Gaceta medica de Mexico最新文献

Functional mitral regurgitation (FMR) is the consequence of a series of geometric and functional alterations in the left ventricle, which precipitate structural changes in the mitral valve (MV). Left ventricular remodeling, whether global or localized, generates abnormal tension or tethering of the papillary muscles and chordae tendineae, thereby compromising proper MV closure. Given that FMR is often associated with coronary artery disease, the surgical indication for concomitant MV surgery with coronary artery bypass grafting (CABG) is unequivocal. However, the surgical indication for isolated MV surgery in patients with FMR without the need for CABG or other concomitant surgical procedures is more contentious. Excluding the indications for non-surgical procedures, this article examines the context and current status of isolated MV surgery in FMR. Furthermore, a potential decision-making algorithm for surgical interventions in patients with FMR is presented, based on the current accumulated evidence.

Background: Several studies show evidence of the relationship between sex hormone (SH) levels and Multiple Sclerosis (MS).

Objective: To describe serum SH levels and gynecological and obstetric characteristics of women with MS in remission and relapse.

Material and methods: This was a cross-sectional study. Gynecological, obstetric, clinical and laboratory measurements were analyzed. Serum determinations included 17b-estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, testosterone, and dehydroepiandrosterone.

Results: Eighty-nine patients were studied, with a mean age of 35.33 ± 9.5 and a mean age of 12.7 ± 1.7 menarche. 65.2% reported regular menstrual cycles (MC), 25.9% reported irregular MC, and 11 postmenopausal patients. Twenty-six patients experienced one or more miscarriages, 37 patients were nulligravidae, and in those who reported pregnancies, the median was two. Thirty-six patients were evaluated during a relapse; 22 of these patients had regular MC, and 59.1% of relapses occurred during the follicular phase. There was no difference in serum HS levels when compared between relapsed and non-relapsed groups.

Conclusions: There is a high frequency of irregular MCs and abortions in this sample of women with MS. In patients with regular BC, relapses occurred most frequently during the follicular phase.

Background: The use of cardiac implantable electronic devices (CIEDs) has increased in the past decade and increasing of associated complications. While infection is the most common indication for lead extraction, other reasons also necessitate the procedure.

Objective: Evaluate the outcomes of transvenous lead extraction (TLE) procedures conducted in tertiary referral hospitals in Mexico.

Material and methods: This retrospective observational study included data from two centers in Mexico City, collected between November 2014 and October 2023. Patients who underwent TLE for indications related to pacemakers, implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization therapy with defibrillator (CRT-D) were included. Primary outcomes assessed were procedure success rate, complications, and reasons for extraction.

Results: The study analyzed 271 patients who underwent TLE, successfully removing 534 leads with an overall success rate of 97.4%. Major complications were reported in four patients.

Conclusions: Transvenous lead extraction is a highly effective therapeutic approach with a high success rate and low complication incidence in a large patient cohort.

Social responsibility and moral agency in the doctor-patient relationship is a complex issue, but at the same time crucial and it can be guided by bioethical and responsibility principles. This relationship goes beyond simple professional interaction and seeks to ensure a health care model with equity and focused on the comprehensive well-being of the patient and the community. It is essential that health care professionals respect and support the moral agency of the patient, providing them with clear and understandable information, and facilitating ethical decision-making. Empathic communication and empathy are key to establishing a strong therapeutic relationship and helping the patient face difficult decisions with the most autonomy possible, confidence, and security. The intention of this article is to explore how the integration of social responsibility and moral agency can transform the doctor-patient relationship, fostering an environment of trust, mutual respect, and active collaboration in decision-making in health care practice and better decision-making. of decisions to avoid bioethical problems.

Gastroesophageal reflux disease (GERD) is common during pregnancy, affecting up to 80% of pregnant women. Treatment aims to relieve symptoms and not harm the fetus. Our objective is to provide guidance on the safe treatment of GERD in pregnancy. An electronic search of the English-language literature was performed in MEDLINE, PubMed, and Cochrane, to identify randomized controlled trials, observational studies, management recommendations, and reviews of GERD and its treatment during pregnancy. The search period was defined from 1992 to 2024. Treatment during pregnancy should be gradual, starting with lifestyle changes. If symptoms are severe, calcium-containing antacids or alginates should be started as the first pharmacological measure (grade A recommendation). If symptoms persist, sucralfate may be introduced (grade C recommendation), followed by a histamine-2 receptor antagonist (grade B recommendation). Proton pump inhibitors are reserved for women with intractable symptoms or complicated GERD; all are Food and Drug Administration category B drugs except omeprazole, which is category C (grade C recommendation). There are drugs that are contraindicated during pregnancy, and others that have not been thoroughly studied in this situation.

Background: RET gene is an oncogene for thyroid cancer, in contrast as tumor suppressor gene in colon cancer.

Objective: To know the role of RET gene in Cervical Cancer (CC) cells.

Materials and methods: Tissue microarray harboring healthy, Low- or High-Squamous Intraepithelial Lesions (LSIL or HSIL), and CC tissues were evaluated by immunohistochemistry. Nuclear cellular membranes were evaluated by an Olympus cellSens Dimension system. DNA from cervical cells and cervical-cell lines were assessed for detecting RET point mutation and methylation promoter status. GraphPad Prism ver. 9.3.1 software was used for the analysis.

Results: Healthy cervical samples expressed RET protein, in contrast a quite similar proportion 75-90% of the LSIL or HSIL, or CC samples (squamous or adenocarcinoma) demonstrated a lack of RET expression. Cervical glandular intraepithelial lesions presented a similar expression pattern compared with the control group. The CC cells do not exhibit RET point mutation for exons 10 and 16, but the RET gene promoter was methylated.

Conclusions: The lack of RET expression could correlate with the promoter methylated in the transformed cervical epithelial cells. These findings could suggest that RET gene acts as tumor suppressor gene in Cervical cancer.