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Glial heterotopia (GH) is the presence of glial tissue outside the cranial cavity, without communication with the brain. The orbital location usually presents as eyelid swelling, strabismus, and proptosis. This is considered a congenital location that usually presents at birth. Its association with anophthalmia is uncommon. We report the case of a 2-day-old male neonate with left congenital intraorbital lesion presenting with massive proptosis. No eyeball could be seen. Preoperative magnetic resonance imaging disclosed a large and predominantly cystic mass occupying and protruding from the left orbit without intracranial extension. In the operating theatre, a large amount of fluid was aspirated prior to total resection of the mass. Chemical analysis of the fluid was compatible with cerebrospinal fluid. Histologically, the tumor was composed of mature neuroglial tissue and ependymal cells. Despite multiple sections, no choroid plexus or intraocular content was found. The diagnosis of GH with anophthalmia was made.Eine gliale Heterotopie (GH) ist das Vorhandensein von Gliagewebe außerhalb der Schädelhöhle ohne Verbindung zum Gehirn. Die orbitale Beteiligung äußert sich in der Regel durch Lidschwellung, Strabismus und Proptosis. Es handelt sich um eine kongenitale Lokalisation, die in der Regel bei der Geburt auftritt. Eine Assoziation mit Anophthalmie ist ungewöhnlich. Wir berichten über den Fall eines 2 Tage alten männlichen Neugeborenen mit linksseitiger kongenitaler intraorbitaler Läsion und massiver Proptosis. Bei der präoperativen MRT-Untersuchung zeigte sich eine große, zystische Masse, die die linke Orbita einnahm und aus ihr hervortrat, ohne sich intrakraniell auszudehnen. Während der Operation wurde vor der vollständigen Resektion der Masse eine große Menge Flüssigkeit aspiriert. Die chemische Analyse der Flüssigkeit war mit Liquor kompatibel. Histologisch bestand der Tumor aus reifem Neurogliagewebe und Ependymzellen. Trotz mehrfacher Schnitte wurde kein Plexus choroideus oder intraokularer Inhalt gefunden. Es wurde die Diagnose einer GH mit Anophthalmie festgestellt.

Objectives To describe the trends of research design in publications from high-impact medical journals. Methods A cross-sectional, descriptive study was conducted by searching the 2011 electronic publications of the journals: New England Journal of Medicine, Journal of the American Medical Association, The Lancet, British Medical Journal, and Annals of Internal Medicine. Studies were classified as primary and secondary. The journal impact factor was taken from the Journal Citation Report website. Descriptive statistics were used to analyze and interpret the data. Results We analyzed 1130 publications: 804 primary and 326 secondary studies, which represented 71.2% and 28.8% of the total publications, respectively. Among the primary studies, randomized clinical trials (30.4%) were the most prevalent, followed by cohort studies (21.9%) and case reports (9.0%). Conclusions These findings can have implications in Evidence-Based Medicine programs. Literature review should focus on reviewing secondary articles first, then experimental studies and finally, observational studies.

We have evaluated the efficacy of dapagliflozin in patients with type 1 diabetes mellitus (DM1) without adequate control. We expected that adding dapagliflozin to this population on top of their base treatment would lower their HbA1c levels.We conducted a pragmatic, open, 24-week study of treatment with 10 mg of oral dapagliflozin in patients with DM1 and chronic hyperglycemia. We evaluated glycemic control, lipid profile, weight, and insulin dose. Safety was assessed by adverse event reporting.Fasting glucose levels decreased from 176.42 ± 45.33 mg/dL to 139.67 ± 44.42 mg/dL (p = 0.05); although no significant valued was reached, postprandial glucose showed a decreased tendency from 230.25 ± 52.06 mg/dL to 193.83 ± 45.43 mg/dL (p = 0.08). The hemoglobin A1C (HbA1C) level decreased from 9.18 ± 1.02 (77 ± 11.1 mmol/mol) to 8.05 ± 1.09 % (64 ± 11.9 mmol/mol) (p = 0.0156); total cholesterol decreased from 299 ± 12 to 199 ± 7 mg/dL (p = 0.02); triglycerides decreased from 184 ± 15 to 160 ± 11 mg/dL (p = 0.0002), HDL-C decreased from 40 ± 17 to 42 ± 9 mg/dL (p = 0.54); and LDL-C decreased from 187 ± 19 to 170 ± 21 mg/dL (p = 0.049). No adverse events were reported.The beneficial effects of SGLT2 inhibitors on metabolic control and their safety after a 24-week open study demonstrate their potential indication as an adjunctive treatment with insulin in patients with DM1; however, long-term clinical trials should be considered.

The goal of this work is to report a novel assay that preserves antigenicity of extracts with high protease content without using enzymatic inhibitors. A great reduction of proteolytic activity in the insoluble chloroform/methanol and heated amoebic fraction (IC[ratio ]MC) was obtained by this method, even in the presence of sodium dodecyl sulphate and 2-mercaptoethanol. The substrates azo-casein and the hide powder azure were used to determine the reduction of proteolytic activity of IC[ratio ]MC compared with the activity of crude extract and crude extract with iodoacetamide. The IC[ratio ]MC SDS-PAGE pattern shows a higher quantity of bands than extract with the inhibitor iodoacetamide or than crude extract. In addition, anti-Entamoeba histolyticaantibodies from amoebic liver abscess patients recognized a richer antigenic Western blot pattern in the IC[ratio ]MC fraction than in crude extract alone or with inhibitor. The described method has proved to be suitable to preserve amoebic antigens for its use in diagnostic tests and it can be used for immunological response studies againstE. histolyticaantigens. Furthermore we propose that this method to obtain the IC[ratio ]MC fraction can be applied for the study of other microorganisms or cells with high enzymatic content.

Diabetes in pregnant women is associated with an increased risk for maternal and neonatal morbidities and remains a significant medical challenge. Fortunately, the prognosis has changed dramatically, related to an increased clinical awareness of the potential risks for the mother and the infant, better health care and intensive treatment strategies to maintain the closest to normal metabolic milieu. Diabetes and pregnancy may be divided into pregestational diabetes (women previously diagnosed with type 1 or type 2 diabetes) and gestational diabetes defined as any glucose intolerance detected during pregnancy that has evolved from a diagnosis associated with the metabolic risk of type 2 diabetes to a clinical condition associated with higher risks for maternal and perinatal morbidity. Early diagnosis of gestational diabetes is an important step to improve outcomes and systematic or selective screening with the OGTT should be established. Associated with the global epidemic in diabetes, pregnancy associated with diabetes is saturating high-risk obstetric clinics and neonatal intensive care units, becoming a heavy burden to the health care systems around the world.

Soil radon behavior related to the volcanic eruptive period 1997–1999 of Popocatepetl volcano has been studied as a function of the volcanic activity. Since the volcano is located 60 km from Mexico City, the risk associated with an explosive eruptive phase is high and an intense surveillance program has been implemented. Previous studies in this particular volcano showed soil radon pulses preceding the initial phase of the eruption. The radon survey was performed with LR-115 track detectors at a shallow depth and the effect of the soil moisture during the rainy season has been observed on the detectors response. In the present state of the volcanic activity the soil radon behavior has shown more stability than in previous eruptive stages.

According to the current international guidelines concerning environmental problems, it is necessary to evaluate and to know the indoor radon levels, specially since most of the natural radiation dose to man comes from radon gas and its progeny. Several countries have established National Institutions and National Programs for the study of radon and its connection with lung cancer risk and public health. The aim of this work is to present the indoor radon measurements and the detection methods used for different regions of Latin America (LA) in countries such as Argentina, Brazil, Ecuador, Mexico, Peru and Venezuela. This study shows that the passive radon devices based on alpha particle nuclear track methodology (NTM) is one of the more generalized methods in LA for long term indoor radon measurements, CR-39, LR-115 and Makrofol being the more commonly used detector materials. The participating institutions and the radon level measurements in the different countries are presented in this contribution.

Soil radon surveys have been performed in a long term monitoring basis with SSNTD (LR 115 type II), in order to observe possible fluctuations due to high magnitude seismic events and volcanic eruptions. Five-year radon time series are available in stations located in an intense seismic zone located along the Pacific coast of Mexico. The series analyses have been performed as a function of the local seismicity and geological characteristics. A discussion is intended to explain the lack of biunivocal relation between single radon peaks and earthquakes for the long term monitoring data using SSNTDs. Examples of short term radon anomalies obtained with continuous probes are also discussed as a function of local earthquakes and meteorological perturbations. Additionally, complementary results from recent changes in the activity pattern of an active volcano indicate that degassing process induced anomalous soil radon emanation correlated with the volcanic activity changes.

Dystrophic epidermolysis bullosa (DEB) is an inherited blistering skin disorder caused by mutations in the type VII collagen gene (COL7A1). In this study, we determined the molecular basis of autosomal recessive DEB in a 19-year-old Hispanic Mexican woman by PCR amplification of genomic DNA, heteroduplex analysis, and automated sequencing of heteroduplex bandshifts. This approach revealed a homozygous frameshift mutation, 2470insG, in exon 19 of COL7A1 and resulted in attenuated basement membrane zone expression of type VII collagen, a reduced number of anchoring fibrils at the dermal-epidermal junction, and a sub-lamina densa level of blister formation. Clinically, the patient had widespread trauma-induced skin fragility and complete loss of the nails, but had less pseudosyndactyly of the fingers and toes and milder mucosal involvement compared to most patients with the generalized form of this genodermatosis. We also screened 7 other Hispanic-Mexican patients with recessive DEB, none of whom were known to be related to this individual, for the mutation 2470insG using heteroduplex analysis and direct sequencing and detected this mutation on 7/14 alleles. Haplotype analysis using intragenic COL7A1 and flanking polymorphisms and microsatellite markers revealed that all the mutant alleles had arisen on similar allelic backgrounds, consistent with propagation of a common Hispanic Mexican ancestral haplotype. In view of the high allelic frequency of the mutation 2470insG in the patients studied, we recommend initial screening for this mutation when attempting to identify the molecular pathology of recessive DEB in Hispanic Mexican patients.

Surveys of radon and trace elements concentration in groundwaters have been carried out. Two different series of aquifers were monitored. One is located along the Pacific coast of Mexico, characterised by an intense seismic activity. The second one is located on the coast of the Gulf of Mexico, where, on the contrary, low seismic activity is observed. Radon determinations are performed with track detectors LR 115 type II and with automatic radon probes. Concentration levels of trace elements in water samples were measured with an Inductively Coupled Plasma Mass Spectrometer. Differences of the geochemical response of each aquifer depend on its specific geological context and recharge pattern.

Two active volcanoes, the Popocatepetl in Mexico, and the Piton de la Fournaise on the island of La Reunion, France, have been monitored for soil radon for several years. The Popocatepetl, located 60 km from Mexico City, started an eruptive period in December, 1994. Two radon-in-soil monitoring stations are operated there, since 1993. The behaviour of soil radon showed an increase as a function of the eruptive phase. The Piton de la Fournaise volcano has also been under survey for several years. A radon network based on 20 Clipperton II automatic probes was set on July, 1994. Since then, the volcano has entered a quiescence phase. Thus it has been possible to draw the pattern of the radon behavior under the influence of atmospheric conditions.

A thyroid nodule (TN) is a discrete lesion in the thyroid gland radiologically distinct from the adjacent parenchyma, with a prevalence variable depending on the diagnostic method used and the study population. Thyroid disorders have been identified in more than 50% of patients with systemic lupus erythematosus (SLE); however, the prevalence of TN has not been frequently studied. We identified a prevalence of 27% TN in 55 SLE patients > 16 years of age. One-third of TN were >1 cm with radiological features of malignancy. The mean age of patients with TN was 39 ± 11 years, 93% women, and SLE duration 10 ± 6 years. Among patients, we reported family history of cancer in three cases (20%), thyroid disease in one (7%), and autoimmune disease in six (40%). Regarding treatment, 50% of patients with TN were treated with azathioprine vs. 23% of patients without TN ( p = 0.02), with an OR of 3.94 (95% CI 1.12–13.84, p = 0.03). As a conclusion a high prevalence of TN in SLE patients was found. Prevalence of TN correlated only with history of azathioprine use. We don’t know the long-term implications of our findings; however, a functional and morphological evaluation of the thyroid gland is warranted in all patients with SLE.

Surveys of radon and short-lived daughters concentration levels have been performed in soil and groundwater around the Laguna Verde, Mexico, nuclear power facility. The soil monitoring was carried out at the power plant site, at a nearby aquifer, and at three localities where local seismic activity of low intensity occur. Groundwater samplings were performed at already existing wells. Solid State Nuclear Track Detectors (SSNTD) were used for radon in soil and groundwater determinations, while 214 Pb and 214 Bi activities in soil and groundwater samples were obtained from the routine gamma spectrometry studies included in the Radiological Environmental Program of the plant. The results showed seasonal variations in the radon and daughters concentration levels, both in groundwater and in soil. The higher soil radon and daughters values are found at a nearby geologic fault. The radon potential of the zone can be considered low risk.

The subduction of the Cocos Plate under the North America Plate defines a high risk seismic zone along the Pacific coast of Mexico. A seismic gap has been identified at the Guerrero State as a place where a large earthquake, up to MS=8.2, can occur within the next years. In this area an in-soil radon network, consisting of fixed SSNTD monitoring stations, has been operated during several years on a monthly exposure basis. A continuous radon probe that registers data on a short term basis is also operating since recently. The results of the two radon detection systems are compared and discussed as a function of the local seismic activity observed at the Guerrero coastal zone.

A radon in soil survey has been conducted in Mexico for 10 years, using solid State Nuclear Tracks Detectors with monthly sampling. The preliminary data analysis shows that a minimum of 20 months is required to attain a significant knowledge of the average radon content and variations. No clear periodicity of the data appears, nor any direct influence of the atmospherical parameters. Recommendations are drawn from this survey depending on the finality of the contemplated experiments using SSNTD for monitoring radon in the ground.

A radon in soil monitoring network has been set-up along the Mexican Pacific Coast, adjacent to the Mesoamerican trench, in order to observe the radon emission fluctuations associated with the pre, co and post seismic phases of future large earthquakes occurring along the Guerrero seismic gap during the next 10 years. Radon determination has been systematically performed with SSNTD exposed in the field for periods of one month. Results from radon in soil fluctuations, from stations located along the Guerrero seismic gap, have shown a behaviour possibly associated with changes in environmental factors and local seismicity. The use of automatic continuous radon detection devices is proposed as an additional methodology for network surveillance purposes.

The weight is an anthropometric parameter routinely used in ambulatory and hospital settings, and takes its importance, because often there are clinical conditions that impede it´s taking in a traditional scale. There are equations to estimate weight. However, they have not been designed for Mexican ambulatory patients.To develop an equation to estimate weight in Mexican ambulatory patients from the Study of Health, Well Being and Aging, corresponding to Mexico city an surrounded area.The database of the Study of Health, Well Being and Aging of Mexico City was used, and adults of 60 years and older, who completed the anthropometric measures were included. Two groups of datasets were crated though random numbers, one for the design and the other for the validation of the equation. The equation was obtained from the first database and cross-validated in the second.The equations obtained were: (0.67)* (Knee height)+(0.46)* (Mid-arm circumference)+(0.60)* (waist circumference)+(0.38)* (hip circumference)+(0.53)* (calf circumference)-(0.17)* (Age in years)-80.01 and (0.69)* (Knee height)+(0.61)* (Mid-arm circumference)+(0.17)* (waist circumference)+(0.45)* (hip circumference)+(0.58)* (calf circumference)-(0.24)* (Age in years)-55.9 in men and women respectively. The correlation coefficients were 0.94 y 0.92 (p0.001 for both). The differences between the real and estimated values were not significant.The equations developed in our analysis were confident and can be employed to estimate weight in ambulatory elderly. It is needed to test its validity in clinical scenarios were it is not possible to weight patients directly in the rest of the Mexican republic and adjust to specific populations.

Management of macroprolactinomas in women who plan to get pregnant is controversial and when this happen there is a risk of pituitary enlargement, if this happens bromocriptine has a safe profile to be used during pregnancy, but if it is not tolerated cabergoline is a good alternative.We describe two patients with macroprolactinomas who intended to get pregnant. One of them had been previously treated surgically and the second one was treated with bromocriptine and got pregnant before the tomographic studies were checked. Both patients developed during pregnancy symptoms of macroprolactinoma enlargement and were initially treated with bromocriptine but this was not tolerated and were switched to cabergoline. Both pregnancies ended with a normal full term newborn.Pregnant women with symptoms of pituitary enlargement must be treated with bromocriptine, but if it is not tolerated cabergoline is a good choice.

the abnormalities in liver function tests (LFTs) and liver complications (LC) from parenteral nutrition (PN) are common and usually multifactorial. These factors have not yet been assessed in the adult Mexican population.To determine whether the dose prescribed1 g/kg is a risk factor for the abnormalities in liver function tests (LFTs) from PN.Cohort study including patients older than 15 years and excluding those managed at the intensive car unit or with abnormalities in liver enzymes before the start of PN. The exposed and non-exposed groups were those receiving1 g of lipids per kg of body weight or1 g/kg, respectively. LFTs were defined as an increase higher than 50% of the normal range for AST, ALT, AF or total bilirrubin.the incidence of LFTs abnormalities was 20 (47.6%) and 15 (41.6%) in the exposed and non-exposed groups, respectively (RR 1.14 95% IC: 0.69-1.88; p = 0.59). The most frequent liver damage pattern was cholestatic, followed by the mixed pattern and then hepatocellular. The dose of prescribed lipids1 g/kg was not associated with the development of LC from LFTs abnormalities. The higher the dose of proteins the lower the frequency of LFTs abnormalities.The dose of lipids prescribed1 g/kg was not associated with the development of LFTs abnormalities from PN in our sample population. These findings should be confirmed in clinical trials.

women with gestational diabetes have an increase risk for maternal and neonatal metabolic complications.to evaluate detection, treatment and close surveillance.we recruited all women with gestational diabetes whose pregnancies ended in this hospital between September to November of 2005. All newborns were examined by a neonatologist and initiated early feeding with infant formula or glucose solution.a total of 74 patients with gestational diabetes were included. The age was 31.03 +/- 4.79 years, and the body mass index before pregnancy was 32.31 +/- 6.41. Eighteen patients developed third-trimester complications, in fourteen of them it was hypertensive disease of pregnancy. All were single pregnancies that ended in 71 term and 3 preterm newborns. There were not fetal or perinatal deaths. There were four small newborns for gestational age, 18 large for gestational age and 52 normal weight newborns. Eleven neonates had metabolic complications, eight of them had idiopathic respiratory distress syndrome, four had hypoglycaemia and one large for gestational age had obstetric trauma. Also two neonates with cardiovascular malformations were diagnosed. Thirty-six mothers returned for revaluation, eight had type 2 diabetes, six glucose intolerance.this group of patients shows the maternal and neonatal morbidity associated to gestational diabetes in patients under close surveillance. Systematic early screening in women at risk and close surveillance are required to obtain healthy newborns.

A radon survey in soil as well as in outdoors and indoors was carried out in Mexico City in order to correlate natural radioactivity concentrations with local environment. Monitoring was made using LR 115 type II track detectors and different detection devices geometries. Results for indoor and outdoor radon concentrations were quite comparable with values lower than 100 Bq/m3. Radon concentration in soil was dependent on the geological subsoil characteristics.

Radon data in soil and gamma and radon levels in air have been obtained for several years at the site of a Nuclear Research Centre and at a Radioactive Waste Storage Facility. Radon detection was carried out with SSNTD while for gamma levels TLD was used. Cross checking of gamma levels in air using gamma scintillation counting was also performed. The results obtained at the site of the Nuclear Research Centre showed a stability over time in the local average radioactive environment except for seasonal fluctuations essentially due to meteorological parameters which were continuously recorded. Results obtained at the Radioactive Waste Storage Facility indicate average gamma levels in air of 0.2 µGy.h-1 for most of the monitoring stations. One station with a higher radioactivity level was systematically observed. Measurements of radon in air up to 150 cm indicate a rapid dilution in the atmosphere.

Neonatal hypoglycemia is a frequent event in the first hours of life of newborns from mothers with diabetes mellitus. We studied a group of diabetic mothers newborns during the first day of life, taking venous blood samples at6 h, 6-12 h and 12-24 h of life for glucose analysis (n = 85), defining hypoglycaemia as a glucose level35 mg/dL. Calcium serum levels were also determined in the first venous sample in 19 neonates and 7 mEq/L was the criteria for hypocalcemia. The mothers age (mean +/- standard deviation) was 30.5 +/- 5.5 years (range 16-41 years), 43 (50.6%) of them with gestational diabetes, 40 (47.1%) with type 2 diabetes and 2 (2.4%) with type 1 diabetes. Pregnancies ended by caesarean section in 78 (91.8%) and by partum in seven (8.2%) women. There were 20 (23.5%) preterm newborns. In relation to neonates weight, 27 (31.7%) were macrosomic and 7 (8.2%) were premature, two of them with very low weight. A total of 55 (64.77%) newborns had hypoglycaemia, but only one of them had a convulsive episode, the rest were asymptomatic. In relation to the newborns weight, 18 (66.6%) of the macrosomic, 33 (64.7%) of the normal weight and four (57.1%) of the premature groups had hypoglycaemia. The comparisons between the newborns weight groups showed non significant differences, but the prevalence of neonatal hypoglycaemia was significantly higher in the group of gestational diabetes than in the type 2 diabetes group (p0.05). Calcium analysis also disclosed asymptomatic hypocalcemia in five (7.25%) newborns. These results show an elevated prevalence of asymptomatic neonatal hypoglycaemia in the offspring of women with diabetes mellitus in their early hours of life, and stress the importance of systematic glucose monitoring and early treatment in the first hours of life of these neonates.

This study was aimed to identify the prevalence of gestational diabetes (GD) defined as any glucose intolerance detected in a pregnant women using the oral glucose tolerance test (OGTT) protocol, proposed by the World Health Organization (WHO) and to explore the effect of late pregnancy on the glucose tolerance test. Two groups of pregnant women20 years of age were evaluated with an OGTT, one group at the beginning, and the other one at the end of the third trimester, newborns weight and gestational age were recorded at the end of pregnancy.Group A (n = 152), was studied at 24-28 weeks and group B (n = 214) was studied at 32-36 weeks, after an overnight fasting a 75 g glucose load was provided and a blood sample was taken after 2 h. Glucose levels140 mg/dL were diagnostic of GD, women with glucose levels in the range of 140-199 mg/dL were prescribed dietary recommendations, but women with glucose levels200 mg/dL were treated with insulin. Newborns were considered macrosomic if weighted4,000 g and large for gestational age if exceeded the 97th percentile or the Lubchenko scale, both conditions are described as macrosomia in the text. Comparisons were done using the Chi-square and Fisher exact tests.In group A GD was diagnosed in 27 women (17.76%), but only three of them (1.97%) had glucose levels200 mg/dL and in group B-GD was diagnosed in 62 women (28.97%), but only eight of them (3.73%) had glucose levels200 mg/dL. The difference in rates between groups A and B was significant (p0.01). In group A, normal women had 19 (15.2%) macrosomic newborns and women with GD had nine (33.33%) macrosomic newborns, this difference was significant (p0.05); however, in group B women with GD vs. normal, had 10 (16.12%) and 19 (12.5%) macrosomic newborns, respectively (p = ns).The new criteria for GD diagnosis increases notoriously its prevalence in our population to 17.76% at the beginning of the third trimester, comparing with 1.97% of women with glucose levels200 mg/dL applying the WHO criteria for diabetes in nonpregnant adults, however, comparing the newborns weight of normal women vs. GD women the prevalence of macrosomia was almost the double, reflecting the importance of this diagnosis in perinatal health. Women screened at the end of pregnancy had a significant increase in GD prevalence, but macrosomia was not different of the normal women of this group suggesting that GD at this stage of pregnancy may help to detect women with a higher risk to develop diabetes, but have no impact on perinatal health.

Natural radionuclides and physicochemical parameters have been evaluated in groundwater samples from boreholes belonging to the drinking water supply system of the Toluca City, Mexico. The results obtained for radon and radium, together with the physicochemical parameters of the studied samples, indicate a fast and efficient recharge pattern. The presence of a local and a regional groundwater flows was also observed. The local flow belongs to shallower water, recognized by its low radon content and dissolved ions, as compared with the regional, deeper groundwater flow with a longer residence time.

Primary pigmented nodular adrenocortical disease is a rare cause of Cushing's syndrome in children and young adults. It is characterized by hypercorticolism resistant to dexamethasone suppression and at microscopic examination by multiple small black cortical nodules containing large cells with eosinophilic cytoplasm and lipofuscin with internodular cortical atrophy. Its pathogenesis is unknown. Bilateral adrenalectomy is the treatment of choice. We report a case of Cushing's syndrome due to primary pigmented nodular adrenocortical disease in a 32 year old female and review the literature.