Salles M.J.C.,Infectious Diseases Clinic |
Zurita J.,Pontifical Catholic University of Ecuador |
Mejia C.,Hospital Roosevelt |
Villegas M.V.,Bacterial Resistance Group |
And 12 more authors.
Epidemiology and Infection | Year: 2013
Latin America has a high rate of community-associated infections caused by multidrug-resistant Enterobacteriaceae relative to other world regions. A review of the literature over the last 10 years indicates that urinary tract infections (UTIs) by Escherichia coli, and intra-abdominal infections (IAIs) by E. coli and Klebsiella pneumoniae, were characterized by high rates of resistance to trimethoprim/sulfamethoxazole, quinolones, and second-generation cephalosporins, and by low levels of resistance to aminoglycosides, nitrofurantoin, and fosfomycin. In addition, preliminary data indicate an increase in IAIs by Enterobacteriaceae producing extended-spectrum β-lactamases, with reduced susceptibilities to third- and fourth-generation cephalosporins. Primary-care physicians in Latin America should recognize the public health threat associated with UTIs and IAIs by resistant Gram-negative bacteria. As the number of therapeutic options become limited, we recommend that antimicrobial prescribing be guided by infection severity, established patient risk factors for multidrug-resistant infections, acquaintance with local antimicrobial susceptibility data, and culture collection. © Cambridge University Press 2013.
Huerta-Garcia G.,Hospital Of Pediatria |
Huerta-Garcia G.,Hospital Of Pediatria Centro Medico Nacional Siglo Xxi |
Mata-Marin J.A.,Hospital Of Infectologia |
Sandoval-Ramirez J.,Hospital Of Infectologia |
And 3 more authors.
AIDS Research and Therapy | Year: 2014
Background: Treatments in patients with multidrug resistance often involve the use of multiple agents with partial antiviral activity and overlapping metabolic toxicities. Enfuvirtide is therefore a welcome addition to the antiretroviral management of patients with multiclass resistant virus, given the low risk of systemic toxicities and novel mechanism of action relative to existing drug classes. Methods: Prospective cohort of treatment-experienced HIV-1-infected adults with virological failure who started therapy with an ENF-containing regimen. The effectiveness of ENF treatment was evaluated with percentages of undetectable HIV-1 RNA viral load after 24 and 48 weeks of treatment, and changes in CD4+ cell counts. Results: Forty patients >18 years were included. After 24 weeks of treatment, 91% of patients had HIV-1 RNA viral load <400 copies/mL and 65.8% had <50 copies/mL. At week 48 of treatment, 81.4% of the patients had HIV-1 RNA <400 copies/mL and 55.5% had <50 copies/mL; in both cases p <0.0001 compared to baseline. Increase CD4+ cells were also statistically significant at weeks 24 and 48 with respect to the baseline. Pain at the site of injection was the main adverse event in 100% of patients. Conclusion: Our study provides clinically important evidence of the effectiveness and safety of ENF in highly ARV-experienced HIV-1-infected patients. These findings strengthen the results of previous randomized controlled trials with this agent. © Huerta-García et al.; licensee BioMed Central.
Medina-Bravo P.,Hospital Infantil Of Mexico Federico Gomez |
Coyote-Estrada N.,Hospital Infantil Of Mexico Federico Gomez |
Nishimura-Meguro E.,Hospital Of Pediatria Centro Medico Nacional Siglo Xxi
Pediatric Diabetes | Year: 2013
Background: Recent evidence suggests that high-density lipoprotein (HDL) physicochemical characteristics and functional capacity may be more important that HDL-C levels in predicting coronary heart disease. There is little data regarding HDL subclasses distribution in youth with type 1 diabetes. Objective: To assess the relationships between glycemic control and HDL subclasses distribution, composition, and function in adolescents with type 1 diabetes. Methods: This cross-sectional study included 52 adolescents with type 1 diabetes aged 12-16 years and 43 age-matched non-diabetic controls. Patients were divided into two groups: one in fair control [hemoglobin A1c (HbA1c) < 9.6%] and the second group with poor glycemic control (HbA1c ≥ 9.6%). In all participants, we determined HDL subclasses distribution, composition, and the ability of plasma and of isolated HDL to promote cellular cholesterol efflux. Levels of soluble adhesion molecules were also measured. Results: Although both groups of patients and the control group had similar HDL-C levels, linear regression analyses showed that compared with non-diabetic subjects, the poor control group had a lower proportion of HDL2b subclass (p=0.029), triglyceride enriched (p=0.045), and cholesteryl ester depleted (p=0.028) HDL particles. Despite these HDL changes, cholesterol efflux was comparable among the three groups. The poor control group also had significantly higher intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 plasma concentrations. Conclusions: In adolescents with type 1 diabetes, poor glycemic control is associated with abnormalities in HDL subclasses distribution and HDL lipid composition, however, in spite of these HDL changes, the ability of HDL to promote cholesterol efflux remains comparable to that of healthy subjects. © 2012 John Wiley & Sons A/S.
Chimal-Ramirez G.K.,Hospital Of Pediatria Centro Medico Nacional Siglo Xxi |
Chimal-Ramirez G.K.,National Polytechnic Institute of Mexico |
Espinoza-Sanchez N.A.,Hospital Of Pediatria Centro Medico Nacional Siglo Xxi |
Espinoza-Sanchez N.A.,National Autonomous University of Mexico |
Fuentes-Panana E.M.,Hospital Of Pediatria Centro Medico Nacional Siglo Xxi
Journal of Oncology | Year: 2013
Experimental and clinical studies indicate that cells of the innate and adaptive immune system have both anti- and pro-tumor activities. This dual role of the immune system has led to a conceptual shift in the role of the immune system's regulation of cancer, in which immune-tumor cell interactions are understood as a dynamic process that comprises at least five phases: immunosurveillance, immunoselection, immunoescape, oncotraining, and oncopromotion. The tumor microenvironment shifts immune cells to perform functions more in tune with the tumor needs (oncotraining); these functions are related to chronic inflammation and tissue remodeling activities. Among them are increased proliferation and survival, increased angiogenesis and vessel permeability, protease secretion, acquisition of migratory mesenchymal characteristics, and self-renewal properties that altogether promote tumor growth and metastasis (oncopromotion). Important populations in all these pro-tumor processes are M2 macrophages, N2 neutrophils, regulatory T cells, and myeloid derived suppressor cells; the main effectors molecules are CSF-1, IL-6, metalloproteases, VEGF, PGE-2, TGF-β, and IL-10. Cancer prognosis correlates with densities and concentrations of protumoral populations and molecules, providing ideal targets for the intelligent design of directed preventive or anticancer therapies. © 2013 G. K. Chimal-Ramírez et al.
Berezin E.N.,Pediatric Infectious Diseases Unit |
Solorzano F.,Hospital Of Pediatria Centro Medico Nacional Siglo Xxi
Journal of Infection in Developing Countries | Year: 2014
In order to review the epidemiology of Gram-negative infections in the pediatric and neonatal intensive care units (PICUs and NICUs) of Latin America a systematic search of PubMed and targeted search of SciELO was performed to identify relevant articles published since 2005. Independent cohort data indicated that overall infection rates were higher in Latin American PICUs and NICUs versus developed countries (range, 5%-37% vs 6%-15%, respectively). Approximately one third of Latin American patients with an acquired PICU or NICU infection died, and crude mortality was higher among extremely low-birth-weight infants and those with an infection caused by Gram-negative bacteria. In studies reporting > 100 isolates, the frequency of Gram-negative pathogens varied from 31% (Colombia) to 63% (Mexico), with Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli the predominant pathogens in almost all countries, and Acinetobacter spp. and Serratia spp. isolated sporadically. The activity of quinolones and third-generation cephalosporins against P. aeruginosa, Acinetobacter spp., and Enterobacteria was seriously compromised, coincident with a high prevalence of circulating extended-spectrum β-lactamases. Furthermore, we identified two observational studies conducted in Chile nd Brazil reporting infections by P. aeruginosa and Acinetobacter baumannii in PICUs, demonstrating resistance to carbapenems, and two outbreaks of carbapenem-resistant K. pneumoniae in Colombia and Brazil. The endemicity of multidrug-resistant Gram-negative infections in Latin American PICUs and NICUs is punctuated by intermittent clonal outbreaks. The problem may be alleviated by ensuring ICUs are less crowded, increasing staffing levels of better-trained health care personnel, and implementing antimicrobial stewardship and surveillance programs. © 2014 Berezin et al.
Eguia-Aguilar P.,Hospital Infantil Of Mexico Federico Gomez |
Ponce-Castaneda V.,Hospital Of Pediatria Centro Medico Nacional Siglo Xxi |
Najera-Garcia N.,Hospital General Of Mexico |
Nieto-Martinez K.,Hospital General Of Mexico |
And 5 more authors.
Archives of Medical Research | Year: 2010
Background and Aims: Rhabdomyosarcoma (RMS) is a pediatric tumor whose classification is based on histological criteria according to two main subgroups, embryonal RMS (ERMS) and alveolar RMS (ARMS). The majority but not all ARMS carry the specific PAX3(7)/. FKHR translocation. The type of translocation in patients with ARMS defines the prognosis. Methods: We retrospectively analyzed 30 cases of ARMS in Mexican patients and evaluated the fusion status of the genes using RT-PCR and fluorescence in situ hybridization (FISH) in formalin-fixed paraffin-embedded tissues (FFPET). Results: From 25 samples (83%) with optimal RNA quality, RT-PCR revealed 15 cases (50%) with the t(2;13)/. PAX3- FKHR. Only one case (3%) was positive to t(1;13)/. PAX7- FKHR and nine cases (30%) were fusion-negative. Correspondingly, using FISH, the t(2;13)/. PAX3- FKHR was found positive in 19 cases (63.5%), one case (3%) revealed the t(1;13)/. PAX7/. FKHR and ten cases (33.5%) were fusion-negative by this method. Five cases were not evaluable by RT-PCR but recovered by FISH. Only four of the total revealed t(2;13); the other was fusion-negative. Conclusions: FISH technique is more sensitive when FFPET is used to describe the chromosomal translocation of ARMS. These Latino patients showed an association of the t(2;13) in older patients (mean: 9 years) and negative translocation in younger patients (mean: 4 years) (p <0.05). Both t(2;13) and negative-fusion were present in patients with clinical stages III and IV (p <0.05). There was a nonsignificant trend of t(2;13) to lower overall survival than negative-fusion status. © 2010 IMSS.
Leal Y.A.,Instituto Mexicano del Seguro Social |
Flores L.L.,San Francisco General Hospital |
Fuentes-Panana E.M.,Hospital Of Pediatria Centro Medico Nacional Siglo Xxi |
Cedillo-Rivera R.,Instituto Mexicano del Seguro Social |
Torres J.,Hospital Of Pediatria Centro Medico Nacional Siglo Xxi
Helicobacter | Year: 2011
Background: The 13C-urea breath test ( 13C-UBT) is a safe, noninvasive and reliable method for diagnosing H. pylori infection in adults. However, the test has shown variable accuracy in the pediatric population, especially in young children. We aimed to carry out a systematic review and meta-analysis to evaluate the performance of the 13C-UBT diagnostic test for H. pylori infection in children. Methods: We conducted a systematic review of the PubMed, Embase and Liliacs databases including studies from January 1998 to May 2009. Selection criteria included studies with at least 30 children and reporting the comparison of 13C-UBT against a gold standard for H. pylori diagnosis. Thirty-one articles and 135 studies were included for analysis. Children were stratified in subgroups of <6 and ≥6years of age, and we considered variables such as type of meal, cutoff value, tracer dose, and delta time for the analysis. Discussion: The 13C-UBT performance meta-analyses showed 1, good accuracy in all ages combined (sensitivity 95.9%, specificity 95.7%, LR+ 17.4, LR- 0.06, diagnostic odds ratio (DOR) 424.9), 2, high accuracy in children >6years (sensitivity 96.6%, specificity 97.7%, LR+ 42.6, LR- 0.04, DOR 1042.7), 3, greater variability in accuracy estimates and on average a few percentage points lower, particularly specificity, in children ≤6years (sensitivity 95%, specificity 93.5%, LR+ 11.7, LR- 0.12, DOR 224.8). Therefore, the meta-analysis shows that the 13C-UBT test is less accurate for the diagnosis of H. pylori infection in young children, but adjusting cutoff value, pretest meal, and urea dose, this accuracy can be improved. © 2011 Blackwell Publishing Ltd.
PubMed | Hospital Of Pediatria Centro Medico Nacional Siglo Xxi
Type: Journal Article | Journal: Archivos argentinos de pediatria | Year: 2016
Changes in body mass index (BMI) among girls with idiopathic central precocious puberty (ICPP) under treatment have been controversial in other populations.To assess changes in BMI Z score and the rate of overweight and obesity in Mexican girls with ICPP during their first year of treatment.A retrospective study was conducted among girls with ICPP under treatment with leuprolide, with a somatometry performed every six months, over a 1-year period. An analysis of variance (ANOVA) was done to establish differences in BMI Z score and a multivariate analysis was used to assess the relationship among the different factors.Among 121 girls, BMI Z score increased from 0.87 to 1.32, and the rate of overweight and obesity increased from 40.5% to 70.3%, a statistically significant difference.Changes in BMI Z score and the rate of overweight and obesity among Mexican girls with ICPP increased significantly.
PubMed | Hospital Of Pediatria Centro Medico Nacional Siglo Xxi
Type: Journal Article | Journal: Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion | Year: 2011
Identification of pediatric patients at the end-of-life is not easy because criteria used are based on adults criteria.In this survey we explore the children end-of-life definition pediatricians have, as well as to determine which interventions they use when caring a patient at end-of-life.Tertiary referral pediatric hospital.Staff pediatricians (SP) and medical residents (MR).A self-administrated questionnaire was built and validated. It contains five vignettes of pediatric patients: Two with WHO criteria for an end-of-life condition (EC) and three without an end-of-life condition (NEC). PARTICIPANTS identified each patient with or without an end-of-life condition, and which palliative actions they would perform accordingly Their responses were recorded in a 4-option Likert scale. Ordinal regression was used to assess if some of the participants characteristics were related to the identification of an end-of-life condition.Response rate was 84.2% (128/152); of whom 63 were SP and 65 MR. EC cases were well identified in 90 and 93%, while NEC in 30 and 40%, respectively Palliative actions were more according in EC patients, but around 20% would not provide them. Among NEC patients, there were more disparities of palliative actions to be delivered, and it was statistically significantly. Ordinal regression showed that some participants characteristics are associated to the appropriate identification of end-of-life patients; however, these factors were not consistent across the five scenarios.Among pediatricians, criteria of end-of-life conditions are not well established, neither the palliative actions. Educational interventions are needed to improve the quality of life of these children.
PubMed | Hospital Of Pediatria Centro Medico Nacional Siglo Xxi
Type: Evaluation Studies | Journal: Archivos de cardiologia de Mexico | Year: 2014
In the last decades, several devices have been used for the percutaneous closure of patent ductus arteriosus, with its own limitations and risks. The Amplatzer Duct Occluder II has been designed to overcome those limitations and reduce risks.We described our initial series of patients who underwent percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder II, emphasis on the technical aspects of the procedure.We reviewed the clinical records of 9 patients with patent ductus arteriosus who underwent percutaneous closure with the Amplatzer Duct Occluder II. Median age was 24 months (range 8-51 months) and the median weight was 10.7kg (range 6-16.3kg). The minimal ductus arteriosus diameter was 2.7mm (1-5mm).Implantation was successful in all cases. The devices most commonly used (33.3%) were the dimensions 4-4mm (3 patients), in 2 patients were used 3-4mm and in the rest of the patients were employed occluder other sizes. Four cases showed slight residual flow immediately after implantation. Total closure was achieved in 24h in 8 of 9 patients (89%). There was no embolization of the occluder or deaths during the procedure and we only observed one minor complication.The Amplatzer Duct Occluder II in this series was effective in 89% of the patients at 24hs after the procedure and 100% follow-up. The implantation was safe and no major complications were observed. The occlusion rate is comparable to those reported for the Amplatzer Duct Occluder I.