A Multidisciplinary Approach to the Classification and Management of Intestinal Failure: Knowledge in Progress.

Intestinal failure (IF) is a debilitating condition characterized by the insufficient function of the gastrointestinal tract to absorb nutrients and fluids essential for life. This review consolidates recent advancements and challenges in managing IF among adult and pediatric populations, highlighting differences in etiology, management, and outcomes. Over the recent years, significant strides have been made in the nutritional and medical management of IF, significantly reducing mortality rates and improving the quality of life for patients. Key advancements include the development and availability of glucagon-like peptide-2 (GLP-2) analogs, improved formulations of parenteral nutrition, and the establishment of specialized interdisciplinary centers. Short bowel syndrome (SBS) remains the predominant cause of IF globally. The pediatric segment is increasingly surviving into adulthood, presenting unique long-term management challenges that differ from adult-onset IF. These include the need for tailored nutritional support, management of IF-associated liver disease, and addressing growth and neurodevelopmental outcomes. The therapeutic landscape for IF continues to evolve with the development of new treatment modalities and better understanding of the condition's pathophysiology. However, disparities in treatment outcomes between children and adults suggest the need for age-specific management strategies. This review underscores the importance of a nuanced approach to IF, incorporating advancements in medical science with a deep understanding of the distinct needs.

Acute Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin I Levels in Adult Patients with Early Sepsis at a Tertiary Referral Center in Mexico: An Exploratory Study.

The objective of the study was to describe the frequency of acute myocardial injury (AMI) assessed by high-sensitivity cardiac troponin I (hs-cTnI) levels and to determine the possible initial risk factors (related to the characteristics of the patient, the disease, and the initial management) in a population of adult patients with early sepsis (within the first 72 h of diagnosis) in a single tertiary hospital center in western Mexico. For the inferential statistics, the proportions of the categorical dichotomous variables were compared using the chi-square test. In all analyses, p values less than 0.05 with a 95% confidence interval were considered significant. We included a total of 64 patients diagnosed with early sepsis, of whom 46 presented elevated hs-cTnI and were classified as having AMI. In our study, the frequency of AMI in patients with early sepsis was 71.87%, and no significant differences were found in all of the characteristics of patients with early sepsis with and without AMI, nor was any significant association found with any of the variables analyzed. In the population of western Mexico, the frequency of AMI in patients with early sepsis, assessed by hs-cTnI levels, is high and similar to that reported in other populations worldwide.

Evaluation of the Effects of Atorvastatin and N-Acetyl Cysteine on Platelet Counts in Patients with Primary Immune Thrombocytopenia: An Exploratory Clinical Trial.

Objective: We aimed to evaluate the efficacy of the combination of atorvastatin and N-acetyl cysteine in increasing platelet counts in patients with immune thrombocytopenia who were resistant to steroid therapy or had a relapse after treatment. Material and Methods: The patients included in this study received oral treatment of atorvastatin at a dose of 40 mg daily and N-acetyl cysteine at a dose of 400 mg every 8 h. The desired treatment duration was 12 months, but we included patients who completed at least 1 month of treatment in the analysis. The platelet counts were measured prior to the administration of the study treatment and in the first, third, sixth, and twelfth months of treatment (if available). A p value < 0.05 was considered statistically significant. Results: We included 15 patients who met our inclusion criteria. For the total treatment duration, the global response was 60% (nine patients); eight patients (53.3%) had a complete response and one patient (6.7%) had a partial response. Six patients (40%) were considered as having undergone treatment failure. Of the responder group, five patients maintained a complete response after treatment (55.5%), three patients maintained a partial response (33.3%), and one patient (11.1%) lost their response to the treatment. All of the patients in the responder group had significant increases in their platelet counts after treatment (p < 0.05). Conclusion: This study provides evidence of a possible treatment option for patients with primary immune thrombocytopenia. However, further studies are needed.

Clinical and Biochemical Profile Associated with Renal Recovery after Acute Kidney Injury in A Mexican Population: Retrospective Cohort Study.

Background and Objectives: Our primary objective was to study the clinical and biochemical characteristics associated with acute kidney injury (AKI) remission in a group of Mexican patients. Materials and methods: We retrospectively enrolled 75 patients who were diagnosed with AKI and separated the sample into two groups: nonremitting patients (n = 27, 36%) vs. remitting patients (n = 48, 64%). Results: We found significant relationships between nonremitting AKI and previous diagnosis of chronic kidney disease (p = 0.009), higher serum creatinine (Cr) at admission (p < 0.0001), lower estimated glomerular filtration rate (eGFR) (p < 0.0001), maximum serum creatinine during hospitalization (p < 0.0001), higher fractional excretion of sodium (FENa) (p < 0.0003) and 24-h urine protein (p = 0.005), higher serum potassium on admission (p = 0.025), abnormal levels of procalcitonin (p = 0.006), and increased risk of death (p = 0.015). Conclusion: Chronic kidney disease (CKD), lower eGFR, higher levels of serum creatinine during hospitalization, higher FENa and 24-h urine protein, abnormal levels of procalcitonin, and higher serum potassium on admission were associated with nonremitting AKI. These findings may facilitate the rapid identification of patients at risk for nonremitting AKI based on clinical and biochemical characteristics. Furthermore, these findings may inform the design of timely strategies for the vigilance, prevention, and treatment of AKI.

Pneumocystis jirovecii Colonization in Mexican Patients with Chronic Obstructive Pulmonary Disease.

The prevalence of colonization by Pneumocystis jirovecii (P. jirovecii) has not been studied in Mexico. We aimed to determine the prevalence of colonization by P. jirovecii using molecular detection in a population of Mexican patients with chronic obstructive pulmonary disease (COPD) and describe their clinical and sociodemographic profiles. We enrolled patients discharged from our hospital diagnosed with COPD and without pneumonia (n = 15). The primary outcome of this study was P. jirovecii colonization at the time of discharge, as detected by nested polymerase chain reaction (PCR) of oropharyngeal wash samples. The calculated prevalence of colonization for our study group was 26.66%. There were no statistically significant differences between COPD patients with and without colonization in our groups. Colonization of P. jirovecii in patients with COPD is frequent in the Mexican population; the clinical significance, if any, remains to be determined. Oropharyngeal wash and nested PCR are excellent cost-effective options to simplify sample collection and detection in developing countries and can be used for further studies.

Prevalence of Dysexecutive Symptoms in High School Students during the COVID-19 Pandemic.

This is an observational cross-sectional study designed to ascertain the prevalence and severity of dysexecutive symptoms in high school students during the COVID-19 pandemic. The validated Spanish version of the Dysexecutive Questionnaire (DEX) was used. A total of 2396 participants aged 14-22 years were included. Our sample yielded a mean DEX scale score of 28.14 ± 17.42. By the DEX classification, 889 (37.1%) students achieved optimal scores, 384 (16%) reported mild dysexecutive symptoms, 316 (13.2%) reported moderate dysexecutive symptoms, and 807 (33.7%) reported strong dysexecutive symptoms. We found a significant difference between those with and those without employed mothers, with the former scoring higher (p = 0.004), the same as those with both parents employed (p = 0.004). Adolescents face emotional susceptibility and changes in their family, social, and educational environment related to isolation, resulting in altered emotional responses and social interaction.

Experiencia de 1000 amnioinfusiones trascervicales en casos de ruptura prematura de membranas (RPM): utilidad, dificultades y relación con la reducción de cesáreas / Experience of one thousand transcervical amnioinfusion in cases of premature rupture of membranes PRM: Utility, difficulties and relationship with c-section reduction

OBJETIVO: Analizar los resultados de un estudio prospectivo y descriptivo de 1000 amnioinfusiones transcervicales, realizadas de 1993 a 1998, en el Hospital Civil de Belén de Guadalajara; así como describir sus indicaciones, dificultades técnicas, beneficios y complicaciones. MATERIAL Y MÉTODOS: Se seleccionaron del servicio de Obstetricia, 1000 pacientes con embarazo de término con ruptura prematura de membranas (RPM), con ocho horas o más de evolución y trabajo de parto irregular, para practicarles amnioinfusión transcervical.RESULTADOS: Tipos de amnioinfusiones : profilácticas (prevenir compresión de cordón umbilical) en 40.6 por ciento (n=406) y terapéuticas (remover líquido amniótico infectado y/o meconial del interior de la cavidad uterina) en 59 por ciento (n=590); fallidas 0.4 por ciento (n=4). De 124 con compresión de cordón; el 79 por ciento (n=98) mejoraron. 392 se efectuaron para sustituir líquido amniótico meconial por solución fisiológica y 71 para lavar la cavidad uterina por corioamnioítis. El 99.2 por ciento de las pacientes (n=992) regularizó la actividad uterina, de 5 a 20 minutos post-amnioinfusión. 93.1 por ciento de pacientes (n=931) parieron de 2 a 6 horas post-amnioinfusión. Se efectuaron 67 cesáreas (6.7 por ciento). Murieron dos productos transparto; por corioamnioítis severa. CONCLUSIONES: Se considera que la amnioinfusión es una alternativa terapéutica útil, fácil de aprender, sencilla, accesible, económica y disponible en cualquier hospital.

Interleukinas y embarazo: una realidad cuestionada / Interleukines and pregnancy: a questioned reality

Se revisa la literatura relacionada con el papel que juegan las Interlukinas (ILs) en el embarazo puntualizándose que en el mecanismo de trabajo de parto espontáneo están involucradas estas substancias, las cuales actúan como disparadores de la cascada ácido araquidónico/prostaglandina; este mismo proceso puede activarse por lipopolisacárdios bacterianos implicados en la etiología del parto pretérmino. Normalmente la producción y actividad de la IL-2 esta inhibida para que el embarazo siga un curso normal, si esto no sucede se tendrían problemas de aborto de repetición, la IL-3 conjuntamente con factores estimuladore de crecimiento (FECs) permite el adecuado crecimiento del producto de la gestación si esto se altera habría retardo en el crecimiento intrauterino; a,bas interleukinas actúan a nivel de la interfase materno fetal. Por lo anterior es importante que el ginecoloobstetra tenga una información básica relacionada con ILs y su relación con el embarazo normal y complicado