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Background: The debate on percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (LMCA) has been constant over time. Objective: To investigate the clinical and procedural characteristics and cardiovascular outcomes of PCI of unprotected LMCA. Material and methods: Observational study which included patients with unprotected LMCA disease undergoing PCI; patients with cardiogenic shock prior to the procedure were excluded. We describe the clinical and angiographic characteristics, as well as the major adverse cardiac and cerebrovascular events (MACCE) according to the year of the procedure. Results: We included 73 patients, with a SYNTAX I score of 31.2 ± 9.1, mostly with ST-elevation acute coronary syndrome (35%). There was a higher frequency of triple vessel coronary disease (63%) and distal LMCA lesions (35%). The provisional stent technique was the most used for distal lesions (58%) and the 2-stent technique for bifurcation lesions (78%), supported by intravascular ultrasound (IVUS) in 38%. During follow-up, 19 presented MACCE (26%), out of which cardiac death occurred in 13%, non-cardiovascular death in 5%, non-fatal acute myocardial infarction in 1%, cerebrovascular event in 2%, and revascularization of the treated vessel in 4%. Conclusions: It was observed a similar frequency to the one appearing in other studies of cardiovascular events, mainly in patients with intermediate risk, which supports the increasing use of percutaneous intervention in this population. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is widely recognized as the prevailing abdominal surgical emergency globally, exhibiting an annual incidence ranging from 96.5 to 100 cases per 100,000 adults. Conversely, situs inversus totalis is a rare anatomical anomaly characterized by the complete reversal of the chest and abdominal organs, occurring in approximately 1 out of every 10,000 to 50,000 individuals. Clinical case: 53-year-old female patient who presented to the emergency department with a complaint of diffuse abdominal pain of colic nature that had persisted for 5 days. The patient referred systemic hypertension, pre-diabetes mellitus type 2, and situs inversus as relevant medical history. A laparotomy procedure was conducted, revealing a perforated appendix located in the right hypochondrium. Additionally, the patient exhibited situs inversus totalis, with the colon positioned in its normal anatomical location. Conclusions: Due to the low incidence of situs inversus totalis, in cases similar to the one presented, the utilization of image studies and laboratory studies is imperative for accurate diagnosis. In the face of diagnostic suspicions and inconclusive paraclinical studies, the most effective approach is to pursue surgical examination and intervention, preferably utilizing laparoscopic techniques. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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: Central Cord Syndrome is the most common incomplete spinal cord injury, and it represents 9% of all spinal injuries of the adult. Objective: to determine the risk factors associated with lethality or/and mechanical ventilation (MV) in patients with Central Cord Syndrome (CCS). Material and Methods: upon a retrospective cohort with patients with posttraumatic CCS we evaluated at the time of emergency admission and until the hospital discharge. The dependent variable was dead or MV. We calculated incidence, relative risk (RR) with CI95% and a multivariate model for the association of statistically significant variables by means of a risk coefficient model upon the variables that evidenciated tendencies towards risk. Results: From 101 patients with CCS, 85.1% with a severe medullary canal stenosis and 9.9% required MV; the mortality was 13.9%. The only risk factor associated with dead was the use of MV with an RR of 3.6 (CI95% 1.4-9.5); the risk with tendencies towards MV was being older than 60 RR 5.4 (CI95% 0.6-44.2). Conclusions: MV is a risk factor associated with mortality, other factors evidenciated tendencies towards mortality; being older than 60, hypertension, diabetes mellitus, narrow spinal canal, more than 20 days of hospital stay and being intervened farther than 10 days from the accident. The incidence of mortality in our sample is greater than thus reported previously on other international articles. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 (AKI) is frequent in sepsis (25 to 51%), with high mortality (40 to 80%) and long-term complications. Despite its importance we do not have accessible markers in intensive care. In other entities (post-surgical and COVID-19) the neutrophil/lymphocyte and platelet (N/LP) ratio has been associated with acute kidney injury; however, this relationship has not been studied in a pathology with a severe inflammatory response such as sepsis. Objective: To demonstrate the association between N/LP with AKI secondary to sepsis in intensive care. Material and methods: Ambispective cohort study in patients over 18 years who were admitted to intensive care with a diagnosis of sepsis. The N/LP ratio was calculated from admission up to the seventh day and up to the diagnosis of AKI and outcome. Statistical analysis was performed with chi squared test, Cramer's V and multivariate logistic regression. Results: Out of the 239 patients studied, the incidence of AKI developed in 70%. 80.9% of patients with N/LP ratio > 3 had AKI (p < 0.0001, Cramer's V 0.458, OR 3.05, 95% CI 1.602-5.8) and increased renal replacement therapy (21.1 vs. 11.1%, p = 0.043). Conclusion: N/LP ratio > 3 has a moderate association with AKI secondary to sepsis in the intensive care unit. [ABSTRACT FROM AUTHOR]

Background: The presence of duodenal atresia related to type IIIb intestinal atresia is a rare association, with few cases reported in the literature, representing a surgical challenge considering that even isolated cases of type IIIb intestinal atresia are a challenge. The objective was to report the successful surgical management of a case of a complex intestinal malformation, characterized by duodenal occlusion secondary to annular pancreas and type IIIb intestinal atresia, with intestinal malrotation by definition and the presence of Meckel's diverticulum. Clinical case: We present the case report of a newborn sent to the second level of care with a diagnosis of duodenal obstruction not diagnosed prenatally, which resulted in duodenal atresia due to annular pancreas and type IIIb intestinal atresia according to the Grosfeld classification. The presence of duodenal atresia with type IIIb intestinal atresia is an extremely rare condition, even more so associated with annular pancreas. These cases are a challenge considering the short length of the small intestine and its consequent need for total parenteral nutrition for a prolonged period. Conclusions: The surgical management of this complex intestinal malformation resulted in a case with an adequate post-surgical evolution, based on the immediate start of enteral feeding with a short period of need for total parenteral nutrition that finally resulted in a short hospital stay. [ABSTRACT FROM AUTHOR]

In health systems, it is necessary to assess the costs for the production of services and the magnitude of the budget to operate, its formulation has been with the Historical Public Budget in Health, which can be complemented with the Zero-Base Budget, with reference medical technical costs. from the Economic Medical Certificate of the Groups Related to the Diagnosis and the Groups Related to Outpatient Care of the IMSS. The preparation of the certificate is for each scenario of treatment by hospital or outpatient diagnosis in four successive phases with groups of IMSS professionals. Each certificate contains information and costs of the production of services specified in: production functions, patient transit services; and production factors such as installed capacity, including personnel of all kinds, depreciation, general services, medicines, medical consumables, laboratory and office studies, and specific studies and procedures; with their respective unit cost. The Reference Technical Medical Cost provided by the Economic Medical Certificate with the necessary scaling allows estimating the budget for services, care units, institutions and health systems with medical, epidemiological, technical and economic information. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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: Clozapine (CZP) is an antipsychotic used in resistant psychosis, but has adverse metabolic effects and is associated with new onset or worsening of epileptic seizures (ES). There is not enough information available regarding its effect on metabolic variables and on ES in patients with epilepsy. Objective: To describe the effect of CZP on the metabolic and hematologic profiles, and on ES in patients with epilepsy and with psychosis and/or aggressive behavior. Methods: A case series of patients with epilepsy and psychosis and/or aggressive behavior that received CZP with an 18-week follow-up. Clinical records were assessed from 2008-2018. 30 patients with epilepsy that received CZP were included. A paired analysis (Student's t-test or Wilcoxon signed rank test) was performed with metabolic variables (glucose, cholesterol, and triglycerides), hematologic variables, weight, body mass index (BMI), and monthly ES before and after CZP administration. Results: The median age to CZP initiation was 31.9 ± 16.07 years. Median CZP dosage was 193 mg/day. There were changes on BMI (p = 0.001; 3.2 kg/m2 increase, median = 3.08), triglycerides (p = 0.002) and glucose (p = 0.030). Weight increase was 7 kg (p = 0.292; median = 4 kg). Monthly ES mean was decreased from 4.9 (median = 2) to 2.04 (median = 1; p = 0.001). Conclusions: This study provide information regarding the security profile of CZP in patients with epilepsy with psychosis and/or aggressive behavior. A decrease on monthly ES was observed, as well as moderate increases in triglycerides, glucose and BMI, which coincide with that described by other authors. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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: Cancer represents an important issue in health, with the economic impact that it takes. The aim of this paper is to analyze the epidemiological characteristics of a population with social security who was diagnosed with some type of cancer and required a disability pension. Methods: Observational study, retrolective cohort type, carried out at the Instituto Mexicano del Seguro Social (IMSS) with IMSS beneficiaries ruled with a state of disability due to malignancy during the period 2006 to 2012. Results: 13 633 cases were studied, observing an increasing behavior among the years mentioned. The age average of the rightful claimants ruled was 47.75 years; the main causes of disability due to malignant tumors were breast, colon and brain cancer. The definitive opinions represented the 49.66%, which are likely to generate a constituent amount for the IMSS. It is important to have data of the survival in relation to the most frequent malignant tumors, which can provide information about the severity and prognosis of these diseases. Conclusions: The results obtained lead to discuss the effectiveness of programs established on the prevention and early detection of non-communicable diseases, mainly in breast cancer, since the impact that has this type of suffering may involve a major financial problem for the IMSS because of the payment of constituent amounts. [ABSTRACT FROM AUTHOR]

Background: Nutrition transition provokes changes in the nutritional status of individuals subjected to the interaction of various environmental factors; therefore, the aim was to demonstrate that nutrition transition is associated with socioeconomic changes, eating habits and physical activity, potentially involved in stunting, overweight and obesity of schoolchildren. Methods: Case-control study. 102 participants from the Instituto Alteño para el Desarrollo de Jalisco (cases) and 194 from the elementary school system (controls), aged 5 to 12 years, were included. Dependent variables were these indexes weight/age (Z), height/age (Z), BMI (Z). Independent variables were the socioeconomic and demographic characteristics. Student's t test, chi square, odds ratio (OR) and 95% confidence intervals (95% CI) were estimated. Results: Family income was low (p = 0.031) and unstable job was higher in cases: OR = 4.1, 95% CI = 2.8-6.0. The frequency of stunting was higher in cases (9.9% vs. 5.9%). The combination of overweight/obesity was higher in controls (27.3% vs. 16.8%), OR = 1.85, 95% CI = 1.0-3.4. Conclusion: The nutritional status of children of Arandas, Jalisco, has been modified by an accelerate nutrition transition, provoked by socioeconomic, educational and demographic factors that might have influence on the persistence of stunting and an increasing prevalence of overweight/obesity. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe educational programs that reportedly teach how to break bad news in the emergency department. We also suggest some recommendations on how to communicate bad news based on the research of evidence available in the field. The examined evidence points toward six major components with which physicians should familiarize when communicating bad news: 1) doctor-patient empathic communication, 2) establishing a proper space to give the news, 3) identifying characteristics of the person who receives the news, 4) essential aspects for communicating the news; 5) emotional support, and 6) medical and administrative aspects of the encounter. Finally, we point out several limitations in the studies in the field and future challenges identified in the communication of bad news in emergency room facilities. [ABSTRACT FROM AUTHOR]

Background: Multiple treatments have been used for the unicameral bone cyst lesion, such as steroid application, multiple perforations, bone curettages, partial resection and bone grafting. The purpose of this study was to describe the evolution of children with unicameral bone cyst who were treated with cryosurgery as coadjuvant therapy. Methods: Cross-sectional descriptive study over the period between January 2001 and December 2006. Twelve patients were studied and treated at the Pediatric Orthopedics Department of the Pediatrics Hospital at the Centro Médico Nacional Siglo XXI. Results: Twelve patients were analyzed; all of them were treated with curettage, cryotherapy and bone grafting. In 7 patients, the lesions were located in the humerus (58.3 %), in 3 in the tibia (25 %), in 1 in the ilioischiopubic branch (8.3 %), and in 1 in the clavicle (8.3 %). Follow-up ranged from 12 to 36 months. Bone healing required 2 to 3 months after the surgery; the response was complete in 9 (75 %) patients and partial in 3 (25 %). Function was restored in all cases, without recurrences. Conclusions: Cryosurgery as an adjuvant treatment and autologous or homologous bone grafting prevented local recurrence of unicameral bone cyst lesions, favored bone healing and allowed for a full range of motion functionality without complications. [ABSTRACT FROM AUTHOR]

Currently, tuberculosis (TB) is a public health problem, is present in all regions of the world and remains one of the most deadly communicable diseases, particularly associated with infection by the human immunodeficiency virus (HIV). Cases of TB Mycobacterium bovis more and more frequent, especially in vulnerable populations. TB caused by M. bovis clinical, radiological and histologically indistinguishable from tuberculosis caused by M. tuberculosis; however, there are some differences that make M. tuberculosis particular. The direct correlation between infection with M. bovis in cattle and human disease has been well documented, but the true prevalence is underestimated. Overall, the proportion of cases of human TB caused by M. bovis is low compared with M. tuberculosis, but its potential in the groups most at risk impact should not be underestimated by the impact on morbidity and mortality. [ABSTRACT FROM AUTHOR]

Factors associated with physical activity and body mass index among schoolchildren from Arandas, Jalisco, Mexico Background: In 2015, Mexico was the top country for childhood obesity. The objective was to identify the association between physical activity and sedentary lifestyle with the social and demographic characteristics of families of schoolchildren in Arandas, Jalisco, Mexico. Methods: In a cross-sectional study, 192 schoolchildren were randomly selected. Body mass index (BMI), active and sedentary behaviors, and socio-demographic characteristics of families were obtained. Logistic regression models with the included variables were constructed. Results: Males living in not-crowding houses [OR 6.12 (2.17-17.25), p = 0.001], whose mothers were housewives [OR 2.44 (1.00, 5.94), p = 0.05], practiced more physical activity. Active transport to school was more common in schoolchildren whose fathers had lower income [OR 3.13 (1.27, 7.7), p = 0.013] and employment as peasant or mason [OR 5.12 (1.13, 23.3), p = 0.034]. Schoolchildren of nuclear families spent more hours watching television [OR 2.69 (1.10, 6.58), p = 0.03]. The frequency of outdoor playing was higher in males whose fathers had unstable employment [OR 2.93 (1.06, 8.1), p = 0.038] and low education [OR 2.94 (0.96, 8.98), p = 0.059]. Conclusion: Families with lower socioeconomic strata (less educated parents, unstable employment and family overcrowding) are more associated with active activities that do not require active economic spending. [ABSTRACT FROM AUTHOR]

Teen pregnancy (TP) is a global public health problem that affects the physical and emotional health, educational and economic status of prospective parents and often also affects the product of gestation. In most cases, the TP is an unplanned event, and often difficult to accept by the couple. But it is more complicated for the future mother who suddenly finds herself without the protection of the couple, her family and her school companions. The risks to which the young mothers are exposed are diverse, but include: submitting to a clandestine abortion, falling into drug addiction, prostitution and crime; Also, it should be noted that with so many adversities, she can develop child maltreatment and frequently, she may be attacked at home, at school or in society giving rise to the twin phenomena of child abuse. To address this problem, it is necessary to develop preventive strategies aimed at risk of early pregnancy or acquiring sexually transmitted diseases by implementing educational programs for personal, family or schools for this age group range. It stresses the need for these programs to be consistent and persistent, as a basic strategy to reduce the consequent risks to unplanned or accepted sex life. [ABSTRACT FROM AUTHOR]

Background: The glenohumeral joint is the most mobile of the body economy. It is due to the laxity of the joint capsule and shallowness of the glenoid in relation to the large size of the humeral head, within the high mobility that owns it is important to determine the normal muscular force. This paper presents a preliminary database of shoulder abduction strength in healthy patients. The aim of this paper is to determine the strength of shoulder abduction in Mexican healthy patients. Methods: Individuals without shoulder diseases or cervical spine known, in an age range of 18-65 years old, male and female, organized into 5 groups were included. Anthropometric measurements and abduction strength test on both shoulders (Kg / force) were performed. The variables were analyzed statistically with r of Pearson and Spearman p < 0.05. Results: Analysis by age group, gender and the dominant and nondominant arm, the maximum force to the dominant arm in male was 26-35 years group with 7.11 Kg/force, while for the same genre nondominant arm was 46-55 years group with 8.04 Kg/force; the maximum force to the dominant arm in female was 26-35 years group with 4.35 Kg/force while for the non-dominant arm of the same gender group was 18-25 with 4.43 Kg/force. Positive correlation of force was observed with the weight and height, as well as the circumference of the wrist. Conclusions: The analysis of abduction strength in healthy patients by age group created a preliminary database will be a framework in acute and chronic shoulder pathology. [ABSTRACT FROM AUTHOR]

Background: Hyperostosis frontalis interna (HFI) is a bone overgrowth on the inside of the frontal bone. This alteration can occur in isolation or together with neuropsychiatry symptoms, metabolic and endocrine manifestations which together form the Morgagni-Stewart-Morel syndrome. In this regard, the case of a patient who meets criteria for this syndrome is presented and a review of the literature is performed with focus on its pathophysiology. Case report: A 74 years old female with a history of exposure to wood smoke, vitiligo, type 2 diabetes mellitus, hypertension and cognitive impairment who enters the hospital by malaise, dizziness, anxiety, confusion, disorientation and difficulty walking. In she were performed imaging of the skull where was observed the presence of extensive hyperostosis frontalis interna, cortical atrophy and a left thalamic lacunar infarction. During this hospital stay the presence of grade I obesity, hyperglycemia, hypertriglyceridemia and hyperuricemia was documented. Conclusions: The patient met the criteria of Morgagni-Stewart-Morel syndrome to manifest the presence of hyperostosis frontalis interna with metabolic, endocrine and neuropsychiatric manifestations. The pathophysiological origin of the syndrome is unknown, although it has been postulated that an endocrine imbalance motivated by genetic and environmental factors may be the cause. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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: The aim of this study Is to differentially Identify MAC by PCR in patients with AIDS and disseminated mycobacteriosis. Methods: A cross sectional study was conducted in Mexico to Identify MAC by Molecular Biology. Two sets of primers were synthesized: MAV and MIN, for M. avium and M. intracellulare, respectively. Whole-cell DNAs obtained from 29 clinical Isolates and clinical serum specimens from other 24 patients with AIDS and disseminated mycobacterial Infection were extracted and amplified by PCR with the MAV and MIN primers. The MAV and MIN primers each amplified one highly specific 1,3-kb segment of the homologous DNA, respectively. Results: Twenty-nine DNAs from MAC clinical isolates identified by Gen-Probe AccuProbes were amplified with the MAV primers. Of the 24 clinical samples, 3 were positive for M. avium and 6 for M. tuberculosis. Conclusions: Our results demonstrated that PCR technique could be applied for the differentiation of M. avium and M. intracellulare by specific 16S rRNA primers. In patients with advanced stage AIDS and in whom disseminated mycobacteriosis is suspected, the presence of anemia (even with negative cultures), elevated alkaline phosphatase and a median CD4 count of 15.9/mL, the diagnosis of infection by MAC should be strongly considered; we suggest that in accordance with our findings, a more precise stratification of patients in terms of their CD4 T cell counts is warranted. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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.)

Diabetes is a global health problem and Mexico rank sixth in prevalence of this entity. In our country, is the leading cause of death and is a major cause of hospital care being responsible for about 1 in 5 discharges. In the hospital setting, it has been observed that hyperglycemia, both diabetic and non-diabetic patients, is associated with an increased risk of complications, disability and death, and that adequate control in the blood glucose level produces a reduction in these complications. With these bases, several associations have recommended the treatment of hospital hyperglycemia through insulin administration, with the therapeutic goal of maintaining a fasting blood glucose level between 100-140 mg/dL and glucose at any time of day less than 180 mg/dL. The insulin application method most recommended consisting in a basal-bolus regimen which has shown efficacy with a low risk of hypoglycemia. The usual practice of the application of insulin through a correction scheme should be abandoned because it is inefficient and involves risks. [ABSTRACT FROM AUTHOR]

Background: Frequently, therapeutic decisions must be made in order to manage meningioma in geriatric patients. This study analyzes the prognostic factors, as well as the Clinical Radiological Grading Score (CRGS) as a complement to make therapeutic decisions. Methods: A retrospective study was conducted between 2009 and 2010. The study population consisted of 28 patients over 65 years of age. We analyzed clinical, imaging and histopathological factors. We used the Χ² test and the Fisher exact test for quantitative variables, as well as the Mann-Whitney U for qualitative variables. Results: Overall mortality at 3, 6 and 12 months of follow-up was 7.14, 10.71 and 14.28 %, respectively. The analysis revealed that performance status with Karnofsky scale (p = 0.02), the location of the lesion (p = 0.002), histopathological malignancy grade (p = 0.038), and a score lower than 10 on the CRGS (p = 0.003) were associated with poor prognosis. Conclusion: The neurosurgical management of geriatric patients is a therapeutic option with a favorable prognosis in patients with a score equal to or greater than 10 and those with adequate functional status. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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: Castleman's disease is an atypical lymphoproliferative disorder which may be compatible with paraneoplastic manifestations of POEMS syndrome. Clinical case: a 53 year old man with a history of type 2 diabetes, hypothyroidism and Addison's disease was attended. He started with numbness and weakness in limbs, dyspnea, skin hardening, Raynaud's phenomenon, weight loss and fatigue appeared. Physical exam showed tachypnea, generalized cutaneous hyperpigmentation and skin hardening of extremities, muscle weakness, hypoesthesia and hyporefl exia. Laboratory showed hyperprolactinemia, low testosterone, hypothyroidism and Addison's disease. Electrophoresis of proteins showed polyclonal hypergammaglobulinemia. Somatosensory evoked potentials reported peripheral neuropathy and severe axonal polyneuropathy by electromyography. Chest X-rays showed bilateral reticular infiltrates and mediastinal widening. Echocardiogram displayed moderate pulmonary hypertension. Skin biopsy had no evidence of scleroderma. CT reported axillar, mediastinal and retroperitoneal nodes. The mediastinal lesion biopsy reported hyaline vascular Castleman's disease, multicentric variety. He was treated with rituximab. Conclusions: the case meet criteria for multicentric hyaline vascular Castleman's disease, POEMS variant, treated with rituximab. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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 evaluate the toxic effect of an aqueous extract of Solanum torvum on microorganisms responsible for genitourinary infections as well as the adverse effects on sperm cells. Methods: it was determined the microbial toxicity of a freeze-dried aqueous extract (obtained from the leaves and stems of Solanum torvum), against wild strains of Escherichia coli, Neisseria gonorrhoeae and Candida albicans, using the test of poisoning in culture medium at concentrations of 50, 100 and 200 mg/mL. The response- was evaluated with the colony diameter (mm). Then, it was evaluated the toxicological potential on male reproductive system using the testing of morphology of the sperm head in NMRI mice. Results: the Solanum torvum had bacteriostatic antibacterial activity. There were not observed alterations in quantity and quality characteristics in semen with the oral and doses used of 500, 1000 y 2000 mg/kg of weight. Conclusions: the Solanum torvum under described, inhibits the growth of bacteria and produces no disturbance on semen quality in the species studied. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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: it has been demonstrated that children obesity is a multifactorial disease and probably, the alteration of the family dynamic is another potential risk factor. The objective was to identify the association between obesity and family dysfunction in school children who attend to a family medicine unit. Methods: case and control study at Mexican Social Security Institute in Guadalajara, Jalisco, Mexico. Sociodemographic factors and family dynamic of obese and non-obese subjects (n = 452) of six to nine years old from nuclear families were achieved. Results: the association between family dysfunction and obesity was [OR = 1.63 (1.08-2.46), p = 0.01]. Area II, Identity formation and area VI, Discipline and methods showed a lower score in cases of children with obesity (p < 0.001 y p = 0.005, respectively). In a logistic regression model family dysfunction [RM 1.79 (1.19, 2.71), p = 0.005] and low literacy of mothers [RM 1.61 (1.06, 2.45), p = 0.02)] were risk factors for obesity in school children. Conclusions: the results showed an association between family dysfunction and obesity in school children. We suggest to consider it in the prevention of obesity in Mexican school children. [ABSTRACT FROM AUTHOR]

Background: cerebral hemiatrophy (CHA) can present in childhood or adulthood, if it presents before or after two years of age. This two entities differ in etiology, clinical presentation and imaging characteristics. The CHA of childhood or Dyke-Davidoff-Masson syndrome, is originated by intrauterine or perinatal insults that affect the perfusion of a single cerebral hemisphere, manifesting clinically by variable mental retardation, refractory epilepsy, facial asymmetry, hemiplegia/hemiparesis or abnormal movements of the contralateral extremities and by imaging studies, loss of volume in one cerebral hemisphere and ipsilateral compensatory cranial changes such as skull vault thickening, elevation of the orbital roof and petreous ridge, also hyperp-neumatization of the frontal sinus and mastoid cells. Instead, the CHA of the adult is multifactorial and by imaging it only manifests as loss of volume in one cerebral hemisphere, without compensatory changes in the skull. Cases report: we present a classic clinical case of CHA secondary to perinatal insult and another case of CHA of adulthood secondary to multiple embolic strokes in a patient with inactive rheumatic heart disease, commenting the imaging differences of these rare clinical entities. [ABSTRACT FROM AUTHOR]

Introduction: Guillain-Barré syndrome (GBS) is an autoimmune polyradiculoneuropathy subdivided in demyelinating and axonal types. There is no established frequency about the electrophysiological subtypes in Mexico. Objective: to determine the frequency of electrophysiological subtypes of GBS in Mexican patients. Material and methods: The study design was descriptive and retrospective. Patients with GBS older than 15 years without coexisting major diseases were selected retrospectively from a three-year period. These patients should have met the clinical and electrophysiological criteria of GBS. Motor nerve conduction studies were made of the median, ulnar, tibial and peroneal nerves, and antidromic sensory conduction studies were performed in the median, ulnar and sural nerves. Descriptive statistics, analysis of variance and ?2 test were used. Results: The study included fifty-one patients with median age of 45.5 years (range 16-79); 37 men and 14 women, with a ratio man-woman 2.6:1; 37% were observed in winter (p = 0.56). The electrophysiological subtypes were acute motor axonal neuropathy (AMAN) 39 %; acute inflammatory demyelinating polyneuropathy (AIDP) 23.5 %; mixed neuropathy (MN) 20%; and acute motor sensory axonal neuropathy (AMSAN) 17.5 %. Conclusions: the most frequent electrophysiological subtype in Mexican patients was AMAN. Other frequent subtypes were MN and AMSAN. Axonal variants were the predominant types. [ABSTRACT FROM AUTHOR]

The prevalence of overweight has significantly increased thorough the world and Mexico is not an exception considering that the National Survey of Nutrition (1999) showed that 19.5 % of scholar children in Mexico have overweight and other survey from Mexico City (ENURBAL, 2002) have shown that 17 % in the same range of age are obese. Therefore, this clinical guide pretends to be an instrument for supporting the professionals of health for the diagnosis, treatment and prevention of obesity in children using the levels of medical attention. It is known that the treatment is difficult and it requires a full multidisciplinary team of professionals and that the key of prevention is the modification of the sedentary lifestyle and the decrease of energy intake. This guide was elaborated by pediatricians working in nutrition in public and university institutions, family and general physicians and pediatricians with private practice. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS 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.)