Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. It is well-known that genetic alterations constitute the basis for the etiology of ALL. However, genetic abnormalities are not enough for the complete development of the disease, and additional alterations such as epigenetic modifications are required. Such alterations, like DNA methylation, histone modifications, and noncoding RNA regulation have been identified in ALL. DNA hypermethylation in promoter regions is one of the most frequent epigenetic modifications observed in ALL. This modification frequently leads to gene silencing in tumor suppressor genes, and in consequence, contributes to leukemogenesis. Alterations in histone remodeling proteins have also been detected in ALL, such as the overexpression of histone deacetylases enzymes, and alteration of acetyltransferases and methyltransferases. ALL also shows alteration in the expression of miRNAs, and in consequence, the modification in the expression of their target genes. All of these epigenetic modifications are key events in the malignant transformation since they lead to the deregulation of oncogenes as BLK, WNT5B and WISP1, and tumor suppressors such as FHIT, CDKN2A, CDKN2B, and TP53, which alter fundamental cellular processes and potentially lead to the development of ALL. Both genetic and epigenetic alterations contribute to the development and evolution of ALL.
Acrodermatitis enteropathica is a low-incidence disease due to inherited or acquired zinc deficiency. It is characterized by acral dermatitis, alopecia, diarrhea and growth retardation. The dermatological condition may mimic a cutaneous fungal infection or other pathogen-related skin diseases.
We report the case of a female patient of 7 months of age, who was sent to Centro Médico Nacional 20 de Noviembre for suspicion of immunodeficiency and cutaneous mycosis. Her condition began with dermatosis disseminated to the head, trunk and genital region; initial treatment with antifungal and broad spectrum antibiotics was given, without improvement. Upon admission, immunodeficiency and fungal infection were discarded. Acrodermatitis enteropathica was suspected, and corroborated later by low serum zinc levels. Immediately after the start of oral treatment with zinc, the patient showed improvement.
There are multiple differential diagnoses of acrodermatitis enteropathica, which includes cutaneous infections. Therefore, the early recognition of the characteristic lesions favors suspicion, diagnosis and appropriate treatment.
In pediatrics, complications of the peripherally inserted central venous catheters (PICC) are reported in 30-40% of the cases, being the age of the patient and the location of PICC the most frequent risk factors. This study aimed to describe the characteristics of PICCs and to identify factors related to their withdrawal due to complications.
A prospective cohort study was conducted. Patients from 2 months to 18 years of age were included and followed-up until PICC was withdrawn. Age, sex, medications administered, PICC location, caliber, the number of lumens, days PICC was on the patient, and the reason for withdrawal was recorded. Univariate and multivariate analyses were performed.
Two hundred and twenty-five patients were included. In 33.02%, PICC was withdrawn due to complications. In the bivariate analysis, age and location were factors associated with complications. A Cox proportional hazards model was performed. Only the caliber thickness (hazard ratio (HR): 0.5, confidence interval (CI) 95%: 0.35-0.99) was associated with any complication, and age (HR: 1.02, CI95%: 1-1.04) to the withdrawal of PICC due to suspected phlebitis.
PICC withdrawal due to complications was performed in 33% of the patients. Risk factors related to complications were PICC caliber thickness and age.
Part II is focused on participatory education (PE), a distinctive way to understand and practice education in contrast to passive education. The core of PE is to develop everyone's cognitive potential, which is frequently neglected or ignored.
The epistemological and empirical basis of PE is defined as the concept of creative critique, the idea of knowledge as each person's construction and life experience as the focus of reflection and cognition. PE aims towards educating individuals with unprecedented cognitive and creative capabilities, qualified to approach a more inclusive and hospitable world.
The last part is about the fact that medical education has remained among the passive education paradigm of the professional capabilities. It emphasizes the critical role of cognitive skills, both methodological and practical (clinical aptitude), in the progress of medical education and practice. Finally, it discusses what to do and how to do all these elements, aiming towards a better world away from human degradation.
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