Unidad Médica de Alta Especialidad Hospital de Pediatria Centro Médico Nacional Siglo XXI

A 25‐year‐old previously healthy man presents to the clinic with a severe headache after cocaine consumption. Physical examination revealed acromegaloid features, and the hormonal profile revealed an IGF‐1 of 308 ng/mL (40.8 nmol/L) (normal reference range 197–333 ng/mL; 17.8–45.6). An MRI showed a heterogeneous, cystic lesion of the pituitary gland with hematic contents, consistent with the diagnosis of a pituitary apoplexy. Considering the normal IGF‐1 level, the patient was classified to be in remission, which deems it unnecessary to initiate pharmacologic or surgical treatment. Remission of acromegaly after a pituitary apoplexy is an extremely rare event, and pituitary apoplexy after cocaine consumption is also anecdotal. We present the first case of remission of acromegaly after a cocaine‐induced pituitary apoplexy.

In dyslipidemia associated with type 2 diabetes (T2DM), elevated triglycerides (TG), increased low-density lipoprotein cholesterol (LDL-C), and decreased high-density lipoprotein cholesterol (HDL-C) levels are commonly found, resulting in a high prevalence of mixed dyslipidemia among patients with T2DM. Therefore, the combination therapy of atorvastatin/fenofibrate may be useful for simplifying pharmacological regimens, enhancing adherence, and requiring fewer doses of each drug to achieve the target, which decreases the number of adverse events. We conducted a randomized multicenter, double-blind clinical trial of patients with T2DM and mixed dyslipidemia to evaluate the magnitude of change in lipid profile with a fixed-dose combination (FDC) therapy group of atorvastatin 20 mg/fenofibrate 160 mg (G_FDC) versus atorvastatin 20 mg monotherapy group (G_M), both oral route, one tablet every 24 h. The magnitude of change in the lipid profile at 2 and 4 months was compared within each group and between groups using the analysis of variance (ANOVA) test. A p value ≤ 0.05 was considered statistically significant. A total of 76 patients were included (38 per group), with an age of 56.7 ± 10.2 years, and 56.6% were women. The values at 4 months for G_FDC vs. G_M were as follow: TG mg/dL (−144.3 vs. −64.0, p = 0.004), TG percentage change (%C) (−47.9 vs. −33.1, p = 0.007); LDL-C mg/dL (−50.5 vs. −51.7, p = 0.784), LDL-C %C (−42.5 vs. −45.6, p = 0.899). The percentage of patients who achieved the targets for triglycerides (TG) was 56.7% compared to 43.8% (p = 0.309), while for LDL-C, it was 73.3% compared to 78.1% (p = 0.660). Finally, the predictive cardiovascular risk indices (∆ of change) showed a TG/HDL index of −3.9 ± 4.6 vs. −1.5 ± 2.9 (p = 0.015) and a Tg/glucose index of −0.7 ± 0.5 vs. −0.3 ± 0.4 (p = 0.003). The FDC therapy of atorvastatin 20 mg/fenofibrate 160 mg achieved a greater percentage reduction in lipid profile than atorvastatin alone. No differences in adverse events were observed between the groups. ClinicalTrials.gov No. NCT04882293, registration date: February 28, 2022.

Background: Human papillomavirus (HPV) is a major contributor to cervical cancer (CC), with Papanicolaou (Pap) smears and HPV testing serving as primary screening tools in developed countries. The effectiveness of these methods can vary based on a country’s epidemiological and socioeconomic context. This study introduces an innovative, noninvasive method employing surgical gauze worn as a feminine pad for HPV detection, with the aim of simplifying and improving screening processes. Materials and Methods: A total of 184 participants, including individuals classified as healthy, with cervical precursor lesions, or as with confirmed CC, were enrolled. All participants underwent cytological and colposcopic evaluations, with biopsies taken in cases of abnormal results. Each participant wore the device for 8 h, after which DNA was extracted from the soiled devices and analyzed via PCR for mitochondrial and HPV–DNA. Sensitivity and specificity were calculated to assess the effectiveness of HPV detection. Sensitivity and specificity values for HPV detection were obtained. Analysis of diagnostic tests was performed by OpenEpi software. Results: The device was well-received, with high compliance among participants. PCR analysis revealed that 17.7% of healthy, 72.1% of precursor-lesion cases, and 97.1% of CC cases tested positive for HPV. The calculated sensitivity and specificity for detecting high-grade lesions (CIN2+ or CIN2/3 and CC) were 94.81% and 51.28%, respectively. For CC detection, sensitivity was 97.14% with a specificity of 54.39%. Conclusions: The use of this noninvasive device demonstrated a significant correlation with clinical outcomes, supporting its potential as an effective and accessible tool for HPV screening. This method offers a promising alternative to conventional screening techniques, particularly in settings where traditional methods face logistical and socioeconomic challenges.

Cardiovascular diseases are a leading cause of global mortality, with hypertension as a major risk factor. Low control rates are often attributed to monotherapy, while evidence and clinical guidelines support the effectiveness of combination therapies. This study aimed to evaluate blood pressure changes and the achievement of target levels in patients treated with losartan/chlorthalidone (L/C) compared to losartan/hydrochlorothiazide (L/H). A randomized, double-blind, prospective, multicenter clinical trial was conducted. Patients were assigned to one of two treatment groups, starting with a lower dose (50/12.5 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide). Blood pressure was evaluated at 30 days, and patients not meeting therapeutic goals were escalated to a higher dose (100/50 mg of losartan/chlorthalidone or losartan/hydrochlorothiazide) and followed until the study end (60 days). The study recruited 163 patients (83 for losartan/chlorthalidone [L/C] group and 80 for the losartan/hydrochlorothiazide [L/H] group), with a mean age of 53.1 years. Both treatment groups demonstrated significant reductions in systolic and diastolic blood pressure, with L/C achieving an average reduction in systolic blood pressure (SBP) of − 24.6 mmHg and − 13.3 mmHg for diastolic blood pressure (DBP), while L/H had reductions of − 25.3-mmHg and − 11.5 mmHg, respectively. The L/C group exhibited a higher likelihood of achieving blood pressure goals compared to the L/H. Adverse events were comparable between groups and were mostly mild. The study showed that both combinations are effective for hypertension, with losartan/chlorthalidone demonstrating greater efficacy in reducing diastolic blood pressure and achieving target levels. Both treatments exhibited similar and favorable safety profiles. NCT04927299. Registered August 6, 2021-https://clinicaltrials.gov/study/NCT04927299

Early detection of diabetic retinopathy is critical for preserving vision in diabetic patients. The classification of lesions in Retinal fundus images, particularly macular edema, is an essential diagnostic tool, yet it presents a significant learning curve for both novice and experienced ophthalmologists. To address this challenge, a novel Convolutional Deep Belief Network (CDBN) is proposed to classify image patches into three distinct categories: two types of macular edema—microhemorrhages and hard exudates—and a healthy category. The method leverages high-level feature extraction to mitigate issues arising from the high similarity of low-level features in noisy images. Additionally, a Real-Coded Genetic Algorithm optimizes the parameters of Gabor filters and the network, ensuring optimal feature extraction and classification performance. Experimental results demonstrate that the proposed CDBN outperforms comparative models, achieving an F1 score of 0.9258. These results indicate that the architecture effectively overcomes the challenges of lesion classification in retinal images, offering a robust tool for clinical application and paving the way for advanced clinical decision support systems in diabetic retinopathy management.

The rise in aesthetic surgery in recent years has led to an increased incidence of complications associated with these procedures. Liposuction and autologous fat transfer have become some of the most common cosmetic interventions worldwide, also raising the risk of developing postoperative infections, including those caused by multidrug-resistant Gram-negative bacilli, which can be life-threatening. We present the case of a 40-year-old woman who developed septic shock secondary to deep necrotizing fasciitis in the right thigh following liposuction and autologous fat transfer to the buttocks. During the postoperative period, she developed a necrotizing soft tissue infection affecting the right thigh and buttock, which progressed to necrotizing fasciitis. The patient required surgical debridement, fasciotomy, and combined antibiotic therapy. Tissue cultures revealed multidrug-resistant Acinetobacter baumannii complex haemolyticus, sensitive to carbapenems. The patient had surgical debridement and a 14-day course of antibiotics, resulting in clinical recovery. A. baumannii is a significant cause of nosocomial infections worldwide, and its persistence on inanimate surfaces may be underestimated. Complications such as necrotizing soft tissue infections are typically caused by Gram-positive microorganisms such as methicillin-resistant Staphylococcus aureus and Gram-negative fermenting enterobacteria. The isolation of A. baumannii in soft tissue cultures is unusual, making this case notable, as necrotizing soft tissue infections caused by this nonfermenting Gram-negative bacillus have not been previously reported following aesthetic body contouring surgery.

Patients with end-stage renal disease (ESRD) are at increased risk of cardiovascular disease (CVD), such as myocardial infarction (MI). Uremic toxins and endothelial dysfunction are central to this process. In this exploratory study, we used the Affymetrix GeneChip microarray to investigate the gene expression profile in uremic serum-induced human coronary arterial endothelial cells (HCAECs) from ESRD patients with and without MI (UWI and UWOI groups) as an approach to its underlying mechanism. We also explored which pathways are involved in this process. We found 100 differentially expressed genes (DEGs) among the conditions of interest by supervised principal component analysis and hierarchical cluster analysis. The expressions of four major DEGs were validated by quantitative RT-PCR. Pathway analysis and molecular network were used to analyze the interaction and expression patterns. Ten pathways were identified as the main enriched metabolic pathways according to the transcriptome profiling analysis, which were, among others, positive regulation of inflammatory response, positive regulation of extracellular signal-regulated kinases 1 and 2 (ERK1/2) cascade, cardiac muscle cell development, highlighting positive regulation of mitogen-activated protein kinase (MAPK) activity (p = 0.00016). Up- and down-regulation of genes from HCAECs exposed to uremic serum could contribute to increased endothelial dysfunction and CVD in ESRD patients. Our study suggests that inflammation and the ERK-MAPK pathway are highly enriched in kidney disease patients with MI, suggesting their role in ESRD pathology. Further studies and approaches based on MAPK pathway interfering strategies are needed to confirm these data.

Greater weight gain following initiation of antiretroviral therapy (ART) with integrase strand transfer inhibitors (INsTI) compared with that seen with other classes of antiretroviral drugs, is an increasingly recognized problem in people living with HIV (PLWH). The purpose of this narrative review is to highlight those clinical trials that have documented weight gain and associated factors among PLWH on INsTI-ART. This includes the underlying pathophysiological mechanisms, toxicity, impact on adipose tissue, and how this tissue becomes metabolically dysfunctional, contributing to the emergence of insulin resistance and other comorbidities in PLWH. Considering the impact of the modern obesogenic environment and that PLWH on INsTI-ART are living longer, a coordinated approach by infectious disease specialists and other physicians to address the metabolic complications affecting this population, is imperative. The use of new anti-obesity drugs is becoming part of co-medication to limit weight gain in this population.

Background Hospitalized pediatric hematology‐oncology patients have frequent clinical deterioration events (CDEs) requiring intensive care unit (ICU) interventions and resulting in high mortality, particularly in resource‐limited settings. This study identifies independent risk factors for CDE mortality in hospitals providing childhood cancer care in Latin America and Spain. Methods Centers implemented a prospective CDE registry, defined as unplanned transfer to a higher level of care, use of ICU‐level interventions on the ward, or nonpalliative ward death. The authors analyzed registry data from April 2017 to December 2022. The primary outcome was CDEs mortality, defined as death occurring during ICU admission, <24 hours of ICU discharge, or end of ward‐based ICU interventions. Multilevel modeling identified event‐, patient‐, and hospital‐level independent risk factors for CDE mortality. Results Among 69 participating hospitals in 18 countries, 4134 CDEs were reported in 3319 pediatric hematology‐oncology patients with an event mortality of 26.8% (1108 events). Of all CDEs, 33.7% used ICU interventions on the ward and 87.5% were transferred to a higher level of care. In multilevel modeling, significant independent risk factors for event mortality present at the start of deterioration included patient (disease relapse) and event (e.g., reason for hospital admission, use of ICU intervention on wards, abnormal lactate, platelets, or C‐reactive protein, reason for deterioration, and number of organs with dysfunction); hospital factors were not significant predictors of mortality. Conclusions Hospitalized pediatric hematology‐oncology patients with CDE have high mortality with significant variability across centers. Mortality, however, is largely driven by modifiable event‐level factors, demonstrating the need for targeted interventions to improve survival.

Background C2 nerve root schwannomas are rare and may be hourglass or dumbbell-shaped at the craniocervical junction. We describe the clinical/radiological features and treatment outcomes of patients with dumbbell C2 schwannomas operated through a far lateral approach and the technical details of this approach. Methods Between 2019 and 2024, seven consecutive patients underwent surgery for dumbbell C2 schwannomas at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI in Mexico City, Mexico. Data regarding clinical presentation, tumor location, and surgical results were investigated retrospectively in institutional databases. Results There were 5 males (71.4%) and 2 females (28.5%); the mean age was 50.4 years (range 36–75). The average duration of symptoms before surgery was 16.7 months (range 8–35). Motor deficit (85.7%) and headache (57.1%) were the most frequent symptoms. In all cases, gross total resection (GTR) was successfully achieved. There were no post-surgical complications reported. The mean follow-up time was 21.4 months (range 1–54). Six patients (85.7%) referred completely recovered from their symptoms. Conclusion Dumbbell C2 schwannomas pose a surgical challenge due to the adjacent anatomical structures involved. The far lateral approach enables GTR of these tumors with minimal neurovascular manipulation and excellent functional outcomes.

Background/Objectives: Chronic kidney disease is associated with increased intestinal barrier permeability, leading to heightened inflammation and oxidative stress. These changes contribute to complications such as cardiovascular disease, anemia, altered mineral metabolism, and CKD progression. Interventions using prebiotics, probiotics, and synbiotics may mitigate dysbiosis and improve intestinal barrier function, Under this premise, the objective of this network meta-analysis was to evaluate the effect of probiotics, prebiotics, and synbiotics in reducing uremic toxins produced by the gut microbiota in CKD patients. Methods: A systematic review and network meta-analysis of randomized clinical trials (RCTs) was performed in the following databases: Web of Science, Scopus, the Cochrane Register of Controlled Trials, and PubMed published between 2019 and 2023. The analysis focused on the use of prebiotics, probiotics, and synbiotics in CKD patients at stages 3 to 5, as per KDIGO guidelines, and their association with reductions in uremic toxins such as Indoxyl Sulfate, p-Cresyl Sulfate, urea, and creatinine. The risk of bias was assessed using the Cochrane risk of bias tool (RoB 2), with evaluations conducted independently by two reviewers, and a third consulted for disagreements. The study follows the PRISMA statement. Results: The studies included 331 patients, primarily male, across CKD stages 3a to 5. The interventions positively impacted the gut microbiota composition, leading to reductions in free and total p-Cresyl Sulfate (SUCRA: 72.6% and 66.2, respectively) and indoxyl sulfate (SUCRA: 88.5% and 83.1%). Conclusions: The findings suggest that modulating the gut microbiota through these interventions can effectively reduce specific uremic toxins. However, further trials are necessary to better understand microbiota modulation and its impact on intestinal bacterial composition (PROSPERO number: CRD42023438901).

Background: Non-IgE-mediated gastrointestinal food allergy includes adverse reactions to food mediated by the innate immune system and cellular immunity. It is characterized by subacute or chronic gastrointestinal symptoms after ingestion of a relevant food allergen, making diagnosis difficult. Objective: To carry out an updated bibliographic review of non-IgE-mediated gastrointestinal food allergy, that summarizes incidence, pathophysiology, clinical manifestations, diagnostic tools and treatment. Methods: A search was conducted in the databases Medline, EMBASE, Scielo, Google Scholar and the Advanced Medicine Informatics Network (RIMA) using the keywords: non-IgE-mediated food allergy, allergic proctocolitis; cow’s milk-induced anemia; food protein-induced enteropathy; food protein-induced enterocolitis syndrome; Celiac disease and Heiner syndrome. The search was limited to articles published in English and Spanish from January 2015 to May 2024. Results: While progress has been made in the recognition of these diseases, the prevalence and pathophysiology remain uncertain. Involvement of the innate immune system and cellular immunity in gastrointestinal inflammation has been found, but further studies are needed to clarify the immunopathogenesis and associated biomarkers. Conclusions: Non-IgE-mediated gastrointestinal food allergy account for an unknown proportion of food allergies. Since there are no biomarkers or non-invasive confirmatory tests, the diagnosis relies on clinical features and is confirmed when the symptoms improve with elimination of the offending food. Management includes avoidance of the causative food from the diet, supportive treatment in case of accidental exposure, and nutritional counseling. Keywords: Non-IgE-mediated food allergy; Food protein-induced enterocolitis syndrome; Celiac disease; Allergic proctocolitis; Cow’s milk-induced anemia; Food protein-induced enteropathy; Heiner syndrome.

BACKGROUND Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals. METHODS This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022. The primary outcome was subsequent ischemic stroke by day 180 after diagnosis. Clinical and imaging variables were compared between those with versus without subsequent ischemic stroke. Significant factors associated with subsequent stroke risk were identified using stepwise Cox regression. Associations between subsequent ischemic stroke risk and antithrombotic therapy type (anticoagulation versus antiplatelets) among patients with identified risk factors were explored using adjusted Cox regression. RESULTS In all, 4023 patients (mean age was 47.4 years; 44.5% were women) were included. By day 180, subsequent ischemic stroke occurred in 5.3% of the cohort. In adjusted Cox regression, factors associated with increased risk of subsequent ischemic stroke were prior history of ischemic stroke (adjusted hazard ratio [aHR], 7.31 [95% CI, 1.61–33.13]; P =0.010), presentation within 7 days from first symptoms (aHR, 3.04 [95% CI, 1.04–8.91]; P =0.043), infarct on baseline imaging (aHR, 9.85 [95% CI, 3.65–26.58]; P <0.001), and occlusive dissection (aHR, 2.34 [95% CI, 1.03–5.34]; P =0.043). Only patients with occlusive dissection demonstrated a reduced risk of subsequent ischemic stroke when treated with anticoagulation versus antiplatelets (aHR, 0.36 [95% CI, 0.16–0.80]; P =0.01). CONCLUSIONS In this post hoc analysis of the STOP-CAD study, several factors associated with subsequent ischemic stroke were identified among patients with CAD. Furthermore, we identified a potential benefit of anticoagulation in patients with CAD with occlusive dissection. These findings require validation by meta-analyses of prior studies to formulate optimal treatment strategies for specific high-risk CAD subgroups.

Intracranial aneurysms are serious vascular conditions that pose a significant risk of lifethreatening subarachnoid hemorrhage (SAH) if ruptured. Over the past century, the surgical management of aneurysms has undergone remarkable advancements, with aneurysm clipping emerging as a cornerstone treatment. This review traces the historical evolution of aneurysm clipping, from the formidable challenges of early 20th-century brain surgery to the sophisticated techniques used today. Key milestones include Victor Horsley’s pioneering ligation methods, Harvey Cushing’s foundational neurosurgical principles, and Walter Dandy’s groundbreaking intracranial aneurysm clipping in 1937. Technological innovations have played a crucial role in advancing the field. The introduction of the operating microscope by M.G. Yasargil in the 1960s and Charles Drake’s fenestrated clip design in 1969 significantly improved surgical precision and outcomes. The emergence of endovascular techniques, particularly Guglielmi’s detachable coils (GDC) in the 1990s, provided a minimally invasive alternative to clipping. Today, both approaches remain valuable, with treatment selection based on aneurysm characteristics and patient-specific factors. Modern aneurysm clipping has further benefited from cutting-edge imaging technologies, intraoperative monitoring systems, and refined clip designs, enhancing both safety and efficacy. Landmark comparative studies, such as ISAT and BRAT, have provided critical evidence guiding treatment strategies and optimizing patient outcomes.

Introduction Cardiac catheterisation in the postoperative period emerges as a primary tool, providing effectiveness and safety in diagnosis, treatment guidance, and resolution of major residual lesions. Materials and methods This is a retrospective case-control study. We collected the clinical records of patients who underwent cardiac catheterisation between January 2003 and December 2022 within the initial 72 hours after surgery in the pediatric cardiac ICU of a national referral hospital in Mexico City. Descriptive, univariate, and multivariate analyses were performed. Results A total of 6,243 surgeries were performed, of which 264 were cardiac catheterizations carried out within the first 72 hours of the postoperative period;these included 73 diagnostic procedures and 191 interventional procedures. One hundred and thirty-five (135) catheterisations targeted recent suture intervention sites. The primary indications for cardiac catheterisation included low cardiac output and the suspicion of major residual lesions. Approximately 65% of interventions occurred within the first 24 hours and solved 426 residual lesions. No significant associations were found between mortality, complications, and the need for surgical reintervention in patients who underwent interventional catheterisation at recent suture sites (OR 1.93;95% CI:0.94–4.07: p = 0.076). Seventeen patients (17) were extubated in the initial 24 hours post-catheterisation. Two major complications were identified: rupture of the systemic-to-pulmonary shunt in the anastomosis, and a pulmonary artery laceration requiring emergency surgery. One patient died. Conclusion Cardiac catheterisation has evolved into a vital instrument to diagnose and resolve abnormalities and significant residual lesions without increasing the morbidity and mortality risks.

Pleopeltis crassinervata has demonstrated antimicrobial effects, including anti-Toxoplasma activity, which has been attributed to the presence of compounds such as terpenes and fatty acid methyl esters. In this study, the effects of P. crassinervata hexane subfraction one (Hsf1) on the Toxoplasma gondii tachyzoite ultrastructure were evaluated using TEM and SEM, and lytic cycle processes such as adhesion, invasion, and proliferation were evaluated using phase-contrast microscopy. Additionally, the antioxidant capacity of the subfraction and its main compounds (phytol and hexadecenoic acid methyl ester) were determined as well as their effects on parasite viability. Hsf1 exhibited a dose-dependent inhibitory effect on the lytic process at a concentration of 47.2 µg/mL. Among the eighteen compounds identified in this subfraction, six were evaluated, of which two (phytol and hexadecanoic acid methyl ester) significantly reduced the viability of T. gondii to 0.11% and 16.6%, respectively, at a concentration of 100 µg/mL. Additionally, Hsf1 demonstrated an antioxidant capacity of 30% as assessed using the ORAC method. The two active compounds also exhibited antioxidant properties, with antioxidant capacities of 13.33% and 33% for hexadecanoic acid methyl ester and phytol, respectively, at concentrations up to 15.4 mg/mL. Hsf1 showed membrane damage and conoid extrusion in T. gondii tachyzoites, suggesting direct interference with the lytic cycle of the parasite. These findings underscore the therapeutic potential of Hsf1 as a promising tool for controlling infections caused by T. gondii, thereby providing an alternative in the search for new antiparasitic agents. However, further research is required to determine the in vivo pharmacological effects and properties of these compounds with potential anti-Toxoplasma activity.

Background: Early childhood development (ECD) is a critical period for achieving milestones in cognitive, motor, and socioemotional development. Parental knowledge of ECD influences the manner in which children are stimulated, as evidenced in previous studies, particularly in developing countries. This study examined parents' understanding of ECD, their stimulation and caregiving practices, and the sources of information that they utilize in the Mexican context. Methods: A descriptive cross-sectional field study was conducted using a questionnaire validated by a panel of experts and a pilot test. A total of 536 mothers and fathers from socioeconomic levels C-, D+, and D/E residing in three Mexican cities were surveyed using non-probability convenience sampling. The questionnaire inquired about respondents' knowledge, stimulation practices, and sources of information related to ECD. Results: In all, 60% of the surveyed parents did not consider the first 3 years of life as a relevant learning stage. Although 44.3% of mothers and 37.6% of fathers identified early learning (at 0-3 months), few socioemotional activities were considered relevant. Only 33% were familiar with the term "early stimulation," and television was the most consulted medium (30%). Conclusions: It is necessary to raise awareness among parents about the importance of play, as well as socioemotional and communicative activities in ECD. The quality of information disseminated through mass media should be improved and public policies to strengthen parental education should be promoted.