International Journal of Medical Science and Clinical Research Studies

La Psychological Impact on the Patient With a History of Pregnancy Loss

2025-01-19T05:37:30+00:00

Pregnancy loss is a traumatic event that deeply affects the mental health of women, predisposing them to the development of disorders such as perinatal grief, anxiety, post-traumatic stress and depression. This study aimed to evaluate the psychological impact on obstetric women with a history of pregnancy loss. An observational and prospective study was conducted at the UMAE Hospital de Gíneco-Obstetricia CMNO. Of the patients initially included, 51 completed the evaluation at the first and third month after the loss. Instruments such as the Perinatal Grief Scale, the Checklist for Post-Traumatic Stress Disorder and the Hamilton scales for depression and anxiety were applied. The results at the first month showed a high prevalence of active (98%) and complicated (94.1%) grief, along with anxiety (84.4%), post-traumatic stress (31.4%) and moderate depression (62.8%, according to the Hamilton scale). At three months, active grief persisted in 88.2% of patients, while depression remained in 60.8%, mostly at moderate levels. Anxiety was the most frequent disorder, presenting in 84.4% of patients with active grief. These findings highlight the need for an early and multidisciplinary psychological approach, especially for those women with active or complicated grief, given its strong association with other mental disorders.

Characteristics of Vitiligo Patients in Dermatology and Venereology Outpatient Clinic Unit at Bali Mandara General Hospital 2021-2022

2024-12-23T01:46:26+00:00

Vitiligo is a depigmentation disorder characterized by the distinct macules or depigmented patches, which are often asymptomatic. Age and geographic location have an impact on the prevalence of vitiligo. This condition affects 0.5-2% of the global population and is caused by a combination of factors, including clinical symptoms and therapeutic outcomes. Methods: The research material was taken from the medical record of vitiligo patients in the Outpatient Clinic Dermatovenerelogy Bali Mandara General Hospital from 2021-2022. The data were analyzed descriptively using SPSS program version 26 for Windows. Result: This study collected 198 visits from vitiligo patients at the Bali Mandara General Hospital Dermatovenereology outpatient clinic. The predominant gender is female (55.1%), with late adolescents comprising 36.4%, students accounting for 38.4%, and the development of vitiligo occurring within 1-5 years for 54% of cases; 63.1% of patients lacked a familial history of vitiligo. The predominant clinical kind is non-segmental vitiligo (59.1%), and the most frequently used treatment is excimer light phototherapy (85.9%). Conclusion: Vitiligo patients at Bali Mandara hospital, Denpasar, mostly female aged 17-25 years old, with non-segmental vitiligo . The most common therapies given are excimer light phototherapy.

Bone Marrow Puncture (BMP): The Initial Step in the Management of Myelodysplastic Syndromes (MDS)

2025-01-02T11:25:13+00:00

Myelodysplastic Syndromes (MDS) encompass a variety of bone marrow disorders characterized by insufficient production of healthy blood cells. Myelodysplastic Syndromes (MDS) represent a cluster of bone marrow conditions where there's a deficiency in generating a sufficient quantity of healthy blood cells. Patients with MDS often exhibit an asymptomatic nature. The clinical manifestations of MDS vary widely depending on the cellular line involved. Infections, bleeding, and anemia are common features of the MDS, while unusual findings include hepatomegaly, splenomegaly and lymphadenopathy. However, the situation changes when the patient progresses to acute myeloid leukemia (AML), leading to a transformation into thrombocytosis. During the process of improving the general condition, on the third day of treatment, the patient experienced a deterioration and unfortunately passed away. The lack of medical and healthcare personnel in Indonesia and the unequal distribution of them are the reasons why patients with rare cases are still far from obtaining their health rights. An important challenge in clinical practice involves distinguishing between primary myelofibrosis and other conditions, as misidentification can delay treatment, potentially leading to patients not receiving necessary healthcare and possibly resulting in fatalities.

The Influence of Health Literacy on Diabetes Prevention Behaviors in Sai Mai District Communities, Bangkok

2024-12-26T08:32:33+00:00

This research aimed to 1) assess health literacy levels 2) evaluate diabetes prevention behaviors and 3) analyze the influence of health literacy on diabetes prevention behaviors among residents in Sai Mai District communities, Bangkok. This cross-sectional survey research included 317 participants aged 35 years and above, selected through stratified random sampling. Data were collected from June to September 2024 using questionnaires with content validity and reliability (Cronbach's alpha coefficient = 0.87). Data were analyzed using descriptive statistics and multiple regression analysis.

The results showed that the majority of participants had moderate levels of health literacy (65.3%) and diabetes prevention behaviors (58.7%). Factors significantly influencing diabetes prevention behaviors included education level (β = .325, p < .001), health information accessibility (β = .298, p < .001), self-management (β = .276, p < .001), age (β = .245, p < .01), and income (β = .198, p < .01). These variables collectively explained 52.3% of the variance in diabetes prevention behaviors (R² = .523). The findings can be applied to develop appropriate health literacy promotion programs and diabetes prevention behaviors suitable for the community context.

The Interplay between Hyperaldosteronism and Heart Failure with Preserved Ejection Fraction: Pathophysiological Insights and Therapeutic Implications

2025-01-04T11:03:25+00:00

Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome characterized by preserved left ventricular systolic function, diastolic dysfunction, and systemic inflammation, often coexisting with metabolic and hemodynamic disorders. Primary hyperaldosteronism (PHA), a condition marked by excessive aldosterone secretion, is increasingly recognized as a pivotal contributor to the pathophysiological mechanisms underpinning HFpEF. This review explores the intricate relationship between hyperaldosteronism and HFpEF, emphasizing the role of aldosterone in myocardial remodeling, endothelial dysfunction, and systemic inflammation. Additionally, it highlights emerging evidence on aldosterone antagonists as potential therapeutic agents in mitigating HFpEF-related morbidity. By integrating clinical findings with molecular insights, we aim to elucidate how hyperaldosteronism exacerbates HFpEF phenotypes and propose strategies for targeted management. This synthesis underscores the need for tailored interventions in patients with concomitant hyperaldosteronism and HFpEF.

Innovative Strategies in the Management of Hypoplastic Left Heart Syndrome: A Multidisciplinary and Translational Approach

2025-01-04T11:07:37+00:00

Background: Hypoplastic Left Heart Syndrome (HLHS) represents one of the most severe congenital cardiac malformations, characterized by underdevelopment of left-sided heart structures, necessitating a complex surgical and medical management strategy. Despite advancements in staged palliation and neonatal care, outcomes remain suboptimal for a significant subset of patients. Recent progress in molecular biology, regenerative medicine, and surgical innovations offers novel approaches that may transform the clinical trajectory of these patients.

Objectives: This article explores emerging strategies for HLHS management, including stem cell therapy, tissue engineering, genomic medicine, hybrid procedures, and long-term monitoring protocols facilitated by artificial intelligence (AI).

Methods: A comprehensive review of contemporary literature was conducted, focusing on the translational application of novel therapies and their integration into current staged palliation frameworks.

Results: Early-stage studies demonstrate promise for stem cell therapies and myocardial regeneration in improving ventricular function. Advances in 3D printing and bioengineering have facilitated patient-specific surgical planning and the development of biocompatible grafts. Furthermore, AI-driven algorithms provide personalized risk assessment and optimized perioperative management strategies.

Conclusions: The integration of multidisciplinary and translational approaches offers an opportunity to redefine HLHS management, potentially improving survival and quality of life for affected individuals. However, further clinical trials and international collaboration are essential to establish these novel therapies as standard of care.

Single Isolated Umbilical Artery in A Healthy Newborn: Case Report

2025-01-07T08:30:46+00:00

Introduction: The umbilical cord (UC) typically contains two arteries and one vein. The presence of a single umbilical artery (SUA) is the most common anomaly associated with the umbilical cord and is linked to various congenital conditions. However, SUA can also appear as an isolated condition (ISUA), occurring without any accompanying fetal structural or chromosomal abnormalities.

Clinical case: The case involves a 37-year-old primiparous patient with inadequate prenatal care. She presents to our medical unit for the first time at 38.2 weeks of pregnancy, experiencing latent phase labor and presentation dystocia. The patient has been diagnosed with SUA since 21.5 weeks of gestation. The pregnancy was resolved through an abdominal delivery, resulting in the birth of a healthy newborn.

Discussion: Pregnancies involving fetuses with SUA are associated with an increased risk of various malformations, including renal, cardiac, nervous system, and gastrointestinal issues. These pregnancies may also lead to complications such as a small fetus for its gestational age, fetal growth restriction, abortion, preterm birth, and perinatal death. However, as illustrated in this case, SUA can occur without resulting in any adverse perinatal outcomes.

The Role of Convolutional Neural Network (CNN) Based on Dermoscopy Imaging for Early Detection of Melanoma: A Systematic Review

2024-12-27T16:34:30+00:00

Background: AI systems for melanoma detection have shown considerable potential. Although, dermoscopy has become a widely utilized non-invasive method for diagnosing skin tumors. However, the variability in diagnosis caused by subjective interpretation of dermatological findings can affect both accuracy and consistency. Therefore, we conducted this study to review the accuracy, sensitivity, and specificity of Convolutional Neural Network (CNN) based on dermoscopy imaging in diagnosing melanoma.

Method: This systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines. We limited the studies from 2019 until 2024. All studies that assessed diagnostic accuracy of CNN in diagnosing melanoma were analyzed. QUADAS (Quality Assessment of Diagnostic Accuracy Studies) is used to assess the quality of diagnostic accuracy studies.

Results: Eleven studies were eligible to be included in this study. The Area Under Curve (AUC) among the studies varied between 81.3% and 92.6%. Sensitivity varied between 69.1% and 94.2%. Specificity varied between 65% and 84.63%.

Conclusion: The AUC, sensitivity, and specificity showed good results compared to dermoscopy alone. However, the usage of artificial intelligence was as an adjunctive tool, not as a replacement for dermatologists.

Revision Arthroplasty Versus Open Reduction Internal Fixation for Distal Femur Periprosthetic Fractures: A Systematic Review

2024-12-29T12:38:42+00:00

Introduction Distal femur periprosthetic fractures are a challenging complication following total knee arthroplasty (TKA). Primary surgical approaches are Revision Arthroplasty (RA) and Open Reduction Internal Fixation (ORIF). RA replaces unstable prosthetic components, while ORIF preserves the prosthesis. This review aims to evaluate the outcomes of RA and ORIF.

Method This review followed PRISMA 2020 guidelines. Literature search was conducted across PubMed, Scopus, and Google Scholar. Data extraction and bias assessment were performed independently.

Results Literature search resulted in 376 papers. After screening, 12 studies were included with a total of 526 patients, with 302 patients treated with ORIF and 224 with RA. ORIF patients showed a fracture union rate of 94.2% and RA patients 94.9%. Average time to union was 15.9 weeks for ORIF and 14.1 weeks for RA. Complication rates were 10% for ORIF and 10.3% for RA. Reoperation rates were 4.1% for ORIF and 4.5% for RA. Mortality rates were slightly higher in RA group (3.8%) compared to ORIF group (3.4%). ORIF patients scored higher on KSS but lower on OKS compared to RA patients.

Discussion RA shows faster time to fracture union compared to ORIF, attributed to RA’s load-sharing design which supports early weight-bearing without compromising fracture stability or healing. Literature suggests that early mobilization may reduce morbidity and enhance ambulatory recovery. Complication, reoperation, mortality, and functional scores were similar in both groups.

Conclusion Both ORIF and RA offer distinct advantages, depending on factors such as prosthetic stability and bone quality. Further researchs are required to establish proper guidelines.

Giant Mesenteric Cyst of The Large Bowel: Case Report

2024-12-19T22:06:10+00:00

Introduction: Mesenteric cysts are rare, benign intra-abdominal cystic lesions that arise from the mesentery, the tissue fold attaching the intestines to the abdominal wall. They can develop from the duodenum to the rectum. Mesenteric cysts have various histological origins, with lymphangiomas being more common in children and mesothelial cysts in young to middle-aged women. While they can remain asymptomatic, they may also cause complications such as intestinal obstruction or perforation. Complete resection is the preferred treatment due to its lower recurrence rate.

Case Presentation: A 48-year-old female with a medical history of systemic arterial hypertension, allergies, hysterectomy, appendectomy, cesarean section, right axillary lipoma resection, and a cyst in the left zygomatic region, presented in June 2021 with dull, constant pelvic pain. Over time, her symptoms progressed to include volume increase, fatigue upon sitting, constipation, and hand tremors. Imaging studies revealed a large cystic lesion extending from the left ovary. In January 2024, an abdominal ultrasound showed a complex ovarian cyst (O-RADS 4). Surgical exploration revealed a mesenteric cyst associated with the sigmoid colon, which was resected along with a distal segment of the descending and sigmoid colon, preserving the left colic artery. The patient recovered well postoperatively, with proper colostomy function.

Discussion: Mesenteric cysts are benign tumors that can occur throughout the gastrointestinal tract, most commonly in the small bowel mesentery. Their clinical presentation can range from asymptomatic to acute abdominal pain secondary to complications such as intestinal obstruction or cyst rupture. Diagnostic imaging typically involves ultrasound, CT, and MRI. Surgical resection is the treatment of choice to prevent recurrence. The prognosis following complete cyst excision is favorable, with no reported recurrences.

Conclusion: Mesenteric cysts present a diagnostic challenge due to their wide range of symptoms. The recommended treatment, as supported by literature, is complete resection to minimize recurrence. Our case followed this approach, and the patient showed a positive clinical outcome

Fistulous Communication Between the Left Atrium and Coronary Sinus: A Rare Case from Nepal

2025-01-07T10:01:13+00:00

Left atrium and coronary sinsus fistulous connection is rare anonaly with devastating consequence leading to alteration in hemodynamic of blood flow. We present a case of 50 years old male who presented for evaluation of chest pain whose TMT was positive for reversible ischmia and coronary CT showed abnormal connection between coronary sinus and left atrium.

Computed Tomography Pattern of Non-Traumatic Intracranial Hemorrhage in Tertiary Hospital of Nepal-A Cross Sectional Study

2024-10-23T15:25:37+00:00

Objective: We aimed to study the pattern of non-traumatic intracranial hemorrhage on Computed Tomography in tertiary hospital of Nepal.

Methodology: 180 cases of intracranial hemorrhage (108 male and 72 female), diagnosed on computed tomography and aged >18 years were enrolled in the study. Cases with known history of trauma and previous intracranial hemorrhage were excluded. CT scan of head was performed in 128 slice Multidetector Philips CT scan Machine using 120 kV and auto mA with multiplanar reconstruction on dedicated workstation. Size and site of hematoma was noted. Intracranial hemorrhage was classified into different types- intraparenchymal, intraventricular, subarachnoid, subdural and epidural. Presence or absence of perilesional oedema was noted separately. SPSS 20 was used for the entry and analysis of the collected data.

Result: Mean age of the study population was 64.6 years ranging from 19 years to 92 years. 60% were male and 40% were female. The most common type of non-traumatic intracranial hemorrhage was intraparenchymal (91.1%) followed by intraventricular (5.6%), subarachnoid (2.2%) and subdural (1.1%). Perilesional oedema was seen in 69.4 % of intracranial hemorrhage. The age group with maximum cases (53.3%) of intracranial hemorrhage was >60 years followed by 50-60 years.

Conclusion: Intraparenchymal type was the most common type of non-traumatic intracranial hemorrhage as seen on computed tomography. Male gender and older age were significantly associated with intracranial hemorrhage.

The WALANT Technique in Osteotomy and Bone Elongation for Brachymetatarsia: A Case Report

2025-01-06T05:46:56+00:00

Introduction: Brachydactyly (BD) is considered a genetic malformation that can cause disproportionately short fingers and toes. The incidence ranges from 0.0% up to 0.05%, with a predilection for females. On the other hand, the Walant anesthetic technique is safe and effective and uses epinephrine, lidocaine, and sodium bicarbonate.

Case presentation: A 50-year-old female diagnosed with BD was scheduled for an elective osteotomy with a bone elongator. During the procedure, we used the Walant technique, which does not require intravenous sedation or supplementary oxygen.

Clinical discussion: Hand surgery is one of the most common procedures and usually requires the use of a tourniquet for hemostatic control, creates pain and makes the use of sedation necessary. In this case, we explained how the Walant technique can be beneficial in cases with BD.

Conclusion: The Walant technique proves anesthesia and avoids the use of tourniquet and sedation, decreasing surgical times, optimizing surgical supplies, and decreasing costs and post-anesthetic recovery. It can be used as a first-line anesthetic option in selected procedures, including tendon repairs and carpal tunnel release.

Reviewing the Potential Use of Curcumin Extract for Topical Therapy Supporting Burn Wound Healing

2024-12-25T05:58:37+00:00

Introduction: Wound dressing is a fundamental aspect of modern healthcare, encompassing a diverse range of materials and techniques aimed at optimizing the healing process while safeguarding against infection and further injury. By understanding the specific benefits of different types of wound dressings, healthcare professionals can optimize the healing process and improve patient outcomes

Methods: This literature review was compiled using information from numerous open access web databases. Data were compiled and analyzed.

Results and Discussions: Curcumin has the ability to improve burn wound healing. Curcumin can reduce inflammation by inhibiting proinflammatory cytokines. It also helps cell proliferation, and has an antimicrobial effect, therefore it speeds up burn wound healing and prevents keloid formation.

Conclusion: Curcumin has potential activity in speeding up burn wound healing, thanks to its anti-inflammation, antioxidant, and antimicrobial activity. However, due to low solubility in water of curcumin and its instability, further research must be done to find out better form for curcumin

Pregnancy Favism and Severe Hemolytic Anemia in a Patient with Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency: A Case Report

2025-01-07T02:44:37+00:00

Introduction: Favism is a genetic disease-causing hemolytic anemia in Mexico, primarily due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Factors triggering favism include infections, pregnancy, certain drugs, and eating beans. The disease is inherited recessively and is more common in men. Diagnosing and managing favism during pregnancy is crucial, as it can lead to severe hemolytic anemia and neonatal jaundice.

Case presentation: A female patient, aged 18, presented with severe anemia and thrombocytopenia during her 20-week pregnancy. During pregnancy, the patient experienced jaundice and anemia at 21.5 weeks of gestation. Despite not presenting evidence of bleeding, transfusions were performed due to critical hemoglobin levels. G6PD deficiency was confirmed at 9 days of hospital admission, indicating severe hemolytic anemia.

Clinical discussion: The hemolytic crisis in a pregnant woman with favism was triggered by pregnancy and repeated infections of candidiasis. Clinical symptoms of hemolysis were confirmed through G6PD and Coombs tests, and blood transfusion was recommended to prevent complications. The patient's hemoglobin was monitored for signs of active intravascular hemolysis, and a folic acid tablet was recommended during the crisis. Post-crisis management involved periodic controls of hemoglobin, hematocrit, lactate dehydrogenase, and bilirubin.

Conclusion: Favism, a prevalent condition in Mexico, should be considered in patients with a family history of hemolytic anemia or compatible symptoms. Early diagnosis and proper management are crucial to prevent complications in the mother and fetus. A multidisciplinary approach, genetic counseling, and medical education are essential for effective management.

Recurrent Urinary Tract Infections with Multidrug Resistance Bacteria in a 50-Year-Old Man Living Donor Kidney Transplant Recipient with Adult Polycystic Kidney Disease: The Issues for Native Nephrectomy

2025-01-15T12:07:50+00:00

A 50-year-old man with polycystic kidney disease had living donor kidney transplant. Simultaneous right sided native nephrectomy was done to give a space for graft kidney. He developed three episodes of urinary tract infections within 2 months after transplant; one episode was associated with septic shock and rise serum creatinine. Two urine culture results taken two weeks apart revealed Klbsiella pneumoniae. It was sensitive to amikacin and resistant to nearly all antibiotics including quinolone, imepenum, colistin, cefepime and tigecycline. The remaining left native kidney was removed as the cysts were nidus to hide bacteria; no more recurrence after second nephrectomy.

Cutaneous Metastasis of Endometrial Adenocarcinoma: An Unusual and Dramatic Presentation of two Cases

2024-12-30T20:09:30+00:00

Skin metastases from endometrial adenocarcinoma, particularly cutaneous lymphangitis carcinomatosis, are rare. We present two cases of endometrial adenocarcinoma that recurred as lymphangitic carcinomatosis after presumed complete resection. Case 1 is a 71-year-old woman with a history of breast adenocarcinoma, who developed painful erythematous lesions and a verrucous plaque in the pubic area three months after surgery for endometrial adenocarcinoma. A skin biopsy confirmed carcinomatous lymphangitis, and she died four months later. Case 2 is a 56-year-old woman with stage IIB endometrioid adenocarcinoma, who developed erythematous plaques and lymphedema on the left thigh a year after treatment. A biopsy confirmed cutaneous lymphangitis carcinomatosis, and she died five months later. Cutaneous lymphangitis carcinomatosis is an uncommon form of skin metastasis, typically seen in breast cancer but rarely in endometrial adenocarcinoma. Early recognition is essential, as it can mimic benign dermatologic conditions. The prognosis is poor, with treatment often being palliative and ineffective. These cases highlight the importance of considering skin metastasis in patients with a history of gynecological cancer presenting with new cutaneous lesions.

Hybrid Management of Taussig-Bing Syndrome in Neonates: An Innovative Approach to Optimize Outcomes in Complex Congenital Heart Disease

2025-01-17T11:07:26+00:00

Taussig-Bing syndrome, a rare and complex congenital cardiac malformation characterized by double outlet right ventricle (DORV) with subpulmonary ventricular septal defect (VSD), poses significant challenges for neonatal management. Traditional surgical approaches often involve extensive cardiopulmonary bypass procedures and staged correction, which may increase perioperative risk and prolong recovery. Hybrid strategies combining surgical and interventional cardiology techniques have emerged as an innovative alternative to address the unique anatomical and physiological complexities of this condition.

This article explores the rationale, methodology, and outcomes of hybrid management for neonates with Taussig-Bing syndrome. We detail preoperative planning, intraoperative strategies, and postoperative care, emphasizing the role of multidisciplinary collaboration. The use of stenting, banding techniques, and minimally invasive surgical corrections is evaluated alongside advanced imaging modalities to enhance procedural success. Current evidence and case reports are reviewed to provide a comprehensive overview of this evolving paradigm. Our findings suggest that hybrid management offers a promising avenue for improving survival and reducing morbidity in neonates with Taussig-Bing syndrome, underscoring the need for further research and refinement of these techniques.

The Interconnection between Obstructive Sleep Apnea and Persistent Atrial Fibrillation: Pathophysiology, Clinical Implications, and Management Strategies

2025-01-18T14:18:21+00:00

Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by intermittent upper airway obstruction, resulting in recurrent hypoxemia, hypercapnia, and sleep fragmentation. Emerging evidence highlights a significant association between OSA and persistent atrial fibrillation (AF), a complex arrhythmia with substantial morbidity and mortality. This relationship is underpinned by multifaceted pathophysiological mechanisms, including autonomic nervous system dysregulation, structural and electrical cardiac remodeling, systemic inflammation, and heightened oxidative stress. Patients with coexistent OSA and AF exhibit a more challenging clinical course with higher rates of arrhythmia recurrence and resistance to conventional therapies such as antiarrhythmic drugs and catheter ablation.

This review explores the intricate interplay between OSA and persistent AF, emphasizing the role of continuous positive airway pressure (CPAP) therapy in modifying arrhythmogenic risk and improving cardiovascular outcomes. Furthermore, the article discusses the importance of multidisciplinary approaches for diagnosis and management, integrating cardiological and sleep medicine perspectives. Understanding this bidirectional relationship is crucial for tailoring therapeutic strategies aimed at mitigating the burden of AF in patients with OSA.

Indicators of General Health Perception in Venezuelan Migrants in a Shelter Situation in Ciudad Juárez, Mexico

2025-01-20T11:24:58+00:00

Venezuelan migrants in a situation of temporary shelter in Ciudad Juárez, Chihuahua, Mexico, maintain processes of adaptability in the face of legal and assistance conditions of transit due to their migratory trajectory to the United States of America. The economic conditions and situations of violence in their country of origin have made it possible to establish themselves as the main reasons for mobility. Various studies indicate that Venezuelan migrants have inadequate physical and mental health conditions in the face of experiences of victimization and vulnerability during their migratory journey. The main objective of the study was to analyze the general health indicators of Venezuelan migrants in a situation of temporary shelter in Ciudad Juárez. Using a descriptive approach with a quantitative, empirical-analytical perspective of non-experimental cross-sectional temporality, 80 Venezuelan migrants with informed consent participated with non-probabilistic sampling by volunteer subjects to analyze the General Health Questionnaires [GHQ-28] according to the reasons for migration. The results indicated that there were significant indicators of anxiety, depression and somatic symptoms in one-sixth of the participating migrants related to economic conditions in their country of origin to a greater extent than situations of violence as reasons for migrating. Even so, the social resources for the construction of support networks are relevant but are associated with general health conditions with inadequate psych affective conditions as a survival and adaptation strategy that allows achieving the goal of migrating to the global north of America.

Primary Retroperitoneal Mucinous Cystadenoma: Laparoscopic Resection and Literature Update.

2025-01-21T10:55:34+00:00

Primary retroperitoneal mucinous cystadenoma (PRMC) is a rare pathology. Until our last update literature review there is 49 cases published. We present the case number 50 to the scientific literature. A 43-years-old female that presented to our clinic with abdominal pain was diagnosed as retroperitoneal cystic lesion by computed tomography scan. She underwent laparoscopic resection with no complications. The histopathology reveled a PRMC with no malignancy futures. These rare cystic lesions should be included as differential diagnosis at the preoperative stage. The best management option is the complete surgical excision with no intraoperative spillage.

Superficial Cutaneous Sporotrichosis, Report of a Case with Adequate Response

2025-01-13T18:07:09+00:00

Introduction: Sporotrichosis is a mycosis caused by the fungus of the genus Sporothrix, of which six species related to human sporotrichosis are recognized, being the S. schenkii complex the most related to transmission in humans. The entry of the agent occurs by contact between the injured skin and the fungal spores, subsequently the fungal conidia are deposited in the host tissue and when introduced, become yeast. The fungus, now in its yeast-like phase, may remain at the site of entry or spread to other sites following the lymphatic vessels (1).

Case presentation: We present the case of a 62-year-old male patient with arterial hypertension of 6 years of evolution, gardener, who came to our unit due to the presence of blistering and ulcerative lesions (image 1) on the foot and ipsilateral thigh. He received empirical treatment by private means with acyclovir cream and oxytetracycline, due to the characteristics of the lesions he was treated for herpes zoster with standard dose Acyclovir, he was seen in an outpatient internal medicine clinic one week later. Due to persistence of lesions and scarce reduction in symptomatology, a diagnosis was made according to clinical history, dermal and biochemical pattern of probable mycosis, with emphasis on sporotrichosis or “gardener's disease”, initiating treatment with itraconazole fractional dose for four weeks, with weekly follow-up of the case.

Conclusions: At present, the diagnosis of S. schenkii, is of exclusion, in the face of predominant agents in the region. The most frequent clinical forms in humans are the fixed cutaneous form, the lymphatic form and the disseminated form; the latter has a poor prognosis due to its association with immunodeficiencies. Our case is an example of timely diagnosis with appropriate initial azole-based treatment, reflecting a successful case response, inviting the clinician to early integration

Case Report: Upper Gastrointestinal Bleeding Due to Gastric Ulceration over Intraluminal Gastrointestinal Stromal Tumor (GIST) at the Fundus of the Stomach

2025-01-16T14:07:30+00:00

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms originating from the interstitial cells of Cajal in the gastrointestinal tract. They can manifest anywhere along the GI tract but are most commonly found in the stomach. GISTs are often asymptomatic, but when symptoms do occur, they may include abdominal pain, gastrointestinal bleeding, or signs of obstruction. In this case, we report on a 70-year-old male who presented with upper gastrointestinal bleeding caused by gastric ulceration over an intraluminal GIST located at the fundus of the stomach. The patient had a history of occasional painless melena over the past month, anemia symptoms, and a significant drop in hemoglobin levels. Despite prior difficulties with anesthesia due to challenging intubation, successful surgical excision of the tumor was achieved after meticulous preoperative preparation. The postoperative course was uneventful, and histopathological examination confirmed a spindle cell type GIST. The patient was subsequently managed according to GIST guidelines with long-term oncological follow-up. This case highlights the clinical presentation, diagnostic challenges, and management strategies for upper gastrointestinal bleeding due to an intraluminal GIST.

Case Report: Ultrasound-Guided Neuroaxial Anesthesia in Pregnant Patient with Opioid-Allergic Achondroplasia

2025-01-17T18:35:59+00:00

Achondroplasia is a low prevalence genetic disorder characterized by disproportionate short stature and skeletal dysplasia, caused primarily by mutations in the fibroblast growth factor receptor 3 (FGFR3) gene associated with disturbances in bone growth. It is the most common form of dwarfism characterized by rhizomelic shortening of the limbs, macrocephaly with frontal bossing and spinal alterations, which presents significant challenges in the anesthetic management of pregnant women due to anatomical and physiological alterations, such as predictors of difficult airway, thoracic restriction due to bone dysplasias, spinal deformities and the multiple physiological changes characteristic of pregnancy. Achondroplasia has an increased incidence of menstrual disorders, infertility, amenorrhea, so conception is rare.

We report the case of a 29-year-old female patient diagnosed with achondroplasia and 37 weeks of pregnancy with cephalopelvic disproportion, with a history of opioid allergy documented by provocation test, who underwent elective cesarean section. After a detailed evaluation that included a careful spinal assessment with ultrasound to ensure the feasibility of the neuroaxial block, given the frequent technical difficulties associated, an ultrasound-guided neuroaxial block was chosen as the primary anesthetic technique due to the predictors of difficult airway and opioid allergy, which was performed with adjusted doses of local anesthetics, in addition to the preoperative use of intravenous non-opioid drugs to optimize intraoperative and postoperative pain control. The procedure passed without complications, and the multidisciplinary management allowed a satisfactory maternal-fetal evolution.

Unilateral Ureterolithiasis Accompined By the Risk of Acute Kidney Injury: Case Report

2025-01-16T07:39:08+00:00

Background: Urolithiasis is the condition of stone formation in the urinary tract, which remains a significant health issue worldwide. The incidence of cases is higher in men than women. Flank pain is the most common manifestation in patients with urolithiasis. The management of urolithiasis includes conservative treatment, lifestyle modifications, medication therapy, medical intervention, and surgical procedures. Complications of urolithiasis may include urinary tract infection and urinary tract obstruction, both of which have the potential to cause acute kidney injury.

Case Report: A 36-year-old male presented with severe left flank pain (visual analogue scale 8) that had worsened since two days prior to hospital admission. The pain was continuous, non-radiating, and worsening. The complaint was accompanied by a burning sensation during urination, incomplete urination, and difficulty in passing urine. The patient also reported reddish and cloudy urine.

Physical examination revealed tenderness in the left lumbar region and pain upon percussion of the left costovertebral angle (CVA). Hematologic tests showed leukocytosis, neutrophilia, elevated serum creatinine, and a decreased estimated glomerular filtration rate (eGFR). Routine urinalysis revealed increased white blood cells, red blood cells, and protein. A Urology Computed Tomography (CT) scan showed left ureterolithiasis at the L4 level, measuring 2.28 cm, along with hydroureter and grade IV hydronephrosis. An open left ureterolithotomy was performed based on medical indications and due to the limitations of urological facilities at our hospital.

Conclusion: Flank pain is the most common manifestation in patients with urolithiasis. Early diagnosis of complications can improve the patient's prognosis. The management of urolithiasis depends on medical indications and can be adjusted according to available facilities.

Reproductive Outcomes in Patients with Infertility and Insulin Resistance

2025-01-17T01:22:06+00:00

Infertility defined as the inability of a couple to achieve conception after one year of sexual intercourse without contraceptive protection, or after 6 months in patients older than 35 years. According to the WHO, 10-15% of couples have some fertility problem and 25-50% of this is due to anovulatory female infertility, which could be due to insulin resistance, especially in overweight and obese patients, since 75% of obese patients suffer from IR, added to the fact that overweight and obesity have a high prevalence in the Mexican population, where a prevalence of up to 35% has been reported, it is important to consider it as a causal factor in patients with infertility. In 2021, 413 first-time patients with a diagnosis of infertility were received at the Gynecology-Obstetrics UMAE of CMNO IMSS; of these, 245 have a diagnosis of anovulation and about 40% are overweight or obese, however, there is no report on reproductive outcomes of these patients who undergo medical treatment, some cases achieve clinical pregnancy and of these some result in term births, preterm, miscarriage and / or death.

Infertility and obesity have a great impact on women's health, affecting the physical, psychological, family and social area, leading to a deterioration in the quality of life, in turn obesity is one of the main risk factors for numerous diseases, so they are of special interest to social level and in the health system, being important its study and treatment to achieve better results of fertility and health in general.

Utility of Bilateral Posterior Tibial Nerve Electrostimulation in the Treatment of Idiopathic Constipation in the Mexican Population

2025-01-19T05:00:55+00:00

Background: Constipation has a prevalence in the Mexican population of up to 14.4% (Remes-Troche 2018). Posterior tibial electrostimulation from L4 to S3 modulates sacral roots through multiple afferent pathways in the spinal cord via a spinal and supraspinal somatovisceral reflex that activates sympathetic nerve flow, increasing rectal distensibility, improving rectal sensory thresholds and favoring anterograde and retrograde colonic propagation sequences through stimulation of S2 and S3 thus improving the defecation mechanism.

Objective: To describe the usefulness of bilateral posterior tibial nerve electrostimulation in the treatment of idiopathic constipation in the Mexican population.

Materials and Methods: Prospective, longitudinal analytical study including 49 patients with idiopathic constipation from the coloproctology and gastroenterology outpatient department of Hospital General Regional no. 1, Orizaba, Veracruz. Two non-randomized groups were formed: group 1 received bilateral posterior tibial stimulation via transcutaneous electrodes 3 times a week for 6 weeks; group 2 was treated with fecal bolus modifiers and dietary habit changes. Constipation status was evaluated at the beginning and end of treatment using a custom survey where higher scores indicated greater symptoms and scores closer to zero indicated fewer symptoms. Descriptive statistics, frequencies, percentages, and central tendency measures were applied. The study took place from September 2023 to February 2024.

Results: A total of 49 patients were selected; group 1 consisted of 15 patients (31%) who underwent bilateral posterior tibial nerve electrostimulation and were compared with 34 participants (69%) in group 2 who were treated with fecal bolus modifiers and changes in dietary habits. The mean age of the bilateral posterior tibial nerve electrostimulation group was 45 ± 18 and 55 ± 14 for the fecal bolus modifiers. The female sex predominated in both groups; group 1 with 12 participants (80%) and the second group with 28 (82%) female participants. Of all the patients in group 1, the mean improvement of symptoms was 16% at 6 weeks with bilateral posterior tibial electrostimulation as a treatment for idiopathic constipation, compared to the mean of 33% reported with the use of fecal bolus modifiers and changes in dietary habits; the use of laxatives was also evidenced, in group 1 only 2 participants (13%) continued with their use and in group 2, 22 participants (65%) continued with their use at the end of 6 weeks.

Conclusion: Bilateral posterior tibial electrostimulation treatment for idiopathic constipation reduced symptom perception and laxative use compared to fecal bolus modifiers and dietary habit changes.

Clinical Characteristics Related to Complications in Abdominal Gynecological Surgery

2025-01-29T06:31:17+00:00

Background: Gynecological conditions account for a significant number of surgical procedures performed worldwide, with complication rates reported between 0.2-34%. In Mexico, complication rates range from 2.15% to 15.06%. Factors such as age, obesity, comorbidities (hypertension, diabetes), and prolonged surgical time are associated with a higher risk of complications, including postoperative infections.

Objective: To determine the clinical characteristics related to complications in abdominal gynecological surgery.

Materials and Methods: A retrospective, descriptive, cross-sectional, and analytical study was conducted on women undergoing scheduled surgery by the Gynecology service at the Hospital de Ginecoobstetricia UMAE-CMNO IMSS during the period from January 2023 to December 2023. The study aimed to determine the frequency of postoperative complications and their relationship with clinical characteristics. The sample size calculation used the proportion formula and finite population, requiring a minimum sample of 156 patients. However, all gynecological surgeries performed during the study period were included. After obtaining approval from the Local Research Committee in Health 1310, data was collected from the hospital’s surgical productivity registry platform. Surgical data was obtained from both electronic and physical clinical records to identify postoperative complications. The data collection tool was entered into a Microsoft Excel database, and statistical analysis was performed using IBM SPSS (version 30.0).

Results: A total of 392 patients were included in the study. Among them, 78 patients (19.9%) experienced complications. The most common complication was hemorrhage (9.2%), followed by wound dehiscence (3.6%), bladder injury (3.1%), surgical wound infection (2.6%), fever (1.5%), vaginal dome hematoma (1.0%), intestinal injury, and urinary tract infection (both at 0.8%), paralytic ileus (0.3%), along with other complications such as vascular injury and death (0.3%).

When analyzing the groups, it was found that patients in the complication group had a higher Body Mass Index (BMI) compared to those without complications. Additionally, the surgical time, estimated bleeding, and hospital stay days were significantly higher in the complication group. Both groups showed similar characteristics in terms of age, parity, prior abdominal surgeries, comorbid conditions, smoking, ASA risk classification, and preoperative hemoglobin levels.

Conclusions: The frequency of postoperative complications in this study aligns with findings reported in most international studies, with hemorrhage being the most common complication. BMI was significantly associated with a higher risk of complications, including bleeding, need for transfusions, and prolonged surgical times.