Objetivo: Determinar la eficacia y la seguridad de hidroxicloroquina (HCQ) más azitromicina (AZT) comparada con HCQ sola y con placebo en pacientes con COVID-19 leve para disminuir el riesgo de hospitalización. Método: Ensayo clínico controlado, doble ciego, en pacientes con COVID-19 leve asignados aleatoriamente a los siguientes grupos: (1) HCQ + AZT 200 mg/250 mg cada 12 horas por 5 días, seguido por HCQ 200 mg cada 12 horas por 5 días; (2) HCQ 200 mg cada 12 horas por 10 días; o (3) placebo cada 12 horas por 10 días. Resultados: Se incluyeron 92 participantes. La incidencia de hospitalización fue del 6.7% (2/30) en el grupo de HCQ + AZT, mientras que en los grupos de HCQ y de placebo no hubo hospitalizaciones. La progresión de la enfermedad fue mayor en el grupo de HCQ. El riesgo de neumonía fue mayor en el grupo de HCQ que en el de placebo (RR = 3.33; IC 95%: 1.01-10.9). No se observó alargamiento del segmento QT en los grupos que recibieron HCQ + AZT y HCQ. Conclusiones: El uso de HCQ + AZT no disminuyó el riesgo de hospitalización; el uso de HCQ incrementó el riesgo de progresión y de neumonía.
Introduction: This article presents comprehensive safety guidelines and risk management strategies for conducting research involving bats in laboratory environments, building upon previously established field safety recommendations. With the increasing use of bats in biomedical and ecological research, proper handling, housing, biosafety, and biosecurity measures are critical for protecting researchers, the surrounding community, and animal welfare.Methods: This document discusses essential topics such as institutional review processes, medical surveillance, regulatory compliance, and the transportation of live bats and their biological materials. It also includes a discussion of pathogens of concern that may be found in bats or bat samples, from rabies and other lyssaviruses to filoviruses, henipaviruses, and others. It emphasizes the need for robust risk assessments tailored to various laboratory settings, highlighting procedures for handling potentially infectious tissues and fluids and managing bat housing in vivarium facilities. In addition, it addresses considerations for quarantine, environmental controls, and biosafety and biosecurity protocols that are critical for protecting researchers and the community, specifically the use of personal protective equipment and training requirements for laboratory personnel.Discussion: By detailing these safety practices using a holistic approach from a broad background of expertise, this article aims to equip researchers and biosafety professionals with the tools necessary to establish a safe and ethical framework for bat-related studies, facilitating responsible and effective research while minimizing zoonotic risks and supporting conservation efforts.
13 Background: Mexico faces a growing cancer burden with limited comparative mortality data across major cancer types. We analyzed 13-year mortality trends for the three leading cancer killers using artificial intelligence-based statistical modeling to inform public health priorities. Methods: We analyzed 271,630 death certificates from Mexico's National Health Information System (SINAIS/INEGI, 2012-2024) for breast cancer (BC), colorectal cancer (CRC), and lung cancer (LC). AI-assisted analysis was implemented using Python 3.x and Claude Sonnet 4.5 on Linux Ubuntu 24 to optimize processing time, handle large-scale data, and generate robust projections. Age-standardized mortality rates were calculated using direct standardization (Mexico 2020 standard population). Second-degree polynomial regression models and Prophet algorithm were developed to project mortality through 2030. Model performance was assessed using R² and mean absolute percentage error (MAPE). 95% confidence intervals were calculated using normal distribution. Results: Analysis through 2024 showed concordance with National Institute of Statistics and Geography (INEGI) official data, validating our approach. Total deaths 2012-2024: BC 98,947; CRC 86,016; LC 86,667. Divergent trends emerged: BC showed stabilization after initial growth (2012-2020: +10.7%; 2020-2024: -4.8%). CRC demonstrated sustained acceleration (+5.43% annually; 2024 surge: +11.4%), surpassing LC for the first time in 2024. LC exhibited unique trend reversal with post-2016 decline (-10.2%). Mean age at death: BC 58.6 years; CRC 65.5 years; LC 69.4 years. All models achieved excellent predictive accuracy (R² >0.92, MAPE <2%). 2030 projections: BC 10,268 deaths (+17.8% vs 2024); CRC 10,362 (+17.5%); LC 6,907 (+9.3%). CRC is projected to become the second leading cancer mortality cause by 2030, despite being detectable early. Conclusions: CRC emerges as Mexico's critical epidemiological challenge, showing accelerated growth despite high prevention potential, indicating systematic failures in screening and risk factor control. Divergent trajectories across cancer types validate the need for differentiated policy strategies. The limited window of opportunity demands immediate implementation of national CRC screening programs and risk factor regulation to prevent an avoidable crisis by 2030. Model performance and 2030 mortality projections. Cancer Type R² MAPE 2024 Deaths 2030 Projected Change Breast 0.98 1.89% 8,716 10,268 +17.8% Colorectal 0.98 1.67% 8,819 10,362 +17.5% Lung 0.92 0.88% 6,321 6,907 +9.3%
Neuroendocrine tumors of the pancreas are rare and can present with atypical metastatic patterns. Axillary involvement is extremely uncommon and requires a diagnosis of exclusion. Furthermore, it can be a therapeutic challenge. We present the case of a 78-year-old woman with a medical history of arterial hypertension, type 2 diabetes mellitus, and Parkinson's disease. She was diagnosed with pancreatic carcinoma with metastatic disease to axillary nodes. The patient developed a massive necrotic axillary tumor, measuring approximately 30 × 30 cm clinically, also associated with erythema, pain, exudate, and local infection. Laboratory tests showed severe anemia (Hb 7.4 g/dL), neutrophilia (95.1%), hyponatremia (Na 132 mmol/L), and hypokalemia (K 2.3 mmol/L). Imaging (contrast-enhanced CT and angio-CT) revealed a well-defined mass displacing the pectoral, deltoid, and serratus muscles; partially compressing the brachial artery with distal recanalization; and measuring approximately 25 cm x 20 cm. Three months after the first diagnosis, the patient underwent a palliative surgery including a block resection of the axillary tumor measuring 26 × 21 × 8 cm and weighing 3000 g. Histopathology results showed a poorly differentiated metastatic neuroendocrine carcinoma with rhabdoid features, extensive necrosis throughout the whole tumor, and positive margins. Immunohistochemistry was also performed and revealed focal enolase positivity, while CD56, p53, and chromogranin were negative. Pancreatic neuroendocrine tumors usually metastasize to the liver, peritoneum, or lymph nodes. Axillary metastasis is extremely rare and has been documented in only a few cases. The presence of a large, necrotic, infected tumor in this location significantly impacts quality of life. Surgical resection, although not curative, may provide substantial pain relief, control local complications, reduce infectious sequelae, and improve quality of life. This particular case highlights an uncommon metastatic site of pancreatic neuroendocrine carcinoma. Awareness of atypical metastatic patterns is essential for more precocious management, and surgical resection can provide substantial palliative benefit in selected patients.
OBJECTIVE:This study aims to determine the efficacy and safety of a fixed combination of hydroxychloroquine (HCQ) + azithromycin (AZT) compared to HCQ alone or placebo in mild COVID-19 to avoid hospitalization. METHOD:This is a randomized, double-blind clinical trial that included participants with mild COVID-19. They were randomly assigned to one of the three treatment arms: (1) HCQ + AZT 200 mg/250 mg every 12 h for 5 days followed by HCQ 200 mg every 12 h for 5 days; (2) HCQ 200 mg every 12 h for 10 days; or (3) placebo every 12 h for 10 days. RESULTS:A total of 92 participants were included. The incidence of hospitalization was 6.7% (2/30) in the HCQ + AZT group compared to the HCQ or placebo groups, in which there were no hospitalizations. Progression of disease was higher in the HCQ group (relative risk [RR] = 3.25 [95% confidence interval [CI], 1.19-8.87]) compared with the placebo group. There was a significant risk of pneumonia in the HCQ group compared with the placebo group (RR = 3.33 [95% CI, 1.01-10.9]). No lengthening of the QT interval prolongation was observed in patients receiving HCQ + AZT or HCQ. CONCLUSIONS:The use of HCQ + AZT does not decrease the risk of hospitalization. The use of HCQ increases the risk of progression and pneumonia.
