Revista medica del Instituto Mexicano del Seguro Social最新文献

Background: Antiretroviral therapy (ART) is highly effective for treating HIV, but it is associated with metabolic alterations, such as insulin resistance (IR), which can be assessed using HOMA-IR, or using more accessible alternatives such as triglyceride-glucose (TG) index, which has been validated in Mexican population with a cut-off point of 4.68, with sensitivity of 96.5% and specificity of 85%. However, there are no studies analyzing the applicability and changes of the TG index after ART initiation in HIV-positive patients.

Objective: To describe the frequency of IR using the TG index in HIV patients without previous treatment (naive) before and one year after starting ART.

Material and methods: Comparative cross-sectional study. The Internal Medicine and Infectology Department records of patients recently diagnosed with HIV from a third-level hospital during 2010-2025 were reviewed. Biochemical, clinical, and anthropometric data were collected at baseline and one year after treatment initiation. Variables were recorded and analyzed blindly using SPSS, v. 25, with nonparametric statistics. It was considered significant a p with a < 0.05 value.

Results: 86 cases, 88.4% men, with a median age of 34.5 years (IQR 24-44.25), had a TG index of 4.70 (IQR 4.55-4.89) at baseline and 4.77 (IQR 4.63-4.89) at 1 year, with a statistically significant increase (p = 0.025).

Conclusions: Out of patients with naive HIV and normal baseline TG index, 64% exhibited an elevation above the IR threshold (> 4.68) after one year of ART. In contrast, among those with an already elevated baseline TG index, 72% remained elevated after one year of treatment.

Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare, but serious complication associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, characterized by persistent fever, systemic inflammation, and multiorgan involvement. It predominantly affects school-aged children and adolescents. Reports in infants under 1 year are limited, and atypical presentations pose diagnostic challenges.

Clinical case: 8-month-old male infant who presented with 10 days of persistent fever, diarrhea, and irritability. Initial laboratory findings revealed leukocytosis, marked thrombocytosis, persistent lymphocytosis, and significantly elevated liver enzymes. No mucocutaneous findings or cardiac involvement were noted. The diagnosis of MIS-C was established based on Centers for Disease Control and Prevention (CDC) criteria and confirmed by positive IgG serology for SARS-CoV-2. Treatment with intravenous immunoglobulin (IVIg), aspirin, and corticosteroids achieved a favorable clinical and biochemical evolution.

Conclusions: This case highlights an atypical presentation of MIS-C in a young infant, with hematological findings that differ from classic patterns. Early recognition and standard immunomodulatory therapy led to a successful outcome. Documenting such variants is essential to expand our understanding of MIS-C in underrepresented age groups.

Background: It has been documented the impact of obesity, specially central obesity on the development of cardiovascular diseases. Educational strategies seek to strengthen non-pharmacological treatment for this disease through interventions.

Objective: To evaluate the impact of the Steps for Health (Pasos por la salud) program on patients with overweight and obesity.

Material and methods: A longitudinal, prospective, observational study was conducted in patients with overweight and obesity, assigned to Family Medicine Unit No. 75 of Mexican Institute for Social Security (IMSS), from September 2023 to March 2024, with a non-probability convenience sample which included participants of the Steps for Health educational strategy. Pregnant women and patients with psychomotor disabilities were excluded. Somatometric, clinical, and biochemical measurements were taken at the beginning and end of the strategy. Physical activity levels were measured using the International Physical Activity Questionnaire (IPAQ).

Results: A positive impact of the intervention was achieved. The mean age was 60 years; women predominated; they were were married; they had a primary school education; 20% had a history of diabetes and hypertension. There was increased physical activity (p = 0.02), decreased anthropometric values (p = 0.01), improved blood pressure (p = 0.03), glucose control (p = 0.03), reduced triglycerides (p = 0.007), and increased HDL (p = 0.02).

Conclusions: The Steps for Health educational strategy had a positive impact.

Background: Mycetoma is a chronic subcutaneous infection caused by fungi (eumycetoma) or filamentous bacteria (actinomycetoma), acquired through traumatic inoculation. It affects the skin, subcutaneous tissue, and in advanced cases, deeper structures such as bones or the spinal cord. Its presentation can lead to severe complications, including paraplegia.

Clinical case: 74-year-old male farmer hospitalized due to sudden-onset paraplegia, with inability to walk and urinary and fecal incontinence. A dermatology consult was requested for a dermatosis affecting the trunk, located on the posterior aspect of the left hemithorax, which was localized and asymmetrical. The lesion consisted of multiple fistulas discharging purulent secretion and numerous erythematous-violaceous atrophic scars that coalesced to form a plaque measuring 30 x 30 cm. Neurologically, a complete spinal cord syndrome was diagnosed. Microbiological studies revealed the presence of grains measuring between 50 and 100 μm composed of filamentous bacteria, positive for periodic acid-Schiff (PAS) stain and acid-fast with Ziehl-Neelsen staining, consistent with Nocardia spp. Magnetic resonance imaging showed involvement of vertebrae T6, T7, and T8.

Conclusions: Actinomycetoma is endemic in Mexico. The classic triad includes a subcutaneous mass, fistulas, and grains. Its progression can cause vertebral destruction and myelopathy. Magnetic resonance imaging is the diagnostic study of choice due to its high soft tissue resolution. Therapeutic management combines antibiotics with activity against actinomycetes.

Delirium is underdiagnosed in the emergency department. The observed frequency was 43.8%. This figure is likely underestimated, given that detection with the Confusion Assessment Method (CAM) requires detailed, sequential clinical assessment, as well as specific training. Likewise, the fluctuating course of delirium can lead to false negatives if assessments are not repeated, which limits sensitivity and biases the estimate downward.

Background: Obesity is a global epidemic whose treatment includes alternatives such as bariatric surgery, in which weight regain is considered a common postoperative complication.

Objective: To compare the incidence of weight regain at 2 years between sleeve gastrectomy and gastric bypass.

Material and methods: Descriptive report of a retrospective cohort study including patients undergoing sleeve gastrectomy or gastric bypass, with postoperative body weight recorded and 2-year follow-up in the outpatient clinic at a tertiary care hospital in Mexico. Pre- and postoperative weight, body mass index (BMI), ideal weight, preoperative excess weight, percentage of excess weight lost, weight regain, and total weight loss were analyzed.

Results: 83 patients were included: 61 (73.4%) women and 22 (26.5%) men with a mean age of 43.3 years, pre-surgical weight of 127.12 ± 28.7 kg and BMI of 47.2 ± 9.14 kg/m². Of these, 15.6% received gastric sleeve and 84.3% gastric bypass. The overall incidence of weight regain was lower after bypass according to the second Voorwinde definition (p = 0.02), and higher in women (62.3%) compared to men (31.8%) in both procedures (p = 0.014).

Conclusions: Gastric bypass had a lower incidence of weight regain compared to gastric sleeve, and it was more common in women. No significant differences in the remission of comorbidities were identified between the 2 techniques.

Accurate statistical analysis is essential in validation studies of instruments that quantify continuous variables against a reference standard. This article describes statistical approaches to evaluate equivalence between measurement instruments combining graphical methods and statistical tests. Its application is exemplified through a study that assessed the accuracy of a physical activity tracking wristband (Xiaomi Mi Band 4) for counting steps walked during different activities in patients with chronic respiratory diseases, and it was compared with a video-based reference method. Confidence intervals were used alongside predefined equivalence zones, TOST (two one-sided tests) procedures were applied, and both group-level and individual-level indicators of agreement were calculated, such as the mean error (ME), mean percentage error (MPE), mean absolute percentage error (MAPE), and root mean squared error (RMSE). In addition, some common errors were also discussed, such as the inappropriate use of scatter plots or correlations to assess accuracy. The article concludes that selecting appropriate statistical methods is a key aspect to ensure clinical and methodological validity in equivalence studies between measurement instruments that quantify continuous variables and a reference method.

Acute leukemia (AL) is the most common malignancy in children in Mexico and Latin America, where high incidence and mortality rates are observed, particularly among populations with indigenous ancestry and unfavorable socioeconomic conditions. This article examines the social and biological determinants that influence the onset and progression of acute lymphoblastic leukemia (ALL), highlighting the Greaves and Kinlen hypotheses and their potential relevance in Latin American contexts. Evidence suggests that factors such as poverty, educational disadvantage, overcrowding, and limited access to healthcare directly affect childhood mortality from AL. In the analysis conducted specifically for this study, using publicly available open-access databases, a poverty-mortality gradient was identified, showing that the poorest municipalities face a higher risk of leukemia-related death in individuals under 20 years of age. The study concludes that epidemiology, when integrated with principles of social justice, is essential for designing and monitoring public policy interventions aimed at reducing inequalities and improving childhood survival in Mexico.

Background: Takotsubo syndrome is a potentially fatal cardiomyopathy, characterized by systolic dysfunction with apical hypokinesia and basal hypercontractility in the absence of coronary lesions. It is triggered by physical or emotional stress and accounts for 2% of acute coronary syndromes; it is more common in older women. Its pathophysiology is not entirely clear, although the adrenergic hypothesis is the most accepted: a cardiotoxic effect is proposed due to beta-adrenergic stimulation, with an imbalance in oxygen supply and demand and dysregulation of calcium-dependent proteins. However, certain comorbidities can mask the condition. The objective was to describe anomalous presentations of Takotsubo syndrome and briefly review its variants to familiarize cardiologists with unusual patterns.

Clinical cases: The first case was about a 68-year-old man with angina, hemodynamic instability, and prominent T waves in V2-V4, with no coronary lesions. A ventriculogram showed systolic dysfunction and basal hypokinesia. Second case was about an 81-year-old woman with pulmonary embolism presented with systolic dysfunction with apical hypokinesia after thrombectomy.

Conclusion: Stress cardiomyopathy can have atypical presentations, which is why it should be suspected in the presence of a ventricular dysfunction with no apparent cause.

Background: Hypertension and type 2 diabetes mellitus (T2DM) are prevalent chronic diseases that share common risk factors and contribute significantly to the economic burden on healthcare systems. Their impact is more pronounced in low-income countries, where they increase the prevalence of complications and associated healthcare costs.

Objective: To compare the costs of pharmacological treatment of hypertension according to the number of complications between patients with hypertension vs. patients with hypertension/T2DM.

Material and methods: An analytical cross-sectional study was conducted in two family medicine units in the metropolitan area of Mexico's central region. Subjects with hypertension and those with hypertension and T2DM were included. Hypertension-related complications were identified, and a microcosting analysis of hypertension pharmacological treatment was performed. To compare treatment costs between both groups it was used the Mann-Whitney U test.

Results: The cost of pharmacological treatment for patients with hypertension and T2DM was $30.5 USD higher compared to those with hypertension alone. The most common complications were heart disease, chronic kidney disease, and hypertensive retinopathy, with costs increasing as the number of complications rose. This effect was more stressed in the hypertension and T2DM group.

Conclusions: The pharmacological treatment cost for patients with hypertension and T2DM was higher compared to those with hypertension alone, even in patients without complications.