It is proposed that the origin of temperament is rooted in events of the third week of gestation, when gastrulation and the notochord organize body axes and morphogenetic gradients, integrated through intracellular pathways with downstream effects on circuit architecture and locomotion. The aim of this article is to propose a theoretical mechanistic model that articulates how gastrulation, the notochord, and prenatal epigenetic programming could contribute—probabilistically rather than deterministically—to the origin of human temperament. A three-phase mechanistic flow is proposed: Phase 1, in which gastrulation and the notochord establish axes and gradients that could modulate the organization of ventral circuits and central pattern generators; Phase 2, in which prenatal epigenetic programming calibrates stress, immune, and affective axes; and Phase 3, in which these levels integrate into profiles of activity, exploration, reactivity, and inhibition, consistent with the distributed polygenic architecture described by personality genomics. The notochord emerges as a plausible morphogenetic axis of temperament. Upon this embryonic scaffold, prenatal epigenetic programming may calibrate allostasis, stress reactivity, and affectivity, contributing to long-term temperamental variation. The model formulates falsifiable hypotheses and suggests translational priorities in perinatal prevention, multimodal biomarkers, and personalized neurodevelopmental medicine, whose short-term clinical feasibility remains uncertain.
Background:Globe rupture constitutes a severe form of open-globe injury and carries a guarded prognosis with a risk of permanent visual loss. The loss of the eyeball entails functional, psychological, and social repercussions that require a comprehensive approach aimed at timely diagnosis, appropriate management, and patient rehabilitation. Clinical case:A 2-year and 1-month-old male patient was brought by his mother to the pediatric emergency department after sustaining craniofacial and ocular trauma caused by the impact of a 45 kg domestic gas tank striking his face while playing at home. This resulted in rupture of the left eyeball and injury to the ipsilateral orbital tissue. Upon arrival at the pediatric emergency department, the patient was consolably crying and did not present any loss of consciousness. He was referred to a tertiary-level care facility for pediatric ophthalmology evaluation. An evisceration of the eyeball was performed, followed by placement of an intraorbital implant and a fenestrated conformer. Conclusions:Open globe trauma without a foreign body in young children, although infrequent, represents a serious ophthalmological emergency with a significant risk of permanent visual and anatomical loss. This case highlights an unusual injury mechanism in a 2-year-old child, emphasizing the vulnerability of young children in home environments and the importance of prevention.
Background:Hip fracture is a high-morbidity and high-mortality event in older adults. Early identification of the risk of death allows for optimized therapeutic decisions. Objective:To evaluate the predictive capacity of the Nottingham Hip Fracture Scale (NHFS) for estimating 30-day mortality in individuals aged 65 years or older with a hip fracture. Material and methods:A prospective, observational, longitudinal study was conducted in two IMSS hospitals in Michoacán, Mexico. Patients aged 65 years or older with a hip fracture were included. The NHFS score and its discriminative capacity were calculated using receiver operating characteristic (ROC) curve analysis. Results:169 patients were included; the 30-day mortality rate was 14.2%. Hemoglobin < 10 g/dL showed the strongest association with mortality, followed by in-hospital delirium and the NHFS score. In the multivariable model, severe anemia remained an independent predictor. The discriminative capacity of the scale was moderate (AUC = 0.746). The optimal cutoff point was ≥ 5 points. Conclusions:The Nottingham scale showed moderate discriminatory ability to predict 30-day mortality. Severe anemia emerged as an independent predictor of mortality.
A physician's death represents a critical point of tension between the values of modern medicine and the ethical limits of care. This review article analyzes how physicians face their own end of life and the type of care they receive compared with the general population. A narrative review of literature published between 2014 and 2025 was conducted using PubMed, Scopus, and SciELO databases with the MeSH and DeCS descriptors: "Terminal care", "Palliative care", "Attitude to death", "Health personnel", "Right to die". Findings show that although physicians express a preference for a dignified death with therapeutic proportionality and symptom control, many still die under highly technological and interventionist schemes. Mexico lacks systematic data documenting how its physicians die, revealing a gap between ethical intention and institutional practice. This analysis proposes developing a observational study to characterize therapeutic intensity, respect for autonomy, and the moral distress experienced by healthcare teams as bioethical and occupational issues within the health system.
Background:Hyperkeratotic psoriasis is a rare variant that includes forms such as elephantiasis, considered the rarest. It is characterized by thick, persistent plaques, resembling elephant skin, located mainly on the extremities and buttocks. Early detection and appropriate treatment, including systemic therapies, are essential for its management. Clinical case:A 58-year-old male patient presented in 2018 with dermatosis on his forehead, right elbow, and the backs of both hands. He was initially diagnosed with seborrheic dermatitis and chronic lichen simplex and received multiple topical therapies without improvement. In 2024, he developed new, disseminated lesions on his elbows, hands, and both legs, characterized by hyperkeratotic plaques and excoriations. A biopsy confirmed the diagnosis of elephantiasis variant hyperkeratotic psoriasis. Treatment with ustekinumab was initiated, resulting in significant improvement of the lesions. Conclusions:Elephantine psoriasis is a rare and difficult-to-treat variant, with few reported cases, which hinders the standardization of its management. Biologic therapies represent an effective alternative for improving prognosis, reducing complications, and preventing progression to other associated pathologies. Disseminating these cases is essential to expanding knowledge of this variant and optimizing available therapeutic options, for the benefit of patients.
The objective of this systematic review is to evaluate the efficacy and safety of short-duration dual antiplatelet therapy (< 6 months) compared with prolonged therapy (> 12 months) following drug-eluting stent implantation. A systematic search was conducted in databases such as PubMed and Google Scholar for articles published between 2019 and 2025, focusing on randomized clinical trials, observational studies, and recent meta-analyses. The primary outcomes analyzed were major ischemic events (cardiovascular death, myocardial infarction, stent thrombosis), major bleeding, and all-cause mortality. Available evidence demonstrates that short-duration dual antiplatelet therapy is non-inferior to prolonged therapy in preventing major adverse cardiovascular events and is consistently associated with a significant reduction in the risk of major bleeding. This strategy offers a superior net clinical benefit when an individualized de-escalation approach is applied, particularly with the use of new-generation drug-eluting stents, supporting the abbreviated regimen as a viable recommendation and, for many patients at high bleeding risk, the preferred option. These findings underscore the importance of integrating ischemic-bleeding risk profiles into personalized therapeutic decision-making.
Epidemiology has been fundamental for analyzing health problems and supporting decision-making in healthcare systems and public health. However, traditional epidemiological methods, designed fundamentally to identify causal associations at the population level through aggregate data measures, present inherent limitations in capturing individual heterogeneity in response to specific exposures. This population-based approach hinders personalized prediction of outcomes in a particular individual whose risk factors may manifest differently from the group average, particularly when multiple contextual variables and unique biological profiles are involved. Advances in artificial intelligence have generated tools capable of integrating large volumes of information, identifying complex patterns in specific subgroups, and producing more personalized estimates, transitioning from a reactive approach based on population averages toward predictive models centered on individual trajectories. However, these developments do not replace the methodological foundations of epidemiology, as the identification of exposures, outcomes, and causal relationships continues to depend on the epidemiological conceptual framework. From this perspective, current tensions do not represent a disciplinary crisis, but rather a transition toward broader approaches that combine population-based analyses with advanced predictive tools. This integration is particularly relevant for large-scale healthcare institutions and national health systems, which require models capable of leveraging diverse data to improve understanding of health processes and support clinical and operational decisions.
Hemostatic control in neurosurgery represents a major clinical challenge, in which even small variations in blood loss can critically alter intracranial pressure and neurological prognosis. Fibrinogen, the first coagulation factor to be depleted during hemorrhage, is also an early marker of coagulopathy and a key determinant of clot stability. This narrative review analyzed the scientific literature published between 2020 and 2025 in PubMed, Scopus, and the Cochrane Library, with emphasis on studies evaluating the pathophysiology, diagnosis, and targeted replacement of fibrinogen in neurosurgical patients. Through critical analysis and systematic integration of the selected studies, convergent evidence was identified demonstrating that low fibrinogen levels are associated with greater blood loss, an increased risk of intracranial rebleeding, and poorer functional outcomes. Viscoelastic test-guided administration allows dose optimization and reduction of transfusion requirements, while empirical strategies based on serum concentrations and surgical context provide safe alternatives when such technologies are unavailable. Understanding when and how to replace fibrinogen constitutes an essential component of comprehensive patient blood management in neurosurgery. This paradigm, summarized by the principle "think, assess, and replace", consolidates an integrated model of goal-directed neurohemostasis.
Background:Postoperative vascular stenosis following the use of temporary clips in cerebral aneurysms represents a current challenge due to the limited available evidence. This study evaluated whether temporary clipping causes significant image-detected stenosis and whether associated factors contribute to its occurrence. pathways with downstream effects on circuit architecture and locomotion. Objective:To determine the presence of early postoperative vascular stenosis related to the use of temporary clips in patients undergoing neurosurgical treatment for cerebral aneurysms. Material and methods:A cross-sectional analytical study was conducted in 43 patients surgically treated for cerebral aneurysms. Clinical and surgical variables were recorded, comparing pre- and postoperative vascular calibers using a paired Student's t-test. The frequency of residual aneurysm and associations with clip type, clinical factors, and clipping time were analyzed. Results:A significant reduction in postoperative vascular caliber was identified (mean 5.2%, p = 0.007). No statistically significant associations were found between stenosis and the evaluated factors. The incidence of residual aneurysm was low, and clipping times remained within safe parameters. Conclusions:Temporary clipping proved to be a safe and effective procedure, with a low rate of significant stenosis and no relationship with clinical or technical variables. Continued imaging follow-up and multicenter studies are recommended to confirm these findings.
Background:Bronchopulmonary dysplasia (BPD) is a chronic disease with a high prevalence in premature infants. Its development is related to multiple risk factors, including prolonged oxygen use, mechanical ventilation, and the presence of infections. Objective:To analyze the clinical characteristics and factors associated with readmission in patients with bronchopulmonary dysplasia after 12 months of follow-up. Materials and methods:This was an observational, analytical, and longitudinal study. Patients born before 36 weeks of gestation with BPD, seen in the Pediatric Pulmonology outpatient clinic between September 2023 and August 2024, were included. Results:Eighty-one patients were analyzed. The median gestational age was 30 weeks (IQR 5; 25th percentile: 28 weeks; 75th percentile: 33 weeks); 53% were female, and 64.2% presented with moderate BPD. All patients had at least one hospital readmission. 61.7% presented with retinopathy of prematurity. 30% required oxygen for more than one year. A significant association was found between low birth weight at one year and a higher number of readmissions (OR: 9.08; 95% CI: 2.10-39.2; p = 0.002). Conclusions:The clinical course of patients with bronchopulmonary dysplasia (BPD) remains unfavorable. Low birth weight at one year was the main factor associated with readmissions. Nutritional monitoring and infection prevention strategies are needed to improve long-term prognosis.
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine tumor with poor prognosis, requiring precise surgical management within a multidisciplinary approach. We conducted a narrative review with a structured literature search in biomedical databases (PubMed, Embase, Scopus, Web of Science) and official guidelines (NCCN, ESMO). Thirty high-quality and clinically relevant articles were selected based on methodological rigor and applicability. Wide local excision with 1-2 cm margins remains the standard of care for localized disease. Sentinel lymph node biopsy should be performed in all clinically node-negative cases, and complete lymphadenectomy is reserved for patients with confirmed nodal involvement or symptomatic disease. While surgery is essential, it is insufficient alone and must be integrated into a multidisciplinary model involving accurate staging, oncologic follow-up, and immunotherapy in advanced stages. This review highlights the crucial role of the surgeon as an active member of the comprehensive care team to improve survival and quality of life in patients with MCC.
Background:Electrical cataracts are an uncommon but clinically significant consequence of high-voltage injuries. Their onset may occur within weeks or months, and, without timely recognition, they may cause severe visual impairment. Electrical current induces thermal and direct cellular damage to the lens epithelium, leading to accelerated opacification distinct from age-related cataracts. Clinical case:A 52-year-old electrician sustained a 23,000-volt electrical burn during a workplace accident, with the current entering through the left arm and exiting through the facial and cervical regions. Two months later, he developed rapidly progressive bilateral visual loss. Ophthalmologic examination revealed mature cataracts in both eyes, normal intraocular pressure, without ultrasonography evidence of posterior segment abnormalities. Visual evoked potentials demonstrated moderate conduction delay with intact pathways. Bilateral phacoemulsification with intraocular lens implantation was performed, resulting in significant improvement, with visual acuity increasing from hand-motion perception to 20/40. Conclusions:High-voltage trauma can produce rapidly progressive bilateral cataracts even in the absence of retinal or optic nerve injury. Early ophthalmologic evaluation is essential in patients with electrical burns, as timely surgical management allows meaningful visual restoration and prevents long-term disability.
Major depressive disorder (MDD) is a highly prevalent and disabling condition, and although conventional treatments focused on monoaminergic neurotransmission have been helpful for many individuals, a substantial proportion of patients fail to achieve adequate symptom remission. Over the past decade, accumulating evidence has highlighted systemic inflammation as a central component in the pathophysiology of MDD, suggesting that immune dysregulation may characterize a distinct subgroup of patients. Activation of the immune system can adversely influence neurotransmission, impair neuroplasticity, disrupt the hypothalamic-pituitary-adrenal (HPA) axis, and promote glial cell activation, all of which can contribute to chronicity and resistance to standard therapies. This understanding has led to the proposal of "inflammatory depression" as a specific endotype within the broader depressive spectrum. Recognizing this profile is essential for advancing precision medicine and improving clinical decision-making. It is increasingly postulated that these patients may benefit from targeted anti-inflammatory strategies, including pharmacologic agents, nutraceuticals, structured physical exercise, and dietary interventions with immunomodulatory effects. Despite these promising avenues, more rigorous clinical trials are needed to establish standardized protocols and refine patient selection based on inflammatory biomarkers, ensuring more effective and personalized treatment approaches.
Background:Accurate identification of the puncture site in neuraxial anesthesia is essential. Accordingly, this study examines the concordance between interlaminar distance and bone landmark palpation in cases of difficult blockade. Objective:To reduce the risk of complications by enhancing the understanding of lumbar anatomy. Material and methods:A concordance study was conducted in 90 patients scheduled for neuraxial anesthesia, using bone landmark palpation and ultrasound measurement, with descriptive and inferential statistics applied through Cohen's Kappa coefficient. Results:The agreement between interlaminar distance and difficult blockade was κ = 0.565, p = 3.07×10⁻⁸; and between bone landmark palpation and difficult blockade was κ = 0.308, p = 0.00086. The odds ratio between difficult blockade and bone palpation was OR = 5.71 (95%CI: 1.93-16.93); for interlaminar distance and difficult blockade, the OR was 19.5 (95%CI: 5.85-65.00). The probability of encountering a difficult neuraxial blockade using the clinical technique was 80.77%, and with ultrasound guidance, it was 57.78%. Conclusions:An interlaminar distance <1.38 cm and grades 3 or 4 show moderate agreement with difficult blockade. Grades 3 or 4 were associated with a 5.71-fold increased likelihood of encountering a difficult blockade, whereas an interlaminar distance <1.38 cm was associated with a 19.5-fold increase. Based on probability difference, the use of ultrasound prior to neuraxial blockade reduces the likelihood of technical difficulty by 22.99% compared to the traditional clinical technique.
Background:Garengeot's hernia is a rare variant of femoral hernia in which the sac contains the vermiform appendix. Described by René-Jacques Croissant de Garengeot in the 18th century, it represents between 0.5% and 3% of femoral hernias, with appendicitis within the hernia being even more exceptional. It is more common in elderly women due to predisposing anatomical factors. Clinical case:A 77-year-old female patient was admitted to the emergency department with sudden and severe right inguinal pain (VAS 9/10), consistent with an incarcerated femoral hernia. During the surgical approach, acute appendicitis was identified within the hernial sac. An appendectomy and anatomical repair of the defect were performed using the McVay technique. The use of prosthetic material was ruled out due to the risk of contamination. Conclusions:Acute appendicitis in a Garengeot hernia is an exceptional clinical entity that is difficult to diagnose preoperatively and requires individualized management. The Guenther classification is a useful tool for standardizing the degree of appendiceal involvement and guiding the choice of surgical technique, especially in deciding whether to avoid using mesh in contaminated settings.
Background:Gestational diabetes due to insulin resistance (IR) is a priority health problem for the WHO given its consequences for both mother and fetus. Objective:To determine the suitability of HOMA-IR for early detection of insulin resistance in the first trimester of pregnancy. Materials and methods:A quantitative, comparative, and correlational study was conducted in 30 pregnant women, selected by convenience sampling. IR was determined in the first trimester using the HOMA-IR test with cut-off points based on pre-pregnancy Body Mass Index (BMI) in the first trimester and oral glucose tolerance test (OGTT) in the second trimester. Analysis was performed using SPSS with the following statistical methods: Shapiro-Wilk normality test; Pearson's and Spearman's r correlation coefficients; Levene's test for independent samples; Student's t-test; and Mann-Whitney U test; as well as risk analysis with respect to BMI. Results:The average age was 27 years. No relationship was found between HOMA-IR and sociodemographic variables or pre-pregnancy BMI. During the first trimester, HOMA-IR detected IR in 56.6% of pregnant women; while in the second trimester, the OGTT detected IR in 66.3% of pregnant women. A moderate relationship was found between HOMA-IR and OGTT values at one and two hours, but not in the fasting state. The difference in mean HOMA-IR values between the groups with and without IR persisted in the OGTT tests performed in the fasting, one-hour, and two-hour states. Pre-pregnancy BMI indicating overweight and obesity did not represent a significant risk. Conclusions:The HOMA-IR study proved useful for the early detection of IR, which can be used to guide lifestyle modifications in women with risk factors. Further scientific evidence is recommended.
Background:Esophageal perforation is a rare and potentially life-threatening condition. Its main etiologies include iatrogenic, traumatic, and neoplastic causes. Diagnosis is based on imaging and endoscopic studies. Although some cases can be managed conservatively, most require endoscopic or surgical interventions. Clinical case:A case study was conducted analyzing the clinical characteristics, treatment, and outcomes of patients with esophageal perforation treated at a referral hospital between 2019 and 2023. Twenty patients were included, with a mean age of 52 years and a predominance of men. The most frequent perforation sites were the cervical and abdominal regions, followed by the thoracic region. The etiology was iatrogenic in 13 cases and traumatic in 7 patients. The most common symptoms were pain, edema, and purulent drainage, and the predominant radiographic finding was contrast medium leakage. The mean time to diagnosis was 5.5 days. All patients required surgical management: primary closure in 4 cases, primary closure with jejunostomy in 5, primary closure with muscle patch in 3, and esophagectomy with esophagostomy and jejunostomy in 8 patients. The overall mortality rate was 20%. Conclusions:In this series, a high proportion of late diagnoses were observed, related to the time of referral to the unit; however, all patients required surgical treatment. Despite this, the observed mortality rate was comparable to that reported in the international literature.
Background:Lophomonas blattarum is a multiflagellate protozoan considered an endocommensal parasite of the cockroach gut. Its identification is clinically relevant in cases of recurrent or refractory pneumonia. The infection manifests with cough, dyspnea, expectoration, bronchiectasis, and pleural effusion; its diagnosis is based on the morphological recognition of the protozoan in respiratory samples, and treatment with metronidazole or tinidazole is usually effective. To describe the manifestations, diagnostic findings, and evolution of a patient with recurrent pneumonia caused by Lophomonas blattarum, the following case is presented. Clinical case:A 73-year-old female patient with type 2 diabetes mellitus, hypertension, hypothyroidism, and depressive disorder, with a history of hospitalization for pneumonia, was admitted with chest pain, progressive dyspnea, hyporexia, edema, and perioral cyanosis. Laboratory studies revealed a ground-glass opacity pattern and bilateral alveolar infiltrates. Given the poor response to treatment, bronchoalveolar lavage was performed, and Lophomonas blattarum was identified by direct microscopy. Treatment with metronidazole was initiated, resulting in clinical improvement and resolution. Conclusions:This case highlights the importance of considering parasitic etiologies in patients with recurrent pneumonia and chronic comorbidities. The timely identification of Lophomonas blattarum by bronchoalveolar lavage allowed for targeted treatment and a favorable clinical outcome.
Background:Developmental Dysplasia of the Hip (DDH) is the most common human congenital malformation. When diagnosed and treated before five months of age, it has a high cure rate. If not, surgical management is required with high economic costs, a great impact on morbidity and sequelae that can generate permanent disability. Objective:To design and validate an instrument to timely detect DDH. Material and methods:An instrument developed from a literature review on the timely diagnosis of DDC, using the PRISMA methodology. To validate it, an expert panel was formed comprising specialists from different healthcare institutions. Results:All participants in the expert panel agreed that DDH is a public health problem. They consider that there are many patients with late diagnosis and sequelae due to a lack of timely treatment. There was consensus on the feasibility of implementing the proposal. The expressed need to update the current regulations regarding diagnostic means was identified. Conclusions:It is necessary to promote epidemiology, risk factors, correct physical examination, ideal imaging methods according to the patient's age, and timely referral pathways for patients. Add our DDH instrument to the section to the healthy child card. This should include risk factors: pelvic presentation, female sex, and family history of DDH. As well as the marking of a normal vs abnormal physical examination.
Background:Bibliometrics allows for the evaluation of the editorial performance and thematic organization of health journals with an institutional function. Objective:To analyze the scientific output of the IMSS Medical Journal, indexed in PubMed (2005-2025), to describe its temporal evolution and publication patterns (productivity, typology, authorship, citations, and topics). Materials and methods:A descriptive and longitudinal bibliometric study was conducted using records retrieved from PubMed. Indicator processing was performed using Anne O' Tate; thematic analysis was based on the co-occurrence of keywords and MeSH terms, with clustering and visualization in VOSviewer. Results:A total of 2,661 articles were identified. Annual output showed variations, with a peak in 2023 (205), followed by 2024 (171) and 2025 (107). Observational clinical-epidemiological designs predominated. Authorship was primarily collaborative (average: 4.1; median: 4), with a concentration in teams of 3-6 authors. Production was centralized in Mexico, particularly in Mexico City (1276). 47.65% of articles received ≥ 1 citation (iCite), with an estimated 3,592 citations and 1.35 citations per article. Conclusions:The journal exhibits a predominantly national, territorially centralized, and methodologically observational profile, with concentrated citations and a broad thematic agenda. These findings provide evidence to guide thematic priorities and actions to strengthen editorial quality and visibility.
