Catastrophic antiphospholipid syndrome. Case report and literature review / Síndrome antifosfolípidos catastrófico. Reporte de caso y revisión bibliográfica.

The present document is the report of a case of a very rare clinical entity, which presents with acute multiorganic failure after a thrombotic storm related to antiphospholipid antibodies, the so-called catastrophic antiphospholipid syndrome, which began as a recurrent picture of mesenteric thrombosis, with a previous history of venous insufficiency and distal ulcers probably associated with an unidentified antiphospholipid; deserving management in intensive care and the consultation by the world expert, Dr. Ricard Cervera who confirmed the diagnosis and recommend treating as such entity, the patient's evolution was satisfactory so far. Final recommendations for diagnosis and current treatment options such as rituximab or eculizumab are made. The present case was added to the international registry that currently houses around 500 cases worldwide (International CAPS Registry).

Se reporta un caso de una condición clínica sumamente rara, la cual cursa con falla multiorgánica aguda posterior a una tormenta trombótica relacionada con anticuerpos antifosfolípidos, el denominado síndrome antifosfolípidos (SAF) catastrófico, el cual comenzó como un cuadro recurrente de trombosis mesentérica, con antecedentes de insuficiencia venosa y úlceras distales probablemente asociadas a un SAF no identificado, ameritando manejo en terapia intensiva y la consulta por el experto mundial Dr. Ricard Cervera, quien confirmó el diagnóstico y recomendó tratar como tal. La evolución del paciente fue satisfactoria hasta el momento. Se hacen recomendaciones finales de diagnóstico y se comentan las opciones de tratamiento actuales, como rituximab o eculizumab. El presente caso fue agregado al registro internacional de SAF catastrófico (International CAPS Registry), que actualmente alberga alrededor de 500 casos en todo el mundo.

Etiopathogenic theories about long COVID.

The main etiopathogenic theories of long coronavirus disease (COVID) are listed and a conjunction of them is carried out with the objective of deciphering the pathophysiology of the entity, finally the main lines of treatment existing in real life are discussed (Paxlovid, use of antibiotics in dysbiosis, triple anticoagulant therapy, temelimab).

[Proposal for a diagnostic approach to long COVID]. / Propuesta de abordaje diagnóstico del COVID persistente.

The objective of this communication is to provide a proposal for a diagnostic approach to persistent COVID based on the various current etiopathogenic theories and to serve as a guide on how to start the diagnostic process in a patient affected by this syndrome according to the prevailing symptomatology and the basic studies and of extension that can be requested and even assisted by commercial kits that would help a better diagnosis.

La presente comunicación tiene como objetivo aportar una propuesta de abordaje diagnóstico del COVID persistente con base en las diversas teorías etiopatogénicas actuales, así como servir de guía para iniciar el proceso diagnóstico en un paciente afectado por este síndrome, acorde a la sintomatología prevaleciente y a los estudios básicos y de extensión que se pueden solicitar, e incluso auxiliados por pruebas comerciales que ayudarían a un mejor diagnóstico.

["Herbalist" supplements maliciously expanding from Mexico to the world. Artriking and company]. / Complementos "herbolarios" expandiéndose maliciosamente de México para el mundo. Artriking y compañíal.

This letter aims to inform the medical community about herbal supplements that have steroidal and non-steroidal drugs hidden in their formulation, entailing risks to the health of consumers, in addition to the fact that they are not regulated at the local level and the producers of these supplements try to sell them internationally, which would bring serious consequences, since it would become a serious global health problem; these supplements have provoked Cushing's syndrome, diabetes mellitus, sepsis, pneumonitis and invasive helminthiasis.

La presente carta pretende informar a la comunidad médica sobre los complementos herbolarios que tienen de manera oculta en su formulación fármacos esteroideos y no esteroideos, lo cual conlleva riesgos a la salud de los consumidores, además de que no hay una regulación de los mismos a nivel local y quienes los producen buscan que se diseminen en forma global, lo cual traería consecuencias graves, dado que se convertiría en un problema de salud pública mundial; estos complementos han condicionado síndrome de Cushing, diabetes mellitus, sepsis, neumonitis y helmintiasis invasivas.

[Intertwined long COVID theories to explain its etiopathogenesis]. / Teorías del long COVID entrelazadas para explicar su etiopatogenia.

This editorial lists the main current theories on long COVID, such as the theory of viral persistence and the one of immunothrombosis associated with deregulation of the immune system; it is discussed as well their interrelation, which finally explains the etiopathogenesis and physiopathology of this new syndrome that afflicts the survivors of COVID-19; it is also discussed the link between viral persistence with the formation of amyloid microthrombi based on the hypothesis that the spike protein causes amyloidogenesis, inducing organic chronic damage that will characterize long COVID.

En este editorial se enumeran las principales teorías actuales sobre el long COVID, como la teoría de la persistencia viral y la de la inmunotrombosis asociada a desregulación del sistema inmune; se discute también su interrelación, que explica la etiopatogenia y fisiopatología de este nuevo síndrome que aqueja a los sobrevivientes de COVID-19; se discute además un nexo entre la persistencia viral y la formación de microtrombos amiloides con base en la hipótesis de que la proteína spike condiciona amiloidogénesis, lo cual condicionará daño orgánico crónico que caracterizará al long COVID.

Catastrophic antiphospholipid syndrome in Mexico. Literature review.

Catastrophic antiphospholipid syndrome (CAPS) is a rare entity, approximately 600 cases have been reported around the world, and the prevalence in Mexico is unknown. OBJECTIVE: To determine the estimated prevalence of CAPS in Mexico. MATERIAL AND METHODS: A literature search of isolated clinical cases or case series was conducted in diverse search engines, using the terms: "Catastrophic Antiphospholipid Syndrome" and "Mexico" in May 2022. RESULTS: We found a series of retrospective cases in autopsies that included 12 cases, two reports that included 2 cases each, and reports of 11 isolated clinical cases; these publications were generated between 2003 and 2020. In total, we collected data on 27 cases of CAPS, of which 16 correspond to primary antiphospholipid syndrome, 10 are associated with systemic lupus erythematosus, and 1 case corresponds to systemic sclerosis. The estimated prevalence rate in the Mexican population in 2022 is 2 cases per 10,000,000 inhabitants. The estimated mortality was 68% in this case series. CONCLUSION: Cases of catastrophic antiphospholipid syndrome in Mexico are underreported; identifying them will help improve current diagnostic and therapeutic strategies used in the country, encouraging the implementation of triple therapy and, in refractory cases, the use of eculizumab, to reduce current mortality.

Glycosylated hemoglobin as a predictor of mortality in severe pneumonia by COVID-19.

OBJECTIVE: Determine whether the levels of glycated hemoglobin (HbA1c) measured on admission to the intensive care unit (ICU) are associated with mortality in patients with severe SARS-CoV-2 pneumonia with invasive mechanical ventilation. DESIGN: Cohort study, retrospective, observational. A single center. PLACE: ICU of a second-level care hospital. PATIENTS: Severe SARS-CoV-2 pneumonia confirmed with IMV since admission to the ICU. INTERVENTIONS: none. RESULTS: A total of 56 patients with severe pneumonia, confirmed with SARS-CoV-2, all with IMV. The group with HbA1c <6.5% included 32 (57.14%) patients and the group with HbA1c ≥6.5% included 24 (42.86%) patients and the mortality rate in ICU was 43.8% and 70.8%, respectively, with p = 0.04. Predictors of mortality at 28 days in ICU were DHL >500 U/L, OR 3.65 (95% CI 1.18-11.29), HbA1c ≥6.5%, OR 3.12 (95% CI 1.01-9.6), SAH, OR 3.12 (95% CI 1.01-9.5), use of vasopressor, OR 0.2 (95% CI 0.05-0.73), diabetes was not statistically significant. CONCLUSION: The 28-day probability of survival in patients with severe SARS-CoV-2 pneumonia with IMV in the ICU is lower when the HbA1c level is ≥6.5% on admission.

Zika virus infection in pregnant women in a General Hospital of Veracruz, Mexico.

Objectives: To characterize the symptomatology of the patients affected by the Zika virus and to determine the incidence of congenital syndrome due to Zika in pregnant women in the city of Veracruz, Mexico.Methods: Descriptive, retrospective, and longitudinal study. All the patients in gestation period who attended the general hospital from 1 August to 30 November, 2016 and who met the criterion of suspected case of Zika virus infection. General symptoms and signs, gestational age, and search for fetopathies (ultrasound/fetometry at first contact) and finally incidence of Congenital Zika Syndrome at the end of gestation are analyzed.Results: A total of 103 pregnant women who met the definition of a suspected case of Zika virus infection were admitted to the study, 25 were positive for Zika by serum RT-PCR (24%). In the group of patients who tested positive for Zika by RT-PCR, all had conjunctivitis and arthralgia, followed by rash and pruritus. In this group, the headache was only reported in 84% and fever in 68%. No neonates with craniofacial or other malformations associated with congenital Zika syndrome, were reported.Conclusions: In this cohort, it is evident that the symptomatology presented by pregnant women during the first Zika outbreak in Mexico in 2016 is directly related to the proposed operational definition. There were no complications directly related to pregnancy during the acute virosis.

Response to comment on article "Zika, afebrile disease?" / Respuesta al comentario sobre el artículo "Zika, ¿enfermedad afebril?"

The almost immediate release, both in Asia and in Latin America, of clinical observations on patients infected by Zika virus has allowed a transmission of timely and useful information in health care. Since the spread of the virus in Mexico so it has happened: the experience published by scholars of South Asia has prompted us to add to the study of the virus in the interest of providing better healthcare services.

La difusión casi inmediata, tanto en Asia como en América Latina, de las observaciones clínicas en pacientes infectados por el virus del Zika ha permitido una transmisión de información oportuna y útil en la atención médica. Desde la propagación del virus en México así ha ocurrido: la experiencia publicada por estudiosos del sur de Asia ha motivado que nos sumemos al estudio del virus en aras de ofrecer mejores servicios de salud.

Zika transmission ways, can it be transmitted from person to person? / Vías de transmisión del Zika, ¿se puede transmitir de persona a persona?

In this article we describe the main transmission mechanisms of the Zika virus, from those already known, such as zoonotic and anthroponotic transmission of the virus, perinatal, occupational transmission, by blood products and by sexual contact. Given the possibility of person-to-person transmission, some measures of attention are proposed as the necessary studies are advanced to confirm or discard it.

En el presente artículo se describen los principales mecanismos de transmisión del virus Zika, desde los ya conocidos, como la transmisión zoonótica y antroponótica del virus, la transmisión perinatal, ocupacional, por hemoderivados y por contacto sexual. Ante la posibilidad de transmisión de persona a persona, se proponen algunas medidas de atención en tanto se avanza en los estudios necesarios para confirmarla o descartarla.

Zika, afebrile disease? / Zika, ¿enfermedad afebril?

In this paper, we emphasize on a probable atypical case of Zika, which is essentially a febrile illness; however, nowadays it has been noticed that fever is not always present in Zika cases, and the incidence of this clinical sign varies in several series; besides, we point out that symptoms such as nonpurulent conjunctivitis or rash could be reliable criteria in the absence of fever for the probable diagnosis of Zika, which invariably requires serological confirmation, even though the latter is not always available.

En el presente escrito, se hace énfasis en un probable cuadro atípico del Zika, el cual característicamente es una enfermedad febril; sin embargo, actualmente se ha notado que el cuadro no siempre presenta fiebre y la incidencia de dicho signo clínico varía en las diversas series; asimismo, se hace hincapié en que síntomas como la conjuntivitis no purulenta o el exantema pudieran ser criterios mayores en ausencia de fiebre, para el diagnóstico probable de Zika, el cual invariablemente requiere confirmación serológica, aunque esta última pocas veces está disponible.

Microcephaly and arbovirus / Microcefalia y arbovirus

In this paper the relationship between the incidence of microcephaly and various arboviruses in current boom is exposed. It stands out that in the infection by the dengue virus, there have been no cases of microcephaly, however in the case series of chikungunya infection, incidence of cases with this affectation was reported, highlighting a cohort called CHIMERE; also the highest incidence of microcephaly associated with the mentioned Zika virus, which has been widely studied. All this, due to the neurotropism of these arboviruses.

En el presente trabajo se expone la relación existente entre incidencia de microcefalia y los diversos arbovirus en auge actual. Destaca que en la infección por el virus del dengue, no se ha registrado casos de microcefalia, sin embargo en las series de casos de infección por chikunguña, se reportó incidencia de casos con esta afectación, destacando una cohorte denominada CHIMERE; asimismo se menciona la mayor incidencia de microcefalia asociada al virus del Zika, la cual ha sido ampliamente estudiada. Todo lo anterior por el neurotropismo de estos arbovirus.

[Transient central diabetes insipidus associated with pregnancy. Case report and bibliography review]. / Diabetes insípida central transitoria asociada a embarazo. Reporte de caso y revisión de bibliografía.

The case of a patient affected by transient diabetes insipidus associated with pregnancy, in the context of eclampsia, which was presented during seizures and identified by polyuria important, as well as changes in the urinary density occurs, and improving after nasal administration of desmopressin, which confirmed the diagnosis and treatment served completely by sending the picture without any sequel.

Se presenta el caso de una paciente afectada por una diabetes insípida central transitoria asociada al embarazo, en el contexto de una eclampsia, la cual se presentó durante las crisis convulsivas, identificándose por poliuria importante, así como alteraciones de la densidad urinaria, y mejorando tras la administración de desmopresina nasal, lo cual con-firmó el diagnóstico y sirvió de tratamiento, remitiendo totalmente el cuadro sin secuela alguna.

[Zika virus and their means of delivery, rather than Aedes]. / Zika y sus vectores, más que Aedes.

In the present work an exposition of the most frequent vectors of the arboviruses is made highlighting the ones of the genus Aedes, of these in each geographic distribution there are specific subgeneros, in Africa emphasizes A. africanus, A. opok and A. vitatus like those in charge of The propagation of arboviruses. In Asia and Oceania, A. hensilii and A. polynesiensis stand out, and A. albopictus, in addition to A. koreicus and A. japonicus, the latter also responsible for dissemination in North America. It is mentioned in the wave that struck to South America the greater importance of other genera like Culex, emphasizing C. pipiens, C. perfuscus, C. quinquefasciatus and C. nigripalpus; Also genera like Anopheles emphasizing A. coustani, A. albimanus and A. pseudopunctipennis (Central America and Mexico). Therefore the importance of other vectors other than Aedes as the participants in the American wave is pointed out.

En el presente trabajo se hace una exposición de los vectores más frecuentes de los arbovirus, destacando los del genero Aedes; de estos, en cada distribución geográfica existen subgéneros específicos, en África destaca el A. africanus, A. opok y A. vitatus como los responsables de la propagación de arbovirus. En Asia y Oceania destacan el A. hensilii y A. polynesiensis, y en Europa ha tomado auge el A. albopictus, ademas del A. koreicus y A. japonicus, estos últimos responsables también de la diseminación en Norteamérica. Se comenta en la oleada que sacudió a Sudamérica, la mayor importancia de otros géneros como Culex, destacando C. pipiens, C. perfuscus, C. quinquefasciatus y C. nigripalpus; asimismo, géneros como Anopheles destacando A. coustani, A. albimanus y A. pseudopunctipennis (presentes principalmente en Centroamérica y México). Por lo que se puntualiza la importancia de otros vectores diferentes de Aedes como los partícipes de la oleada americana.