A systematic review and meta-analysis of serum lipid concentrations in people with Down syndrome.

BACKGROUND: Down syndrome (DS) is the most prevalent chromosomal disorder, being the leading cause of intellectual disability. The increased life expectancy of individuals with DS has led to a shift in the incidence of non-communicable chronic diseases, resulting in new concerns, particularly cardiovascular disease (CVD) and Alzheimer's disease. This study aimed to analyse the blood lipid profile of a large DS cohort to establish a baseline for evaluating health risk parameters. METHODS: A comprehensive literature search was conducted on PubMed and Virtual Health Library databases to identify original articles published before July 2022. Selected studies were included in the meta-analysis. RESULTS: Fifteen studies reporting serum lipid levels in individuals with DS were incorporated into the analysis. The meta-analysis used the means and standard deviations extracted from the selected studies. The analysis encompassed 671 participants in the DS group and 898 euploid controls. The results indicated significant differences in total cholesterol [C] (mean difference [MD]: -3.34; CI: 95%: -4.94 to -1.73; P < 0.0001), HDL-C (MD: -3.39; CI: 95%: -6.72 to -0.06; P = 0.05) and triglycerides (MD: 21.48; CI: 95%: 9.32 to 33.65; P = 0.0005) levels between individuals with DS and their control counterparts. CONCLUSIONS: Individuals with DS have less favourable blood lipid concentrations than their controls, particularly HDL-C, triglycerides, and total-C, even when grouped by age. These findings underscore the importance of closer monitoring of lipid profiles in people with DS and the necessity for specific cut-offs for this population, considering the risk for ischemic heart and Alzheimer's diseases.

Incidencia del espectro de acretismo placentario en la unidad de cuidados intensivos obstétricos del Hospital de la Mujer de Sinaloa / Incidence of the placental accretism spectrum in the obstetric intensive care unit of the Hospital de la Mujer of Sinaloa

Resumen OBJETIVO: Determinar la incidencia del espectro del acretismo placentario en pacientes ingresadas a la unidad de cuidados intensivos obstétricos del Hospital de la Mujer, Culiacán, Sinaloa. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo fundamentado en el análisis de la base de datos del Hospital de la Mujer de pacientes internadas entre los años 2017 a 2020 con diagnóstico de espectro de placenta acreta, referidas o diagnosticadas en la institución e intervenidas para histerectomía por la complicación estudiada. RESULTADOS: Se analizaron 22 pacientes con diagnóstico de acretismo placentario que dieron una incidencia de 0.09%; de éstas, a 1 se le indicó cesárea; 19 de las 22 pacientes tenían antecedente de cicatriz uterina previa, todas con placenta previa. El promedio de edad fue de 30.86 ± 4 años. La cesárea se practicó, en promedio, a las 34 semanas de embarazo con dos técnicas quirúrgicas. El sangrado promedio estimado fue de 1.947 mL. Las complicaciones transoperatorias fueron las lesiones: ureteral (n = 2) y vesical (n = 1). La principal complicación posoperatoria fue la fístula vesicouterina (n = 1). El promedio de estancia fue de 2 días en 16 de las 22 pacientes y de 7 días en las 6 restantes. CONCLUSIONES: Lo importante del acretismo placentario es el diagnóstico oportuno que permita derivar a las pacientes a centros hospitalarios que cuenten con especialistas experimentados en la atención de estos casos.

Abstract OBJECTIVE: To determine the incidence of placental accretism spectrum in pregnant women admitted to the obstetric intensive care unit of the Hospital de la Mujer, Culiacán, Sinaloa. MATERIALS AND METHODS: Retrospective, cross-sectional, descriptive study based on the analysis of the database of the Hospital de la Mujer of patients admitted between 2017 and 2020 with a diagnosis of placenta accreta spectrum, referred or diagnosed at the institution and underwent hysterectomy for the complication studied. RESULTS: Twenty-two patients with a diagnosis of placenta accreta were analysed, giving a prevalence of 0.09%; of these, caesarean section was indicated in 0.2%. 19 of the 22 patients had a history of previous uterine scarring, all with placenta praevia. Mean age was 30.86 ± 4 years. Caesarean section was performed at a mean gestational age of 34 weeks using two surgical techniques. The mean estimated blood loss was 1,947 mL. The most common operative complications were ureteral (n = 2) and bladder (n = 1) injuries. The most common postoperative complication was vesico-uterine fistula (n = 1). The mean length of stay was 2 days in 16 of the 22 patients and 7 days in the remaining 6 patients. CONCLUSIONS: The most important aspect of placenta accreta is early diagnosis, which allows referral to hospital centres with specialists experienced in the management of these cases.

Unusual Manifestation of Membranous Dysmenorrhea: Case Report.

BACKGROUND In the 18th century, Morgagni described membranous dysmenorrhea as the sudden and complete detachment of the decidua during menstruation. This causes intense and painful contractions of the myometrium, aggravated by the expulsion of tissues produced by the decidualization of the endometrium. It is a rare pathology associated with oral contraceptives, ectopic pregnancies, abortions, and natural cycles, with consequent thickening and endometrial decidualization with molding of the tissue of the uterine cavity of membranous appearance. The definitive diagnosis is made by histopathological examination. CASE REPORT A 43-year-old female patient came for urgent consultation for an acute picture of severe pain in the lower abdomen, radiating to the genital area with transvaginal bleeding of 2 h of evolution. She had no significant past medical history. A transvaginal ultrasound was performed and showed an unchanged endometrial cavity. A vaginal examination revealed a foreign body of soft consistency; therefore, a speculum examination was performed, which showed tissue of endometrial origin located in the cervical canal of a reddish spongy texture. The tissue was removed, thus improving the symptomatology, and was sent to the pathological anatomy service for histopathologic diagnosis. CONCLUSIONS Membranous dysmenorrhea is a rare gynecologic disorder with only a few documented cases. According to other case reports, our patient's case, at age 43 years, was an atypical presentation. The clinical features and association with this pathology allowed the diagnosis and its confirmation by histopathological examination.

Quemadura genital por producto químico: reporte de caso / Genital burn by chemical product: case report

Resumen ANTECEDENTES: Las quemaduras son la forma más severa de estrés que el cuerpo puede sufrir; pueden generarse por diferentes agentes térmicos y químicos. CASO CLÍNICO: Paciente de 25 años, con dolor intenso en la región genital de 12 horas de evolución, secundario a la introducción en la vagina de una piedra de alumbre. Se le hicieron múltiples irrigaciones con solución salina al 0.9% sin obtener el resto de la piedra de alumbre. Se le aplicó sulfadiazina de plata en la cavidad vaginal cada 12 horas, óvulos vaginales de ketanserina, miconazol y metronidazol cada 8 horas, ketorolaco por vía oral 10 mg cada 8 horas. Durante su estancia hospitalaria tuvo buena evolución, con disminución de la inflamación en la zona genital, epitelización adecuada. Al tercer día se dio de alta del hospital con cita para valoración a los siete días. CONCLUSIÓN: El tratamiento de las quemaduras en el área genital, por agentes químicos, tiene como piedra angular la identificación del agente causante de la lesión que permita actuar de forma inmediata y evitar las secuelas físicas, sexuales y psicológicas mediante el lavado exhaustivo con solución o agua estéril para remover el agente causal y disminuir que continúe actuando en el sitio afectado.

Abstract BACKGROUND: Burns are the most severe form of stress that the body can suffer; they can be caused by various thermal and chemical agents. CLINICAL CASE: A 25-year-old female patient presented with severe genital pain of 12 hours' duration, secondary to the introduction of an alum stone into the vagina. She underwent several irrigations with 0.9% saline without obtaining the rest of the alum stone. She was given vaginal silver sulfadiazine every 12 hours, vaginal ketanserin, miconazole and metronidazole every 8 hours and oral ketorolac 10 mg every 8 hours. During her stay in hospital, she progressed well, with a decrease in genital inflammation and adequate epithelialisation. She was discharged on the third day with an appointment for a seven-day follow-up. CONCLUSION: The management of genital burns caused by chemical agents is based on the identification of the agent causing the lesion, which allows immediate action and prevents physical, sexual and psychological sequelae by thorough washing with sterile solution or water to remove the causative agent and reduce its continued action in the affected area.

Síndrome de Karsch-Neugebauer: Reporte de caso / Karsch-Neugebauer Syndrome: Case Report

Resumen ANTECEDENTE: El síndrome de Karsch-Neugebauer o ectrodactilia del pie o pie hendido, es una enfermedad congénita sumamente rara, caracterizada por aplasia-hipoplasia de las falanges y metatarsianos del pie. Cuando aparece de forma aislada se debe a una forma autosómica dominante de expresión variable, aunque también puede ser de carácter autosómico recesivo. CASO CLÍNICO: Paciente de 31 años, sin antecedentes heredofamiliares de importancia, con IMC de 25.95 kg/m2, signos vitales en parámetros normales. Con dos embarazos, cesárea previa sin complicaciones. El ultrasonido estructural 20 a 23.6 semanas del embarazo actual reportó un feto vivo, de sexo femenino y 22.2 semanas de gestación, con múltiples alteraciones anatómicas: arteria umbilical única, hueso nasal hipoplásico, micrognatia en ángulo facial y miembros inferiores con ectrodactilia bilateral. CONCLUSIONES: Los estudios ultrasonográficos, en especial el de las semanas 20 a 23.6 de gestación son decisivos para la detección de malformaciones congénitas. Sin embargo, a partir de las 11 a 13.6 semanas es posible establecer diagnósticos estructurales de manera temprana. Muchas alteraciones y síndromes, como el de Karsch-Neugebauer, suelen ser incapacitantes y al combinarse con otras anomalías pueden llegar a ser incompatibles con la vida. Se requieren diagnósticos tempranos para la toma de decisiones de manera consensuada con la familia y el equipo multidisciplinario.

Abstract BACKGROUND: Karsch-Neugebauer syndrome, or ectrodactyly of the foot or cleft foot, is an extremely rare congenital disorder characterized by aplasia-hypoplasia of the phalanges and metatarsals of the foot. When it occurs in isolation, it is due to an autosomal dominant form of variable expression, although it can also be autosomal recessive. CLINICAL CASE: 31-year-old female patient with no significant hereditary family history, BMI of 25.95 kg/m2, vital signs within normal parameters. With two pregnancies, previous caesarean section without complications. Structural ultrasound 20 to 23.6 weeks of the current pregnancy showed a live fetus, female sex and 22.2 weeks gestation, with multiple anatomical anomalies: single umbilical artery, hypoplastic nasal bone, micrognathia in the facial angle and lower limbs with bilateral ectrodactyly. CONCLUSIONS: Ultrasound examinations, especially at 20 to 23.6 weeks of gestation, are crucial for the detection of congenital malformations. However, from 11 to 13.6 weeks it is possible to make early structural diagnoses. Many disorders and syndromes, such as Karsch-Neugebauer syndrome, are often disabling and, in combination with other anomalies, can become incompatible with life. Early diagnosis is necessary to make informed decisions with the family and the multidisciplinary team.

Manejo insulínico de las hiperglucemias en el paciente hospitalizado / INSULIN MANAGEMENT OF HYPERGLYCEMIA IN THE HOSPITALIZED PATIENT

La hiperglucemia es una alteración de las cifras de glucosa reportada frecuentemente por el personal de enfermería en los pacientes hospitalizados que representa un factor de riesgo para diferentes entidades patológicas, como el infarto de miocardio, infarto cerebral, sepsis, infecciones nosocomiales, insuficiencia cardíaca y renal, además de ser una complicación de difícil manejo por la falta de protocolos apropiados. Para ello, existen diferentes tipos de insulina de los cuales debe conocerse su farmacocinética y posología para el tratamiento de las hiperglucemias intrahospitalarias. El esquema que se emplea con mayor frecuencia es el de insulina rápida, utilizando la regla de 2UI de insulina rápida por cada 50 mg/dL de glucosa por arriba de 150 mg/dL.

Price and Availability of Sugar-Free, Sugar-Reduced and Low Glycemic Index Cereal Products in Northwestern México.

Sugar-free (SF), sugar-reduced (SR), or low-glycemic-index (low GI) cereal products could be helpful for the dietary treatment of disorders related to glucose homeostasis. However, access and economic aspects are barriers that could hamper their consumption. Thus, the availability and price of such cereal products were evaluated in Northwestern México. The products were categorized in 10 groups. The data were collected in five cities by store visitation (from November 2015 to April 2016). The availability in specialized stores and supermarkets was expressed as availability rates based on the total number of products. The price of the SF, SR, and low GI products were compared with their conventional counterparts. Availability rates were higher in supermarkets than in specialized stores by product numbers (14.29% versus 3.76%, respectively; p < 0.001) and by product categories (53.57% versus 26.92%, respectively; p < 0.001). Five categories of products labeled as SF, SR, and low GI (oats, cookies and crackers, flours, snacks, and tostadas/totopos) had higher prices than their conventional counterparts (p < 0.05). In conclusion, in Northwestern Mexico, the availability of SF, SR, and low GI cereal-based foods is relatively low, and these foods are more expensive than their conventional counterparts.

Prevalence of Self-Reported Gluten Sensitivity and Adherence to a Gluten-Free Diet in Argentinian Adult Population.

BACKGROUND: Previous studies suggest that the prevalence of wheat/gluten sensitivity and adherence to a gluten-free diet (GFD) are high in Latin population despite a poor diagnosis of celiac disease. However, these prevalence rates still remain unknown in most Latin American countries. METHODS: A cross-sectional survey study was conducted in Santa Fe, Argentina. RESULTS: The estimated self-reported prevalence rates were (95% Confidence Interval [CI]): self-reported gluten sensitivity (SR-GS) 7.61% (6.2-9.2), SR-GS currently following a GFD 1.82% (1.2-2.7), celiac disease 0.58% (0.3-1.2), wheat allergy 0.33% (0.12-0.84), self-reported non-celiac gluten sensitivity (SR-NCGS) 6.28% (5.1-7.8), SR-NCGS currently following a GFD 0.91% (0.5-1.6), and adherence to a GFD 6.37% (5.1-7.9). SR-GS was more common in women (6.0%; p < 0.001) and associated with irritable bowel syndrome (p < 0.001). Among the GFD followers, 71.4% were doing it for reasons other than health-related benefits and 50.6% without medical/dietitian advice. In the non-SR-GS group, the main motivations for following a GFD were weight control and the perception that a GFD is healthier. CONCLUSION: In Argentina, gluten sensitivity is commonly reported and it seems that physicians/gastroenterologists are aware of celiac disease diagnosis. Trustable information about the benefits and potential consequences of following a GFD should be given to the general population.

Self-Reported Prevalence of Gluten-Related Disorders and Adherence to Gluten-Free Diet in Colombian Adult Population.

Background. Celiac disease seems to be rare in Colombians, but there are currently no data about the prevalence rates of symptomatic adverse reactions to gluten or adherence to gluten-free diet (GFD) in this population. Aim. to evaluate the self-reported prevalence rates of adverse reactions to gluten, adherence to GFD, and gluten-related disorders at population level in Colombia. Methods. A self-administered questionnaire-based cross-sectional study was conducted in a population from Northwest Colombia. Results. The estimated prevalence rates were (95% CI) 7.9% (6.5-9.6) and 5.3% (4.1-6.7) for adverse and recurrent adverse reactions to wheat/gluten, respectively, adherence to GFD 5.9% (4.7-7.4), wheat allergy 0.74% (0.3-1.4), and nonceliac gluten sensitivity 4.5% (3.5-5.8). There were no self-reported cases of celiac disease. Prevalence of self-reported physician-diagnosis of gluten-related disorders was 0.41% (0.17-0.96). Most respondents reported adherence to GFD without a physician-diagnosis of gluten-related disorders (97.2%). The proportion of gluten avoiders was 17.2% (15.2-19.5). Most of them did not report recurrent adverse reactions to wheat/gluten (87.0%). Conclusions. Nonceliac gluten sensitivity is rarely formally diagnosed in Colombia, but this population has the highest prevalence rate of adherence to GFD reported to date. Consequently, most respondents were avoiding wheat- and/or gluten-based products for reasons other than health-related symptoms.

Relationships between the occurrence of Giardia and Cryptosporidium and physicochemical properties of marine waters of the Pacific Coast of Mexico.

Untreated sewage has adversely affected the quality of marine recreational waters worldwide. Exposure to marine recreational water with poor microbial quality may pose a threat to bathers. The objectives of this study were to assess the effect of physicochemical parameters on Cryptosporidium and Giardia presence in marine recreational water of Sinaloa, Mexico, by Logistic Regression Analyses. Thirty-two 10-litre water samples were collected from two tourist beaches, Altata and Mazatlan, between November 2006 and May 2007. Water samples were processed by the EPA 1623 method and pH, temperature, salinity and turbidity were also determined. Cryptosporidium and Giardia were present in 71 and 57% of the samples collected from Altata, respectively. In Mazatlan, Cryptosporidium and Giardia were found in 83 and 72% of the samples, respectively. The overall concentration of Cryptosporidium ranged from 150 to 2,050 oocysts/10 L with an average of 581 oocysts/10 L and Giardia ranged from 10 to 300 cysts/10 L with an average of 73 cysts/10 L. The occurrence of both parasites increased in water with decreasing temperatures and increasing turbidity of the water.