Parras de la Fuente, Mexico
Parras de la Fuente, Mexico

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Segura-Lopez F.K.,UMAE | Guitron-Cantu A.,UMAE | Leon-Carballo S.,ISSSTECH | Guerrero-Perez L.,HGZ No. | Fox J.G.,Massachusetts Institute of Technology
Helicobacter | Year: 2015

Background and Aims: The biliary tract cancer or cholangiocarcinoma (CCA) represents the sixth leading cause of gastrointestinal tumors in the Western world, and mortality varies across the world, with regions such as Chile, Thailand, Japan, and northeastern India presenting the highest rates. CCA may develop in the bile duct, gallbladder, or ampulla of Vater; and risk factors include obesity, parity, genetic background, geographical and environmental factors. Inflammation induced by bacterial infections might play a role in the pathogenesis of CCA. In this work, we investigated whether there is an association between extrahepatic cholangiocarcinoma (ECCA) and infection with S. typhi, H. hepaticus, or H. bilis in a Mexican population. Methods: A total of 194 patients were included and divided into 91 patients with benign biliary pathology (controls) and 103 with ECCA (cases). Tumor samples were taken during endoscopic retrograde cholangiopancreatography by biliary brushing, followed by DNA extraction and PCR testing for infections. Results: We found that 44/103 cases were positive for H. bilis, compared with 19/91 controls (p = 0.002; OR 2.83, 95% CI 1.49-5.32), and when analyzed by sub-site, H. bilis infection was significantly more associated with cancer in the common bile duct (p = 0.0005; OR 3.56, 95% CI 1.77-7.17). In contrast, H. hepaticus infection was not different between cases (17/103) and controls (13/91) (p = 0.82; OR 1.19, 95% CI 0.54-2.60). None of the samples were positive for S. typhi infection. Conclusion: In conclusion, infection with H. bilis but neither H. Hepaticus nor S. typhi was significantly associated with ECCA, particularly with tumors located in the common bile duct. © 2015 John Wiley & Sons Ltd.


Guitron A.,UMAE | Segura-Lopez F.,UMAE | Mendez-Tenorio A.,National Polytechnic Institute of Mexico | Iwai S.,Second Genome | Hernandez-Guerrero A.,Endoscopia Gastrointestinal
Clinical Microbiology and Infection | Year: 2016

Biliary tract cancer or extrahepatic cholangiocarcinoma (ECCA) represents the sixth commonest cause of cancer in the gastrointestinal tract in western countries. We aimed to characterize the microbiota and its predicted associated functions in the biliary tract of ECCA and benign biliary pathology (BBP). Samples were taken from 100 patients with ECCA and 100 patients with BBP by endoscopic cholangio-pancreatography for DNA extraction. Ten patients with ECCA and ten with BBP were selected for microbiota studies using the V4-16S rRNA gene and sequenced in Illumina platform. Microbiota analyses included sample-to-sample distance metrics, ordination/clustering and prediction of functions. Presence of Nesterenkonia sp. and Helicobacter pylori cagA and vacA genes were tested in the 100 ECCA and 100 BBP samples. Phylum Proteobacteria dominated all samples (60.4% average). Ordination multicomponent analyses showed significant microbiota separation between ECCA and BBP (p 0.010). Analyses of 4002 operational taxonomic units with presence variation in at least one category probed a separation of ECCA from BBP. Among these, Nesterenkonia decreased, whereas Methylophilaceae, Fusobacterium, Prevotella, Actinomyces, Novosphingobium and H. pylori increased in ECCA. Predicted associated functions showed increased abundance of H. pylori virulence genes in ECCA. cagA and vacA genes were confirmed by PCR in ECCA and BBP samples. This is the first microbiota report in ECCA and BBP to show significant changes in microbial composition. Bacterial species unusual for human flora were found: Methylophilaceae and Nesterenkonia are reported in hypersaline soils, and Mesorhizobium is a nitrogen-fixing bacterium. Enrichment of virulence genes confirms previous studies suggesting that H. pylori might be associated with ECCA. © 2015 European Society of Clinical Microbiology and Infectious Diseases.


PubMed | Second Genome, National Polytechnic Institute of Mexico, UMAE and Endoscopia Gastrointestinal
Type: Journal Article | Journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases | Year: 2016

Biliary tract cancer or extrahepatic cholangiocarcinoma (ECCA) represents the sixth commonest cause of cancer in the gastrointestinal tract in western countries. We aimed to characterize the microbiota and its predicted associated functions in the biliary tract of ECCA and benign biliary pathology (BBP). Samples were taken from 100 patients with ECCA and 100 patients with BBP by endoscopic cholangio-pancreatography for DNA extraction. Ten patients with ECCA and ten with BBP were selected for microbiota studies using the V4-16S rRNA gene and sequenced in Illumina platform. Microbiota analyses included sample-to-sample distance metrics, ordination/clustering and prediction of functions. Presence of Nesterenkonia sp. and Helicobacter pylori cagA and vacA genes were tested in the 100 ECCA and 100 BBP samples. Phylum Proteobacteria dominated all samples (60.4% average). Ordination multicomponent analyses showed significant microbiota separation between ECCA and BBP (p 0.010). Analyses of 4002 operational taxonomic units with presence variation in at least one category probed a separation of ECCA from BBP. Among these, Nesterenkonia decreased, whereas Methylophilaceae, Fusobacterium, Prevotella, Actinomyces, Novosphingobium and H. pylori increased in ECCA. Predicted associated functions showed increased abundance of H. pylori virulence genes in ECCA. cagA and vacA genes were confirmed by PCR in ECCA and BBP samples. This is the first microbiota report in ECCA and BBP to show significant changes in microbial composition. Bacterial species unusual for human flora were found: Methylophilaceae and Nesterenkonia are reported in hypersaline soils, and Mesorhizobium is a nitrogen-fixing bacterium. Enrichment of virulence genes confirms previous studies suggesting that H. pylori might be associated with ECCA.


Petri M.H.,University of Guadalajara | Satoh M.,University of Florida | Martin-Marquez B.T.,University of Guadalajara | Vargas-Ramirez R.,University of Guadalajara | And 15 more authors.
Arthritis Research and Therapy | Year: 2013

Introduction: Autoantibodies and clinical manifestations in polymyositis/dermatomyositis (PM/DM) are affected by both genetic and environmental factors. The high prevalence of DM and anti-Mi-2 in Central America is thought to be associated with the high UV index of the area. The prevalences of autoantibodies and the clinical manifestations of PM/DM were evaluated comparing two cohorts in Mexico. Methods: Ninety-five Mexican patients with PM/DM (66 DM, 29 PM; 67 Mexico City, 28 Guadalajara) were studied. Autoantibodies were characterized by immunoprecipitation using 35S-methionine labeled K562 cell extract. Clinical information was obtained from medical records. Results: DM represented 69% of PM/DM and anti-Mi-2 was the most common autoantibody (35%), followed by anti-p155/140 (11%); however, anti-Jo-1 was only 4%. The autoantibody profile in adult-onset DM in Mexico City versus Guadalajara showed striking differences: anti-Mi-2 was 59% versus 12% (P = 0.0012) whereas anti-p155/140 was 9% versus 35% (P = 0.02), respectively. A strong association of anti-Mi-2 with DM was confirmed and when clinical features of anti-Mi-2 (+) DM (n = 30) versus anti-Mi-2 (-) DM (n = 36) were compared, the shawl sign (86% versus 64%, P < 0.05) was more common in the anti-Mi-2 (+) group (P = 0.0001). Levels of creatine phosphokinase (CPK) were higher in those who were anti-Mi-2 (+) but they responded well to therapy. Conclusions: Anti-Mi-2 has a high prevalence in Mexican DM and is associated with the shawl sign and high CPK. The prevalence of anti-Mi-2 and anti-p155/140 was significantly different in Mexico City versus Guadalajara, which have a similar UV index. This suggests roles of factors other than UV in anti-Mi-2 antibody production. © 2013 Petri et al.; licensee BioMed Central Ltd.


Mendoza-Pinto C.,systemIC | Mendoza-Pinto C.,Autonomous University of Puebla | Garcia-Carrasco M.,systemIC | Garcia-Carrasco M.,Autonomous University of Puebla | And 7 more authors.
Lupus | Year: 2015

Background: Low bone mineral density (BMD) and vertebral fractures (VF) have been associated with atherosclerosis in the general population. We sought to investigate the relationship between BMD and VF and carotid atherosclerosis in women with systemic lupus erythematosus (SLE).Methods: We studied 122 women with SLE. All patients had BMD, carotid intima-media thickness (IMT), and carotid artery atherosclerotic plaque assessment by ultrasound.Results: Mean age at study entry was 44 years and mean disease duration was 11 years. Carotid plaque was found in 13 (11%) patients (9 postmenopausal and 4 premenopausal). Patients in the highest IMT quartile were more likely to be older (p=0.001), have a higher body mass index (p=0.008), and exhibit dyslipidemia at study entry (p=0.041), compared with the lower three quartiles. BMD at the lumbar spine was lower in patients in the highest IMT quartile compared with the lower quartiles in the multivariate logistic analysis, however, there was no association between lumbar or total hip BMD and IMT (p=0.91 and p=0.6, respectively). IMT measurements did not differ according to the presence or absence of VF (0.08-0.12 vs. 0.06-0.03 mm, p=0.11). A trend towards higher incidence of VF was found in patients with carotid plaque compared with those without (33% vs. 21%; p=0.2).Conclusions: In patients with SLE, the presence of carotid atherosclerosis is not associated with low BMD or VF. Lupus (2015) 24, 25-31.


PubMed | Cardiovascular Unit, Autonomous University of Puebla, UMAE, Clinical Epidemiology Research Unit and 3 more.
Type: Journal Article | Journal: Lupus | Year: 2014

Low bone mineral density (BMD) and vertebral fractures (VF) have been associated with atherosclerosis in the general population. We sought to investigate the relationship between BMD and VF and carotid atherosclerosis in women with systemic lupus erythematosus (SLE).We studied 122 women with SLE. All patients had BMD, carotid intima-media thickness (IMT), and carotid artery atherosclerotic plaque assessment by ultrasound.Mean age at study entry was 44 years and mean disease duration was 11 years. Carotid plaque was found in 13 (11%) patients (9 postmenopausal and 4 premenopausal). Patients in the highest IMT quartile were more likely to be older (p=0.001), have a higher body mass index (p=0.008), and exhibit dyslipidemia at study entry (p=0.041), compared with the lower three quartiles. BMD at the lumbar spine was lower in patients in the highest IMT quartile compared with the lower quartiles in the multivariate logistic analysis, however, there was no association between lumbar or total hip BMD and IMT (p=0.91 and p=0.6, respectively). IMT measurements did not differ according to the presence or absence of VF (0.080.12 vs. 0.060.03mm, p=0.11). A trend towards higher incidence of VF was found in patients with carotid plaque compared with those without (33% vs. 21%; p=0.2).In patients with SLE, the presence of carotid atherosclerosis is not associated with low BMD or VF.


Gomez-Vazquez M.E.,Hospital General Of Zona No 89 | Hernandez-Salazar E.,UMAE | Novelo-Otanez J.D.,Hospital Of Especialidades | Cabrera-Pivaral C.E.,Hospital Of Especialidades | And 2 more authors.
Cirugia y Cirujanos | Year: 2012

Background: Postoperative pain is the main symptom following a surgical event and is related to an inflammatory process involving cytokine secretion. This type of pain is usually treated with opioids such as morphine, whose analgesic efficacy is well known. However, it is unknown when compared with ketorolac in measuring proinflammatory cytokine levels. The aim of this study was to determine the postoperative analgesic effect with endovenous morphine on proinflammatory cytokine levels in patients who underwent laparoscopic choleystectomy. Methods: We studied 40 patients who underwent laparoscopic cholecystectomy. Patients were randomized to receive morphine (0.05 mg/kg) or ketorolac (0.2 mg/kg) IV during gallbladder extraction and after the surgical event at the following dose: morphine (0.15 mg/kg) or ketorolac (0.7 mg/kg) for 40 min. Clinical evaluations included were hemodynamic, analgesic with visual analogue scale, and sedation (Ramsay scale). IL-1β and TNF-α were measured pre- and postoperatively and after 12 h. Safety profile was evaluated with hemodynamic constants. Statistical analysis was carried out using Mann-Whitney U test and Fisher exact test. Results: TNF-α was increased significantly in the immediate postoperative period and after 12 h in the morphine group. IL-1β was not detected preoperatively, in the immediate postoperative period and 12 h after surgery the levels were similar in both groups. The main adverse event was respiratory depression, which occurred in the morphine group. Conclusions: Proinflammatory cytokines were increased after surgery, particularly TNF-α in the group receiving morphine. The use of morphine is safe postoperatively.


Objective: The aim of this study was to determine the degree of subclavian vein stenosis in a preoperative phlebography that can be used to predict venous hypertension development.Material and methods: A prospective cohort study was done, including 58 patients undergoing construction of AV fistula ipsilateral to the subclavian vein stenosis site that were followed for 6 months with clinical assessment for venous hypertension and vascular access functionality.Results: 13 of 58 patients developed clinical significant venous hypertension syndrome of which 11 had > 67.5[%] stenosis, without differences between gender, age, anastomosis diameter, vascular access location or configuration. Only 3 patients required dismantling of AV fistula.Background: The venous hypertension syndrome as a complication of an arteriovenous fistula is linked to ipsilateral central venous stenosis, caused in most cases by hemodialysis catheter placement, which is the inicial vascular access in 77[%] of patients in México whom start renal function replacement therapy.Conclusions. The degree of subclavian vein stenosis may predict the development of clinical significant venous hypertension syndrome when it is greater than 67.5[%] [[]PPV 76[%], NPV 93.6[%], RR 14.24 CI95[%] (4.69-43.24) p = 0.0000].


Maillet D.,National Polytechnic Institute of Mexico | Montiel-Cervantes L.,National Polytechnic Institute of Mexico | Padilla-Gonzalez Y.,UMAE | Sanchez-Cortes E.,UMAE | And 3 more authors.
Revista de Investigacion Clinica | Year: 2012

Objective. To evaluate the impact of different prognostic factors that has been suggested to be useful in predicting the survival of patients with multiple myeloma (MM). Materials and methods. A longitudinal prospective study was conducted on 24 adult Mexican patients diagnosed with primary MM. The levels of expression of CD38, CD138 and cyclin D1 were analyzed in plasma cells (PCs) from patients and mononuclear cells from healthy donors. Serum levels of lactate dehydrogenase, creatinine, calcium, β 2 microglobulin and interleukin-6 (IL-6) as well as hemoglobin and platelet count were taken into consideration. Results. CD138 and cyclin D1 levels in absolute numbers were significantly overexpressed in malignant PCs. A positive correlation was noted between cyclin D1 and CD38 expression levels in malignant PCs. IL-6 and serum calcium were also positively correlated in MM patients. Cyclin D1 overexpression was not associated with better overall survival (OS). Normal calcium levels were associated with better overall survival (OS). Serum calcium was the only variable correlating with better OS in Cox regression analysis. Conclusion. Serum calcium is an independent prognostic factor of OS in a population of Mexican patients with MM.


Vasquez-Marquez P.I.,UMAE | Castellanos-Olivares A.,UMAE
Revista Mexicana de Anestesiologia | Year: 2013

Regardless of the cultural level have a lot people think that the anesthesiologist is a technician, a nurse or a general practitioner trained to practice anesthesiology. Unfortunately we as anesthesiologists are responsible for these views, because of the attitudes that we project in our environment. We need to reflect on what is professionalism, how can achieve? And how can you measure? Professionalism is something specific to the profession in question and is a mantle of behaviors. It is a state that takes years to achieve and must be maintained throughout the career. For Hilton and Slotnik, professionalism consists of personal attributes and cooperation attributes. How professionalism can be achieved? Is achieved through protoprofesionalismo, period of time before professionalism gained, begins when an individual starts his career as a medical student and ends when the individual is a mature professional who possesses Phronesis or practical wisdom. How can you measure? One of the main problems of teaching and professional assessment is the lack of adequate teaching professionally for doctors anesthesiology residents. The professionalism has many factors difficult to measure and most are subjective, that is, many of the items that can serve to measure depend on the perception of the evaluators. There are good studies evidence level to assess the communication skills and professionalism of practicing physicians and anesthesiology residents in a variety of environment using a multi-scale technique with feedback, measurement or evaluation of anesthesiology resident learning and teachers should be performed with well-structured and high levels of evidence that allowing us to achieve assessments increasingly objective.

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