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Introduction: According to reports from China and Europe, there are various clinical and laboratory risk factors that associate with both death and the use of a ventilator in coronavirus disease 2019 (COVID-19). In Wuhan, blood type A was related to these complications, but this factor is unknown for Latin America. Objective was to describe the association of blood type with complications related to COVID-19 infection. Material and methods: A retrospective comparative study from the clinical files of patients cared for in the emergency department between April and May 2020. Results: Data was analyzed from 120 patients hospitalized with COVID-19 infection. There were no differences in age and gender by blood type. Type O was the most frequent (80.8%) followed by type A (11.7%) and type B (7.5%). In univariate analysis, there was no impact of blood type on survival, individually (groups A, B, O) (log rank 0.154). In multivariate analysis, only age influenced prognosis ( p =0.004). Above the risk, type O showed no impact on mortality (OR 1.0119, 95% CI: 0.3898–2.6272, p =0.980) or ventilator use (1.5616, 95% CI: 0.4834–5.0453, p =0.456), likewise for types A and B (OR 0.9882, 95% CI, 0.3806–2.5657). Conclusion: Blood type does not impact prognosis in Mexican patients with COVID-19.

Containment safety analysis is a field in expansion given the complex phenomenology developed during an accident, and the recent code capabilities improvement. In this paper, a modeling strategy to create complex containments with porous CFDs in a single control volume is presented. This methodology involves using solely Computer Aided Design (CAD) tools, to manage the geometrical model, instead of using the GOTHIC code pre-processor interface. This methodology is applied to Trillo NPP (KWU 3 loops) where a LBLOCA is simulated to illustrate its capabilities. The results are compared against a Lumped Parameters model obtaining similar average values. Finally, a sensitivity analysis is made to quantify the influence of the modeling simplifications showing a small dependence. This implies that this modeling strategy is able to recreate models accurately, with an affordable computational cost, and with a time saving improvement, which nowadays is the main bottleneck for 3D containment models.

Introduction: During the era of COVID-19, an increase has surged in the number of cases of mucormycosis; the use of high doses of steroids, and states of immunosuppression such as diabetes are the main related risk factors. In the treatment of acute leukemia, it is recommended to reduce the dose of chemotherapy, postponing highly myeloablative schemes and the use of caution with monoclonal antibodies. Case presentation: We present the case of a patient (25 years-old male) with acute lymphoblastic leukemia and COVID-19 confirmed infection who developed rhino-cerebral mucormycosis during the induction stage. Conclusion: In the age of COVID-19, taking samples through a nasal swab should be avoided in individuals with risk of infection from mucormycosis, such as diabetes, cancer, or individuals treated with high doses of steroids.

Background Different studies have recognized the existence of subtypes of obesity and normal weight, in which it is reported that not all patients show the same cardiometabolic risk, called “metabolically healthy” and “metabolically unhealthy”. In several reviews, differences in the inflammatory profile have been studied, but there is not information on the relationship of body size phenotypes with thrombosis risk. Objective Determine the association between body size phenotypes and fibrinolytic activity by measuring the concentration of plasminogen activator inhibitor-1 (PAI-1). Methods A cross-sectional study was conducted in women aged 40 to 65 years. Anthropometric measurements and biochemical determinations were performed on all participants. The fibrinolytic activity was determined by measuring PAI-1 by ELISA. Karelis criteria were used to define metabolic status. Four groups were formed: Metabolically healthy normal weight (MHNW), Metabolically unhealthy normal weight (MUNW), Metabolically healthy obese (MHO) and Metabolically unhealthy obese (MUO). Results 230 women were included in our study with a mean age 52.3 ± 5.9 years. The concentration of PAI-1 showed a significant difference between the groups MHNW, MUNW, MHO, MUO [2.3 (0.08, 13.6), 12.7, (0.08, 33.1), 23.4 (2.6, 28.8) and 22.8 (2.0, 46.7) ng/mL, respectively, p = 0.006]. Multiple regression analysis identified that BMI and HOMA-IR were independent factors influencing PAI-1 levels. Conclusion This study is the first one that recognizes differences in the fibrinolytic activity between body size phenotypes. The groups with the lowest fibrinolytic activity were MUO and MHO, however, MUNW also present alterations of fibrinolysis, thus suggesting a prothrombotic state.

The plasminogen activator inhibitor type 1 (PAI-1) is the major determinant of fibrinolytic activity. PAI-1 concentrations are elevated in obesity, type 2 diabetes and metabolic syndrome (MetS). On the other hand, during menopause, fibrinolytic activity decreases and, consequently, PAI-1 concentration increases; however, it is debated whether menopause is an independent determinant factor of PAI-1 levels. The objective of this study was to evaluate the effect of hormonal and metabolic status on the concentration of PAI-1 in pre-and post-menopausal women. A case-control study was conducted in ninety pre-and post-menopausal women aged 45 to 55 years, matched by body mass index (BMI). Anthropometric measurements and biochemical determinations were performed on all participants. The fibrinolytic activity was determined by measuring PAI-1 by ELISA. Of all the women, 30% presented MetS. Women with MetS had higher values of PAI-1 (36.0 ± 19.1 vs 19.3 ± 14.8 ng/mL

Aims To evaluate the frequency of diabetes and admission hyperglycaemia in Mexican COVID‐19 patients, to describe the clinical and biochemical characteristics of patients with admission hyperglycaemia and to determinate the impact of diabetes and admission hyperglycaemia on COVID‐19 severity and mortality. Methods A multicentric study was performed in 480 hospitalized patients with COVID‐19. Clinical and biochemical characteristics were evaluated in patients with admission hyperglycaemia and compared with non‐hyperglycaemic patients. The effect of diabetes and admission hyperglycaemia on severity and risk of death were evaluated. Results Age was 50.7 ± 13.6 years; 68.3% were male. Some 48.5% (n = 233) had admission hyperglycaemia; 29% (n = 139) of these patients had pre‐existing diabetes. Patients with admission hyperglycaemia had more requirement of invasive mechanical ventilation (IMV), higher levels of urea, D‐dimer and neutrophil‐lymphocyte ratio (NLR), as well as lower lymphocyte count. An association between admission hyperglycaemia with IMV and D‐dimer with glucose was found. Age ≥50 years (OR 2.09; 95%CI 1.37–3.17), pre‐existing diabetes (OR 2.38; 95%CI 1.59–5.04) and admission hyperglycaemia (OR 8.24; 95%CI 4.74–14.32) were risk factors for mortality. Conclusions Admission hyperglycaemia is presented in 48.5% of COVID‐19 patients. Diabetes and admission hyperglycaemia are associated with the severity of disease and mortality. This study shows the devastating conjunction of hyperglycaemia and COVID‐19. Clinical trial registration: Clinical characteristics of patients with COVID‐19, DI/20/204/04/41 (Hospital General de Mexico) and NR‐13‐2020 (Hospital Regional de Alta Especialidad Ixtapaluca)., ‐Diabetes and admission hyperglycaemia are risk factors in severity and mortality among COVID‐19 patients. Patients with pre‐existent diabetes and hyperglycaemia showed an OR 8.24 (95%CI 4.74–14.32) for mortality.‐The results of present study denote the devastating conjunction of two pandemics, diabetes and COVID‐19, in a country with a very high prevalence of metabolic diseases.‐Early detection of hyperglycaemia in patients with COVID‐19, both with and without diabetes, timely treatment and the restoration of normoglycaemia are essential.

Various biomarkers based on blood counts have been useful for the prognosis of patients critically ill with COVID-19.To describe the usefulness of the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and lymphocyte-to-platelet (LPR) ratios for the prognosis of mortality and ventilatory support requirement for COVID-19.Retrospective cohort of clinical records of patients with COVID-19 who required hospital care.One-hundred and -twenty-five cases were analyzed; mean age was 51 years, and 60 % were of the male gender; 21.6 % had type 2 diabetes mellitus, and 18.4 % had hypertension. Mean leukocyte count was 9.5 x 10NLR and MLR are useful for predicting mortality in patients with COVID-19.Diversos biomarcadores basados en conteos sanguíneos han sido de utilidad para el pronóstico de los pacientes en estado crítico por COVID-19.Describir la utilidad de los índices neutrófilo/linfocito (INL), monocito/linfocito (IML) y linfocito/plaqueta (IPL) para el pronóstico de la mortalidad y necesidad de soporte ventilatorio por COVID-19.Cohorte retrospectiva de registros clínicos de pacientes con COVID-19 que requirieron atención hospitalaria.Se analizaron 125 casos, la edad media fue de 51 años y 60 %, del sexo masculino; 21.6 % padecía diabetes mellitus tipo 2 y 18.4 %, hipertensión. La media de leucocitos fue 9.5 × 10INL e IML son de utilidad para predecir la mortalidad en pacientes con COVID-19.

espanolIntroduccion: Diversos biomarcadores basados en conteos sanguineos han sido de utilidad para el pronostico de los pacientes en estado critico por COVID-19. Objetivo: Describir la utilidad de los indices neutrofilo/linfocito (INL), monocito/linfocito (IML) y linfocito/plaqueta (IPL) para el pronostico de la mortalidad y necesidad de soporte ventilatorio por COVID-19. Metodo: Cohorte retrospectiva de registros clinicos de pacientes con COVID-19 que requirieron atencion hospitalaria. Resultados: Se analizaron 125 casos, la edad media fue de 51 anos y 60 %, del sexo masculino; 21.6 % padecia diabetes mellitus tipo 2 y 18.4 %, hipertension. La media de leucocitos fue 9.5 × 103/µL y la de neutrofilos, de 8.0 × 103/µL. La media del INL fue de 12.01; del IML, de 0.442 y del IPL, de 373.07. Respecto al area bajo la curva se registraron los siguientes valores en cuanto a mortalidad: INL, 0.594; IML, 0.628 e ILP, 0.505; en cuanto a ventilacion mecanica: INL, 0.581; IML, 0.619 e ILP, 0.547. En el analisis univariado, INL > 13 (RM = 2.750, p = 0.001) e IML > 0.5 (RM = 2.069, p = 0.047) se asociaron a mortalidad; ILP no mostro impacto en la mortalidad ni en el soporte respiratorio. Conclusion: INL e IML son de utilidad para predecir la mortalidad en pacientes con COVID-19. EnglishIntroduction: Various biomarkers based on blood counts have been useful for the prognosis of patients critically ill with COVID-19. Objective: To describe the usefulness of the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and lymphocyte-to-platelet (LPR) ratios for the prognosis of mortality and ventilatory support requirement for COVID-19. Method: Retrospective cohort of clinical records of patients with COVID-19 who required hospital care. Results: One-hundred and twenty-five cases were analyzed; mean age was 51 years, and 60 % were of the male gender; 21.6 % had type 2 diabetes mellitus, and 18.4 % had hypertension. Mean leukocyte count was 9.5 x 103/µL, with a neutrophil mean of 8.0 x 103/µL. Mean NLR was 12.01, while for MLR it was 0.442, and for LPR, 373.07. Regarding the area under the curve, the following values were recorded for mortality: 0.594 for NLR, 0.628 for MLR and 0.505 for LPR; as for mechanical ventilation, the values were 0.581 for NLR, 0.619 for MLR and 0.547 for LPR. In the univariate analysis, an NLR value > 13 (OR: 2.750, p = 0.001) and an MLR of > 0.5 (OR: 2.069, p = 0.047) were associated with mortality; LPR showed no impact on mortality or respiratory support. Conclusion: NLR and MLR are useful for predicting mortality in patients with COVID-19.

Resumen Introduccion En pacientes con enfermedad coronaria se ha observado una disminucion de la actividad fibrinolitica y aumento del grosor del tejido adiposo epicardico. El objetivo del estudio fue determinar la relacion entre la grasa epicardica y la actividad fibrinolitica, midiendo la concentracion del inhibidor del activador del plasminogeno tipo-1 (PAI-1). Metodos Estudio transversal que incluyo a 56 mujeres aparentemente sanas, con edad de 45-60 anos. A las participantes se les realizaron mediciones antropometricas y bioquimicas, la actividad fibrinolitica se determino midiendo PAI-1 por la tecnica de ELISA. El grosor epicardico se evaluo por ecocardiografia transtoracica. Resultados La concentracion de PAI-1 se asocio directamente con el grosor del tejido adiposo epicardico (r = .475, p = .001), glucosa, trigliceridos, resistencia a la insulina, IMC, tejido adiposo visceral y grasa corporal total. El analisis de regresion multivariado indico que la grasa epicardica predice en forma independiente el valor de PAI-1. Conclusiones Las mujeres con incremento de tejido adiposo epicardico muestran menor actividad fibrinolitica por presentar niveles aumentados de PAI-1 y, en consecuencia, un posible mayor riesgo trombotico.

Background To identify inherited factors: Protein C (PC), protein S (PS), antithrombin (AT), plasminogen (Plg), the activated PC resistance (APCR), prothrombin (PT) mutation G20210 A (PTG20210 A) and methylenetetrahydrofolate reductase C677 T polymorphism (MTHFR C677 T), as well as acquired-risk factors such as: diabetes mellitus, surgeries, smoking, obesity, hypertension, trauma, alcoholism, family history; and their association, in Mexican patients with diagnostic of thrombophilia. Methods Overall, 200 patients diagnosed with thrombophilia and 100 healthy controls. Commercial kits were used for the coagulometric tests and polymerase chain reaction, restriction fragment length polymorphism for molecular alterations. Results Alterations were found with an estimated prevalence to PC 0.65%, AT 2.04% and Plg 2.5%, APCR 2%, PT 20210 2%, and MTHFR 65%. The C677 T polymorphism of the MTHFR did not associate with acquired-risk factors so we can suppose that it is an independent risk factor. For the patients that only presented acquired-risk factors (21 of 200), the association smoking–alcoholism showed to be the cause of thrombosis with high risk. The following were also associated: smoking with AT, PC, and alcoholism; obesity with Plg; smoking with alcoholism, and PS deficiency. Conclusions Risk factors for both primary and secondary and their association were present as a cause of thrombosis in the patients studied, and the possibility to suffer a recurrent thrombosis.

Background CIWA-Ar score is the gold standard for stratifying severity of alcohol withdrawal syndrome (AWS). Aim To identify the correlation between the different scales used in patients with AWS, and with the biochemical–haematological profile. Material and methods Prospective, analytical observational study in 49 patients with AWS diagnosed between February 2011 and July 2012. Maddrey, Glasgow, MELD, CIWA-Ar scores and laboratory values were obtained at diagnosis. Results There was no correlation between CIWA-Ar and other scales (R2 = 0.001, p = 0.823, 95%CI); however, a linear relationship (p = 0.000, 95%CI) was found. On the correlation matrix, CIWA-Ar was not associated with any of the study parameters. There were no significant differences in length of stay when analyzed by type of treatment. Conclusion CIWA-Ar is a good predictor of severity, albeit with no biochemical or hematic correlation.

Folic acid and cobalamin are B-group vitamins that play an essential role in many cellular processes. Deficiency in one or both of these vitamins causes megaloblastic anaemia, a disease characterized by the presence of megaloblasts. Megaloblasts occur when inhibition of DNA synthesis causes asynchronous maturation between the nucleus and the cytoplasm. Clinical manifestations are similar to those of other types of anaemia, with the exception of cobalamin deficiency megaloblastic anaemia, which presents distinctive neurological symptoms. An understanding of the metabolism of these vitamins will enable clinicians to make the best use and interpretation of laboratory studies and monitor therapeutic strategies, which consist mainly of administering supplements to restore body reserves.

Introduction A decrease in fibrinolytic activity and an increase in the thickness of the epicardial adipose tissue have been observed in patients with coronary artery disease. The aim of this study was to determine the association between epicardial adipose tissue and fibrinolytic activity by measuring the concentration of plasminogen activator inhibitor-1 (PAI-1). Methods A cross-sectional study was conducted on 56 apparently healthy women aged 45–60 years. Anthropometric measurements and biochemical determinations were performed on all participants. The fibrinolytic activity was determined by measuring PAI-1 by ELISA. Epicardial thickness was assessed by transthoracic echocardiography. Results The concentration of PAI-1 was directly associated with the thickness of the epicardial adipose tissue (r = 0.475, p = 0.001), glucose, triglycerides, insulin resistance, body mass index (BMI), visceral adipose tissue and total body fat. The multivariate regression analysis indicated that epicardial fat independently predicts the concentrations of PAI-1. Conclusions Women with thicker epicardial adipose tissue have reduced fibrinolytic activity due to presenting increased PAI-1 levels, and consequently greater thrombotic risk.

Quality of life must be a part of the goals of care given to blood cancer patients and it must be used to assess the effectiveness of their treatment. The objective was to evaluate the quality of life of patients with leukemia and its relationship with psychological, familial and disease-related aspects.An analytic cross-sectional study was carried out in patients with acute leukemia at different stages of treatment. We used SF-36, Optimism and Family Cohesion scales.Quality of life was affected physically and mentally in the treatment phases aimed to mitigate the active, and the advanced stage of this disease (50.6 ± 25.6, 62 ± 14.3; 46 ± 23.2, 53.8 ± 23.4, respectively), regardless of gender, age, level of optimism and family cohesion. Patients could carry out basic functions of self-care (bathing, feeding, etcetera), but not activities of daily living (shopping, household chores, etcetera), which require a greater effort. Although the patients perceived having been affected in the emotional health area-by the presence of anxiety and depression-they did not consider that these alterations limited their ability to carry out work and everyday activities.Quality of life was most affected at mental dimension and physical dimension, mainly in patients at induction and palliative treatment. The results showed that the objectives of care aimed to reduce symptoms and maintain patient comfort are not achieved.Introducción: la calidad de vida debe ser parte de los objetivos de la atención a pacientes oncohematológicos y ser utilizada para evaluar la eficacia del tratamiento que se les brinda. El objetivo fue evaluar la calidad de vida en pacientes con leucemia y su relación con aspectos del padecimiento, psicológicos y familiares. Métodos: se realizó un estudio transversal analítico en pacientes con leucemia aguda en diferentes etapas de tratamiento. Se aplicaron las escalas SF-36, Optimismo y Cohesión Familiar. Resultados: la calidad de vida se vio afectada física y mentalmente en las fases del tratamiento dirigidas a combatir la enfermedad activa (50.6 ± 25.6; 62 ± 14.3) y avanzada (46 ± 23.2; 53.8 ± 23.4), independientemente del género, la edad, el nivel de optimismo y la cohesión familiar. Los pacientes podían llevar a cabo funciones básicas de autocuidado, no así actividades de la vida diaria y laborales que requieren mayor esfuerzo. Si bien los pacientes percibieron afectación en el área de salud emocional (por la presencia de ansiedad y depresión), no consideraron que estas alteraciones limitaban su capacidad para llevar a cabo actividades laborales y cotidianas. Conclusiones: la calidad de vida estuvo más afectada en la dimensión mental (Salud emocional) y física (Rol físico), principalmente en los pacientes en tratamiento paliativo y de inducción. Los resultados muestran que no se cubren los objetivos de los esfuerzos asistenciales dirigidos a aminorar los síntomas y mantener el confort del paciente.

INTRODUCCIÓN: La disponibilidad y comercialización de la inmunoglobulina G humana ha modificado el curso y pronóstico de diversas enfermedades. Hoy en día representa el tratamiento de primera línea para al menos 10 enfermedades y de segunda línea, empírico o de indicación compasiva en otras alteraciones. La mayor parte de estas enfermedades son excepcionales (afectan a menos de 1 de cada 2000 individuos), por lo que la generación de evidencia robusta derivada de ensayos clínicos aleatorizados y controlados no es común. OBJETIVO: desarrollar Elaborar o Emitir un Consenso Mexicano para la prescripción de Inmunoglobulina G Humana como tratamiento de reemplazo e inmunomodulación con un enfoque de medicina basada en evidencias. MATERIALES Y MÉTODOS: Se integró un grupo multidisciplinario de especialistas en diversas áreas de la medicina en México, con la finalidad de emitir un análisis crítico y sistematizado de la evidencia clínica disponible para la prescripción de la inmunoglobulina G humana. Se revisaron las bases de datos MEDLINE, EMBASE, BVS-LILACS, NGS, NICE, CENETEC, Imbiomed, TripDatabase y Medigraphic. Para el análisis de la información se utilizaron algoritmos con términos Medical Subject Headings (MeSH) o Descriptores en Ciencias de la Salud (DeCS) específicos para cada enfermedad, con la intención de identificar guías de práctica clínica u otro tipo de guías, revisiones sistemáticas, metanálisis, ensayos clínicos aleatorizados, estudios clínicos, estudios descriptivos u observacionales y análisis de costobeneficio. Para el estudio de la evidencia se organizaron ocho grupos de trabajo, de acuerdo con el campo de conocimiento y la experiencia de los especialistas. Se formularon preguntas clínicas con el constructo PICO, por su acrónimo en inglés: Patients (pacientes o población), Intervention (intervención de interés), Comparison (comparación con otra intervención) y Outcome (desenlace de interés). Después de discutir las evidencias correspondientes y responder las preguntas, se redactó un documento con declaraciones específicas por indicación y calidad de evidencia con el esquema GRADE. Las declaraciones fueron sometidas a evaluación y consenso por todo el grupo de trabajo y se elaboró un documento con el formato actual para validación externa por los principales representantes de las academias y los colegios de las áreas del conocimiento incluidas, para finalmente publicarlo como tratamiento de referencia en la prescripción de la inmunoglobulina G humana en México. CONCLUSIONES: La integración del consenso representa un esfuerzo en aras de proporcionar a los clínicos de instituciones de segundo y tercer nivel de atención en salud de México. Además de proporciona un instrumento validado para la prescripción correcta de inmunoglobulina G humana como tratamiento de reemplazo e inmunomodulación. Este documento debe actualizarse de manera continua, debido al activo campo de investigación clínica en diferentes aplicaciones de la medicina.

PAI-1 is the main inhibitor of fibrinolysis. Increase in PAI-1 levels has been associated with the risk of coronary disease; however, there are few studies on the relationship between subclinical atherosclerosis and PAI-1 levels.The aim of this study was to analyze the relationship between PAI-1 level and carotid intima-media thickness in premenopausal and postmenopausal women without apparent cardiovascular disease.A cross-sectional study was conducted in 142 women aged 45 to 60 years with no history of cardiovascular disease. Anthropometric and laboratory measurements were performed, including PAI-1 levels. All participants underwent a B-Mode ultrasound to measure intima-media thickness. Subclinical atherosclerosis was considered when intima-media thickness was ≥ 0.7 mm and/or an atheromatous plaque was observed.Postmenopausal women had greater intima-media thickness than premenopausal women (0.688 ± 0.129 vs. 0.621 ± 0.113 mm; p0.05). Compared to women with normal intima-media thickness, women with subclinical atherosclerosis had higher PAI-1 levels (23.2 ± 13.7 vs. 30.4 ± 20.7 ng/ml; p0.05). In all participants, intima-media thickness correlated with PAI-1 (r = 0.302; p = 0.01) and with age (r = 0.358; p = 0001).An increase in intima-media thickness was observed in postmenopausal women compared with premenopausal women. Asymptomatic women with increased intima-media thickness had higher PAI-1 levels. These findings suggest that fibrinolytic activity is low in the subclinical stage of atherosclerosis.

Von Willebrand disease is an inherited disease in which the structure, function, and concentration of von Willebrand factor are altered, as well as the platelet von Willebrand factor endothelium interaction. In Mexico there are no epidemiological records of the disease. Only a few isolated studies have been reported from the clinical and hematological standpoint.We studied 155 Mexican Mestizos: 75 with presumptive diagnosis of von Willebrand disease, 15 with suspected diagnosis ofhemophilia A and 65 healthy donors (controls). Basic coagulation tests, special tests and classification test (analysis of multimeric composition) were carried out.There were 15 patients with clinical diagnosis of hemophilia A, 75 patients with suspected von Willebrand disease of which 50 were diagnosed as the following types and subtypes: Type 1 (62%), Type 2 (22%) [subtypes: 2A (14%), 2B (2%), and 2N (6%)] and Type 3 (16%).It has been reported that analysis of von Willebrand factor is a method that meets the characteristics for the diagnosis of von Willebrand disease. It is necessary to implement this methodology to study and improve the specific diagnoses.Antecedentes: la enfermedad de von Willebrand es un padecimiento hereditario en el que la estructura, función y concentración del factor de von Willebrand están alteradas y, en consecuencia, también la interacción plaqueta-factor de von Willebrand-endotelio. En México no hay registros epidemiológicos de la enfermedad, sólo se han efectuado algunos estudios aislados desde el punto de vista clínico y hematológico. Material y métodos: estudio retrospectivo efectuado en 155 mexicanos mestizos, 75 de ellos con diagnóstico presuntivo de enfermedad de von Willebrand, 15 con sospecha de hemofilia A y 65 donadores sanos (testigos). Se realizaron pruebas: básicas de coagulación, especiales y de clasificación: análisis de la composición multimérica. Resultados: 15 pacientes se diagnosticaron con hemofilia A; de los 75 sujetos con sospecha de enfermedad de von Willebrand se diagnosticaron 50 de la manera siguiente: tipo 1 (62%), tipo 2 (22%) [subtipos: 2A (14%), 2B (2%) y 2N (6%)] y tipo 3 (16%). Conclusión: el análisis de los multímeros del factor de von Willebrand es un método que cumple con las características adecuadas para el diagnóstico de la enfermedad de von Willebrand, por lo que es necesario implementar esta metodología para su estudio y mejorar su diagnóstico específico.

Inflammation is accompanied by activation of the plasma kallikrein-kinin system (KKS). KKS activation has been demonstrated in a variety of inflammatory human diseases. To further explore the participation of KKS in arthritis and inflammatory bowel disease, we used two experimental animal models in arthritis and enterocolitis. We found that activation of KKS is associated with arthritis induced by intraperitoneal injection of peptidoglycan-polysaccharide polymers (PG-PS) as well as the enterocolitis and systemic inflammation induced also by PG-PS when injected into the intestinal wall of genetically susceptible Lewis rats. We postulated that KKS participates in the pathogenesis of inflammatory reactions involved in cellular injury, coagulation, fibrinolysis, kinin formation, complement activation, cytokine secretion, and release of proteases. We demonstrated that therapy with a specific plasma kallikrein inhibitor modulated the experimental enterocolitis, arthritis, and systemic inflammation. The fact that deficiency of plasma high molecular weight kininogen in the genetically susceptible Lewis rat results in decreased chronic enterocolitis and systemic inflammation also supports our hypothesis. We suggest that KKS plays a similar role in idiopathic human intestinal inflammatory disease and arthritis, making kallikrein-kinin system proteins appealing targets for drug therapy in chronic inflammatory diseases such as rheumatoid arthritis and Crohn's disease.

Summary. A model was developed to assess the lifetime costs and outcomes associated with haemophilia in Mexico. A retrospective chart review of 182 type A haemophiliacs was conducted for patients aged 0–34 years receiving one of three treatments: (i) cryoprecipitate at clinic; (ii) concentrate at home; or (iii) concentrate at clinic. Patients treated at home experienced 30% less joint damage, used 13–54% less factor VIII, had four times fewer clinic visits, and utilized half as many hospital days than those treated at a clinic. For cryoprecipitate at clinic patients, the annual incidence rates of HCV and HIV were calculated to be 3.6% and 1.4% respectively. The life expectancy for patients receiving cryoprecipitate and those receiving concentrate was estimated to be 49 years and 69 years respectively, with 58% of cryoprecipitate patients predicted to die of AIDS before age 69. Across the lifespan, the average annual cost of care was US$11 677 (MN$110 464) for cryoprecipitate at clinic patients, US$10 104 (M$95 580) for concentrate at home patients and US$18 819 (MN$178 027) for concentrate at clinic patients. Using a 5% discount rate, the incremental lifetime cost per year of life added for treatment with concentrate at home compared with cryoprecipitate at a clinic was US$738 (MN$6981). Rank order stability analysis demonstrated that the model was most sensitive to the cost of fVIII. These results indicate that treatment with concentrate at home compared with cryoprecipitate at a clinic substantially improves clinical outcomes at reduced annual cost levels.

In order to assess the mortality and toxicity of the Hyper-CVAD protocol used as first-line treatment of acute lymphoblastic leukemia, a retrospective cohort study was performed in patients less than 40 years of age from March to September 2011 treated with Hyper-CVAD regimen. Mortality and toxicity was compared with the results of patients treated with the institutional HGMLAL07 regimen between 2009-2012. 18 patients were included; the median age was 26 years old. Complete remissions (67.7% versus 81.9%) as well as one-year (40% versus 62%) and 2 year survival rates (18% versus 34%) were lower with the Hyper-CVAD regimen. By selecting only patients younger than 35 years, the effectiveness of Hyper-CVAD was also lower. In our experience and because of its high cost and toxicity, the Hyper-CVAD regimen should be limited to patients with relapsed or refractory leukemia.

In order to identify the clinical approach of a sample of Mexican hematologists for primary immune thrombocytopenia (ITP) in adults in Mexico, we applied an electronic survey via the internet to identify common practices for the diagnosis and treatment of ITP and draw a comparison between the information from these hematologists with international guidelines or the international literature. The results were analyzed using measures of central tendency. The sample was 21 medical hematologists, predominantly from Mexico City (average age: 51.4 years). A total of 66.7% of the surveyed physicians use international guidelines to make therapeutic decisions, and 43% defined ITP including the numerical concept (100 x 10(9)/l). We found some differences between requested clinical exams and tests indicated by the guidelines. In first-line treatment (except emergency), 91% of the participants start with prednisone and 24% use dexamethasone. Danazol is used in persistent ITP by most (41%) of the specialists. In second-line treatment, 67% would indicate splenectomy. Some differences were found between clinical practice of the hematologists in Mexico versus guidelines recommendations.

Recently it has been reported a benefit effect with the use of metformin in patients with malignant disease. Our objective was to evaluate the effect of adding metformin to chemotherapy regimen over the percentage of early relapse in acute lymphoblastic leukemia.A prospective, longitudinal and experimental study was performed in patients with de novo acute lymphoblastic leukemia enrolled in the Hospital General de México. They were divided in two groups: first group received chemotherapy + metformin (850 mg three times a day); second group only received standard chemotherapy. The sample was randomized 3:1 in favor of the second group.93 patients were included (73 treated with chemotherapy + metformin and 20 received standard chemotherapy), with 303 ± 53 days of follow-up. Complete remission was higher in the group without metformin (81.3 % [n = 61] versus 70 % [n = 14]), which also presented more patients with relapse (47.9 % versus 25 %). Overall survival at one year was of 68 % and free survival disease was 64 %, without significant differences between groups. Absence of metformin was the only variable of adverse prognostic considered significant (p = 0.55). Cox regression showed that adding metfomin reduced 56 % the risk of relapse.The adding metformin to the treatment of leukemias showed that was useful in our research. However, randomized and double-blind studies must be designed in order to express final recommendations about its use.INTRODUCCIÓN: se ha informado efecto benéfico con metformina en pacientes con cáncer. El objetivo de esta investigación fue evaluar el efecto de adicionar metformina a la quimioterapia sobre las recaídas tempranas en pacientes con leucemia linfoblástica aguda. MÉTODOS: estudio prospectivo, longitudinal y experimental de pacientes portadores de leucemia linfoblástica aguda de novo, realizado en el Hospital General de Mexico. La muestra fue dividida en dos brazos de tratamiento: uno recibió metformina (850 mg cada ocho horas) + quimioterapia; otro recibió únicamente quimioterapia estándar. La distribución de los pacientes fue aleatoria, 3:1 a favor del segundo brazo.se incluyeron 93 pacientes (73 recibieron quimioterapia + metformina y 20, quimioterapia estándar); el seguimiento fue de 303 ± 53 días. La remisión completa fue mayor en el grupo sin metformina comparado con el que recibió quimioterapia + metformina (81.3 % [n = 61] y 70 % [n = 14], respectivamente), al igual que las recaídas (47.9 y 25 %, respectivamente). La supervivencia global a un año fue de 68 % y la supervivencia libre de la enfermedad fue de 64 %, sin diferencias entre los grupos. La única variable de pronóstico adverso con relevancia significativa fue la ausencia de metformina (p = 0.55). La regresión de Cox demostró que adicionarla redujo 56 % el riesgo de recaída.la adición de metformina al tratamiento de la leucemia fue de utilidad en nuestra investigación, sin embargo, deberán diseñarse estudios aleatorizados y doble ciego para emitir recomendaciones definitivas.

The nasal colonization by Staphylococcal (epidermidis or aureus) is frequent and it has importance when it is associated to bacteremia in immunocompromised patients. The objective was to determine the frequency of strains that colonize the nasal mucosa in patients with leukemia and its relationship with peripheral blood cultures.A retrospective, observational, transversal, retrolective study was done. We analyzed the weekly results of nasal cultures and peripheral blood cultures in patients with leukemia undergoing chemotherapy. The chi-squared test and odds ratio value were estimated in the statistical analysis.We included 67 patients, 55 of them with acute lymphocytic leukemia (ALL); 28.5 % of the cultures (n = 47) corresponded to a positive nasal culture. Staphylococcus epidermidis and Staphylococcus aureus were the most isolated bacteria. During the first week of treatment, the positive cultures were the most frequently. All the samples isolated were sensitive to vancomycin or linezolid. It was established only the association between negative nasal cultures and negative peripheral blood cultures (p = 0.0005). Odds ratio for positive nasal cultures and the risk of bacteremia was 0.0269.The frequency of the positive bacteria culture was low, with an adequate sensitivity measure. The presence of bacteria in nasal culture was not identified as a risk factor for the occurrence of bacteremia.INTRODUCCIÓN: la colonización nasal por Staphylcoccus epidermidis y Staphylococcus aureus es frecuente y se ha relacionado con bacteremia en huéspedes inmunocomprometidos. En la investigación que se presenta, los objetivos fueron determinar la frecuencia de cepas que colonizan la mucosa nasal en pacientes en tratamiento de leucemia aguda y su relación con los cultivos de sangre periférica. MÉTODOS: estudio retrospectivo, observacional, transversal, retrolectivo de cultivos nasales obtenidos durante cuatro semanas. La relación con los hemocultivos se estableció mediante chi cuadrada; se calculó razón de momios.se estudiaron 67 casos, en su mayoría con leucemia linfoblástica aguda (n = 55). De 165 cultivos nasales, 28.5 % fue positivo (n = 47). Las principales bacterias identificadas fueron Staphylcoccus epidermidis y Staphylococcus aureus. La primera semana de tratamiento fue el principal momento de aislamiento. Todas las cepas fueron sensibles a vancomicina o linezolid. Se estableció relación entre los cultivos nasales y los hemocultivos negativos (p = 0.0005). La razón de momios para los cultivos nasales positivos respecto a los hemocultivos y el riesgo de bacteremia fue de 0.0269 (IC 95 % = 0.0016, 0.4484).se aislaron pocas bacterias en la mucosa nasal, y la sensibilidad de estas a los antibióticos fue adecuada. La presencia de bacterias en la mucosa nasal no fue un factor de riesgo para la aparición de bacteremia.

"Antecedentes: la enfermedad de von Willebrand es un padecimiento hereditario en el que la estructura, función y concentración del factor de von Willebrand están alteradas y, en consecuencia, también la interacción plaqueta-factor de von Willebrand-endotelio. En México no hay registros epidemiológicos de la enfermedad, sólo se han efectuado algunos estudios aislados desde el punto de vista clínico y hematológico. Material y métodos: estudio retrospectivo efectuado en 155 mexicanos mestizos, 75 de ellos con diagnóstico presuntivo de enfermedad de von Willebrand, 15 con sospecha de hemofilia A y 65 donadores sanos (testigos). Se realizaron pruebas: básicas de coagulación, especiales y de clasificación: análisis de la composición multimérica. Resultados: 15 pacientes se diagnosticaron con hemofilia A; de los 75 sujetos con sospecha de enfermedad de von Willebrand se diagnosticaron 50 de la manera siguiente: tipo 1 (62%), tipo 2 (22%) [subtipos: 2A (14%), 2B (2%) y 2N (6%)] y tipo 3 (16%). Conclusión: el análisis de los multímeros del factor de von Willebrand es un método que cumple con las características adecuadas para el diagnóstico de la enfermedad de von Willebrand, por lo que es necesario implementar esta metodología para su estudio y mejorar su diagnóstico específico."

"Introducción: la colonización nasal por Staphylcoccus epidermidis y Staphylococcus aureus es frecuente y se ha relacionado con bacteremia en huéspedes inmuno-comprometidos. En la investigación que se presenta, los objetivos fueron determinar la frecuencia de cepas que colonizan la mucosa nasal en pacientes en tratamiento de leucemia aguda y su relación con los cultivos de sangre periférica. Métodos: estudio retrospectivo, observacional, transversal, retrolectivo de cultivos nasales obtenidos durante cuatro semanas. La relación con los hemocultivos se estableció mediante x2 ; se calculó razón de momios. Resultados: se estudiaron 67 casos, en su mayoría con leucemia linfoblástica aguda ( n = 55). De 165 cultivos nasales, 28.5 % fue positivo ( n = 47). Las principales bacterias identi fi cadas fueron Staphylcoccus epidermidisy S taphylococcus aureus . La primerasemana de tratamiento fue el principal momentode aislamiento. Todas las cepas fueron sensibles a vancomicina o linezolid. Se estableció relación entre los cultivos nasales y los hemocultivos negativos( p = 0.0005). La razón de momios para los cultivos nasales positivos respecto a los hemocultivos y el riesgo de bacteremia fue de 0.0269 (IC 95 % = 0.0016, 0.4484). Conclusiones: seaislaronpocasbacteriasen la mucosa nasal, y la sensibilidad de estas a los antibióticos fue adecuada. La presencia de bacterias en la mucosa nasal no fue un factor de riesgo para la aparición de bacteremia."