Introduction: Upper gastrointestinal bleeding of variceal origin has a high mortality. The platelet count/spleen major diameter ratio may be a useful noninvasive parameter to predict esophageal variceal bleeding in cirrhotic patients. Objective: to determine the sensitivity and specificity of the platelet count/spleen diameter ratio for the diagnosis of esophageal varices with risk of bleeding in patients with hepatic insufficiency. Material and Methods: Process study, performed in a Second Level Medical Facility, in patients with liver failure who underwent ultrasound, blood cytometry, liver function tests and endoscopy. Sensitivity and specificity of the platelet/spleen ratio were assessed in patients with esophageal variceal and bleeding risk. Results: There were 70 patients: 28 women, 42 men; main cause of liver failure in men was ethylism in 31 patients and hepat...

Introduction: Upper gastrointestinal bleeding of variceal origin has a high mortality. The platelet count/spleen major diameter ratio may be a useful noninvasive parameter to predict esophageal variceal bleeding in cirrhotic patients. Objective: to determine the sensitivity and specificity of the platelet count/spleen diameter ratio for the diagnosis of esophageal varices with risk of bleeding in patients with hepatic insufficiency. Material and Methods: Process study, performed in a Second Level Medical Facility, in patients with liver failure who underwent ultrasound, blood cytometry, liver function tests and endoscopy. Sensitivity and specificity of the platelet/spleen ratio were assessed in patients with esophageal variceal and bleeding risk. Results: There were 70 patients: 28 women, 42 men; main cause of liver failure in men was ethylism in 31 patients and hepat...

Background: The use of coffee in patients undergoing surgery of the lower gastrointestinal tract promotes the stimulation of peristalsis, favors tolerance to the initiation of the oral route as well as early progression to the soft diet. Objective: To present the clinical effects of starting the oral route with coffee in patients undergoing lower gastrointestinal tract surgery. Methods:  A descriptive study was performed to analyze the clinical effects of coffee in 14 postoperative patients of lower gastrointestinal tract surgery. The variables analyzed were: presentation of bowel sounds, expulsion of flatus, and effective evacuation.  Results: Fourteen patients were included, 9(64.3%) women and 5(35.7%) men, the use of coffee in patients with lower gastrointestinal tract surgery showed early progression to soft diet tolerance. Conclusions: The initiation of coffee in patients ...

Extravasation Compartment Syndrome (SCE) is an infrequent pathology, with an incidence of 0,01-6,5%, whom 1,8-11% are children. Communication in children is usually difficult, with high risk of development of SCE. A case about a 9 month old male patient with an over-infected viral pneumonia and a triggered SCE is presented. He received compartmental decompression of right forearm and right hand; however he presented mild sequelae. Treatment of extravasation injury is not always sufficient enough. Mild-to-moderate complications or SCE can be presented. Recognizing clinical manifestations and risk factors and the use of auxiliary studies is fundamental for a good diagnosis and as prevention in children. Faciotomies, gold standard for treatment, are not completely safe, and have an impact on morbidity. Early protocols against extravasation, early examination by surgeon and investigation abo...

Extravasation Compartment Syndrome (SCE) is an infrequent pathology, with an incidence of 0,01-6,5%, whom 1,8-11% are children. Communication in children is usually difficult, with high risk of development of SCE. A case about a 9 month old male patient with an over-infected viral pneumonia and a triggered SCE is presented. He received compartmental decompression of right forearm and right hand; however he presented mild sequelae. Treatment of extravasation injury is not always sufficient enough. Mild-to-moderate complications or SCE can be presented. Recognizing clinical manifestations and risk factors and the use of auxiliary studies is fundamental for a good diagnosis and as prevention in children. Faciotomies, gold standard for treatment, are not completely safe, and have an impact on morbidity. Early protocols against extravasation, early examination by surgeon and investigation abo...

Inflammatory transverse myelitis is a rare condition that affects one or more levels of the spinal cord. Its etiology includes multiple sclerosis, infectious causes, or disorders within the spectrum of neuromyelitis optica. It presents acutely with motor, sensory, and/or dysautonomic symptoms, such as those related to the gastrointestinal and urinary systems. Diagnosis is based on symptomatology, evolution, and is confirmed by lumbar puncture, magnetic resonance imaging, and complete blood analysis. We present a clinical case of a patient with transverse myelitis who presented with gastrointestinal symptoms, motor symptoms, and was diagnosed with magnetic resonance imaging.

Objective. Metabolic syndrome has been associated with changes in the composition of circulating blood cells. Hematologic indices can be used to identify the subjects at risk of metabolically unhealthy phenotype (MUP). This study investigated whether hematological indices can serve as biomarkers to distinguish metabolically healthy phenotype (MHP) from MUP in children and adolescents. Methods. Two hundred ninety-two children and adolescents were enrolled in a cross-sectional study. The MUP was diagnosed using consensus-based criteria proposed by Damanhoury et al. Group comparisons were performed using one-way ANOVA. To examine if sex, age group, nutritional status, puberty, hematological parameters, and insulin resistance were associated with MUP, we used multiadjusted logistic regression analysis with metabolic status as the dependent variable.    Results. The subject's a...

Pulmonary embolism is one of the leading causes of precordial pain in the hospital setting. We present the case of a 31-year-old male patient who reported sudden precordial pain and dyspnea with minor exertion, a significant elevation of D-dimer and, as revealed by computed tomography angiography (CTA), the presence of a thrombus in the main, segmental and subsegmental pulmonary branches. He underwent an embolectomy, with subsequent recovery and good progress. Pulmonary embolism produces pathophysiological interference with gas exchange and circulation, and the cause of death in these patients is right ventricular failure due to acute pressure overload. The most frequent clinical manifestations and signs are dyspnea, palpitations, chest pain, syncope and hemoptysis, tachycardia, tachypnea and jugular venous distension. The McGinn-White pattern consists of an electrocardiographic trace sh...

Systemic Lupus Erythematosus (SLE) is an autoimmune disease caused by an autoreactive B and T cell response with loss of immune tolerance to self-antigens. It manifests with asthenia, fever, myalgias, arthralgias, skin rash and fatal organ damage. Dengue is a zoonotic disease caused by the dengue virus (DENV), transmitted by mosquitoes of the Aedes aegypti species. Diagnostic suspicion is made in the presence of acute febrile syndrome with clinical manifestations and demographic history. Confirmation is by detection of the virus by PCR-RT, or of the structural protein NS1. The present case report is a 58-year-old woman with data of lupus exacerbation and with clinical manifestations suggestive of Dengue fever, with a history of travel to an endemic area. The confirmatory PCR-RT test leads to appropriate medical treatment. The importance of the case lies in differentiating the diagnosis i...

Introduction. Liver cancer is the seventh most common neoplasm worldwide and the second cause of mortality directly associated with cancer. In Mexico it has an incidence of 3.9% in the entire population. Although computed tomography (CT) is the imaging study of choice, the final diagnosis is established with the anatomopathological study of the lesion. Objective. Correlate the tomographic findings with the histopathological result in patients with liver lesions with suspicion of malignancy, who underwent USG-guided biopsy. Methods. Descriptive, correlation, retrolective, homodemographic and single-center study. The study period was from September 2021 to February 2022. Patients older than 18 years with liver lesions suspicious of malignancy were selected and underwent Computed Axial Tomography and ultrasound-guided biopsy. Shapiro Wilk tests (for normality) were used and chi-square was u...

Objective: To determine the prevalence of anatomical variations of the circle of Willis (CoW) andtheir association with cerebrovascular malformations detected on cerebral computed tomographyangiography (CTA). Materials and methods: A descriptive, observational, cross-sectional studywas conducted at a tertiary-care hospital involving a Mexican population. Patients of all ages andboth sexes, with complete medical histories and a cerebral CTA scan, were included. Patientswith incomplete CTA studies or missing data were excluded. Descriptive statistics and the phicoefficient were used to assess the relationship between cerebrovascular malformations andanatomical variations of the CoW. A p value ≤ 0.05 was considered significant. All personal datawere handled with strict confidentiality and used exclusively for research purposes. Results:The sample consisted of 97 patients, with a mean age ...

Introduction: Eating disorders under 5 years old may cause development and grow problems. Disorders in family functionality can be associated. Objective: To describe non-organic eating disorders in children under 5 years of age and their association with family functionality in a second-level hospital in Puebla. Methods: It was a descriptive, cross-sectional study. Children under 5 years old with non-organic eating disorders were included. A questionnaire to study eating disorders (IMFED) and other one to describe family functionality (FACES III) were applied to their parents who previously signed informed consent. Descriptive statistics and Spearman test were used. Results: 105 patients were evaluated, 57 men and 48 women, medium age 3.042, minimum 2, maximum 60, ± 16.68 months old. Children 12-23 months old were more frequent. Parents reported chaoti...

Background: COVID-19 is a disease that since its appearance in 2019 has represented a challenge for health services. The sequelae are a consequence of a deterioration in the quality of life, fatigue, dyspnea and joint pain. Objective: Compare physical, respiratory, cognitive and functional independence functional parameters in post-COVID-19 patients, with respiratory sequelae before and after a respiratory physical and occupational therapy program. Methods: A comparative, quasi-experimental, prospective study was conducted in outpatients discharged from hospitalization due to COVID-19 in a 3rd level hospital of the Instituto Mexicano del Seguro Social in Puebla, Mexico during 2020-2021. Scales were applied before and after the rehabilitation program. Descriptive statistics were used. Results: We included 116 patients, 57.7% men, mean age 47.32 years (min. 20, max. 79); 77 (66.3%) patient...

Background: Juvenile laryngeal papillomatosis (JLP) is a chronic benign disease from viral etiology, whose clinical course can be aggressive. In Mexico, the Human Papillomavirus (HPV) genotypes that cause this disease have been poorly studied. Objective: To identify the HPV genotypes in patients with JLP in a reference Hospital in Puebla, Mexico. Mehods: A retrospective descriptive study was performed in patients with JLP attended in a 3rd level care of the Instituto Mexicano del Seguro Social in Puebla, México, from 2018 to 2021. Medical records were revised. In all patients, HPV identification was performed by polymerase chain reaction for genomes 6, 11, 16 and 18 using specific oligonucleotides. Descriptive statistics were applied. Results: 9 patients were included, 56% women, mean age 9.5 ±5.7 years; 7 patients were HPV-11 positive and 2 HPV-6. The mean age at diagnosis was 2.35 ±...

Surgical wound infection secondary to complicated acute appendicitis is frequent. The objective was to compare the Dakin and the Superoxidative solutions to prevent surgical wound infections in complicated acute appendicitis. It was a comparative, cross-sectional study, in 104 patients with complicated acute appendicitis (medium age 36.29 years, 69(66.43%) men). Group 1: 52 patients with surgical wound lavage with Dakin modified solution. Group 2: 52 patients with superoxidative solution (Microdacyn®). All patients received ceftriaxone 1 g before surgery; conventional appendectomy was performed and the wall closure with Vicryl 1 and Nylon 2/0. Surgical wound was evaluated 7 days after surgery, looking for pus, edema, erythema, local heat. X2 and Student's t were used. Surgical wound infection was present in 11 (10.6%) patients, 3(5.8%) patients from group 1 and 8(15.4%) from group 2 (p=...

Introduction: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of death worldwide, with an incidence of 10.2%. The treatment of CRC has evolved over the past 25 years. Two surgical procedures are used: abdominoperineal resection (APR) and low anterior resection (LAR) and ultra-low anterior resection (ULAR). The recurrence rate and quality of life are similar between these approaches. Objective: To compare the quality of life of rectal cancer patients treated with abdominoperineal resection versus conservative sphincter-preserving surgeries: low anterior resection (LAR) and ultra-low anterior resection (ULAR) at UMAE of Puebla. Methods: A comparative, observational, cross-sectional study was conducted on CRC patients treated between 2015 and 2019 at a tertiary-level hospital in Puebla. Two groups were formed: those managed with APR and those manage...

Introduction: Ectopic pregnancy is any gestation in which the implantation site of the fertilized egg is located outside the endometrial cavity. Abdominal ectopic pregnancy represents 1.4% of these. Case report: 28-year-old patient with two previous cesarean sections; bilateral tubal obstruction during the last operation. The patient was admitted to the hospital with blood pressure of 180/130 mm Hg that did not respond to medical treatment and not progression to labor so it was decided to interrupt the pregnancy by cesarean section. During surgery, a small uterus with extrauterine pregnancy was observed adhered to the serosa of the cecum, ascending colon, and appendix. A live preterm female product was obtained; the mother had a favorable evolution and no postoperative complications. Conclusion: Ectopic pregnancies are rera. An adequate prenatal control by well trained personnel is essen...

Objective: To compare the effectiveness of stratifying high cardiovascular disease (CVD) risk inpatients diagnosed with rheumatoid arthritis (RA) using the Framingham Risk Score (FRS), modifiedSystematic Coronary Risk Evaluation (mSCORE), 2013 American College of Cardiology/AmericanHeart Association (2013 ACC/AHA) guidelines and QResearch Risk Estimator version 3 (QRISK3),with carotid ultrasound (CUS) serving as the gold standard for detecting subclinical atherosclerosis.Materials and methods: A comparative, observational and cross-sectional diagnostic study was conducted in patients aged 40 to 75 years, of both sexes, with RA and without CVD, at a tertiarycare hospital in Puebla, Mexico. Patients on treatment with one or more disease-modifying antirheumatic drugs (DMARDs) for at least three months were included. Patients with chronic diseases and those who did not undergo a CUS were exc...

Introduction: Transplantation is the treatment of choice in patients with chronic kidney disease (CKD). It requires immunosuppression, which predisposes to the development of complications. Chronic rhinosinusitis (CRS) is one of the most important. Objective: To compare the characteristics of patients with CKD with and without CRS undergoing renal transplantation protocol in a concentration Hospital in Puebla, Mexico. Methods: Comparative, cross-sectional, retrospective study in patients in a tertiary care hospital with CKD and undergoing renal transplantation protocol. The SNOT-22 and Lund-Mackay scales were applied. Descriptive statistics and Mann-Whitney U test, Fisher's exact test and Phi coefficient were used; p<0.05 was considered significant. Results: 360 patients were recruited, 49 presented CRS, prevalence: 13.61%. Means: age: 39.22 ±12.09 years and evolution time: 17.73 ±5...