Guillain-Barre syndrome during COVID-19 pandemic: experience from a referral healthcare center in Mexico. / Síndrome de Guillain-Barré durante la pandemia de COVID-19: experiencia de un centro de referencia en México.

INTRODUCTION: To describe clinical characteristics and electrophysiological variants of GBS cases during the pandemic, we carried out a comparative analysis between SARS-CoV2 related GBS and non-SARS-CoV2 patients and then compared to the 2019 cases. PATIENTS AND METHODS: We carried out a cross-sectional study of GBS patients diagnosed according to Asbury and Cornblath criteria. We collected information on clinical and paraclinical variables. We defined a SARS-CoV-2 related GBS case according to the description of Ellul et al. We used Hadden criteria to classify the electrophysiological variants. We performed a comparative analysis between groups. RESULTS: Fourty-two patients were diagnosed with GBS in 2020, men 64.2%, age 46 ± 17.4 years, patients with obesity/overweight 42.8%, previous diarrhea 31%, history of respiratory tract infection 14.2%. Guillain Barre Disability Scale = 3 points 71.4% and, cranial nerve involvement 69%. The most frequent electrophysiological variant was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 53.5%. Seven (16.6%) cases were SARS-CoV2 related, four men, age 43.4 ± 13.4 years. When comparing patients with GBS in 2020 vs patients in 2019, we observed a decrease in the previous infection history during 2020 (45.2% vs 73.3%, p-value = 0.005) and a decrease in previous respiratory infection (14.2% vs 33.3%, p = 0.045), as well as a higher frequency of cranial nerve involvement, and albuminocytologic dissociation. CONCLUSIONS: SARS-CoV2 virus infection preventive measures may be impacting the presentation of post-infectious diseases such as GBS. We did not observe an increase in GBS cases during 2020. Also, the AIDP variant were more frequent in our population in the COVID-19 pandemic.

TITLE: Síndrome de Guillain-Barré durante la pandemia de COVID-19: experiencia de un centro de referencia en México.Introducción. Se trata de describir las características clínicas y variantes electrofisiológicas de los casos de síndrome de Guillain-Barré (SGB) durante la pandemia. Llevamos a cabo un análisis comparativo entre pacientes con SGB relacionado con el SARS-CoV-2 y sin antecedente del virus, y posteriormente realizamos una comparación con los casos de 2019. Pacientes y métodos. Se llevó a cabo un estudio transversal de los pacientes con diagnóstico de SGB según los criterios de Asbury y Cornblath. Se recolectaron información clínica y variables paraclínicas. Definimos el SGB relacionado con el SARS-CoV-2 conforme a la descripción de Ellul et al. Se utilizaron los criterios de Hadden para la clasificación de las variantes electrofisiológicas. Por último, realizamos un análisis comparativo entre grupos. Resultados. Se diagnosticó a 42 pacientes con SGB en 2020, un 64,2% hombres, con una edad de 46 ± 17,4 años, un 42,8% con obesidad/sobrepeso, un 31% con historia de diarrea previa y un 14,2% con infección respiratoria previa. El 71,4% tuvo una puntuación en la Guillain-Barré Disability Score igual o mayor que 3 puntos y el 69% tenía afectados los nervios del cráneo. La variante electrofisiológica más común fue la polirradiculoneuropatía desmielinizante inflamatoria aguda (PDIA; 53,5%). Siete (16,6%) casos tuvieron relación con el SARS-CoV-2, cuatro hombres, con edad de 43,4 ± 13,4 años. Al realizar la comparación entre pacientes con SGB de 2020 frente a los de 2019, observamos un decremento en el antecedente de infección previa en 2020 (45,2 frente a 73,3%; p = 0,005) y un decremento específico en la historia de infección respiratoria (14,2 frente a 33,3%; p = 0,045), así como una mayor frecuencia de afectación de los nervios del cráneo y de disociación albuminocitológica. Conclusiones. Las maniobras preventivas para la infección por el SARS-CoV-2 impactan directamente en la presentación de enfermedades postinfecciosas como el SGB. No observamos un incremento en los casos de SGB durante 2020. Asimismo, la variante de PDIA fue la más frecuente en nuestra población durante la pandemia de COVID-19.

Cirugía antiincontinencia en mujeres posmenopáusicas / Anti-incontinence surgery in postmenopausal women

RESUMEN OBJETIVO: comparar la tasa de curación subjetiva y objetiva en mujeres posmenopáusicas después de habérseles realizado cirugía antiincontinencia. MATERIALES Y MÉTODOS: estudio de cohorte, retrospectivo, comparativo, efectuado en pacientes del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes atendidas entre enero de 2009 y diciembre de 2011. Criterios de inclusión: haber sido intervenidas quirúrgicamente para antiincontinencia. Grupo I: menores de 45 años (n=50); grupo II: 45-65 años (n=109); grupo III: mayores de 65 años (n=8). Variables de estudio: curación subjetiva (síntoma) y objetiva (prueba de la tos y estudio de urodinamia). Se analizaron los resultados quirúrgicos, postquirúrgicos y estudio de urodinamia, con estadística descriptiva y análisis bivariado con χ2 y t-Student. RESULTADOS: se estudiaron 167 pacientes con los siguientes resultados: curación subjetiva: 82% en el grupo I y 80.7% en el grupo II, y 100% en el grupo III, con p= no significativa. La curación objetiva se consiguió en: 90% de las pacientes del grupo I, 92.6 del grupo II y 50% en el grupo III, con p no significativa. La cirugía antiincontinencia efectuada fue por vía transobturadora en 52% del grupo I y 48.6% en el grupo II, y vía retropúbica (62.5%) en el grupo III. La estancia hospitalaria fue mayor en el grupo III, de 3 días, con p=0.018. Los cambios en la presión máxima de cierre uretral para el grupo I fueron de 48.8 cmH2O a 43.6 cmH2O, en el grupo II de 46.1 cmH2O a 45.8 cmH2O y en el grupo III de 38.1 cmH2O a 31 cmH2O, valores pre y posquirúrgicos en todos los grupos (p<0.005). CONCLUSIONES: a pesar de la disminución en la curación subjetiva, mayor morbilidad y menor presión máxima de cierre uretral en mujeres mayores de 65 años no existió diferencia clínica en la evolución.

ABSTRACT OBJECTIVE: Compared the rates of objective and subjective cure, in menopause female after incontinence procedures. MATERIALS AND METHODS: Retrospective study, between January 2009 and December 2011, 167 female patients with urinary incontinence who underwent a incontinence procedure, where divided in 3 groups: Group I: under 45 years (n=50), Group II: 45 to 65 years (n=109), Group III: up 65 years (n=8). The sequential outcomes and urodynamic findings were comparing and analyzed. RESULTS: The rates of subjective cure was 82% and 80.7% in Group I and II, 100% in Group 3, p=NS. The rates of objective cure was 90%, 92.6% and 50%, for each group p=NS. The transobturator procedure was the most done in group I and II, 52% and 48.6%, and retropubic procedure in group III 62.5%. The length of hospital stay (3 days) in Group III, p=0.018. The significant lower postoperative maximal urethral closure pressure in all groups, Group I was 48.8 cmH2O to 43.6 cmH2O, Group II was 46.1 cmH2O to 45.8 cmH2O and Group III was 38.1 cmH2O to 31 cmH2O, (p<0.005) CONCLUSION: Despite the decrease in subjective cure, higher morbidity and lower maximum urethral closure pressure in women older than 65 years, there was no clinical difference in the evolution.

Malla para la reparación del prolapso vaginal apical y anterior: resultados subjetivos y complicaciones / Vaginal mesh for repair of apical and anterior vaginal prolapse: subjective outcomes and complications

Resumen Antecedentes: la aplicación de mallas con fijación al ligamento sacroespinoso para corregir el prolapso apical de órganos pélvicos tiene tasas de éxito objetivo de 92%, con 2-12% de eventos adversos. Objetivo: evaluar los resultados clínicos posteriores a la aplicación de la malla UpholdTM en pacientes con prolapso apical, con o sin útero. Materiales y métodos: estudio retrospectivo y descriptivo efectuado en pacientes atendidas en la Clínica de Urología Ginecológica del Instituto Nacionalo de Perinatología Isidro Espinosa de los Reyes entre los meses de noviembre de 2013 a marzo de 2017 con prolapso de órganos pélvicos de la cúpula a quienes se aplicaron mallas que se fijaron al ligamento sacroespinoso. A las pacientes con incontinencia urinaria de esfuerzo se les colocó una cinta mediouretral. Resultados: se estudiaron 22 pacientes de las que 72% (n = 16) tenían histerectomía previa. El estadio del prolapso de órganos pélvicos fue II en 18% (n = 4), III en 41% (n = 9) y IV en 41% (n = 9). El compartimento anterior se encontró afectado en 41% (n = 9) y en 59% (n = 13) el apical. El 54% (n = 12) de las pacientes tenía incontinencia urinaria de esfuerzo. A 9% (n = 2) de las pacientes solo se les colocó la malla UpholdTM, a 45% (n = 10) se les practicó una cirugía concomitante para corrección del prolapso de órganos pélvicos (colpoplastia posterior [n = 5], colpoperineoplastia [ n = 4] y 1 culdoplastia) y para incontinencia urinaria de esfuerzo a 68% (n = 15) se les colocó una cinta mediouretral. El 9% (n = 2) tuvieron lesión vesical, 40% (n = 9) retención urinaria, 4.5% (n = 1) exposición y 4.5% (n = 1) extrusión. El éxito subjetivo y objetivo fue de 100%. Conclusiones: la colocación de la malla Uphold con fines de corrección del prolapso apical tiene buenos resultados, con mínimos efectos adversos. El procedimiento antiincontinencia concomitante incrementa la retención urinaria.

Abstract Introduction: The use of mesh with fixation to sacoespinous ligament (SEL) for correction of pelvic organ prolapse has a success rate of 92% and adverse events are reported in 2-12%. The aim of this study was to evaluate the clinical results after the application of Uphold mesh in women with apical prolapse with or without uterus. Methods: A retrospective and descriptive study, 22 patients with E ≥ II voult pelvic organ prolapse who underwent vault fixation or hysteropexy to SEL and mediourethral tape (CMU) in those with stress urinary incontinence (SUI) from November-2013 to March-2017. Results: 72.7% (n = 16) had previous hysterectomy. The pelvic organ prolapse stage was grade II in 18% (n = 4), III in 41% (n = 9) and IV in 41% (n = 9), the anterior compartment was affected in 40.9% and 59% (n = 13) for apical. 54.5% (n = 12) had SUI. In 9% (n = 2) were placed exclusively Uphold, concomitant surgery was performed for correction of posterior compartment pelvic organ prolapse in 45% (n=10) and at 68% (n = 15) CMU was placed. 9% (n = 2) had bladder injury, 40% (n = 9) urinary retention of patients with CMU application, 4.5% (n = 1) exposure and 4.5% (n = 1) extrusion. Subjective and objective success was 100%. Conclusions: The placement of Uphold has successful results in the correction of apical prolapse. The concomitant anti-incontinence procedure increases the presence of urinary retention.

Reparación de fístula urogenital con interposición de injerto biológico de submucosa intestinal / Urogenital fistula repair with intestinal submucosa biological graft interposition

Resumen ANTECEDENTE: el tratamiento de una fístula genitourinaria compleja es un reto por las múltiples dificultades para conseguir un resultado exitoso; el injerto biológico de intestino porcino puede ser una opción en estos casos. OBJETIVO: describir el diagnóstico de las fístulas genito-urinarias y su reparación con una innovadora interposición de injerto biológico de intestino delgado porcino. MATERIALES Y MÉTODOS: estudio prospectivo de serie de casos con diagnóstico de fístula vésico-vaginal y uretro-vaginal de pacientes atendidas en el Instituto Nacional de Perinatología entre los años 2012 a 2014. Descripción de los datos demográficos de cada paciente, proceso diagnóstico-clínico y estudios de gabinete y laboratorio; características de la fístula, técnica quirúrgica y seguimiento. RESULTADOS: se estudiaron 5 pacientes con fístulas tipo III o vésico-vaginales localizadas en el trígono, 3 de ellas relacionadas con cirugía ginecológica y 2 con un evento obstétrico, y una tipo I o uretrovaginal en la uretra proximal, relacionada con parto instrumentado. En el cierre del segundo plano, para la colocación del injerto biológico, se aplicó la técnica de reparación de Latzko modificada. Una paciente tuvo 4 reparaciones previas, otra una reparación previa y el resto ninguna. El tamaño varió de 0.5 cm a 3 cm. El seguimiento posoperatorio no evidenció recurrencia; una paciente tuvo incontinencia urinaria de esfuerzo un año después. El seguimiento mínimo fue de 1 y el máximo de 2 años. No se registraron complicaciones posoperatorias. CONCLUSIÓN: el injerto de mucosa de intestino delgado porcino para la reparación de fístulas urogenitales complejas y recurrentes fue efectivo en todas las pacientes.

Abstract BACKGROUND: treatment of a complex genitourinary fistula is a challenge given the multiple difficulties to achieve a successful result, the biological grafting of porcine intestine can be an option in these cases. OBJECTIVE: to describe the diagnosis of genitourinary fistulas and their repair with an innovative interposition of small intestine porcine biological graft. MATERIALS AND METHODS: a prospective trial of a series of cases with a diagnosis of vesicovaginal and urethrovaginal fistula in patients of the Instituto Nacional de Perinatología between 2012 to 2014. Description of patient demographics, diagnostic and clinical process, imaging and lab tests; characteristics of the fistula, surgical technique and follow up. RESULTS: 5 patients with type III or vesicovaginal fistulas located in the trigone were studied, 3 of the fistulas are related to gynecological surgery and 2 with an obstetric event and one type 1 or urethrovaginal in the proximal urethra caused by an instrumented delivery. In the closure of the second layer for placement of the biological graft, we applied the modified Latzko repair technique. One patient had 4 previous repairs, another one had one previous repair and the rest had none. The size varied from 0.5 cm to 3 cm. The postoperative follow-up period did not show recurrence; one patient had stress urinary incontinence one year later. The minimum follow-up was 1 year and the maximum 2 years. No postoperative complications were reported. CONCLUSION: the porcine small intestinal submucosa graft for the repair of complex and recurrent urogenital fistulas was effective in all patients.

Sperm chromatin dispersion by formaldehyde in Wistar rats.

Formaldehyde (FA) is an environmental xenobiotic, which is genotoxic and carcinogenic to humans and animals; it induces DNA damage, mutations, and clastogenicity during critical cytogenetic events. FA-mediated oxidative stress is an important mechanism that has been associated with the induction of cytotoxic and genotoxic damage. Therefore, the objective of this study was to evaluate the dispersion of sperm chromatin and reproductive parameters induced by exposure to different concentrations of FA in Wistar rats. Compared to the percentage of sperm with fragmented DNA in the control group (18.10 ± 8.62%), the percentage of sperm with fragmented DNA increased following exposure to 5, 10, and 30 mg FA/kg body weight (29.60 ± 8.44, 85.20 ± 20.94 and 96.0 ± 7.87, respectively; P = 0.0001). Histopathological alterations were evident, especially in the seminiferous tubules. In conclusion, this study provides experimental evidence concerning the genotoxicity of FA, with particular reference to the decreased sperm concentration and motility and increased dispersion of DNA chromatin in rats.

Detection of flagellin by interaction with human recombinant TLR5 immobilized in liposomes.

Digestive diseases caused by flagellated bacteria are a huge public health problem worldwide and rapid detection methods are needed for contaminated environments. In this study, we propose a method to detect patterns associated with pathogens based on the properties of the innate immune system. Specifically, we use Toll-like receptor 5 (TLR5), a transmembrane protein that specifically recognizes flagellin (the structural protein of bacterial flagella). TLR5, which was obtained by recombinant production in insect cells, was immobilized into liposomes to form TLR5-proteoliposomes. Through surface plasmon resonance (SPR) and competition flow cytometry assays, the sensitivity of proteoliposomes to recognize Escherichia coli and Salmonella typhimurium flagellin was evaluated. In addition, we compared the results obtained by immobilizing anti-flagellin antibodies into liposomes. The results of the flagellin-affinity tests, expressed as an SPR kinetic rate constant ratio in the equilibrium equation K(D) = k(d)/k(a), showed values of 13.8 × 10(-9) and 7.73 × 10(-9) M for the TLR5-proteoliposomes and anti-flagellin antibodies, respectively, against S. typhimurium. The anti-flagellin affinity results for E. coli showed K(D) of 84.1 × 10(-8) M for SPR assays and K (D) of 3.5 × 10(-8) M for competitive flow cytometry, which was used as a detection system without the immobilization of proteoliposomes. This research demonstrates the practical possibility of using proteoliposomes as recognition elements in the generation of systems for the rapid detection of flagellated bacteria, which could help avoid consumption of contaminated food by humans and thereby prevent intestinal infections.

Antimicrobial activity of Hedeoma drummondii against opportunistic pathogens.

Hedeoma drummondii is a medicinal plant with diverse properties; however, validations of its medicinal uses are scarce. To evaluate its antimicrobial properties H. drummondii, was tested against opportunistic pathogens of medical importance. Antimicrobial tests were performed by the microdilution method in order to determine the Minimal Inhibitory Concentration (MIC) for each extract. Extracts of this plant showed relevant antimicrobial activity, results revealed that the hexanic extract has stronger activity and broader spectrum compared to acetone and methanol extracts. The activity of hexanic extract may be attributed mainly to the presence of the monoterpenes pulegone and menthol. In conclusion, the hexanic extract possess relevant antibacterial properties which suggests that H. drummondii have bioactive principles; these new data provide scientific support for the use of this plant in traditional medicine, particularly for gastrointestinal diseases.

Scaling patterns of heart rate variability data.

Detrended fluctuation analysis (DFA) is becoming a widely used technique for exploring the structure of correlations in heart rate variability (HRV) data. This method provides a scaling or fractal exponent alpha(x) derived from the behaviour of the root-mean-square fluctuations along different time scales n. Rather than just finding a single exponent, covering either short (alpha(1)) or long range (alpha(2)), we recently suggested tracking the local evolution of alpha(x), as in this way scaling patterns (SP), which seem to provide more detailed characterizations of HRV data, are revealed. Here, we evaluate such potential advantage by classifying long-term data from 51 subjects in normal sinus rhythm and 29 congestive heart failure patients. Using the SP we achieved a significantly better classification of these data than using alpha(x), or the statistic pNN20, thereby confirming that the SP provide a useful assessment of the correlation structure in HRV data.

Lamellar bodies as a diagnostic test of fetal lung maturity.

OBJECTIVES: To determine the number of lamellar bodies in the amniotic fluid indicating fetal lung maturity and to define the effectiveness of a diagnostic test in a healthy pregnant population. METHODS: The study took place at the Hospital General de Zona #16 Centro Médico Nacional del Instituto Mexicano del Seguro Social. Torreón, Coahuila, México, where 264 pregnant women were followed-up from August 1997 to October 1998. The women presented in labor between 26 and 41 weeks of gestation. Amniotic fluid was obtained during cesarean section or from the vaginal pool and lamellar bodies were counted without prior centrifugation in Cell-Dyn 3000's channel for blood platelets. Results were masked for neonatologists. RESULTS: The prevalence of respiratory distress syndrome (RDS) was found to be 14.9%. At the 8200/microl threshold, sensitivity was: 15.4% (95% CI=5.9-30.5%), specificity: 99.6% (95% CI=97.5-99.9%), positive predictive value (PPV): 85.7, negative predictive value (NPV): 87.1, likelihood ratio for a negative test (LR-): 0.85, and likelihood ratio for a positive test (LR+): 85.7. At the 57 000/microl level, sensitivity was: 92.3% (95% CI=79.1-98.3%), specificity: 70.9% (64.4-76.7%), PPV: 35.6, NPV: 98.1, LR-: 0.11, and LR+: 3.17. When the cut-off point was 79000/microl, sensitivity was: 100.0%, specificity: 43.0% (95% CI=36.5-49.8%), PPV: 23.5, NPV: 100.0, LR+: 34.3, and LR-: less than 0.001. CONCLUSIONS: Counting lamellar bodies is a quick, readily available, and very effective test.

Esophageal fibrovascular polyp protruding from the mouth.

A case of a 66-year-old woman with a giant fibrovascular polyp protruding from the mouth is presented. The polyp was successfully removed by a cervical esophagotomy.

[Biochemical and endocrine heterogeneity in the complete form of testicular feminization syndrome]. / Heterogeneidad bioquímica y endocrina en la forma completa del síndrome de feminización testicular.

A familial variant of male pseudohermaphroditism different from the classical form of the complete testicular feminization syndrome was studied. The three affected 46, XY sibling (16,18 and 20 years old) exhibited female phenotype identical to that of a 17 years old patient with the classical form, included as a control. The major endocrine and biochemical differences observed in this family, as compared with the classical form, includes: a. Markedly elevated serum levels of LH and FSH; b. Non-elevated serum testosterone levels; c. Poor testicular hCG responsiveness; d. Abnormally elevated baseline and hCG-stimulated androstenedione: testosterone ratio; e. Slight pituitary responsiveness to androgens; f. presence of residual androgen uptake by cultured fibroblasts derived from genital skin. These differences were more evident in the two older patients. All subjects presented a lack of nitrogen retention following testosterone administration. These results were interpreted as demonstrating a testicular impairment of testosterone biosynthesis in the older subjects of this family, which resulted in an unusual gonadotropin profile. The altered androstenedione: testosterone ratio suggests a secondary partially decreased activity of testicular 17-hidroxysteroid dehydrogenase, as demonstrated in TFM mice and rats. The overall data indicate an age-dependent variability in the expression of androgen insensitivity in this family, thus demonstrating the wide biochemical heterogeneity of the androgen resistant syndromes.

Meningoencefalitis por Listeria monocytogenes (Informe de cinco casos). / Meningoencephalitis by Listeria monocytogenes (Report of 5 cases)

Se presentam cinco casos de meningoencefalitis por Listeria monocytogenes. Se senalan las caracteristicas clinicas epidemiologicas, serologicas y bacteriologicas del microrganismo asi como su escasa frecuencia en nuestro medio, y las dificultades en su diagnostico tanto desde el punto de vista clinico, como de laboratorio. Se hace una revision de la literatura mundial y nacional sobre el tema

[Scintillography of the adrenal medulla]. / Centelleografia de la medula adrenal

The "nerve growth factor" is a polipeptide isolated from salivary glands of some mammals. Its main physiological effect is on the autonomic nervous system. The injection of antiserum in newborn animals leads to nearly total destruction of the sympathetic ganglia (immunosympathectomy). Anti-nerve growth factor labelled with Iodine-131 was injected in rats for the determination of organ distribution at different times (2,4,6,8 and 24 hours). A selective concentration in the adrenal medulla was obtained at 4 hrs. after intravenous administration of 50 uCi of anti-nerve growth factor with an specific activity of 0.001 g/mCi that permits, for the first time, the scan of the adrenal medulla. No intolerance or radiotoxicity was observed in the animals during a six-month follow-up period. The results are very encoragin, and the application of this new method in humans is at present under study.