Noise analysis in direct detection and coherent detection phase-sensitive optical time-domain reflectometry systems.

This study compares noise and signal-to-noise ratio (SNR) in direct detection and coherent detection fiber-based distributed acoustic sensing (DAS) systems. Both detection schemes employ the dynamic analysis of Rayleigh-backscattered light in phase-sensitive optical time-domain reflectometry (ΦOTDR) systems. Through theoretical and experimental analysis, it is determined that for photodetection filters with a sufficiently narrow bandwidth, the SNR performance of both detection schemes is comparable. However, for filters with poor selectivity, coherent detection was found to exhibit superior performance. These findings provide crucial guidelines for the design of high-performance time-domain DAS systems.

Efforts for detection of aortic aneurysms and human resources training for the optimization of their treatment.

OBJECTIVE: To review admissions, interventions and in-hospital mortality associated to Abdominal Aortic Aneurysms (AAA), and to analyze the impact of the introduction of a training program and imaging screening at our institution. METHODS: Retrospective study where hospitalizations, procedures and mortality secondary to AAA were recorded. The national databases (ND) from the Secretariat of Health were utilized from 2010 to 2020. In-hospital lethality was calculated and compared with the experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). The statistical analysis was completed with the STATA version 17. RESULTS: According to the ND, 899 (91%) hospital admissions secondary to AAA occurred, while in the INCMNSZ 85 (9%). Most of them belonged to the male gender (68%); 811 (82%) patients underwent open surgical repair, and 173 (18%) to an endovascular exclusion (EVAR), the latter approach was significantly more frequently performed at our institution (p = 0.007). The 30-day hospital mortality was 22.5%; in the ND was 23.9 vs. a 16.4% in the INCMNSZ without significant difference (p = 0.1). CONCLUSIONS: AAA remain unrecognized in our country. The introduction of University programs and imaging screening might impact in the early detection, and to reduce the morbidity and mortality associated to emergency procedures.

OBJETIVO: Revisar los ingresos, procedimientos y defunciones intrahospitalarias asociadas a aneurismas aórticos abdominales (AAA) y analizar el impacto de la introducción de programas de formación de recursos humanos y tamizaje ultrasonográfico. MÉTODOS: Estudio retrospectivo, se analizaron las bases de datos nacionales obtenidas del portal datos abiertos de la Dirección General de Información en Salud (DGIS) del año 2010 al 2020. Se calculó la letalidad intrahospitalaria anual y comparamos la experiencia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ). El análisis estadístico se realizó en el programa STATA versión 17. RESULTADOS: De acuerdo con la base nacional (BN), se registraron 899 (91%) ingresos, mientras que en el INCMNSZ 85 (9%). La mayoría pertenecía al sexo masculino (68%), un total de 811 (82%) pacientes fueron sometidos a cirugía abierta, mientras que 173 (18%) a terapia endovascular (EVAR), siendo este abordaje más frecuente en nuestra institución (p = 0.007). La mortalidad intrahospitalaria fue del 22.5%, en la BN fue del 23.9%, mientras que en el INCMNSZ fue del 16.4%, sin que encontráramos diferencia significativa (p = 0.1). CONCLUSIONES: Los AAA continúan siendo poco reconocidos en nuestro país. La introducción de programas universitarios de especialidad y el tamizaje podría impactar en la reducción de la morbimortalidad.

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica.

ANTECEDENTES: Las enfermedades cardiovasculares son la principal causa mundial de mortalidad y México no es la excepción. Los datos epidemiológicos obtenidos en 1990 mostraron que los padecimientos cardiovasculares representaron el 19.8% de todas las causas de muerte en nuestro país; esta cifra se incrementó de manera significativa a un 25.5% para 2015. Diversas encuestas nacionales sugieren que más del 60% de la población adulta tiene al menos un factor de riesgo para padecer enfermedades cardiovasculares (obesidad o sobrepeso, hipertensión, tabaquismo, diabetes, dislipidemias). Por otro lado, datos de la Organización Panamericana de la Salud han relacionado el proceso de aterosclerosis como la primer causa de muerte prematura, reduciendo la expectativa de vida de manera sensible, lo que tiene una enorme repercusión social. OBJETIVO: Este documento constituye la guía de práctica clínica (GPC) elaborada por iniciativa de la Sociedad Mexicana de Cardiología en colaboración con la Sociedad Mexicana de Nutrición y Endocrinología, A.C., Asociación Nacional de Cardiólogos de México, A.C., Asociación Mexicana para la Prevención de la Aterosclerosis y sus Complicaciones, A.C., Comité Normativo Nacional de Medicina General, A.C., Colegio Nacional de Medicina Geriátrica, A.C., Colegio de Medicina Interna de México, A.C., Sociedad Mexicana de Angiología y Cirugía Vascular y Endovenosa, A.C., Instituto Mexicano de Investigaciones Nefrológicas, A.C. y la Academia Mexicana de Neurología, A.C.; con el apoyo metodológico de la Agencia Iberoamericana de Desarrollo y Evaluación de Tecnologías en Salud, con la finalidad de establecer recomendaciones basadas en la mejor evidencia disponible y consensuadas por un grupo interdisciplinario de expertos. El objetivo de este documento es el de brindar recomendaciones basadas en evidencia para ayudar a los tomadores de decisión en el diagnóstico y tratamiento de las dislipidemias en nuestro país. MATERIAL Y MÉTODOS: Este documento cumple con estándares internacionales de calidad, como los descritos por el Instituto de Medicina de EE.UU., el Instituto de Excelencia Clínica de Gran Bretaña, la Red Colegiada para el Desarrollo de Guías de Escocia y la Red Internacional de Guías de Práctica Clínica. Se integró un grupo multidisciplinario de expertos clínicos y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Se consensuó un documento de alcances, se establecieron las preguntas clínicas relevantes, se identificó de manera exhaustiva la mejor evidencia disponible evaluada críticamente en revisiones sistemáticas de la literatura y se desarrollaron las recomendaciones clínicas. Se utilizó la metodología de Panel Delphi modificado para lograr un nivel de consenso adecuado en cada una de las recomendaciones contenidas en esta GPC. RESULTADOS: Se consensuaron 23 preguntas clínicas que dieron origen a sus respectivas recomendaciones clínicas. CONCLUSIONES: Esperamos que este documento contribuya a la mejor toma de decisiones clínicas y se convierta en un punto de referencia para los clínicos y pacientes en el manejo de las dislipidemias y esto contribuya a disminuir la morbilidad y mortalidad derivada de los eventos cardiovasculares ateroscleróticos en nuestro país. BACKGROUND: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. OBJECTIVE: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. MATERIAL AND METHODS: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. RESULTS: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. CONCLUSIONS: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica / Mexican clinical practice guideline for the diagnosis and treatment of dyslipidemias and atherosclerotic cardiovascular disease

resumen está disponible en el texto completo

Abstract Background: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. Objective: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. Material and methods: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. Results: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. Conclusions: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

Acroangiodermatitis of the hand secondary to a dysfunctional arteriovenous fistula.

Acroangiodermatitis (AAD) is often seen in association with various vascular anomalies such as venous insufficiency, vascular syndromes, and conditions associated with thrombosis. This is the first case reported in the literature associated with arteriovenous fistula stenosis in a patient with chronic kidney disease on hemodialysis. This case is being described for its rarity and to familiarize the clinicians with this unusual complication, especially, to prevent them from thinking of this condition as an infectious complication. It is essential to recognize the uniqueness of the pathophysiology of this disease and to do a clear distinction with that of a venous ulcer. With this work we also aim to help health practitioners with proper management of the condition. As we've seen, surgical treatment in appropriately selected cases corrects the reflux of the venous system and successfully improves the appearance of the verrucous lesion. Our patient was successfully treated by correcting the arteriovenous fistula stenosis with near-complete subsidence of the verrucous lesion within days of the procedure. Acroangiodermatitis management must be conducted with a multidisciplinary approach (dermatology, vascular surgery, and internal medicine). It is essential the comprehensive management of these patients, to ensure prompt recovery and avoid chronic effects, as well as to guarantee the quality of life in the future.

Humoral Immune Pressure Selects for HIV-1 CXC-chemokine Receptor 4-using Variants.

Although both C-C chemokine receptor 5 (CCR5)- and CXC chemokine receptor 4 (CXCR4)-using HIV-1 strains cause AIDS, the emergence of CXCR4-utilizing variants is associated with an accelerated decline in CD4+ T cells. It remains uncertain if CXCR4-using viruses hasten disease or if these variants only emerge after profound immunological damage. We show that exclusively CXCR4- as compared to cocirculating CCR5-utilizing variants are less sensitive to neutralization by both contemporaneous autologous plasma and plasma pools from individuals that harbor only CCR5-using HIV-1. The CXCR4-utilizing variants, however, do not have a global antigenic change because they remain equivalently susceptible to antibodies that do not target coreceptor binding domains. Studies with envelope V3 loop directed antibodies and chimeric envelopes suggest that the neutralization susceptibility differences are potentially influenced by the V3 loop. In vitro passage of a neutralization sensitive CCR5-using virus in the presence of autologous plasma and activated CD4+ T cells led to the emergence of a CXCR4-utilizing virus in 1 of 3 cases. These results suggest that in some but not necessarily all HIV-1 infected individuals humoral immune pressure against the autologous virus selects for CXCR4-using variants, which potentially accelerates disease progression. Our observations have implications for using antibodies for HIV-1 immune therapy.

Elevated Levels of Microbial Translocation Markers and CCL2 Among Older HIV-1-Infected Men.

The aging of the human immunodeficiency virus type 1 (HIV-1)-infected population obligates a focus on the interaction between aging, comorbid conditions, and HIV-1. We recruited a cohort of HIV-1-infected men aged ≤ 35 years or ≥ 50 years who were receiving fully suppressive antiretroviral therapy (ART). We analyzed plasma markers of inflammation; T-cell activation, exhaustion, proliferation; and innate cellular subsets and functional capacity. Levels of lipopolysaccharide and the plasma marker of chemokine (C-C motif) ligand 2 were significantly elevated in older HIV-infected men despite comparable cellular phenotypes. Compared with similarly age-stratified uninfected subjects, older HIV-1-infected adults were also more frequently in the upper quartile of soluble CD14 expression.

Plasmodium falciparum Infection Does Not Affect Human Immunodeficiency Virus Viral Load in Coinfected Rwandan Adults.

BACKGROUND: Plasmodium falciparum infection has been reported to increase human immunodeficiency virus (HIV) viral load (VL), which can facilitate HIV transmission. We prospectively studied the impact of mild P falciparum coinfection on HIV VL in Rwanda. METHODS: We measured plasma HIV VL at presentation with malaria infection and weekly for 4 weeks after artemether-lumefantrine treatment in Rwandan adults infected with HIV with P falciparum malaria. Regression analyses were used to examine associations between malaria infection and HIV VL changes. Samples with detectable virus underwent genotypic drug-resistance testing. RESULTS: We enrolled 28 HIV-malaria coinfected patients and observed 27 of them for 5 weeks. Three patients (11%) were newly diagnosed with HIV. Acute P falciparum infection had no significant effect on HIV VL slope over 28 days of follow-up. Ten patients with VL <40 copies/mL at enrollment maintained viral suppression throughout. Seventeen patients had a detectable VL at enrollment including 9 (53%) who reported 100% adherence to ARVs; 3 of these had detectable genotypic drug resistance. CONCLUSIONS: Unlike studies from highly malaria-endemic areas, we did not identify an effect of P falciparum infection on HIV VL; therefore, malaria is not likely to increase HIV-transmission risk in our setting. However, routine HIV testing should be offered to adults presenting with acute malaria in Rwanda. Most importantly, we identified a large percentage of patients with detectable HIV VL despite antiretroviral (ARV) therapy. Some of these patients had HIV genotypic drug resistance. Larger studies are needed to define the prevalence and factors associated with detectable HIV VL in patients prescribed ARVs in Rwanda.

Env sequence determinants in CXCR4-using human immunodeficiency virus type-1 subtype C.

HIV-1 subtype C (HIV-1C) CXCR4-using virus is isolated infrequently and is poorly characterized. Understanding HIV-1C env characteristics has implications for the clinical use of antiretrovirals that target viral entry. A total of 209 env clones derived from 10 samples with mixed CCR5-(R5), CXCR4-using (X4) or dual-tropic HIV-1C were phenotyped for coreceptor usage. Intra-patient X4 and R5 variants generally formed distinct monophyletic phylogenetic clusters. X4 compared to R5 envs had significantly greater amino acid variability and insertions, higher net positive charge, fewer glycosylation sites and increased basic amino acid substitutions in the GPGQ crown. Basic amino acid substitution and/or insertion prior to the crown are highly sensitive characteristics for predicting X4 viruses. Chimeric env functional studies suggest that the V3 loop is necessary but often not sufficient to impart CXCR4 utilization. Our studies provide insights into the unique genotypic characteristics of X4 variants in HIV-1C.

[Presentation of gastric cancer as a soft tissue tumor]. / Presentación de cáncer gástrico como tumor de tejidos blandos.

Soft tissue metastasis of gastric cancer is extremely rare. We report an 82 year old male, who was being evaluated for benign prostate hyperplasia and incidentally a soft tissue mass in the right buttock was discovered. Differential diagnosis included neurofibroma vs. soft tissue sarcoma. Patient underwent surgical resection and pathologic analysis reported adenocarcinoma with ring cell differentiation. Postoperative work-up included a CT scan of abdomen and pelvis and upper gastrointestinal endoscopy. An ulcer in the gastric antrum was discovered and biopsied. Pathology reported the same tumor as the soft tissue mass. PET scan demonstrated extensive metastatic disease. We reviewed the literature looking for other cases of soft tissue metastasis of gastric cancer.

Health-related quality of life and depression in patients with chronic hepatitis C.

BACKGROUND: Hepatitis C is a major cause of liver disease worldwide. It has been associated with decreased health-related quality of life (HRQL) and psychiatric symptoms. Our aim was to assess HRQL, depression, and illness understanding in patients with chronic hepatitis C without previous interferon therapy. METHODS: Consecutive patients attending a referral center were enrolled. HRQL was measured using SF-36 questionnaire, depression with Zung self-rating depression scale, and illness understanding with self-applied knowledge test. RESULTS: Of 157 patients enrolled, 112 were female (71%) and 45 male (29%). Ninety-seven patients (61.8%) had cirrhosis. HRQL was significantly decreased in chronic hepatitis C patients compared to historical normal controls in all eight domains of the SF-36 (p < 0.001). In hepatitis C cirrhotic patients, HRQL was significantly lower among Child-Pugh class B and C subjects in domains reflecting physical health (p <0.05). Ninety-two patients (58.6%) had depression that resulted in lower HRQL when compared to nondepressed patients (p <0.05). One hundred fourteen patients (72.6%) had poor illness understanding of hepatitis C. These subjects had significantly lower HRQL scores in six of eight SF-36 domains when compared to patients with better understanding of the disease (p <0.05). CONCLUSIONS: Chronic hepatitis C patients attending a tertiary-referral center had significant decrease in HRQL associated with depression (58.6%) and poor illness understanding (72.6%). Educational programs and their impact on HRQL need to be addressed in detail, particularly for the pre-treatment scenario.

Tratamiento no quirúrgico del aneurisma disecante de la aorta torácica mediante colocación de implante endovascular: informa de un caso / Non-surgical treatment for a dissecting aneurism of thoracic aorta by endovascular tube endortesis: case report

Se presenta el primer caso reportado en la República Mexicana, de aneurisma de la aorta tratado mediante la aplicación de un tubo protésico endovascular. Se trata de un paciente del sexo masculino de 77 años de edad, militar retirado, con dilatación aneurismática de la aorta torácica cuya dimensión era de 115 mm de longitud, la cual se determinó mediante angiografía y tomografía computada. Su sintomatología se manifestaba por dolor y sensación de muerte inminente. El paciente se trató mediante la colocación de una prótesis endovascular de 130 mm fabricada en una aleación de níquel y titanio (nitinol) cuya biocompatibilidd ya ha sido comprobada. La correcta colocación del implante se verificó por medio de arteriografía a través de la arteria subclavia derecha. Al momento de la presente publicación y después de un periodo de observación de 7 meses, el paciente no ha tenido complicaciones inherentes a la prótesis, lo cual nos permite continuar utilizándola en lugar de la cirugía abierta, que tiene una mortalidad superior al 50 por ciento.

Incidencia y frecuencia del pie diabético en un período de cinco años: 1994-1998 / Incidence and frequency of diabetic foot in a five-year period: 1994-1998

Se registró un total de 3,316 casos nuevos de diabetes mellitus de enero de 1994 a diciembre de 1998, de los cuales se seleccionaron al azar 500 expedientes clínicos, a razón de 100 por año. Se encontró que 228 pacientes (45.6 por ciento) de los 500 mencionados, tenían pie diabético, lo cual nos permite concluir que 45.6 por ciento (casi la mitad) de los casos, se encuentra epidemiológicamente en riesgo de sufrir pie diabético. Se propone que debe establecerse un programa educativo y preventivo para los pacientes diabéticos que les permita evitar esta severa complicación así como recibir tratamiento oportuno.

Aplicación de la cirugía torácica de mínima invasión: experiencia e informe preliminar / Application of the minimally invasive thoracic surgery: experience and preliminary report

El presente trabajo es el resultado preliminar de la aplicación de cirugía torácica de mínima invasión en el Hospital Central Militar de la Ciudad de México. Este estudio incluyó a 38 sujetos sometidos a toracoscopia o cirugía torácica de mínima invasión durante el periodo comprendido de septiembre de 1998 a septiembre de 1999. Hubo predominio de pacientes del sexo femenino (22 casos), la edad promedio fue de 46.7 años (rango de 16 a 78 años). El 55 por ciento de los procedimientos se efectuaron con fines diagnósticos, el 32 por ciento como modalidad terapéutica y el 13 por ciento restante con fines mixtos (diagnósticos y terapéuticos). La toma de biopsia fue la indicación más frecuente: pulmonar en 35 por ciento, pleural en 10 por ciento y mediastinal en 10 por ciento. La morbilidad asociada al procedimiento fue del 5 por ciento, la mortalidad 0 por ciento y la cifra de conversión de la técnica del 2 por ciento. El tiempo promedio de cirugía fue de 1.6 horas (desviación estándar de + 0.74). La distribución por tipo de patología fue la siguiente: pleural 39 por ciento, pulmonar 36 por ciento, mediastinal 13 por ciento y combinada 12 por ciento. El 73.6 por ciento fueron padecimientos benignos y el 26.4 por ciento malignos. Sólo hubo un caso de cirugía videoasistida. Consideramos que la técnica es reproducible y factible en nuestro medio. Los resultados obtenidos son similares a los documentados en otras series. Con base en ellos se demuestra que la toracoscopia es un procedimiento bien tolerado en cuanto al dolor posoperatorio, ideal para nódulos pulmonares solitarios, lo mismo que para drenajes de colecciones pleurales crónicas; se demuestra también el gran impacto clínico que posee esta técnica y la factibilidad de realizar procedimientos avanzados de tipo terapéutico, como son las resecciones de masas mediastinales.

Cultivo en las úlceras del pie diabético infectado / Cultures from ulcerations in infected diabetic foot

Se incluyeron pacientes voluntarios, diabéticos, con úlceras clínicamente infectadas en extremidades inferiores. Tomándose cultivo de secreción. Se estudiaron 47 pacientes, entre 42 y 85 años de edad, de 1 a 30 años de diagnóstico de diabetes mellitus. En 30 cultivos (63.8 por ciento) el desarrollo fue positivo, en 4 (8.5 por ciento) no se obtuvo desarrollo, y a 13 (27.6 por ciento) no se tomó cultivo. De los cultivos positivos, en 20 (66.6 por ciento) se desarrolló un solo microorganismo, en 10 (33.3 por ciento) se desarrollaron dos microorganismos. Se aislaron 17 microorganismos diferentes. El desarrollo de úlceras en los pies y en las extremidades inferiores es un problema especial en el diabético que se manifiesta clínicamente por daño neurológico sensitivo-motor-autónomo. Las infecciones son comunes, a menudo con múltiples microorganismos. Los gérmenes encontrados en los cultivos de las úlceras del pie diabético es de origen polimicrobiano, no predomina ningún tipo de microorganismo. No todas las úlceras se encuentran colonizadas, la infección no es el factor más importante en la falta de cicatrización de las úlceras, se deben considerar los problemas vasculares.

Angiomiolipoma de hígado no asociado a esclerosis tuberosa / Liver angiomyolipoma non associated to tuberous sclerosis

El angiomiolipoma es un tumor benigno del hígado poco frecuente. Se presenta el caso de una paciente de 32 años de edad, a quien se le realizó ultrasonido abdominal por sospecha de embarazo, detectándose masa hiperecoica en el lóbulo izquierdo del hígado, misma que se corroboró por tomografía. La biopsia percutánea reportó neoplasia maligna compatible con liposarcoma, por lo que se decidió realizar laparotomía exploradora, efectuando resección hepática, que evolucionó sin complicaciones. El informe anatomopatológico fue de angiomiolipoma de hígado. Este caso demuestra la dificultad para realizar el diangóstico preoperatorio de lesiones grasas en hígado, por lo que se revisó la literatura y se discutió el diagnóstico, así como el tratamiento de estas lesiones