Implementation of a roadmap for the comprehensive diagnosis, follow-up, and research of childhood leukemias in vulnerable regions of Mexico: results from the PRONAII Strategy

The main objective of the National Project for Research and Incidence of Childhood Leukemias is to reduce early mortality rates for these neoplasms in the vulnerable regions of Mexico. This project was conducted in the states of Oaxaca, Puebla, and Tlaxcala. A key strategy of the project is the implementation of an effective roadmap to ensure that leukemia patients are the target of maximum benefit of interdisciplinary collaboration between researchers, clinicians, surveyors, and laboratories. This strategy guarantees the comprehensive management of diagnosis and follow-up samples of pediatric patients with leukemia, centralizing, managing, and analyzing the information collected. Additionally, it allows for a precise diagnosis and monitoring of the disease through immunophenotype and measurable residual disease (MRD) studies, enhancing research and supporting informed clinical decisions for the first time in these regions through a population-based study. This initiative has significantly improved the diagnostic capacity of leukemia in girls, boys, and adolescents in the regions of Oaxaca, Puebla, and Tlaxcala, providing comprehensive, high-quality care with full coverage in the region. Likewise, it has strengthened collaboration between health institutions, researchers, and professionals in the sector, which contributes to reducing the impact of the disease on the community

Hallazgos electrocardiográficos en pacientes hospitalizados con infección activa por SARS-CoV-2

Antecedentes: Reconocer oportunamente las alteraciones electrocardiográficas en COVID-19 permite obtener un diagnóstico rápido y preciso para instaurar un tratamiento oportuno. Objetivo: Describir las características electrocardiográficas en pacientes con COVID-19 en un hospital de tercer nivel. Método: Estudio descriptivo. Se evaluaron los hallazgos electrocardiográficos de pacientes con diagnóstico confirmado de COVID-19 mediante PCR o pruebas de amplificación molecular. Se incluyeron pacientes mayores de 18 años, hospitalizados en terapia intensiva y área COVID durante febrero a noviembre de 2021. Se utilizó estadística descriptiva, frecuencias y porcentajes, chi cuadrado para asociación de variables categóricas. Resultados: Se evaluaron 75 expedientes: 42 (56.0%) hombres y 33 (44.0%) mujeres; edades comprendidas entre los 20 y 110 años , media 54.84, DE: 14.99 años. Los principales hallazgos electrocardiográficos fueron ritmo cardiaco sinusal (94.7%), alteraciones en el segmento ST (7.7%), alteraciones en la onda P (12.0%), anomalías en la morfología del complejo QRS (13.4%) y alteraciones en la onda T (22.6%). Las complicaciones asociadas a COVID-19 fueron pericarditis (2.7%), hipertrofia ventricular izquierda (4.0%) y bloqueo auriculoventricular completo (4.0%). Se obtuvo una p = 0.001 en la relación de la onda T y la presencia de comorbilidades en pacientes infectados. Conclusión: Las principales alteraciones electrocardiográficas se relacionan con la repolarización tardía del corazón

Apendicitis xantogranulomatosa; un desafío diagnóstico: Caso Clínico : Xanthogranulomatous appendicitis; a diagnostic challenge: Clinical Case

Introduction: Xanthogranulomatous inflammation is a chronic inflammatory process, rarely located in the appendix. A case of xanthogranulomatous appendicitis is presented. Clinical case. A 77-year-old male presents with intermittent pain in the right hemiabdomen and hyperthermia of one month's evolution. Physical examination showed a tumor in the iliac fossa and right abdomen. He underwent surgery for a probable incarcerated right inguinal hernia, acute perforated appendicitis was found, with inflammation and adhesions, purulent fluid in the right hemiabdomen and abdominal wall dissection. The histopathological result was xanthogranulomatous appendicitis. The evolution of the patient was favorable. Conclusion. Xanthogranulomatous appendicitis simulates a typical picture of acute appendicitis. Histopathologically, pathologies such as Crohn's disease, malacoplakia and tuberculous appendicitis were ruled out.Introducción. La inflamación xantogranulomatosa es un proceso inflamatorio crónico, rara vez se localiza en apéndice. Se presenta un caso de apendicitis xantogranulomatosa. Caso clínico. Masculino de 77 años, presenta con dolor intermitente en hemiabdomen derecho e hipertermia de un mes de evolución. La exploración física mostró tumoración en fosa iliaca y abdomen derecho. Se sometió a cirugía por probable hernia inguinal derecha incarcerada, se encontró apendicitis aguda perforada, con inflamación y adherencias, líquido purulento en hemiabdomen derecho y disección en pared abdominal. El resultado histopatológico fue apendicitis xantogranulomatosa.  La evolución del paciente fue favorable. Conclusión. La apendicitis xantogranulomatosa simula un cuadro típico de apendicitis aguda. Histopatológicamente se descartan patologías como enfermedad de Crohn, malacoplaquia y apendicitis tuberculosa

Factors Associated with Health-Related Quality of Life in Mexican Lupus Patients Using the LupusQol.

Health-related quality of life (HRQOL) is affected by numerous clinical variables, including disease activity, damage, fibromyalgia, depression and anxiety. However, these associations have not yet been described in Mexican patients with systemic lupus erythematosus (SLE).To evaluate the relationship between disease activity, damage, depression and fibromyalgia and HRQOL measured by the LupusQoL-instrument in Mexican patients with SLE.A cross-sectional study was conducted in women fulfilling the 1997 ACR classification criteria for SLE. HRQOL was evaluated using a disease-specific instrument for SLE, the LupusQoL (validated for the Spanish-speaking population). Patients were evaluated clinically to determine the degree of disease activity and damage using the Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and Systemic Lupus International Collaborating Clinics-Damage Index (SLICC), respectively. Fibromyalgia and depression were assessed using the ACR criteria and the CES-D scale, respectively. The relationship between HRQOL and these variables was measured using Spearman's rank correlation coefficient and linear regression analysis.A total of 138 women with SLE, age 40.3±11 years, disease duration 8.8±6.4 years, with disease activity in 51.4%, depression in 50%, damage in 43% and fibromyalgia in 19.6% were included. Poorer HRQOL correlated with depression (r = -0.61; p< 0.005), fibromyalgia (r = -0.42; p< 0.005), disease activity (r = -0.37; p < 0.005) and damage (r = -0.31; p < 0.005). In the multivariate linear regression analysis, damage (β = -3.756, p<0.005), fibromyalgia (β = -0.920, p<0.005), depression (β = -0.911, p<0.005) and disease activity (β = -0.911, p<0.005) were associated with poor HRQOL.SLE disease activity, damage, fibromyalgia and depression were associated with poor HRQOL in our sample of Mexican SLE patients

Evaluación clínica, bioquímica, endoscópica e histopatológica del tratamiento biológico de colitis ulcerativa: Clinical, biochemical, endoscopic and histopathological evaluation of biological treatment in ulcerative colitis

Background: Biological treatment is currently used as an alternative for the treatment of ulcerative colitis in patient’s refractory to conventional treatment. Objective: To evaluate biological treatment in patients with ulcerative colitis refractory to conventional treatment in a 3rd level care Hospital. Methods: A descriptive, retrospective, longitudinal study was carried out in patients with UC who were refractory to conventional treatment and who received biological treatment. The variables were evaluated in 3 moments: basal state (without biological treatment), at six and twelve months from the start of biological treatment. Descriptive statistics were used to characterize general population, later the 3 states mentioned above were described with their respective variables. Results: Eighteen patients with a mean age of 41.2 years were included. Evaluations at baseline and at 6 and 12 months showed: presence of blood in stools and abdominal pain in 94.4%%, 22.2% and 11.1% respectively; hemoglobin concentration &gt;10.5 g/dl in 50%, 83.3% and 88.9%; serum albumin concentration &gt;3.2 g/dl in 72.2%, 83.3% and 88.9%; the visual Mayo endoscopic scale 38.9%, 33.3% and 16.7% presented Mayo 2 and 61.1%, 16.7% and 1.7% Mayo 3. The histological activity in the baseline evaluation reached a severe level (11.1%), while in evaluations at 6 and 12 months they reached moderate in 55.6% and 27.8% respectively. Conclusions: Biological therapy as a treatment in patients with ulcerative colitis showed improvement in clinical, biochemical, endoscopic and histological manifestations, so far none with deep remission of the disease, no adverse reactions to treatment have been presented.Introducción: El tratamiento biológico es una alternativa para manejar la colitis ulcerativa en pacientes refractarios al tratamiento convencional. Objetivo: Evaluar el tratamiento biológico en pacientes con colitis ulcerativa refractarios al tratamiento convencional en un hospital de 3er nivel de atención. Métodos: Estudio descriptivo, retrospectivo, longitudinal en pacientes con colitis ulcerativa refractarios al tratamiento convencional y que recibieron tratamiento biológico. Las cortes se evaluaron en tres momentos: estado basal (sin terapia biológica), a los seis y doce meses de inicio del tratamiento biológico. Se utilizó estadística descriptiva para la caracterización de la población en general, posteriormente los tres puntos de corte se describieron con sus respectivas variables. Resultados: Se incluyeron 18 pacientes con edad media de 41,2 años. Las evaluaciones, en un estado basal, a los seis y 12 meses; demostraron presencia de sangre en las evacuaciones y dolor abdominal en 94,4%, 22,2% y 11,1% respectivamente, concentración de hemoglobina &gt;10,5 g/dl en 50%, 83,3% y 88,9%; concentración sérica de albúmina &gt;3,2 g/dl en 72,2%, 83,3% y 88,9% y escala visual endoscópica de Mayo 38,9%, 33,3% y 16,7% presentaron Mayo 2 y 61,1%, 16,7% y 1,7% Mayo 3. La actividad histológica en la evaluación basal llego hasta un nivel severo (11,1%), mientras que en evaluaciones a seis y 12 meses llegaron hasta moderada en un 55,6% y 27,8% respectivamente. Conclusiones: La terapia biológica en pacientes con colitis ulcerativa refractaria demostró mejoría en manifestaciones clínicas, bioquímicas, endoscópicas e histológicas. No se registró remisión profunda de la enfermedad, ni reacciones adversas al tratamiento

Cognitive characteristics and quality of life in attention deficit hyperactivity disorder

Background: Attention deficit hyperactivity disorder (ADHD) is the most frequent pediatric neurodevelopmental disorder. Studies in Mexico about health-related quality of life (QOL) and cognitive characteristics in these patients are scarce. Objectives: The objective of this study is to describe the relationship between cognitive characteristics and health-related QOL in children with ADHD in Puebla, Mexico. Method: A cross-sectional, analytical study was carried out in a second-level care hospital in Puebla, Mexico. Both genders, from 6 to 12 years old patients with ADHD were included. Those with visual/hearing disabilities and/or severe language delays were excluded. Patients who did not complete the information were eliminated. The Wechsler Intelligence Scale for Children IV (WISC-IV), The Neuropsi and Brief Multidimensional Life Satisfaction Scale for Students (as health-related QOL indicator) scales were applied. Spearman test was used; p ≤ 0.05 was considered significant. Results: 104 children were recruited, 71 male (68.26%), medium age was 8.94 years old (SD = 1.83, min = 6, max = 12). Work memory and processing speed (WISC-IV), and memory and attention (Neuropsi) were the most affected domains. Health-related QOL was low at 60%. WISC-IVs intellectual quotient (r = 0.3962, p = 0.000), and Neuropsi’s memory and attention (r = 0.451, p = 0.018) reported a significant moderated correlation with health-related QOL. Conclusion: Attention, memory, and processing speed were the most affected cognitive characteristics in children with attention deficit/hyperactivity disorder. Health-related QOL resulted low. Intellectual coefficient, as well as memory and attention, reported a significant moderated correlation with health-related QOL

Bone mineral density and vertebral fractures in patients with systemic lupus erythematosus : A systematic review and meta-regression

Background Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (VF) in patients with systemic lupus erythematosus (SLE). Therefore, the objectives of this systematic review and meta-regression were: 1) to compare BMD between SLE patients and healthy controls and 2) to evaluate the relationship between BMD and glucocorticoid therapy and VF in SLE patients. Methods and findings Articles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). Prospective longitudinal and cross-sectional studies were considered for review. We evaluated the quality of the evidence included using the Oxford Centre for evidence- based medicine (EBM) Levels of Evidence. In total, 38 articles were identified and analyzed (3442 SLE cases and 6198 controls) in the analysis of BMD (9232 women and 408 men). There were significant differences in mean BMD between SLE patients and controls. BMD mean difference in cases/controls: -0.0566 95% CI (-0.071, -0.0439; p = &gt; 0.0001). When only SLE patients were analyzed, the BMD did not significantly differ between patients who had or had not received glucocorticoid (GCT) therapy. 694 SLE patients were included in the analysis of VF (189 with VF vs. 505 without VF). Patients with VF had lower BMD than patients without VF (BMD mean difference without VF/with VF: 0.033 (95%CI: 0.006±0.060); p-value: 0.0156). Conclusions Patients with SLE had lower BMD than healthy controls. Moreover, SLE patients with VF had lower BMD than patients without VF. However, our data did not show that GCT therapy had an impact on BMD. © 2018 van den Berg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Bone mineral density and vertebral fractures in patients with systemic lupus erythematosus: A systematic review and meta-regression

<div><p>Background</p><p>Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density (BMD) and vertebral fractures (VF) in patients with systemic lupus erythematosus (SLE). Therefore, the objectives of this systematic review and meta-regression were: 1) to compare BMD between SLE patients and healthy controls and 2) to evaluate the relationship between BMD and glucocorticoid therapy and VF in SLE patients.</p><p>Methods and findings</p><p>Articles were identified from electronic databases (PubMed, Embase, VHL, SciELO and the Cochrane Library). Prospective longitudinal and cross-sectional studies were considered for review. We evaluated the quality of the evidence included using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence. In total, 38 articles were identified and analyzed (3442 SLE cases and 6198 controls) in the analysis of BMD (9232 women and 408 men). There were significant differences in mean BMD between SLE patients and controls. BMD mean difference in cases/controls: -0.0566 95% CI (-0.071, -0.0439; p = < 0.0001). When only SLE patients were analyzed, the BMD did not significantly differ between patients who had or had not received glucocorticoid (GCT) therapy. 694 SLE patients were included in the analysis of VF (189 with VF vs. 505 without VF). Patients with VF had lower BMD than patients without VF (BMD mean difference without VF/with VF: 0.033 (95%CI: 0.006–0.060); p-value: 0.0156).</p><p>Conclusions</p><p>Patients with SLE had lower BMD than healthy controls. Moreover, SLE patients with VF had lower BMD than patients without VF. However, our data did not show that GCT therapy had an impact on BMD.</p></div

Factores de riesgo asociados a recaída de enfermedad por reflujo gastroesofágico en pacientes de primer nivel de atención exitosamente tratados con inhibidor de la bomba de protones [Risk factors associated with gastroesophageal reflux disease relapse in primary care patients successfully treated with a proton pump inhibitor]

Resumen Antecedentes No existen estudios en primer nivel de atención sobre factores asociados a recaída de enfermedad por reflujo gastroesofágico (ERGE). Objetivo Identificar factores de riesgo asociados a recaída de ERGE en pacientes de primer nivel de atención que respondieron adecuadamente a un tratamiento corto con inhibidor de la bomba de protones. Pacientes y métodos Estudio de cohorte, se incluyeron casos incidentes de ERGE. Se dio tratamiento con omeprazol durante 4 semanas. Se aplicó ReQuest y un cuestionario de factores de riesgo. Se determinó la tasa de éxito terapéutico y de recaída a las 4 y 12 semanas después de suspender el tratamiento. Se realizó análisis de regresión logística de los posibles factores de riesgo para recaída de ERGE. Resultados De 83 pacientes, 74 (89.16%) respondieron al tratamiento. Los síntomas recurrieron en 36 pacientes (48.64%) a las 4 semanas y en 13 pacientes (17.57%) a las 12 semanas; recaída acumulada: 66.21%. En el análisis multivariado RM (intervalo de confianza del 95%): escolaridad básica o menor 24.95 (1.92-323.79), sobrepeso 1.76 (0.22-13.64), obesidad 0.25 (0.01-3.46), consumo de 4-12 tazas de café al mes 1.00 (0.12-7.84), cítricos 14.76 (1.90-114.57), AINE 27.77 (1.12-686.11), chocolate 0.86 (0.18-4.06), ácido acetilsalicílico 1.63 (0.12-21.63), tabaquismo 0.51 (0.06-3.88), bebidas carbonatadas 4.24 (0.32-55.05), picante de 7-16 veces/mes 1.39 (0.17-11.17), picante ≥ 20 veces/mes, 4.06 (0.47-34.59) de recaída de ERGE a las 12 semanas de suspender tratamiento. Conclusiones La tasa de recaída posterior al tratamiento corto con omeprazoI fue alta. El consumo de cítricos y el consumo de AINE incrementaron la posibilidad de recaída de ERGE. Abstract Background There are no studies on the factors associated with gastroesophageal reflux disease (GERD) relapse in primary care patients. Aim To identify the risk factors associated with GERD relapse in primary care patients that responded adequately to short-term treatment with a proton pump inhibitor. Patients and methods A cohort study was conducted that included GERD incident cases. The patients received treatment with omeprazole for 4 weeks. The ReQuest questionnaire and a risk factor questionnaire were applied. The therapeutic success rate and relapse rate were determined at 4 and 12 weeks after treatment suspension. A logistic regression analysis of the possible risk factors for GERD relapse was carried out. Results Of the 83 patient total, 74 (89.16%) responded to treatment. Symptoms recurred in 36 patients (48.64%) at 4 weeks and in 13 patients (17.57%) at 12 weeks, with an overall relapse rate of 66.21%. The OR multivariate analysis (95% CI) showed the increases in the possibility of GERD relapse for the following factors at 12 weeks after treatment suspension: basic educational level or lower, 24.95 (1.92-323.79); overweight, 1.76 (0.22-13.64); obesity, 0.25 (0.01-3.46); smoking, 0.51 (0.06-3.88); and the consumption of 4-12 cups of coffee per month, 1.00 (0.12-7.84); citrus fruits, 14.76 (1.90-114.57); NSAIDs, 27.77 (1.12-686.11); chocolate, 0.86 (0.18-4.06); ASA 1.63 (0.12-21.63); carbonated beverages, 4.24 (0.32-55.05); spicy food 7-16 times/month, 1.39 (0.17-11.17); and spicy food ≥ 20 times/month, 4.06 (0.47-34.59). Conclusions The relapse rate after short-term treatment with omeprazole was high. The consumption of citrus fruits and NSAIDs increased the possibility of GERD relapse