Electroacupuncture efficacy in diabetic polyneuropathy: Study protocol for a double-blinded randomized controlled multicenter clinical trial.

BACKGROUND: Diabetic peripheral neuropathy (DPN) is the most common complication of type 2 diabetes mellitus (T2DM); its diagnosis and treatment are based on symptomatic improvement. However, as pharmacological therapy causes multiple adverse effects, the implementation of acupunctural techniques, such as electroacupuncture (EA) has been suggested as an alternative treatment. Nonetheless, there is a lack of scientific evidence, and its mechanisms are still unclear. We present the design and methodology of a new clinical randomized trial, that investigates the effectiveness of EA for the treatment of DPN. METHODS: This study is a four-armed, randomized, controlled, multicenter clinical trial (20-week intervention period, plus 12 weeks of follow-up after concluding intervention). A total of 48 T2DM patients with clinical signs and symptoms of DPN; and electrophysiological signs in the Nerve Conduction Study (NCS); will be treated by acupuncture specialists in outpatient units in Mexico City. Patients will be randomized in a 1:1 ratio to one of the following four groups: (a) short fibre DPN with EA, (b) short fibre DPN with sham EA, (c) axonal DPN with EA and (d) axonal DPN with sham EA treatment. The intervention will consist of 32 sessions, 20 min each, per patient over two cycles of intervention of 8 weeks each and a mid-term rest period of 4 weeks. The primary outcome will be NCS parameters, and secondary outcomes will include DPN-related symptoms and pain by Michigan Neuropathy Screening Instrument (MNSI), Michigan Diabetic Neuropathy Score (MDNS), Dolour Neuropatique Score (DN-4), Semmes-Westein monofilament, Numerical Rating Scale (NRS) for pain assessment, and the 36-item Short Form Health Survey (SF-36). To measure quality of life and improve oxidative stress, the inflammatory response; and genetic expression; will be analysed at the beginning and at the end of treatment. DISCUSSION: This study will be conducted to compare the efficacy of EA versus sham EA combined with conventional diabetic and neuropathic treatments if needed. EA may improve NCS, neuropathic pain and symptoms, oxidative stress, inflammatory response, and genetic expression, and it could be considered a potential coadjutant treatment for the management of DPN with a possible remyelinating effect. TRIAL REGISTRATION: ClinicalTrials.gov. NCT05521737 Registered on 30 August 2022. International Clinical Trials Registry Platform (ICTRP) ISRCTN97391213 Registered on 26 September 2022 [2b].

Geographical variation in human papillomavirus prevalence in Mexican women with normal cytology.

OBJECTIVE: To determine the prevalence of human papillomavirus (HPV) infection and genotype distribution in Mexican women with similar lifestyles from two geographical regions who receive medical care from the Mexican Navy Health System, and to identify the associated sociodemographic and reproductive characteristics. METHODS: Cervical swabs from 671 women, beneficiaries of the Mexican Navy Health System, from two distinct southern coast regions of Mexico, were analyzed. Data were obtained regarding sociodemographic variables and sexual and reproductive history. For HPV detection and typing, PCR with general primers and direct sequencing were performed on extracted DNA. Association with clinical variables was evaluated. RESULTS: Most patients had a normal cytology or low-grade intraepithelial neoplasia. A high prevalence of HPV was found (43.6%), with a significant difference between the two regions studied from the southwest Pacific coast of Mexico (37.6% in Acapulco, Guerrero vs. 49.7% in Lázaro Cárdenas, Michoacán). Some differences were also found associated to HPV type distribution, particularly related to genotypes 18, 58, and 53. Factors influencing these differences could not be identified with the analysis of typical risk factors linked to the acquisition of an HPV infection. CONCLUSIONS: Regional differences in HPV prevalence and distribution show an apparent geographic boundary between the studied populations that deserves further analysis, taking into account other factors such as those related to the sexual partners.

Litoquelifopedion: presentación de un caso de nueve años de evolución / Lithokelyphopedion: presentation of one case of nine years evolution

Se informa de un caso de litoquelifopedion en una paciente de 40 años de edad, que permaneció con un feto muerto de 24 semanas de gestación durante nueve años. El caso se diagnosticó por clínica y por ultrasonografía. Su resolución fue quirúrgica. Se comentan los factores que condiciona su formación y se efectúa la correlación anatomoclínica del caso

Iniencefalia asociada a malformación e Arnold-Chiari tipo III y herniación diafragmática de intestinos hacia la cavidad torácica: estudio de un caso / Ienencephaly associated to Arnold-Chiari type III malformation and diophragmatic hernia of intestine towards thoracic cavity. Presentation of one case

Se presenta un caso de iniencefalia asociada a la malformación de Arnold-Chiari tipo III y herniación diafragmática de intestinos delgado y grueso hacia la cavidad torácida. El caso fue estudiado en la Unidad de Patología del Hospital General de Acapulco, Guerrero, México. La Iniencefalia es considerada la forma más grave del síndrome de Klippel y Feil como resultado de anomalías congénitas de la columna cervical. El síndrome de Arnold-Chiari tipo III es también una rara malformación que consiste en un meningomielocele occipitocervical con herniación del cerebelo a través de un defecto óseo. Más ejemplos de esta condición fueron descritos por Peach en una serie de artículos (1965a). Estas dos malformaciones son una rareza. Pensamos que la ausencia de publicaciones se debe principalmente al desinterés por la teratología. Comentamos aspectos clínicos, radiológicos y revisamos la literatura actual