High mortality at the beginning of the COVID-19 pandemic in a referral center in the metropolitan area of Mexico City.

INTRODUCTION: There is limited information about the coronavirus disease 2019 (COVID-19) disease in Latin-American countries. Our objective was to describe the clinical characteristics and outcomes of COVID-19 patients in Mexico. METHODOLOGY: We conducted a retrospective cohort study with 333 consecutive patients who were admitted to Hospital de Especialidades "Dr. Antonio Fraga Mouret" in Mexico City with COVID-19 between April 1, 2020, and June 30, 2020. Demographic, clinical, laboratory data, treatment details and 30-day outcomes were analyzed. RESULTS: The patients studied included 52% men (172/233) and the median age was 45 years. Up to 75% (250/333) of patients were classified as overweight or obese. There were 185 (56%) inpatients; 85% (158/185) were hospitalized in the general ward, and 15% (27/185) in the Intensive Care Unit (ICU). Laboratory measurements showed significant differences between inpatients and outpatients such as lymphocyte-count (median 0.8 vs 1.2×109/L, p < 0.001), LDH (median 650 vs 294 U/L, p < 0.001), CRP (median 147 vs 5 mg/L, p = 0.007), CK-MB (median, 15 vs 10 U/L, p = 0.008), ferritin (median, 860 vs 392 ng/mL, p = 0.02), and D-dimer (median, 780 vs 600 ng/mL, p = 0.15). These differences were seen between survivor and non-survivor patients as well. The rate of death in mechanically ventilated patients was 94% (67/71). Mortality at 30-day follow-up was 57% (105/185). CONCLUSIONS: We observed that majority of the non-survivors were obese and young. Complications leading to death was observed in majority of the cases.

Decreased quality of life and spirometric alterations even after mild-moderate COVID-19.

BACKGROUND: The follow-up of recovered COVID-19 patients is still limited. We aimed to evaluate the changes in quality-of-life (QOL) and spirometric alterations in the convalescent phase of 115 patients with at least 30 days post-COVID-19. METHODS: We included patients with confirmed COVID-19 infection, available past medical records and at least 30 days after the onset of symptoms. All patients were asked to rate their general health condition before and after COVID-19 using the EQ-5D-5L standardized questionary and perform a spirometry at evaluation. RESULTS: In this study, that included 70%(81/115) of patients with mild or moderate COVID-19; there was a severe decrease in QOL up to 56%(64/115). Alterations in usual activities and anxiety/depression were present in 59% of patients with a severe decrease in QOL. The persistence of symptoms was present in 63%(72/115). Restrictive lung impairment was the most common spirometric alteration in 17%(20/115), of whom 65%(13/20) had mild COVID-19. CONCLUSIONS: Spirometric alterations are presented even in mild COVID-19, and more remarkably, there is a high rate of alterations in quality of life after the recovery of this disease.

[Intestinal endometriosis: a diagnostic challenge for the internist?] / Endometriosis intestinal: ¿un reto diagnóstico para el médico internista?

Background: Within the wide variety of clinical skills distinctive of the internist the diagnostic approach of abdominal pain is paramount in everyday clinical practice. It is well known that no physician can diagnose what they don't know: classically considered as one of the ''great simulators'', intestinal endometriosis is a rare yet potentially fatal cause of abdominal pain if misdiagnosed, thus requiring a comprehensive medical evaluation. Case report: We present the case of a 33-year-old woman evaluated for a bowel obstruction, in the first instance associated with a probable abdominal tumor, subsequently concluding the definitive diagnosis of intestinal endometriosis. Conclusions: Although endometriosis is a frequent pathology, the location and clinical presentation presented in this case is not. However, the lack of information on this, like any other pathology, can delay the diagnosis or carry the risk of offering inappropriate treatments for an incorrect diagnosis. This is the importance of its knowledge and dissemination among first-contact doctors as well as clinical and surgical specialists.

Introducción: Dentro del gran abanico de competencias características del médico clínico se encuentra el abordaje diagnóstico del síndrome doloroso abdominal. Es bien sabido que el médico no diagnostica lo que no conoce. Considerada como una gran simuladora en la patología abdominal, la endometriosis intestinal es una causa de dolor abdominal poco frecuente, pero potencialmente mortal, siendo necesario un abordaje diagnóstico detallado. Caso clínico: Presentamos el caso de una mujer de 33 años evaluada por un cuadro de obstrucción intestinal, en primera instancia asociada a un probable tumor abdominal, concluyendo posteriormente el diagnóstico definitivo de endometriosis intestinal. Conclusiones: Si bien la endometriosis es una patología frecuente, la localización y la presentación clínica de este caso no lo son. Sin embargo, la falta de información de esta, al igual que de cualquier otra patología, puede retrasar el diagnóstico o conllevar el riesgo de ofrecer tratamientos no adecuados por un diagnóstico incorrecto. He aquí la importancia de su conocimiento y difusión entre médicos de primer contacto, así como entre especialistas clínicos y quirúrgicos.