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Angle-closure glaucoma secondary to ciliary body cysts is a rare condition. Different pharmacological and surgical treatment modalities have been described. Among these, subliminal transscleral cyclophotocoagulation is a promising alternative due to fewer ocular complications and the same intraocular pressure reducing efficacy. The case is presented of a 33-year-old woman with a 6-year history of uncontrolled ocular hypertension, and a one-month history of glaucoma, treated with multiple drugs and surgical interventions, with persistent elevated intraocular pressure. She came to the clinic due to eye pain and photophobia of the right eye of 3 days onset prior to her visit. An ultrasound biomicroscopy was performed, finding cysts in the ciliary body. It was then decided to perform subliminal transscleral cyclophotocoagulation, achieving a reduction in intraocular pressure, which was maintained after three months of follow-up.

Resumen El glaucoma de angulo cerrado secundario a quistes del cuerpo ciliar es una entidad infrecuente. Se han descrito diferentes modalidades de tratamiento tanto farmacologicas como quirurgicas. Entre estas, la ciclofotocoagulacion transescleral subliminal es una alternativa comprometedora por menores complicaciones oculares y la misma eficacia reductora de la presion intraocular. Presentamos el caso de una mujer de 33 anos con antecedente de hipertension ocular de 6 anos de evolucion sin control y glaucoma de un mes de evolucion, tratada con multiples farmacos e intervenciones quirurgicas, con persistencia de la presion intraocular elevada. Acudio a consulta por presentar dolor ocular y fotofobia de ojo derecho de 3 dias de evolucion previos a su visita. Se le realizo una ultrabiomicroscopia, encontrando quistes en el cuerpo ciliar por lo que se opto por la realizacion de ciclofotocoagulacion transescleral subliminal, consiguiendo una reduccion de la presion intraocular mantenida en el seguimiento a los 3 meses.

Introduction: Family-Planning services should ideally be offered to any person who is of reproductive age, but when health personnel are not properly trained, the counselling can become suboptimal especially to patients at higher reproductive risk. The use of simulators of human patients and the use of simulation with standardised patients has shown to be useful in improving learning and communication attitudes, as well as reinforcing theoretical learning of medical students. To our knowledge, its use in producing skills in Family Planning and the counselling of contraceptive methods has not yet been sufficiently explored. Objective: To evaluate a simulation-based contraceptive counselling learning strategy for medical students to improve the skills involved in counselling of Family-Planning methods. Methods: Exploratory, mixed-method study consisting of three groups of medical students. Results: The theoretical knowledge of the students increased by 7.24 points, while in the analysis of the performance in the simulation performed at the beginning and end of the semester, a significant increase of 14.26 points was observed. Discussion: The use of a simulation centre and standardised patients in a carefully represented environment favoured a meaningful learning. It also improved personalised counselling and strengthened the communications skills of medical students. Resumen: Introducción: Los servicios de planificación familiar deben ofrecerse a cualquier persona en edad reproductiva, pero si el personal de salud no está debidamente capacitado, su asesoramiento puede ser subóptimo, especialmente para las pacientes con mayor riesgo reproductivo. El uso de simuladores humanos, y el uso de simulación con pacientes estandarizados, ha demostrado ser útil en la generación de aprendizaje actitudinal y comunicativo de estudiantes de medicina, pero a nuestro entender, su utilidad en la generación de competencias para métodos anticonceptivos y consejería de planificación familiar aún no ha sido implementada. Objetivo: Evaluar una estrategia de aprendizaje de consejería anticonceptiva para estudiantes de medicina basada en simulación para mejorar las competencias involucradas en la orientación sobre los métodos de planificación familiar. Métodos: Estudio exploratorio con enfoque metodológico mixto, conformado por 3 grupos de estudiantes universitarios de medicina. Resultados: El conocimiento teórico de los estudiantes aumentó 7,24 puntos, mientras que en el análisis del desempeño en la simulación realizada al inicio y al final del semestre se observó un aumento significativo de 14,26 puntos. Discusión: El empleo de un centro de simulación, pacientes estandarizados en un entorno cuidadosamente representado favoreció un aprendizaje significativo y facilitó el asesoramiento personalizado y fortaleció las habilidades de comunicación de los estudiantes de medicina de pregrado.

In 2020, while living through unprecedented health outcomes from the COVID-19 epidemic in Mexico, a human ecology perspective provides us with an unconventional way to analyze the role of the media...

La fiebre tifoidea se ha considerado históricamente una enfermedad prevenible, de trascendencia clínica y epidemiológica. Su incidencia disminuyó con el uso de antibióticos y el mejoramiento de las medidas higiénicas. Actualmente, es considerada una entidad atípica, por lo que sus complicaciones son poco comunes. Masculino de once años, sin antecedentes patológicos de importancia, residente en medio urbano al sureste, en México. Después de dos semanas de fiebre y diarrea, el paciente evolucionó con reagudización del dolor abdominal, el cual se sumó a un cuadro de deshidratación e hiperémesis. Fue tratado ambulatoriamente con metronidazol y metamizol, pero sin esquema de rehidratación. Debido a la exacerbación del dolor abdominal, fue llevado al departamento de urgencias de un hospital general, donde evolucionó tórpidamente desencadenando choque séptico y posteriormente falla orgánica múltiple. La fiebre tifoidea, es actualmente una entidad reemergente, cuyas manifestaciones clínicas pueden enmascarar patologías gastrointestinales, retrasando el diagnóstico y tratamiento inmediato, incrementando la probabilidad de complicaciones.

Objective To describe age-sex differences in the duration from symptom onset to fatality as an outcome in coronavirus desease 2019 (COVID-19) patients. Methods The Mexican surveillance system database (up to 15th August 2020) of 70,515 death cases (45,053 males, 25,462 females) in COVID-19 was used for analysis. Age groups for pediatric patients were

In the 1970s, in the suburbs of a US city, five sisters between thirteen and seventeen years of age committed suicide, starting with Cecilia, the youngest of the Lisbon sisters. A wave of sadness plagued with questions invaded the minds of those who lived with them and of all those who witnessed how little by little they lost their joy, their motivations and their essence until they became inexpressive shadows of what they once were. Given the peculiarities described between the deaths of the sisters in the Suicide Virgins of Sofia Coppola 1999, the expectation may ask several questions related to proper health approach and the role of health personnel to optimally address mental health in adolescence and of preventive measures recommended in both, individual and collective levels. This article is offered as an analysis of the fictional suicidal behaviors reported in the film, as if in some way, the Lisbon sisters could be treated with the resources and knowledge that contemporary doctors have in present time through the healthcare system, without ignoring the conditions in which their tragic deaths occurred. En la década de 1970, en una ciudad norteamericana, cinco hermanas entre los trece y los diecisiete años cometieron suicidio, comenzado por Cecilia, la menor de las hermanas Lisbon. Una ola de tristeza plagada de interrogantes inundó las mentes de aquellos que convivieron con ellas y de todos aquellos fueron testigos de cómo poco a poco fueron perdiendo su alegría, sus motivaciones y su esencia hasta convertirse en sombras inexpresivas de lo que una vez fueron. Ante las peculiaridades descritas entre las muertes de las hermanas en las Vírgenes suicidas de Sofía Coppola 1999, el espectador puede plantearse diversas cuestiones relacionadas con el manejo sanitario adecuado y el papel del personal de salud para abordar de manera óptima la salud mental durante la adolescencia y de las medidas de prevención recomendables tanto en lo individual como en lo colectivo. El presente artículo se ofrece como un análisis a propósito de las conductas suicidas ficticias reportadas en el filme, como si de algún modo, las hermanas Lisbon pudiesen atenderse con los recursos y conocimientos que tienen en la actualidad los médicos contemporáneos a través del sistema sanitario, sin pasar por alto las condiciones en las cuales sucedieron sus trágicas muertes.

La rosácea es una alteración cutánea crónica que se ha asociado con factores etiológicos inespecíficos y diversas manifestaciones sistémicas. La rosácea cutánea suele evolucionar a rosácea ocular del 6 al 72 % de los pacientes. Al no existir criterios específicos que la caractericen, la rosácea ocular implica un reto diagnóstico. Para fortalecer la sospecha diagnóstica temprana, se presentan tres casos de pacientes con evolución clínica distinta, pero que tuvieron en común el retraso diagnóstico, lo que se tradujo en manifestaciones graves y daño ocular extenso.

This study aims to analyze the probability of an increase in mortality due to venous thrombosis of the lower limbs (VTLL), and it´s relation to days of hospital stay.We included all hospital records of patients with thrombosis in the lower limbs as main diagnosis from open access national datasets, we obtained epidemiological description of diagnosis, length of stay and mortality.Deep vein thrombosis (DVT) constituted 69% (1223/1785) of cases. From all the patients registered, 47 (2.63%) died. The highest mortality rate was observed in older adults, and patients with a longer hospital stay.Patients diagnosed with DVT, who endure a longer hospital stay, face a major risk of death.Analizar la probabilidad de un aumento de la mortalidad por trombosis venosa de miembros inferiores (TVMI) y su relación con los días de estancia hospitalaria.Se incluyeron los registros de egreso hospitalario con el diagnóstico de VTLL, obtenido de las bases de datos de los hospitales públicos de México.El diagnóstico más frecuente fue la trombosis venosa profunda (TVP) con el 69% (1223/1785) de los casos. Del total de casos se registraron 47 (2.63%) muertes, la mortalidad fue más alta a mayor edad y estancia hospitalaria.Los pacientes diagnosticados por TVP y con estancia hospitalaria prolongada, presentaron mayor mortalidad.

Objetivo: Analizar la probabilidad de un aumento de la mortalidad por trombosis venosa de miembros inferiores (TVMI) y su relación con los días de estancia hospitalaria. Material y métodos: Se incluyeron los registros de egreso hospitalario con el diagnóstico de VTLL, obtenido de las bases de datos de los hospitales públicos de México. Resultados: El diagnóstico más frecuente fue la trombosis venosa profunda (TVP) con el 69% (1223/1785) de los casos. Del total de casos se registraron 47 (2.63%) muertes, la mortalidad fue más alta a mayor edad y estancia hospitalaria. Conclusiones: Los pacientes diagnosticados por TVP y con estancia hospitalaria prolongada, presentaron mayor mortalidad.

espanolEl conjunto deconocimientos, habilidades, principios y valores de un individuo para ejercer bien su trabajo en medicina sirven para fortalecer el desenvolvimiento en una comunidad. La pelicula Bienvenue a Marly-Gomont (2016) de Julien Rambaldi, tiene por tema principal el esfuerzo y las actitudes del medico congoleno Zantoko ante el racismo que demuestran los habitantes de la villa rural Marly-Gomont de los anos setenta. La pelicula muestra a una comunidad francesa aislada, quienes nunca habian visto a una persona de color; nos situa con la familia de Zantoko en el contexto de la comunidad, lo que nos permite comprender los puntos fundamentales que pudieron haber servido como herramientas practicas y necesarias para la labor del medico comunitario. Nos invita a reflexionar acerca de las dificultades que pueden presentarse ante la falta de conocimientos necesarios para atenderuna comunidad y la poca prevencion en dicha comunidad. En suma, es una pelicula excelente para la ensenanza y aprendizaje de temas relacionados con la labor que desarrollan los profesionales de la salud a nivel poblacional/loca EnglishAn individual’s set of knowledge, skills, principles and values to carry out his medical work well serves to strengthen the unfolding in a community. The film the African physician (2016) of Julien Rambaldi, has as its main theme the effort and attitudes of the Congolese doctor Zantoko and how he faces the fear racism of the habitans of rural village Marly-Gomont on the seventies. The film shows an isolated French community, who had never seen black people; places us with Zantoko s family in the context of the community, which allows us to understand the fundamental point that may have served as practical and necessary tools for the work of the community doctor. It invites us to reflect on the difficulties that may occur in the face of the lack of knowledge needed to serve a community and ignorance of it. It is an excellent film for teaching and learning topics related to the work of health professionals at the population/local level

Objetivo: Describir las características epidemiológicas de los pacientes hospitalizados por urolitiasis en el Estado de Yucatán, México en comparación a las referencias oficiales estatales y nacionales. Diseño metodológico: Estudio observacional descriptivo de corte transversal retrospectivo. Se incluyeron las hospitalizaciones por urolitiasis en el sector salud de 2014 a 2016 en Yucatán; se contrastaron con las referencias nacionales y estatales de fuentes oficiales, mediante pruebas de contraste de hipótesis para muestras independientes ajustadas al tamaño poblacional. Resultados: Se registraron 1078 hospitalizaciones por urolitiasis en Yucatán, un 52.8% de correspondió a pacientes masculinos. La edad media de hospitalización fue significativamente menor para las mujeres tanto a nivel estatal como nacional. La prevalencia de obesidad en los pacientes hospitalizados fue de 33.33, no difiriendo estadísticamente de la reportada en el estado. La proporción de hospitalizados residentes de la capital fue significativamente menor a lo esperado (31.9 versus 52.9). Limitaciones: Este estudio se restringe a los datos de hospitalizaciones del sector público y, por ende, excluye los registros de medios privados. Originalidad y valor: Primer estudio epidemiológico que compara y evalúa los factores epidemiológicos de los casos registrados de hospitalización por urolitiasis en el Estado de Yucatán. Conclusiones: El Estado de Yucatán tuvo un mayor número de hospitalizaciones a la referencia nacional, con la tasa de hospitalizaciones más alta del país. La prevalencia fue discretamente mayor en los hombres, mientras que las mujeres fueron más jóvenes. La prevalencia de obesidad y la proporción de hospitalizados de ascendencia maya no difirió de la referencia estatal; la proporción de hospitalizados con residencia en la ciudad capital fue menor a la esperada.

Introducción: El abordaje epidemiológico permite a los profesionales del área de la salud identificar las tendencias poblacionales de morbilidad y problemas de salud, al mismo tiempo que ayuda identificar grupos en riesgo y describir a las poblaciones en términos de sus perfiles de salud. Objetivo: Describir el impacto del conocimiento situado sobre los resultados académicos, científicos y sociales de la materia de epidemiología clínica que se imparte en décimo semestre de la carrera de medicina de la Universidad Marista de Mérida. Método: Estudio descriptivo, observacional, prospectivo en la asignatura de epidemiología clínica, se desarrolló un programa académico basado en la cognición situada que contempló el aprendizaje teórico al mismo tiempo que el aprendizaje práctico mediante el diseño, implementación, análisis y difusión de proyectos de salud de diseño epidemiológico que adicionalmente permiten integrar los conocimientos clínico-prácticos y teóricos adquiridos durante la carrera. Resultados: Los alumnos expresaron opiniones positivas acerca de la actividad de campo, lograron integrar los conocimientos teóricos, prácticos y clínicos de otras áreas de la medicina; reforzaron su vocación de servicio e interés por los problemas de salud de su comunidad, a la vez que expresaron interés por involucrarse en la continuación de sus proyectos presentándolos en congresos, publicándolos y continuándolos en el desarrollo de sus temas de tesis. Conclusiones: Este estudio permitió a los alumnos comprender el contexto cultural y social en el que se presentan los problemas de salud y facilitar el análisis estadístico de los datos entendiendo su origen.

Introduction. Every region in the world has an epidemiological trend of death by suicide that is particular and dependent on its sociodemographic and cultural aspects. Knowing the epidemiological characteristics of people who have died by suicide in the state of Yucatan is important for understanding the phenomenon and planning future preventive strategies. Objective. To describe the epidemiological characteristics of suicide mortality between 2013 and 2016. Method. Observational, descriptive study, retrospective longitudinal section, in which the epidemiological trends of mortality are analyzed. Results. In the period studied, Yucatan was among the states with the highest mortality rate due to suicide. Hanging was the most frequent method, followed by the use of agrochemicals. Together, these methods were employed by nearly 95% of those who died. Agrochemical use was associated with a greater likelihood of receiving medical care before death compared with other methods, particularly hanging (24.5 to 1.00). Discussion and conclusion. In this study, sociodemographic differences and factors associated with suicide were observed. Suicide methods are consistent with those observed nationwide and in countries with poverty and agricultural societies. Preventive measures to address this problem in the state could incorporate the epidemiological characteristics of the population with suicidal tendencies in Yucatan. Suicide in the state of Yucatan is an ongoing public health problem, which showed an annual increase in the period studied and a significant predominance in the month of May.

Diving as a method of fishing is used worldwide in small-scale fisheries. However, one of the main causes of morbidity and mortality among fishermen is decompression sickness (DCS). We report the case of a 46-year-old male fisherman diver who presented with chronic inguinal pain that radiated to the lower left limb. Living and working in a fishing port in Yucatan, he had a prior history of DCS. A diagnosis of avascular necrosis in the left femoral head secondary to DCS was made via analysis of clinical and radiological findings. The necrosis was surgically resolved by a total hip arthroplasty. Dysbaric osteonecrosis is a more probable diagnosis. In this region fishermen undergo significant decompression stress in their daily fishing efforts. Further studies regarding prevalence of dysbaric osteonecrosis among small-scale fisheries divers are needed. In a community where DCS is endemic and has become an epidemic, as of late, the perception of this health risk remains low. Furthermore, training and decompression technique are lacking among the fishing communities.

Background In Mexico, the COVID-19 pandemic led to preventative measures such as confinement and social interaction limitations that paradoxically may have aggravated healthcare access disparities for pregnant women and accentuated health system weaknesses addressing high-risk patients’ pregnancies. Our objective is to estimate the maternal mortality ratio in 1 year and analyze the clinical course of pregnant women hospitalized due to acute respiratory distress syndrome and COVID-19. Methods A retrospective surveillance study of the national maternal mortality was performed from February 2020–February 2021 in Mexico related to COVID-19 cases in pregnant women, including their outcomes. Comparisons were made between patients who died and those who survived to identify prognostic factors and underlying health conditions distribution. Results Maternal Mortality Ratio increased by 56.8% in the studied period, confirmed COVID-19 was the cause of 22.93% of cases. Additionally, unconfirmed cases represented 4.5% of all maternal deaths. Among hospitalized pregnant women with Acute Respiratory Distress Syndrome consistent with COVID-19, smoking and cardiovascular diseases were more common among patients who faced a fatal outcome. They were also more common in the age group of 38. In addition, pneumonia was associated with asthma and immune impairment, while diabetes and increased BMI increased the odds for death (Odds Ratio 2.30 and 1.70, respectively). Conclusions Maternal Mortality Ratio in Mexico increased over 60% in 1 year during the pandemic; COVID-19 was linked to 25.4% of maternal deaths in the studied period. Lethality among pregnant women with a diagnosis of COVID-19 was 2.8%, and while asthma and immune impairment increased propensity for developing pneumonia, obesity and diabetes increased the odds for in-hospital death. Measures are needed to improve access to coordinated well-organized healthcare to reduce maternal deaths related to COVID-19 and pandemic collateral effects.

Clinical or serological coinfections of Rickettsia and Leptospira are uncommon but should be included in differential diagnosis when poor sanitation and cohabitation with infected animals may converge. Rickettsial and leptospiral infections have been continuously increasing throughout the past decade in Yucatan, Mexico. Leptospirosis is a zoonotic disease caused by aerobic spirochetes, while rickettsiosis is an arthropod-borne disease. In 2020, 16% of all rickettsiosis cases and 10% of leptospirosis in the country originated in Yucatan. The objective of the present case report was to document an unusual case of probable coinfection with Rickettsia and Leptospira with emphasis on clinical manifestations and the epidemiological context that may orient future multidisciplinary measures. Here, we presented the case of a 12-year-old female whose mother had recently recovered from a rickettsial infection. The patient presented with fever and developed unspecific signs and symptoms of infection; however, her condition quickly deteriorated with gastrointestinal, hepatic, renal, and neurological dysfunction. After discounting rabies and identifying infection with Rickettsia and Leptospira, antibiotic treatment was indicated, but it was too late to prevent death. Simultaneous infections of Rickettsia and Leptospira may be considered in endemic regions when environmental, epidemiological, and clinical conditions converge.

Bilateral complex ovarian cysts in newborns are rare and their reporting becomes imperative to in crease knowledge about the best therapeutic management.To describe the clinical case of a newborn with a diagnosis of bilateral complex ovarian cysts and to discuss the conditions for conservative or surgical management according to the ultrasound characteristics of the cyst.At 35 weeks of gestational age, prenatal ultrasound identified the presence of cystic masses in both adnexa, so it was decided to interrupt the pregnancy by cesarean section at 37 weeks. After birth, bilateral ovarian cysts of 3.5 x 4.4 x 2.7 and 3.4 x 2.4 x 3.3 cm, right and left, respectively, were corro borated. The right cyst had a septum of 1.4 mm thick and thickened wall of 3 mm which was com patible with complex cysts. On the 4th day of extrauterine life, laparoscopic vacuum aspiration and deroofing with electrocautery of the upper wall of both cysts was performed, without complications. The diagnosis of ovarian serous cystadenoma was made by pathological anatomy.We describe a case with adequate prenatal diagnosis and laparoscopic surgical intervention of a bilateral ovarian cyst4 cm. Prenatal diagnosis is essential for choosing the best therapy management (con servative or surgical) depending on the echography characteristics of the cyst. Neonatal surgery is recommended for simple ovarian cysts4 cm, complex cysts regardless of their size, and those that become complex cysts during conservative management.

espanolEl ultimo concierto/ A Late Quartet (2012) es una pelicula del genero dramatico dirigida por Yaron Zilberman. Este filme protagonizado por Christopher Walken, relata la historia de un cuarteto de cuerda, el cual tras 25 anos de exito y fama mundial, atraviesa fuertes adversidades cuando el creador del cuarteto, Peter Mitchell, esta padeciendo los primeros sintomas del Parkinson, una enfermedad que en poco tiempo pondra fin a su pasion y a sus suenos como interprete. Pero ?que hubiera podido ofrecerse para el manejo de Peter desde la fisioterapia y rehabilitacion? ?El impacto de esta profesion en la calidad de vida, pudiera ayudar a mitigar la cuesta debajo de un gran musico con enfermedad de Parkinson que se ubica en la cima de su carrera? El objetivo del presente articulo es describir las alternativas basadas en evidencia que la fisioterapia y rehabilitacion pueden ofrecer a los pacientes con enfermedad de Parkinson. EnglishA Late Quartet (2012) is a film of the dramatic genre directed by Yaron Zilberman. This film, starring Christopher Walken, provides an insight to the story of a string quartet, which after 25 years of success and world fame, goes through severe adversities when the creator of the quartet, Peter Mitchell, is suffering from the first symptoms of Parkinson´s Disease, a disease that threatens to end to his passion and his dreams as a performer. But what could have been offered for Peter's management from physical therapy specialty for rehabilitation? Could it provide a positive impact for this profession on his quality of life? Could it help mitigate the downhill slope of a great musician with Parkinson's disease from the peak of his career?The objective of this article is to describe the evidence-based alternatives that physical therapy and rehabilitation can offer to patients with Parkinson's disease.

IntroductionCOVID-19 affected worldwide, causing to date, around 500,000 deaths. In Mexico, by April 29, the general case fatality was 6.52%, with 11.1% confirmed case mortality and hospital recovery rate around 72%. Once hospitalized, the odds for recovery and hospital death rates depend mainly on the patients’ comorbidities and age. In Mexico, triage guidelines use algorithms and risk estimation tools for severity assessment and decision-making. The study’s objective is to analyze the underlying conditions of patients hospitalized for COVID-19 in Mexico concerning four severity outcomes.Materials and MethodsRetrospective cohort based on registries of all laboratory-confirmed patients with the COVID-19 infection that required hospitalization in Mexico. Independent variables were comorbidities and clinical manifestations.Dependent variables were four possible severity outcomes(a) pneumonia, (b) mechanical ventilation (c) intensive care unit, and (d) death; all of them were coded as binary Results: We included 69,334 hospitalizations of laboratory-confirmed and hospitalized patients to June 30, 2020. Patients were 55.29 years, and 62.61% were male. Hospital mortality among patients aged65 died. Male gender and increasing age predicted every severity outcome. Diabetes and hypertension predicted every severity outcome significantly. Obesity did not predict mortality, but CKD, respiratory diseases, cardiopathies were significant predictors.ConclusionObesity increased the risk for pneumonia, mechanical ventilation, and intensive care admittance, but it was not a predictor of in-hospital death. Patients with respiratory diseases were less prone to develop pneumonia, to receive mechanical ventilation and intensive care unit assistance, but they were at higher risk of in-hospital death.

Objective To analyze the association between newborn and maternal characteristics and the risk for cesarean section (CS) due to cephalopelvic disproportion (CPD) and non-CPD causes compared to vaginal deliveries (VD) in a sample of infants and mothers from Merida, Yucatan, Mexico. Methods The final sample consisted of 3453 single, live, and term infants born between January 2016 and May 2017 at the Maternal-Infant Hospital in Merida and their mothers (aged ≥19 years). The mode of delivery was established as the dependent variables: (a) VD, (b) CS due to CPD, and (c) non-CPD CS. Independent variables were maternal height and weight, the number of previous VD, newborn weight, and neonatal birthweight (BW) index/maternal height index. A multinomial regression model was used to analyze the association between newborn and maternal characteristics and outcome variable. Results By mode of delivery, 2124 (62%) births corresponded to VD, 1042 (30%) to non-CPDCS, and 287 (8%) to CS due to CPD. Mothers who had CS due to CPD weighed more at the end of their pregnancy and were shorter. Maternal age and weight increased the risk for having CS due to CPD compared to VD and maternal height, and the number of previous VD reduces the risk for experiencing CS due to CPD compared to vaginal births. The relative risk ratio for higher neonatal BW/maternal height index was significant for CS due to CPD and non-CPD CS. Conclusion According to our results from a public hospital in Merida, Mexico, CPD is a result of the interrelation of maternal and fetal size, rather than an independent result of maternal height or BW.

This study&rsquo, s objective is to analyze the incidence, lethality, hospitalization, and confirmation of COVID-19 cases in Mexico. Sentinel surveillance for COVID-19 cases in Mexico began after the confirmation of the first patient with community transmission. Methods: This epidemiologic, cross-sectional study includes all clinically suspected, and laboratory-confirmed cases nationwide from the beginning of the outbreak to 21 April 2020. State-cluster demographic data and health indicators were analyzed in reference to epidemiologic measures, with logistic regressions for the dependent variables of incidence, confirmation, and lethality. Results: The national incidence was 13.89/100,000 inhabitants with a 6.52% overall lethality and a confirmed-case mortality of 11.1%. The incidence variation significantly correlated with migration, but not urbanization. Pediatric patients were less prone to be tested (OR = &minus, 3.92), while geriatric individuals were a priority. State lethality positively correlated with the proportion of the population assisted at public hospitals and correlated inversely to the number of hospitals and clinics in the state. Conclusions: Migration strongly correlated with incidence, elderly patients had lower odds of being hospitalized but were likely to die. Patients aged &lt, 15 were less prone to be laboratory-confirmed. Case confirmation was not performed in all hospitalized patients, but 72.15% of hospitalized patients had favorable outcomes to date.

Los quistes ováricos complejos bilaterales en los recién nacidos son poco frecuentes y su reporte resulta de gran importancia para el conocimiento sobre el mejor manejo terapéutico.Objetivo: Describir el caso clínico de una recién nacida con diagnóstico de quistes ováricos complejos bilaterales y discutir las condiciones para el manejo conservador o quirúrgico según las características ecográficas del quiste.Caso Clínico: A las 35 semanas de edad gestacional se identificó mediante ultrasonido prenatal la presencia de masas quísticas en ambos anexos por lo que se decidió interrupción del embarazo por cesárea en la semana 37. Posterior al nacimiento, se corroboró la presencia de quistes ováricos bilaterales de 3,5 x 4,4 x 2,7 y 3,4 x 2,4 x 3,3 cm, derecho e izquierdo, respectivamente. El derecho con tabique de 1,4 mm y pared engrosada de 3 mm, hallazgos compatibles con quistes complejos. Al cuarto día de vida extrauterina se realizó aspiración evacuadora y destechamiento de la pared superior de ambos quistes con electrocauterio por vía laparoscópica, sin complicaciones. Se realizó el diagnóstico por anatomía patológica de cistoadenoma seroso de ovario.Conclusiones: Describimos un caso con adecuado diagnóstico prenatal e intervención quirúrgica laparoscópica exitosa de quiste ovárico bilateral > 4 cm. El diagnóstico prenatal es fundamental para un abordaje oportuno, según las características ecográficas del quiste: conservador o quirúrgico. Se recomienda la intervención quirúrgica neonatal en quistes de ovario simples > 4 cm, quistes complejos independientemente de su tamaño y aquellos que durante el manejo conservador evolucionen a quistes complejos.

Resumen Objetivo Determinar el riesgo de caidas, de neuropatia periferica, antecedentes de caidas y factores de riesgo en el hogar entre adultos mayores con diabetes mellitus tipo 2. Materiales y metodos Se empleo un diseno observacional, descriptivo de corte transversal en una poblacion de adultos mayores con diabetes. La obtencion de los datos fue realizada en dos fases: a) revision de expedientes clinicos, y b) visitas para la aplicacion de un cuestionario ad hoc y de las pruebas estandarizadas de riesgo de caidas y sensibilidad periferica. Resultados El 88% de los participantes presento niveles elevados de glucosa en ayuno, y el 85%, riesgo de neuropatia diabetica. La media de caidas en el ultimo ano fue de 1 (± 0,7). En cuanto al riesgo de caidas con la escala Tinetti, el 3% no tuvo riesgo, el 81% tuvo riesgo y el 16%, riesgo grave; con la escala J.H. Downton, el 2% tuvo riesgo leve, el 70%, moderado, y el 28%, grave. Estadisticamente se produjo una correlacion positiva entre el numero de caidas y la puntuacion Tinetti ( CC 0,83), la sensibilidad periferica (0,96) y el numero de obstaculos en el hogar (CC 0,62). Conclusiones Entre los adultos mayores con diabetes tipo 2 existe un riesgo de caidas y de neuropatia periferica.

RESUMEN. Introduccion : El sindrome de Rapunzel es una forma inusual de tricobezoar gastrico, se localiza desde el estomago llegando a traspasar el piloro y extendiendose hasta el intestino delgado y/o colon derecho. Se le llama bezoar a la formacion de cuerpos extranos, debido a la ingestion de uno o varios materiales no digeribles. El tricobezoar, uno de los bezoares que mas se presentan en la practica clinica consisten en una masa formada por cabello debido a la ingestion de este. Objetivo: describir la frecuencia de signos y sintomas del sindrome de Rapunzel en los reportes de caso y ofrecer una comparacion en edad pediatrica y adulta. Metodo. Revision sistematica en la base de datos PubMed, Google Academico, EBSCO y Scopus, empleando los terminos “Rapunzel syndrome” AND “case report” OR “Clinical case” Resultados. Un total de 110 articulos de reporte de caso fueron analizados, encontrando diferencias por sexo y edad. La tricotilomania se distribuyo sin predominancia por grupo de edad. Se identificaron diferencias en el reporte de algunas manifestaciones clinicas al analizarlas por grupo de edad, incluyendo diarrea, constipacion, vomitos y dolor abdominal. Los casos recidivantes representaron un 9%. Conclusiones: El sindrome de Rapunzel es una entidad que se encuentra en pacientes con patologias psiquiatricas como la tricotilomania y la tricofagia. Es mas frecuente en mujeres que en hombres. La tecnica diagnostica por eleccion fue la endoscopia y el tratamiento elegido incluyo la remocion quirurgica con psicoterapia. Palabras clave: sindrome de Rapunzel, signos y sintomas, bezoar, diagnostico, tricotilomania, adolescencia. Introduction: Rapunzel syndrome is an unusual type of gastric trichobezoar, which is located from the stomach through the pylorus and extends into the small intestine and/or right colon. Tricobezoar is a collection of foreign bodies that can form in the stomach, small intestine or colon, due to the ingestion of one or more indigestible materials. trichobezoar, one of the most present bezoars in Clinical practice consists of a mass formed by hair due to the ingestion of it, either consciously or unconsciously. Objective: To compile case reports to identify and analyze little-known aspects of Rapunzel syndrome, as well as patient characteristics along with the best and most documented methods of diagnosis and treatment. Method. Systematic review in the Pubmed, Google Scholar, EBSCO and Scopus databases using as search terms: "Rapunzel syndrome" AND "case report" OR "Clinical case" Results: A total of 110 case report articles were analyzed, finding differences by sex and age. Trichotillomania was distributed without predominance by age group. Differences were identified in the reporting of some clinical manifestations when analyzed by age group, including diarrhea, constipation, vomiting and abdominal pain. Recidivist cases were 9%. Conclusion: Throughout the review of reported cases, we found that part of the patient's recovery includes psychiatric treatment; Rapunzel syndrome is not a mental disorder, however, both trichotillomania and pica as factors of it. The entity is more frequent in women than in men, the technique for diagnosis by choice was the endoscopy and the chosen treatment included surgical removal with psychotherapy. Keywords: Rapunzel Syndrome, Signs and Symptoms, Bezoar, Diagnosis Trichotillomania, Adolescence.

La trama del Joker nos muestra el surgimiento del antihéroe a partir de Arthur, un individuo con un trastorno llamado afectación pseudobulbar, con antecedentes de abandono y abuso físico severo y maltrato con probable traumatismo encefálico, que vive sin vínculos sociales, carente de afecto, como cuidador primario de una familiar dependiente enteramente de él; el protagonista se mueve en un ambiente adverso, hostil en el que la sociedad que espera que él se comporte como si no tuviera ningún trastorno. un comportamiento normal". Sin recursos y rechazado por su medio, resulta colateralmente afectado por la reducción de presupuesto para terapia y medicamentos. En un momento decisivo, convergen los diferentes detonantes de sus manifestaciones psicopatológicas que dan paso a la transformación del joker y paradójicamente lo llevarán a ser aceptado socialmente. Joker nos invita a reflexionar sobre la importancia de a los programas de salud mental, los valores humanos, la cultura de la Paz y el buen trato como pilares fundamentales para promover la salud mental en la sociedad. El presente artículo tiene por objetivo el revisitar la fisiopatología de la afección pseudobulbar y establecer los aspectos clínicos, familiares, ambientales y socioculturales potencialmente asociados a la conducta destructiva de Joker. The plot of the Joker shows us the emergence of the antihero from Arthur, an individual with a pseudobulbar disorder, a history of abandonment and severe physical abuse and abuse with probable brain trauma, living without social ties, lacking affection, as a primary caregiver of a relative dependent entirely on him; the protagonist moves in an adverse, hostile environment in which the society that expects him to behave as if he had no disorder. normal behavior. «Without resources and rejected by its means, it is collaterally affected by the reduction of budget for therapy and medications. At a decisive moment, the different triggers of his psychopathological manifestations converge that give way to the transformation of the joker and paradoxically lead him to be socially accepted. Joker invites us to reflect on the importance of mental health programs, human values, the culture of Peace and good treatment as fundamental pillars to promote mental health in society. This article aims to revisit the pathophysiology of the pseudobulbar condition and establish the clinical, family, environmental and sociocultural aspects potentially associated with Joker's destructive behavior.

Human health and well-being are highly dependent of the individual and collective human activities and behaviors, but they are also tied to dynamic ecological determinants in a constantly changing society. These interactions can seem simple or obvious, as the relation between high sugar consumption with diabetes, diving and decompression illness or mosquito bites with febrile infections. But when it comes to a human ecology approach to health problems, the study of the aspects underlying those simple associations become less simplistic. Complex health-related questions can be thus analyzed within the interdisciplinary approach that characterizes the human ecology. In this chapter, we invite you to familiarize yourself with our inclusive approach and to have an insight of the health conditions in the Yucatan peninsula, with emphasis in those that are both endemic and frequent in the region.

Introduction: Influenza season is expected between October and February in the northern hemisphere, including Mexico. Previous studies suggested that transmission peak may occur earlier in Yucatan, a state in southeast Mexico. Objectives: (a) Describe the seasonality of 2018 influenza cases seen at O´Horan hospital, statewide, and nationwide; (b) analyze the characteristics, clinical manifestations and outcomes of ambulatory and hospitalized patients; (c) analyze fatal outcomes occurrence among vaccinated and unvaccinated individuals. Methods: Retrospective analytic cohort of all confirmed influenza cases assisted at O´Horan hospital during 2018, along with a chronologic graphic description of the statewide epidemic curve from the epidemiological surveillance registries. Results: A total of 264 influenza cases were analyzed; 145 (55%) were female; 26% were vaccinated. Health workers and unvaccinated individuals were more prone to develop severe cases. Dyspnea and tachypnea were strong predictors of hospitalization; headache, myalgias, arthralgias and rhinorrhea correlated inversely. 236 (89.47%) cases occurred in July and 22 of the 23 deaths occurred before October. No fatal outcomes were observed among vaccinated individuals. Influenza AH1N1 represented 83.6% of serotyped cases. Discussion: Onset of influenza season in Yucatan may reflect a need for rethinking timing of vaccination and of preventive campaigns, as most cases occurred before vaccination period. Keywords: Influenza virus, Infection, Hospitalization, Signs and symptoms

Introducción: El tétanos es una enfermedad infecciosa causada por Clostridium tetani, con un cuadro clínico grave y una elevada mortalidad. En Yucatán, la tasa de incidencia es baja (0.09 por 100,000 habitantes), reportándose únicamente dos casos en 2017, por lo que actualmente es una enfermedad de baja sospecha diagnóstica en la región. Caso clínico: Preescolar masculino de 5 años, originario de una comunidad rural de Yucatán y con esquema de inmunización incompleto, quien fue atendido por espasmos musculares generalizados, así como heridas recientes por cuerpo extraño y síndrome del niño maltratado. En la Unidad de Terapia Intensiva, se integró el diagnóstico de tétanos, por lo que recibió manejo etiológico y sintomático, logrando mejoría a su egreso. Discusión: Yucatán es una de las entidades federativas con mayor índice de maltrato infantil. Ante la presencia de dicha problemática social, es importante descartar un esquema de inmunización incompleto, mismos que con la coexistencia de hallazgos clínicos típicos y herida reciente por cuerpo extraño, se debe sospechar tétanos.Background: Tetanus is an infectious disease caused by Clostridium tetani, with severe symptoms and a high mortality rate. In Yucatan, the incidence rate is low (0.09 per 100,000 population), reporting only two cases in 2017, so it is now a disease of low diagnostic suspicion in the region. Case presentation: A 5-year-old male preschool, from a rural community of Yucatán and with incomplete immunization scheme, who was attended by generalized muscle spasms as well as recent foreign body wounds and battered child syndrome. In the Intensive Care Unit, the diagnosis of tetanus was integrated, for which he received etiological and symptomatic management, achieving improvement at his discharge. Discussion: Yucatan is a state with high child abuse rate of. In the presence of this social problem, it is important to rule out an incomplete immunization scheme, which with the coexistence of typical clinical findings and recent foreign body wound, tetanus should be suspected.

In Latin America, 51 995 emergencies and 337 deaths are caused by snakebites yearly. Prompt and adequate treatment is crucial after an envenomation. We here report the case of a 40-year-old male agriculturalist, who was bitten by a venomous snake. Hours after the bite, he was admitted at the nearest clinic, diagnosed with type IV envenomation. After initial antivenom treatment he was transported to an urban hospital. Hemorrhage persisted and the patient developed compartmental syndrome and renal failure. The patient died 3 days after the accident. To reduce fatalities from snakebite envenomation, such as the case we here presented, there is a need for coordinated and multilevel approach, collaborative work and continual medical training.

Rosacea is a chronic skin disorder that has been associated with unspecific etiological factors and diverse systemic manifestations. Cutaneous rosacea usually evolves to ocular rosacea in 6 to 72% of patients. In the absence of specific criteria to characterize this pathology, ocular rosacea can mean a diagnostic challenge. To strengthen early diagnostic suspicion, we present three cases of patients with different clinical evolution who had in common diagnostic delay resulting in severe manifestations and extensive ocular damage.La rosácea es una alteración cutánea crónica que se ha asociado con factores etiológicos inespecíficos y diversas manifestaciones sistémicas. La rosácea cutánea suele evolucionar a rosácea ocular del 6 al 72 % de los pacientes. Al no existir criterios específicos que la caractericen, la rosácea ocular implica un reto diagnóstico. Para fortalecer la sospecha diagnóstica temprana, se presentan tres casos de pacientes con evolución clínica distinta, pero que tuvieron en común el retraso diagnóstico, lo que se tradujo en manifestaciones graves y daño ocular extenso.

La enfermedad de Chagas (ECh) o tripanosomiasis americana es una enfermedad transmitida principalmente por insectos hematófagos detectados en zonas rurales y urbanas desde México hasta Argentina. De acuerdo a la Organización Panamericana de la Salud, entre 7,7 y 10 millones de personas cursan con infección crónica. La ECh es causada por el protozoario flagelado Trypanosoma cruzi. Posterior al contacto inicial con el vector, la fase aguda es comúnmente seguida por una fase silente que dura 15-20 años antes de debutar con manifestaciones cardíacas, neurológicas o gastrointestinales. Objetivo: Analizar el curso clínico atípico de un caso de cardiopatía chagásica en un paciente pediátrico del sureste de México. Caso clínico: El paciente consultó al desarrollar un chagoma en la pierna izquierda. Cinco meses después, se observó en su electrocardiograma una taquicardia sinusal y un crecimiento auricular izquierdo con ondas P anchas e intervalo QT prolongado. En la radiografía de tórax se observó cardiomegalia (índice cardiotorácico = 0,52); en el ecocardiograma transtorácico mostró dilatación del atrio y ventrículo izquierdos. Conclusión: Es importante realizar evaluaciones cardíacas oportunas en pacientes pediátricos con ECh, pues no debe asumirse que cursarán con una fase silente o que debutarán tardíamente con cardiopatía.