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Falavigna A.,University of Caxias do Sul | Filho D.E.M.,Federal University of São Paulo | Avila J.M.J.,Centro Medico Nacional Of Occidente | Guyot J.P.,Hospital Universitario Fundacion Favaloro | And 2 more authors.
European Journal of Orthopaedic Surgery and Traumatology | Year: 2015

Background: The emancipatory nature of education requires research as its fundamental base, because physicians can only improve their skills and knowledge through enquiry. The number and quality of scientific publications by Latin-American spine surgeons found in the Medline database was low between 2000 and 2011. Nevertheless, the research Bank Survey of AOSpine Latin America (AOSLA) members showed that 96 % of responders were very interested and motivated to perform scientific research. Methods and population: The research officer of AOSLA together with the Country Council and the AOSpine Research Commission established a competency-based curriculum to improve understanding of what is necessary to produce research and the best methods to achieve this goal. The research curriculum was divided into four main components: (1) research educational plan, (2) performing research, (3) technical and professional support and (4) assessment. Results: The competences, learning outcomes and a syllabus on knowledge in research were developed to enable the participants to understand and perform investigations effectively. The eLearning module was designed to improve the competences to access, evaluate and use scientific information available in the main databases efficiently. Research courses were given as an isolated activity four times in Brazil and Mexico and as precourse activities six times in Brazil, Mexico and Peru. The result was an increased number of articles published and works presented at congresses. Conclusions: The project of education in research can be effectively disseminated and applied across regions, across students and across specialties. © 2015, Springer-Verlag France.


Fierro J.A.A.,Centro Medico Nacional Of Occidente | Avina D.A.H.,Hospital General Of Zona Num 2
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.


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.


Coronado-Cordero I.A.,University of Guadalajara | Escalante-Pulido J.M.,Centro Medico Nacional Of Occidente
Medicina Interna de Mexico | Year: 2014

The DAWN multinational study in 2001 revealed significant differences between the needs of psychosocial and educational support for people living with diabetes and the care available to them. Therefore The call for global action DAWN looking to implement a model of personcentered care based on their needs was conducted. DAWN 2 (2011) then arises for the perception of care and needs of all actors from its context with the aim of assess barriers and facilitators for active and successful management of diabetes among patients living with diabetes family members or caregivers and professional health care providers. DAWN 2 is a hybrid, multinational, interdisciplinary study conducted in 17 countries in Africa, America (including Mexico for 1st time), Asia and Europe, with a total sample of 16,100 participants: 9,040 patients living with diabetes, 2,160 family members or caregivers and 4,900 professional health care providers: One sample per country of 900 participants: 500 patients living with diabetes, 120 family members or caregivers and 280 professional health care providers. Patients living with diabetes were included with ≥ 1 year of diagnosis, family members or caregivers without diabetes and with adult care patients living with diabetes; professional health care providers different in diabetes care, all over 18 years. A survey via Internet or interview was applied and quantitative (descriptive statistics, parametric and nonparametric bivariate and multivariate) and qualitative data (thematic content: encoding) were analyzed. DAWN 2 is a window to the understanding of the needs and perceptions of the actors to take concrete actions towards a model of person-centered care.


Tabchy A.,University of Texas M. D. Anderson Cancer Center | Valero V.,University of Texas M. D. Anderson Cancer Center | Vidaurre T.,Instituto Nacional Of Enfermedades Neoplasicas | Lluch A.,Grupo Espanol de Investigacion en Cancer de Mama | And 13 more authors.
Clinical Cancer Research | Year: 2010

Purpose: We examined in a prospective, randomized, international clinical trial the performance of a previously defined 30-gene predictor (DLDA-30) of pathologic complete response (pCR) to preoperative weekly paclitaxel and fluorouracil, doxorubicin, and cyclophosphamide (T/FAC) chemotherapy, and assessed if DLDA-30 also predicts increased sensitivity to FAC-only chemotherapy. We compared the pCR rates after T/FAC versus FACx6 preoperative chemotherapy. We also did an exploratory analysis to identify novel candidate genes that differentially predict response in the two treatment arms. Experimental Design: Two hundred and seventy-three patients were randomly assigned to receive either weekly paclitaxel × 12 followed by FAC × 4 (T/FAC, n = 138), or FAC × 6 (n = 135) neoadjuvant chemotherapy. All patients underwent a pretreatment fine-needle aspiration biopsy of the tumor for gene expression profiling and treatment response prediction. Results: The pCR rates were 19% and 9% in the T/FAC and FAC arms, respectively (P < 0.05). In the T/FAC arm, the positive predictive value (PPV) of the genomic predictor was 38% [95% confidence interval (95% CI), 21-56%], the negative predictive value was 88% (95% CI, 77-95%), and the area under the receiver operating characteristic curve (AUC) was 0.711. In the FAC arm, the PPV was 9% (95% CI, 1-29%) and the AUC was 0.584. This suggests that the genomic predictor may have regimen specificity. Its performance was similar to a clinical variable-based predictor nomogram. Conclusions: Gene expression profiling for prospective response prediction was feasible in this international trial. The 30-gene predictor can identify patients with greater than average sensitivity to T/FAC chemotherapy. However, it captured molecular equivalents of clinical phenotype. Next-generation predictive markers will need to be developed separately for different molecular subsets of breast cancers. ©2010 AACR.


Caldera G.,Centro Medico Nacional Of Occidente | Cahueque M.,Centro Medico Nacional Of Occidente
Trauma Case Reports | Year: 2016

In fracture dislocations of the lumbar region, two anatomical facts can help preserve neurological damage in patients, when compared with trauma in the cervical or thoracic region. Firstly, the spinal cord in adults extends only to the lower edge of the first lumbar vertebra, and secondly, the large vertebral space in this region gives ample space for the roots of the cauda equine. As a result, the nerve injury may be minimal, because the nerve roots in this region are accommodated in a larger area, with less content and space. This study presents the case of a 48-year-old male, a construction worker, who suffered a fall from a height of approximately 15 meters, directly hitting the lumbar region against a beam, and presenting pain and inability to move the legs. The patient was brought to the emergency room 1 hour after the accident, clinically assessed, submitted to x-rays and a CT scan, and diagnosed as having an ASIA B L3-L4 fracture dislocation. Three hours after the accident, reduction was performed via posterior transpedicular fixation. One week later, an anterior approach was performed. The patient progressed to ASIA C 24 hours after the first surgery. Three months later, the patient was functional with ASIA D and good sphincter control. The author's purpose is to show the results obtained by an intervention in the initial hours of the trauma, which helped promote the evolution from a nonfunctional injury to a functional one, with near-total recovery. © 2016.


da Silva H.B.,University of Washington | Messina-Lopez M.,Centro Medico Nacional Of Occidente | Sekhar L.N.,University of Washington
Methodist DeBakey cardiovascular journal | Year: 2014

Microsurgery for brain aneurysms is a current relevant technique, as advances in endovascular and stent-assisted coiling have not solved many of the difficulties inherent in the management of complex brain aneurysms. The following review highlights the importance of microsurgical bypass techniques for the management of complex cerebrovascular aneurysms and emphasizes, through two clinical cases, the technical difficulties and indications for bypass surgery. These cases demonstrate that in selected scenarios, bypass microsurgery still offers the only viable treatment for complex aneurysms.


PubMed | Centro Medico Nacional Of Occidente and University of Guadalajara
Type: | Journal: Journal of immunology research | Year: 2014

The macrophage migration inhibitory factor (MIF) is related to the progression of atherosclerosis, which, in turn, is a key factor in the development of acute coronary syndrome (ACS). MIF has a CATT short tandem repeat (STR) at position -794 that might be involved in its expression rate. The aim of this study was to investigate the association between the -794 (CATT)5-8MIF gene polymorphism and susceptibility to ACS in a western Mexican population. This research included 200 ACS patients classified according to the criteria of the American College of Cardiology (ACC) and 200 healthy subjects (HS). The -794 (CATT)5-8MIF gene polymorphism was analyzed using a conventional polymerase chain reaction (PCR) technique. The 6 allele was the most frequent in both groups (ACS: 54% and HS: 57%). The most common genotypes in ACS patients and HS were 6/7 and 6/6, respectively, and a significant association was found between the 6/7 genotype and susceptibility to ACS (68% versus 47% in ACS and HS, resp., P = 0.03). We conclude that the 6/7 genotype of the MIF -794 (CATT)5-8 polymorphism is associated with susceptibility to ACS in a western Mexican population.


PubMed | Centro Medico Nacional Of Occidente, Hospital General Of Occidente and University of Guadalajara
Type: | Journal: Mediators of inflammation | Year: 2014

The acute coronary syndrome (ACS) is a complex disease where genetic and environmental factors are involved. E-selectin gene is a candidate for ACS progression due to its contribution in the inflammatory process and endothelial function. The rs5361 (561A>C) polymorphism in the E-selectin gene has been linked to changes in gene expression, affinity for its receptor, and plasmatic levels; therefore it is associated with an increased risk of cardiovascular disease. The aim of this study was to determine the association of the rs5361 polymorphism with ACS and to measure serum levels of soluble E-selectin (sE-selectin).283 ACS patients and 205 healthy subjects (HS) from Western Mexico were included. The polymerase chain reaction-restriction fragment length polymorphism was used to determine the rs5361 polymorphism. The sE-selectin levels were measured by enzyme-linked immunosorbent assay.Neither genotype nor allele frequencies of the rs5361 polymorphism showed statistical differences between groups. The sE-selectin levels were significantly higher in ACS patients compared to HS (54.58 versus 40.41ng/ml, P = 0.02). The C allele had no effect on sE-selectin levels.The rs5361 E-selectin gene polymorphism is not a susceptibility marker for ACS in Western Mexico population. However, sE-selectin may be a biological marker of ACS.


PubMed | Centro Medico Nacional Of Occidente, Research Center Biomedica Of Occidente and University of Guadalajara
Type: | Journal: Disease markers | Year: 2015

Acute coronary syndrome (ACS) has an important impact in public health with high morbidity and mortality. Prothrombotic and proinflammatory states are involved in the pathogenesis of the disease. Plasminogen activator inhibitor-1 (PAI-1) is the major inhibitor of the fibrinolysis and also is part of immune response. The -844 G>A gene polymorphism is related to increased PAI-1 protein levels. The aim of the study is to evaluate the association of -844 G>A PAI-1 polymorphism with ACS.A total of 646 individuals were recruited from Western Mexico: 350 unrelated healthy subjects and 296 patients with diagnosis of ACS.The most important risk factor in our population was hypertension, followed by smoking. The genetic distribution showed an association of the A allele (OR = 1.27, P = 0.04) and AA genotype (OR = 1.86, P = 0.02) with ACS. The recessive model displayed similar results (OR = 1.76, P = 0.02). As additional finding, we observed significant differences in the genetic distribution of ACS dyslipidemic patients (OR = 1.99, P = 0.04). The A allele and AA genotype of -844 polymorphism of PAI-1 gene are risk factors for ACS. The AA genotype might be associated with the development of dyslipidemia in ACS patients.

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