RESUMEN INVESTIGADORES-2

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 21057162 (55.44±93.3 vs. 128.56 ± 109.22), posmenopausal (44.98 ± 51.41 vs. 42.72 PMID: 21219817 ± 51.48) and PCOS women (64.9 ± 53.3 vs. 101.36 ± 80.89) had significant- ly different hormone profile. CONCLUSION: These results suggest that NAFLD is more prevalent in postmenopausal and women with PCOS than those premenopausal ones. The estrogens may have a protective effect of against NAFLD in women. CITA: Ann Hepatol. Oct-Dec 2010;9(4):402-9 DOI: 10.1016/S1665-2681(19)31616-3 TÍTULO: Liver diseases in Mexico and their associated mortality trends from 2000 to 2007: A retrospective study of the nation and the federal states AUTORES: Méndez-Sánchez N, García-Villegas E, Merino-Zeferino B, Ochoa-Cruz S, Villa AR, Madrigal H, Kobashi-Margáin RA, Gutiérrez-Gro- be Y, Chávez-Tapia N, Ponciano-Rodríguez G, Uribe M. INTRODUCTION: Liver disease is a major health issue in Mexico. Although several studies have been performed to analyze the impact of liver diseases on the Mexican population, none has compared the prevalence and impact of liver disease between states within Mexico. AIM: To analyze trends in mortality associated with liver diseases from 2000 to 2007 at the national and state levels. METHODS: Data was obtained from the Ministry of Health (number of deaths) and the National Population Council (CONAPO) (population at risk) and mortality rates were analyzed using statistical software. RESULTS: Mortality due to viral hepatitis, liver tumors, and cirrhosis in- creased over the study period. Alcohol-related mortality decreased but was still the main cause of liver-related deaths. Viral hepatitis infection occurred predominantly in the northern states and liver tumors occurred predominant- ly in the central region. Alcohol-related deaths were elevated along the Pa- cific shoreline and deaths associated with cirrhosis occurred mainly in the central and southern states. CONCLUSION: Incidence of liver-related mortality has increased and will continue to do so in the future. CITA: Ann Hepatol. Oct-Dec 2010;9(4):428-38 DOI: 10.1016/S1665-2681(19)31619-9 TÍTULO: Renal tuberculosis AUTORES: Carrillo-Esper R, Moreno-Castañeda L, Hernández-Cruz AE, Aguilar-Zapata DA. BACKGROUND: tuberculosis (TB) is a disease with a high incidence and prevalence worldwide. Renal TB is the second most common extrapulmo- nary form of TB. The purpose of this report is to present the case of a patient with renal TB in order to emphasize the importance of this disease. CLINICAL CASE: we report the case of a 30-year-old female who present- ed with fever, cough, diaphoresis and an abdominal right flank mass. Right 101

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 21348288 hydronephrosis, dilated collector system and loss of renal function were docu- PMID: 21400767 mented. A right nephrectomy was performed. Histopathological exam revealed acid-fast mycobacteria, granulomas and multinucleated Langhans-type giant cells. Renal TB was diagnosed and anti-TB treatment was initiated. CONCLUSIONS: renal TB is a disease whose incidence has increased in relation to the TB epidemic. Renal TB should be considered in the evaluation of renal masses. CITA: Cir Cir. Sep-Oct 2010;78(5):442-7 TÍTULO: [Cancer and obesity] AUTORES: Sánchez-Lara K, Morales-Graf L, Green D, Sosa-Sánchez R, Méndez-Sánchez N. SUMMARY: The prevalence of obesity is increasing worldwide. Obesity is also a major risk factor for developing chronic diseases, including malignan- cies thereby increasing the risk of several types of tumors such as breast, endometrium, colon, prostate and kidney cancer. The mechanisms associat- ed with obesity and insulin resistance, hormonal regulation and other proin- flammatory factors are also involved in neoplastic processes including: cell proliferation, carcinogenesis, and angiogenesis vascularization. In addition to contributing to cancer pathogenesis obesity is associated with comorbid- ities and poor prognosis in cancer patients. The aim of this review is to de- scribe some of the mechanisms involved in the association of obesity and malignancies. CITA: Gac Med Mex. Sep-Oct 2010;146(5):326-31 TÍTULO: [Anterior enucleation of a talus with \"triple loss of relations\". Case report and literature review] AUTORES: García-Juárez JD, Tohen-Bienvenu A, Lozano-Reyes S, Jiménez-Cabuto C. INTRODUCTION: When the talus loses its triple connection with the ankle mortise, a rare injury occurs in 3-4% of the ankle dislocations; 75% of the injuries are open. A clinical case is presented herein, together with its clinical course and a review of the literature. CLINICAL CASE: The case of a male, 52-year-old patient with a left ankle inversion and extension injury is presented. At the time of admission to the emergency room he had triple closed anterior dislocation of the talus. Closed reduction was performed under anesthesia, an acrylic boot was placed and he was followed-up at the outpatient service. RESULTS: The patient did well and was immobilized initially with an acrylic foot-thigh brace for six weeks; he then wore an acrylic suropodalic brace for 4 weeks and started partial weight bearing with crutches at 10 weeks; total weight bearing with crutches at 12 weeks, and without crutches at 16 weeks. Shortly before this a bone scan was performed and no signs of avascular necrosis were found. CONCLUSIONS: Triple talar dislocation is a rare injury and its major com- plication is avascular necrosis and secondary arthrosis that could result in the need for panastragalodesis; the prognosis depends on the timeliness of care, it is a true emergency. CITA: Acta Ortop Mex. Nov-Dec 2010;24(6):420-3 102

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR 2011 PMID: 21042231 TÍTULO: Live-atten- uated Tetravalent Dengue Vaccine in Dengue-naïve Children, Adolescents, and Adults in Mexico City: Randomized Controlled Phase 1 Trial of Safety and Immunogenicity AUTORES: Poo J, Galan F, Forrat R, Zambrano B, Lang J, Dayan G. BACKGROUND: Preliminary results in healthy, young US adults showed that a tetravalent, live-attenuated dengue vaccine (TDV) was safe and im- munogenic, but no data are available in children. METHODS: In a multicenter, randomized, controlled, observer-blinded study in the city of Mexico, children aged 2 to 5, 6 to 11, and 12 to 17 years (36 children per age group), and adults (n = 18) aged <45 years received the following: 3 injections of TDV at months 0, 3.5, and 12 (TDV-TDV-TDV), or 1 injection of yellow fever vaccine (YF) at month 0, and 2 injections of TDV at months 3.5 and 12 (YF-TDV-TDV). Adverse events and biologic safety (biochemistry and hematology) were documented. Plaque reduction neutral- ization test (PRNT50) antibody titers against the TDV parental viruses were measured 28 days after vaccination. Seropositivity was defined as antibody titers ≥10 1/dil. RESULTS: No vaccine-related serious adverse events, other significant clinical adverse events, or clinically significant trends in biologic safety were observed. Reactogenicity did not increase with successive TDV injections, and mild-to-moderate injection site pain, headache, myalgia, and malaise were most commonly reported (14%-40% after each vaccination). After 3 TDV vaccinations, the seropositivity rate against each dengue serotype was in the range 77% to 92%, compared with 85% to 94% after completion of the YF-TDV-TDV regimen. Of the 2- to 11-year-old participants, 95% were seropositive against ≥3 serotypes after 3 vaccinations. CONCLUSIONS: A 3-dose TDV regimen had a favorable safety profile in children and adults and elicited neutralizing antibody responses against all 4 serotypes. These findings support the continued development of this vaccine. CITA: Pediatr Infect Dis J. 2011 Jan;30(1):e9-17 DOI: 10.1097/INF.0b013e3181fe05af PMID: 21190880 TÍTULO: Cutaneous angiosarcoma. Analysis of 434 cases from the Surveil- lance, Epidemiology, and End Results Program, 1973-2007 AUTORES: Albores-Saavedra J, Schwartz AM, Henson DE, Kostun L, Hart A, Angeles-Albores D, Chablé-Montero F. SUMMARY: Cutaneous angiosarcoma is an aggressive malignant mes- enchymal vasoformative neoplasm that accounts for 1% of all soft tissue sarcomas. Using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, we analyzed the demographics and survival of cutaneous angiosarcoma. The Surveillance, Epidemiology, and End Results program recorded 434 cases of cutaneous angiosarcoma from 1973 to 2007. The incidence was nearly the same in men (222 cases) and women (212 cases). Most patients were white (88%) with a mean age of 73 years. African Americans made up only 4% of the cases. Two hun- dred seventy (62%) cases were tumors of the head and neck, whereas 106 103

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR (24%) cases arose in the skin of the trunk. Grade was recorded in 194 cases (45%): 28 were grade I, 44 were grade II, 60 were grade III, and 62 were grade IV. Survival rates of cutaneous angiosarcoma correlated with age, an- atomical site, and stage of disease. Patients younger than 50 years had a 10-year relative survival rate of 71.7%, whereas patients 50 years and older had a 36.8% 10-year survival rate. Tumors of the scalp and neck resulted in a 13.8% 10-year relative survival rate, whereas tumors arising in the trunk resulted in a 75.3% 10-year survival rate. Tumors localized to the skin had better prognosis (53.6% 10-year relative survival rate) than those with re- gional or distant stage (19.0% and 6.2%). Twenty-six percent of patients with angiosarcoma had a prior primary. Cutaneous angiosarcomas arise predom- inantly in the head and neck of white individuals older than 60 years. CITA: Ann Diagn Pathol. 2011 Apr;15(2):93-7 DOI: 10.1016/j.anndiagpath.2010.07.012 PMID: 21216084 TÍTULO: Patterns of skin prick test positivity in allergic patients: usefulness of a nationwide SPT chart review AUTORES: Larenas-Linnemann DE, Fogelbach GA, Alatorre AM, Cruz AA, Colín DD, Pech JA, Hernández AM, Imperial DA, del Prado ML, Zapién FJ, Huerta RE, Martell JA. BACKGROUND: A previous survey on allergens used by Mexican allergists in their skin prick test (SPT) panel showed wide variation. Humidity varies in different zones of Mexico. This might lead to differences in natural exposure and allergic sensitisation throughout the country. We aim to describe the SPT sensitivity patterns in the different climatic zones in Mexico and to show the usefulness of a structured SPT chart-review including multiple clinics in obtaining these allergen sensitisation patterns. METHODS: A retrospective, structured chart-review of SPT results was un- dertaken in allergy clinics throughout Mexico. Ratios of SPT positivity were calculated for individual allergens, per climatic zone and nation-wide. Per al- lergen group the most important allergens were identified. Statistically signif- icant differences between zones and the nation-wide data were tested with Pearson's Chi-squares test. RESULTS: 4169 skin test charts were recollected. The most important al- lergens causing sensitisation were very similar in different zones, despite climate variation. The allergen with highest ratio of SPT positivity was Dermatophagoides pteronyssinus (51%), with trees (Ash-27%, Alder-22%, Oak19%), and Bermuda grass (26%) as second and third. In the hot zones (humid and dry) Aspergillus was statistically significant more frequently than in more temperate zones. Cockroaches thrive in big cities and humid zones and Mesquite and Poplar in dry zones. Weeds are less important. CONCLUSION: Mexico has its own SPT sensitisation pattern, which is dif- ferent from America and Europe. A structured chart-review of SPT results is able to show this and might be a tool for allergists in other countries. CITA: Allergol Immunopathol (Madr). Nov-Dec 2011;39(6):330-6 DOI: 10.1016/j.aller.2010.09.006 104

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 21226599 TÍTULO: Therapeutic hypothermia after cardiac arrest AUTORES: González-Chon O, Aguilar-Zapata D SUMMARY: Letter to the editor CITA: N Engl J Med. 2011 Jan 13;364(2):186-7 DOI: 10.1056/NEJMc1012158 PMID: 21301021 TÍTULO: Biliverdin and heme oxygenase antiviral activity against hepati- tis C virus AUTORES: Gutiérrez-Grobe Y, Vitek L, Tiribelli C, Kobashi-Margáin RA, Uribe M, Méndez-Sánchez N. SUMMARY: Letter to the editor CITA: Ann Hepatol. Jan-Mar 2011;10(1):105-7 DOI: 10.1016/S1665-2681(19)31598-4 PMID: 21477523 TÍTULO: Education in the intensive care unit. AUTORES: Carrillo-Esper R. SUMMARY: Intensive care medicine is a newly formed specialty. Intensive care is characterized by a multidisciplinary activity focused on patients whose vital organs are compromised or who are at risk of multiorgan failure. Education in the intensive care unit is a complex activity where the educa- tional and pedagogical process interacts with research, continuous improve- ment, professionalism, and bioethics. This model provides leadership and excellence in care with high standards of quality, security, solidarity and hu- manism. CITA: Cir Cir. Jan-Feb 2011;79(1):83-9 PMID: 21527972 TÍTULO: [Citomegalovirus reactivation in critical ill intensive care patients] AUTORES: Carrillo Esper R. SUMMARY: Cytomegalovirus (CMV) is a β herpesvirus and a significant human pathogen. After primary infection establishes life long latency. In im- munocompetent individuals cell-mediated host immune responses prevent the development of overt CMV disease. It has increasingly come to be rec- ognized that critically ill patients are at risk for CMV reactivation from the latency. The risk factors associated to CMV reactivation in the critically ill are infection, sepsis, trauma, transfusions, major surgery, prolonged mechanical ventilation, steroids and vasopressors. In the pathogenesis are involved im- munodysfunction and imbalance in immunomodulatory mediators principally tumor necrosis factor (TNF) and nuclear factor κB (NF-κB). Several studies have shown an association between CMV reactivation in immunocompetent critically ill patients and poor clinical outcomes. Further studies are warrant- ed to identify subsets of patients who are at risk of developing CMV reacti- 105

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 21530875 vation and to determine the role of antiviral agents on clinically outcomes in PMID: 21707680 critically ill patients. CITA: Gac Med Mex. Mar-Apr 2011;147(2):159-62 TÍTULO: European and Mexican vs US diagnostic extracts of Bermuda grass and cat in skin testing AUTORES: Larenas-Linnemann D, Cruz AA, Gutierrez IR, Rodriguez P, Shah-Hosseini K, Michels A, Mösges R. BACKGROUND: Laboratory testing of various diagnostic extracts has shown lower potencies for several European and Mexican extracts relative to the US Food and Drug Administration (FDA) reference (10,000 BAU/mL). Quantitative skin prick testing (QSPT) with Dermatophagoides pteronyssi- nus extracts have previously shown a similar picture. OBJECTIVE: To compare European and Mexican Bermuda grass (BG) and cat diagnostic extracts against an FDA-validated extract using QSPT. METHODS: Six diagnostic BG and cat extracts (1 reference FDA extract, 3 European extracts, 1 imported nonstandardized extract from the United States, and 1 Mexican extract) were tested with quadruplicate QSPT, as a concentrate and as 2 serial 2-fold dilutions, in cat and BG allergic individuals. RESULTS: BG showed good dose response in wheal size for the concen- trate (1:2-1:4 dilutions; steep part of the curve). Cat showed poorer dose response. The Wilcoxon test for linked random samples was used to inves- tigate whether the distribution of the reference differed from each of the test extracts to a statistically significant degree (2-sided asymptotic significance, α = .05). All BG and 2 cat extracts were statistically less potent than the 10,000 BAU/mL US reference. European BG extracts were 7,700, 4,100, and 1,600 BAU/mL, and cat extracts were 12,500, 4,400, and 5,100 BAU/mL. CONCLUSIONS: The potency of some diagnostic extracts of BG and cat used in Europe, Mexico, and the United States differs, with the US extracts being generally more potent. On the basis of provocation tests, optimal di- agnostic concentrations should be determined. Similar comparisons using other manufacturers and therapeutic extracts might be interesting. CITA: Ann Allergy Asthma Immunol. 2011 May;106(5):421-8 DOI: 10.1016/j.anai.2010.11.020 TÍTULO: Meta-analysis: antibiotic prophylaxis for cirrhotic patients with up- per gastrointestinal bleeding - an updated Cochrane review AUTORES: Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F, Soa- res-Weiser K, Mendez-Sanchez N, Gluud C, Uribe M. BACKGROUND: Antibiotic prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention. AIM: To assess the benefits and harms of antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding by performing a systematic review of randomised trials. 106

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 21818342 METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index EX- PANDED until June 2010. We statistically combined data calculating relative risk (RR) for dichotomous outcomes and mean difference (MD) for continu- ous outcomes. RESULTS: Twelve trials (1241 patients) evaluating antibiotic prophylaxis against placebo or no antibiotic prophylaxis were included. Antibiotic pro- phylaxis was associated with reduced mortality (RR 0.79, 95% CI 0.63-0.98), mortality from bacterial infections (RR 0.43, 95% CI 0.19-0.97), bacterial infections (RR 0.35, 95% CI 0.26-0.47), rebleeding (RR 0.53, 95% CI 0.38- 0.74) and days of hospitalisation (MD -1.91, 95% CI -3.80-0.02). Trials an- alysing rebleeding rate and hospitalisation length are still scarce, thus, cau- tion should be exerted when interpreting the results. CONCLUSIONS: Antibiotic prophylaxis in patients with cirrhosis and upper gastrointestinal bleeding significantly reduced bacterial infections, and re- duce all-cause mortality, bacterial infection mortality, rebleeding events and hospitalisation length. Novel clinically significant outcomes were included in this meta-analysis. Some benefits are biased and the risks are not yet prop- erly assessed, this encourages future research in this field. CITA: Aliment Pharmacol Ther. 2011 Sep;34(5):509-18 DOI: 10.1111/j.1365-2036.2011.04746.x TÍTULO: Prophylactic activated recombinant factor VII in liver resection and liver transplantation: systematic review and meta-analysis AUTORES: Chavez-Tapia NC, Alfaro-Lara R, Tellez-Avila F, Barrientos-Guti- érrez T, González-Chon O, Mendez-Sanchez N, Uribe M. BACKGROUND AND AIM: Intraoperative blood loss is a frequent complica- tion of hepatic resection and orthotopic liver transplantation. Recombinant activated coagulation factor VII (rFVIIa) is a coagulation protein that induc- es hemostasis by directly activating factor X. There is no clear information about the prophylactic value of rFVIIa in hepatobiliary surgery, specifically in liver resection and orthotopic liver transplantation. The aim of this study was to assess the effect of rFVIIa prophylaxis to prevent mortality and bleeding resulting from hepatobiliary surgery. METHODS: Relevant randomized trials were identified by searching The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index. Randomized clinical tri- als comparing different rFVIIa prophylactic schemas against placebo or no intervention to prevent bleeding in hepatobiliary surgery were included. Adults undergoing liver resection, partial hepatectomy, or orthotopic liver transplantation were included. Dichotomous data were analyzed calculating odds ratios (ORs) and 95% confidence intervals (CIs). Continuous data were analyzed calculating mean differences (MD) and 95% CIs. RESULTS: Four randomized controlled trials were included. There were no significant differences between rFVIIa and placebo for mortality (OR 0.96; 95% CI 0.35-2.62), red blood cell units (MD 0.32; 95% CI -0.08-0.72) or ad- verse events (OR 1.55; 95% CI 0.97-2.49). CONCLUSIONS: The available information is limited, precluding the ability to draw conclusions regarding bleeding prophylaxis in hepatobiliary surgery 107

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 21877073 using rFVIIa. Although an apparent lack of effect was observed in all out- PMID: 21894231 comes studied, further research is needed. CITA: PLoS One. 2011;6(7):e22581 DOI: 10.1371/journal.pone.0022581 TÍTULO: Viral hepatitis infection and insulin resistance: a review of the pathophysiological mechanisms AUTORES: Gutiérrez-Grobe Y, Ponciano-Rodríguez G, Méndez-Sánchez N. SUMMARY: Viral hepatitis is a common cause of morbidity in Mexico. Insulin resistance (IR) is related to the liver damage caused by some viral infections, especially chronic infections. Chronic viral infection is an important risk fac- tor for the development of type 2 diabetes mellitus, disease that is currently among the 10 main causes of morbidity and the most common cause of mor- tality. Although several studies have reported an association between IR and hepatitis B virus or hepatitis C virus (HCV) infection, the pathophysiology has been studied thoroughly only for the association between IR and HCV infec- tion. It is thought that HCV infection causes direct damage through the action of the core proteins, which induces an inflammatory state characterized by se- cretion of proinflammatory cytokines that interfere with normal insulin signaling and disturb glucose, lipid and protein metabolism. This review summarizes the mechanisms by which viral infection is thought to induce IR. CITA: Salud Publica Mex. 2011;53 Suppl 1:S46-51 TÍTULO: [Principles and technique of magnetic resonance guided focused ultrasound surgery (MRgFUS) in the treatment of uterine fibroids] AUTORES: Vázquez-Lamadrid J, Fernández-de Lara Y, Carrasco-Choque A, Romero-Trejo C, Cosme-Labarthe J, Roldan-Valadez E. SUMMARY: Uterine fibroids are a significant source of morbidity for women of reproductive age, and can result in substantial symptoms affecting their quality of life. Definitive treatment has traditionally been a myomectomy, but increasingly women are not prepared to undergo such an invasive proce- dure for a benign and usually self-limiting condition. Focused ultrasound ablation is one of the least invasive treatment options outside medical ther- apy and does not require an anesthetic.Magnetic resonance guided focused ultrasound (MRgFUS) ablation combines therapy delivered by an ultrasound transducer with imaging guidance for therapy and thermal feedback provid- ed by magnetic resonance imaging. This paper provides an overview of the MRgFUS technique, including a brief description of the treatment system, guidelines for selection of patients and follow-up, and a comparison with oth- er treatment techniques. CITA: Gac Med Mex. Jul-Aug 2011;147(4):333-41 PMID: 21894234 TÍTULO: [Severe sepsis, septic shock and secondary multiple organ dys- function in infection by Kluyvera ascorbata] AUTORES: Carrillo Esper R, Peña Pérez C, Muciño Bermejo J, Carrillo Córdova JR, Carrillo Córdova LD. 108

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR SUMMARY: Kluyvera, a new genus of Enterobacteriaceae, is an emergent pathogen. Kluyvera species have been isolated from sputum, urine, stools, and blood. Kluyvera strains are infrequent but potentially dangerous patho- gens in the immunocompetent or immunocompromised host due to their potential to provoke a wide range of infections and their ability to transfer extended spectrum beta lactamase genes. We herein report the case of a teenage male with severe sepsis and septic shock due to K. ascorbata. CITA: Gac Med Mex. Jul-Aug 2011;147(4):355-60. PMID: 21967873 TÍTULO: [Mexican clinical practice guidelines of immunotherapy 2011] PMID: 21975237 AUTORES: Larenas-Linnemann D, Ortega-Martell JA, Del Río-Navarro B, Rodríguez-Pérez N, et al. BACKGROUND: Several international guidelines on immunotherapy exist, but they only apply partially in Mexico. The Mexican guideline of immuno- therapy dates from 1998. OBJECTIVES: To establish clinical recommendations and suggestions for Aller- gy residents and specialists for skin testing and allergen immunotherapy based on evidence and Mexican expert opinion, according to the GRADE system. METHODS: The guidelines were developed following the methodology of a guideline for clinical practice starting with the formulation of clinical ques- tions, in the context of Mexican environmental conditions and morbidity, with the participation of allergists from all regions of the country. External valida- tion was obtained. Its development followed three steps: 1. formulation of 24 clinical questions. 2. Search for consensus on the answers among members of the Regional chapters of both Mexican Colleges of Allergists (CMICA and COMPEDIA) during regional meetings. 3. Literature search for articles relat- ed to the questions and grading of its quality according to GRADE. RESULTS: Based on the regional consensus, 116 articles and the safety, patient acceptance/ comfort and cost clinical recommendations and sugges- tions were developed on basic aspects of skin testing, subcutaneous and sublingual immunotherapy (patient preparation, vial preparation and applica- tion schedules) and the treatment of eventual adverse reactions. CONCLUSIONS: A clinical guideline was developed respecting particular methodology, validated by CMICA and COMPEDIA for its implementation among Mexican allergists. Several aspects deserve further study to improve scientific evidence. CITA: Rev Alerg Mex. Jan-Feb 2011;58(1):3-75 TÍTULO: [Refractory, incomplete and atypical Kawasaki disease. Case re- port and review of the literature] AUTORES: Parra-Moronatti P, Rivera-Rodríguez L, Yamazaki-Nakashima- da MA, Nava-García F, Rodríguez-Álvarez J, Bolaños-Reyes R. SUMMARY: We report the case of a 2 year 7 month old boy with the di- agnosis of incomplete and atypical Kawasaki disease, whom showed only two of the classical criteria: fever and conjunctival injection without exudate, presenting clinical manifestations that are reported less often, such as gall- bladder hydrops, aseptic meningitis, arthralgia, sterile pyuria, coronary an- 109

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR eurysms and myocardial ischemia. This patient had recurrent and refractory Kawasaki disease not responding to treatment with intravenous immuno- globulin and thus requiring steroids and immunosuppressive management. CITA: Arch Cardiol Mex. Jul-Sep 2011;81(3):221-7 PMID: 22018611 TÍTULO: Evidence of effect of subcutaneous immunotherapy in children: PMID: 22018618 complete and updated review from 2006 onward AUTORES: Larenas-Linnemann DE, Pietropaolo-Cienfuegos DR, Calderón MA. OBJECTIVE: To update the scientific evidence of subcutaneous immuno- therapy (SCIT) in children. DATA SOURCES: PubMed, EMBASE, and known articles. STUDY SELECTION: All publications on SCIT in pediatric patients from Jan- uary 2006 to April 2011. Study design was not a restriction. The articles were analyzed according to their outcomes and evaluated on their scientific quality using the Grading of Recommendations Assessment, Development, and Eval- uation and Jadad tools. Clinical, safety, and immunologic data were gathered. RESULTS: The scientific evidence produced by the 31 articles analyzed showed that there is high-quality evidence that grass pollen SCIT causes a reduction in the combined symptom-medication score and increases the threshold of the conjunctival provocation test, immediately and 7 years after termination of SCIT, as well as the threshold of the specific bronchial prov- ocation test and the skin prick test reactivity. Alternaria SCIT improves med- ication scores, combined symptom-medication scores, and quality of life. It augments the threshold in the nasal provocation test. High-quality evidence of house dust mite SCIT shows that asthma symptom and medication scores improve and emergency department visits and skin reactivity are reduced; moderate evidence indicates improvement in pulmonary function tests. Pol- len SCIT prevents asthma (moderate evidence); evidence for long-term ben- efit of pollen SCIT (7-12 years after termination) is low to moderate. There is inconclusive evidence for SCIT reducing new sensitizations. CONCLUSION: There is acceptable evidence that shows that grass pollen, Alternaria, and house dust mite SCIT is beneficial in allergic children. CITA: Ann Allergy Asthma Immunol. 2011 Nov;107(5):407-416.e11 DOI: 10.1016/j.anai.2011.07.018. TÍTULO: Maintenance dosing for sublingual immunotherapy by prominent European allergen manufacturers expressed in bioequivalent allergy units AUTORES: Larenas-Linnemann D, Esch R, Plunkett G, Brown S, Maddox D, Barnes C, Constable D. BACKGROUND: Sublingual immunotherapy (SLIT) has become estab- lished in Europe, and its efficacy is being evaluated in the United States. The doses used for SLIT in Europe today are difficult to evaluate, because each manufacturer expresses the potency of its extracts differently. 110

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR OBJECTIVES: To compare in vitro European SLIT maintenance solutions against US licensed standardized allergenic extract concentrates and to de- termine the monthly SLIT doses delivered expressed in bioequivalent allergy units ([B]AU). METHODS: We studied Dermatophagoides pteronyssinus, timothy grass pollen, cat (hair) and short ragweed pollen allergen extracts. The SLIT main- tenance solutions of 4 leading European manufacturers and standardized concentrate extracts of 3 US manufacturers were analyzed with the following assays: protein content, relative potency (immunoglobulin E [IgE]-binding enzyme-linked immunosorbent assay [ELISA] inhibition) and major allergen content. The relative monthly allergen dose in (B)AU was calculated for each recommended SLIT schedule. RESULTS: Relative potency was approximately 10 times higher for US con- centrate standardized extracts-which are meant to be diluted-than for Eu- ropean SLIT maintenance solutions of D pteronyssinus and timothy grass pollen. For cat (hair) and short ragweed pollen, the difference was less. Measurements of relative potency and major allergen content correlated well. In our assays, European mite extracts contain a very low quantity of Der p 2 compared with US mites. CONCLUSION: Recommended SLIT doses in Europe vary widely among the manufacturers, but are consistently lower (Eur1) or higher (Eur4) over all four allergens tested. SLIT efficacy probably depends on additional factors apart from the exact dose. SLIT dose finding studies should be done for each product. CITA: Ann Allergy Asthma Immunol. 2011 Nov;107(5):448-458.e3 DOI: 10.1016/j.anai.2011.07.001. PMID: 22019653 TÍTULO: 3D volumetry comparison using 3T magnetic resonance imaging between normal and adenoma-containing pituitary glands AUTORES: Roldan-Valadez E, Garcia-Ulloa AC, Gonzalez-Gutierrez O, Martinez-Lopez M. Background: Computed-assisted three-dimensional data (3D) allows for an accurate evaluation of volumes compared with traditional measurements. AIMS: An in vitro method comparison between geometric volume and 3D volumetry to obtain reference data for pituitary volumes in normal pituitary glands (PGs) and PGs containing adenomas. DESIGN: Prospective, transverse, analytical study. MATERIALS AND METHODS: Forty-eight subjects underwent brain mag- netic resonance imaging (MRI) with 3D sequencing for computer-aided vol- umetry. PG phantom volumes by both methods were compared. Using the best volumetric method, volumes of normal PGs and PGs with adenoma were compared. Statistical analysis used the Bland-Altman method, t-statis- tics, effect size and linear regression analysis. RESULTS: Method comparison between 3D volumetry and geometric volume revealed a lower bias and precision for 3D volumetry. A total of 27 patients ex- hibited normal PGs (mean age, 42.07 ± 16.17 years), although length, height, width, geometric volume and 3D volumetry were greater in women than in 111

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR men. A total of 21 patients exhibited adenomas (mean age 39.62 ± 10.79 years), and length, height, width, geometric volume and 3D volumetry were greater in men than in women, with significant volumetric differences. Age did not influence pituitary volumes on linear regression analysis. CONCLUSIONS: Results from the present study showed that 3D volume- try was more accurate than the geometric method. In addition, the upper normal limits of PGs overlapped with lower volume limits during early stage microadenomas. CITA: Neurol India. Sep-Oct 2011;59(5):696-9 DOI: 10.4103/0028-3886.86543 PMID: 22116185 TÍTULO: [Imaging anatomy of the cranial nerves using 3.0 Tesla MRI: a practical review for clinicians] AUTORES: Chávez-Barba O, Martínez-Martínez L, Cazares-Arellano JL, Martínez-López M, Roldan-Valadez E. SUMMARY: Magnetic resonance (MR) imaging is the method of choice to evaluate the cranial nerves (CN). These nerves constitute a group of struc- tures that have acquired during their phylogenetic development a high degree of specialization. There are 12 pairs of CN to which we use their specific name or number. The olfactory (I) and optic (II) pairs are not real nerves but tracts from the encephalon. The spinal nerve (XI) derives from superior cer- vical segment of the spine. The other 9 pairs of CN are related with the brain stem. Although the skull base foramina can be seen on computed tomog- raphy, the nerves themselves can only be visualized in detail on MR. That means, in order to see the different segments of nerves I to XII, the right sequences must be used. It is important to provide detailed clinical informa- tion to the radiologist so that a tailored MR study can be performed. In this review, the basic imaging anatomy of the 12 CN is discussed and illustrated briefly with an emphasis on more advanced extra-axial anatomy, illustrated with high-resolution MR images. Clinicians looking for complete anatomic de- scriptions and/or MR illustrations are advised to consult specialized textbooks considering it is not possible to describe all of the anatomy in one article. This manuscript is intended to be a practical review for clinicians. CITA: Gac Med Mex. Nov-Dec 2011;147(6):526-37 PMID: 22169379 TÍTULO: Neutrophil gelatinase-associated lipocalin: a novel biomarker in acute kidney injury AUTORES: Carrillo-Esper R, Castillo-Albarrán FM, Pérez-Jáuregui J. SUMMARY: Acute kidney injury (AKI) is a frequent complication in critically ill patients and is associated with high morbidity and mortality; therefore, its pro- phylaxis, diagnosis and intervention positively impact patient evolution. Neutro- phil gelatinase-associated lipocalin (NGAL) or lipocalin, a protein synthesized by renal tubular cells, has the property to transport lipophilic molecules such as vitamins, hormones and antigenic agents. It is a novel biomarker of AKI of several etiologies and is increased in both serum and urine 48 h before the increase of creatinine. It has a strong correlation with early diagnosis of AKI. 112

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 22228886 NGAL is of the most investigated and promising biomarkers for early diagnosis PMID: 22384531 of AKI in different clinical scenarios, most notably in sepsis, cardiorenal syn- drome, cardiac surgery, kidney transplant, contrast nephropathy and hemolytic uremic syndrome. Lipocalin guides the early institution of therapeutic interven- tions to improve prognosis in AKI of several etiologies. CITA: Cir Cir. Nov-Dec 2011;79(6):577-81 TÍTULO: Albumin dialysis with molecular adsorbent recirculating system (MARS) for the treatment of hepatic encephalopathy in liver failure AUTORES: Kobashi-Margáin RA, Gavilanes-Espinar JG, Gutiérrez-Grobe Y, Gutiérrez-Jiménez AA, Chávez-Tapia N, Ponciano-Rodríguez G, Uribe M, Méndez Sánchez N. SUMMARY: Acute, acute-on-chronic and chronic liver diseases are major health issues worldwide, and most cases end with the need for liver trans- plantation. Up to 90% of the patients die waiting for an organ to be trans- planted. Hepatic encephalopathy is a common neuropsychiatric syndrome that usually accompanies liver failure and impacts greatly on the quality of life. The molecular adsorbent recirculating system (MARS) is a recently de- veloped form of artificial liver support that functions on a base of albumin dialysis. It facilitates the dialysis of albumin-bound and water-soluble toxins, allowing the patient to survive and even improving some clinical features of liver failure. The following manuscript reviews the technical features of MARS operation and some of the clinical trials that analyze the efficacy of the system in the therapy of liver diseases. CITA: Ann Hepatol. 2011 Jun;10 Suppl 2:S70-6 DOI: 10.1016/S1665-2681(19)31611-4 TÍTULO: [Cytogenetic diagnosis of first trimester spontaneous abor- tion] AUTORES: Alonso López AG, Bermejo Huerta S, Hernández Galván R, AyalaPosadas R, González del Angel A, González PG. BACKGROUND: About 15% of all pregnancies end in abortion. In approxi- mately 60% of all losses are chromosomal abnormalities as a cause of preg- nancy loss. OBJECTIVE: To determine the importance of cytogenetic study in patients with spontaneous abortion. MATERIALS AND METHODS: A series of cases of women diagnosed with spontaneous abortion less than 12 weeks and cytogenetic studies. Two groups, one group of women with normal cytogenetics and group 2 patients with abnormal cytogenetic result. 44 patients were excluded by cytogenetic study failed. RESULTS: We included 164 women, 55 and 65 for groups 1 and 2, respec- tively. In 44 cases the material was not suitable for performing karyotype. Of the 120 cases included, had abnormal karyotypes in 65 cases (54%), of which 34 cases (52.3%) were trisomy, 16 cases (24.6%) to polyploidy and 9 cases (13.8%) a monosomy. In addition, we found six cases (8.7%) with recurrent pregnancy loss. The maternal age limit increased incidence of chromosomal 113

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 22385760 abnormalities occurred in the group of 31 and 35 years with 20 cases (30%). PMID: 22470010 Of trisomies, the 16 were the mostfrequent with 11 cases (32.3%). CONCLUSIONS: The finding of 54% of chromosomal abnormalities in spon- taneous abortion products demonstrates the importance of cytogenetic study, regardless of patient age and number of previous pregnancy losses. CITA: Ginecol Obstet Mex. 2011 Dec;79(12):779-84 TÍTULO: Experience in the management of the severe form of human influ- enza A H1N1 pneumonia in an intensive care unit AUTORES: Carrillo-Esper R, Sosa-García JO, Arch-Tirado E. BACKGROUND: At the beginning of the second trimester of 2009 there was an influenza A (H1N1) outbreak. The aim of this study is to describe the clin- ical presentation and mortality of the severe form of pneumonia in patients with human influenza A H1N1. METHODS: We conducted a retrospective review of all files of confirmed and suspected patients with severe human influenza A (H1N1) pneumonia. RESULTS: We studied 26 patients admitted to the ICU from April 1 to De- cember 31, 2009, among which 16 were males (61.54%) and 10 females (38.46%) with an average age of 52.26 ± 15.48 years. The time of onset of symptoms to admission to the ICU was 6.3 ± 3.19 days. The most fre- quent symptoms and signs were salmonated sputum (47%), chills (45%), dry cough (44%) and myalgia (42%). The mortality rate was 19.23%. The treat- ment was based on antiviral therapy, modulating inflammation and ventilato- ry techniques to optimize oxygenation. There was an association between combined therapy based on methylprednisolone, activated protein C and statins with a better survival (p = 0.05). CONCLUSIONS: Pneumonia virus of human influenza A (H1N1) is asso ciated with high morbidity and mortality. According to our results, it is rec- ommended to make an early diagnosis and to initiate a treatment regimen based on treatment bundles designed to optimize oxygenation, reduce viral load and modulate inflammation. CITA: Cir Cir. Sep-Oct 2011;79(5):409-16 TÍTULO: [Neural pathophysiology of cancer anorexia] AUTORES: Sánchez-Lara K, Sosa-Sánchez R, Green-Renner D, Mén- dez-Sánchez N. INTRODUCTION: Approximately two thirds of cancer patients at advanced stages of the disease suffer from anorexia. Defined as the loss of the de- sire to eat, anorexia lower the energy intake which further exacerbates a progressive deterioration of the patient nutritional status. Malnutrition has a large impact on morbidity and mortality affecting the quality of life. Cancer anorexia etiology is multifactorial including complex interactions among the tumor, host metabolism and antineoplastic treatment. New related theories include peripheral and brain mechanisms affecting hypothalamic pathways; inducing behavioral and metabolic failure of responses to energy balance. The aim of this review is to describe actual concepts involved in the patho- genesis of cancer anorexia with special interest in brain mechanisms. 114

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR CONCLUSIONS: Anorexia and reduced food intake are important issues in the management of cancer patients, more knowledge about pathogenic mechanism is needed to improve therapeutic options, prognosis and quality of life in cancer patients. CITA: Nutr Hosp. Jul-Aug 2011;26(4):677-84 DOI: 10.1590/S0212-16112011000400003 2012 PMID: 21561776 TÍTULO: Distal femoral dome varus osteotomy: surgical technique with mini- PMID: 22018803 mal dissection and external fixation AUTORES: Luna-Pizarro D, Moreno-Delgado F, De la Fuente-Zuno JC, Meraz-Lares G. SUMMARY: The results obtained when employing distal femoral varus os- teotomy are variable. Our objective was to describe a surgical technique in- volving minimal dissection, semicircular osteotomy with external fixation for valgus angular deformities, and early weight bearing. DESIGN: Series of cases. SETTING: Orthopedic Referral Trauma Center. PATIENTS: Sixteen patients with valgus angular deformities of >12°. INTERVENTION: Wedge varus osteotomy, minimal dissection with exter- nal fixation using a standard system, multidirectional Newfix. Main outcome measurements included pain, surgical time, knee flexion and extension an- gles, and assessment of knee function based on the Hospital Special Sur- gery knee rating scale (HSSkrs). RESULTS: Of 16 patients, 14 were evaluated to the end of the study. When we compared preoperative values with those obtained postoperatively at a mean of 24±2.1months, pain measurement was reduced from 7 to 2.1 (p=0.002), angle of flexion was reduced from 105.4±14.6° to 105.3±11.1° (p=0.06), and angle of extension, from -1.67 to -1.25° (p=0.6), while HSSkrs assessment increased from 67.5±2.7 to 79.4±5 (p=0.003). Two patients were excluded from the study, one due to infection that developed along the trajec- tory of a screw, and the other patient underwent complete arthroplasty of the knee, which was performed to combat the pain that was not being alleviated. CONCLUSIONS: The technique improves function and reduces pain while facilitating early rehabilitation in 83% of cases. CITA: Knee. 2012 Mar;19(2):99-102 DOI: 10.1016/j.knee.2011.01.005 TÍTULO: Diagnostic performance of PWI/DWI MRI parameters in discrim- inating hyperacute versus acute ischaemic stroke: finding the best thresh- olds AUTORES: Roldan-Valadez E, Gonzalez-Gutierrez O, Martinez-Lopez M. 115

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR AIM: To determine the accuracy of the perfusion/diffusion-weighted imaging (PWI/DWI) parameters [time to peak (TTP), mean time to peak (MTT), rel- ative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) maps]; in the evaluation of acute versus hyperacute ischaemic stroke. MATERIALS AND METHODS: Fifty-five patients with symptomatic hyper- acute (first 6h) or acute (7-24h) ischaemic stroke underwent diffusion and perfusion evaluation. Statistical analysis included Student's t-test, receiver operating characteristics (ROC) analysis of apparent diffusion coefficient (ADC), TTP, MTT, CBV, and CBF; correlation, linear, and logistic regression analysis. RESULTS: Area under receiver operating characteristics (AUROC) analysis identified the ADC cut-off value 385×10(-6)mm(2)/s, MTT at 109.5%, TTP at 3.05s, CBV at 129%, and CBF at 98.5% (the record of the time of onset was considered the reference standard). The best performance corresponded to TTP, which showed a sensitivity of 0.94 and specificity of 0.88 (p<0.001). CONCLUSIONS: Based on the present findings, hyperacute penumbra is re- liably defined with a TTP >3s with no visible changes in diffusion. ADC, rCBF, and rCBV are not useful for discriminating between acute and hyperacute ischaemic stroke. CITA: Clin Radiol. 2012 Mar;67(3):250-7 DOI: 10.1016/j.crad.2011.08.020 PMID: 22166565 TÍTULO: Association between cholecystectomy for gallstone disease and risk factors for cardiovascular disease AUTORES: Chavez-Tapia NC, Kinney-Novelo IM, Sifuentes-Rentería SE, Torres-Zavala M, Castro-Gastelum G, Sánchez-Lara K, Paulin-Saucedo C, Uribe M, Méndez-Sánchez N. OBJECTIVE: Gallbladder disease and cardiovascular disease share risk factors. Both have a great impact on the economics of health systems. There is evidence suggesting an increased risk of cardiovascular disease in patients with gallbladder disease, but the association of gallbladder disease with other risk factors for cardiovascular disease is unclear. The aim of this study is to analyse the relationship between cholecystectomy for gallstone disease and risk factors for cardiovascular disease. MATERIAL AND METHODS: This is a case-control study comparing sub- jects undergoing cholecystectomy with controls without gallbladder disease or cholecystectomy. Demographic, anthropometric, and biochemical data were recorded and risk factors for cardiovascular disease were assessed. The data were analysed with chi square test, student t test and logistic re- gression (univariate and multivariate). RESULTS: Seven hundred and ninety-eight subjects were included. The multivariate analyses demonstrated that, compared with controls, cases had an increased prevalence of metabolic risk factors for cardiovascular disease (odds ratio (OR) 2.8, 95% confidence interval (CI) 1.8-4.8, p = 0.001), includ- ing type 2 diabetes mellitus (OR 2.2, 95% CI 1.1-4.5, p = 0.018), high blood pressure (OR 5.1, 95% CI 2.6-10.1, p = 0.001), and high cholesterol levels (OR 2.7, 95% CI 1.3-5.5, p = 0.004). No differences were observed in the incidence of cardiovascular disease. 116

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 22187655 CONCLUSION: Patients undergoing cholecystectomy had an increased prevalence of risk factors for cardiovascular disease, independent of age, PMID: 22209343 sex, or body mass index. PMID: 22345344 CITA: Ann Hepatol. Jan-Feb 2012;11(1):85-9. DOI: 10.1016/S1665-2681(19)31490-5 TÍTULO: Nuclear receptors in nonalcoholic Fatty liver disease AUTORES: López-Velázquez JA, Carrillo-Córdova LD, Chávez-Tapia NC, Uribe M, Méndez-Sánchez N. SUMMARY: Nuclear receptors comprise a superfamily of ligand-activated transcription factors that are involved in important aspects of hepatic phys- iology and pathophysiology. There are about 48 nuclear receptors in the human. These nuclear receptors are regulators of many hepatic processes including hepatic lipid and glucose metabolism, bile acid homeostasis, drug detoxification, inflammation, regeneration, fibrosis, and tumor formation. Some of these receptors are sensitive to the levels of molecules that control lipid metabolism including fatty acids, oxysterols, and lipophilic molecules. These receptors direct such molecules to the transcriptional networks and may play roles in the pathogenesis and treatment of nonalcoholic fatty liver disease. Understanding the mechanisms underlying the involvement of nu- clear receptors in the pathogenesis of nonalcoholic fatty liver disease may offer targets for the development of new treatments for this liver disease. CITA: J Lipids. 2012;2012:139875 DOI: 10.1155/2012/139875 TÍTULO: On being a pathologist: a brief chronicle of an academic surgical pathologist AUTORES: Albores-Saavedra J. SUMMARY: Letter to the editor CITA: Hum Pathol. 2012 Oct;43(10):1533-7 DOI: 10.1016/j.humpath.2011.09.007 TÍTULO: Increased mortality from acute liver failure in Mexico AUTORES: Chávez-Tapia NC, Barrientos-Gutiérrez T, Guerrero-López CM, Santiago-Hernández JJ, Méndez-Sánchez N, Uribe M. INTRODUCTION: There is significant geographic variation in the etiology and prognosis of acute liver failure (ALF). Since, little information is available for Latin America. We analyzed ALF mortality trends in Mexico. MATERIAL AND METHODS: The rates of mortality attributable to ALF were obtained for 1998 to 2009 from the National System of Health Information in Mexico and analyzed according to date, etiology, sex, age and geographic characteristics through graphical assessment and joinpoint regression. RESULTS: From 1998 to 2009, 2,193 ALF-related deaths were reported. A threefold increase in ALF mortality was observed during the period from 117

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR 1998 to 2009 (the global mortality rate increased from 13.1 to 40.2 deaths per 10,000,000 inhabitants). The most significant increase was observed for viral etiologies after 2006, affecting people 45 years old and over. CONCLUSION: ALF-related deaths have increased since 2006. Although we cannot speculate on the specific causes of this increase, it may reflect improvements in the access of vulnerable populations to health care. CITA: Ann Hepatol. Mar-Apr 2012;11(2):257-62 DOI: 10.1016/S1665-2681(19)31032-4 PMID: 22386521 TÍTULO: Adenomas of the gallbladder. Morphologic features, expression of gastric and intestinal mucins, and incidence of high-grade dysplasia/carcino- ma in situ and invasive carcinoma AUTORES: Albores-Saavedra J, Chablé-Montero F, González-Romo MA, Ramírez Jaramillo M, Henson DE. SUMMARY: We report 201 gallbladder adenomas from 91 patients most of whom were adult females. Fifty-three (58%) patients had gallstones. In 83 (91%) patients the adenomas were single. One gallbladder had 102 adeno- mas. Histologically, 165 (82%) of 201 adenomas were classified as pyloric, 28 (14%) as intestinal, 5 (2.4%) as foveolar, and 3 (1.4%) as biliary. Two patients had intestinal-type adenomas coexisting with biliary papillomatosis. Twenty-eight percent of pyloric gland adenomas contained squamoid mor- ules. Two pyloric gland adenomas were composed predominantly of colum- nar oxyphil cells. High-grade dysplasia/carcinoma in situ was identified in 44 (27%) of 165 pyloric gland adenomas and low-grade dysplasia in 25 (15%) of 165. However, only 2 (1%) invasive adenocarcinomas, both of intestinal type, arose in pyloric gland adenomas. Both patients survived more than 5 years. Intestinal-type adenomas were classified as tubular, papillary, and tubulopapillary. High-grade dysplasia/carcinoma in situ was recognized in 13 (46%) of 28 intestinal adenomas. However, only 1 (3.5%) invasive adenocar- cinoma with biliary phenotype arose in an intestinal-type adenoma. Foveolar adenomas showed low-grade dysplasia, and biliary adenomas were com- posed of columnar cells similar to the normal biliary cells of the gallbladder. None of these tumors progressed to adenocarcinoma. MUC5AC and MUC6 labeled 44 (95%) of 46 pyloric gland adenomas, whereas CDX2 was positive in 14 (78%) of 18 intestinal adenomas and MUC2 in 6 (33%) of 18. MUC5AC and MUC6 labeled 2 foveolar adenomas, and 2 biliary adenomas expressed only CK7. The immunophenotype of gallbladder adenomas justifies their classification into pyloric, intestinal, foveolar, and biliary. Our results indicate that adenomas of the gallbladder play a minor role in the pathway of gall- bladder carcinogenesis. CITA: Hum Patho. 2012 Sep;43(9):1506-13 DOI: 10.1016/j.humpath.2011.11.011 PMID: 22472159 TÍTULO: Spontaneous uterine rupture: report of two cases AUTORES: Martínez-Garza PA, Robles-Landa LP, Roca-Cabrera M, Vis- ag-Castillo VJ, Reyes-Espejel L, García-Vivanco D. 118

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 22472161 BACKGROUND: Uterine rupture is a rare entity with an incidence of 0.07% and is a cause of perinatal mortality. Dehiscence of previous uterine scar is the most important cause, but other causes have been reported such as placenta percreta. Almost 80% of uterine ruptures are spontaneous and its complications lead to an elevated mortality rate for the mother and the fetus. CLINICAL CASES: Case 1. We present the case of a 28-year-old female with no previous relevant medical history. The patient was 20 weeks preg- nant with a diagnosis of uterus didelphys (double uterus) with lower placen- tal implantation with normal pregnancy evolution at the time. Evolution of her illness was with intense abdominal pain and transvaginal bleeding. Case 2. We present the case of a 20-year-old female with a history of spontaneous abortion 1 year prior. The patient denied pregnancy and even reported her last menstruation date on 3/23/09. She began with sudden abdominal pain associated with two episodes of diarrhea, dizziness and fainting. CONCLUSION: Uterine rupture is a rare clinical entity with an elevated peri- natal mortality. Clinical suspicion is of vital important for early diagnosis and timely treatment. CITA: Cir Cir. Jan-Feb 2012;80(1):81-5 TÍTULO: Practice guidelines for the implementation of a quality program in thromboprophylaxis and treatment management in patients with venous thromboembolic disease AUTORES: Carrillo-Esper R, Alcántar-Luna E, Herrera-Cornejo MA, Jai- movich D, Ramos-Corrales MA, Villagómez-Ortiz A. BACKGROUND: Venous thromboembolic disease is a major cause of mor- bidity and hospital mortality worldwide. Although exact figures are unknown in Mexico, achieving uniformity of criteria among the specialties involved in the prophylaxis and treatment will offer a clearer picture and contribute to a more rational and interdisciplinary approach in order to improve the quality of care for patients and increase the level of awareness of this entity. DISCUSSION: For the preparation of this document, a total of 11 medical specialists from Mexico City and the interior of the country met along with a highly experienced professional from Chicago, IL, USA with wide experience in the field and knowledge of methodology for the development of a manage- ment algorithm for prophylaxis in at-risk patients of venous thromboembolic disease. The expert group met in plenary working sessions, managed uni- form criteria and reached consensus agreement by issuing a series of useful recommendations for the care of patients with venous thromboembolism in Mexican hospitals. CONCLUSIONS: In Mexico there is the need to develop and disseminate guidelines on thromboprophylaxis and treatment of venous thromboembol- ic disease because of the wide disparity of views or simple misinformation, leading to diagnostic and treatment behaviors unique to each institution. CITA: Cir Cir. Jan-Feb 2012;80(1):92-105 PMID: 22481447 TÍTULO: Acute kidney injury in critically ill cirrhotic patients: a review AUTORES: Muciño-Bermejo J, Carrillo-Esper R, Uribe M, Méndez-Sán- chez N. 119

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR SUMMARY: Acute kidney injury (AKI) is an important marker of morbidity and mortality in critically ill cirrhotic patients. The most common causes of AKI in cirrhotic patients include prerenal or hepatorenal syndrome (HRS). Diagnosis of AKI may be delayed by the lack of clinical, biochemical, and radiological markers with proven sensitivity and specificity in cirrhotic patients. In this re- view, we discuss the epidemiology, pathophysiology, diagnosis, and therapies for AKI in cirrhotic patients admitted to an intensive care unit (ICU). CITA: Ann Hepatol. May-Jun 2012;11(3):301-10 DOI: 10.1016/S1665-2681(19)30924-X PMID: 22481454 TÍTULO: High coffee intake is associated with lower grade nonalcoholic fatty liver disease: the role of peripheral antioxidant activity AUTORES: Gutiérrez-Grobe Y, Chávez-Tapia N, Sánchez-Valle V, Gavilanes-Espinar JG, Ponciano-Rodríguez G, Uribe M, Méndez-Sánchez N. BACKGROUND & AIMS: Some phytochemicals present in coffee have a potential antioxidant role which seems to protect the human body against cardiovascular diseases, liver disease and malignancies. Nonalcoholic fat- ty liver disease is a common disease with limited therapeutic options. This study investigated the antioxidant effect of coffee by measuring antioxidant enzymes and lipid peroxidation markers in patients with nonalcoholic fatty liver disease. MATERIAL AND METHODS: We performed a case-control study at the University Hospital, Mexico City. Anthropometric, metabolic, dietary and bio- chemical variables of all patients were determined and compared. The pres- ence of nonalcoholic fatty liver disease was established by ultrasonography. All patients completed a dietary questionnaire in order to determine their of coffee consumption. Catalase, superoxide dismutase and thiobarbituric acid reactive substances were measured in all of the patients. RESULTS: Seventy-three subjects with and 57 without nonalcoholic fatty liver disease were included. Patients with nonalcoholic fatty liver disease had signifi- cantly higher body mass index, blood glucose, homeostasis model of assess- ment-insulin resistance and insulin values in comparison to patients without non- alcoholic fatty liver disease. On the one hand, there was a significant difference in coffee intake between the groups (p < 0.05, for all comparisons). There was no significant difference between groups in catalase (0.39 ± 0.74 vs. 0.28 ± 0.69 nM/min/mL), superoxide dismutase (5.4 ± 3.45 vs. 4.7 ± 2.1 U/mL) or thiobarbi- turic acid-reactive substances (4.05 ± 1.87 vs. 3.94 ± 1.59 µM/mL). CONCLUSIONS: A high intake of coffee has a protective effect against non- alcoholic fatty liver disease however there was no significant difference in the antioxidant variables analyzed. CITA: Ann Hepatol. May-Jun 2012;11(3):350-5 DOI: 10.1016/S1665-2681(19)30931-7 PMID: 22489794 TÍTULO: Association of nutrition parameters including bioelectrical imped- ance and systemic inflammatory response with quality of life and prognosis in patients with advanced non-small-cell lung cancer: a prospective study AUTORES: Sánchez-Lara K, Turcott JG, Juárez E, Guevara P, Núñez-Va- lencia C, Oñate-Ocaña LF, Flores D, Arrieta O. 120

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR SUMMARY: Early identification and treatment of nutritional deficiencies can lead to improved outcomes in the quality of life (QoL) and survival of pa- tients with nonsmall cell lung cancer (NSCLC). Noninvasive techniques are needed to evaluate changes in body composition as part of determining nu- tritional status. The aim of the study was to evaluate the association of nutri- tional parameters in health-related quality of life (HRQL) and survival in pa- tients with advanced NSCLC. Chemotherapy-naïve patients with advanced NSCLC with good performance status Eastern Cooperative Oncology Group (ECOG) 0-2 were included prospectively in the study. We evaluated inflam- matory parameters such as C-reactive protein, platelet/lymphocyte index, neutrophil/lymphocyte index, serum interleukin (IL)-6, and tumor necrosis factor-α, and nutritional variables such as body mass index (BMI) and serum albumin levels. Bioelectrical impedance analysis including phase angle was obtained before cisplatin-based chemotherapy was started. HRQL was as- sessed by application of the European Organization for Research and Treat- ment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-LC13 instruments at baseline. Overall survival (OS) was calculated with the Ka- plan-Meier method and analyzed with log-rank and Cox proportional hazard models. One hundred nineteen patients were included. Mean BMI was 24.8 ± 4.5 kg/m(2), average weight loss of patients was 8.4%, and median phase angle was 5.8°. Malnutrition measured by subjective global assessment (SGA), weight loss >10%, BMI >20 was associated with lower HRQL scales. Patients with ECOG 2, high content serum IL-6, lower phase angle, and mal- nutrition parameters showed lower OS; however, after multivariate analysis, only ECOG 2 [Hazard ratio (HR), 2.7; 95% confidence interval (95% CI), 1.5- 4.7; P = 0.001], phase angle ≤5.8° (HR = 3.02; 95% CI: 1.2-7.11; P = 0.011), and SGA (HR = 2.7; 95% CI, 1.31-5.5; P = 0.005) were associated with poor survival. Patients were divided into low-, intermediate-, and high-risk groups according to regression coefficients; OS at 1 yr was 78.4, 53, and 13.8%, re- spectively. Malnutrition is associated with low HRQL and is an independent prognostic factor in advanced NSCLC. The results warrant prospective trials to evaluate the impact of different nutritional interventions on HRQL and sur- vival. CITA: Nutr Cancer. 2012;64(4):526-34 DOI: 10.1080/01635581.2012.668744 PMID: 22525388 TÍTULO: One hundred years of immunotherapy: review of the first landmark PMID: 22541411 studies AUTORES: SUMMARY: Larenas Linnemann DE. CITA: Allergy Asthma Proc. Mar-Apr 2012;33(2):122-8 DOI: 10.2500/aap.2012.33.3515 TÍTULO: Survey on immunotherapy practice patterns: dose, dose adjust- ments, and duration AUTORES: Larenas-Linnemann DE, Gupta P, Mithani S, Ponda P. BACKGROUND: Practical issues dealing with the administration of allergen immunotherapy (AIT) by European and US allergists are not well known. Several concerns are only partially covered by guidelines. 121

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR Objective: To survey AIT practice patterns among worldwide members of the American Academy of Allergy, Asthma and Immunology (AAAAI). METHODS: A web-based survey was conducted among AAAAI members on dosing, dose adjustment after missed doses, and duration of AIT. RESULTS: A total of 1,201 replies (24.7% response rate of which 10% of re- sponses were from non-US and non-Canada members). A total of 57% to 65% of the US-Canadian dosing falls within the recommended Practice Parameter ranges (9.4%-19% too low). Dose adjustment after missed doses is based on time elapsed since the last administered dose by 77% of US-Canadian and 58% of non-US-Canadian allergists. Doses are reduced when a patient comes in more than 14 days for 5 weeks after the last administration and initial dos- ing restarted after more than 30 days for 12 weeks since last administration during the build-up or maintenance stage. After missing 1 to 3 doses, the dos- ing schedules were mostly followed (build-up phase: repeat last dose, reduce by 1 dose, reduce by 2doses; maintenance phase: reduce by 1 dose, reduce by 2 doses, reduce by 3 doses). AIT is prescribed for a median of 3 years by non-US-Canadian allergists but for a median of 5 years by 75% of US-Canadi- an allergists. Main reasons for continuing beyond 5 years were \"after stopping, symptoms reappeared\" or \"patient afraid to relapse.\" CONCLUSION: Many patients receive less than recommended doses. Two areas in which to plan further research are establishment of an optimal dose-adjustment plan for missed applications and exploration of the maxi- mum appropriate duration of immunotherapy. CITA: Ann Allergy Asthma Immunol. 2012 May;108(5):373-378.e3 DOI: 10.1016/j.anai.2012.03.009 PMID: 22688826 TÍTULO: Secondary MRI-findings, volumetric and spectroscopic measure- ments in mesial temporal sclerosis: a multivariate discriminant analysis AUTORES: Lopez-Acevedo ML, Martinez-Lopez M, Favila R, Roldan-Vala- dez E. INTRODUCTION: Primary- and secondary MR findings, volumetric mea- surements and MR spectroscopy data of each hippocampus represent more a dozen of variables that radiologists should consider in a quantitative MR report of temporal lobe epilepsy (TLE). There is a paucity of data about the significance of secondary MR findings simultaneously evaluated with volu- metry and MR spectroscopy. We analyzed the influence of qualitative-sec- ondary MR findings simultaneously with quantitative (volumetry and spec- troscopy) data in MRI positive- and negative patients with mesial temporal sclerosis (MTS). METHODS: Analytic and transversal study of 59 patients with TLE and sus- piciousness of MTS. 13 variables were analyzed for each hippocampus: age, gender, cerebral hemisphere, temporal lobe atrophy, choroidal fissure dila- tation, mamillary body atrophy, collateral white matter atrophy, fornix asym- metry; Naa/Cr, Cho/Cr, mI/Cr, Naa/(Cr+Cho); and hippocampus volume (mm3). Multivariate discriminant analysis (DA) was performed with the aim to identify specific morphologic and metabolic attributes in hippocampi with and without MTS. 122

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR RESULTS: Discriminant function significantly differentiated the hippocam- pi with- and without MTS (Wilks' λ = 0.211, χ2 (11) = 116.072, p = < .001. The model explained 79.03% of the variation in the grouping variable. The pooled within-groups correlations showed the highest influence of discrim- inating function for the secondary MR findings over metabolite indices and hippocampal volumes, the overall predictive accuracy was 93.9%. DISCUSSION: Due of the large number of variables (qualitative and quan- titative) to which a radiologist is exposed in a conventional hippocampal MR-report, such evaluation might benefit from the use of predictive models generated by unconventional statistical methods, such as DA. CITA: Swiss Med Wkly. 2012 Jun 6;142:w13549 DOI: 10.4414/smw.2012.13549 PMID: 22700644 TÍTULO:  Atherosclerosis and chronic hepatitis C AUTORES: Carrillo-Córdova LD, Uribe M, Méndez-Sánchez N. SUMMARY: Letter to the editor CITA: Ann Hepatol. Jul-Aug 2012;11(4):574- DOI: 10.1016/S1665-2681(19)31477-2 PMID: 22709007 TÍTULO: Role of oxidative stress and molecular changes in liver fibrosis: a review AUTORES: Sánchez-Valle V, Chávez-Tapia NC, Uribe M, Méndez-Sán- chez N. SUMMARY: Liver fibrosis represents a health problem with significant mor- bidity and mortality that affects 100 million people worldwide. It is a final pathway to several chronic liver diseases and is characterized by excess collagen and accumulation of extracellular matrix in response to chronic hepatocellular damage. Clinical and experimental data suggest that oxida- tive stress (OS) mediates the progression of fibrosis, and that OS-related molecules may act as mediators of molecular and cellular events implicated in liver fibrosis. The generation of reactive oxygen species (ROS) plays an important role in producing liver damage and initiating hepatic fibrogenesis. OS disrupts lipids, proteins and DNA, induces necrosis and apoptosis of hepatocytes and amplifies the inflammatory response. ROS also stimulate the production of profibrogenic mediators from Kupffer cells and circulating inflammatory cells and directly activate hepatic stellate cells, resulting in the initiation of fibrosis. Advances in understanding the mechanisms involved in fibrosis have identified new molecular targets with therapeutic potential for more targeted and personalized control of this disease. This review will highlight recent concepts in OS, antioxidants and the molecular pathways involved in hepatic fibrosis. CITA: Curr Med Chem. 2012;19(28):4850-60 DOI: 10.2174/092986712803341520 123

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 22727150 TÍTULO: Food and Drug Administration reclassification of allergens for diag- PMID: 22732996 nosis and treatment: now is the time to be heard AUTORES: Larenas-Linnemann DE, Finegold I, Nelson H. SUMMARY: Letter to the editor CITA: Ann Allergy Asthma Immunol. 2012 Jul;109(1):6-9 DOI: 10.1016/j.anai.2012.03.007 TÍTULO: Malnutrition and associated factors in elderly hospitalized AUTORES: Lara-Pulido A, Guevara-Cruz M. OBJECTIVES: To investigate the frequency of malnutrition and associated factors in patients over 65 years of age in a hospital. METHODS: We conducted an observational, crosssectional and descriptive study. Department of Nutritional Support, Hospital Medica Sur, Mexico, we evaluated patients over 65 years of age within the first 24 hours of admission. RESULTS: We evaluated 769 patients, 49% of whom were women and 51% were men, with an average age of 75.3 ± 7.7 years. Among the patients evaluated, 53.6% exhibited an altered nutritional state. In addition, 9% were diagnosed as obese and 15% as overweight. Their risk of malnutrition was determined to be 22.5%, and at the time of admission, 7% were malnour- ished. CONCLUSION: The prevalence of malnutrition in hospitalized patients over 65 years of age was high. Thus, the early diagnosis of patients who are at risk for malnutrition or who are malnourished is essential and allows for prompt treatment. CITA: Nutr Hosp. Mar-Apr 2012;27(2):652-5 DOI: 10.1590/S0212-16112012000200044 PMID: 22795356 TÍTULO: Adenocarcinoma with pyloric gland phenotype of the extrahepatic bile ducts: a previously unrecognized and distinctive morphologic variant of extrahepatic bile duct carcinoma AUTORES: Albores-Saavedra J, Chablé-Montero F, Méndez-Sánchez N, Mercado MÁ, Vilatoba-Chapa M, Henson DE. SUMMARY: Carcinomas of the extrahepatic bile ducts are uncommon and morphologically heterogeneous. We report 3 unique examples of adenocar- cinomas that show predominantly pyloric gland differentiation (80%-100%) and compare their immunohistochemical profile with that of pyloric gland adenomas of the gallbladder, foveolar, and intestinal-type adenocarcinomas of the extrahepatic bile duct. The 3 patients with pyloric gland adenocarci- nomas were younger than those with conventional adenocarcinomas. The 3 tumors were very well differentiated but showed extensive perineural in- vasion. They consisted of a variable proportion of small, medium-sized, and cystically dilated glands separated by abundant desmoplastic stroma. The glands were lined by columnar cells with abundant mucin-containing cyto- plasm and small hyperchromatic basally placed nuclei with inconspicuous 124

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR nucleoli. A characteristic feature of these pyloric gland adenocarcinomas was that the glands had a stellar pattern that was not seen in foveolar-, in- testinal-, or biliary-type adenocarcinomas. Two pyloric gland adenocarcino- mas coexpressed MUC6 and MUC5AC. The diffuse pattern of reactivity of MUC5AC and MUC6 was similar to that of 10 pyloric gland adenomas of the gallbladder and 2 foveolar adenocarcinomas of the extrahepatic bile duct. In contrast, 5 intestinal adenocarcinomas of the extrahepatic bile duct la- beled with the intestinal marker CDX2 and 3 with the colonic MUC2 but were negative for MUC6 and MUC5AC. We believe that these pyloric gland ade- nocarcinomas represent a previously unrecognized distinct clinicopathologic entity. Despite their deceptively benign microscopic appearance, 1 patient died with local recurrence and liver metastasis, another patient is living with tumor, and the third patient is asymptomatic but only 5 months after surgery. CITA: Hum Pathol. 2012 Dec;43(12):2292-8 DOI: 10.1016/j.humpath.2012.04.003 PMID: 22884150 TÍTULO: Diffusion tensor imaging-derived measures of fractional anisotropy across the pyramidal tract are influenced by the cerebral hemisphere but not by gender in young healthy volunteers: a split-plot factorial analysis of variance AUTORES: Roldan-Valadez E, Rios-Piedra E, Favila R, Alcauter S, Rios C. BACKGROUND: Diffusion tensor imaging (DTI) permits quantitative exam- ination within the pyramidal tract (PT) by measuring fractional anisotropy (FA). To the best of our knowledge, the inter-variability measures of FA along the PT remain unexplained. A clear understanding of these reference values would help radiologists and neuroscientists to understand normality as well as to detect early pathophysiologic changes of brain diseases. The aim of our study was to calculate the variability of the FA at eleven anatomical land- marks along the PT and the influences of gender and cerebral hemisphere in these measurements in a sample of young, healthy volunteers. METHODS: A retrospective, cross-sectional study was performed in twen- ty-three right-handed healthy volunteers who underwent magnetic reso- nance evaluation of the brain. Mean FA values from eleven anatomical land- marks across the PT (at centrum semiovale, corona radiata, posterior limb of internal capsule (PLIC), mesencephalon, pons, and medulla oblongata) were evaluated using split-plot factorial analysis of variance (ANOVA). RESULTS: We found a significant interaction effect between anatomical landmark and cerebral hemisphere (F (10, 32) = 4.516, P = 0.001; Wilks' Lambda 0.415, with a large effect size (partial η(2) = 0.585)). The influence of gender and age was non-significant. On average, the midbrain and PLIC FA values were higher than pons and medulla oblongata values; centrum semiovale measurements were higher than those of the corona radiata but lower than PLIC. CONCLUSIONS: There is a normal variability of FA measurements along PT in healthy individuals, which is influenced by regions of interest location (anatomical landmarks) and cerebral hemisphere. FA measurements should be reported for comparing same-side and same-landmark PT to help avoid comparisons with the contralateral PT; ideally, normative values should exist for a clinically significant age group. A standardized package of selected DTI processing tools would allow DTI processing to be routinely performed in clinical settings. CITA: Chin Med J (Engl). 2012 Jun;125(12):2180-7 125

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 22947525 TÍTULO: Clinical course and management of acute hepatitis A infection in adults PMID: 22947539 AUTORES: Mackinney-Novelo I, Barahona-Garrido J, Castillo-Albarran F, PMID: 23109451 Santiago-Hernández JJ, Méndez-Sánchez N, Uribe M, Chávez-Tapia N. BACKGROUND: Hepatitis A is the most common type of viral hepatitis in Mexico. The change of hepatitis A epidemiology in Mexico from high to inter- mediate endemicity leads to increasing susceptible adults for severe illness. OBJECTIVE: To describe the clinical characteristics and hospital outcome of adult patients with acute hepatitis A infection, and determine risk factor for mortality. MATERIAL AND METHODS: This is a retrospective observational, multi- centre study in Mexico City and in Guatemala City. All inhospital patients were followed until discharge or death. Risk factors for death/acute liver fail- ure were identified. RESULTS: Forty seven patients were analyzed, sixty percent were male, the prodrome phase was from 3 to 30 days. The three most common symp- toms were fever, malaise and jaundice, with 87%, 74% and 62% respectively. The incidence of patients who were treated with antibiotics before hospital admission was up to 34%. Unnecessary imaging studies and out of guide- lines drugs were used. Presence of encephalopathy, leukocytes > 19,000/ mL, blood urea nitrogen > 36 mg/dL, creatinine > 2 mg/dL, albumin < 2.5 mg/ dL and total bilirubin > 9.6 mg/dL, are predictors of mortality. Serum creati- nine > 2 mg/dL has the best sensibility and specificity for predicting fulminant hepatitis/death. CONCLUSION: Acute hepatitis A infection in adults is associated some un- necessary diagnostic and therapeutic approach. Could be associated with fulminant hepatitis, and a creatinine value > 2 mg/dL is the best predictor for fulminant hepatitis and death. CITA: Ann Hepatol. Sep-Oct 2012;11(5):652-7 DOI: 10.1016/S1665-2681(19)31438-3 TÍTULO: Silybin/Silymarin treatment in chronic hepatitis C AUTORES: Barbero-Becerra VJ, Méndez-Sánchez N. SUMMARY: Letter to the editor CITA: Ann Hepatol. Sep-Oct 2012;11(5):731-3 DOI: 10.1016/S1665-2681(19)31452-8 TÍTULO: IL28B polymorphisms predict the response to chronic hepatitis C virus infection treatment in a Mexican population AUTORES: Martínez-Gómez LE, Chávez-Tapia NC, Burguete-García AI, Aguilar-Olivos N, Madrid-Marina V, Román-Bahena M, Orbe-Orihuela C, Misael U, Méndez-Sánchez N. INTRODUCTION: The treatment of hepatitis C virus (HCV) genotype 1 with ribavirin (RBV) and pegylated-interferon alpha (peg-IFNα) provides a 126

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23240228 low-level sustained virological response (SVR). Single nucleotide polymor- PMID: 23287324 phisms (SNPs) in the interleukin 28B (IL28B) gene have been identified as SVR predictors. Our aim was to establish an association between three IL28B SNPs (rs8099917, rs12979860, and rs8103142) and the peg-IFNα/ RBV treatment response in a Mexican population cohort with chronic HCV. MATERIAL AND METHODS: A cohort study was performed with 83 chronic HCV patients at the Fundación Clínica Médica Sur in Mexico City. All pa- tients were treated with peg-IFNα and RBV. The data were analyzed by lo- gistic regression, with adjustments for age, gender, and viral genotype, to determine any associations between the SNPs and the treatment response. RESULTS: In the study group of 83 HCV patients, the main genotype was genotype 1 (70%, n = 58) and the overall SVR was 32.53% (n = 27). In the HCV-1 group, SVR was 27%, whereas SVR was 44% in the HCV-2 group. We found an association between rs12979860 CC and SVR in a codomi- nant model (OR = 4.83, 95% CI = 1.12-20.8, P = 0.033). There was no sta- tistically significant association between SVR and rs8099917 or rs8103142. rs12979860 polymorphisms of CC, CT, and TT, were present in 24%, 41%, and 35% of patients, respectively. CONCLUSION: A Mexican HCV-1-infected population treated with peg-IF- Nα and RVB had a low SVR rate, which was associated with the SNP rs12979860 (CC). SVR was not associated with the SNPs rs8099917 or rs8103142. CITA: Ann Hepatol. Nov-Dec 2012;11(6):876-81 DOI: 10.1016/S1665-2681(19)31413-9 TÍTULO: [Small bowel obstruction secondary to incomplete torsion of proxi- mal ileum following laparoscopic hysterectomy. Case report] AUTORES: López Rangel JA, Audifred Salomón J, Ortiz Reyes H, Cer- vantes Mondragón PJ. SUMMARY: A minimally invasive approach for gynecologic procedures has become popular in recent years. Despite the advantages of this kind of sur- gery over open technique, laparoscopic hysterectomy is not free of complica- tions. A case of small bowel obstruction secondary to incomplete torsion of proximal ileum ten days after an uneventful total laparoscopic hysterectomy is reported. Partial small bowel obstruction (PSBO) is a rare complication after gynecologic laparoscopy; its post-operatory incidence is 0.036% within a month after. A clean, adequate surgical technique, with minimal manipula- tion of internal organs, reduces the risk of adhesive process and PSBO. CITA: Ginecol Obstet Mex. 2012 Oct;80(10):650-3 TÍTULO: Neuroanatomy of episodic and semantic memory in humans: a brief review of neuroimaging studies AUTORES: García-Lázaro HG, Ramirez-Carmona R, Lara-Romero R, Roldan-Valadez E. SUMMARY: One of the most basic functions in every individual and species is memory. Memory is the process by which information is saved as knowl- edge and retained for further use as needed. Learning is a neurobiological phenomenon by which we acquire certain information from the outside world 127

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23336151 and is a precursor to memory. Memory consists of the capacity to encode, PMID: 23405511 store, consolidate, and retrieve information. Recently, memory has been de- fined as a network of connections whose function is primarily to facilitate the long-lasting persistence of learned environmental cues. In this review, we present a brief description of the current classifications of memory networks with a focus on episodic memory and its anatomical substrate. We also pres- ent a brief review of the anatomical basis of memory systems and the most commonly used neuroimaging methods to assess memory, illustrated with magnetic resonance imaging images depicting the hippocampus, temporal lobe, and hippocampal formation, which are the main brain structures partic- ipating in memory networks. CITA: Neurol India. Nov-Dec 2012;60(6):613-7 DOI: 10.4103/0028-3886.105196 TÍTULO: [Syndrome of abdominal compartment in trauma] AUTORES: Carrillo-Esper R, Sosa-García JO, Carrillo-Córdova JR, Ley- va-Mondragón C. BACKGROUND: the intra-abdominal hypertension is defined as an increase in intra-abdominal pressure more or equal as ≥ 12 mmHg and it is called as abdominal compartment syndrome when associates with any organ dys- function. Its development in the patient with multiple trauma is the result of the mechanism of injury, aggressive resuscitation and/or surgical treatment. The goal of this investigation is to describe the monitoring and all decisions made based on the measurement of intra-abdominal pressure in a patient with multiple injuries that developed abdominal compartment syndrome. CLINICAL CASE: 21 years old male with multiple trauma who underwent damage control surgery with splenectomy, repair of liver injury and packag- ing. Intra-abdominal pressure monitoring showed progressive increase that was associated with cardiopulmonary dysfunction resistant to medical treat- ment so we decided to unpack, which reduced the intra-abdominal pressure and improved cardiopulmonary fitness. CONCLUSIONS: intra-abdominal hypertension / abdominal compartment syndrome significantly increases morbidity and mortality therefore the mea- surement of intra-abdominal pressure is a fundamental tool for early detec- tion and timely management of this condition and its complications. CITA: Cir Cir. Nov-Dec 2012;80(6):550-5 TÍTULO: [Latzko surgery in recidivant vesicovaginal fistulae. Two case re- ports and literature review] AUTORES: Meraz Avila D, Vilchis Nava P, Nevarez Bernal RA. SUMMARY: Recurrent vesicovaginal fistulae represent a clinical problem of the utmost importance due to the impact on the patients' quality of life. The current standard of treatment for this problem is surgical, with an abdominal approach, notwithstanding, may authors state that this repair should be done with the technique and approach that the surgeon feels most comfortable. We have successfully treated two patients with recurrent vesicovaginal fis- tulae using a vaginal approach, therefore we suggest it as a viable alter- native in the treatment of this condition. We present two case reports an literature review, with the necessary modifications of the Latzko technique. CITA: Ginecol Obstet Mex. 2012 Dec;80(12):788-94 128

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24377031 TÍTULO: The prescription of oral anticancer drugs: Another perspective PMID: 24416531 AUTORES: Linares L, Poitevin A, De la Pena C, Britton KR, Ospino R, Lara 2013 R, Sarria G, Motta N, Rene N, Pinillos L, Novaes P SUMMARY: Editorial PMID: 22691288 CITA: Rep Pract Oncol Radiother. 2012 Nov 8;17(6):295-7 DOI: 10.1016/j.rpor.2012.10.005 TÍTULO: Patterns of care of radiotherapy in México AUTORES: Poitevin-Chacón A, Hinojosa-Gómez J. AIM: This survey is performed to learn about the structure of radiotherapy in México. BACKGROUND: Radiation oncology practice is increasing because of the higher incidence of cancer. There is no published data about radiotherapy in México. MATERIALS AND METHODS: A questionnaire was sent to the 83 regis- tered centers in the database of the Mexican regulatory agency. One out of the 32 states has no radiotherapy. 27 centers from 14 states provided their answers. RESULTS: 829 patients are treated annually with any radiotherapy modal- ity in each center. Two centers have one cobalt machine, 7 have a cobalt and a linac and 10 have more than one linac. Five centers use 2D planning systems, 22 use 3D; 9, conventional simulators; 22, CT based simulation, and 1 center has no simulation. Most of the centers verify beams with films, electronic portal image devices and cone beam CTs are also used. Intensity modulated and image guided radiotherapy are performed in 5 states. Breast, prostate, cervix, lung, rectum and head and neck cancer are the six most common locations. There are 45 public and 38 private centers, 2 dedicated to children. Two gamma knife units, 5 Novalis systems, 1 tomotherapy and 2 cyberknife machines are working. All centers have at least one radiation oncologist, one physicist and one radiotherapist. CONCLUSIONS: Definitive conclusions cannot be drawn from this limited feedback due to a low participation of centers. This survey about radiother- apy in Mexico shows the heterogeneity of equipment as well as medical and technical staff in the whole country. CITA: Rep Pract Oncol Radiother. 2012 Oct 4;18(2):57-60 DOI: 10.1016/j.rpor.2012.09.001 TÍTULO: Gastrointestinal symptoms and weight loss in cancer patients re- ceiving chemotherapy AUTORES: Sánchez-Lara K, Ugalde-Morales E, Motola-Kuba D, Green D. SUMMARY: Cancer patients receiving chemotherapy have a high risk of malnutrition secondary to the disease and treatment, and 40-80 % of cancer 129

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR patients suffer from different degrees of malnutrition, depending on tumour subtype, location, staging and treatment strategy. Malnutrition in cancer pa- tients affects the patient's overall condition, and it increases the number of complications, the adverse effects of chemotherapy and reduces the quality of life. The aim of the present study was to evaluate weight-loss prevalence depending on the tumour site and the gastrointestinal (GI) symptoms of on- cology patients receiving chemotherapy. We included 191 cancer patients receiving chemotherapy. Files of all patients were reviewed to identify symp- toms that might potentially influence weight loss. The nutritional status of all patients was also determined. The cancer sites in the patients were as fol- lows: breast (31·9 %); non-colorectal GI (18·3 %); colorectal (10·4 %); lung (5·8 %); haematological (13·1 %); others (20·5 %). Of these patients, 58 % experienced some degree of weight loss, and its prevalence was higher among the non-colorectal GI and lung cancer patients. Common symptoms included nausea (59·6 %), anorexia (46 %) and constipation (31·9 %). A higher proportion of patients with ≥ 5 % weight loss experienced anorex- ia, nausea and vomiting (OR 9·5, 2·15 and 6·1, respectively). In conclusion, these results indicate that GI symptoms can influence weight loss in cancer patients, and they should be included in early nutritional evaluations. CITA: Br J Nutr. 2013 Mar 14;109(5):894-7 DOI: 10.1017/S0007114512002073 PMID: 23085868 TÍTULO: Diagnostic performance of regional DTI-derived tensor metrics in glioblastoma multiforme: simultaneous evaluation of p, q, L, Cl, Cp, Cs, RA, RD, AD, mean diffusivity and fractional anisotropy AUTORES: Cortez-Conradis D, Favila R, Isaac-Olive K, Martinez-Lopez M, Rios C, Roldan-Valadez E. OBJECTIVES: Almost a dozen diffusion tensor-imaging (DTI) variables have been used to evaluate brain tumours with scarce information about their diagnostic ability. We aimed to perform a comprehensive evaluation of tensor metrics reported in the last decade. METHODS: Retrospective case control study performed in 14 patients with glioblastoma multiforme (GBM) and 28 controls. Conventional brain MR se- quences and image postprocessing of DTI allowed the calculation of: MD, FA, p, q, L, Cl, Cp, Cs, RA, RD and AD, classified into five regions: normal appearance white matter (NAWM), immediate and distant oedema, enhanc- ing rim and cystic cavity. ANOVA and AUROC analyses were performed. RESULTS: ANOVA depicted a significant difference among all metrics (p < 0.05). RA had the highest performance in the NAWM and cystic cavity; im- mediate and distant zones of oedema were best diagnosed by RD and Cp respectively; q was the best biomarker of the enhancing rim zone; p < 0.001 for all metrics. CONCLUSIONS: FA and MD, accepted biomarkers of brain injury, were sur- passed by other metrics. RA, together with Cs, Cl and CP, might be the new leaders in the evaluation of brain tumours. DTI tensor metrics depict differ- ent clinical applicability at each tumour region. CITA: Eur Radiol. 2013 Apr;23(4):1112-21 DOI: 10.1007/s00330-012-2688-7 130

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23293205 TÍTULO: Granulomatous hepatitis caused by Q fever: a differential diagno- sis of fever of unknown origin PMID: 23293211 AUTORES: Aguilar-Olivos N, del Carmen Manzano-Robleda M, Gutiér- PMID: 23312708 rez-Grobe Y, Chablé-Montero F, Albores-Saavedra J, López-Méndez E. SUMMARY: The differential diagnosis of fever of unknown origin (FUO) in- cludes infectious, neoplastic, rheumatic inflammatory and miscellaneous dis- eases. We report the case of a 35-year-old man with FUO caused by Q fever. A liver biopsy showed the characteristic fibrin-ring lipogranulomas compatible with Q fever. The serologic tests confirmed the diagnosis of acute infection by Coxiella burnetii. The therapeutic response was excellent. In conclusion, we described a patient with acute Q fever and granulomatous hepatitis. CITA: Ann Hepatol. Jan-Feb 2013;12(1):138-41 DOI: /doi.org/10.1016/S1665-2681(19)31396-1 TÍTULO: Raloxifene hydrochloride as hepatitis C treatment AUTORES: Motola-Kuba M, Méndez-Sánchez N. SUMMARY: Letter to the editor CITA: Ann Hepatol. Jan-Feb 2013;12(1):164-5 DOI: 10.1016/S1665-2681(19)31402-4 TÍTULO: Mucinous cystadenoma of the pyelocaliceal system: a report of 3 examples and an analysis of 17 previously published cases AUTORES: Chablé-Montero F, Mendoza-Ramírez S, Lavenant-Borja MI, González-Romo MA, Soto-Abraham V, Henson DE, Albores-Saavedra J. SUMMARY: We report 3 patients all men between 45 and 64 years of age with unilocular or multilocular mucinous cystadenomas of the kidney. One tumor arose from the renal pelvis, and 2 involved the entire pyelocaliceal system. The tumors measured between 2.4 and 37 cm in greatest dimension. Two patients were asymptomatic, and 1 had recurrent attack of acute pyelonephritis. Micro- scopically, the morphology and immunophenotype (CK20, MUC2, and CDX2 positive) of the tumors were similar to the colonic adenomas. Two patients were asymptomatic 24 and 64 months after surgery, including the patient with muci- nous cystadenoma and intramucosal carcinoma. One patient died of acute myo- cardial infarction, and his tumor was an autopsy finding. Only 17 cases of muci- nous cystadenomas and 5 cases of mucinous cystadenocarcinomas have been reported. Of the 17 mucinous cystadenomas, 2 arose in horseshoe kidneys. The mean size of these neoplasms was 15 cm (2.4-37 cm). Despite their large size, some patients with mucinous cystadenomas were asymptomatic. Sixty percent were associated with renal lithiasis. Thirty percent progressed to mucinous ade- nocarcinomas, and only 2 cases showed areas of intramucosal carcinomas. Two cases were associated with carcinoid tumors, similar to those reported in the ap- pendix. Most patients were asymptomatic after surgery, and only 1 patient died by abdominal sepsis related to adenomucinosis. The 3 examples of mucinous cystadenomas of the pyelocaliceal system reported here, and those previously published indicate that they are very uncommon neoplasms with morphology and intestinal immunophenotype similar to the colonic adenomas. CITA: Ann Diagn Pathol. 2013 Jun;17(3):239-44 DOI: 10.1016/j.anndiagpath.2012.10.008 131

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23435081 TÍTULO: [Acute adverse effects in transfusion. Proposals for the hemosur- PMID: 23435082 veillance system] PMID: 23522316 AUTORES: Baptista González H. SUMMARY: The management model based on risk prevention has become a major influence in shaping policies for transfusion safety. There are ap- proximately sixty interactions between the health worker and the patient during the transfusion process,representing the number of times where you have the opportunity to make a mistake.We present an analysis of the weak- nesses of the National Blood System, with particular attention to the hae- movigilance donor and patient. The proposals include the implementation of the National Blood containing the need to establish from the National Blood Safety, significant changes in the regulatory framework and the internal regulations of the Ministry of Health, the CNTS and COFEPRIS. Is required to promote and coordinate the collection of accurate information from the committees of transfusion medicine, which will be accompanied by an initial diagnosis from the National Survey of Blood. Requires notice to other forms of funding to ensure the viability of the projects operating blood bank. Finally, as a strategic resource, the blood is of public, so access should not be re- stricted. CITA: Gac Med Mex. Jan-Feb 2013;149(1):94-101 TÍTULO: [Liver abscess syndrome with lung involvement secondary to hy- permucoviscosity Klebsiella pneumoniae] AUTORES: Carrillo Esper R, Soto Hernández JL, Peña Pérez CA, Carrillo Córdova LD, Carrillo Córdova CA, Carrillo Córdova DM. SUMMARY: Klebsiella pneumoniae liver abscess syndrome (KLAS) is an emerging infection characterized by primary monomicrobial liver abscess, bacteremia and metastatic complications. KLAS is endemic in Taiwan but additional cases has also been described in other world regions. It’s caused by strains of K. pneumonia serotype K1, rmpA, magA positive, displaying hy- permucoviscosity. We present the case of a previously healthy 69 years old patient who developed fever, liver abscess,septic shock, bacteremia, and pneumonia. In cultures grew hypermucoviscous phenotype of K. pneumonia characterized by positive “string test”. The patient responded favourably to antibiotic therapy with ceftriaxone, meropenem, amykacin and percutaneous drainage of the abscess. Increased awareness about this globally emerging infection by physicians could allow earlier detection and optimal treatment. CITA: Gac Med Mex. Jan-Feb 2013;149(1):102-7 TÍTULO: [Hemolytic anemia secondary to the placement of a portosystemic stented shunt] AUTORES: Carrillo-Esper R, Carrillo-Cortes U, Carrillo-Córdova JR, Car- rillo-Córdova LD, Carrillo-Córdova CA, Carrillo-Córdova DM. INTRODUCTION: portal hypertension and variceal hemorrhage are com- mon complications of hepatic cirrhosis, both associated with a high mor- bimortality. Portal system decompression by the placement of a transjugular intrahepatic portosystemic stented shunt, can reduce portal venus pressure and is effective controling complications of portal hypertension, like variceal hemorrhage and ascitis. The aim of this document is to describe a case of hemolytic anemia secondary to the placement of a transjugular intrahepatic portosystemic stented shunt. 132

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23559487 CLINICAL CASE: patient with portal hypertension secondary to liver cir- PMID: 23619258 rosis was given a transjugular intrahepatic portosystemic stented shunt for recurrent variceal hemorrhage. After the procedure, hemoglobin decreased 2 g/dL, associated with reticulocitosis, hipohaptoglobinemia, elevated lactic dehydrogenase and indirect hyperbilirrubinemia with negative Coombs test. The peripheral blood smear showed abnormal erythrocytes, with the preva- lence of schistocytes. The final diagnosis was hemolytic anemia secondary to transjugular intrahepatic portosystemic stented shunt. CONCLUSIONS: the hemolytic anemia secondary to Transjugular Intrahe- patic Portosystemic Stented Shunt is a rare complication. Usually, it has a benign prognosis, and it is self-limited once the stent is endothelialized. CITA: Cir Cir. Mar-Apr 2013;81(2):143-7 TÍTULO: An update on the management of hepatitis C: guidelines for prote- ase inhibitor-based triple therapy from the Latin American Association for the Study of the Liver AUTORES: Chávez-Tapia NC, Ridruejo E, Alves de Mattos A, Bessone F, Daruich J, Sánchez-Ávila JF, Cheinquer H, Zapata R, Uribe M, Bosques-Pa- dilla F, Gadano A, Sosa A, Dávalos-Moscol M, Marroni C, Muñoz-Espinoza L, Castro-Narro G, Paraná R, Méndez-Sánchez N, et al SUMMARY: Hepatitis C is a common cause of end-stage liver disease, and the main indication for liver transplantation in Latin America. Treatment of hepatitis C infected patients improves important long-term outcomes as mor- tality. Sustained viral response is reached in near 50% of patients with the previous management based in pegylated interferon and ribavirin. Recently new drugs were available increasing sustained viral response significantly, changing the standard of care to triple therapy. This guidelines provides a framework for practitioner in Latin America, to the management of patients with hepatitis C chronic infection. CITA: Ann Hepatol. Mar-Apr 2013;12 Suppl 2:s3-35 DOI: 10.1016/S1665-2681(19)31404-8 TÍTULO: Validation study of systems for noninvasive diagnosis of fibrosis in nonalcoholic fatty liver disease in Latin population AUTORES: Pérez-Gutiérrez OZ, Hernández-Rocha C, Candia-Balboa RA, Arrese MA, Benítez C, Brizuela-Alcántara DC, Méndez-Sánchez N, Uribe M, Chávez-Tapia NC. Background: The incidence of liver cirrhosis is significantly high in Latin population. The high prevalence of nonalcoholic fatty liver disease NAFLD is likely partially responsible for these figures. Liver biopsy is not a practical diagnostic option in this scenario. The validation of noninvasive markers of fibrosis is important in populations with a high prevalence of NAFLD. AIM: To compare the diagnostic value of noninvasive assessment systems to detect fibrosis in a cohort of Latin patients with biopsy-proven NAFLD. MATERIAL AND METHODS: Patients with biopsy-proven NAFLD were included. Noninvasive evaluations included calculations of NAFLD fibrosis, FIB-4, BARD scores, APRI, and AST/ALT ratio. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the re- ceiver-operating characteristic curve (AUROC) were calculated. 133

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23706708 RESULTS: A total of 228 patients (mean age, 48.6 ± 12.7 years) were in- cluded. Fifty-one percent were women; 48% were overweight and 23% were obese. The severity of fibrosis was classified as G0, 56.6%; G1, 25%; G2, 6.6%; G3, 7%; and G4, 4.8%. The AUROC values for advanced fibrosis were 0.72 for the NAFLD fibrosis score, 0.74 for FIB-4 score, 0.67 for AST/ ALT ratio, 0.66 for APRI score, and 0.65 for BARD score. In 54% of patients with undetermined FIB-4 score and in 60% of patients with undetermined NAFLD fibrosis score, fibrosis was observed in the liver biopsy. CONCLUSIONS: The NAFLD fibrosis, FIB-4, and APRI scores can be used for the noninvasive diagnosis of fibrosis. However, 25% of patients evaluat- ed by these methods have an indeterminate degree of fibrosis. CITA: Ann Hepatol. May-Jun 2013;12(3):416-24 DOI: 10.1016/S1665-2681(19)31004-X TÍTULO: Pediatric sublingual immunotherapy efficacy: evidence analysis, 2009-2012 AUTORES: Larenas-Linnemann D, Blaiss M, Van Bever HP, Compalati E, Baena-Cagnani CE. OBJECTIVE: To perform a structured analysis of the latest scientific evi- dence obtained for the clinical efficacy of sublingual immunotherapy (SLIT) in children. DATA SOURCES: PubMed, Embase, reference lists from reviews, and per- sonal databases were reviewed for original articles on clinical trials with SLIT inpatients younger than 18 years published from January 1, 2009, through December31, 2012, using broad search and medical subject heading terms. STUDY SELECTIONS: Clinical trials, irrespective of their design, of SLIT in the treatment of respiratory and food allergy in patients 18 years or younger were selected. Clinical outcomes (symptom scores, medication use, provo- cation tests, pulmonary function tests, skin prick tests, and adverse events) and immunologic changes were tabulated. Quality of each trial and total quality of compounded evidence was analyzed with the Grading of Recom- mendations Assessment, Development and Evaluation system. RESULTS: Of 56 articles, 29 met the inclusion criteria. New evidence is ro- bust for the precoseasonal tablet and drop grass pollen SLIT efficacy in al- lergic rhinitis and scarce for seasonal asthma. Some evidence for Alternaria SLIT efficacy is appearing. For house dust mite (HDM) SLIT in asthma, there is high-quality evidence for medication reduction while maintaining symptom control; evidence for HDM SLIT efficacy in allergic rhinitis is of moderate-low quality. There is moderate evidence for efficacy of dual grass pollen-HDM SLIT after 12months of treatment and 1 year after discontinuation. Specific provocation test results (nasal, skin) improve with grass pollen and HDM SLIT but nonspecific bronchial provocation testing does not. Food oral immuno- therapy is more promising than food SLIT. Possible new surrogate markers have been reported. No anaphylaxis was found among 2469 treated children. CONCLUSION: Evidence for efficacy of SLIT in children with respiratory or food allergy is growing. CITA: Ann Allergy Asthma Immunol. 2013 Jun; 110(6):402-415.e9 DOI: 10.1016/j.anai.2013.02.017 134

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23742732 TÍTULO: A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy AUTORES: Chavez-Tapia NC, Cesar-Arce A, Barrientos-Gutiérrez T, Vil- legas-López FA, Méndez-Sanchez N, Uribe M. BACKGROUND AND AIM: Because low serum zinc levels precipitate he- patic encephalopathy, zinc supplementation is considered a potential ther- apeutic option. The aim of this study was to assess the effects of oral zinc supplementation in the treatment of hepatic encephalopathy. METHODS: For this systematic review and meta-analysis, data sources in- cluded electronic databases (CENTRAL, MEDLINE, EMBASE) and manual searching. Randomized clinical trials of adult patients diagnosed with liver cirrhosis and hepatic encephalopathy were included. The types of interven- tions considered were any oral zinc supplementation versus no intervention, placebo, or other interventions for the management of hepatic encephalopa- thy. The data were analyzed by calculating the RR for each trial and express- ing the uncertainty as 95% CI. Continuous data were analyzed by calculating the standard mean differences (SMD) between groups within each trial and their 95% CI. Statistical heterogeneity was defined as a P-value > 0.10 (χ2) or I2 > 25%. RESULTS: Four trials with a total of 233 patients were included. Oral zinc supplementation was associated with a significant improvement in perfor- mance on the number connection test (SMD -0.62; 95% CI -1.12 to -0.11) reported in three trials (n = 189), but not with encephalopathy recurrence reduction (RR 0.64; 95% CI 0.26 to 1.59) reported in two trials (n = 169). Other clinically significant outcomes (mortality, liver related morbidity, quality of life) were not reported. CONCLUSION: Oral zinc supplementation improved performance on the number connection test, but no evidence about other clinical or biochemical outcomes was available. CITA: Nutr J. 2013 Jun 6; 12:74 DOI: 10.1186/1475-2891-12-74 PMID: 23759261 TÍTULO: Brain activity correlated with food preferences: a functional study comparing advanced non-small cell lung cancer patients with and without anorexia AUTORES: Sánchez-Lara K, Arrieta O, Pasaye E, Laviano A, Mercadillo RE, Sosa-Sánchez R, Méndez-Sánchez N. OBJECTIVE: The aim of this study was to examine the brain activity man- ifested while non-small cell lung cancer (NSCLC) patients with and without anorexia were exposed to visual food stimuli. METHODS: We included 26 treatment-naïve patients who had been recently diagnosed with advanced NSCLC. Patients with brain metastasis were ex- cluded. The patients were classified into anorectic and non-anorectic groups. Data from functional magnetic resonance imaging based on blood oxygen level-dependent (BOLD) signals were analyzed while the patients perceived pleasant and unpleasant food pictures. The brain records were analyzed with SPM 5 using a voxelwise multiple regression analysis. 135

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23759823 RESULTS: The non-anorexic patients demonstrated BOLD activation, com- prising frontal brain regions in the premotor and the prefrontal cortices, only while watching unpleasant stimuli. The anorectic patients demonstrated no activation while watching the pleasant and unpleasant food pictures. CONCLUSIONS: Anorectic patients with lung cancer present a lack of activa- tion in the brain regions associated with food stimuli processing. These results are consistent with experiences in the clinical environment: Patients describe themselves as not experiencing sensations of hunger or having an appetite. CITA: Nutrition. 2013 Jul-Aug; 29(7-8):1013-9 DOI: 10.1016/j.nut.2013.01.020 TÍTULO: Feasibility of in vivo quantitative magnetic resonance imaging with diffusion weighted imaging, T2-weighted relaxometry, and diffusion tensor imaging in a clinical 3 tesla magnetic resonance scanner for the acute trau- matic spinal cord injury of rats: technical note AUTORES: Mondragon-Lozano R, Diaz-Ruiz A, Ríos C, Olayo Gonzalez R, Favila R, Salgado-Ceballos H, Roldan-Valadez E. STUDY DESIGN: Prospective longitudinal study. OBJECTIVE: To verify the feasibility of performing in vivo quantitative mag- netic resonance imaging evaluation of moderate traumatic spinal cord injury (SCI) in rats using a clinical 3T scanner. SUMMARY OF BACKGROUND DATA: Animal models of human diseases are essential for translational medicine. Potential treatments of SCI are eval- uated in 2 ways: anatomical and functional. Advanced magnetic resonance sequences allow a noninvasive assessment of the spinal cord depicting both. This study describes and validates a very reproducible, feasible, affordable, and reliable method, designed to be applied in commercial 3T equipment, us- ing a novel stereotactic device for spinal cord, leading to a readily available as- sessment of the progression of damage generated after traumatic SCI in rats. METHODS: Four Long-Evans female rats were injured with a New York Uni- versity weight-drop device to produce the SCI by contusion at thoracic level 10. All animals were placed in a fixation system, using a commercial wrist antenna to obtain magnetic resonance imaging data of the relaxometry time, apparent diffusion coefficient, and fractional anisotropy. Three sets of data obtained before SCI and 1 and 4 weeks after injury were compared. RESULTS: The data showed a progressive decline in fractional an isotropy measurements after SCI comparing baseline versus the 1-week period (P < 0.001)and baseline versus the 4-week period (P < 0.019), with a significant progressive increase in apparent diffusion coefficient values and T2 after SCI only in the baseline versus the 4-week period (P < 0.045 and P < 0.024, respectively). CONCLUSION: Our results helped us to validate a novel method to acquire highly reproducible and reliable quantitative biomarkers of traumatic SCI in vivo by using a 3T clinical MR scanner coupled with a novel stereotactic device for rats. CITA: Spine (Phila Pa 1976). 2013 Sep 15; 38(20):E1242-9 DOI: 10.1097/BRS.0b013e31829ef69c 136

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23807339 TÍTULO: [\"The mechanic's hands\" sign: It's clinical implication] AUTORES: Carrillo Esper R, Carrillo Córdova DM, Carrillo Córdova CA. SUMMARY: Case report CITA: Gac Med Mex. 2013 May-Jun; 149(3):354- PMID: 23808448 TÍTULO: [Association between overweight, glucocorticoids and metabolic PMID: 23883465 syndrome in cancer patients under chemotherapy] AUTORES: Sánchez-Lara K, Hernández D, Motola D, Green D. SUMMARY: Metabolic syndrome components like overweight, obesity, in- sulin resistance, and hyperglycemia are common findings in patients with cancer diagnosis under chemotherapy treatment. These factors have been associated with higher recurrence rates. This study associates Body Mass index, steroids treatment and tumor site with metabolic syndrome (MS) com- ponents in patients with cancer diagnosis under chemotherapy treatment. METHODS: In this retrospective study, files from patients under chemo- therapy treatment treated in a university oncology center from 2008 to2010 where reviewed. Anthropometric data and ATP III MS criteria were reviewed. RESULTS: 158 patients were included, 75.9% female. Most common tumors were breast, gastrointestinal and lung cancer. 56.3% presented =3 compo- nent of MS; 43.6% of patients received Dexametasone as part of chemother- apy treatment. Mean BMI was 25.3 kg/m (2). Breast cancer diagnosis was associated with presence of 3or more components of metabolic syndrome. Glococorticoid treatment was not significantly associated with MS diagnosis. CONCLUSIONS: patients with IMC>25 presented 12.6 more risk of MS, in- dependently of glucocorticoids treatment. Weight maintenance is important to reduce MS CITA: Nutr Hosp. 2013 Jan-Feb; 28(1):182-7 DOI: 10.3305/nh.2013.28.1.6177 TÍTULO: [DRESS syndrome. A clinical case report] AUTORES: Muciño-Bermejo J, Díaz de León-Ponce M, Briones-Vega CG, Guerrero-Hernández A, Sandoval-Ayala OI, Sáenz-Coronado AG, Briones- Garduño JC. BACKGROUND: DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) or reaction to drugs with eosinophilia and systemic symptoms is a serious drug reaction associated with the use of aromatic anticonvulsants and allopurinol. At least 44 drugs have been associated with DRESS. The aim was to present the case of a patient with DRESS syn- drome associated with phenytoin. CLINICAL CASE: A 20 year old woman, with a history of seizures since childhood, presented generalised tonic-clonic seizures for the last three months. Therefore, she began treatment with 100 mg of phenytoin, admin- istered orally, every 8 hours. Three weeks later, she developed fever up to 42 degrees, papules in the hands extending to trunk and extremities, gener- 137

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 23938236 alized rubicund, pruritus, pain while urinating, adding hyperoxia, dysphagia PMID: 24027645 and dry cough. Consequently, she went to the emergency room. DISCUSSION: The diagnosis is clinical and it is set according to the criteria of the scale of Regi SCAR. As the initial manifestations are unspecific, the diagnosis and treatment could be delayed. The importance of recognizing this syndrome is an early treatment to get better prognostics. The mortality is up to 10 %. CITA: Rev Med Inst Mex Seguro Soc. 2013 May-Jun; 51(3):330-5 TÍTULO: Gender and age groups interactions in the quantification of bone marrow fat content in lumbar spine using 3T MR spectroscopy: a multivari- ate analysis of covariance (Mancova) AUTORES: Roldan-Valadez E, Piña-Jimenez C, Favila R, Rios C. INTRODUCTION: There is an age-related conversion of red to yellow bone marrow in the axial skeleton, with a gender-related difference less well es- tablished. Our purpose was to clarify the variability of bone marrow fat frac- tion (FF) in the lumbar spine due to the interaction of gender and age groups. METHODS: 44 healthy volunteers (20 males, 30-65 years old and 24 fe- males, 30-69years old) underwent 3T magnetic resonance spectroscopy (MRS) and conventional MRI examination of the lumbar spine; single-voxel spectrum was acquired for each vertebral body (VB). After controlling body mass index (BMI), a two-way between-groups multivariate analysis of cova- riance (MANCOVA) assessed the gender and age group differences in FF quantification for each lumbar VB. RESULTS: There was a significant interaction between gender and age group, p=.017, with a large effect size (partial η(2)=.330). However the inter- action explained only 33% of the observed variance. Main effects were not statistically significant. BMI was non-significantly related to FF quantification. CONCLUSIONS: Young males showed a high FF content, which declined in the 4thdecade, then increased the next 3 decades to reach a FF content just below the initial FF means. Females' FF were low in the 3rd decade, de- picted an accelerate increase in the 4th decade, then a gradual increase the next 3 decades to reach a FF content similar to males' values. Our findings suggest that quantification of bone marrow FF using MRS might be used as a surrogate biomarker of bone marrow activity in clinical settings. CITA: Eur J Radiol. 2013 Nov; 82(11):e697-702 DOI: 10.1016/j.ejrad.2013.07.012 TÍTULO: Acute liver failure associated with levetiracetam and lacosamide combination treatment for unspecified epileptic disorder AUTORES: Gutiérrez-Grobe Y, Bahena-Gonzalez JA, Herrera-Gomar M, Mendoza-Diaz P, García-López S, González-Chon O. BACKGROUND AND AIM: Levetiracetam is a second-generation antiepi- leptic drug. Itis approved as an adjunctive treatment of partial onset seizures with or without secondary generalization. It is considered safe with less than 1% of patients with transient elevations of liver enzymes. 138

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR METHODS: We report a case of acute liver failure secondary to Levetirace- tam in combination with Lacosamide documented with a liver biopsy. RESULTS: Liver biopsy demonstrated acute liver injury with a predominant submassive necrosis pattern and features of a drug-induced hepatitis. CONCLUSION: This is the first published case of acute liver failure due to antiepileptic therapy with Levetiracetam in combination with Lacosamide. CITA: Case Rep Emerg Med. 2013; 2013:634174 DOI: 10.1155/2013/634174 PMID: 24054373 TÍTULO: Author response PMID: 24114821 AUTORES: Larenas Linnemann D, Compalati E, Blaiss M, Van Bever HP, Baena-Cagnani CE. SUMMARY: Letter to the editor CITA: Ann Allergy Asthma Immunol. 2013 Oct;111(4):306-7 DOI: 10.1016/j.anai.2013.07.032 TÍTULO: Metabolic syndrome and nonalcoholic fatty liver disease. The role of endothelial progenitor cells AUTORES: Gutiérrez-Grobe Y, Gavilanes-Espinar JG, Masso-Rojas FA, Sánchez-Valle V, Páez-Arenas A, Ponciano-Rodríguez G, Chávez-Tapia NC, Uribe M, Méndez-Sánchez N. BACKGROUND: Endothelial dysfunction has been previously described in metabolic syndrome patients. The levels of circulating endothelial progen- itor cells (EPCs) inversely correlates with the incidence of cardiovascular disease. The aim of this study was to investigate the association between NAFLD, metabolic syndrome and EPC levels. MATERIAL AND METHODS: A cross-sectional pilot study was performed at a university hospital in Mexico. Two groups of patients without previously known chronic diseases were studied and classified according to the pres- ence of NAFLD. Anthropometric, dietary, and biochemical variables, and circulating EPC number were measured and compared between the groups. RESULTS: Forty subjects were included and classified into two groups: pa- tients with NAFLD (n = 20) and a control group (n = 20). The overall preva- lence of insulin resistance and metabolic syndrome was 25% and 17.5%, re- spectively. EPC levels were found to be higher in the NAFLD group (p < 0.05) as in the patients with insulin resistance (p < 0.01) and metabolic syndrome (p < 0.01). These levels showed correlation with the severity of steatosis. CONCLUSIONS: Patients with NAFLD have increased levels of EPC, such levels are associated with the severity of NAFLD. These findings may sug- gest that these cells may play a role in the early natural history of NAFLD. EPC might be increased in an attempt to repair the endothelial damage re- sulting from metabolic alterations accompanying NAFLD. Further studies are needed to establish the dynamics of these cells in NAFLD. 139

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR CITA: Ann Hepatol. 2013 Nov-Dec; 12(6):908-14 DOI: 10.1016/S1665-2681(19)31296-7 PMID: 24114828 TÍTULO: Hepatolithiasis with secondary cholangitis and supernumerary left hepatic lobe AUTORES: Lavenant-Borja MI, Fernández-Rivero J, Pachuca-González D, Mercado MA, Esquivel-Ayanegui F, Méndez-Sánchez N, Al- bores-Saavedra J, Chablé-Montero F. SUMMARY: We report the case of a 31-year old woman with recurrent chol- angitis secondary to hepatolithiasis. The stones were composed of calcium bilirubinate. The patient also had a supernumerary hepatic lobe connected to the inferior aspect of the segment III of the liver. The role of the supernu- merary hepatic lobe in the development of hepatolithiasis is unclear and may be coincidental. CITA: Ann Hepatol. 2013 Nov-Dec; 12(6):966-8 DOI: 10.1016/S1665-2681(19)31303-1 PMID: 24136790 TÍTULO: Main effect and interactions of brain regions and gender in the cal- culation of volumetric asymmetry indices in healthy human brains: ANCOVA analyses of in vivo 3T MRI data AUTORES: Roldan-Valadez E, Rios C, Suarez-May MA, Favila R, Aguilar- -Castañeda E. INTRODUCTION: Macro anatomical right-left hemispheric differences in the brain are termed asymmetries, although there is no clear information on the global influence of gender and brain-regions. The aim of this study was to evaluate the main effects and interactions of these variables on the mea- surement of volumetric asymmetry indices (VAIs). MATERIALS AND METHODS: Forty-seven healthy young-adult volunteers (23 males, 24females) agreed to undergo brain magnetic resonance imag- ing in a 3T scanner. Image post processing using voxel-based volumetry allowed the calculation of 54VAIs from the frontal, temporal, parietal and oc- cipital lobes, limbic system, basal ganglia, and cerebellum for each cerebral hemisphere. Multivariate ANCOVA analysis calculated the main effects and interactions on VAIs of gender and brain regions controlling the effect of age. RESULTS: The only significant finding was the main effect of brain regions (F (6, 9373.605) 44.369, P < .001; partial η2 = .101, and power of 1.0), with no significant interaction between gender and brain regions (F (6, 50.517) .239,P = .964). CONCLUSION: Volumetric asymmetries are present across all brain regions, with larger values found in the limbic system and parietal lobe. The absence of a significant influence of gender and age in the evaluation of the numer- ous measurements generated by multivariate analyses in this study should not discourage researchers to report and interpret similar results, as this top- ic still deserves further assessment. CITA: Anat Rec (Hoboken). 2013 Dec;296(12):1913-22 DOI: 10.1002/ar.22817 140

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24274225 TÍTULO: Over diagnosis of persistent allergic rhinitis in perennial allergic rhinitis patients: a nationwide study in Mexico AUTORES: Larenas-Linnemann D, Dinger H, Shah-Hosseini K, Michels A, Mösges R BACKGROUND: Allergic rhinitis (AR) symptom phenotypes have been described, and two different classifications exist. The former classification, seasonal versus perennial AR (SAR-PAR), and the Allergic Rhinitis and Its Impact on Asthma (ARIA) classifications, intermittent (INT) versus persistent (PER; ≥4 days/wk and ≥4consecutive weeks) and mild versus moderate/ severe. ARIA cataloging of INT-PER is based on the patient's description of the frequency of symptoms. This study was designed to (1) describe the epidemiology of these two AR classifications and relate them to one another and to a visual analog severity scale (VAS) and (2) describe how the catalog- ing of these classifications differs between patients and allergists. METHODS: Skin-prick test-positive AR patients seen nationwide by Mexican allergists completed a validated questionnaire cataloging AR. They recorded demographic data and AR severity on a VAS. The patients' physicians were also asked to classify the AR phenotypes. RESULTS: Of the patients, 56.5% had INT and 82.2% had PAR and mod- erate-severe (84.7%) AR. However, 57% of the INT-PAR patients were mis- diagnosed as PER-PAR by their physicians. PER patients had more severe disease with a longer clinical history, more PAR, nose and eye symptoms, and a higher VAS score, and only 7% had mild symptoms. VAS values ≥7.45 relate to PER (sensitivity, 68%; specificity, 65%). VAS ≤6.2 indicated mild and ≥6.4 indicated moderate-severe AR. Similar to the adults, in the 2- to 11 year and 12- to 17-year age groups perennial, INT, and moderate-severe AR was the most frequent finding, but the children had more INT (p < 0.01) and mild (p < 0.03) symptoms, less SAR (p = 0.03), and more physician-di- agnosed asthma (p < 0.05). Public health care (PHC) patients had more INT (p = 0.016). CONCLUSION: In the PAR group, the physicians' classification of INT-PER often goes astray. PER over diagnoses might affect treatment decisions be- cause PER is a more severe phenotype. VAS is useful to evaluate severity. In Mexican AR patients, rhinitis symptom phenotypes differ according to age and between private and PHC system patients. CITA: Am J Rhinol Allergy. 2013 Nov-Dec; 27(6):495-501 DOI: 10.2500/ajra.2013.27.3957 PMID: 24280179 TÍTULO: [Medical significance of endothelial glycocalyx] AUTORES: Frati-Munari AC. SUMMARY: Endothelial glycocalyx is a layer composed by glycosaminogly- cans, proteoglycans and glycoproteins attached to the vascular endothelial luminal surface. It has several physiological roles: shear stress mechano- transduction to the endothelial cells, regulation of fluids and macromolecules vascular permeability, of coagulation cascade activation and fibrinolysis, and protects the endothelium from platelets and leukocytes adhesion. In general, glycocalyx protects vascular wall against pathogenic insults. The glycocalyx may be damaged by abnormal shear stress, reactive oxygen species, hyper- 141

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24378272 natremia, hyperglycemia, hypercholesterolemia and inflammatory molecules, PMID: 24378274 resulting in endothelial dysfunction, enhanced vascular permeability, lipo- proteins leakage to subendothelial space, activation of plasma coagulation, and increased adherence of platelets and leukocytes to the endothelial cells. Shredding of glycocalyx appears as an important initial step in the patho- physiology of vascular diseases. CITA: Arch Cardiol Mex. 2013 Oct-Dec; 83(4):303-12 DOI: 10.1016/j.acmx.2013.04.015 TÍTULO: Bilirubin alone as a biomarker for short-term mortality in acute-on- chronic liver failure: an important prognostic indicator AUTORES: López-Velázquez JA, Chávez-Tapia NC, Ponciano-Rodríguez G, Sánchez-Valle V, Caldwell SH, Uribe M, Méndez-Sánchez N. BACKGROUND AND AIMS. Acute-on-chronic liver failure has been recog- nized as a sudden deterioration of cirrhosis, with a high short-term mortality. Prognostic scores are used to assess liver dysfunction. However, there is not enough information on a score to predict short term mortality in those patients. We aimed to investigate the prognostic value of bilirubin concen- tration in predicting the 1-week outcome of patients with acute-on-chronic liver failure. MATERIAL AND METHODS. We performed a retrospective analysis with a cohort of 65patients (33 women/32 men), age average of 64 years, diag- nosed with acute-on-chronic liver failure with at least 1 week follow-up. De- mographics, clinical and biochemical variables were analyzed. Most patients died (59 %) within 1 week of follow-up. RESULTS. In univariate logistic regression analysis, admission to the inten- sive care unit, use of vasoactive drugs, need for parenteral nutrition, and lev- els of conjugated, unconjugated, and total bilirubin at the time of hospital ad- mission were significantly associated with 1-weekmortality; in a multivariate logistic regression, conjugated (p = 0.01), unconjugated (p =0.01), and total bilirubin (p = 0.009) were independently associated with 1-week mortality. In ROC curve analysis, conjugated (0.751, p <0.05) and total bilirubin (0.746, p < 0.05) levels were significantly the best short-term mortality predictors. CONCLUSIONS. High levels of bilirubin are able to predict short-term mor- tality in these patients. Also, we suggest that bilirubin can be used as a bio- chemical marker to improve triage of patients with acute-on-chronic liver fail- ure especially with emerging interventions such as extracorporeal liver assist devices and possibly improved early phase pharmacological therapies. CITA: Ann Hepatol. 2013 Jan-2014 Feb DOI: 10.1016/S1665-2681(19)30910-X TÍTULO: Kinetics of the inflammatory response induced by free fatty acid accumulation in hepatocytes AUTORES: Chávez-Tapia NC, Rosso N, Uribe M, Bojalil R, Tiribelli C. BACKGROUND. The information available on time and dose effects of the exposure of hepatocytes to free fatty acids (FFA) in vitro is controversial, 142

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24459776 and very few studies have assessed the hepatocyte inflammatory response in an in vitro model. AIM. To analyze the effect of treatment with FFA on cell viability and on the kinetics of cytokine expression using hepatic cell lines. MATERIAL AND METHODS. Hepatic cell lines, IHH and HuH7, were cul- tured for 3 h, 6 h, 12 h and 24 h in an enriched medium with palmitic and ole- ic acids. The cytotoxicity of the FFA was assessed by the MTT test and the intracellular fat content determined cytofluorimetrically and by fluorescence microscopy using Nile Red staining. The expression of mRNA for interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-αwas assessed by real time re- verse transcription-polymerase chain reaction(RT-PCR). RESULTS. Treatment with 600 μM FFA did not affect the viability of either cell line despite a significant increase in the intracellular content of lipid droplets already evident after 3 h of treatment. A time- and dose-dependent upregulation of the expression of IL-6 and IL-8 mRNA was observed during the treatment at 3 and 24 h. In contrast, TNF-α mRNA expression was highly upregulated at 3 h after FFA exposure but returned to control values at 24 h. In conclusion, hepatocytes exposed in vitro for a short time to low FFA con- centrations showed a significant upregulation of IL-6 and IL-8 to, and a rapid but transitory elevation of TNF-α. CITA: Ann Hepatol. 2013 Jan-2014 Feb;13(1):113-20 DOI: 10.1016/S1665-2681(19)30912-3 TÍTULO: [National consensus of diagnosis and treatment of non-small cell lung cancer] AUTORES: Arrieta O, Guzmán-de Alba E, Alba-López LF, (…) Gutiér- rez-Velázquez H, (…) Motola-Kuba D, (…) Rodríguez-Cid J, (…) Sán- chez-Lara K, et al. SUMMARY: Mexican specialists in oncology, oncologic surgery, thoracic surgery, pneumology, pathology, molecular biology, anesthesiology, algology, psychology, nutrition, and rehabilitation (all of them experts in lung cancer treatment) in order to develop the National Consensus on Lung Cancer. The consensus has been developed as an answer to the need of updated Mex- ican guidelines for the optimal treatment of the disease, as well as to the requirements that such guidelines be established by multidisciplinary panel, depicting the current attention given to cancer lung cases in Mexico. Thus, this paper analyses the epidemiological review, screening, diagnosis, stag- ing, pathology, translational medicine, and the suitable therapies for early, locally advanced, and metastatic disease in the first, second, and third lines of management, as well as rehabilitation and palliative measures. CITA: Rev Invest Clin. 2013 Mar; 65 Suppl 1:S5-84 PMID: 24895509 TÍTULO: Paraneoplastic Cerebellar Degeneration as Initial Presentation of Papillary Carcinoma of the Fallopian Tube: Evaluation and Usefulness of (18)F-FDG PET-CT. Case Report and Literature Review AUTORES: López NO, González DP, García JA, Reyna JC, López LF. SUMMARY: The acquisition of an (18)F-FDG PET-CT scan in patients with suspected paraneoplastic cerebellar syndrome can be helpful in determining the origin of a neoplasm because of its high sensitivity and also helps guide the neurological development course depending on the degree of incorpo- 143

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 25806228 ration of (18)F-FDG to the cerebellar parenchyma when compared with the rest of the brain. 2014 CITA: Nucl Med Mol Imaging. 2013 Mar;47(1):55-60 DOI: 10.1007/s13139-012-0180-6 TÍTULO: Adaptive resistance to targeted therapies in cancer AUTORES: Rosell R, Karachaliou N, Morales-Espinosa D, Costa C, Mo- lina MA, Sansano I, Gasco A, Viteri S, Massuti B, Wei J, González Cao M, Martínez Bueno A. SUMMARY: It is widely acknowledged that there is a need for molecular profiling in non-small-cell lung cancer. For example, treatment based on EGFR mutation status has attained successful results. However, in spite of excellent initial response to oral EGFR tyrosine kinase inhibitors (TKIs), progression-free survival is still limited. Current research has focused most- ly on acquired resistance mechanisms, such as overexpression of AXL and loss of the Mediator MED12. In this review, in contrast, we discuss adaptive, rather than acquired, resistance. Adaptive resistance can occur almost im- mediately after starting targeted therapy through a rapid rewiring of cancer cell signaling. By losing ERK negative feedback on receptor tyrosine kinase (RTK) expression, cancer cells are exposed to the stimuli of several ligands, and the ensuing activation of several RTKs reprograms all the canonical signaling pathways. The overexpression of several RTKs was observed in breast cancer cell lines treated with a MEK inhibitor and in BRAF (V600E) melanoma cell lines treated with BRAF inhibitors. This rebound effect of overexpression of several RTKs, including ERBB3, also occurs in lung can- cers driven by Kras or EGFR mutations when treated with MEK, PI3K or dual PI3K/mTOR inhibitors. Synthetic lethality can be effectively induced by co-targeting these overexpressed RTKs. We speculate that in patients with EGFR mutations, adaptive resistance occurs in a significant proportion of patients. Re biopsies performed hours after starting treatment with EGFR TKIs can identify which RTKs are overexpressed after treatment. Efficient co-targeting of these RTKs can induce synthetic lethality and help overcome the limited effect of EGFR TKI monotherapy. CITA: Transl Lung Cancer Res. 2013 Jun; 2(3):152-9 DOI: 10.3978/j.issn.2218-6751.2012.12.08 PMID: 24199604 TÍTULO: Metal-reinforced single implant mandibular overdenture retained by an attachment: a clinical report AUTORES: Grageda E, Rieck B. SUMMARY: Results of studies have shown that a single implant mandibu- lar overdenture significantly increases the satisfaction and quality of life of patients with edentulism. The single implant-retained overdenture has the additional advantage of being less expensive and invasive than a 2-implant supported overdenture but has a high incidence of fracture of the acrylic resin base at the point of the implant. The treatment, design, and fabrication 144

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24302433 of a metal-reinforced single-implant mandibular overdenture with the Locator attachment as a retention device is described. CITA: J Prosthet Dent. 2014 Jan; 111(1):16-9 DOI: 10.1016/j.prosdent.2013.07.009 TÍTULO: 3T MRI and 128-slice dual-source CT cisternography images of the cranial nerves a brief pictorial review for clinicians AUTORES: Roldan-Valadez E, Martinez-Anda JJ, Corona-Cedillo R. SUMMARY: There is a broad community of health sciences professionals interested in the anatomy of the cranial nerves (CNs): specialists in neu- rology, neurosurgery, radiology, otolaryngology, ophthalmology, maxillofacial surgery, radiation oncology, and emergency medicine, as well as other re- lated fields. Advances in neuroimaging using high-resolution images from computed tomography (CT) and magnetic resonance (MR) have made high- ly-detailed visualization of brain structures possible, allowing normal findings to be routinely assessed and nervous system pathology to be detected. In this article we present an integrated perspective of the normal anatomy of the CNs established by radiologists and neurosurgeons in order to provide a practical imaging review, which combines128-slice dual-source multiplanar images from CT cisternography and 3T MR curved reconstructed images. The information about the CNs includes their origin, course (with emphasis on the cisternal segments and location of the orifices at the skull base trans- mitting them), function, and a brief listing of the most common pathologies affecting them. The scope of the article is clinical anatomy; readers will find specialized texts presenting detailed information about particular topics. Our aim in this article is to provide a helpful reference for understanding the com- plex anatomy of the cranial nerves. CITA: Clin Anat. 2014 Jan; 27(1):31-4 DOI: 10.1002/ca.22311 PMID: 24333119 TÍTULO: Update of the Mexican College of Rheumatology guidelines for the pharmacologic treatment of rheumatoid arthritis AUTORES: Cardiel MH, (…) Rosete Reyes A, et al. BACKGROUND: The pharmacologic management of rheumatoid arthritis has progressed substantially over the past years. It is therefore desirable that existing information be periodically updated. There are several pub- lished international guidelines for the treatment of rheumatoid arthritis that hardly adapt to the Mexican health system because of its limited healthcare resources. Hence, it is imperative to unify the existing recommendations and to incorporate them to a set of clinical, updated recommendations; the Mexi- can College of Rheumatology developed these recommendations in order to offer an integral management approach of rheumatoid arthritis according to the resources of the Mexican health system. OBJECTIVE: To review, update and improve the available evidence within clinical practice guidelines on the pharmacological management of rheuma- toid arthritis and produce a set of recommendations adapted to the Mexican health system, according to evidence available through December 2012. 145

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24552857 METHODS: The working group was composed of 30 trained and experi- enced rheumatologists with a high quality of clinical knowledge and judg- ment. Recommendations were based on the highest quality evidence from the previously established treatment guidelines, meta-analysis and con- trolled clinical trials for the adult population with rheumatoid arthritis. RESULTS: During the conformation of this document, each working group settled the existing evidence from the different topics according to their ex- perience. Finally, all the evidence and decisions were unified into a single document, treatment algorithm and drug standardization tables. CONCLUSIONS: This update of the Mexican Guidelines for the Pharmaco- logic Treatment of Rheumatoid Arthritis provides the highest quality infor- mation available at the time the working group undertook this review and contextualizes its use for the complex Mexican health system. CITA: Reumatol Clin. Jul-Aug 2014;10(4):227-40 DOI: 10.1016/j.reuma.2013.10.006 TÍTULO: Clinical decisions in hepatology: the pirfenidone case analysis AUTORES: Chavez-Tapia NC, Méndez-Sánchez N. SUMMARY: Editorial CITA: Ann Hepatol. 2014 Mar-Apr; 13(2):163-5 DOI: 10.1016/S1665-2681(19)30878-6 PMID: 24552858 TÍTULO: The prevalence of nonalcoholic fatty liver disease in the Americas AUTORES: López-Velázquez JA, Silva-Vidal KV, Ponciano-Rodríguez G, Chávez-Tapia NC, Arrese M, Uribe M, Méndez-Sánchez N. SUMMARY: Nonalcoholic fatty liver disease (NAFLD) is an alarming pub- lic health problem. The disease is one of the main causes of chronic liv- er disease worldwide and is directly linked to the increased prevalence of obesity and type 2 diabetes mellitus (T2DM) in the general population. The worldwide prevalence of NAFLD has been estimated at 20-30%, but the prevalence is unknown in the Americas because of a lack of epidemiological studies. However, given the trends in the prevalence of diabetes and obesity, the prevalence of NAFLD and its consequences are expected to increase in the near future. The aim of the present study is to present the current data on the prevalence of NAFLD in the Americas. We performed an electronic search of the main databases from January 2000 to September 2013and identified 356 reports that were reviewed. We focused on the epidemiology and prevalence of known NAFLD risk factors including obesity, T2DM, and the metabolic syndrome (MS). The prevalence of the MS was highest in the United States, Mexico, Costa Rica, Puerto Rico, Chile, and Venezuela. In addition, Puerto Rico, Guyana, and Mexico have the highest prevalence of T2DM in the Americas, while USA has the most people with T2DM. In conclu- sion, the prevalence rates of NAFLD and obesity were highest in the United States, Belize, Barbados, and Mexico. CITA: Ann Hepatol. 2014 Mar-Apr; 13(2):166-78 DOI: 10.1016/S1665-2681(19)30879-8 146

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24552865 TÍTULO: Profile of idiosyncratic drug induced liver injury in Latin America: an analysis of published reports AUTORES: Hernández N, Bessone F, Sánchez A, di Pace M, Brahm J, Zapata R, A Chirino R, Dávalos M, Méndez-Sánchez N, Arrese M, Schinoni M, Lucena MI, Andrade RJ. INTRODUCTION: Drug-induced liver injury (DILI) remains a major problem for drug development and represents a challenging diagnosis for clinicians. The absence of specific biomarkers for diagnosing DILI precludes the avail- ability of reliable data on the epidemiology of the disease. In this study we aimed to describe the features of idiosyncratic hepatotoxicity reports in Latin American countries. MATERIAL AND METHODS: A literature search was performed using the online version of MEDLINE, EMBASE, Scopus, Google Scholar and specif- ic data bases from Latin America (LA) (Scielo, Lilacs) to identify any case report or case series of published DILI from 1996 to 2012. From 1996 to 2012, a total of 176 patients with DILI were published in LA, involving 53 suspicious drugs. The median age in the adult population of these patients was 55 years (17-82) with prevalence of women (67%). Among main ther- apeutic classes, the rank order was led by non-steroidal anti-inflammatory (61 cases) and systemic antibacterial drugs (37 cases). Nimesulide was the individual drug responsible for the highest number of cases (53), followed by cyproterone acetate (18), nitrofurantoin (17), antituberculous drugs (13) and flutamide (12). Thirty two percent of published cases evolved to acute liver failure (ALF), and half of the subjects required liver transplantation or eventually died. CONCLUSIONS: This study represents the first structured attempt to as- sess the spectrum of DILI profile in LA. The establishment of a Latin Ameri- can registry to collect prospective DILI cases using a standardized protocol will advance our knowledge about idiosyncratic DILI in this region. CITA: Ann Hepatol. 2014 Mar-Apr; 13(2):231-9 DOI: 10.1016/S1665-2681(19)30886-5 PMID: 24552866 TÍTULO: The molecular adsorbent recirculating system as a liver support system: summary of Mexican experience AUTORES: Cisneros-Garza LE, Muñoz-Ramírez Mdel R, Muñoz-Espino- za LE, Ruiz Velasco JA, Moreno-Alcántar R, Marín-López E, Méndez-Sán- chez N. AIM: The aim of this study was to assess the effects of the molecular absor- bent recirculating system (MARS) on patients with acute liver failure (ALF) and liver failure with cirrhosis (AoCLF) as well as in cholestatic patients with- in tractable pruritus in a Mexican population. MATERIAL AND METHODS: From August 2003 to December 2011, MARS was used in 38patients with ALF, 15 patients with AoCLF, and 17 cholestatic patients within tractable pruritus. The patients were examined using a stan- dard liver function test and for vital signs, presence of ascites and encepha- lopathy before and after each treatment. The therapeutic response, patient status, follow-up status, and need for liver transplantation were determined. 147

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24558224 RESULTS: Seventy-nine MARS procedures were performed. MARS was PMID: 24570887 used for ALF in54.3% of patients, AoCLF in 24.2%, and cholestatic dis- ease in 21.5%. There were significant improvements in serum bilirubin (p = 0.000), aspartate aminotransferase (p = 0.000), alanine aminotransferase (p = 0.030), gamma-glytamyl transpeptidase (p = 0.044), alkaline phosphatase (p = 0.006), and encephalopathy grade (p = 0.000). Thirty-eight ALF patients were listed for emergency liver transplantation and treated with MARS; 20 of these patients died on a waiting list, 18 survived. only four underwent liv- er transplantation and 14 (37%) recovered without transplantation after the MARS procedure. CONCLUSION: MARS is a safe and effective procedure, especially for ALF patients. Our results suggest that MARS therapy can contribute to native liver recovery in ALF patients. CITA: Ann Hepatol. 2014 Mar-Apr; 13(2):240-7 DOI: 10.1016/S1665-2681(19)30887-7 TÍTULO: Variability of apparent diffusion coefficients in metastatic small cell lung carcinoma: comparisons between-within normal tissue and liver metastases AUTORES: Roldán-Valadez E, Cortez-Conradis D, Ríos-Hoyo A, Arrieta Ó. SUMMARY: In recent years, the use of diffusion weighted MRI (DW-MRI) has increased for the diagnosis of focal liver lesions (FLLs). DW-MRI may help in the differentiation of benign and malignant FLLs by measuring the apparent diffusion coefficient (ADC) values. Unfortunately, liver metastases present dif- ferent histopathologic features with variable MRI signals within each lesion; this histologic variability explains the intra- and inter-lesion variations of ADC measurements. We present the case of a 64-year-old female with diagnosis of liver metastasis from small cell lung carcinoma admitted to the emergency unit due to symptoms of inappropriate antidiuretic hormone secretion. Quantitative comparison of two liver MRI, on admission and 2-months after transcatheter arterial chemoembolization showed persistence of the hyperintense metastatic lesions with significant difference in the ADC values in the with-in metastatic lesions (p =0.001) and between normal tissue and liver metastases only at the end of treatment (p < 0.001). Several publications state that DWMRI is capable to predict the response to chemotherapy in malignant tumors, the histologic variability of liver metastasis and their response to different treat- ments is reflected in intra- and inter-lesion variations of ADC measurements that might delay an accurate imaging diagnosis. We present evidence of this variability, which might encourage prospective clinical trials that would define better cut-off values, would help understand the ADC biological behaviour, and would reach consensus about the best acquisition parameters for this promis- ing quantitative biomarker. CITA: Ann Hepatol. 2014 Mar-Apr; 13(2):297-302 DOI: 10.1016/S1665-2681(19)30895-6 TÍTULO: Diagnostic yield and therapeutic impact of rectal retroflexion: a pro- spective, single-blind study conducted in three centers. AUTORES: Téllez-Ávila F, Barahona-Garrido J, García-Osogobio S, López-Arce G, Camacho-Escobedo J, Saúl A, Herrera-Gómez S, Elizondo- -Rivera J, Barreto-Zúñiga R. 148

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24581432 BACKGROUND/AIMS: No clear data have been established and validat- PMID: 24600229 ed regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view ex- amination. METHODS: A prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included. RESULTS: A total of 934 patients (542 women, 58%) were included. The mean age was57.4±14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10(1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact. CONCLUSIONS: Rectal retroflexion has minimal diagnostic yield and thera- peutic impact. However, its low rate of major complications and the possibili- ty of detecting lesions undetectable by straight viewing justify its use. CITA: Clin Endosc. 2014 Jan;47(1):79-83 DOI: 10.5946/ce.2014.47.1.79 TÍTULO: Use of omalizumab to improve desensitization safety in allergen immunotherapy AUTORES: Larenas-Linnemann D, Wahn U, Kopp M. ABSTRACT: Case report CITA: J Allergy Clin Immunol. 2014 Mar; 133(3):937-937.e2 DOI: 10.1016/j.jaci.2013.12.1089 TÍTULO: Hypoxic hepatitis in cardiac intensive care unit: a study of cardio- vascular risk factors, clinical course, and outcomes AUTORES: Chávez-Tapia NC, Balderas-Garces BV, Meza-Meneses P, Herrera-Gomar M, García-López S, Gónzalez-Chon O, Uribe M. INTRODUCTION: Hypoxic hepatitis (HH) is observed frequently in intensive care units. Information in the cardiac intensive care unit (CICU) is limited. The aim of this study was to analyze the clinical course and outcomes of HH in the specific setting of the CICU. METHODS: We analyzed records of patients with HH admitted to the CICU (Group 1). Data were collected and compared with those of an intermedi- ate group of patients with altered liver test results that did not meet the HH criteria who had a serum aminotransferase level of five to ≤20 times the upper-normal limit (Group 2), and with a control group who had an amino- transferase level less than five times the upper-normal limit (Group 3). RESULTS: patients with HH exhibited a worse hemodynamic profile and more of these patients were in shock: 17 (94.4%) in Group 1, 14 (77.8%) in 149

RESÚMENES DE ARTÍCULOS PUBLICADOS POR MÉDICOS E INVESTIGADORES DE MÉDICA SUR PMID: 24603997 Group 2, and seven (38.9%) in Group 3 (P=0.001). Cardiogenic shock was PMID: 24606815 the most frequent event: 12(66.7%) in Group 1, 13 (72.2%) in Group 2, and six (33.3%) in Group 3 (P=0.006). The mortality rate was 55.6%. Mechani- cal ventilation was an independent factor associated with death (odds ratio 12.25, 95% confidence interval 1.26-118.36). CONCLUSION: The mortality rate of patients with HH in CICU is high and is associated with ventilatory disturbances. CITA: Ther Clin Risk Manag. 2014 Feb 25; 10:139-45 DOI: 10.2147/TCRM.S59312 TÍTULO: [Ultrasonographic evaluation of the diameter of the optic nerve sheath for medication of intracranial pressure: a case report] AUTORES: Carrillo Esper R, Flores Rivera OI, Peña Pérez CA, Carrillo Córdova LD, Carrillo Córdova JR, Carrillo Córdova CA, Carrillo Córdova DM. SUMMARY: The main complication associated with acute brain injury is the elevation of intracranial pressure (ICP) and it is associated with high morbid- ity and mortality. In these patients, multimodal neurological monitoring has emerged as a fundamental tool in the intensive care unit, with the minimally invasive trend seen in recent years. We report the case of a patient in which ICP monitoring was based on the measurement of the diameter of the optic nerve sheath (DONS), a procedure that has shown a good correlation with the ICP, as well as a high specificity, sensitivity, and low cost. CITA: Gac Med Mex. 2014 Mar-Apr; 150(2):165-70 TÍTULO: Expression of Epstein-Barr virus-encoded latent membrane protein (LMP-1), p16 and p53 proteins in nonendemic nasopharyngeal carcinoma (NPC): a clinicopathological study AUTORES: Rosales-Pérez S, Cano-Valdez AM, Flores-Balcázar CH, Gue- dea-Edo F, Lino-Silva LS, Lozano-Borbalas A, Navarro-Martín A, Poite- vin-Chacón A. BACKGROUND AND AIMS: Although the latent membrane protein type 1 (LMP1) is frequently expressed in Epstein-Barr virus (EBV) malignancies, its contribution to the pathogenesis of nasopharyngeal carcinoma (NPC) is not fully defined. LMP1 functions as a viral mimic of the TNFR family member engaging a number of signaling pathways that induce morphological and phenotypic alterations. This study aimed to investigate the LMP1 expression and EBV infection in relation to clinical outcome and survival in a series of Mexican NPC patients. We also studied expression of p16 and p53 proteins. METHODS: We analyzed in 25 tumor specimens the expression of LMP1, p16 and p53 by immunohistochemistry (IHC) and EBV presence by IHC/in situ hybridization. Differences in clinical outcome and survival in relation to protein expression were correlated through χ (2) statistics and Kaplan-Meier survival curves. RESULTS: Our results showed a rate of 92% (23/25) of EBV infection. The expressions of LMP-1, p16 and p53 proteins were 40.0, 44.0 and 40.0%, respectively. LMP-1 immuno expression was more common in older patients (>50 vs. <50 years old, p = 0.02) and with parapharyngeal space invasion (p = 0.02). The presence of metastatic disease at diagnosis (p = 0.03), distant 150