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Rios O.M.,Hospital Infantil Of Mexico Federico Gomez | Gutierrez L.J.,Hospital Infantil Of Mexico Federico Gomez | Talavera J.O.,Centro Medico Nacional Siglo XXI IMSS | Tellez-Rojo M.M.,Instituto Nacional Of Salud Publica | And 3 more authors.
International Journal of Clinical Pharmacy | Year: 2016

Background Physicians identify from 45.7 to 96.2 % of Adverse Drug Reactions (ADRs) in their patients, with under-reporting ranging from 6 to 100 %. In order to improve ADR reporting, several interventions have been evaluated in different studies, but not with regard to ADR identification. In addition, it is not known whether some patient characteristics might influence on ADR identification and reporting by physicians. Objectives (a) To assess the effectiveness of a comprehensive intervention directed to Emergency Department physicians and coordinated by a pharmacist in a tertiary care pediatric hospital on ADR identification and reporting. (b) To assess if some of the children’s characteristics might influence on ADR identification and reporting. Setting The Emergency Department of the Hospital Infantil de México “Federico Gómez”, which is a national pediatric institute of health in México. Methods A Quasi-experimental, pre-post test trial was designed. During the intervention, the pharmacist gave talks on Pharmacovigilance and on the program for electronic capture of data, took part in patient visits, left reminders, improved accessibility to ADR report format and performed feedback activities. To classify and quantify correctly identified ADRs and ADRs reported to the Institutional Pharmacovigilance Center (IPC), 1136 clinical records were reviewed. The models were adjusted for patient variables. Main outcome measures Total ADRs, ADRs correctly identified by physicians, ADRs reported to the IPC by physicians. Results Before the intervention, 97 % of ADRs were correctly identified and 6.1 % reported by physicians. During the intervention, 99.6 % were correctly identified and 41.2 % were reported, and after the intervention, 99.6 and 41.7 %, respectively. Identification during the intervention showed a sevenfold increase with regard to preintervention and was maintained post-intervention. ADR reporting during the intervention showed a 14-fold increase with regard to pre-intervention and was maintained during post-intervention. Conclusion Physicians do identify ADRs, but fail to report them. The intervention increased ADR correct identification and reporting. The effect was maintained after the intervention. © 2015, Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie.


Saldana Z.,University of Florida | De La Cruz M.A.,University of Florida | De La Cruz M.A.,Centro Medico Nacional Siglo XXI IMSS | Carrillo-Casas E.M.,Hospital General Dr Manuel Gea Gonzalez | And 6 more authors.
PLoS ONE | Year: 2014

Uropathogenic Escherichia coli (UPEC) strains cause urinary tract infections and employ type 1 and P pili in colonization of the bladder and kidney, respectively. Most intestinal and extra-intestinal E. coli strains produce a pilus called E. coli common pilus (ECP) involved in cell adherence and biofilm formation. However, the contribution of ECP to the interaction of UPEC with uroepithelial cells remains to be elucidated. Here, we report that prototypic UPEC strains CFT073 and F11 mutated in the major pilin structural gene ecpA are significantly deficient in adherence to cultured HeLa (cervix) and HTB-4 (bladder) epithelial cells in vitro as compared to their parental strains. Complementation of the ecpA mutant restored adherence to wild-type levels. UPEC strains produce ECP upon growth in Luria-Bertani broth or DMEM tissue culture medium preferentially at 26°C, during incubation with cultured epithelial cells in vitro at 37°C, and upon colonization of mouse bladder urothelium ex vivo. ECP was demonstrated on and inside exfoliated bladder epithelial cells present in the urine of urinary tract infection patients. The ability of the CFT073 ecpA mutant to invade the mouse tissue was significantly reduced. The presence of ECP correlated with the architecture of the biofilms produced by UPEC strains on inert surfaces. These data suggest that ECP can potentially be produced in the bladder environment and contribute to the adhesive and invasive capabilities of UPEC during its interaction with the host bladder. We propose that along with other known adhesins, ECP plays a synergistic role in the multi-step infection of the urinary tract. © 2014 Saldaña et al.


Hernandez-Magro P.M.,Hospital Guadalupano Of Celaya | Esparza J.P.P.R.,Hospital Of Especialidades | Saenz E.V.,Hospital Of Especialidades | Ramirez J.L.R.,Hospital Of Especialidades | And 2 more authors.
Journal of Coloproctology | Year: 2015

Background: Human bone marrow transplantation (BMT) becomes an accepted treatment ofleukemia, aplastic anemia, immunodeficiency syndromes, and hematologic malignancies.Colorectal surgeons must know how to determine and manage the main colonic complica-tions.Objective: To review the clinical features, clinical and pathological staging of graft vs hostdisease (GVHD), and treatment of patients suffering with colonic complications of humanbone marrow transplantation.Patients and methods: We have reviewed the records of all patients that received an allogeneicbone marrow transplant and were evaluated at our Colon and Rectal Surgery departmentdue to gastrointestinal symptoms, between January 2007 and January 2012. The study wascarried out in patients who developed colonic complications, all of them with clinical,histopathological or laboratory diagnosis.Results: The study group was constituted by 77 patients, 43 male and 34 female patients. Weidentified colonic complications in 30 patients (38.9%); five patients developed intestinaltoxicity due to pretransplant chemotherapy (6.4%); graft vs. host disease was present in16 patients (20%); 13 patients (16.8%) developed acute colonic GVHD, and 3 (3.8%) chronicGVHD. Infection was identified in 9 patients (11.6%).Conclusions: The three principal colonic complications are the chemotherapy toxicity, GVHD,and superinfection; the onset of symptoms could help to suspect the type of complication(0–20 day chemotherapy toxicity, 20 and more GVHD), and infection could appear in anytime of transplantation. © 2014 Sociedade Brasileira de Coloproctologia. Published by Elsevier Editora Ltda. Allrights reserved.


Gallardo Hernandez A.,Centro Medico Nacional Siglo XXI IMSS
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference | Year: 2012

Theoretically High-Order Sliding-Mode Controllers are well suited to perform closed loop glucose regulation because they are insensitive to parameter uncertainties and robust to unknown dynamics that may perturb the system. The implementation of the controller based on the concept of practical relative degree is presented. The controller was tested in Sprague-Dawley rats with steptozotocin induced diabetes. The tests demonstrated high efficacy and robustness of the controller.


Perez Aceves E.,Centro Medico Nacional Siglo XXI IMSS | Perez Cristobal M.,Centro Medico Nacional Siglo XXI IMSS | Espinola Reyna G.A.,Centro Medico Nacional Siglo XXI IMSS | Ariza Andraca R.,Hospital Angeles del Pedregal | And 2 more authors.
Reumatologia Clinica | Year: 2013

Background: Pulmonary hemorrhage (PH) occurs in 2-5% of SLE patients, and is associated with a high mortality rate (79-90%). Diagnostic criteria for this complication include: 1) Pulmonary infiltrates, with at least 3/4 of lung tissue involved in a chest x ray, 2) Acute respiratory failure, 3) A decrease of 3. g/dL or more in hemoglobin levels. PH might lead to organized pneumonia, collagen deposition, and pulmonary fibrosis which in time might cause changes in pulmonary function tests with either restrictive or obstructive patterns. Aim: To evaluate the existence of abnormalities in pulmonary function tests after a PH episode. Methods: We included patients with SLE and primary vasculitis that developed PH. During the acute episode, we measured SLEDAI in SLE patients, five factor score in microscopic polyangiitis (MPA) and Birmingham Vasculitis Activity Store (BVAS) in granulomatosis with polyangiitis (GPA) (Wegener). We determined the number of PH events, treatment, and ventilator assistance requirements and correlated its association with abnormal pulmonary function tests. Results: We included 10 patients, 7 with SLE, 2 with MPA and 1 with GPA (Wegener). The mean activity measures were: SLEDAI 20.4 ± 7.5, FFS 2, and BVAS 36. Treatment consisted in methylprednisolone (MPD) in 3 patients, MPD plus cyclophosphamide (CY) in 6 patients, and MPD, CY, IV immunoglobulin, and plasmapheresis in one patient. Five patients required ventilatory support. We found abnormalities in pulmonary function tests in 8 patients, three had an obstructive pattern and five a restrictive pattern; 2 patients did not show any change. We did not find a significant association with any of the studied variables. Conclusion: PH might cause abnormalities in pulmonary function tests and prolonged immunosuppressive treatment could be required. © 2012 Elsevier España, S.L.


Cruz Guzman O.D.R.,Centro Medico Nacional Siglo XXI IMSS | Chavez Garcia A.L.,Centro Medico Nacional Siglo XXI IMSS | Rodriguez-Cruz M.,Centro Medico Nacional Siglo XXI IMSS
International Journal of Endocrinology | Year: 2012

Common metabolic and endocrine alterations exist across a wide range of muscular dystrophies. Skeletal muscle plays an important role in glucose metabolism and is a major participant in different signaling pathways. Therefore, its damage may lead to different metabolic disruptions. Two of the most important metabolic alterations in muscular dystrophies may be insulin resistance and obesity. However, only insulin resistance has been demonstrated in myotonic dystrophy. In addition, endocrine disturbances such as hypogonadism, low levels of testosterone, and growth hormone have been reported. This eventually will result in consequences such as growth failure and delayed puberty in the case of childhood dystrophies. Other consequences may be reduced male fertility, reduced spermatogenesis, and oligospermia, both in childhood as well as in adult muscular dystrophies. These facts all suggest that there is a need for better comprehension of metabolic and endocrine implications for muscular dystrophies with the purpose of developing improved clinical treatments and/or improvements in the quality of life of patients with dystrophy. Therefore, the aim of this paper is to describe the current knowledge about of metabolic and endocrine alterations in diverse types of dystrophinopathies, which will be divided into two groups: childhood and adult dystrophies which have different age of onset. Copyright © 2012 Oriana del Roco Cruz Guzmn et al.


Abdo-Francis J.M.,Hospital General Of Mexico | Perez-Hernandez J.L.,Hospital General Of Mexico | Hinojosa-Ruiz A.,Hospital General Of Mexico | Hernandez-Vasquez J.R.,Centro Medico Nacional Siglo XXI IMSS
Revista de Gastroenterologia de Mexico | Year: 2010

Background: Hepatic encephalopathy (HE) is a common cause of hospital admission in patients with cirrhosis involving high costs of care. Aim: To evaluate the use of L-ornithine L-aspartate (LOLA) vs. lactulose is able to reduce the length of hospital stay and the timing of improvement of hepatic encephalopathy. Methods: Retrospective and comparative study of patients with HE admitted to the Medical Gastroenterology Unit of a tertiary referral center in Mexico City (Hospital General de México) in a period of three years. Patients were divided in two treatment groups: LOLA vs. oral lactulose. We compared time to remission of encephalopathy, days of hospital stay and costs of hospital care. Results: We included 80 patients: 40 patients who received treatment with latulose had acumulative hospital stay of 443 days vs. 264 days for those who received LOLA (40% reduction in permanecieron hospitalizados 264 días acumulados, lo que significó una disminución global de 40% en los días de internamiento. En el grupo tratado con lactulosa, la estancia hospitalaria promedio fue de 11.07 días vs. 6.47 días del grupo tratado con LOLA. Así, un número significativamente mayor de los pacientes tratados con LOLA permanecieron internados una semana menos en comparación con los tratados con lactulosa (65% vs. 20%, respetivamente; RM 4.33, IC 95% 1.67-11.23, p = 0.004). El tiempo promedio de recuperación de la encefalopatía fue menor con LOLA (4.32 vs. 10.15 días). Conclusiones: La utilización de LOLA para el tratamiento de encefalopatía hepática, disminuye significativamente la estancia intrahospitalaria y la revierte más rápidamente.


Flores-Lopez L.A.,Centro Medico Nacional Siglo Xxi Imss | Flores-Lopez L.A.,Metropolitan Autonomous University | Diaz-Flores M.,Centro Medico Nacional Siglo Xxi Imss | Garcia-Macedo R.,Centro Medico Nacional Siglo Xxi Imss | And 6 more authors.
Molecular Biology Reports | Year: 2013

Pancreatic β-cell death in type 2 diabetes has been related to p53 subcellular localisation and phosphorylation. However, the mechanisms by which p53 is phosphorylated and its activation in response to oxidative stress remain poorly understood. Therefore, the aim of this study was to investigate mitochondrial p53 phosphorylation, its subcellular localisation and its relationship with apoptotic induction in RINm5F cells cultured under high glucose conditions. Our results show that p53 phosphorylation in the mitochondrial fraction was greater at ser392 than at ser15. This increased phosphorylation correlated with an increase in reactive oxygen species, a decrease in the Bcl-2/Bax ratio, a release of cytochrome c and an increase in the rate of apoptosis. We also observed a decline in ERK 1/2 phosphorylation over time, which is an indicator of cell proliferation. To identify the kinase responsible for phosphorylating p53, p38 mitogen-activated protein kinase (MAPK) activation was analysed. We found that high glucose induced an increase in p38 MAPK phosphorylation in the mitochondria after 24-72 h. Moreover, the phosphorylation of p53 (ser392) by p38 MAPK in mitochondria was confirmed by colocalisation studies with confocal microscopy. The addition of a specific p38 MAPK inhibitor (SB203580) to the culture medium during high glucose treatment blocked p53 mobilisation to the mitochondria and phosphorylation; thus, the release of cytochrome c and the apoptosis rate in RINm5F cells decreased. These results suggest that mitochondrial p53 phosphorylation by p38 MAPK plays an important role in RINm5F cell death under high glucose conditions. © 2013 Springer Science+Business Media Dordrecht.


PubMed | Laboratorio Of Farmacologia, Centro Medico Nacional Siglo Xxi Imss and Metropolitan Autonomous University
Type: | Journal: Journal of ethnopharmacology | Year: 2016

Cucurbita ficifolia Bouch(C. ficifolia) is a plant used in Mexican traditional medicine to control type 2 diabetes (T2D). The hypoglycemic effect of the fruit of C. ficifolia has been demonstrated in different experimental models and in T2D patients. It has been proposed that D-chiro-inositol (DCI) is the active compound of the fruit. Additionally, it has been reported that C. ficifolia increases the mRNA expression of insulin and Kir 6.2 (a component of the ATP-sensitive potassium (K(+)ATP) channel, which is activated by sulphonylurea) in RINm5F cells. However, it remains unclear whether C. ficifolia and DCI causes the secretion of insulin by increasing the concentration of intracellular calcium ([Ca(2+)]i) through K(+)ATP channel blockage or from the reservoir in the endoplasmic reticulum (ER).The aqueous extract of C. ficifolia was obtained and standardized with regard to its DCI content. RINm5F pancreatic -cells were incubated with different concentrations (50, 100, 200 and 400M) of DCI alone or C. ficifolia (9, 18, 36 and 72g of extract/mL), and the [Ca(2+)]i of the cells was quantified. The cells were preloaded with the Ca(2+) fluorescent dye fluo4-acetoxymethyl ester (AM) and visualized by confocal microscopy. Insulin secretion was measured by an ELISA method. Subsequently, the effect of C. ficifolia on the K(+)ATP channel was evaluated. In this case, the blocker activator diazoxide was used to inhibit the C. ficifolia-induced calcium influx. In addition, the inositol 1,4,5-trisphosphate (IP3)-receptor-selective inhibitor 2-amino-thoxydiphenylborate (2-APB) was used to inhibit the influx of calcium from the ER that was induced by C. ficifolia.It was found that DCI alone did not increase [Ca(2+)]i or insulin secretion. In contrast, treatment with C. ficifolia increased [Ca(2+)]i 10-fold compared with the control group. Insulin secretion increased by 46.9%. In the presence of diazoxide, C. ficifolia decreased [Ca(2+)]i by 50%, while insulin secretion increased by 36.4%. In contrast, in the presence of 2-APB, C. ficifolia increased [Ca(2+)]i 18-fold, while insulin secretion remained constant, indicating an additive effect. Therefore, C. ficifolia was not found to block the K(+)ATP channel. However, it did exert an effect by increasing [Ca(2+)]i from the ER, which may partly explain the insulin secretion observed following treatment with C. ficifolia.The hypoglycemic properties of C. ficifolia can be explained in part by its effect as a secretagogue for insulin through an increase in [Ca(2+)]i from the calcium reservoir in the ER. Therefore, the mechanism of action of C. ficifolia is different to those of the currently used hypoglycemic drugs, such as sulfonylureas. These results support that C. ficifolia may be a potential natural resource for new agents to control T2D.


PubMed | Centro Medico Nacional Siglo XXI IMSS
Type: Journal Article | Journal: Reumatologia clinica | Year: 2013

Pulmonary hemorrhage (PH) occurs in 2-5% of SLE patients, and is associated with a high mortality rate (79-90%). Diagnostic criteria for this complication include: 1) Pulmonary infiltrates, with at least of lung tissue involved in a chest x ray, 2) Acute respiratory failure, 3) A decrease of 3g/dL or more in hemoglobin levels. PH might lead to organized pneumonia, collagen deposition, and pulmonary fibrosis which in time might cause changes in pulmonary function tests with either restrictive or obstructive patterns.To evaluate the existence of abnormalities in pulmonary function tests after a PH episode.We included patients with SLE and primary vasculitis that developed PH. During the acute episode, we measured SLEDAI in SLE patients, five factor score in microscopic polyangiitis (MPA) and Birmingham Vasculitis Activity Store (BVAS) in granulomatosis with polyangiitis (GPA) (Wegener). We determined the number of PH events, treatment, and ventilator assistance requirements and correlated its association with abnormal pulmonary function tests.We included 10 patients, 7 with SLE, 2 with MPA and 1 with GPA (Wegener). The mean activity measures were: SLEDAI 20.4 7.5, FFS 2, and BVAS 36. Treatment consisted in methylprednisolone (MPD) in 3 patients, MPD plus cyclophosphamide (CY) in 6 patients, and MPD, CY, IV immunoglobulin, and plasmapheresis in one patient. Five patients required ventilatory support. We found abnormalities in pulmonary function tests in 8 patients, three had an obstructive pattern and five a restrictive pattern; 2 patients did not show any change. We did not find a significant association with any of the studied variables.PH might cause abnormalities in pulmonary function tests and prolonged immunosuppressive treatment could be required.

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