas para conocer su Índice de saponificación (IS) aplicando el procedimiento señalado por la Norma Mexicana NMX-F-174-S-1981. Los valores obtenidos mostraron una confiabilidad muy aceptable y variaron en un rango de IS=83.25 a IS=168.43, lo que refleja la presencia de aceites vegetales cuyos triglicéridos tienen pesos moleculares entre 997.45 g/mol hasta 2,018 g/mol; los ácidos grasos constituyentes poseen masas molares promedio entre 332.48 g/mol y 672.67 g/mol. Esta última información revela la longitud de los ácidos grasos aportados por la mayonesa

Biomarcadores moleculares en la predicción de sarcopenia

A lo largo de la vida se presentan diferentes cambios a nivel de composición corporal, siendo más notorios durante el proceso de envejecimiento. La sarcopenia se define como la pérdida progresiva y constante de la masa muscular magra así como la función y la fuerza del músculo esquelético. Se presenta como un proceso del envejecimiento, en el que el cuerpo experimenta un deterioro progresivo de calidad, reducción de tamaño, número de las fibras musculares, colágeno, modificación de unidad motora que se ha relacionado con el aumento de porcentaje de grasa, cambios hormonales, mecanismos inflamatorios, estrés oxidativo, ingesta de proteínas y actividad física. El envejecimiento puede ser considerado como la resistencia de varios estímulos anabólicos al músculo (sistema nervioso central [SNC], hormona del crecimiento, estrógeno, testosterona, proteína dietética, actividad física, acción de insulina) y posiblemente el desarrollo de varios procesos catabólicos naturales del mismo (inflamación subclínica, producción de citoquinas catabólicas: factor de necrosis tumoral- [TNF- -6 [IL-6], interleucina- - -1, IL- s causas de la sarcopenia todavía no se comprenden claramente, existen muchos mecanismos potenciales que han sido investigados en mayor o menor medida, como la edad, las relacionadas a la enfermedad, nutrición y actividad física. Los criterios para identificar a la sarcopenia incluye la cantidad, función muscular y el rendimiento físico, lo cual, si se llegaran a integrar biomarcadores moleculares en la evaluación clínica, el diagnóstico podría efectuarse de una manera temprana, para evitar la complicaciones asociadas a la fragilida

Myeloid-Derived Suppressor Cells Show Different Frequencies in Diabetics and Subjects with Arterial Hypertension

Type 2 diabetes mellitus (DM2) is strongly associated with other comorbidities such as obesity, atherosclerosis, and hypertension. Obesity is associated with sustained low-grade inflammatory response due to the production of proinflammatory cytokines. This inflammatory process promotes the differentiation of some myeloid cells, including myeloid-derived suppressor cells (MDSCs). In this study, two groups of individuals were included: DM2 patients and non-DM2 individuals with similar characteristics. Immunolabeling of CD15+ CD14- and CD33+ HLA-DR-/low was performed from whole peripheral blood, and samples were analyzed by flow cytometry, and frequencies of MDSCs and the relationship of these with clinical variables, cytokine profile (measured by cytometric bead array), and anthropometric variables were analyzed. The frequency of CD33+ HLA-DR-/low MDSCs (that produce IL-10 and TGF-β, according to an intracellular detection) is higher in patients with DM2 (P < 0:05), and there is a positive correlation between the frequency of CD15+ CD14- and CD33+ HLA-DR-/low MDSC phenotypes. DM2 patients have an increased concentration of serum IL-5 (P < 0:05). Also, a negative correlation between the frequency of CD15+CD14- MDSCs and LDL cholesterol was found. Our group of DM2 patients have an increased frequency of mononuclear MDSC CD33+ HLA-DR-/low that produce TGF-β and IL-10. These cytokines have been associated with immune modulation and reduced T cell responses. DM2 and non-DM2 subjects show a similar cytokine profile, but the DM2 patients have anincreased concentration of IL-5

Long-term survival in patients with non-small cell lung cancer and synchronous brain metastasis treated with whole-brain radiotherapy and thoracic chemoradiation

<p>Abstract</p> <p>Background</p> <p>Brain metastases occur in 30-50% of Non-small cell lung cancer (NSCLC) patients and confer a worse prognosis and quality of life. These patients are usually treated with Whole-brain radiotherapy (WBRT) followed by systemic therapy. Few studies have evaluated the role of chemoradiotherapy to the primary tumor after WBRT as definitive treatment in the management of these patients.</p> <p>Methods</p> <p>We reviewed the outcome of 30 patients with primary NSCLC and brain metastasis at diagnosis without evidence of other metastatic sites. Patients were treated with WBRT and after induction chemotherapy with paclitaxel and cisplatin for two cycles. In the absence of progression, concurrent chemoradiotherapy for the primary tumor with weekly paclitaxel and carboplatin was indicated, with a total effective dose of 60 Gy. If disease progression was ruled out, four chemotherapy cycles followed.</p> <p>Results</p> <p>Median Progression-free survival (PFS) and Overall survival (OS) were 8.43 ± 1.5 and 31.8 ± 15.8 months, respectively. PFS was 39.5% at 1 year and 24.7% at 2 years. The 1- and 2-year OS rates were 71.1 and 60.2%, respectively. Three-year OS was significantly superior for patients with N0-N1 stage disease vs. N2-N3 (60 vs. 24%, respectively; Response rate [RR], 0.03; <it>p</it>= 0.038).</p> <p>Conclusions</p> <p>Patients with NSCLC and brain metastasis might benefit from treatment with WBRT and concurrent thoracic chemoradiotherapy. The subgroup of N0-N1 patients appears to achieve the greatest benefit. The result of this study warrants a prospective trial to confirm the benefit of this treatment.</p

A nationwide pilot study on breast cancer screening in Peru

"Introduction: A high prevalence of advanced breast cancer (BC) is a common scenario in Latin America. In Peru, the frequency of BC at Stages III/IV is ≈50% despite implementation of a programme for breast cancer screening (BCS) along the country. We carried out a study to assess the feasibility and develop an instrument to evaluate the knowledge, barriers and perception about BCS in a nationwide pilot study in Peru among candidates for BCS. Methods: We conducted a systematic review of 2,558 reports indexed in PubMed, Scopus, Web of Science, Medline-Ovid and EMBASE, regarding to our study theme. In total, 111 were selected and a 51-items survey was developed (eight items about sociodemographic characteristics). Patients were recruited in public hospitals or private clinics, in rural and urban areas of nine departments of Peru. Results: We surveyed 488 women from: Lima (150), Cajamarca (93), Ica (59), Arequipa (56), Loreto (48), Ancash (38), Junín (15), Puerto Maldonado (15) and Huancavelica (14); 27.9% of them were from rural areas. The mean of age was 53.3 years (standard deviation ± 9.1). Regarding education level, 29.8% had primary, 33.2% secondary and 37.0% higher education. In total, 28.7% of women did not know the term ‘mammogram’ and 47.1% reported never receiving a BCS (36.9% from urban and 73.5% from rural population). In women that underwent BCS, only 67% knew it is for healthy women. In total, 54.1% of patients had low levels of knowledge about risk factors for BC (i.e. 87.5% of women respond that injuries in the breast produce cancer). Cultural, economic and geographic barriers were significantly associated with having a mammogram where 56.9% of participants considered a cost ≤ 7 USD as appropriate. Mammogram was perceived as too painful for 54.9% of women. In addition, women with a self-perception of low-risk for BC and a fatalistic perception of cancer were less likely to have a BCS. Conclusion: We found that it is feasible to conduct a large-scale study in Peru. The results of this pilot study highlight an urgent need of extensive education and awareness about BCS in Peru.

Disease Severity in Patients Infected with Leishmania mexicana Relates to IL-1β

Leishmania mexicana can cause both localized (LCL) and diffuse (DCL) cutaneous leishmaniasis, yet little is known about factors regulating disease severity in these patients. We analyzed if the disease was associated with single nucleotide polymorphisms (SNPs) in IL-1β (−511), CXCL8 (−251) and/or the inhibitor IL-1RA (+2018) in 58 Mexican mestizo patients with LCL, 6 with DCL and 123 control cases. Additionally, we analyzed the in vitro production of IL-1β by monocytes, the expression of this cytokine in sera of these patients, as well as the tissue distribution of IL-1β and the number of parasites in lesions of LCL and DCL patients. Our results show a significant difference in the distribution of IL-1β (−511 C/T) genotypes between patients and controls (heterozygous OR), with respect to the reference group CC, which was estimated with a value of 3.23, 95% CI = (1.2, 8.7) and p-value = 0.0167), indicating that IL-1β (−511 C/T) represents a variable influencing the risk to develop the disease in patients infected with Leishmania mexicana. Additionally, an increased in vitro production of IL-1β by monocytes and an increased serum expression of the cytokine correlated with the severity of the disease, since it was significantly higher in DCL patients heavily infected with Leishmania mexicana. The distribution of IL-1β in lesions also varied according to the number of parasites harbored in the tissues: in heavily infected LCL patients and in all DCL patients, the cytokine was scattered diffusely throughout the lesion. In contrast, in LCL patients with lower numbers of parasites in the lesions, IL-1β was confined to the cells. These data suggest that IL-1β possibly is a key player determining the severity of the disease in DCL patients. The analysis of polymorphisms in CXCL8 and IL-1RA showed no differences between patients with different disease severities or between patients and controls

IV consenso mexicano sobre Helicobacter pylori

Desde el último consenso mexicano para el diagnóstico y tratamiento de la infección por Helicobacter pylori (H. pylori) en el 2007, han existido avances importantes al respecto. Por tal motivo, la Asociación Mexicana de Gastroenterología convocó a 20 expertos para la realización del «IV consenso mexicano sobre H. pylori». Durante febrero y junio del 2017 se organizaron 4 mesas de trabajo, una revisión de la literatura y 3 rondas de votaciones donde se establecieron 32 enunciados para discusión y consenso. Dentro de las recomendaciones se destaca el reconocer a México como un país con riesgo de cáncer gástrico bajo a intermedio a pesar de la alta prevalencia de infección por H. pylori. Se corrobora que enfermedad ulcerosa péptica, presencia de lesiones premalignas, antecedentes de cáncer gástrico y linfoma asociado a la mucosa deben considerarse indicaciones claras para erradicación. La relación del H. pylori con los síntomas dispépticos sigue siendo controversial. La triple terapia de erradicación con amoxicilina, claritromicina y un inhibidor de la bomba de protones ya no debe ser considerada la primera línea de tratamiento. En su lugar, se proponen 2 opciones: la terapia cuádruple con bismuto (inhibidor de la bomba de protones, subcitrato de bismuto, tetraciclina y metronidazol) y la terapia cuádruple sin bismuto (inhibidor de la bomba de protones, amoxicilina, claritromicina y metronidazol). Se establece la necesidad de la realización de sensibilidad antimicrobiana ante la falla a 2 tratamientos de erradicación. Finalmente, se proponen campañas de educación respecto al diagnóstico y tratamiento del H. pylori para médicos de primer contacto y población general. Abstract Important advances have been made since the last Mexican consensus on the diagnosis and treatment of Helicobacter pylori (H. pylori) infection was published in 2007. Therefore, the Asociación Mexicana de Gastroenterología summoned 20 experts to produce ‘‘The Fourth Mexican Consensus on Helicobacter pylori’’. From February to June 2017, 4 working groups were organized, a literature review was performed, and 3 voting rounds were carried out, resulting in the formulation of 32 statements for discussion and consensus. From the ensuing recommendations, it was striking that Mexico is a country with an intermediate-to-low risk for gastric cancer, despite having a high prevalence of H. pylori infection. It was also corroborated that peptic ulcer disease, premalignant lesions, and histories of gastric cancer and mucosaassociated lymphoid tissue lymphoma should be considered clear indications for eradication. The relation of H. pylori to dyspeptic symptoms continues to be controversial. Eradication triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor should no longer be considered first-line treatment, with the following 2 options proposed to take its place: quadruple therapy with bismuth (proton pump inhibitor, bismuth subcitrate, tetracycline, and metronidazole) and quadruple therapy without bismuth (proton pump inhibitor, amoxicillin, clarithromycin, and metronidazole). The need for antimicrobial sensitivity testing when 2 eradication treatments have failed was also established. Finally, the promotion of educational campaigns on the diagnosis and treatment of H. pylori for both primary care physicians and the general population were proposed