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BACKGROUND:  Although tumors of the central nervous system (CNS) are rare, they can cause significant morbidity and mortality. The clinical presentation of patients with non-functional pituitary adenomas (NFPA) ranges from being completely asymptomatic to causing pituitary, hypothalamic, or visual dysfunction due to their large size. Patients usually arrive with large tumors at the time of diagnosis.  Objectives: Try to describe the characteristics of NFPA and explain the causes of delayed diagnosis.  Methods: We carried out a retrospective study including 58 patients with NFPA and analyzed the tumor volume at the time of diagnosis and its relationship with sociodemographic and health sector variables.  Results: Low socioeconomic status (SES) was associated with high tumor volume (SES 1-2 of 17.4 cm3 vs 3-6 of 11.7 cm3, p=0.018), and the time between first consultation and diagnosis was longer in the public sector than in the private sector (13.5 months vs 5.1 months). The time between the first symptom and the first consultation was shorter when they had visual impairment than when they did not (4.1 vs 18.4 months, p=0.006). CONCLUSIONS: On the one hand, citizens should be made aware that a visual deficit should make them go to a medical check-up, and on the other hand, strengthen the health system so that they have the NFPA as a differential diagnosis in patients with some visual alteration. Socioeconomic inequality in our country undoubtedly puts the underprivileged at greater risk.

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OBJECTIVES: Normal thyroid activity has an essential role in fetal development, its deficiency may hamper fetal neurodevelopment and neonatal growth. The quantitation of thyroid hormones although useful, still exposes differences on cut off levels to diagnose thyroid deficit accurately that can elicit under or over diagnosis of thyroid dysfuntion. METHODS: A total of 839 pregnant patients were studied for thyroidal clinical assessment through quantitation of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) circulating levels. Patients evaluated for prenatal and neonatal outcomes. Thyroid function deficiencies were determined with the American Thyroid Association (ATA) 2011 and 2017 values. Statistical analysis searched for associations between variables, odds ratios (OR) and correlations were calculated to evaluate the reliability of the cutoff values recommended by the ATA. RESULTS: Mean age of our cases was 27.5 + 5.83 years at diagnosis, mean gestational age at first consultation was 23.8 + 10.5 weeks. Mean TSH levels detected were: 2.5 + 1.89 mIU/L, total T3: 3.55 + 4.1 ng/dL, FT4: 3.14 + 4.4 ng/dL. The ATA 2011 values yielded 332 hypothyroidism cases vs. 507 euthyroid patients, a total incidence of 39.6% vs. the ATA 2017 values, diagnosing 100 hypothyroidism cases and 739 euthyroid patients, total incidence of 11.9%. Association with complications were not significant. CONCLUSIONS: Using ATA 2017 values showed a decreased population with gestational hypothyroidism, hence preventing overdiagnosis and over-treatment. No significant complications were associated, requiring the determination of new regional values. Education and sensibilization of our population is needed to comply with early prenatal consultation and thyroid function testing.

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PURPOSE: The Mexican Jewish community (MJC) is a previously uncharacterized, genetically isolated group composed of Ashkenazi and Sephardi-Mizrahi Jews who migrated in the early 1900s. We aimed to determine the heterozygote frequency of disease-causing variants in 302 genes in this population. METHODS: We conducted a cross-sectional study of the MJC involving individuals representing Ashkenazi Jews, Sephardi-Mizrahi Jews, or mixed-ancestry Jews. We offered saliva-based preconception pan-ethnic expanded carrier screening, which examined 302 genes. We analyzed heterozygote frequencies of pathogenic/likely pathogenic variants and compared them with those in the Genome Aggregation Database (gnomAD). RESULTS: We recruited 208 participants. The carrier screening results showed that 72.1% were heterozygous for at least 1 severe disease-causing variant in 1 of the genes analyzed. The most common genes with severe disease-causing variants were CFTR (16.8% of participants), MEFV (11.5%), WNT10A (6.7%), and GBA (6.7%). The allele frequencies were compared with those in the gnomAD; 85% of variant frequencies were statistically different from those found in gnomAD (P <.05). Finally, 6% of couples were at risk of having a child with a severe disorder. CONCLUSION: The heterozygote frequency of at least 1 severe disease-causing variant in the MJC was 72.1%. The use of carrier screening in the MJC and other understudied populations could help parents make more informed decisions.

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Background:The coronavirus disease 2019 (COVID-19) pandemic has disrupted the health care system in various ways, one of which is the implementation of telemedicine as a part of the daily clinical practice for many physicians. Sofía is a Mexican health care and technology startup that implemented an app-based telemedicine program during this pandemic in Mexico.Materials and Methods:The telemedicine program included on-demand video consultations with internal medicine specialists from March to September 2020. In the following study, we present a descriptive analysis of all the patients in the telemedicine program, called Coronaid. Results:2,585 video consultations were conducted for a total of 1,545 patients and 44.4% of these were associated with respiratory symptoms. Of all patients, 46% were female and the mean age was 34 years, 52.2% were overweight or obese, and 25% presented at least one comorbid condition. Aside from respiratory complaints, the most common chief complaints were associated with gastrointestinal, psychiatric, and genitourinary symptoms. Patient satisfaction after video consultation services was >80%.Discussion:During the COVID-19 pandemic, an application-based telemedicine program had a high patient satisfaction rate in a significant sample of young patients, which can be attributed to the accessibility of the medical services and widespread use of smartphones in this patient demographic.Conclusion:Telemedicine has proven to be a useful, safe, and effective tool to improve patients' health, which has been boosted by the COVID-19 pandemic. The use of mobile applications and video consultation services can encourage patients to improve their health and prevent complications in the short and long terms.

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OBJECTIVES: Identify risk factors associated with increased hospital admission and mortality due to dengue fever (DF), and estimate the risk magnitude associated with each individual variable. METHODS: Records of patients diagnosed with dengue were obtained from the Mexican National Epidemiological Surveillance System. Descriptive statistics were performed in all variables. Demographic characteristics and comorbidities were compared between patients based on type of care and mortality. Multivariable analysis was done with a logistic regression model, using two different outcomes: hospitalization and mortality. RESULTS: A total of 24,495 patients were included in the analysis, with a DF case fatality rate of 0.58%. Patients younger than 10 and older than 60, were found to have a greater risk of both hospitalization and mortality due to DF. Comorbidities associated with a higher risk for hospital admission include cirrhosis, CKD, immunosuppression, diabetes, and hypertension. For mortality, CKD, diabetes, and hypertension were identified as risk factors, along with pregnancy. CONCLUSION: Identification of risk factors associated with increased hospitalization and mortality due to DF can help categorize patients that require close monitoring and inpatient care. Early identification of warning signs and patients at increased risk is key to avoiding delay of supportive care.

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Objective: to evaluate the knowledge of the general population about the COVID-19 pandemic, including the disease and the preventive measures to reduce spreading of the virus undertaken by participants. Materials and methods: a cross-sectional study on a Mexican population sample was conducted during the period of March 20th to March 27th in Mexico, via a computer-based survey. General knowledge about COVID-19 and the adherence to recommendations were evaluated. Results: a total of 2,577 participants completed the survey. The results revealed an overall proper knowledge about the disease, with 76.2% having the proper knowledge about the disease, which was significantly correlated with age (r=0.15, p<0.001), socioeconomic status (r=0.06, p<0.003) and maximum academic level achieved by the study subjects (r=0.12, p<0.001). Conclusions: overall, people have good knowledge of COVID-19 and know about the specific public health recommendations, but a large proportion of people do not strictly follow these recommendations..Au

Objetivo: evaluar el conocimiento de la población general acerca de la pandemia de COVID-19, incluyendo datos sobre la enfermedad y las medidas preventivas para reducir la propagación del virus. Materiales y métodos: se realizó un estudio transversal en una muestra de la población mexicana durante el periodo del 20 al 27 de marzo del 2020 por medio de una encuesta electrónica. Se evaluó el conocimiento general sobre COVID-19 y el apego a las recomendaciones de salud pública Resultados: 2,577 participantes completaron la encuesta. Los resultados muestran un adecuado conocimiento sobre la enfermedad en la población general (76.2% de la muestra), el cual está levemente correlacionado con la edad (r=0.15, p<0.001), estado socioeconómico (r=0.06, p<0.003) y grado académico (r=0.12, p<0.001). Conclusiones: en general, la población conoce la información acerca del COVID-19 y conoce las recomendaciones de salud pública, pero una gran proporción de la gente no sigue estrictamente estas recomendaciones..Au

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OBJECTIVE: To describe the results of a Mexican telemedicine program for patients with coronavirus disease 2019 (COVID-19). METHODS: An observational retrospective study was conducted to analyze and describe the baseline demographic and clinical characteristics of patients who received medical video consultations for respiratory symptoms. RESULTS: A total of 1,148 video consultations were given from March to September 2020 via Sofía's mobile app. A total of 580 patients sought medical consultation regarding respiratory symptoms. Of the patients, 51% were male and the mean age was 36 years (SD = 13). Of the patients, 35% had comorbidities such as diabetes, hypertension, and obesity, and 1.2% were sent to the ED. Fifty-seven polymerase chain reaction (PCR) tests for COVID-19 were requested and we detected a 53% positivity rate with a mean follow-up of 4.6 consultations. CONCLUSION: Telemedicine has proven to be a safe and effective tool for triaging, testing, treating, and remote monitoring of patients with mild COVID-19. Patients triaged by Sofía had good overall outcomes and reduced the risks of in-person consultation in the pandemic.

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BACKGROUND: Early identification of different COVID-19 clinical presentations may depict distinct pathophysiological mechanisms and guide management strategies. OBJECTIVE: To determine the aggressiveness of SARS-CoV-2 using symptom progression in COVID-19 patients. DESIGN: Historic cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry. SETTING: Population-based. Patients registered in the Epidemiologic Surveillance System in Mexico. PARTICIPANTS: Subjects who sought medical attention for clinical suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2. MEASUREMENTS: We measured the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) and compared it to the primary outcomes (mortality and pneumonia). RESULTS: 65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PISYCS, patients were distributed as follows: 14.89% in <24 hours, 43.25% between 1-3 days, 31.87% between 4-7 days and 9.97% >7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in <24 hours, 2.5% and 14% between 1-3 days, 3.6% and 19.5% between 4-7 days, 4.1% and 20.6% >7 days, respectively (p<0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): <24 hours = 1.75 [1.55-1.98], p<0.001; 1-3 days = 1 (reference value); 4-7 days = 1.53 [1.37-1.70], p<0.001; >7 days = 1.67 [1.44-1.94], p<0.001. For pneumonia: <24 hours = 1.49 [1.39-1.58], p<0.001; 1-3 days = 1; 4-7 days = 1.48 [1.41-1.56], p<0.001; >7 days = 1.57 [1.46-1.69], p<0.001. LIMITATIONS: Using a database fed by large numbers of people carries the risk of data inaccuracy. However, this imprecision is expected to be random and data are consistent with previous studies. CONCLUSION: The PISYCS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings.

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Cardiac angiosarcoma is a rare and clinically challenging pathology. It is a high-grade primary malignant tumor of the heart tissue that has many variants, of which the epithelioid variant is rarely present in the heart or the great vessels. As with many other cardiac tumors, it is mainly a diagnosis of exclusion and the initial diagnostic test is an echocardiogram followed by a biopsy with immunohistochemistry analysis to ascertain the type of tumor. The differential diagnosis of cardiac tumors is challenging due to the overlapping clinical manifestations with different cardiac tumors and systemic diseases. Cardiac angiosarcomas are often aggressive with a poor prognosis even with treatment. Herein, we present a case of the epithelioid variant of a cardiac angiosarcoma in addition to a thorough review of the recent literature on the clinical manifestation, diagnosis, and treatment of this type of tumors.

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Anorexigenics are compounds capable of reducing or suppressing appetite. Their three main types act on different neurotransmitters, either norepinephrine, serotonin or a combination of both. Among the drugs that act on norepinephrine are fenproporex, amfepramone and clobenzorex. Derivatives of the thyroid hormone triiodothyronine have also been associated with weight loss and used as a controversial treatment for obesity, despite their known cardiovascular side effects. Recent data suggest a possible vasodilating effect for these four substances that might be beneficial in a subset of patients. Herein we performed a systematic review of the literature (with emphasis on recent reports) to determine the implications and mechanisms of the vasodilating effects of some anorectics, specifically fenproporex, clobenzorex, amfepramone and triiodothyronine. Data analysis showed these four drugs to be vasodilating agents for rat aortic rings. The different mechanisms of action include endothelium-dependent vasodilation via activation of the NO-cGMP-PKG pathway and the opening of calcium-activated potassium channels. The finding of vasodilating activity indicates a potential role for some anorexigenic drugs in the treatment of obesity in hypertensive patients. Further in vivo studies are needed to test the clinical benefits of these four drugs.

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Antecedentes:La escritura es una parte esencial de la comunicación. Uno de los componentes más importantes es la prehensión fina, es decir el agarre de la pluma, de la cual existen cinco variantes. Reconociendo que la educación tiene un rol importante en la generación de buenos hábitos de escritura para un mejor producto: la legibilidad. Metodología:Se realizó un estudio transversal de correlación. Se usaron dos métodos de recolección de información: cuestionario electrónico y prueba caligráfica. Resultados:Se reclutaron 120 sujetos, con edades entre 18 y 30 años. No se encontró relación significativa entre la legibilidad del texto con la duración de la educación caligráfica, el sexo, la edad, la mano preferente, el promedio ni tipo de letra. Se encontró relación significativa entre la comparación de los agarres estandarizados con el agarre alterno respecto a su legibilidad (p=0.01). Discusión:El 77.5% de la muestra obtuvo un promedio alto en la prueba caligráfica; sin embargo, no se encontró relación estadísticamente significativa con la duración de la educación caligráfica en la infancia, la legibilidad según sexo y edad, mano preferente, instrumento, tipo de letra y promedio académico. La única asociación significativa (p=0.01) fue entre legibilidad en agarre estandarizado con el alterno. Conclusión:La legibilidad de la caligrafía es multifactorial, con peso principal en la educación caligráfica infantil. Sin embargo, se comprobó que la duración de esta educación no es significativa para la legibilidad. Igualmente, el uso de un agarre alterno a las cinco variantes se asocia con peores resultados en la prueba caligráfica.

Background:Handwriting is an essential part of human communication. Its successful development is decisive for its personal and academic future. One of the most important components is the grip of the pen, which there are 5 standard variants. Calligraphic education has a very important role in the generation of writing habits and a better legibility. Methods:In a cross-sectional study of correlation between variables, the aim was to correlate calligraphic education with many variables. The data was collected with an electronic questionnaire and a calligraphic test.Results:The sample consisted of 120 subjects between the ages of 18-30. No statistically significant correlation was found between legibility and years of calligraphic education, gender, age, dominant hand, GPA and preferred font. The only significant correlation was found between legibility and the use of one standard grips of the pen and an alternative (p=0.01). Discussion:77.5% of the subjects had a high average in the calligraphic test and no correlation was found between legibility and length of calligraphic education in childhood, gender, age, dominant hand, writing tool, font and GPA. However, a significant association between legibility and the use of the standard grips was found, in comparison with people that do not use one of those grips (p=0.01).Conclusions:Handwriting legibility is a multi-factor influenced skill, and calligraphic education during childhood is decisive to develop it properly. Nevertheless, the study showed no association between the length of the education and legibility, and a correlation was found between the use of an alternative pen grip and a worse result in the calligraphic test.

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En la búsqueda de marcadores serológicos de daño miocárdico activo en pacientes con infección crónica chagásica, se demuestra que el suero de aquéllos que presentan cardiomiopatía manifiesta reconoce las regiones C-terminales de las proteínas ribosomales P del Trypanosoma cruzi. En este estudio se demuestra que la infección no induce la respuesta autoinmune anti P que caracteriza a los pacientes con lupus, sino origina una respuesta anti P característica, expresada por los niveles elevados de anticuerpos contra las regiones polianiónicas presentes en dichas proteínas. Los anticuerpos anti P chagásicos son responsables del efecto estimulante de la IgG de los pacientes con cardiomiopatía chagásica crónica sobre los receptores ß1 adrenérgicos cardíacos, razón por la cual podrían participar en la patogenia de algunas manifestaciones de la cardiomiopatía chagásica crónica, en particular en las arritmias ventriculares. Los resultados de este trabajo indican que la actividad funcional (y patogenicidad) sobre el tejido miocárdico de los anticuerpos generados contra antígenos intracelulares del parásito resultan de su capacidad para reaccionar en forma cruzada con proteínas de la membrana celular cardíaca. Esta demostración obliga a replantear la utilización de quimioterápicos tripanomicidas eficientes y tolerados a largo plazo para anular la producción de esos anticuerpos

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En la búsqueda de marcadores serológicos de daño miocárdico activo en pacientes con infección crónica chagásica, se demuestra que el suero de aquéllos que presentan cardiomiopatía manifiesta reconoce las regiones C-terminales de las proteínas ribosomales P del Trypanosoma cruzi. En este estudio se demuestra que la infección no induce la respuesta autoinmune anti P que caracteriza a los pacientes con lupus, sino origina una respuesta anti P característica, expresada por los niveles elevados de anticuerpos contra las regiones polianiónicas presentes en dichas proteínas. Los anticuerpos anti P chagásicos son responsables del efecto estimulante de la IgG de los pacientes con cardiomiopatía chagásica crónica sobre los receptores ß1 adrenérgicos cardíacos, razón por la cual podrían participar en la patogenia de algunas manifestaciones de la cardiomiopatía chagásica crónica, en particular en las arritmias ventriculares. Los resultados de este trabajo indican que la actividad funcional (y patogenicidad) sobre el tejido miocárdico de los anticuerpos generados contra antígenos intracelulares del parásito resultan de su capacidad para reaccionar en forma cruzada con proteínas de la membrana celular cardíaca. Esta demostración obliga a replantear la utilización de quimioterápicos tripanomicidas eficientes y tolerados a largo plazo para anular la producción de esos anticuerpos (AU)

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