Publications by authors named "Alfonso Reyes-López"

24 Publications

  • Page 1 of 1

Association of Genetic Polymorphisms and Serum Levels of IL-6 and IL-8 with the Prognosis in Children with Neuroblastoma.

Cancers (Basel) 2021 Jan 30;13(3). Epub 2021 Jan 30.

Subdirección de Pediatría Ambulatoria Hospital Infantil de México Federico Gómez, Dr. Márquez No. 162, Col Doctores, Delegación Cuauhtémoc, Ciudad de Mexico 06720, Mexico.

There is evidence that high circulating levels of IL-6 and IL-8 are markers of a poor prognosis in various types of cancer, including NB. The participation of these cytokines in the tumor microenvironment has been described to promote progression and metastasis. Our objective was to evaluate the prognostic role of genetic polymorphisms and serum levels of IL-6 and IL-8 in a cohort of Mexican pediatric patients with NB. The detection of the SNPs rs1800795 IL-6 and rs4073 and rs2227306 IL-8 was carried out by PCR-RFLP and the levels of cytokines were determined by the ELISA method. We found elevated circulating levels of IL-8 and IL-6 in NB patients compared to the control group. The genotype frequencies of the rs1800795 IL-6 and rs4073 IL-8 variants were different between the patients with NB and the control group. Likewise, the survival analysis showed that the GG genotypes of rs1800795 IL-6 ( = 0.014) and AA genotypes of rs4073 IL-8 ( = 0.002), as well as high levels of IL-6 ( = 0.009) and IL-8 ( = 0.046), were associated with lower overall survival. We confirmed the impact on an adverse prognosis in a multivariate model. This study suggests that the SNPs rs1800795 IL-6 and rs4073 IL-8 and their serum levels could be promising biomarkers of a poor prognosis, associated with overall survival, metastasis, and a high risk in Mexican children with NB.
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http://dx.doi.org/10.3390/cancers13030529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866803PMC
January 2021

Ocular preservation in patients with bilateral retinoblastoma before chemotherapy in situ era: A report from a Mexican Retinoblastoma Reference Hospital.

Pediatr Blood Cancer 2020 10 3;67(10):e28625. Epub 2020 Aug 3.

Department of Ophthalmology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.

Background: Bilateral retinoblastoma (Rb) treatment remains a challenge for ophthalmologists and pediatric oncologists despite new therapeutic strategies for eye preservation. The purpose of this work is to evaluate treatment outcomes in patients who underwent eye salvage treatment at a single-center prior to the chemotherapy in situ era.

Procedure: We followed a cohort of 88 consecutive Rb patients diagnosed at Hospital Infantil de México between November 2000 and June 2014. Eye salvage treatment consisted of systemic chemotherapy plus focal therapy planned by a multidisciplinary team. Unresponsive tumors were treated with episcleral brachytherapy and external beam radiotherapy (EBRT).

Results: A total of 96 eyes underwent eye salvaging therapy. Seventy-eight eyes (81%) were salvaged. Seven patients (8%) required brachytherapy and 34 patients (39%) underwent EBRT. Thirty-three of 78 preserved eyes (42%) achieved normal visual acuity: 5/27 (20%) in radiated patients and 28/51 (61%) in nonradiated patients. Eight patients developed secondary primary malignancies; however, those treated with EBRT did not have a significantly increased risk when compared with nonirradiated patients (OR: 1.66; P = 0.492). The overall survival rate was 86% (95% CI, 76%-92%) after a mean follow-up of 10 years.

Conclusions: Eye preservation, long-term tumor control, and functional visual acuity could be maintained in many child and adolescent Rb survivors. Our data suggest that ocular radiotherapy can be used as consolidation treatment when other recently developed therapies with potentially fewer side effects are not available. Multidisciplinary management of Rb is mandatory to obtain cancer control during eye salvage treatment.
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http://dx.doi.org/10.1002/pbc.28625DOI Listing
October 2020

Safety and efficacy of step-down to oral outpatient treatment versus inpatient antimicrobial treatment in pediatric cancer patients with febrile neutropenia: A noninferiority multicenter randomized clinical trial.

Pediatr Blood Cancer 2020 06 20;67(6):e28251. Epub 2020 Mar 20.

Oncology Department, Instituto Nacional de Pediatría, Mexico City, Mexico.

Background: It has been suggested that low-risk febrile neutropenia (FN) episodes can be treated in a step-down manner in the outpatient setting. This recommendation has been limited to implementation in middle-income countries due to concerns about infrastructure and lack of trained personnel. We aimed to determine whether early step-down to oral antimicrobial outpatient treatment is not inferior in safety and efficacy to inpatient intravenous treatment in children with low-risk FN.

Procedure: A noninferiority randomized controlled clinical trial was conducted in three hospitals in Mexico City. Low-risk FN was identified in children younger than 18 years. After 48 to 72 hours of intravenous treatment, children were randomly allocated to receive outpatient oral treatment (experimental arm, cefixime) or to continue inpatient treatment (standard of care, cefepime). Daily monitoring was performed until neutropenia resolution. The presence of any unfavorable clinical outcome was the endpoint of interest. We performed a noninferiority test for comparison of proportions.

Results: We identified 1237 FN episodes; 117 cases were randomized: 60 to the outpatient group and 57 for continued inpatient treatment. Of the FN episodes, 100% in the outpatient group and 93% in the inpatient group had a favorable outcome (P < 0.001). The mean duration of antibiotics was 4.1 days (SD 2.5; 95% CI, 3.4-4.8 days) in the outpatient group and 4.4 days (SD 2.5; 95% CI, 3.7-5.0 days) in the inpatient group (P = 0.70).

Conclusions: In our population, step-down oral outpatient treatment of low-risk FN was as safe and effective as inpatient intravenous treatment. Clinical Trials Identifier: NCT04000711.
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http://dx.doi.org/10.1002/pbc.28251DOI Listing
June 2020

Differential expression of miRNA-146a and miRNA-155 in gastritis induced by Helicobacter pylori infection in paediatric patients, adults, and an animal model.

BMC Infect Dis 2018 Sep 15;18(1):463. Epub 2018 Sep 15.

Infectology Laboratory, Hospital Infantil de México Federico Gómez, México City, Mexico.

Background: Helicobacter pylori is a major aetiologic agent associated with gastritis. H. pylori infections increase the expression of the Toll-like receptor (TLR), which in turn modulates the expression of microRNA (miRNA)-146a and miRNA-155. The objective of this study was to compare the expression of miRNA-146a and miRNA-155 in gastric lesions of paediatric and adult patients with different pathologies and in Mongolian gerbils (Meriones unguiculatus) infected with H. pylori 26,695.

Methods: Quantification of miRNA expression was performed by quantitative real-time polymerase chain reaction (qRT-PCR) of paraffin-embedded gastric lesions of children with or without an infection (n = 25), adults with follicular gastritis and metaplasia (n = 32) and eight-week-old M. unguiculatus males (Hsd:MON) infected with H. pylori 26,695 for 0, 3, 6, 12 and 18 months (n = 25). The genes RNU48 and RNU6 were used as endogenous controls for data normalization. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney, ANOVA and Student's t-test.

Results: The expression of miRNA-146a and miRNA-155 in infected children increased by 247.6- and 79.4-fold (on average), respectively, compared to that observed in the control group. However, these results were not significant (p = 0.12 and p = 0.07 respectively). In some children a gradual increase in expression was observed, while in others, expression was very high. Additionally, the expression levels of miRNA-146a and miRNA-155 increased by an average of 21.7- and 62-fold, respectively, in adult patients with follicular gastritis when compared to those of the controls. In M. unguiculatus infected with H. pylori 26,695, the expression of both miRNAs increased as the infection progressed.

Conclusion: This is the first report to show differences in the expression of miRNA-146a and miRNA-155 in paediatric and adult patients with gastritis who were infected with H. pylori. In addition, in M. unguiculatus infected with H. pylori, miRNA expression was associated with the progression of infection and the ability of the bacteria to adapt to the host.
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http://dx.doi.org/10.1186/s12879-018-3368-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139157PMC
September 2018

Pediatric mature B-cell NHL, early referral and supportive care problems in a developing country.

Hematology 2019 Dec 27;24(1):79-83. Epub 2018 Aug 27.

i Servicio de Oncología, Instituto Nacional de Pediatría , México City , México.

Objective: Mature B-cell non-Hodgkin lymphoma (B-NHL) comprises more than 50% of all non-Hodgkin lymphoma (NHL) in children and adolescents. An official report published by the Mexican National Center for the Control and Prevention of Cancer in the Pediatric and Adolescent Populations, reported a lymphoma OS of 71% (including all Hodgkin and NHL). The Mexican Association of Pediatric Oncology and Hematology conducted a retrospective study to analyze the clinical characteristics and outcomes of children with diagnosis of B-NHL in Mexico, in order to perceive the main areas of improvement in the health care.

Methods: From 1 January 2000 to 31 December 2016, 166 pediatric patients were diagnosed with B-cell NHL at the participant institutions.

Results: According to histology the outcomes were 5-year EFS 63%, for BL/BLL, and 80% DLBCL, (P = .051), 5-year PFS 81%, for BL/BLL, and 91% for DLBCL, (P = .126), and 5-year OS 71%, for BL/BLL, and 83% for DLBCL, (P = .095).

Discussion: Overall, 18 patients died due to acute treatment toxicity, resulting in a cumulative incidence of toxic death of 10.84% and an early death rate of 7.23%, defined as <30 days after initial treatment. In conclusion, there is an urgent need to establish an academic collaboration to create strategies to improve pediatric cancer care according to our resources, especially in diseases with expected excellent prognosis as B-NHL. These strategies must include comprehensive supportive care, early referral, and the creation of easy communication between pediatric and adults centers as well as late-effects clinics.
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http://dx.doi.org/10.1080/10245332.2018.1510087DOI Listing
December 2019

Delivery of Pediatric Cancer Care in Mexico: A National Survey.

J Glob Oncol 2018 07;4:1-12

Laura Rodriguez-Romo, Queen's University; Kelly Brennan and Christopher M. Booth, Queen's University Cancer Research Institute, Kingston; Sumit Gupta, The Hospital for Sick Children, Toronto, Ontario, Canada; Laura Rodriguez and Rafael Pineiro-Retif, Hospital Universitario de la Universidad Autónoma de Nuevo León, Nuevo León; Alberto Olaya Vargas and Jaime Shalkow-Klincovstein, Instituto Nacional de Pediatria; Alfonso Reyes-Lopez and Carlo Cicero-Oneto, Hospital Infantil de México; Juan Mejia-Arangure, Centro Médico Nacional Siglo XXI; Maria de los Angeles Del Campo-Martinez, Centro Médico Nacional La Raza, Mexico City; Lourdes Vega-Vega, Hospital Infantil Teletón de Oncología, Querétaro; Oscar Gonzalez-Ramella, Hospital Civil de Guadalajara, Guadalajara; Aracely Lopez-Facundo, Universidad Autónoma del Estado de México, México; and Isidoro Tejocote, Hospital para el Nino del Instituto Materno Infantil, México, México, Toluca, Mexico.

Purpose Limited data describe the delivery of pediatric cancer care in Mexico. We report a nationwide survey of pediatric cancer units. Methods An electronic survey was distributed to 74 pediatric cancer units in Mexico to describe case volumes; organization of care; and availability of medical/surgical specialists, supportive care, complex therapies, and diagnostic services. Centers were classified as low (< 30 new patients/year), medium (30 to 59/year) and high (≥ 60/year). Results Sixty-two centers completed the survey (response rate, 84%). The median annual new case volume per center was 50 (interquartile range [IQR], 23 to 81). Thirty-four percent (n = 21), 26% (n = 16), and 40% (n = 25) of units were low-, medium-, and high-volume centers, respectively. Treatment units reported a median of two pediatric oncologists (IQR, 2) and one pediatric hematologist (IQR, 1 to 2). Availability of medical and surgical subspecialists varied by center size, with substantially more specialist support at higher-volume centers ( P < .01). Multidisciplinary tumor boards are available at 29% (six of 21), 56% (nine of 16), and 76% (19 of 25) of low- to high-volume centers, respectively ( P = .005). Radiation and palliative care services are available at 42% (n = 26) and 63% (n = 36) of all centers, which did not vary by center volume. Educational support for hospitalized children and school reintegration programs are available at 56% (n = 36) and 58% (n = 36) of centers, respectively. One third (38% [n = 23]) of centers reported that at least one half of patients were lost to follow-up during the transition from pediatric to adult programs. Conclusion A large variation exists in annual case volumes across Mexican pediatric cancer centers. Additional efforts to increase access to multidisciplinary, supportive, and palliative care across all pediatric cancer units in Mexico are required.
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http://dx.doi.org/10.1200/JGO.17.00238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223522PMC
July 2018

Potential drug-drug interactions and their risk factors in pediatric patients admitted to the emergency department of a tertiary care hospital in Mexico.

PLoS One 2018 5;13(1):e0190882. Epub 2018 Jan 5.

Comisión Nacional de Arbitraje Médico, Ciudad de México, México.

Background: Drug-drug interactions (DDIs) detected in a patient may not be clinically apparent (potential DDIs), and when they occur, they produce adverse drug reactions (ADRs), toxicity or loss of treatment efficacy. In pediatrics, there are only few publications assessing potential DDIs and their risk factors. There are no studies in children admitted to emergency departments (ED). The present study estimates the prevalence and describes the characteristics of potential DDIs in patients admitted to an ED from a tertiary care hospital in Mexico; in addition, potential DDI-associated risk factors are investigated.

Methods: A secondary analysis of data from 915 patients admitted to the ED of the Hospital Infantil de México "Federico Gómez" was conducted. The Medscape Drug Interaction Checker software was used to identify potential DDIs. The results are expressed as number of cases (%), means (95% CI) and medians (25-75th percentiles). Count data regressions for number of total and severity-stratified potential DDIs were performed adjusting for patient characteristics, number of administered drugs, days of stay, presence of ADRs and diagnoses.

Results: The prevalence of potential DDIs was 61%, with a median of 4 (2-8). A proportion of 0.2% of potential DDIs was "Contraindicated", 7.5% were classified as "Serious", 62.8% as "Significant" and 29.5% as "Minor". Female gender, age, days of stay, number of administered drugs and diagnoses of Neoplasms (C00-D48), Congenital malformations (Q00-Q99), Diseases of the Blood, Blood-forming Organs and Immunity (D50-D89) and Diseases of the nervous system (G00-G99) were significantly associated with potential DDIs.

Conclusion: The prevalence of potential DDIs in the ED is high, and strategies should therefore be established to monitor patients' safety during their stay, in addition to conducting investigations to estimate the real harm potential DDIs inflict on patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190882PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755936PMC
February 2018

Reply to Letter to the Editor.

J Pediatr Surg 2017 Oct 17. Epub 2017 Oct 17.

Hospital Infantil de Mexico Federico Gomez, Pediatric Surgery, Dr. Marquez 162, Col. Doctores, Mexico City 06720, Mexico.

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http://dx.doi.org/10.1016/j.jpedsurg.2017.10.041DOI Listing
October 2017

Analysis of Normal Hematopoietic Stem and Progenitor Cell Contents in Childhood Acute Leukemia Bone Marrow.

Arch Med Res 2016 11;47(8):629-643

Oncology Research Unit, Oncology Hospital, Instituto Mexicano del Seguro Social, Mexico City, Mexico. Electronic address:

Background And Aims: Childhood acute leukemias (AL) are characterized by the excessive production of malignant precursor cells at the expense of effective blood cell development. The dominance of leukemic cells over normal progenitors may result in either direct suppression of functional hematopoiesis or remodeling of microenvironmental niches, contributing to BM failure and AL-associated mortality. We undertook this study to investigate the contents and functional activity of hematopoietic stem/progenitor cells (HSPC) and their relationship to immune cell production and risk status in AL pediatric patients.

Methods: Multiparametric flow cytometry of BM aspirates was performed to classify AL on the basis of lineage and differentiation stages and to analyze HSPC and immune cell frequencies. Controlled co-culture systems were conducted to evaluate functional lineage potentials of primitive cells. Statistical correlations and inter-group significant differences were established.

Results: Among 113 AL BM aspirates, 26.5% corresponded to ProB, 19.5% to PreB and 32% contain ProB and PreB differentiation stages, whereas nearly 9% of the cases were T- and 13% myeloid-lineage leukemias. We identified ProB-ALL as the subtype endowed with the highest relative contents of HSPC, whereas T-ALL and PreB-ALL showed a critically reduced size of both HSC and MLP compartments. Notably, lower cell frequencies of HSPC in ProB-ALL correlated to high-risk prognosis at disease debut.

Conclusions: HSPC abundance at initial diagnosis may aid to predict the clinical course of ALL and to identify high-risk patients. A clearer understanding of their population dynamics and functional properties in the leukemia setting will potentially pave the way for targeted therapies.
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http://dx.doi.org/10.1016/j.arcmed.2016.12.004DOI Listing
November 2016

[Assessment and intervention thresholds to detect cases at risk of osteoporosis and fragility fractures with FRAX® in a mexican population for the first level of healthcare].

Gac Med Mex 2016 Oct;152(Suppl 2):22-31

Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil Federico Gómez, Ciudad de México, México.

Objective: To estimate the evaluation and intervention thresholds using FRAX® in Mexican population.

Methods: Probabilities for a mayor fracture using the Mexican FRAX® version to estimate the evaluation and intervention thresholds using clinical scenarios were obtained in both sexes 40 years and over. Projections for 2020 were done to estimate the number of patients at the intervention level taking the osteoporosis prevalence in Mexicans aged 50 years and over.

Results: The cutoffs for the intervention thresholds were 2.6%-20.0%. Individuals with thresholds above these probabilities are amenable for intervention. The assessment thresholds range from 1.2-3.2% to 12.5-24.4% for 40 to 90 years. According to projections of our population, approximately three million people are susceptible to intervention by 2020.

Conclusion: The use of FRAX® thresholds of intervention and evaluation developed in this study will be useful in the primary care level for case detection at high risk of fragility fracture.
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October 2016

Economic Evaluation of the Use of Drug-Eluting Stents versus Bare-Metal Stents in Adults with Ischemic Cardiomyopathy Requiring Angioplasty.

Rev Invest Clin 2015 Jul-Aug;67(4):219-26

Department for Epidemiological Investigation and Health Services, Aging Area, CMN-SXXI, IMSS, México, D.F., México.

Background: The value of drug-eluting stents in preventing cardiovascular events has not been investigated in Mexico.

Objective: To conduct a cost-effectiveness analysis of early and new-generation drug-eluting stents from the perspective of a healthcare provider.

Methods: We conducted a cost-effectiveness analysis of early and new-generation drug-eluting stents in patients with ischemic cardiomyopathy attending a Cardiology Hospital of the Mexican Social Security Institute. The health endpoint used was major acute cardiovascular events prevented. The effectiveness by stent type was obtained from the literature. A retrospective chart review study was conducted to collect cost data on cardiovascular events including seven cost categories. Average and incremental cost-effectiveness ratios were estimated. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of estimates.

Results: Incremental cost-effectiveness ratios in base-case were 28,910 and US$ 35,590 for early and new-generation stents, respectively. In an optimal scenario, incremental-cost effectiveness ratio was 24,776 and US$ 25,262 for early and new stents, respectively. Probabilistic sensitivity analysis suggested that 90% of cases were cost-effective when willingness-to-pay was 58,000 and US$ 66,000 for early and new-generation stents, respectively.

Conclusions: The cost-effectiveness ratios of early and new-generation stents were significantly higher than corresponding bare-metal stents.
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January 2018

[Treatment of Fallot tetralogy with a transannular patch. Six years follow-up].

Cir Cir 2015 Nov-Dec;83(6):478-84. Epub 2015 Jul 29.

Unidad de Investigación Médica en Epidemiologia Clínica, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México. Electronic address:

Background: Primary repair of Fallot tetralogy has been performed successfully for the last 45 years. It has low surgical mortality (< 5%), with excellent long-term results. However, there are delayed adverse effects: progressive right ventricular dilation and dysfunction, arrhythmia, and sudden death. In our centre, Fallot tetralogy is the most common form of cyanotic congenital heart disease (including transannular patch) and accounts for 7.5% of all cardiovascular surgical procedures. The mid-term follow-up results are reported.

Material And Methods: Case series. The study included patients who had complete repair of Fallot tetralogy with transannular patch from January 2000 to December 2009. An analysis was performed on the clinical variables, morbidity and mortality.

Results: There were 52 patients in the study, with mean age 4 ± 2 years. Perioperative mortality in 6 patients, with 5 associated with residual right ventricular obstruction and, 1 associated with further surgery. The survival rate was 88% (46) patients, with a follow-up 75 ± 26 months. Late morbidity occurred in 14, due to right ventricular dysfunction in 11, recurrent distal obstruction in 2, and residual ventricular septal defect in 1. Associated risk factors were severe pulmonary insufficiency (p=0.001); QRS > 160 ms, p=0.001); cardiothoracic > 0.60 index, (p=0.048), and tricuspid regurgitation (p=0.001).

Conclusions: There was reasonable long-term survival and excellent quality of life after total correction of Fallot tetralogy; however, progressive right ventricular dysfunction requires continuous monitoring, as well as the choice of optimal timing of pulmonary valve replacement.
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http://dx.doi.org/10.1016/j.circir.2015.06.003DOI Listing
September 2016

Risk Factors Associated with Nosocomial Peritonitis in Children on Peritoneal Dialysis.

Rev Invest Clin 2015 May-Jun;67(3):170-6

Nephrology Research Laboratory, Hospital Infantil de México Federico Gómez, México, D.F., Mexico.

Background: Peritoneal dialysis is the most frequent dialysis method in children, and peritonitis is a frequent complication. The responsible organisms differ between nosocomial and community acquired peritonitis, they cause longer hospitalization time, and can lead to dialysis failure.

Objective: The aim of the study was to describe the risk factors associated with nosocomial peritonitis in children with end-stage renal disease undergoing dialysis treatment.

Methods: A nested case-control study was conducted in an academic medical center.

Subjects: The basic cohort included all pediatric patients with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis therapy and who were hospitalized for non-infectious causes during the study period, January 2008 to December 2009. Cases were subjects who developed nosocomial peritonitis during hospitalization, and controls were children free of nosocomial peritonitis. The final groups consisted of 10 cases and 35 controls.

Results: There were 11 episodes of nosocomial peritonitis in 10 subjects (incidence rate, 6.6 cases per year of hospitalization). By multiple logistic regression analysis, the presence of congenital abnormalities of the kidney and urinary tract was the only risk factor significantly associated with nosocomial peritonitis (OR: 11.54; 95% CI: 1.86-71.59).

Conclusion: Congenital abnormality of the kidney and urinary tract was a significant risk factor for nosocomial peritonitis in pediatric patients with end-stage renal disease undergoing peritoneal dialysis.
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January 2018

Bone Marrow Cells in Acute Lymphoblastic Leukemia Create a Proinflammatory Microenvironment Influencing Normal Hematopoietic Differentiation Fates.

Biomed Res Int 2015 18;2015:386165. Epub 2015 May 18.

Oncology Research Unit, Oncology Hospital, Mexican Institute for Social Security, Avenida Cuauhtemoc 330, Colonia Doctores, 06720 Mexico City, DF, Mexico.

B-cell acute lymphoblastic leukemia (B-ALL) is a serious public health problem in the pediatric population worldwide, contributing to 85% of deaths from childhood cancers. Understanding the biology of the disease is crucial for its clinical management and the development of therapeutic strategies. In line with that observed in other malignancies, chronic inflammation may contribute to a tumor microenvironment resulting in the damage of normal processes, concomitant to development and maintenance of neoplastic cells. We report here that hematopoietic cells from bone marrow B-ALL have the ability to produce proinflammatory and growth factors, including TNFα, IL-1β, IL-12, and GM-CSF that stimulate proliferation and differentiation of normal stem and progenitor cells. Our findings suggest an apparently distinct CD13(+)CD33(+) population of leukemic cells contributing to a proinflammatory microenvironment that may be detrimental to long-term normal hematopoiesis within B-ALL bone marrow.
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http://dx.doi.org/10.1155/2015/386165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450234PMC
March 2016

Role of Genetic Polymorphisms of Deoxycytidine Kinase and Cytidine Deaminase to Predict Risk of Death in Children with Acute Myeloid Leukemia.

Biomed Res Int 2015 18;2015:309491. Epub 2015 May 18.

Hospital Infantil de México Federico Gómez, Research Division, Calle Doctor Márquez 162, Colonia Doctores, Delegación Cuauhtémoc, 06720 Mexico City, DF, Mexico.

Cytarabine is one of the most effective antineoplastic agents among those used for the treatment of acute myeloid leukemia. However, some patients develop resistance and/or severe side effects to the drug, which may interfere with the efficacy of the treatment. The polymorphisms of some Ara-C metabolizing enzymes seem to affect outcome and toxicity in AML patients receiving cytarabine. We conducted this study in a cohort of Mexican pediatric patients with AML to investigate whether the polymorphisms of the deoxycytidine kinase and cytidine deaminase enzymes are implicated in clinical response and toxicity. Bone marrow and/or peripheral blood samples obtained at diagnosis from 27 previously untreated pediatric patients with de novo AML were processed for genotyping and in vitro chemosensitivity assay, and we analyzed the impact of genotypes and in vitro sensitivity on disease outcome and toxicity. In the multivariate Cox regression analysis, we found that age at diagnosis, wild-type genotype of the CDA A79C polymorphism, and wild-type genotype of the dCK C360G polymorphism were the most significant prognostic factors for predicting the risk of death.
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http://dx.doi.org/10.1155/2015/309491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450239PMC
March 2016

Importance of maternal diabetes on the chronological deregulation of the intrauterine development: an experimental study in rat.

J Diabetes Res 2015 9;2015:354265. Epub 2015 Feb 9.

Laboratorio de Investigación en Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, 06720 Colonia Doctores, DF, Mexico.

We investigated whether maternal diabetes induced in rats using streptozotocin (STZ) on Day 5 of pregnancy affects the intrauterine developmental timeline. A total of 30 pregnant Sprague-Dawley diabetic rats (DRs) and 20 control rats (CRs) were used to obtain 21-day fetuses (F21) and newborn (NB) pups. Gestational age, weight, and body size were recorded as were the maxillofacial morphometry and morphohistological characteristics of the limbs. In DRs, pregnancy continued for ∼1.7 days, and delivery occurred 23 days postcoitus (DPC). In this group, the number of pups was lower, and 13% had maxillofacial defects. F21 in the DR group had lower weights and were smaller; moreover, the morphological characteristics of the maxillofacial structures, derived from the neural crest, were discordant with their chronological gestational age, resembling 18- to 19-day-old fetuses. These deficiencies were counterbalanced in NB pups. We conclude that hyperglycemia, which results from maternal diabetes and precedes embryo implantation, deregulates the intrauterine developmental timeline, restricts embryo-fetal growth, and primarily delays the remodeling and maturation of the structures derived from neural crest cells.
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http://dx.doi.org/10.1155/2015/354265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337320PMC
October 2015

[Clinical research design and causality: does oral rotavirus vaccine cause intussusception?]

Bol Med Hosp Infant Mex 2015 Sep - Oct;72(5):346-352. Epub 2015 Oct 16.

Dirección de Investigación, Hospital Infantil de México Federico Gómez, México D.F., México.

Design of clinical research whose purpose is to answer questions about causality can be classified in relation to four axes: the number of study groups, the implementation of an experimental maneuver, cause-effect directionality and source from which the data are collected. The basic designs used in epidemiology are the clinical trial, the cohort study, the case-control study and the cross-sectional survey. This text aims to facilitate the identification and understanding of each of these designs through examples related to the association between rotavirus vaccination and intussusception.
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http://dx.doi.org/10.1016/j.bmhimx.2015.09.005DOI Listing
October 2015

Phenotypic characterization of multidrug-resistant Pseudomonas aeruginosa strains isolated from pediatric patients associated to biofilm formation.

Microbiol Res 2015 Mar 5;172:68-78. Epub 2014 Dec 5.

Laboratorio de Investigación en Bacteriología Intestinal, Unidad de Hemato-Onocología e Investigación. Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Delegación Cuauhtémoc, México, D.F. 06720, Mexico. Electronic address:

Background: Pseudomonas aeruginosa is an opportunistic pathogen that has acquired several mechanisms of resistance to multiple groups of antibiotic agents and has been widely employed as a model organism for the study of biofilm formation. Many P. aeruginosa structures embedded in the extracellular matrix, such as exopolysaccharides (EPS), flagella, and type-IV pili (T4P), have been associated with biofilm formation. In this study, we assess biofilm formation by crystal violet quantification in clinical strains of multidrug-resistant (MDR) P. aeruginosa isolated from the Hospital Infantil de México Federico Gómez (HIMFG) associated to total and reducing EPS production (quantification by the anthrone and DNS method, respectively), twitching motility activity by T4P, and flagellar-mediated motility.

Results: The determination of Minimum Inhibitory Concentration (MIC) showed that >50% of P. aeruginosa strains were resistant to 12 different antibiotics (TIC, CAZ, CTX, CRO, FEP, AZT, GM, CIP, LEV, PZT, IMP, and MEM). Total and reducing EPS analysis of the 58 biofilm-forming MDR P. aeruginosa strains showed heterogeneous values ranging from OD600 9.06 to 212.33, displaying a linear correlation with the production of total EPS (59.66μg/ml to 6000.33μg/ml; R(2)=0.89), and a higher correlation with reducing EPS (88.33μg/ml to 1100.66μg/ml; R(2)=0.96). T4P twitching motility showed a moderated linear correlation (2.00mm to 28.33mm; R(2)=0.74). Even though it has been demonstrated that flagella contribute to the initial stages of biofilm formation, crystal violet analysis showed a moderate correlation (R(2)=0.49) with flagellar-mediated motility in MDR P. aeruginosa under the tested conditions. In addition, PFGE profiles revealed two subgroups generating profiles group A, consisting of 89.63% (52/58) of the strains, and group B, consisting of 13.09% (6/58) of the strains.

Conclusions: Phenotypic analysis showed a correlation among the biofilms developed in the MDR P. aeruginosa strains with EPS (total and reducing) production, T4P-activity by twitching motility and flagellar-mediated motility.
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http://dx.doi.org/10.1016/j.micres.2014.11.005DOI Listing
March 2015

[Frequency of allergy to cow's milk proteins and its association to other allergic diseases in patients of Hospital Infantil de Mexico Federico Gomez].

Rev Alerg Mex 2014 Oct-Dec;61(4):288-97

Hospital Infantil de México Federico Gómez, México, DF.

Background: The cow's milk protein allergy is the most common food allergy among children under two years and is associated with other atopic diseases.

Objectives: To evaluate cow's milk protein allergy frequency in patients sensitized to them, attended at the consultation of Immunology and Allergy in the Hospital Infantil de México Federico Gómez, and its association with other atopic diseases.

Material And Method: A cross-sectional, analytical and descriptive study that reviewed medical records of patients aged 0-19 years, attended at the consultation of Immunology and Allergy in the Hospital Infantil de México Federico Gómez, from January 2010 to January 2013, sensitized to the cow's milk protein by in vitro or in vivo studies, mediated or not by IgE, to determine its association with other atopic diseases during the course of their clinical evolution.

Results: We included 252 patients with symptoms suggestive of cow's milk protein allergy, which was diagnosed only in 15.1% by oral challenge. In relation to respiratory symptoms, about two-thirds of patients had rhinorrhea, nasal obstruction and nasal itching. Regarding gastrointestinal symptoms, about a third had abdominal pain, diarrhea and abdominal distension, being statistically significant. The most common dermatologic symptom, statistically significant, was xerosis. The most frequently associated atopic diseases were food allergy (76.3%), allergic rhinitis (65.8%), asthma (47.4%) and atopic dermatitis (23%).

Conclusions: The cow's milk protein allergy can be associated with other atopic diseases, such as allergy to other foods, allergic rhinitis, asthma and atopic dermatitis.
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December 2014

Does the Medical Insurance Siglo XXI have the potential to reduce neonatal and under-5 mortality rate in Mexico?

Bol Med Hosp Infant Mex 2014 Sep - Oct;71(5):259-260. Epub 2015 May 19.

Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, México D.F., México. Electronic address:

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http://dx.doi.org/10.1016/j.bmhimx.2014.10.004DOI Listing
May 2015

Economic evaluation of the use of exogenous pulmonary surfactants in preterm newborns in a Mexican population.

Salud Publica Mex 2012 ;54 Suppl 1:S73-81

Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, México, DF, México.

Objective: To estimate the cost-effectiveness ratio of surfactant rescue treatment of premature infants with respiratory distress syndrome (RDS) who are covered by the Medical Insurance for a New Generation.

Materials And Methods: A cost-effectiveness evaluation was conducted from the third-payer perspective. Comparisons were made between the use of bovine surfactant (BS) therapy and without BS therapy. A decision tree model with a lifetime horizon was used where the measurements of effectiveness were life years gained (LYG) and quality-adjusted life years (QALYs). A 5% discount rate was considered for costs and health outcomes. All costs are expressed in Mexican pesos 2009.

Results: Incremental cost-effectiveness ratios (ICER) were MXN$136,670 per LYG and MXN$125,250 per QALY.

Conclusion: Surfactant therapy was confirmed as a cost-effective strategy in accordance with World Health Organization criteria of three per capita gross domestic product (GDP) per QALY in premature infants with RDS in Mexico.
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http://dx.doi.org/10.1590/s0036-36342012000700010DOI Listing
February 2013

Cost-effectiveness analysis of the use of palivizumab in the prophylaxis of preterm patients in Mexico.

Salud Publica Mex 2012 Jan-Feb;54(1):47-59

Dirección de Investigación, Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, DF.

Objective: The study evaluated the incremental cost-effectiveness ratio (ICER) of the prophylaxis of palivizumab, for the reduction of complications associated to the respiratory syncytial virus in preterm patients in Mexico.

Material And Methods: A decision tree was developed in preterm groups [<29 and 29-32 weeks of gestational age (wGA)], by using epidemiological and cost local data; the effectiveness was obtained with a systematic review. Patients were evaluated according to their life expectancy. Mexican Health System perspective was used. Effectiveness measures employed were LYG and QALYs. The costs are reported in USD 2009.

Results: ICERs per LYG resulted on values of USD $25,029 and USD $29,637 for <29 wGA and 29-32 wGA respectively, whereas ICERs per QALYs obtained in the model accounted for USD $17,532 and USD $20,760.

Conclusions: Palivizumab prophylaxis for preterm newborn patients ≤32 weeks of age resulted in a cost-effective alternative.
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July 2012

Unnecessary gastric decompression in distal elective bowel anastomoses in children: a randomized study.

World J Surg 2010 May;34(5):947-53

Pediatric Surgery, Hospital Infantil de Mexico Federico Gomez, Dr. Márquez No. 162, Col. Doctores, Delegación Cuauhtemoc, Mexico, DF, CP 06720, Mexico.

Background: The goal of this study was to investigate the role of nasogastric drainage in preventing postoperative complications in children with distal elective bowel anastomosis. Nasogastric drainage has been used as a routine measure after gastrointestinal surgery in children and adults to hasten bowel function, prevent postoperative complications, and shorten hospital stay. However, there has been no study that shows in a scientific manner the benefit of nasogastric drainage in children.

Methods: We performed a clinical, controlled, randomized trial comprising 60 children who underwent distal elective bowel anastomoses and compared postoperative complications between a group with nasogastric tube in place (n = 29) and one without it (n = 31).

Results: Demographic data and diagnoses were comparable in both groups (P = NS). No anastomotic leaks or enterocutaneous fistulae were found in any patient. There were no significant differences between the two groups with respect to abdominal distension, infection, or hospital stay. Only one patient in the experimental group required placement of the nasogastric tube due to persistent abdominal distension (3.2%).

Conclusions: The routine use of nasogastric drainage after distal elective intestinal surgery in children can be eliminated. Its use should depend on the individual patient's situation.
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http://dx.doi.org/10.1007/s00268-010-0442-3DOI Listing
May 2010

Streptococcus pneumoniae isolates in healthy children attending day-care centers in 12 states in Mexico.

Salud Publica Mex 2007 Jul-Aug;49(4):249-55

Hospital General Dr Manuel Gea González, Mexico.

Objective: The aim of this study was to determine the prevalence of asymptomatic nasopharyngeal carriage of Streptococcus pneumoniae, which is a major factor in the transmission of this bacterium.

Material And Methods: Nasopharyngeal cultures were performed on children attending 32 day-care centers in 12 states in Mexico.

Results: Streptococcus pneumoniae was isolated from the nasopharynx of 829 out of 2,777(29.9%) subjects aged two months to six years. All children lived in urban areas and 80% spent more than six hours daily in a day-care center. Streptococcus pneumoniae serotypes most frequently identified were: 19F (23%), 6B (15.6%), 23F (11.2%) and 6A (14.9%). Thirty-six percent of the isolates were susceptible to penicillin.

Conclusions: Serotype distribution suggests the possible benefits that could be obtained from the heptavalent pneumococcal conjugate vaccine.
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http://dx.doi.org/10.1590/s0036-36342007000400004DOI Listing
November 2007