Revista medica del Instituto Mexicano del Seguro Social最新文献

Background: Motor multifocal neuropathy is an immunemediated neuropathy characterized by progressive and asymmetric weakness of the distal extremities, without sensory symptoms, and an important feature of conduction blocks. The objective of this study is to comprehensively describe the nosological and pathogenic implications of this neurodegenerative disorder, given the unclear diagnosis of MMN and the significant challenges it poses.

Clinical cases: We present three clinical cases with a chronic clinical presentation, in which neuroconduction studies were performed, revealing the presence of anti-IgM GM1 antibodies, consistent with the diagnosis of motor multifocal neuropathy. Although the treatment administered in these cases was successful, it is important to note that the diagnosis of MMN experienced some delay, emphasizing the need for greater awareness and understanding of this disease.

Conclusion: The diagnosis of motor multifocal neuropathy is often delayed, and an incorrect treatment can worsen symptoms, especially due to its similarity to other neuropathies and nerve and muscle diseases. Despite a generally favorable prognosis, the lack of early diagnosis can lead to severe motor sequelae. In this study, we provide detailed descriptions of three clinical cases from a reference center in Mexico, presenting their clinical manifestations, observed neurophysiological patterns, and treatment response.

Background: There is a continuing increase in the prevalence of people affected with progressive chronic diseases. Palliative care is another form of care and organization of health problems that improve quality.

Objective: To determine the incidence of patients with advanced chronic illness and need of palliative care (NPC) and intrahospital mortality in a reference hospital.

Methods: Prospective observational study in hospitalized patients over 18 years of age in the internal medicine department who met at least one criterion of the NECPAL CCOMS-ICO tool. They were followed until death or discharge to determine intrahospital mortality. We used descriptive and inferential statistics.

Results: We studied 370 admissions from April to August 2021, including 110 patients, 59 women (55.3%) and 51 men (44.7%), age 65.5 ± 15.85 years. The incidence of NPC was 29.7%. The most frequent comorbidity was oncologic in 39 patients (35.5%), followed by chronic heart disease in 17 patients (15.5%); 38 patients were classified as NECPAL grade I (34.5%), 44 NECPAL II (40%) and 28 NECPAL III (25.5%). Twenty-five patients died during their in-hospital stay, with a mortality of 22.7%.

Conclusions: The incidence of hospitalized patients in need of palliative care is considerable, more than half of them for non-oncologic pathology. More effective care strategies are required for external referral and multidisciplinary in-hospital care.

Background: Kidney transplant is the best replacement therapy for kidney function; However, donors are insufficient, so extended criteria donors (ECD) are needed, which, in well-selected recipients, provide better survival than being on dialysis. Dual kidney transplantation (DRT) should be offered to elderly patients with lower immunological risk and with a lower body mass index. DCE are considered donors who died due to stroke, ≥ 60 years old or aged between 50 and 59 years, with diabetes or previous hypertension, clinical proteinuria, estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min, or Terminal serum creatinine > 2.5 mg/dL.

Clinical case: 57-year-old male patient undergoing TRD of a 67-year-old DCE, with creatinine of 2 mg/dL at the time of extraction, without previous pathologies, with eGFR: 34 mL/min, KDPI: 92% , KDRI: 1.64, Remuzzi pre-implantation biopsy 5, with 14-hour cold ischemia. He was discharged on the eighth day with a creatinine of 1 mg/dL. At 45 months with creatinine of 0.9 mg/dL, and eGFR by CKD-EPI of 91 mL/min/ 1.73m2.

Conclusion: TRD is an alternative for ECD grafts. The "old for old" strategy allows TRD in older recipients a better survival than being on replacement treatment. The correlation with the KDRI, KDPI scales and the preimplantation biopsy according to the Remuzzi score improves transplant results by discarding kidneys with severe histopathological alterations, this can help reduce the rate of discarding SCAD and kidneys.

In the design of cross-sectional studies, the measurement of the components of the architectural design (baseline state, maneuver, and outcome) are measured simultaneously, for this reason it is relevant to try to respect that the maneuver is prior to the outcome, in this way, in the present study it was considered to exclude subjects with a history of alterations that generate alterations of cognitive function. However, the presence of conditions such as dependence on basic activities of daily living has not been shown to be a condition related to impaired cognitive function, which is why it was included as one of the factors studied.

The prevalence of chronic metabolic diseases in Mexico is high, being type 2 Diabetes mellitus (T2DM) as the most common disease. Several studies have shown that, compared with healthy individuals, patients with T2DM suffer a higher severity and mortality of Coronavirus disease 2019 (COVID-19). Therefore, it is important to the knowledge of the bidirectional relationship between these diseases. T2DM can increase SARS-CoV-2 virus pathogenicity in part due to metabolic disturbance. As a result, COVID-19 susceptibility and severity rise in diabetic individuals, which makes them a high-risk population. On the other hand, the infection caused by SARS-CoV-2 can lead individuals to hyperglycemia or new-onset diabetes. In order to understand the relationship between COVID-19 and T2DM, this review aims to emphasize the tropism of the SARS-CoV-2 virus to pancreatic beta-cells, as well as the physiologic effects of these.

Background: Diabetes is a metabolic disease highly prevalent in our country that ends in disabling complications such as diabetic retinopathy and macular edema. As a high-impact socioeconomic issue, it is important to look for an early diagnostic test that also allows us to introduce a telemedicine service for the population with little access to specialized health services.

Objective: To describe the performance in discrimination of macular edema of a feature detection algorithm on retinal fundus images from diabetic patients.

Material and methods: We use a database of 266 retinal fundus images of diabetic patients and were classified in Macular Edema or Without Macular Edema by ophthalmologists' assessment and we test if the algorithm was capable of establish the presence or not of macular edema.

Results: We made 3 tests in which the standards of sensitivity, specificity and efficiency of the algorithm were increasing according to the amount of retinal fundus images in the training phase, reaching specificity values of 100%, sensitivity 84% and efficiency 91.30%.

Conclusions: Our study lays the foundation of a reliable screening method due to its high specificity value and allows not only a binary reply in the presence or not of macular edema but the clinical and topographic classification favoring the onset of treatment.

Background: Trisomy of the short arm of chromosome 9 (9p) is the fourth most common chromosomopathy. It is a partial or complete autosomal structural anomaly of the short arm of chromosome 9. It is generally caused by a reciprocal parental translocation between chromosome 9 and another autosome; spontaneous genetic alteration (de novo) is rare. It presents great phenotypic variability due to the variable size of the chromosome fragment involved.

Clinical case: We present the case of a patient diagnosed with trisomy of the short arm of chromosome 9 with a karyotype with a chromosomal complement 46,XX,add(9)(p24), interpreted as an additional chromosome fragment on chromosome 9p. A microarray study was carried out, which reported that the 9p24.3-p13.1 region is found in triple dose, which corresponds to a partial trisomy 9p or Rethoré syndrome, which is a low prevalence entity, with an expressiveness and variable prognosis. In the present case, the finding of a murmur and diagnosis of pulmonary valve stenosis was the initial approach; The heart disease described in our patient has not been reported in the literature as part of the clinical picture, meaning that it was not an initial diagnostic suspicion.

Conclusion: Despite having described an already defined phenotype, other clinical data that are not documented should be considered, and when new clinical evidence is found, report it and thereby expand the phenotype for a timely diagnosis.

Background: Ectopic pancreas is a benign subepithelial tumor with an abnormal anatomical position, typically diagnosed incidentally as it does not produce symptoms and is challenging to identify in paraclinical studies. The incidence is very low, so our objective is to present the case of a patient with ectopic pancreas as a rare cause of obscure gastrointestinal bleeding.

Clinical case: A 70-year-old man presented with melena, anemia, and weight loss. The initial approach involved endoscopic studies (panendoscopy, colonoscopy, enteroscopy), a tagged red blood cell scan and computed tomography, none of which identified the bleeding site. Therefore, an exploratory laparoscopy was performed, revealing a 3 x 3 cm exophytic lesion in the proximal jejunum, which was completely resected. Histopathology confirmed an ectopic pancreas.

Conclusions: This condition is an uncommon but potentially serious cause of gastrointestinal bleeding, as the definitive diagnosis is often delayed. Therefore, clinical suspicion is crucial for early diagnosis and timely treatment, involving a multidisciplinary team of specialists in gastroenterology, radiology, pathology, and general surgery. In this manuscript, we present one of the few reported cases of ectopic pancreas as the cause of mid-intestinal bleeding.

Background: RYDG is the second most prevalent bariatric operation worldwide in terms of surgical treatment for the management of obesity and its comorbidities; however, one of its complications is the development of Petersen's space hernia. Currently there is no specific cause for their development since, based on studies published worldwide, they have an unpredictable behavior in each individual.

Objective: To establish the prevalence of Petersen's hernia and risk factors for its development.

Material and methods: Retrospective cohort study that included patients who underwent laparoscopic gastric bypass from January 2015 to December 2020. All procedures were performed by a single surgeon using antecolic and retrogastric configuration. Study variables: weight, BMI, mesenteric gap closure, suture material used, post-surgical complications.

Results: 00 patients were included, 64 women and 36 men, age 40.33 ± 2.08 years. The prevalence of Petersen's space hernia was 3% with a mean presentation time of 18 ± 7.54 months. The variables related to its development in the 3 cases were closure of the mesenteric gap, height, body mass index (BMI) and weight after the surgical procedure. All patients underwent reoperation, reducing the content and closing the mesenteric gap with non-absorbable suture material.

Conclusion: The development of the hernia not only depends on the closure of the mesenteric gap, but also on the reduction of weight and loss of volume of the mesentery with the reopening of the space.

Viruses represent one of the main causes of human morbidity and mortality worldwide. Plants have been used since time immemorial to treat, cure or alleviate diseases. We present some of them that make compounds with antiviral action and are used in traditional medicine. The objective of this work was to contribute to the knowledge of plants popularly used for the treatment of respiratory diseases of viral origin. The parts or organs mainly used are: the stem, leaves and flowers, while the method of use is mainly in decoction or infusion and its administration route is orally. The chemical compounds contained in plants used with antiviral properties are very diverse in nature, and belong to the groups of: essential oils, phenolic acids, alkaloids, flavonoids, glycosides, gums and mucilages, oleoresins; pectins, lignans, saponins and tannins.