Mortality due to lung cancer in Mexico

The highest mortality due to cancer worldwide for both genders corresponds to lung cancer (1,179,000 deaths). In Mexico, the crude mortality rate due to lung cancer was of 5.01 per 10(5) inhabitants in 1979. The most important risk factor is smoking. The present study was aimed at analyzing the mortality due to lung cancer in Mexico, assessing data from each of the states constituting the Mexican Republic during the 1998-2004 period. Data were obtained from the National Institute of Statistics, Geography and Informatics (INEGI, for its initials in Spanish) corresponding to deaths due to lung cancer (1998-2004). We estimated the mean annual mortality rate (MAMR) for each of the 32 states of Mexico. We used the "World Population Standard". The MAMR was standardized according to age (ARS) direct method, and the standard error was determined by Poisson's approximation at a 95% confidence interval. To know the excess risk due to mortality, we calculated the standardized mortality ratios (SMRs) of ARS for each federal state, using the national rate as reference. In this period, 397,400 deaths due to malignant neoplasms were recorded, corresponding 45,578 (11.5%) to lung cancer; for men, 31,025 (68.1%) with MAMR of 8.9 and the respective ARS of 13.2 both x10(5) inhabitants. For women, results were 4553 (31.9%) deaths with MAMR of 4.1 and ARS of 5.4 both x10(5) inhabitants. The highest mortality rates due to lung cancer in both genders were observed in the north of Mexico, whereas for women this was observed in the central states. Although smoking is the main risk for lung cancer, there are other factors such as environmental pollution or exposure to toxicants that could be associated to this cancer. The years potentially lost due to lung cancer were 258,550 for men and 133,315 for women, with a total of 391,865 according to histopathology registry neoplasm malignant RHNM (1985-1995). Studies focused on the characterization and measurement of polluting agents would be a good start to determine the level of participation of air pollution in the development of lung cancer.     

Gonadotropins and prolactin serum levels during the perimenopausal period: correlation with diverse factors

We studied 490 women aged 35 to 55 years randomly selected from the urban population of León, México. The mean age for the onset of menopause, calculated with a probit regression was 48.5 years. The median of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) increased with the rate of menopause women, but the 10th percentile for both hormones did not increase above 15 IU/L in older groups. Meanwhile, prolactin did not change. In menopause women FSH correlated positively with cigarette smoking, and negatively with body mass index. Luteinizing hormone had negative correlation with the number of pregnancies. Most symptoms studied were not associated with menopause or gonadotropins levels, except hot flushes, and the empty nest syndrome. It was concluded that during menopause, FSH increases with the smoking habit, and decreases with overweight.     

Minimally invasive heart surgery]

Minimally invasive heart surgery encompasses a variety of techniques, each with its own objective (minimal incisions, absence of cardiopulmonary bypass and cost reduction). Postoperative care after such procedures are simpler, with early extubation and shortened hospital stays. A period of close observation in a postoperative intensive care recovery ward is still required.     

Recurrent hydrochlorothiazide-induced pulmonary edema

Hydrochlorothiazide-induced pulmonary edema is an unusual but life-threatening adverse reaction. It causes hypoxemia, hypotension, tachycardia, fever, and occasionally electrocardiographic and echocardiographic abnormalities. The mechanism of production is, probably, idiosyncratic. Received: 26 May 1997 Accepted: 13 January 1998     

Gastrointestinal Issues in Infants and Children with Autism and Developmental Delays

Controversy exists regarding whether gastrointestinal (GI) issues play a role in the symptomatology of autism spectrum disorder (ASD). While some studies have found GI problems to be more prevalent in individuals with ASD, others have reported no such difference. Studies looking at the relationship between GI issues and ASD symptom severity have also had mixed results. The current study examined 112 participants between the age of 17 to 37 months. Participants comprised four groups of 28 children: an ASD and no GI issues group, an ASD with GI problems group, an atypical development and no GI issues group, and an atypical development with GI issues group. The results of the current study suggest that although the prevalence of GI symptoms was higher in participants with ASD than those without, this difference was not significant. The study also found that GI issues were not related to ASD symptom severity or developmental functioning.     

Modern management of myelofibrosis

The conventional treatment of myelofibrosis involves a wait-and-see approach for asymptomatic patients, oral chemotherapy for the hyperproliferative forms of the disease, androgens or erythropoietin for the anaemia, and splenectomy in selected patients. Low-dose thalidomide plus prednisone is a well-tolerated therapy for the anaemia and the thrombocytopenia of myelofibrosis, whereas imatinib has shown little efficacy. Allogeneic stem cell transplantation (allo-SCT) is the only curative therapy for myelofibrosis. Its standard modality has an associated mortality of about 30% and can be applied to younger patients with high-risk disease or resistant to conventional treatment. Reduced-intensity conditioning allo-SCT involves a low mortality and is a promising therapy for patients aged 45-70 years old with the above characteristics. Autologous SCT is a palliative therapy for patients resistant to conventional treatment who lack a suitable donor. The next candidates for the treatment of myelofibrosis are the thalidomide derivatives, the proteasome inhibitors, and vascular endothelial growth factor neutralizing antibodies.     

The changing profile of Ph-positive chronic myeloid leukemia at presentation: possible impact of earlier diagnosis on survival

BACKGROUND AND OBJECTIVE: Although there are indications that the profile of chronic myeloid leukemia (CML) at presentation has changed in recent years, information is scarce. The objective of the present study was to ascertain whether the initial features of CML have changed over time, as well as the possible impact on survival. DESIGN AND METHODS: The initial features of 167 patients diagnosed with chronic phase Ph-positive CML from 1972 to 1985 were compared with those of 174 such patients diagnosed at the same institution from 1985 to 1998. The survival of the two groups was also compared. RESULTS: CML patients diagnosed since 1985 were significantly older at presentation (mean age 47+17 vs 43+17 years, p = 0.04), were more often asymptomatic (36% vs 19%, p = 0.0003), less often had constitutional symptoms (30% vs 45%, p = 0.004), less frequently had splenomegaly (59% vs 75%, p = 0.0008) and hepatomegaly (35% vs 49%, p = 0.01), had less marked leukocytosis (mean WBC count 139+/-124x10(9)/L vs 179+/-132x10(9)/L, p = 0.007), with 30% of them showing an initial WBC count below 50x10(9)/L (vs 19%, p = 0.02), and showed less marrow blast cell infiltration (p = 0.0003). No significant differences were observed in the distribution by Sokal's risk groups. Median survival of patients diagnosed since 1985 was 5. 33 years (95% CI: 4.3-6.36), vs 4.06 years (95% CI: 3.28-4.84) for patients diagnosed before (p = 0.07). Finally, patients asymptomatic at diagnosis had a longer survival (median survival 5.7 years, 95% CI: 4.5-6.9, vs 4.1 years, 95% CI: 3.4-4.7, p = 0.03). INTERPRETATION AND CONCLUSIONS: A substantial proportion of CML patients are currently diagnosed early in the course of the disease. The effect of earlier diagnosis on survival prolongation in such patients should be taken into account.     

Clinical,imaging, and molecular findings in a sample of Mexican families with pantothenate kinase‐associated neurodegeneration

Pantothenate kinase‐associated neurodegeneration (PKAN) is an autosomal recessive disorder characterized by iron accumulation in the brain, because of mutations in the PANK2 gene. Phenotypic and genotypic characteristics of 11 patients from five Mexican families with PKAN disease are reported. Sequencing of PANK2 confirmed the diagnosis. The 11 patients had dysarthria associated with dystonia and Parkinsonism in six. Brain magnetic resonance imaging (MRI) showed the ‘eye‐of‐the‐tiger’ sign in all patients. Three different mutations were identified, a novel one (p.A469P) and two (p.G219V and p.N404I) very rare. Homozygous sibs for the p.G219V mutation had a severe disease progression with early death. Dystonia predominated in the p.A469P/p.N404I compound heterozygous patients. Homozygous for p.N404I showed Parkinsonism, tics and personality and speech disorders. Early and late disease onset and variable expression was present in carriers of the different identified mutations. The ‘eye‐of‐the‐tiger’ is an excellent neuroimaging hallmark to predict PANK2 mutations. We detected a ‘cluster’ of patients harboring the p.N404I mutation, strongly suggesting a founder effect for this mutation. This is the first familial clinical‐genetic PKAN disease study accomplished in Mexico.