Search

Introduction: Pulmonary aspergilloma is commonly associated with comorbidities that cause immunodeficiency such as diabetes mellitus, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome and/or a pre-existing parenchymal lung disease such as chronic obstructive pulmonary disease. Predisposing factors can further increase the risk of acquiring this mycosis. Our objective was to determine the frequency, clinical and microbiological characteristics of pulmonary aspergilloma in immunocompromised patients., Methodology: Retrospective case series of patients diagnosed with pulmonary aspergilloma in a respiratory care unit in Mexico City from 2000 to 2019 was studied. Bronchoalveolar lavage cultures on Sabouraud-dextrose agar and serum galactomannan determination were performed on each patient., Results: We identified twenty-four patients with pulmonary aspergilloma (sixteen male and eight female), thirteen had a history of tuberculosis (54%), seven of diabetes mellitus (29%), three of human immunodeficiency virus/acquired immunodeficiency syndrome (13%) and one of chronic obstructive pulmonary disease (4%). The most commonly reported symptoms were hemoptysis in eighteen patients (75%), dyspnea in sixteen patients (67%) and chest pain in thirteen patients (54%). Aspergillus fumigatus was identified in all cultures and galactomannan was positive in 21 serum samples (87%)., Conclusions: Coexistence of diseases that could suppress the immune system predispose to pulmonary aspergilloma; clinical presentation is often confused with other systemic diseases. A high degree of clinical suspicion is important for early detection., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Alejandro Hernandez-Solis; Pablo Alvarez-Maldonado, Javier Araiza-Santibanez, Kevin Cruz-Munoz, Raul Cicero-Sabido, Andrea Quintana Martinez.)

Resistance exercises eliciting eccentric overload (EO) are considered to strongly promote muscular hypertrophy and broad neuromuscular adaptations but typically require specialized equipment. The aims of these experiments were to assess whether EO is achieved during common high-speed stretch-shortening cycle (SSC) exercises (rebound bench press throw [RBPT] and squat jump [SJ]), and to test the effect of the external load on the EO achieved. Twenty-nine under 18 handball players and fifteen physically active males (24.9 ± 3.2 years) took part in the experiments. Testing consisted of a single set of 6 repetitions with light (25%-30% 1-RM), moderate (50% 1-RM), and heavy (70%-75% 1-RM) loads. Eccentric and concentric force near the zero-velocity point (50-200 ms) as well as eccentric-concentric force ratio (EO; %) were calculated. In RBPT, higher EO values were found at 50% 1-RM than 70% 1-RM in the time interval 50 ms before and after the zero-velocity point. Higher EO values were also found at 50% 1-RM than both 30% 1-RM and 70% 1-RM 100 ms before and after the zero-velocity point. For the SJ, higher EO values were found at 50% 1-RM and 75% 1-RM than 25% 1-RM 100 ms before and after the zero-velocity point. Higher EO values were found at 50% 1-RM than 25% 1-RM 200 ms before and after the zero-velocity point. However, the higher EO values in the SJ were found far from the zero-velocity point. High-speed SSC resistance training provides similar EO to other methods and thus should promote muscle hypertrophy and other neuromuscular adaptations., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Coronavirus disease 2019 (COVID-19) frequently involves cardiovascular manifestations such as right ventricular (RV) dysfunction and alterations in pulmonary hemodynamics. We evaluated the application of the critical care ultrasonography ORACLE protocol to identify the most frequent alterations and their influence on adverse outcomes, especially those involving the RV (dilatation and dysfunction)., Methods: This cross-sectional study included 204 adult patients with confirmed COVID-19 admitted at three centers. Echocardiography and lung ultrasound images were acquired on admission using the ORACLE ultrasonography algorithm., Results: Two-hundred and four consecutive patients were evaluated: 22 (11.9%) demonstrated a fractional shortening of < 35%; 33 (17.1%) a tricuspid annular plane systolic excursion (TAPSE) of < 17 mm; 26 (13.5%) a tricuspid peak systolic S wave tissue Doppler velocity of < 9.5 cm/sec; 69 (37.5%) a RV basal diameter of > 41 mm; 119 (58.3%) a pulmonary artery systolic pressure (PASP) of > 35 mm Hg; and 14 (11%) a TAPSE/PASP ratio of < .31. The in-hospital mortality rate was 37.6% (n = 71). Multiple logistic regression modeling showed that PASP > 35 mm Hg, RV FS of < 35%, TAPSE < 17 mm, RV S wave < 9.5, and TAPSE/PASP ratio < .31 mm/mm Hg were associated with this outcome. PASP and the TAPSE/PASP ratio had the lowest feasibility of being obtained among the investigators (62.2%)., Conclusion: The presence of RV dysfunction, pulmonary hypertension, and alteration of the RV-arterial coupling conveys an increased risk of in-hospital mortality in patients presenting with COVID-19 upon admission; therefore, searching for these alterations should be routine. These parameters can be obtained quickly and safely with the ORACLE protocol., (© 2021 Wiley Periodicals LLC.)

The purpose of the present meta-analysis was to examine the effect of flywheel resistance training (FRT) on main sport action (i.e., jumping performance, sprinting time and change of direction performance) improvements in athletes and healthy active people. A Boolean search strategy adapted for each of the databases employed was conducted to identify all studies measuring change in sport actions performance after FRT interventions up to July 2019. Outcomes were analysed using an average effect size (D + ) and a 95% confidence interval (CI), which was calculated assuming a random-effects model. A total of 9 studies with 283 participants met the inclusion criteria and were selected for the analysis. The mean quality score (PEDro scale) of the articles included in the meta-analysis was 5.67. The meta-analysis showed significant positive effects on jumping performance (SMC 0.65; 95% CI, 0.11-1.19; p = 0.02), sprinting time (SMC 1.33; 95% CI, 0.39-2.28; p < 0.01) and change of direction performance (SMC 1.36; 95% CI, 0.58-2.14; p < 0.01) after FRT interventions compared to control/traditional resistance training groups. The results of the present meta-analysis provide evidence of the usefulness of FRT to improve variables related to sport performance in both athletes and healthy population., (© 2021 Javier Raya-González, Amaya Prat-Luri, Alejandro López-Valenciano, Rafael Sabido, Jose Luis Hernández-Davó, published by Sciendo.)

Introduction: Lung ultrasound (LUS) implementation in patients with COVID-19 can help to establish the degree of pulmonary involvement, evaluate treatment response and estimate in-hospital outcome., Objective: To evaluate the application of a LUS protocol in patients with COVID-19 infection to predict in-hospital mortality., Methods: The study was carried out from April 1 to August 1, 2020 in patients with COVID-19 infection admitted to the Intensive Care Unit. Lung evaluation was carried out by physicians trained in critical care ultrasonography., Results: Most patients were males, median age was 56 years, and 59 % required mechanical ventilation. In-hospital mortality was 39.4 %, and in those with a LUS score ≥ 19, mortality was higher (50 %). The multiple logistic regression model showed that a LUS score ≥ 19 was significantly associated with mortality (hazard ratio = 2.55, p = 0.01)., Conclusions: LUS is a safe and fast clinical tool that can be applied at bedside in patients with COVID-19 infection to establish the degree of parenchymal involvement and predict mortality., (Copyright: © 2021 Permanyer.)

Background and objectives : Fatigue is one of the most disabling symptoms that limit daily life activities in persons with multiple sclerosis (pwMS). This study aimed to evaluate the effects of maximal strength training (MST) on perceived-fatigue and functional mobility in pwMS. Materials and Methods : 26 participants with MS were balanced according to their pre-intervention fatigue scores and distributed into an MST group ( n = 13) and a control group (CG; n = 13). The MST group completed eight weeks using high loads, evaluating detraining after ten weeks. Quadriceps and hamstring isokinetic (QPT IK ; HPT IK ) and isometric (QPT IM ; HPT IM ) peak torques were assessed using an isokinetic dynamometer. Effect size differences were estimated with the Hedges' g index ( d g ). Fatigue was evaluated through the Fatigue Severity Scale (FSS), while functional mobility was assessed via the Timed Up and Go Test (TUG). Results : The MST significantly improved all the strength measurements after the intervention (Δ6.43-29.55%; p < 0.05) compared to the control group. FSS showed a significant reduction (59.97%, d g = 5.41, large). The MST group also reduced the TUG time (19.69%; d g = 0.93, large) compared to the control group. Improvements caused by the intervention did not remain after a 10-week follow-up, with decreases in strength performance from 4.40% to 13.86% ( d g = 0.24-0.56, small to moderate), 112.08% in the FSS ( d g = -3.88, large), and 16.93% in TUG ( d g = -1.07, large). Conclusions : MST (up to 90% 1RM) seems to be a feasible and useful way to obtain clinically relevant improvements in the perceived-fatigue symptoms and functional mobility. Still, symptom improvements decrease after a 10-week detraining period.

Background: Coronavirus disease 2019 (COVID-19) is characterized by severe lung involvement and hemodynamic alterations. Critical care ultrasonography is vital because it provides real time information for diagnosis and treatment. Suggested protocols for image acquisition and measurements have not yet been evaluated., Methods: This cross-sectional study was conducted at two centers from 1 April 2020 to 30 May 2020 in adult patients with confirmed COVID-19 infection admitted to the critical care unit. Cardiac and pulmonary evaluations were performed using the ORACLE protocol, specifically designed for this study, to ensure a structured process of image acquisition and limit staff exposure to the infection., Results: Eighty-two consecutively admitted patients were evaluated. Most of the patients were males, with a median age of 56 years, and the most frequent comorbidities were hypertension and type 2 diabetes, and 25% of the patients had severe acute respiratory distress syndrome. The most frequent ultrasonographic findings were elevated pulmonary artery systolic pressure (69.5%), E/e' ratio > 14 (29.3%), and right ventricular dilatation (28%) and dysfunction (26.8%). A high rate of fluid responsiveness (82.9%) was observed. The median score (19 points) on pulmonary ultrasound did not reveal any variation between the groups. Elevated pulmonary artery systolic pressure was associated with higher in-hospital mortality., Conclusion: The ORACLE protocol was a feasible, rapid, and safe bedside tool for hemodynamic and respiratory evaluation of patients with COVID-19. Further studies should be performed on the alteration in pulmonary hemodynamics and right ventricular function and its relationship with outcomes., (© 2020 Wiley Periodicals LLC.)

The use of flywheel devices has increased in popularity within resistance training programs. However, little is known about modifiable variables which may affect power output responses, as the rope length and the height level used in a conical pulley device. The aim of this study was to assess the influence of using three different rope lengths (1.5, 2.5 and 3.5 meters) and four different height levels (L1, L2, L3 and L4) on concentric peak power (PPconc), eccentric peak power (PPecc) and eccentric overload (eccentric/concentric PP ratio; EO) during conical pulley exercises (i.e. seated and stand-up row). A total of 29 recreationally trained subjects (25.3±7.1 years; 1.74±0.06 m; 72.5±8.3 kg) took part in the study. Testing sessions consisted of 1 set of 10 repetitions under each condition; experiment 1: seated row exercise using the three different rope lengths; experiment 2: stand-up row exercise using four different height levels of the conical pulley. Results from experiment 1 did not show differences between rope lengths, although a trend for greater PPecc (ES=0.36-0.38) and EO (ES=0.40-0.41) was found when using longer rope lengths (2.5 and 3.5). Experiment 2 showed significant increases in both PPconc and PPecc as the height level used was closer to the cone base (L4). In contrast, EO values were significantly greater when using upper height levels (L1). These results suggest that the height level used during conical pulley exercises highly influences power output responses. Therefore, this variable should be carefully managed depending on the training goal (e.g. power vs hypertrophy)., (© 2020 Rafael Sabido, Jose Luis Hernández-Davó, Adrián García-Valverde, Pablo Marco, Pablo Asencio, published by Sciendo.)

This study aimed to analyze the influence of the inertial load on both concentric and eccentric power output production during the flywheel leg curl exercise, and to assess the reliability of power output variables. Sixteen participants (8 males, 8 females) attended 4 testing sessions. During testing, participants performed one set of eight repetitions using a specific inertial load (0.083, 0.132, 0.182, 0.266 and 0.350 kg·m 2 ) with a flywheel leg curl exercise. Concentric (CON) power, eccentric (ECC) power and the ECC/CON ratio were analyzed. The reliability analysis between sessions was performed. A significant interaction of inertia load x gender was found in CON power (p < 0.001) and in ECC power (p = 0.004), but not in the ECC/CON ratio (p = 0.731). A significant with-in (inertia loads) effect was found in CON power (p < 0.001) and in ECC power (p < 0.001), but not in the ECC/CON ratio (p = 0.096). CON power showed very high reliability scores, ECC power showed high to very high reliability scores, while the ECC/CON ratio ranged from poor to moderate. A significant between gender effect was found in CON power (p < 0.001) and in ECC power (p < 0.001), but not in the ECC/CON ratio (p = 0.752). This study is the first to report that power output in the flywheel leg curl exercise is altered by the inertia load used, as well as power output is different according to gender. CON and ECC power output presents high to very high reliability scores, and the ECC/CON ratio should not be used instead. These results can have important practical implications for testing and training prescription in sports., (© 2020 Francisco Piqueras-Sanchiz, Rafael Sabido, Javier Raya-González, Marc Madruga-Parera, Daniel Romero-Rodríguez, Marco Beato, Moisés de Hoyo, Fabio Yuzo Nakamura, Jose Luis Hernández-Davó, published by Sciendo.)

It is known that, in ancient Mexico, diseases of the respiratory system were a major cause of death in the population. Severe epidemics in the XVI Century ravaged and killed nine out of ten indigenous persons. Pre-Hispanic physicians served as medical sorcerers and dealt with the physical and spiritual diseases that afflicted the population. Important medical knowledge pertaining to each culture has been identified; this knowledge explained the diseases depending on the religious beliefs of each culture, and it tried to solve the health problems that afflicted the population at that time.

The use of flywheel devices has increased in popularity during the last few years. Flywheel training is an attractive alternative to traditional resistance exercise because it allows for the loading stimulus to be manipulated. Some of the benefits associated with flywheel training include increases in muscle hypertrophy, muscular strength and reductions in injury risk. Nevertheless, there is a lack of research about how basic training variables [i.e., rest intervals (RI) between sets], or variables associated with manipulation of the loading stimulus (i.e., different inertial loads), influence the acute responses during a flywheel session. Thus, the aim of this study was to assess the influence of three different RI between sets (1, 2, or 3 min), during a flywheel squat session with two different inertial loads: light (0.025 kg⋅m 2 ) and high (0.075 kg⋅m 2 ). Twenty-three participants performed six exercise sessions (two inertial loads × three RI) consisting of four sets of 11 repetitions. Concentric and eccentric power, lactate concentration ([La]) and ratings of perceived exertion (RPE) were measured during the exercise session, and delayed onset muscular soreness (DOMS) were recorded 24 h post-exercise. Both concentric (9.1 and 22.1% at light and high load respectively; p = 0.022 and 0.005) and eccentric peak power (17.5% at high load; p = 0.02) decreased across sets when the 1 min RI was used. Concentric peak power was decreased (11.1%, p = 0.041) from the 2 min RI only with the high inertial load. RPE was higher during the 1 min compared with the 3 min RI protocol when using the high inertial load ( p = 0.028). [La] was higher when using the 2 min RI compared with the 3 min RI at light load ( p = 0.03). In conclusion, during flywheel training sessions, a short RI (1 min) was insufficient to maintain power output across all four sets and was linked to greater perceptual variables. A 2 min RI allowed for power to be maintained, but only when training with light inertial loads. Based on these results, coaches should consider prescribing 3 min RI's when performing flywheel squat exercises regardless the inertial load. In contrast, when using 2 min RI's the inertial load should be light., (Copyright © 2020 Sabido, Hernández-Davó, Capdepon and Tous-Fajardo.)

Background: Diabetes mellitus is a public health problem in Mexico, and the trend of the disease is increasing. From 2000 to 2017, 7.32 million new cases were diagnosed, with pulmonary mycoses being one of the most serious complications., Aims: To describe the frequency and the clinical characteristics of patients diagnosed with pulmonary mycoses, and to identify the risk factors associated with this entity., Methods: Case-control study, paired by gender (1:1-3) and age (± 5 years), that analyzed patients with pulmonary mycosis (mucormycosis, histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis, cryptococcosis, paracoccidioidomycosis) and studied the risk factors present in each patient., Results: From the 162 patients studied, 56 suffered pulmonary mycosis and 106 were controls. The median of the age was 51 and 50 years for the cases and for the controls, respectively. Multiple logistic regression analysis showed that patients with diabetes mellitus had an odds ratio of 8,3 (p < 0.001), and patients with a history of tuberculosis had an odds ratio of 8,8 (p < 0.001)., Conclusions: Our results show that 52% of the patients with pulmonary mycoses had a history of diabetes mellitus. Diabetes mellitus is a relevant risk factor for pulmonary mycoses, which are usually diagnosed in advanced stages and have a high mortality., (Copyright © 2020 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area., Objective: To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital., Method: Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI)., Results: Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01)., Conclusions: In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources., (Copyright: © 2020 Permanyer.)

Non-tuberculous mycobacterial infection has increased significantly in recent years, especially in emerging countries. We present the case of a 25-year-old male patient, immunocompetent, with cervical lymphadenopathy, identifying Mycobacterium kumamotonense, a rare species in extrapulmonary forms and with a high drug resistance index., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2019 Alejandro Hernández Solis, Maribel González Villa, Ernesto Ramírez González, Yesenia Colin Muñoz, Raúl Cicero Sabido.)

Background: Eccentric overload training (EOT) has been proposed as an effective stimulus to optimize dynamic athletic performance. Nevertheless, the appropriate intensity during EOT remains unknown. The purpose of this study was to evaluate the influence of the inertial load used during an EOT program on performance adaptations in rugby union players., Methods: Fifteen rugby players were divided into a low (0.025 kg·m2; G 0.025) or a high (0.075 kg·m2; G 0.075) inertial load for training. Both groups trained using the flywheel half squat exercise twice a week during the seven-week EOT. Athletic performance was evaluated by testing the half squat maximum repetition (1RM), countermovement jump (CMJ), 40 m linear sprint, the modified agility T-Test, and power output in the flywheel squat exercise. Data were analysed using magnitude-based inferences., Results: Both groups improved their 1RM and CMJ to a similar extent. Nevertheless, the G 0.025 showed likely trivial changes in linear sprint (ES=-0.02), and possibly positive effects on the agility T-Test (ES=0.16), while the G 0.075 showed possibly negative effects on 40 m linear sprint (ES=-0.23) and likely trivial effects on the T-Test (ES=0.07)., Conclusions: Due to the similar gains in 1RM and CMJ, and the superior maintenance in linear sprint, the use of low inertial loads during EOT may be a better option when looking for athletic performance optimization.

Objective: To evaluate the occurrence of adverse events during a multifaceted program implementation., Design: Cross-sectional secondary analysis., Setting: The respiratory-ICU of a large tertiary care center., Participants: Retrospectively collected data of patients admitted from 1 March 2010 to 28 February 2014 (usual care period) and from 1 March 2014 to 1 March 2017 (multifaceted program period) were used., Interventions: The program integrated three components: (1) strategic planning and organizational culture imprint; (2) training and practice and (3) implementation of care bundles. Strategic planning redefined the respiratory-ICU Mission and Vision, its SWOT matrix (strengths, weaknesses, opportunities, threats) as well as its medium to long-term aims and planned actions. A 'Wear the Institution's T-shirt' monthly conference was given in order to foster organizational culture in healthcare personnel. Training was conducted on hand hygiene and projects 'Pneumonia Zero' and 'Bacteremia Zero'. Finally, actions of both projects were implemented., Main Outcome Measures: Rates of adverse events (episodes per 1000 patient/days)., Results: Out of 1662 patients (usual care, n = 981; multifaceted program, n = 681) there was a statistically significant reduction during the multifaceted program in episodes of accidental extubation ([Rate ratio, 95% CI] 0.31, 0.17-0.55), pneumothorax (0.48, 0.26-0.87), change of endotracheal tube (0.17, 0.07-0.44), atelectasis (0.37, 0.20-0.68) and death in the ICU (0.82, 0.69-0.97)., Conclusions: A multifaceted program including strategic planning, organizational culture imprint and care protocols was associated with a significant reduction of adverse events in the respiratory-ICU., (© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Home parenteral nutrition (HPN) has become a common therapy, with tunneled central venous catheters (CVCs) being the preferred route of administration. Peripherally inserted central catheters (PICCs) have been used increasingly, but whether they should be preferred over other types of CVCs is still controversial. The aim of this study was to evaluate catheter-related complications of CVC in patients receiving HPN., Methods: All patients treated at our center for HPN from 2007 to 2017 were prospectively included. A specialized intravenous therapy team took care of these patients. Catheter-related bloodstream infections (CRBSI) were confirmed with positive, simultaneous, differential blood cultures drawn through the CVC and peripheral vein and then semiquantitative or quantitative culture of the catheter tip., Results: In all, 151 patients received HPN during the 11-y study period. Of these patients, 95 were women (63%) and 55 were men (37%), with a mean age of 58 ± 13 y. Twenty-six were non-cancer patients (17%) and the remaining 125 patients had an underlying malignancy (83%). Regarding the CVC, 116 were PICCs, 18 Hickman, and 36 ports. Confirmed CRBSI per catheter-days showed 0.15 episodes per 1000 catheter-days for PICCs, 0.72 for Hickman, and 2.02 for ports. PICCs had less-confirmed CRBSIs per 1000 catheter-days than ports (φ = 0.54, P = 0.005), but no difference between PICCs and Hickman was found (φ = 0.32, P = 0.110). Confirmed episodes of CRBSI (2 versus 13%, χ 2  = 6.625, P = 0.036) were more frequent with multilumen catheters., Conclusions: In our setting, single-lumen PICC and Hickman catheters showed low infectious complications., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: The sputum smear or the culture are the definitive diagnosis of pulmonary tuberculosis. Only a fraction of clinical patients are culture-confirmed., Methodology: A total of 24 clinical cases (40 ± 14 years old) with positive smear and negative co-morbidity were studied. Cases were selected from 600 patients who attended the pneumology service over two years. A sputum sample was cultured in Löwenstein-Jensen medium with consequent amplification of the rrnA V2 promoter, the differentiation region 4, and the IS6110 insertion sequence of Mycobacterium tuberculosis. After the culture result, the patients were divided into negative (n = 14) or positive (n = 10) culture groups. In addition, 30 samples from healthy donors (45 ± 10 years) were studied. The numbers of CD4, CD8 and CD19 lymphocytes were determined by flow cytometry. Levels of IgA and IgG to M. tuberculosis were measured by ELISA., Results: IgG and IgA levels were detected in patients with positive culture, while only IgA was found in patients with negative cultures. The lymphocyte populations in the two groups were similar.  The presence of a pleural apical cap was found more frequently in patients with negative- (57%) than with positive cultures (10%)., Conclusions: The isotype profile in patients with positive cultures was both IgA and IgG positive, while in patients with negative culture, only IgA was found. The results will contribute to improve the diagnostic algorithm and appropriate treatment of patients with clinical tuberculosis. Further studies are needed to determine if this profile is predictive of the outcome of isolation., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2019 Jorge-Luis de-la-Rosa-Arana, Fernando-Renato Cázares-Sosa, Alejandro Hernández-Solís, Atenea-Estela Andrés-Dionicio, Heliodora González-González, Miguel Ibáñez-Hernández, Raúl Cicero-Sabido, Herón Huerta, Raquel Tapia-Romero.)

Introduction: In Mexico, there is an alarming increase in the number of cases of Mycobacterium bovis infection on pulmonary and extrapulmonary presentations. The lack of timely identification triggers complications and increases mortality., Objective: To know the frequency of M. bovis infections in clinical samples of patients with tuberculosis in the mycobacteria laboratory of a reference hospital in Mexico City., Method: Prospective, descriptive study. Strains isolated from biological material were studied in Löwestein-Jensen and MGITI960 cultures. M. bovis was identified by amplifying the RD9 fragment with end-point polymerase chain reaction (PCR)., Results: Eight-hundred and fifty tuberculosis-diagnosed patients were included; in 441 cases, Mycobacterium tuberculosis was confirmed by positive culture (250 pulmonary, 65 ganglionic, 39 renal, 34 meningeal, 25 miliary, 14 pleural, 8 peritoneal, 4 bone and 2 pericardial cases). Forty-eight strains (10.8%) were typified as M. bovis by amplification of the RD9 fragment with end-point PCR., Conclusions: M. bovis is not currently thought of a causative agent of tuberculosis, which could be the cause of pharmacological treatment failure. In this study, the main extrapulmonary form was observed to be cervical lymphadenopathy., (Copyright: © 2019 Permanyer.)

Introduction: New hospitals are replacing old facilities. There is little information on the performance of an intensive care unit (ICU) when it is relocated in a new and equipped area., Objective: To analyze the impact of the change of ICU facilities from a shared environment to individual beds on the occurrence of adverse events., Method: Cross-sectional, comparative study, with prospectively collected data from patients admitted from March 01, 2014 to February 28, 2017 to the former ICU (f-ICU) and from July 17, 2017 to January 17, 2019 to the new ICU (n-ICU) of a public teaching hospital. The rate of adverse events was measured in events per 1,000 patient-days., Results: Among 1,188 patients (f-ICU, n = 681 vs. n-ICU, n = 507), a reduction in the rate of unforeseen cardiac arrest (rate ratio: 0.31; 95% confidence interval [CI] = 0.12-0.80) and an increase in the rate of unplanned extubation (rate ratio: 2.49; 95% CI = 1.24-5.01) were observed, with both being statistically significant. The other nine monitored adverse events showed no changes., Conclusions: In comparison with the f-ICU, most of the monitored adverse events did not significantly change within the first 18 months of activities at the n-ICU., (Copyright: © 2019 Permanyer.)

Introduction: intracavitary electrocardiogram (IC-ECG) guidance has been recently proposed for peripherally inserted central catheter (PICC) placement since it may reduce the time of placement and avoid radiological control., Objective: to evaluate IC-ECG compared to conventional radiological control. METHOS: prospective study of 532 consecutive patients. Those with arrhythmias or on antiarrhythmic drugs were excluded. In all cases, PICC tip placement was checked by IC-ECG guidance and by a chest X-ray, which was considered as the reference test., Results: PICC placement with IC-ECG guidance was achieved in 96.8% of patients (applicability). PICC correct placement according to IC-ECG guidance was confirmed by chest X-ray in 94% of patients (accuracy). In 13 patients (2.7%) the catheter had to be repositioned after radiological control. The κ concordance index was 0.356 (p < 0.001). The IC-ECG sensitivity was 0.98, with a PPV of 0.97 and a positive likelihood ratio of 1.5. However, the specificity was only 0.35 with a NPV of 0.41 and a negative likelihood ratio of 0.06., Conclusion: PICC placement by IC-ECG guidance is plausible, safe, presents adequate indexes of validity and reliability, and allows reducing the time of catheter placement. However, radiological verification is still necessary, especially in cases of negative or uncertain ECG.

Purpose: To evaluate the reliability and validity of vertical and horizontal jump tests in football players with cerebral palsy (FPCP) and to analyze the jump performance differences between current International Federation for Cerebral Palsy Football functional classes (ie, FT5-FT8)., Methods: A total of 132 international parafootballers (25.8 [6.7] y; 70.0 [9.1] kg; 175.7 [7.3] cm; 22.8 [2.8] kg·m -2 ; and 10.7 [7.5] y training experience) participated in the study. The participants were classified according to the International Federation for Cerebral Palsy Football classification rules, and a group of 39 players without cerebral palsy was included in the study as a control group. Football players' vertical and horizontal jump performance was assessed., Results: All the tests showed good to excellent relative intrasession reliability scores, both in FPCP and in the control group (intraclass correlation = .78-.97, SEM < 10.5%). Significant between-groups differences (P < .001) were obtained in the countermovement jump, standing broad jump, 4 bounds for distance, and triple hop for distance dominant leg and nondominant leg. The control group performed higher/farther jumps with regard to all the FPCP classes, obtaining significant differences and moderate to large effect sizes (ESs) (.85 < ES < 5.54, P < .01). Players in FT8 class (less severe impairments) had significantly higher scores in all the jump tests than players in the lower classes (ES = moderate to large, P < .01)., Conclusions: The vertical and horizontal jump tests performed in this study could be applied to the classification procedures and protocols for FPCP.

Purpose: To analyze the effects of different inertial loads on power production and power maintenance, as well as the number of sessions required for proper familiarization during the flywheel quarter-squat., Methods: Twenty-four high-level handball players attended 4 testing sessions consisting of 4 sets of 10 repetitions using 4 different inertial loads (0.025, 0.050, 0.075, and 0.100 kg·m 2 ). In addition, a 5th set of 15 repetitions was performed. Both concentric and eccentric peak power and the eccentric:concentric ratio were recorded., Results: The results showed the need to perform 3 sessions for a proper familiarization (ie, outcomes stabilization). The inertial load of 0.025 kg·m 2 led to greater concentric peak power compared with the other inertial loads (from likely to most likely greater values). Both 0.025 and 0.050 kg·m 2 inertial loads entailed greater eccentric peak power compared with 0.075 and 0.100 kg·m 2 (most likely greater). Conversely, the 0.025-kg·m 2 inertial load showed a lower eccentric:concentric ratio, presenting negative effects (most likely lower values) compared with the inertial loads of 0.050, 0.075, and 0.100 kg·m 2 . Participants were able to perform 5-12 repetitions per set without significant peak power output decrements., Conclusions: This study highlights the importance of performing at least 3 sessions to obtain a stable measure during flywheel squat exercise. Lower inertial loads (0.025 kg·m 2 ) are the better option for eliciting high concentric peak power output values. In contrast, medium to high inertial loads are more appropriate to achieve greater eccentric overload values.

The appearance of new anti-tuberculosis drugs such as bedaquiline and delamanid makes it impossible not to remember that the first strictly controlled medical trials of tuberculosis treatment were published in two rigorously researched outstanding articles that can be qualified as historical. In 1948, streptomycin was formally studied as an efficacious anti-tuberculosis drug. In 1952, another trial compared streptomycin-paramino salicylic acid with isoniazid, by means of which the first bases of pharmacological tuberculosis treatment were established., (Copyright: © 2018 SecretarÍa de Salud.)

Background: Boccia is a paralympic sport played by athletes with severe neurological impairments affecting all four limbs. Impaired manual dexterity (MD) and intralimb coordination (ILC) may limit individuals' ability to perform certain activities such as grasping, releasing, or manipulating objects, which are essential tasks for daily life or to participate in para sports such as boccia. However, there are currently no specific instruments available to assess hand-arm coordination in boccia players with severe cerebral palsy (CP)., Purpose: To design new sport-specific coordination tests to assess impaired MD and ILC in boccia players; afterward, quantify to what extent their coordination is impaired compared to a control group (CG) without neurological impairments., Methods: Seventy-three recreational boccia players with severe CP (BC1: age = 34.01 ± 16.43 years; BC2: age = 33.97 ± 14.29 years), and 19 healthy adults (age = 27.89 ± 7.08 years) completed the test battery. The Box and Block test (BBT) and Box and Ball test (BBLT) were used to assess MD and four tapping tests to assess upper ILC., Results: Both MD tests were able to discriminate between sport classes. Boccia players obtained better scores in the BBLT in comparison to the BBT, showing that the BBLT had more appropriate testing features. On the other hand, only one of the ILC tests was able to discriminate between sport classes, displaying the highest practical significance ( d  = -1.12). Participants with CP scored significantly worse in all the coordination tests compared to the CG., Conclusion: Using sport-specific equipment facilitated grasp function during the MD assessment. Regarding the ILC, the type of movement (continuous vs. discrete) seems to be more relevant for classification than the movement direction (vertical vs. horizontal) or the presence of a ball.

Background: There is a progressive increase in nontuberculous mycobacteria (NTM) in pulmonary and extrapulmonary infections that might cause confusion with the Mycobacterium tuberculosis complex. To determine the frequency of finding NTM in clinical samples from patients diagnosed with active tuberculosis, with negative acid-alcohol-resistant bacilli (acid-fast bacillus [AFB]) in a third-level specialty hospital's mycobacterial laboratory between January 2013 and December 2014., Methods: This is a prospective, descriptive study where isolated strains of biological material were studied in Lowenstein-Jensen and BACTEC MGIT 960 cultures., Results: Clinical samples of 120 patients were studied, with pulmonary samples of 99/120 (82%) and extrapulmonary samples of 21/120 (18%). We identified NTM in 37/120 samples (30.8%), of which 16 in pulmonary, 13 in genitourinary, 3 in bone marrow, and 5 in various specimens. Mycobacterium avium was isolated in 20 samples, Mycobacterium intracellulare in seven samples, and various other species of NTM in the other 10 samples., Conclusion: To establish adequate treatment, we point out the importance of identifying the presence of NTM in the clinical samples of active tuberculosis patients with negative AFB, as possibly becoming confused with M. tuberculosis and which is essential in deciding which treatment is the most adequate.

Background: Pulmonary mucormycosis is a rare opportunistic infection with high mortality that is caused by species of Mucorales. The most common species involved are Rhizopus, Mucor, Lichtheimia, and Rhizomucor., Case Report: A 56 year-old woman presented with a clinical history of diabetes mellitus type 2 and chronic renal disease. She underwent a cadaveric kidney transplantation two years before her admission, for which immunomodulating therapy with thymoglobulin, tacrolimus, mofetil-microphenolate and prednisone was established. The patient suffered a pneumonic process with cough, expectoration, and dyspnoea. The computed tomography scan showed a cavitation in the right upper lobe. With all these findings an invasive broncopulmonary aspergillosis was suspected and the patient began an antifungal treatment with voriconazole without improvement. Rhizomucor pusillus was isolated from a clinical specimen obtained by fine needle aspiration, and its identification was confirmed by PCR. After this finding amphotericin B was administered, but the patient had an uncontrolled haemoptysis and died., Conclusions: Pulmonary mucormycosis is a rare infection, usually fatal in kidney transplant recipients with anti-rejection therapy. Mucorales species usually produce thrombotic phenomena, associated with necrosis and parenchymal destruction that caused a fatal uncontrolled haemoptysis in our patient. Early diagnosis is important in order to perform any surgical treatment and to administer amphotericin B., (Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

To investigate the influence of adding a weekly eccentric-overload training (EOT) session in several athletic performance's tests, 18 team-handball players were assigned either to an EOT (n = 11) or a Control (n = 7) group. Both groups continued to perform the same habitual strength training, but the EOT group added one session/week during a 7-week training programme consisting of four sets of eight repetitions for the bilateral half-squat and unilateral lunge exercises. The test battery included handball throwing velocity, maximum dynamic strength (1RM), countermovement jump (CMJ), 20 m sprint, triple hop for distance, and eccentric/concentric power in both the half-squat and lunge exercises. Data were analysed using magnitude-based inferences. Both groups improved their 1RM in the half squat, 20 m sprint time, and CMJ performance to a similar extent, but the EOT group showed a beneficial effect for both right [(42/58/0), possibly positive] and left [(99/1/0), very likely positive] triple hop for distance performance. In addition, the EOT group showed greater power output improvements in both eccentric and concentric phases of the half-squat (difference in percent of change ranging from 6.5% to 22.0%) and lunge exercises (difference in per cent of change ranging from 13.1% to 24.9%). Nevertheless, no group showed changes in handball throwing velocity. Selected variables related to team-handball performance (i.e. functional jumping performance, power output) can be improved by adding a single EOT session per week, highlighting the usefulness of this low-volume/high-intensity training when aiming at optimizing dynamic athletic performance.

Hernández Davó, JL, Botella Ruiz, J, and Sabido, R. Influence of strength level on the rest interval required during an upper-body power training session. J Strength Cond Res 31(2): 339-347, 2017-The present study aimed to investigate the influence of subjects' strength level on both the ability to maintain power output performance and the physiological and perceived exertion responses during a power training session when different rest intervals (RI) are used. Thirty-eight (18 men and 20 women) subjects were divided into a stronger or weaker group based on their ability to produce peak power output. Testing was performed using the same protocol (5 sets of 8 repetitions with 40% of 1 repetition maximum) in the bench press throw exercise, but differing the RI between sets (1, 2, and 3 minutes). During the sessions, mechanical (peak power), physiological ([La]) and perceptual (RPE) variables were measured. In addition, delayed onset muscular soreness (DOMS) 24 and 48 hours after the training session was reported. Both stronger and weaker (men and women) groups showed significant impairments in mechanical, physiological, and perceptual data when resting 1 minute. Nevertheless, although stronger groups were able to sustain power output over the sets when using the 2-minute RI, weaker groups needed at least 3 minutes to maintain power output performance. Therefore, strength level heavily influences the rest interval required during a power training session and should be taken into account when prescribing such training sessions.

The nucleoside hydrolase gene from Leishmania donovani was cloned and expressed in Escherichia coli as a full length 36-kDa protein (LdNH36). Following lysis and extraction, the protein was purified by anion exchange and gel filtration chromatography. The purified protein had a molecular mass of approximately 36-kDa and was confirmed to be >99% pure. Using a nucleoside hydrolase assay, the protein was found to exhibit a Km of 741 ± 246 μM. Protein integrity was confirmed by lithium dodecyl sulfate polyacrylamide gel electrophoresis (LDS-PAGE), mass spectrometry (MS), and enzymatic assay. Analysis of antibody levels from immunized mice indicated that LdNH36 alone or in a stable emulsion with the Toll-like receptor-4 ligand glucopyranosyl lipid adjuvant (GLA-SE) as immunostimulant induced high levels of antigen-specific IgG antibodies. The cellular immune response indicated a T h 1 response in mice immunized with LdNH36, but only when formulated with GLA-SE. Mice immunized with the LdNH36 antigen in combination with the GLA-SE adjuvant and challenged with Leishmania mexicana showed significant reductions (>20 fold) in parasite burden, confirming the protective efficacy of this vaccine candidate., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To compare the effect of 4-week unknown vs known loads strength training intervention on power output performance and throwing velocity in junior team handball players., Methods: Twenty-eight junior team-handball players (17.2 ± 0.6 years, 1.79 ± 0.07 m, 75.6 ± 9.4 kg)were divided into two groups (unknown loads: UL; known loads: KL). Both groups performed two sessions weekly consisting of four sets of six repetitions of the bench press throw exercise, using the 30%, 50% and 70% of subjects' individual 1 repetition maximum (1RM). In each set, two repetitions with each load were performed, but the order of the loads was randomised. In the KL group, researchers told the subjects the load to mobilise prior each repetition, while in the UL group, researchers did not provide any information. Maximal dynamic strength (1RM bench press), power output (with 30, 50 and 70% of 1RM) and throwing velocity (7 m standing throw and 9 m jumping throw) were assessed pre- and post-training intervention., Results: Both UL and KL group improved similarly their 1RM bench press as well as mean and peak power with all loads. There were significant improvements in power developed in all the early time intervals measured (150 ms) with the three loads (30, 50, 70% 1RM) in the UL group, while KL only improved with 30% 1RM (all the time intervals) and with 70% 1RM (at certain time intervals). Only the UL group improved throwing velocity in both standing (4.7%) and jumping (5.3%) throw (p > 0.05)., Conclusions: The use of unknown loads has led to greater gains in power output in the early time intervals as well as to increases in throwing velocity compared with known loads. Therefore unknown loads are of significant practical use to increase both strength and in-field performance in a short period of training.

Objective: To compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU)., Design: A prospective, comparative, longitudinal and interventional study was carried out., Setting: The RICU of Hospital General de México (Mexico)., Patients: All patients admitted to the RICU from March 2012 to March 2013., Interventions: An evidence-based bundle of interventions was implemented in order to reduce the ratios of three quality indicators: non-planned extubation (NPE), reintubation, and ventilator-associated pneumonia (VAP)., Variables of Interest: NPE, reintubation and VAP ratios., Results: A total of 232 patients were admitted, with a mean age of 49.5±17.8years; 119 (50.5%) were woman. The mean Simplified Acute Physiology Score (SAPS-3) was 49.8±17, and the mean Sequential Organ Failure Assessment (SOFA) score was 5.3±4.1. The mortality rate in the RICU was 38.7%. The standardized mortality ratio was 1.50 (95%CI: 1.20-1.84). An improved ratio was observed for reintubation and NPE indicators compared to the ratios of the previous 2011 cohort: 1.6% vs. 7% (P=.02) and 8.1 vs. 17 episodes per 1000 days of mechanical ventilation (P=.04), respectively. A worsened VAP ratio was observed: 18.4 vs. 15.1 episodes per 1000 days of mechanical ventilation (P=.5)., Conclusions: Quality improvement is feasible with the identification of areas of opportunity and the implementation of strategies. Nevertheless, the implementation of a bundle of preventive measures in itself does not guarantee improvements., (Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

Background: Bronchogenic cyst is a rare congenital malformation and commonly located in the mediastinum and lung parenchyma., Objective: To determine the clinical characteristics of the patients with diagnosis of bronchogenic cysts, their location and the infectious bacteria when the cysts are infected. The cases were collected from 1 January 2005 to 1 January 2013, in a third level hospital., Material and Methods: The cases with bronchogenic cysts resected by thoracotomy were confirmed by histological study. Age, sex, admission diagnosis, location, size, imagenologic studies, and bacteriological cultures were evaluated., Results: Of the 12 cases with diagnosis of bronchogenic cysts surgically resected by thoracotomy, six were male and six female, with 50% located in lung parenchyma and 50% in mediastinum, one of the latter was para-oesophageal. Bacteriological study of the cystic content demonstrated bacterial infection in seven (58%) cases., Conclusions: Bronchogenic cysts are rare congenital benign lesions. They must be resected because their content might be infected. The histopathology study is necessary to confirm the diagnosis, together with bacteriological examination. Thoracotomy is a safe procedure to resect bronchogenic cysts., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.)

Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27-29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring (n = 74) or usual standard-of-care (n = 79). Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%). Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services.

Background: Spirometry is a very useful clinical test to evaluate pulmonary function in asthmatic patients. However, pulmonary function could be affected by the sex, time of clinical evolution, lung age (LA) and chronological age (CA)., Objective: To evaluate LA/CA as index of clinical improvement or severity in asthmatic patients., Material and Method: A prospective study was done where asthma severity was evaluated according to GINA classification. Spirometry was performed at the beginning of this study, at 46, 96, 192 days and after 10 months. Statistical analysis was performed using t test, two-way ANOVA test, correlation and multiple regression models as well as ROC curves were also performed, a p<0.05 was considered significant., Results: Seventy asthmatic patients were included (22 male and 48 female), mean CA was 35-years; mean LA was 48-years with a LA/CA index=1.4, time of clinical evolution was 13 years. A LA/CA index=1 (range 0.5 to 0.9) was observed in asymptomatic patients. LA/CA index over 1 were related with airway inflammation, and a LA/CA index higher than 2 correlated with GINA step 3. Interestingly when we analyzed CA and LA, we observed in female group a higher than 10 years difference between CA and LA (GINA step 2 and 3); while in male we observed (GINA step 1, step 2 and step 3). LA/CA index less than or equal to 1 was considered normal., Conclusions: LA/CA index could be used as clinical indicator of clinical improvement or severity in asthma patients in both, male and female, with excellent correlation of pulmonary function and age.

Primary tracheobronchial amyloidosis (TBA) is a rare disease characterized by extracellular focal or diffuse submucosal deposits of amyloid proteins. Various types of endobronchial lesions have been described in TBA when bronchoscopy is performed using white light. Narrow-band imaging bronchoscopy has been mainly employed for detecting preneoplastic and neoplastic endobronchial lesions as it provides more detailed images of the microvasculature reflective of an altered angiogenesis process. Here, we describe bronchoscopic findings with white light and narrow-band imaging in 2 patients presenting with central airway obstructive disease later confirmed as having primary TBA.

Background and Aims: Nontuberculous mycobacteria (NTM) are mainly distributed as important emerging pathogens in patients with chronic or immunosuppressive diseases. Accurate identification of causative species is crucial for proper treatment and patient follow-up. However, several difficulties are associated with phenotypic and molecular diagnostic methods for precise identification at the species level due to shared metabolic and genetic characteristics. We undertook this study to evaluate the application of the phylogenetic method based on hsp65 gene into Telenti's PCR-restriction enzyme analysis (PRA) for molecular identification of NTM., Methods: The study population was comprised of 1646 Mycobacterium clinical isolates (AFB positive) collected from 2008-2011, of which 537 (32.6%) were MNT identified by PRA analysis. DNA sequencing of hsp65 in 53 isolates (10%) was performed. Sequence identification through NCBI-Basic Local Alignment Search Tool (BLAST) achieved correct identification in 23 isolates. Phylogenetic trees including hsp65 available GenBank sequences for all described genres of NTM and hsp65 obtained sequences were constructed using Mega 5.05 software. We compared sequence identification based on phylogenetic clustering and BLAST similarity search., Results: Phylogenetic clustering allowed more specific differentiation of closely related species and clearer identification in comparison with BLAST; 30 Mycobacterium species (this is the first report of isolation of some of these from clinical samples in Mexico) were identified in this way., Conclusions: The proposed 440 bp hsp65 phylogenetic method allows a better identification tool to differentiate Mycobacterium species and is useful to complement diagnosis and epidemiological surveillance of NTM., (Copyright © 2014 IMSS. Published by Elsevier Inc. All rights reserved.)

We present the case of a 33-year-old woman who was being treated for bronchial asthma for 4 years. A tracheal tumor was evident on a computed tomography of the thorax and removed with argon plasma coagulation. It was diagnosed as pleomorphic adenoma of the trachea. It is a rare tracheal tumor without definite treatment guidelines. Our endoscopic approach to this rare lesion is discussed.

Background: Malignant mesothelioma is a neoplasm of bad prognosis, it is linked with asbestos contact, but there are cases without this antecedent., Objective: To investigate the relationship of asbestos exposition and other factors with malignant mesothelioma., Methods: Retrospective analysis of histologic confirmed cases of malignant mesothelioma, neoplasic familiar history, tobacco smoking, exposure to wood smoke and to asbestos, were annotated in a paired case/control study 1: 1-3 with logistic regression model to identify risk factors for OR., Results: 61 cases of malignant mesothelioma were confirmed by histopathologic study, 41 male and 20 female. Mean age was 56 years ± 13 years; 56 cases (91.8%) correspond to epithelial malignant mesothelioma, three sarcomatous (4.9%) one desmoplastic and one biphasic. One in eight (13.1%) had exposure to asbestos. Model of logistic regression with four variables: history of familiar cancer, tobacco smoking, wood smoke and asbestos exposition, the the last one with an OR= 3.083 and p > 0.05. No other variables found to be a risk factor for malignant mesothelioma., Conclusions: Exposure to asbestos is a risk factor for malignant mesothelioma, which is confirmed in this study, however it is important to extend the investigation of other possible causal factors of this disease.

Introduction: When compared with conventional surgery, bronchoscopy-guided percutaneous tracheostomy has demonstrated some advantages. We compare the results obtained with bronchoscopy-guided percutaneous tracheostomy performed by Intensive Care Unit personnel with those of conventional surgery., Methods: Prospective and descriptive cohort of patients admitted to a respiratory intensive care unit from March 2010 to March 2012., Results: A total of 510 patients were admitted to the respiratory Intensive Care Unit. Tracheostomy was performed in 51 (10%); of which, 27 (53%) underwent bronchoscopy-guided percutaneous tracheostomy, and 24(47%) underwent tracheostomy by conventional surgery. There were no differences between bronchoscopy-guided percutaneous tracheostomy and conventional surgery groups in age (52 ± 16 vs 53 ± 18 years, p = 0.83). Simplified Acute Physiology Score-3 differed among groups (59.4 ± 11.2 vs 51.5 ± 14.3, p = 0.03). Indications for performing tracheostomy were prolonged intubation (74.1% vs 62.5%, p = 0.55), neurologic impairment (22.2% vs 16.6%, p = 0.88), and laryngeal disease (3.7% vs 20.8%, p 0.14). Mean time between intubation and tracheostomy was 13.3 days (range 4-45) vs 13.4 days (range 2-40). There were three minor complications in bronchoscopy-guided percutaneous tracheostomy patients, transient bigeminism in one, and moderate bleeding in two, and one minor complication of moderate bleeding in one patient in the conventional surgery group, p = 0.68., Conclusion: Bronchoscopy-guided percutaneous tracheostomy is a versatile and safe alternative for conventional tracheostomy when performed in Intensive Care Unit by personnel with expertise and appropriate training.

Unlabelled: Mass communication is essential to social harmony and for the dissemination of ideas and ways of life., Objective: understanding the impact of social networking to complete health communication microblogging and dissemination of tobacco control and describe its scope and limitations., Methods: they opened accounts on Facebook and Twitter Wall recording activity, messages and papers presented at the January 2010 period through September 2011 in the profiles of both accounts., Results: 1,694 there were friends, 707 men and 987 women plus 814 institutions and 77 followers Facebook Twitter followers, having both a greater response between 20-40 years of age in different social levels, with similar characteristics and results of operation as models of counter-advertising to quit smoke and effective with good impact on the measures related to treatment and harm to health caused by smoking, it was shown that the non-professional population has a high interest in these themes., Conclusions: we suggest that the cost-effectiveness of these programs should be evaluated, and improved future programs should be considered also for selected universal smoking cessation programs indicated by activist via the internet.

Background: Solitary fibrous tumor (SFT) is a localized fibrous mesothelioma and was originally described as a benign pleural lesion. It is a mesenchymatous lesion that has been found in different structures and tissues of the human organism. It originates from a stromal fibroblastic cell positive to CD4. We undertook this study to determine the clinical and histopathological characteristics of SFT found from January 1, 2002--January 31, 2010 in a concentrated third-level general hospital in Mexico City., Methods: We present 16 resected cases of different localizations: three pleural, three mediastinal, three lung, two oral cavity, one nasopharyngeal, one in the lateral aspect of the neck, one kidney, one paratesticular and another in the crural region. All were studied with hematoxylin and immunoperoxidase., Results: There was similar affection in both genders. Mean age was 51 years (range: 43-81 years). Two pleural cases presented recurrence and one had hypoglycemia but none demonstrated metastases. No deaths were registered during a mean follow-up of 18 months. Histological pattern corresponded to a fusocellular growth that coincided with hemangiopericytoid zones in five cases and sarcomatoid in four. These cases were considered as mixed. All were positive to vimentin., Conclusions: Definitive diagnosis must be made by immunoperoxidase. Immediate treatment is surgical resection; relapses.