22q11.2 microdeletion syndrome, also known as DiGeorge syndrome, is a multisystem genetic disorder characterized by congenital heart disease and immune dysfunction. Adults with conotruncal defects are at an increased risk for infective endocarditis. We present the case of a 42-year-old man who experienced transient loss of consciousness, stroke, and hypoxemia. Chest computed tomography revealed multiple cavitated pulmonary nodules consistent with septic emboli. Transthoracic echocardiography demonstrated tetralogy of Fallot accompanied by valvular vegetations. Blood cultures identified the presence of Streptococcus parasanguinis. In addition, fluorescence in situ hybridization confirmed a 22q11.2 microdeletion. The patient underwent 6 weeks of intravenous ceftriaxone treatment, resulting in a favorable clinical outcome. This case underscores the significance of genetic and echocardiographic assessment in adults with congenital heart diseases and highlights the importance of early recognition of 22q11.2 deletion syndrome in preventing severe cardiovascular complications.
Craniopharyngioma (CP), a benign embryonic tumor with aggressive clinical behavior, poses significant anesthetic challenges due to its proximity to critical neuroendocrine structures. We present the perioperative management of a 17-year-old male with a giant recurrent CP who underwent bicoronal craniotomy with bispectral index-guided multimodal anesthesia, invasive hemodynamic monitoring, and strict endocrine control. Hemodynamic and metabolic stability were maintained, ensuring adequate cerebral perfusion. Transient polyuria occurred without hyponatremia, osmolar disturbances, or signs of diabetes insipidus or cerebral salt-wasting syndrome. Multimodal anesthesia, supported by invasive monitoring and close neuroendocrine surveillance, optimized surgical conditions and facilitated early recovery.
Polycyclic aromatic hydrocarbons (PAHs) are pollutants produced during the incomplete combustion of organic materials and are linked to carcinogenic and mutagenic effects. 1-hydroxypyrene (1-OHP) serves as a biomarker for assessing PAH exposure and is recognized as a reliable indicator due to its correlation with PAH levels in both occupational and urban settings. This study aims to review the scientific evidence concerning 1-OHP excretion levels as a biomarker of PAH exposure in the Mexican population.
Lead (Pb), cadmium (Cd), and arsenic (As) are persistent environmental pollutants that significantly threaten public health in Mexico. This review summarizes the last decade’s scientific literature on biomarkers of effect in the Mexican population exposed to these metals. A comprehensive search was conducted in PubMed and Google Scholar, revealing consistent associations between exposure to these metals and various biomarkers indicative of renal, neurological, cardiovascular, endocrine, and pulmonary damage, in addition to oxidative stress and genotoxicity. The findings suggest multi-organ effects may occur even at low concentrations. However, methodological heterogeneity and the limited assessment of combined exposures underscore the necessity for standardized and integrative research approaches. Future studies should address co-exposure scenarios and regional variability to enhance epidemiological surveillance and guide preventive actions. Biomarkers of effect represent essential tools for the early detection of toxicity and the development of public health interventions to reduce the impact of heavy metal exposure in Mexico.
Background: Adverse events represent one of the main threats to health in low and middle resource countries; adverse drug events (ADEs) are frequent in hospitalized pediatric patients, so the objective of the study was to assess the impact of an educational intervention for healthcare personnel on the incidence of AEs related to prescribing and administration in the pediatric inpatient service of a tertiary public university hospital. Methods: A quasi-experimental before-and-after study was conducted in a pediatric inpatient unit. Eight experts analyzed adverse events (AEs) documented in the Computerized Physician Order Entry and Electronic Medical Record systems, categorizing them using a risk matrix. The most common incidents were related to prescription and medication administration. Three training courses were provided to residents and nursing staff by specialists, focusing on the safe handling of cytotoxics, insulins, and concentrated electrolytes while reinforcing the “five rights” principle and the use of double-check lists. Competence was evaluated through pre- and post-course questionnaires. Preventable events from 2022 and 2023 were compared using the X2/Fisher’s exact test, with significance established at p < 0.05 (Statistical Package for the Social Sciences v25). Results: The educational intervention led to a significant reduction in AEs related to administration and prescription. Incidence rates decreased from 60% to 30% (p = 0.0007) for administration and from 23% to 6% (p = 0.006) for prescription. Nursing staff primarily reported these AEs, with higher reporting rates observed during daytime shifts. Conclusions: The educational intervention significantly reduced drug-related events in pediatric hospitalization and enhanced the role of nursing staff in ensuring safety during daytime shifts. Further research is needed to validate these findings.
Background: Cognitive impairment is a notable complication of end-stage renal disease (ESRD), associated with adverse outcomes. Early detection is crucial for improving treatment adherence and informing risk reduction strategies. This study screens for risk factors and cognitive symptoms in hemodialysis patients in Brunei Darussalam. Methods: A cross-sectional screening survey was conducted using cluster sampling of adults aged ≥ 50 years who were receiving hemodialysis. Participants completed a structured questionnaire on dementia risk factors and symptoms, followed by the Mini-Cog assessment. Results: In a study of 206 patients with a median age of 62 years (42.7% male), significant risk factors for cognitive impairment included hypertension (83.9%), hypercholesterolemia (55.8%), and diabetes mellitus (51.0%). Cognitive symptoms were reported by 159 patients (77.2%), with misplacing items (45.1%), visuospatial difficulties (38.3%), and forgetfulness (35.0%) being the most common. Mini-Cog assessment revealed that 17 patients (8.3%) were likely to have cognitive impairment. Conclusions: A significant proportion of hemodialysis patients exhibited cognitive symptoms, with approximately one in twelve screening positive for likely cognitive impairment. The feasibility of conducting cognitive impairment screenings in this population underscores the importance of early identification and intervention for cognitive issues in hemodialysis patients.
Objective: This study aims to evaluate the quality of corneal tissues obtained from donors diagnosed with sepsis. Methods: We conducted an observational, descriptive, and retrospective study at the Yucatán Eye Bank from 2016 to 2024. The findings include microbiological culture results, endothelial cell counts, and the final outcomes of corneal tissues from both donors with and without sepsis. Results: Of the 353 corneal donors with an average age of 52 years (range 15-83), 66% were men. Among them, 184 (33%) had corneas associated with sepsis, with a mean endothelial cell count of 2228 cells/mm2. About 57% were referred for pathology, primarily due to positive fornix or blood cultures. In addition, 43% were intended for optic/ tectonic transplantation, with no reported infectious adverse events. Conclusions: Corneas from sepsis donors can be used for optic and tectonic transplantation following thorough evaluation of clinical history, microbiological analysis, and slit lamp findings.
Background: This study describes the outcomes of the Aspirantes a Residencias Médicas (ARM) 2024 cohort and examines factors associated with selection success compared with previous years. Methods: A cross-sectional analytical study was conducted utilizing institutional data from the Universidad Autónoma de Nuevo León school of medicine spanning from 2020 to 2024. Historical comparisons were made using institutional reports from 2021 to 2023. The variables analyzed included course attendance, Examen Nacional Para ARM (ENARM) selection status, and class ranking (1-100, 101-200, 201-300). Categorical variables were examined using Chi-square or Fisher’s exact tests, while temporal trends were assessed through linear regression (p < 0.05). Results: Among the 300 graduates of 2024, 229 were selected, resulting in a selection rate of 76.3%. While attendance was linked to a higher selection rate, this difference did not achieve statistical significance within the 2024 cohort. The proportion of participants ranked in the top 100 rose from 54% in 2020 to 56.5% in 2024. There was a noteworthy upward trend in selection rates from 2020 to 2024, with an R2 of 0.93 and a p = 0.008. In addition, class ranking was significantly related to specialty choice (p = 0.022), indicating that higher-ranking candidates were more likely to pursue surgical or high-demand specialties. Conclusions: Attendance in the ARM course demonstrated a positive correlation with favorable outcomes on the ENARM. The observed progressive enhancement in selection rates from 2020 to 2024 underscores the potential significance of structured preparatory programs within an institutional framework.
Malignant pleural effusion (MPE) significantly diminishes the quality of life in cancer patients. While drainage is effective, it carries associated risks, leading to interest in diuretics, whose role remains unclear. In a series of 13 patients with metastatic disease treated with furosemide, 46% experienced improvement in dyspnea. Notably, patients with serum B-type natriuretic peptide (BNP) levels > 132 pg/mL showed a superior response, both in symptom relief and effusion reduction. This suggests that BNP may be a useful biomarker for selecting candidates for diuretic therapy in MPEs.
This report presents the first documented case of minimally invasive staging surgery using indocyanine green for sentinel lymph node detection in endometrial cancer at a tertiary hospital in Monterrey. A 42-year-old female patient with moderately differentiated endometrial carcinoma underwent total hysterectomy with bilateral salpingo-oophorectomy and lymph node evaluation. Dye migration to the sentinel lymph node was found to be satisfactory and proceeded without any complications. The case was classified as FIGO stage IA2. This technique is safe, has fewer complications, and yields oncological outcomes comparable to traditional pelvic and para-aortic lymphadenectomy.
Acute lymphoblastic leukemia (ALL) is the most prevalent form of cancer in children, and maintenance therapy with 6-mercaptopurine (6-MP) is crucial for treating these patients. While many patients respond well to treatment, some fail to achieve the desired therapeutic outcomes. This can occur for a variety of reasons, including ineffective metabolism of 6-MP. The drug is metabolized into thioguanine nucleotides (6-TGN), the active metabolites responsible for myelosuppression, and 6-methylmercaptopurine ribonucleotides (6-MMPR), which are linked to hepatotoxicity and gastrointestinal toxicity. Therapeutic failure in certain patients may necessitate dosage increases, thus raising the risk of adverse effects, such as myelosuppression and hepatotoxicity. This paper emphasizes the significance of monitoring 6-MP metabolites as a supportive strategy to optimize therapy for pediatric ALL patients, which is typically guided by adjustments in leukocyte count, white blood cells. Measuring 6-TGN and 6-MMPR provides a valuable tool for more precise and personalized patient management, allowing clinicians to initiate treatment with lower dosages in patients presenting elevated levels of 6-MMPR. This monitoring approach not only enhances long-term prognoses but also reduces the likelihood of adverse effects.
Background: To evaluate the representation of female authors in Mexican orthopedic journals, examining authorship roles, subspecialties, article types, and regional distribution. Methods: A retrospective observational study was conducted using articles published between 2005 and 2024 from three leading Mexican orthopedic journals. Authorship gender was determined through name analysis and online verification tools. Articles were classified by type, subspecialty, and state affiliation. Descriptive statistics and logistic regression were utilized to assess trends over time. Results: In our study of 1,223 articles, 24% (n = 295) included female authors, with first authorship at 12.1% and corresponding authorship at 11.9%. Female authorship rose from 2% in 2005 to 12% in 2024, predominantly from Mexico City and the State of Mexico (63.3%). The highest female representation was found in trauma (36.67%), epidemiology (22.22%), and foot and ankle (20.72%). Original articles represented the majority of female-authored works (53.9%). Conclusions: Despite a 2-decade increase in female participation in Mexican orthopedic research, women remain underrepresented, particularly in certain subspecialties and regions. These disparities highlight the necessity for targeted initiatives to promote gender equity and support women in this field across Mexico.
Injury to the femoral cutaneous nerve can result in meralgia paresthetica syndrome, depending on the site of compression, which may include the psoas muscle, pelvis, inguinal ligament, or thigh. 50-year-old male, post-operative bilateral inguinal hernioplasty. Later, he developed pain on the anterolateral aspect of both thighs. Neurophysiology confirmed bilateral femoral cutaneous nerve injury, and it was decided to remove the prosthetic material with clinical improvement. Given the clinical suspicion and history of abdominopelvic surgery, it is essential to perform magnetic resonance imaging and neurophysiological testing for diagnostic support, followed by timely treatment.
Background: Neonatal mortality accounts for up to 70% of infant deaths and 50% of deaths in children under five. This study aims to quantify neonatal mortality rates per 1000 live births and identify common causes, comparing premature and term infants. The findings will assist in developing effective preventive strategies to reduce neonatal mortality. Methods: This observational, comparative, and retrospective study analyzes neonatal death records from January 1, 2021, to December 31, 2024. It examines general variables such as age, weight, gender, and trophism, as well as specific pathologies including cardiac, respiratory, neurological, gastrointestinal, and infectious conditions. Binary logistic regression was utilized for statistically significant variables. Results: In the study period, there were 263 deaths, with 215 (81.7%) occurring in premature infants. This group showed significantly higher mortality due to respiratory distress syndrome (RDS) (58.6% vs. 10.4%, p < 0.05) and late-onset sepsis (12.6% vs. 2.1%, p < 0.05). In contrast, term infants had greater mortality from persistent pulmonary hypertension (12.5% vs. 3.7%, p < 0.05) and hypoxic-ischemic encephalopathy (16.7% vs. 1.9%, p < 0.05). The remaining variables were not statistically significant. Conclusions: The neonatal mortality rate was 16.3/1000 live births. Premature infants predominantly died from RDS and late-onset sepsis, whereas term infants had higher mortality rates due to persistent pulmonary hypertension and hypoxic-ischemic encephalopathy.
Meningiomas account for 39.7% of primary intracranial tumors, with atypical types comprising 17.7%. Here, we report a case of a 55-year-old woman with a giant right frontoparietal atypical meningioma, for which initial surgery was postponed due to excessive bleeding. Pre-operative endovascular embolization effectively reduced arterial flow to the tumor, allowing for successful complete resection. Histopathological analysis confirmed the atypical meningioma diagnosis according to the World Health Organization criteria. The post-operative course was favorable, with no complications or early recurrence. The objective of this article is to highlight the usefulness of pre-operative embolization in reducing intraoperative bleeding, which helps optimize complete resection, thereby lowering morbidity and the risk of recurrence, as demonstrated in this case.
