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Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Lead poisoning has a very varied clinical presentation, which in many cases complicates the diagnosis; the severity of it depends on the time and amount of exposure, this exposure is usually occupational, especially those activities related to mining, metallurgy, water or contaminated food and, on rare occasions, it is secondary to contact with retained bullets in the body. CLINICAL CASE: A 34-year-old male patient, who 10 years earlier suffered gunshot wounds in four body regions, which caused the retention of shards that in turn caused lead poisoning. CONCLUSIONS: Diagnosis is made with an adequate medical history, identifying the source of contact and confirming it by measuring lead levels in blood, treatment is based on reducing the degree of exposure or, if required, chelation therapy. [ABSTRACT FROM AUTHOR]

BACKGROUND: The classification of the heart rate in emergencies requires electrocardiography or monitor, so cellular technology could be a more accessible alternative. The prompt classification of the rhythm in the Emergency department can save lives. OBJECTIVE: To evaluate the accuracy of the electrocardiographic readings obtained with a conventional vs cellular electrocardiogram. MATERIALS AND METHODS: Prospective cohort study, conducted at the Emergency Medical Service of Culiacan Civil Hospital, Mexico. 12 lead electrocardiography and cellular electrocardiography were performed on all patients who requested medical attention from November 2018 to January 2019. They were classified according to the rhythm reported and then compare the rhythms by type of electrocardiogram. RESULTS: One-hundred patients were analyzed, 48 men and 52 women; aged between 20 and 90 years with an average of 39.4 ± 2.0 years. Three independent cardiologists determined rhythm, characteristics of the segments and overall diagnostic impression and among them the value of general Kappa was 0.81 (p = .000). 100% N95 concordance (p = 0.00) for the detection of rhythm with wireless cellular electrocardiography, finding no difference with the standard that is the 12-lead electrocardiogram. CONCLUSIONS: The electrocardiography of a shunt using a cardiochip is capable of clinically meaningful recording and translating the heart rate. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To know the prevalence of vitamin D deficiency in older adults with and without hip fracture in a third level hospital. MATERIAL AND METHOD: An observational, descriptive, retrospective and crosssectional study was conducted in elderly patients from August 1st 2016 to August 1st 2017. For their analysis, they were divided into two groups, one group with a hip fracture and the other without a fracture history. Demographic data, levels of 25-hydroxyvitamin-D [25(OH)D] and PTH were collected. Vitamin D deficiency was defined according to Holick's classification. RESULTS: There were included 58 patients, each group with 29. The levels of 25(OH) D were, on average, 18.24 ± 7.8 ng/mL in all patients, with differences between the groups of fractured vs non-fractured: 14.83 ± 5.28 ng/mL vs 21.66 ± 7.45 ng/mL, respectively; p < 0.001. The prevalence of vitamin D deficiency was 63.7%, being higher in the fractured group compared to those without this background: 86.2% vs 41.4%. CONCLUSIONS: Deficiency of vitamin D is high in the population of elderly adults and its frequency is increased with age. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: To determine if there is a difference between measuring blood pressure in the arm with and adequate size bracelet for patients (arm circumference > 34 cm) vs measuring blood pressure in the forearm with a standard bracelet (arm circumference < 22-33 cm) in patients with arm circumference > 34 cm. MATERIAL AND METHOD: A prospective, observational, cross-sectional study was done from January to June 2017. Sample: patients from external consult of Hospital General de Mexicali with arm circumference > 34 cm. Blood pressure was measured in the forearm of the patient with a standard bracelet, blood pressure was measured again in the arm with an adequate bracelet (for patients with an arm circumference > 33 cm). RESULTS: 320 patients were included for this study, 67% were women, with an average age of 41 years, average arm circumference was of 38 cm. In men, the average age was 35 years with an average arm circumference of 38 cm. Average of the systolic pressure in the forearm was 128.6 ± 12.5 vs 125.5 ± 13.6 mmHg in the arm, with a difference of 3.54 with a p = 0.0007. The average of the diastolic pressure in the forearm was 83.42 ± 8.95 vs 79.21 ± 8.88 mmHg in the arm with a difference of 4.21, p ≤ 0.0001. CONCLUSIONS: Measurement of blood pressure in the forearm with a standard bracelet in patients with an arm circumference > 34 cm when we don't have the adequate bracelet will give us similar values compared to the blood pressure in the arm with an adequate bracelet, with higher values but differences below 5 mmHg. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Acute kidney injury is a common complication in patients with acute heart failure. OBJECTIVE: To describe the clinical, epidemiological and laboratory characteristics of patients hospitalized due to an event of type 1 cardiorrenal syndrome. MATERIAL AND METHOD: A prospective study including patients hospitalized with acute heart failure, whose clinical diagnosis was established according to Framingham criteria. Definitive diagnosis was corroborated by echocardiography and serum levels of brain natriuretic peptide. Acute kidney injury was diagnosed and classified at admission or during hospitalization according to Acute Kidney Injury Network (AKIN). Clinical, epidemiological and laboratorial characteristics were compared between patients with and without acute kidney injury. Etiology, severity and evolution of acute kidney injury episodes were studied. The risk factors associated to acute kidney injury were studied with logistic regression analysis. RESULTS: There were included 67 patients with mean age of 66 ± 16 years and 52.2% were male. Acute kidney injury was observed in 53.7% of the patients, of whom 47.2% corresponded to episodes of AKIN 1, 27.8% to AKIN 2 and 25% to AKIN 3. Oliguric acute kidney injury was present in 33.3% of cases and 13.9% required dialysis. Renal function recovery at hospital discharge was observed in 50% of patients. The risk factors associated with acute kidney injury were: inotropic use with OR of 5.0 (95% CI 0.98-26.6, p = 0.05) and previous diagnosis of chronic renal disease with OR of 18 (95% CI, 3.6-102.2; p < 0.01). CONCLUSIONS: Acute kidney injury was a frequent complication in patients hospitalized for acute heart failure in our population. Inotropic requirement as an expression of the severity of heart failure and a history of chronic renal disease were the independently factors associated with the development of acute kidney injury. [ABSTRACT FROM AUTHOR]

This paper reports the case of a 33-year-old female patient who had previous smoking history and a three years diagnosis of systemic lupus erythematosus (SLE) with mucocutaneous and articular activity. She was admitted in the Internal Medicine department in order to diagnose and treat painful purpuric lesions. These purpuric lesions had a recent onset and were localized predominantly on the face and upper and lower extremities. The skin lesions progressed into extensive painful purpuric plaques on both legs and thighs, including large areas of necrosis. The patient denied symptoms of lupus activity in other organs. She referred three previous episodes with similar clinical findings but with minor skin involvement. On admission DNA antibodies, antinuclear antibodies and rheumatoid factor were positive. Skin biopsy reported leukocytoclastic vasculitis and other systemic involvement for vasculitis were discarded. A final diagnosis of leukocytoclastic vasculitis associated with SLE was made. Patient was treated with systemic steroids and intravenous antibiotics due to the large area of skin involvement. [ABSTRACT FROM AUTHOR]

Background: Pharmacists play a fundamental role in multidisciplinary team that provides health care to patients, both primary and specialized care, since pharmacist specializes in drugs management. In hospitals, pharmacists are able to follow up pharmacotherapy outcomes, and analyzing the whole medication use process in order to identify medication errors. Objective: To identify, quantify and classify medication errors found in medical records of a Hospital Regional Lic. Adolfo Lopez Mateos, Mexico City. Material and method: A retrospective study was performed reviewing medical prescriptions done during 2012 and those available of 2013, found in the files of all patients attending to consultation at Preventive Medicine Unit of Regional Hospital Lic. Adolfo Lopez Mateos, ISSSTE, from April 2 to June 28, 2013. Results: We identified 686 medication errors, 84.3% (578) were found in hospitalization management and 15.7% (108) in outpatient management. Drugs classes mainly involved in medication errors were: antibiotics, nonsteroidal anti-inflammatory drugs and antihypertensive drugs. Conclusions: It is evident the need of participation of health professionals trained in the hospitalary pharmacy field who colaborate with the team of medical care in order to detect, correct and avoid the medication errors, real or potential, occuring in the daily practice. [ABSTRACT FROM AUTHOR]

Background: Hypoglycemia is a frequent complication in patients with diabetes mellitus. Furthermore it has a negative impact on morbidity, mortality and quality of life of these patients. Objective: To identify risk factors associated with episodes of severe hypoglycemia in patients with diabetes mellitus. Material and method: A case-control study was performed including 58 patients with diabetes mellitus who were admitted to the emergency department with a diagnosis of severe hypoglycemia and 63 controls diabetic patients. Binary logistic regression was used to study the effect of clinical, demographic and laboratorial characteristics for severe hypoglycemia risk. Results: Mean age was 63 ± 13 years, 66.1% (n = 80) were female and 95% had diabetes mellitus 2. Risk factors associated with severe hypoglycemia were: age with OR of 1.12 (95% CI 1.05-1.20; p = 0.01), administration of secretagogues with OR of 9.92 (95% CI 1.56-63.22; p = 0.02), administration of NPH insulin with OR of 131.99 (95% IC 8.5- 2,049.9; p = 0.01) and number of previous hypoglycemic events with OR 26.33 (95% IC 3.92-176.71; p = 0.01). Protective factors against severe hypoglycemia were: previous follow up by internal medicine doctor with OR of 0.07 (95% CI 0.01-0.35; p = 0.01) and previous follow up by endocrinologist with OR of 0.01 (95% CI 0.00-0.40; p = 0.02). Conclusions: Risk factors for severe hypoglycemia were: age, previous hypoglycemic event, administration of NPH insulin and secretagogues. Interestingly, follow up by specialist doctor had an important role in reducing the risk of severe hypoglycemia. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The autoimmune hemolytic anemias antibody can be hot or cold, have an incidence of 70 to 80% may be idiopathic in 50 to 60% and the rest of the cases secondary to lymphoproliferative disorders, collagen disease, drugs, solid tumors, infections and inlammatory bowel disease. Case: 27 year old male starts with a runny nose, rhinolalia, malaise so Treating yourself with ampicillin 500 mg every 6 hrs x 3 days. Then drink alcohol and generalized jaundice, myalgia, arthralgia, predominantly in the hands and knees, symmetrical, nausea, vomiting and hematemesis on two occasions. Physical examination BP 90/60, HR 110, FR 16, temperature 37.7 ∞, oriented with generalized paleness of skin, icteric sclerae, mucous membranes dehydrated, parotid hypertrophy, short neck, without lymphadenopathy. Thorax with anterior axillary lymphadenopathy in 2 cm and painless. Abdomen globose at the expense of adipose tissue, liver edge was palpable 3 cm below the costal margin, soft in consistency, smooth, tender, palpable spleen 2 cm below the left costal margin, non tender, bloat in colonic frame, peristalsis of 6 per minute. Limbs without swelling or pain in joints without deformity, with preserved muscle strength and tone, capillary reill 3 seconds without edema. Leukocyte 16400, 13 300 neutrophils, lymphocytes 2530, monocytes 350, 105 eosinophils, basophils, 109, 3.82 Hb, Hct 8.07, MCV 96.8, platelets 103 000 CMH45. glucose 207, l7 BUN, creatinine 1.1, Na 133, K 3.63, Cl 108, total protein 6.3, albumin 3.6, cholesterol 120, calcium 7.8, PO2 1.1, Mg 2.6, BD 1.7 BT 9.2, BI 7.5, AST 59 ALT 78 LDH GGT 903 51. 05/04/1910: TP 15.8 seconds, PTT 22.2 seconds. Direct Coombs: positive. Peripheral blood smear: promyelocytes 1%, leukocyte cell 2 monositos 3%, neutrophils 94%, 72% erythroblasts in 100 leukocytes, has corrected WBC 20.8 x 10 3 / ml, macrocytosis and diffuse basophilia. With ESR 45 mm / m PCR rheumatoid factor 55 and 12.7 IU / ml. 05/10/1910. Packed red blood cells with Rh incompatibility so are washed and packed red blood cells are transfused in February because the patient is anemic data cor. Persisting with hemolysis data. Immunological proile are requested to report: Anti Nuclear Ab negative, anti-Smith Ab negative 3.6, positive Anti cyclic citrullinated peptide 88.1. U / ml. Management starts with pulses of methylprednisolone and metotrextate showing improvement. [ABSTRACT FROM AUTHOR]

Reumatoid arthritis is a disorder autoimmune of unknown etiology characterized by symmetrical, erosive sinovitis and in some cases implication of extraarticulating, Most of the patients have experience a chronic course of the disease that in spite of the therapy, can give rise to the progressive destruction towards the deformity, until the postration or incapacitation. Methotrexate is one of inmunomoduladores medicines more widely used in reumatoid arthritis and is generally safe in the used meterings. Nevertheless, one is due to be alert with respect to some of its less common indirect effect like the pneumonitis. We present the case of a patient who developed pulmonary toxicity induced by methotrexate and a bibliography review. [ABSTRACT FROM AUTHOR]

Acromegaly is a chronic, multisystemic disease caused by chronic growth hormone (GH) hypersecretion. Over 95% of acromegaly is caused by a adenoma in the pituitary, with only rare cases of ectopic neoplasms producing growth hormone or growth hormone releasing hormone (GHRH). The condition is rare, with prevalence rates reported at 53-69 cases per million, and incidence of three to four new cases per million per year. Mortality rates are approximately two times higher than in general population, relating to an average reduction in life expectancy of around ten years. The excess deaths are due predominantly to cardiovascular, cerebrovascular and respiratory diseases. The gradual onset and non-specific nature of many of the clinical signs and symptoms of acromegaly, the delay to diagnosis averages eight to ten years from the onset of symptoms. This delay in diagnosis is reflected in the size of the pituitary tumors that are a macroadenoma (>1 cm) at the time of diagnosis in at least 70% of patients. The diagnosis is performed with high rised quantify according to age and gender of insulin like growth factor (IGF-1) and corroborates with nadir growth hormone serum levels should be above 1 ng/mL, in the two hours after 75g oral glucose. Surgery currently is the preferred approach for treating most patients. Serum growth hormone levels are controlled within an hour after complete removal of the growth hormone-secreting adenoma. Transsphenoidal microsurgical adenomectomy approach is used most commonly and, in the hands of seasoned neurosurgeons, cures most patients who are harboring a well-circumscribed microadenoma. The follow-up is continuous with determination of insulin like growth factor (IGF-1), levels of suppressed growth hormone and magnetic resonance imaging of the hypophysis. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Spinal cord compression is a complication in 5 to 14% of cancer cases, and first manifestation in almost 10%. There is little information about neoplasm with this first manifestation. Objectives: To review epidemiologic, clinical and radiological data of spinal cord compression as first manifestation of metastatic cancer, and to propose diagnose guidelines for these patients. Material and methods: We made a retrospective, descriptive study of 5 years in which we reviewed 360 files with spinal cord compression diagnosis of any etiology. We included male and female patients that counted on final diagnosis of spinal cord compression secondary to metastasis of primary initially unknown tumor. We obtained demographic aspects, clinical picture, and studies of magnetic resonance of medulla and histopathology reports. Results: Twenty-seven patients had the spinal cord compression diagnosis as first manifestation of neoplasm. Seventeen of them were men (62.9%), with an average of age of 58 years. Most frequent clinical data was pain in back or radiculated pain (55.5% of the cases), as initial manifestation of the disease. The rest of patients had motor deficit and paresthesis. Thoracic column was the mainly affected segment (59.2%), two or more vertebral bodies were affected in 51.8%. In most cases spinal cord compression was secondary to hematology neoplasm (five multiple myeloma and two non-Hodgkin lymphomas), second most frequent was lung cancer and adenocarcinoma of prostate, five cases each one. Conclusions: Spinal cord compression as first manifestation of neoplasm appears in almost 7.5% medullar compression cases, with hematology neoplasm, lung cancer and adenocarcinoma of prostate gland as the most frequents. All patient with spinal cord compression as initial manifestation of metastatic cancer must be studied for this neoplasm. [ABSTRACT FROM AUTHOR]

Background: The neutropenic enterocolitis is a syndrome that is developed mainly in patients with hematologic neoplasms subjected to treatment with high dose of chemotherapy; it is characterized by neutropenia, abdominal pain and fever, with bowel wall thickening measured by ultrasonography or computed tomography. There are not reports of incidence neither mortality in Mexico. Objective: To determine the incidence of neutropenic enterocolitis in patient with hematologic neoplasms. Patients and method: Prospective, observational, and analitic study. Male and female patients were included, with diagnosis of hematologic neoplasm demonstrated by histopathology, subjected to treatment with chemotherapy agents, and that secondarily developed neutropenia. Neutropenic enterocolitis was defined with the neutropenia presence, fever, abdominal pain and, preferently, with demonstration for ultrasonography of a bowel wall thickening (BWT) bigger than 4 mm. Results: One-hundred ten patients were included, 58 male (52.7%). It was diagnosed neutropenic enterocolitis in 8 patients with an incidence of 7.27%, 6 of them were male. The mortality of patients with neutropenic enterocolitis was of 62.5% (5). The mean of beginning of neutropenic enterocolitis symptoms later to have begun the chemotherapy administration was of 14.38 days. The 8 patients with neutropenic enterocolitis had neutropenia, fever, abdominal pain with data of peritoneal irritation and diarrheic syndrome; in 6 of them it could be carried out abdominal ultrasonography pointing out BWT bigger than 4 mm. The hematologic neoplasm associated to the presence of NE was the mieloblastic acute leukemia M4 (MAL M4) OR = 9.6, IC 95% (1.84-50), p = 0.018. The cause of death of the patients with neutropenic enterocolitis was septic shock. An association between neutropenic enterocolitis and mortality was found in patients with neutropenia, OR 26.6, IC 95% (5.1-139.1), p < 0.0001. Conclusions: Neutropenic enterocolitis is a little frequent complication, but with high mortality. In this study we found that the MAL-M4 was associated with neutropenic enterocolitis; nevertheless, it is necessary to make new prospective studies to confirm this data. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)