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Sandoval-Sanchez J.H.,Centro Medico Nacional Of Occidente | Ramos-Zuniga R.,University of Guadalajara | Luquin De Anda S.,University of Guadalajara | Lopez-Dellamary F.,University of Guadalajara | And 3 more authors.
World Neurosurgery | Year: 2012

Objective: To evaluate whether bilayer chitosan scaffolding (BChS) can provide a watertight dural closure and permit regeneration by fibroblasts in an experimental in vivo model. Methods: In the in vitro phase, BChS was elaborated and the following characteristics were evaluated: pore size, thickness, water absorption capacity, tensile strength, strain, and toughness. In the second in vivo phase, 27 durectomized New Zealand rabbits were randomly assigned into three duraplasty groups with autologous dura, collagen matrix (CM), or BChS. In all groups, fluid leakage pressure was measured at 10, 21, or 180 days. Histology response to regeneration was evaluated through hematoxylin and eosin stain. Results: BChS was standardized to obtain bilayer scaffoldings with a nonporous layer and a porous layer. The pore size was 10 μm, total thickness was 400 μm, strain was 57.8%, and tensile strength was 5.5 gr/mm 2. The physical characteristics of BChS allowed dural closure without cerebrospinal fluid (CSF) leak. There were no differences in fluid leakage pressures between the BChS, dura, and CM groups. Histologic analysis showed fibroblast migration with adequate dural regeneration. Conclusions: BChS is an ideal alternative for a watertight dural closure because it can be sutured, and it induces organized regeneration with fibroblasts without evidence of fibrosis. © 2012 Elsevier Inc. All rights reserved.

Sanchez-Ramirez C.A.,University of Colima | Flores-Martinez S.E.,Instituto Mexicano del Seguro Social | Garcia-Zapien A.G.,Instituto Mexicano del Seguro Social | Montero-Cruz S.A.,University of Colima | And 2 more authors.
Pancreas | Year: 2012

Objectives: The study's objective was to assess the association between the PRSS1 R122H and N29I and the SPINK1 N34S mutations and acute pancreatitis (AP) and recurrent pancreatitis in Mexican pediatric patients. Methods: The N34S and R122H mutations were detected using polymerase chain reaction-restriction fragment length polymorphism, and the N29I mutation was detected using allele-specific polymerase chain reaction in 92 pancreatitis patients (58 AP and 34 recurrent pancreatitis patients) and 144 controls. Results: We found 1 mutated allele in 4 (4.3%) of 92 pancreatitis patients and none in the controls. All 4 patients bearing mutations had AP, with a frequency of 6.8% (4/58). Three (5.2%) of 58 patients were heterozygous for the N34S mutation, and 1 (1.7%) of 58 patients was heterozygous for the N29I mutation. The comparison between the AP and control groups revealed both a significant number of patients carrying any mutations in the screened genes (P = 0.008) and bearing the N34S mutation (P = 0.023). Moreover, we found that the N34S G allele increased the risk of developing AP (odds ratio, 10.3; confidence interval, 1.1-248.8). Conclusions: Patients bearing the N34S G allele exhibited a 10-fold increased risk of developing AP compared with controls, suggesting that the SPINK1 N34S mutation represents an etiologic risk factor for AP in our Mexican pediatric patients. Copyright © 2012 by Lippincott Williams & Wilkins.

Fierro J.A.A.,Centro Medico Nacional Of Occidente | Avina D.A.H.,Medicina Familiar
Revista Mexicana de Pediatria | Year: 2014

The enlargement in the population with diabetes mellitus had increased in the incidence of the newborn from diabetic mothers with malformations by diabetic embryopathy caused by inadequate metabolic control of the disease during the first trimester of pregnancy, especially after the third week of pregnancy and before the seventh during embryogenesis and organogenesis. The clinical manifestations show slight appearance of facial dysmorphism, and moderated skeletal muscle malformations mainly in lower segments (caudal dysgenesis) with vertebral abnormalities, hypoplasia of lower limbs and polydactyly with supernumerary toe in hallucal location. Some others defects may also occur in heart and great vessels, abnormalities in the development of the brain and neural tube and less frequently gastrointestinal, genital or urinary diseases. Newborn of diabetic mothers should be carefully reviewed to detect early these defects and try to work on those that are modifiable, although the main objective should be obtain adequate glycemic level during pregnancy and raise the awareness about these risks.

Salazar-Lopez-Ortiz C.G.,National Autonomous University of Mexico | Ortiz-Plata A.,Instituto Nacional Of Neurologia Y Neurocirugia | Rembao-Bojorquez J.D.,Oncopatologo | Sandoval-Huerta G.A.,Centro Medico Nacional Of Occidente
Ginecologia y Obstetricia de Mexico | Year: 2014

Background: Hyperprolactinemia is a common finding within clinical practice in both endocrinology and general practice fields, amongst other specialties. The general practitioner and other specialists must know the indications and serum prolactin determination parameters in order to, once detected, derive the patient for a correct assessment and begin treatment. Objective: Formulate a clinical practice guideline evidence-based for the diagnosis and treatment of hyperprolactinemia. Method: It took the participation of eight gynecologists, two pathologists and a pharmacologist in the elaboration of this guideline due their experience and clinical judgement. These recommendations were based upon diagnostic criteria and levels of evidence from treatment guidelines previously established, controlled clinical trials and standardized guides for adolescent and adult population with hyperprolactinemia. Results: During the conformation of this guideline each specialist reviewed and updated a specific topic and established the evidence existent over different topics according their field of best clinical expertise, being enriched by the opinion of other experts. At the end, all the evidence and decisions taken were unified in the document presented here. Conclusions: It is presented the recommendations established by the panel of experts for diagnosis and treatment of patients with high levels of prolactin; also the level of evidence for the diagnosis of hyperprolactinemia, handling drug-induced hyperprolactinemia and prolactinomas in pregnant and non-pregnant patients.

Macias-Rosales R.,Centro Medico Nacional Of Occidente | Larrosa-Haro A.,University of Guadalajara | Ortiz-Gabriel G.,Instituto Mexicano del Seguro Social
Journal of Pediatric Gastroenterology and Nutrition | Year: 2016

Objectives: The aim of this study was to compare the effectiveness of oral (PO) versus enteral nutrition (EN) medium-chain triglyceride (MCT) containing formula to prevent malnutrition and growth impairment in infants with biliary atresia (BA) waiting for a liver transplant. Methods: A total of 15 infants, 3 to 9 months old with BA were included. They were randomly assigned to either PO or EN. For 12 weeks, both groups received an MCT formula fortified with glucose polymers and corn oil to reach a caloric density between 0.8 and 1 kcal/mL. The formula given to the PO group was administered ad libitum and that given via EN was infused through a nasogastric tube to reach 140% of the energy intake recommended by the Dietary Recommended Intake guidelines. Protein intake was adjusted to 4 to 5 g/kg present weight. Outcome variables were growth and nutritional status evaluated periodically by anthropometric indicators. Biochemical and hematological variables were evaluated through the study. Results: Baseline clinical, nutritional, biochemical, and hematological variables showed no differences between the study groups. Baseline length/age was < 2SD in 10 of the 15 patients; in the PO group, it fell <-3 SD, whereas in the EN group, it remained stable. Head circumference z score dropped 0.6SD in the PO group, whereas in the EN group it remained stable. Triceps skinfold values improved in the infants taking EN, P<0.001. The frequency of adverse effects-respiratory infection and diarrhea-was higher in the EN group. No biochemical or hematological differences were observed between the study groups throughout the study. Conclusions: A 12-week EN trial with an MCT-fortified formula prevented malnutrition and growth impairment in infants with BA waiting for a liver transplant. © 2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

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