[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.

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).

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.

[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.

["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.

Hemodynamic monitoring with two blood gases: "a tool that does not go out of style" / Monitoreo hemodinámico con dos gasometrías: "Una herramienta que no pasa de moda"

Abstract Hemodynamic monitoring of a critically ill patient is an indispensable tool both inside and outside intensive care; we currently have invasive, minimally invasive and non-invasive devices; however, no device has been shown to have a positive impact on the patient's evolution; arterial and venous blood gases provide information on the patient's actual microcirculatory and metabolic status and may be a hemodynamic monitoring tool. We aimed to carry out a non-systematic review of the literature of hemodynamic monitoring carried out through the variables obtained in arterial and venous blood gases. A non-systematic review of the literature was performed in the PubMed, OvidSP and ScienceDirect databases with selection of articles from 2000 to 2019. It was found that there are variables obtained in arterial and venous blood gases such as central venous oxygen saturation (SvcO2), venous-to-arterial carbon dioxide pressure (Δpv-aCO2), venous-to-arterial carbon dioxide pressure/arteriovenous oxygen content difference (Δpv-aCO2/ΔCavO2) that are related to cellular oxygenation, cardiac output (CO), microcirculatory veno-arterial flow and anaerobic metabolism and allow to assess tissue perfusion status. In conclusion, the variables obtained by arterial and venous blood gases allow for non-invasive, accessible and affordable hemodynamic monitoring that can guide medical decision-making in critically ill patients.

Resumen El monitoreo hemodinámico de un paciente en estado crítico es una herramienta indispensable tanto dentro como fuera de la terapia intensiva; actualmente se cuenta con dispositivos invasivos, mínimamente invasivos y no invasivos; sin embargo, ningún dispositivo ha demostrado tener impacto positivo en la evolución del paciente; la gasometría arterial y venosa proporcionan información del estado microcirculatorio y metabólico real del paciente pudiendo ser una herramienta de monitoreo hemodinámico. El objetivo de esta revisión fue realizar una revisión no sistemática de la literatura del monitoreo hemodinámico realizado mediante las variables obtenidas en la gasometría arterial y venosa. Se estudiaron las bases de datos de PubMed, OvidSP y ScienceDirect con selección de artículos del 2000 al 2019. Se encontró que hay variables obtenidas en la gasometría arterial y venosa como la saturación venosa central de oxígeno (SvcO2), la diferencia de presión venoarterial de dióxido de carbono (Δpv-aCO2), la diferencia de presión venoarterial de dióxido de carbono/diferencia del contenido arteriovenoso de oxígeno (Δpv-aCO2/ΔCa-vO2) que están relacionadas con la oxigenación celular, con el gasto cardiaco (GC), con el flujo venoarterial microcirculatorio y con el metabolismo anaerobio que permiten realizar una valoración del estado de perfusión tisular. En conclusión, las variables obtenidas por gasometría arterial y venosa permiten realizar un monitoreo hemodinámico no invasivo, accesible y asequible que pueden guiar la toma de decisiones médicas en el paciente en estado crítico.

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.