A challenging case of eosinophilic myocarditis leading to heart failure and transplantation.

The large spectrum of etiologies, severities, and histologic appearances of eosinophilic myocarditis (EoM) poses challenges to its diagnosis and management. Endomyocardial biopsy is the current gold standard for diagnosis. However, cardiovascular magnetic resonance imaging is becoming more frequently used to diagnose acute myocarditis because of enhanced sensitivity when compared to histopathologic examination, and its less invasive nature. We report a complicated case of EoM in a male in his mid-thirties that led to fulminant cardiogenic shock that required immunosuppressive therapy on day 5 of admission and implantation of a left ventricular assist device (LVAD) on day 30. EoM was diagnosed on histopathologic examination of the resected fragment of the left ventricular myocardium. Nine months after the initial presentation, the patient ultimately required heart transplantation. The explanted heart showed minimal residual interstitial inflammation with evidence of mildly active intimal arteritis and patchy areas of interstitial fibrosis. In this report, we describe our patient's clinical features and correlate them with imaging and histopathologic findings to illustrate the difficulty in diagnosing EoM, particularly in this complicated patient that ultimately required heart transplantation. The diagnosis can be challenging due to the variable histopathologic features, clinical presentation, and utilization of therapeutic medications and devices.

VNTR (CAG)n polymorphism of the ATXN2 gene and metabolic parameters of cardiovascular risk associated with the degree of obesity in the Amerindian population of Oaxaca.

INTRODUCTION: The ATXN2 gene has a VNTR (CAG)n with locus in exon1. Long alleles within the normal range (22-29 repeats) are associated with severe obesity in people from the United Kingdom, Indonesia and the Caribbean. OBJECTIVE: To analyse the influence of VNTR (CAG)n on metabolic profile in adults with obesity and pre-obesity, as well as to estimate its effect on the risk of developing diabetes. METHODS AND MATERIAL: 255 adults of Chinantec Amerindian ethnic origin were included, who underwent anthropometric and biochemical evaluation. The VNTR was amplified by end-point PCR and by 8% PAGE electrophoresis. RESULTS: Differences were found in the waist/hip circumference index and body mass index in the carriers of genotypes different to the one homozygous for 22 repeats with a Student's t-test value of 0.0041 and 0.0334, respectively. We also found an association with a family history of chronic disease. CONCLUSION: The VNTR of ATXN2 is associated with obesity in Mexican adults of Chinantec ancestry.

Outcomes in Hospitalization in Patients with Heart Failure Undergoing Remote Pulmonary Artery Pressure Monitoring: A Systematic Review and Meta-Analysis of Major Trials.

Heart failure is a leading global pandemic and a cause of economic burden. Although, treatments exist to help symptomatic alleviation, patient compliance and monitoring is the basis of ensuring efficacy. With devices that allow for remote wireless PA pressure monitoring such as CardioMEMS, the inconsistency in patient reporting and factors such as symptoms and hospitalizations can be reduced. A systematic review and meta-analysis utilizing the MEDLINE, Cochrane, and Scopus database was performed to identify randomized and non-randomized clinical trials evaluating baseline characteristics and hospitalizations. Five trials for the systematic review and 2 trials for the meta-analysis meeting the inclusion and exclusion criteria were included. Baseline characteristics included an average age of 64.6 years, male predominance, mean BMI of 29.6, predominance of HFrEF, hypertension the most prevalent comorbidity, and a mean PA pressure of 27.2 mm Hg. The follow-up periods ranged from 90 days to 12 months. There was a total of 64 adverse events, mostly non-serious. Patients who underwent remote PA monitoring were less likely to be hospitalized compared with patients who did not (Odds Ratio: 0.52; 95% Confidence Interval 0.39, 0.69). Remote PA pressure monitoring allows for reduced hospitalizations. With the recent and now resurging SARS-CoV-2 pandemic, devices such as CardioMEMS can allow for heart failure patients to be managed from home to not only reduce hospitalizations but for symptom prevention and management.

Outcomes With sGC Therapy in Patients With HFpEF: A Meta-Analysis of Prior Trials.

Soluble guanylate cyclase (sGC) agents have been shown to have possible beneficial effects in heart failure treatment. Unfortunately, the role of sGC in HFpEF has not been shown to be efficacious based on recent trials. The CAPACITY HFpEF and VITALITY-HFpEF trials independently showed that sGC does not improve 6-minute walk test (6MWT) distance or the Kansas City Cardiomyopathy Questionnaire (KCCQ) physical limitation score (PLS). The objective of this study was to analyze current data on the 6MWT and KCCQ PLS score from trials that included patients with HFpEF treated with sGC. Using MEDLINE and Cochrane databases, meta-analysis and systematic review was performed looking at data in the CAPACITY HFpEF and VITALITY-HFpEF trials.  For safety analysis we evaluated serious adverse events between the CAPACITY HFpEF, VITALITY-HFpEF, SOCRATES-PRESERVED, and DILATE-1trials. A total of 2 trials were analyzed to assess 6MWT and KCCQ score. The total number of combined patients from both trials assessing 6MWT distance in sGC vs placebo therapy were 620 with 309 in the treatment group and 311 in the placebo group. The total number of combined patients from both trials assessing KCCQ score outcomes were 583 with 280 in the treatment group and 303 in the placebo group. A total of 4 trials were evaluated for safety analysis with a total of 987 patients with 529 in the treatment group and 458 in the placebo group. The analysis did not demonstrate significant difference in 6MWT (P = 0.97), KCCQ PLS (P = 0.83), or serious adverse events (P = 0.67).

VNTR (CAG)n polymorphism of the ATXN2 gene and metabolic parameters of cardiovascular risk associated with the degree of obesity in the Amerindian population of Oaxaca. / Polimorfismo VNTR (CAG)n del gen ATXN2 y parámetros metabólicos de riesgo cardiovascular asociados con el grado de obesidad en población amerindia de Oaxaca.

INTRODUCTION: The ATXN2 gene has a VNTR (CAG)n with locus in exon1. Long alleles within the normal range (22-29 repeats) are associated with severe obesity in people from the United Kingdom, Indonesia and the Caribbean. OBJECTIVE: To analyse the influence of VNTR (CAG)n on metabolic profile in adults with obesity and pre-obesity, as well as to estimate its effect on the risk of developing diabetes. METHODS AND MATERIAL: 255 adults of Chinantec Amerindian ethnic origin were included, who underwent anthropometric and biochemical evaluation. The VNTR was amplified by end-point PCR and by 8% PAGE electrophoresis. RESULTS: Differences were found in the waist/hip circumference index and body mass index in the carriers of genotypes different to the one homozygous for 22 repeats with a Student's t test value of 0.0041 and 0.0334, respectively. We also found an association with a family history of chronic disease. CONCLUSION: The VNTR of ATXN2 is associated with obesity in Mexican adults of Chinantec ancestry.

Cnidoscolus aconitifolius: therapeutic use and phytochemical properties. Literature review / Cnidoscolus aconitifolius: usos terapéuticos y propiedades fitoquímicas. Revisión de la literatura

Abstract Introduction: Medicinal plants have been traditionally used to cure or alleviate infectious and non-infectious diseases. They are widely accepted due to their low cost and low toxicity indexes. These plants are frequently used in cases involving skin irritation, superficial wounds, insect bites, and snake bites. Objective: To compile available evidence on the main therapeutic uses and phytochemical components of Cnidoscolus aconitifolius (popularly known as chaya), a plant that grows in tropical regions of Mexico and Central America. Materials and methods: A literature review of studies on C. aconitifolius published until 2017 was conducted in the BIREME, PubMed/Medline, Elsevier and SciELO databases. Descriptors "Cnidoscolus" and "aconitifolius" were used for the literature search, and no language restrictions were applied. Results: 82 articles were retrieved after completing the initial search. Once the studies were filtered by title (descriptors in the title) and duplicates were removed, 18 articles were reviewed. Based on the information found, it was possible to confirm that this plant has multiple health benefits. Conclusions: The traditional therapeutic use of Cnidoscolus aconitifolius is backed by scientific evidence. Therefore, further research aimed at identifying new phytochemical properties of this plant should be conducted to establish alternative therapies for treating different conditions.

Resumen Introducción. El uso tradicional de plantas medicinales para tratar diferentes enfermedades, ya sean infecciosas o no, es ampliamente aceptado debido a su bajo costo y sus bajos índices de toxicidad. Estas plantas son frecuentemente usadas en casos que involucran irritaciones de la piel, heridas superficiales, picaduras de insectos y mordeduras de víboras. Objetivo. Recopilar la información disponible sobre los principales usos terapéuticos y los componentes fitoquímicos de Cnidoscolus aconitifolius, una planta conocida popularmente como chaya y que crece en regiones tropicales de México y Centroamérica. Materiales y métodos. Se realizó una revisión de la literatura sobre C. aconitifolius publicada hasta 2017 en las bases de datos BIREME, PubMed/Medline, Elsevier y SciELO. Para la búsqueda se emplearon los descriptores "Cnidoscolus" y "aconitifolius", y no se aplicaron filtros de idioma. Resultados. Se identificaron 82 artículos luego de completar la búsqueda inicial. Después de filtrar los estudios por título (presencia de descriptores de búsqueda en el título) y remover duplicados, se incluyeron 18 artículos en la revisión. De acuerdo a la información encontrada, fue posible confirmar que esta planta ofrece diversos beneficios para la salud. Conclusiones. El uso terapéutico tradicional de la chaya está sustentado por evidencia científica, por lo que se sugiere realizar más investigaciones centradas en la identificación de nuevas propiedades fitoquímicas de esta planta y, así, establecer alternativas terapéuticas para distintas afecciones.

Patrón de consumo alimentario y su relación con el estado de nutrición en lactantes de la región del Istmo de Tehuantepec / Pattern of food consumption and its relation to the nutritional status of infants in the Isthmus of Tehuantepec region

FUNDAMENTOS: En la etapa lactante los patrones de consumo alimentario (PCA) adecuados pueden mantener el correcto estado nutricional. La presente investigación buscó asociar el PCA durante la alimentación complementaria con el estado nutricional en lactantes. MÉTODOS:Se realizó un estudio transversal analítico (mayo-julio de 2017) con población lactante (n=35, femeninos 60% y masculinos 40%) de 4 a 12 meses de edad del municipio de Santo Domingo, Oaxaca. Se evaluó el estado nutricional con indicadores (Peso/Edad, Peso/Longitud y Longitud/Edad), así como se realizó valoración dietética aplicada a las madres o cuidadoras. RESULTADOS: El 68,57% de los lactantes presentaron un estado de nutrición normal. Se encontró una asociación significativa entre el adecuado estado de nutrición y el consumo de verduras, cereales sin grasa, alimentos de origen animal, leche, aceites sin proteína y con proteína. La asociación del estado de nutrición con el PCA no fue significativa (p=0,501). CONCLUSIONES: Se encontró una asociación significativa entre el adecuado estado de nutrición y el consumo de ciertos alimentos. El balance energético positivo de los lactantes es un factor que conduce a un sesgo de información, ya que el PCA inadecuado en esta etapa y la ingesta elevada de calorías incrementa el peso corporal

BACKGROUND: In the lactating stage, adequate dietary consumption patterns (PCA) can maintain the correct nutritional status. The present investigation seeks to associate the PCA during complementary feeding with the nutritional status in infants. METHODS: An analytical cross-sectional study was included (May-July 2017) with a lactating population (n=35, 60% female and 40% male) from 4 to 12 months of age born from the Santo Domingo, Oaxaca. The nutritional status was evaluated with indicators (Weight/Age, Weight/Length and Length/Age), as well as dietary assessment applied to mothers or caregivers. RESULTS: 68.57% of infants had a normal nutritional status. A significant association was found between the proper state of nutrition and the consumptionof vegetables, non-fat cereals, foods of animal origin, milk, oils without protein and with protein. The association of the nutritional status with the PCA was not significant (p = 0.501). CONCLUSIONS: A significant association was found between the proper state of nutrition and the consumption of certain foods. The positive energy balance of infants is a factor that leads to information bias, since inadequate PCA at this stage and high calorie intake increases body weight

Posttraumatic stress symptoms in people exposed to the 2017 earthquakes in Mexico.

This is the first study to produce a reliable valid measure of the symptoms of Posttraumatic Stress Disorders (PTSD) in Mexico, which has a high incidence of disasters, and has not had a measurement of PTSD frequency in the population. The objective was to analyze the prevalence of PTSD symptoms in persons who experienced the 2017 earthquakes in Mexico. A probabilistic sample of 1539 participants from Mexico City, the State of Mexico, Chiapas, Puebla, Morelos and Oaxaca during November and December of 2017 was screened using the Davidson Trauma Scale (DTS) for symptoms of post-traumatic stress. The prevalence of PTSD symptoms was 34.6%, with greater effects on the inhabitants of Oaxaca, Morelos and Puebla, women, indigenous people and people who experienced damage to their homes (p = 0.001). The DTS had a moderate negative correlation with the RS-14 and a Cronbach's alpha coefficient of 0.957. The confirmatory factor analysis generated four factors that explain 50% of the variance, compatible with a Dysphoria model. We can conclude that one in three people exposed to earthquakes had symptoms of post-traumatic stress.

Relationship between body mass index, bone mineral density, and oral hygiene with periodontal disease in a Mexican elderly group / Relación del índice de masa corporal, densidad mineral ósea e higiene oral con enfermedad periodontal en un grupo de adultos mayores mexicanos

Abstract: the aim of this study was to evaluate the relationship of body mass index (BMI), bone mineral density (BMD), and oral hygiene with periodontal disease (PD) in a group of elderly adults in Mexico City. Material and Methods: A cross-sectional study with a convenience sample of 151 elderly adults was conducted. Before applying the epidemiological survey, each subject was asked to sign an informed consent. Standardization for measuring Ramfjord’s Periodontal Disease Index (PDI), BMI, and Green and Vermilion’s OHI-S was carried out. Descriptive statistics and linear regression models were performed. Results: The 93.4 percent of the group had PD, 33.8 percent showed severe gingivitis and 20.5 percent mild gingivitis. A 28.5 percent five percent of the group had osteopenia and 18.5 percent had osteoporosis, being more common in people over 69 years. The 38.4 percent percent of the group was underweight and 53.0 percent had poor oral hygiene. Oral hygiene accounted for 63.1 percent of the PD variance (p=0.0001), figure that did not increase considerably by adding BMD and BMI variables to the regression model. Conclusion: The frequency of PD in this group of elderly adults was high and significantly associated with BMD, BMI, and mainly oral hygiene.

Resumen: el objetivo de este estudio fue evaluar la relación del índice de masa corporal (IMC), densidad mineral ósea (DMO) e higiene oral con enfermedad periodontal en un grupo de adultos mayores de la Ciudad de México. Material y métodos: Se llevó a cabo un estudio transversal con una muestra por conveniencia de 151 adultos mayores. Para la encuesta epidemiológica se solicitó el consentimiento informado de cada persona, se llevó a cabo la estandarización para la medición del Índice de Enfermedad Periodontal de Ramjford (IEP), IMC e IHO-S de Green y Vermillion. Se realizó estadística descriptiva y modelos de regresión lineal. Resultados: El 93,4 por ciento del grupo presentó EP, un 33,8 por ciento mostró gingivitis severa y el 20,5 por ciento moderada. El 28,5 por ciento del grupo presentó osteopenia y el 18,5 por ciento osteoporosis, siendo más frecuente en personas mayores de 69 años. El 38.4 por ciento del grupo presentó bajo peso y el 53,0 por ciento mala higiene oral. La higiene oral explicó un 63,1 por ciento de varianza de la EP (p=0,0001), valor que no se incrementó de manera relevante al agregar las variables DMO e IMC al modelo de regresión. Conclusión: La frecuencia de EP en este grupo de adultos mayores fue alta, asociándose significativamente con la DMO, el IMC y principalmente la higiene oral.

Prevalence of temporomandibular joint disorders in a mexican elderly group / Prevalencia de trastornos temporomandibulares en un grupo de adultos mayores mexicanos

Abstract: Aim: to determine frequency and distribution of temporomandibulardisorders (TMD) by age and sex in a group of elderly adults in Mexico City. Material and methods: One hundred and fifty-four older adults in Mexico City were examined in a cross-sectional study. Subjects who had big edentulous gaps (absence of two or more teeth) or those who were fully edentulous, as well as those who refused to participate, were excluded from the study. For the epidemiological survey, diagnostic criteria for Temporomandibular Disorders (DC/TMD), after standardization by a dentist (kappa=0.892), were considered. Results. A 33.1 percent had some type of TMD, being more common in people between 60 and 69 years old, variable with which it was related (Likelihood Ratio=21.553, p=0.006, X2 MH=08.389, p=0.021). A 14.3 percent reported some type of facial trauma history, behavior that also was statistically significant (X2 MH=13.566, p= 0.0001). Disorders that occurred most frequently were: disc displacement with reduction (62.8 percent) and disc displacement without reduction (9.8 percent). Conclusions. TMD occurred in one of every three subjects examined, showing a relationship with age and trauma history.

Resumen: Objetivo. determinar la frecuencia y distribución de los trastornos temporomandibulares (TTM) por edad y sexo en un grupo de adultos mayores de la Ciudad de México. Material y métodos. Estudio de corte transversal. Se examinaron 154 adultos mayores de la Ciudad de México. Fueron excluidos del estudio a todos aquellos que presentaron brechas edéntulas amplias (ausencia de dos ó más dientes) o edentulismo total, así como aquellos que no aceptaron participar en el estudio. Para la encuesta epidemiológica se tomaron en cuenta los Criterios Diagnósticos de los Trastornos Temporomandibulares (CD/TTM), previa estandarización de una Cirujana Dentista (kappa=0.892). Resultados. El 33.1 por ciento presentó algún tipo de TTM, siendo más frecuente en personas entre 60 y 69 años variable con la cual estuvo relacionada (Razón de verosimilitud=21,553, p=0,006, X2 MH=08,389, p=0,021). El 14,3 por ciento refirió algún tipo de antecedente traumático facial, comportamiento que también resultó ser estadísticamente significativo (X2 MH=13,566, p=0,0001). Los trastornos que se presentaron con mayor frecuencia fueron: el desplazamiento del disco con reducción (62,8 por ciento) y el desplazamiento del disco sin reducción (9,8 por ciento). Conclusiones. Los TTM se presentaron en uno de cada tres adultos mayores examinados, existiendo una relación con la edad y los antecedentes traumáticos.

Bruxism frequency and dental occlusion type in a group of Mexican adolescents / Frecuencia de bruxismo y tipo de oclusión dental en un grupo de adolescentes mexicanos

Bruxism is a parafunctional habit characterized by the relentless action of clenching and grinding teeth in an inappropriate way. It can be developed when dental occlusion is altered due to premature contacts between teeth and excursive occlusal interferences. These features can influence its frequency, intensity and duration. The objective of the study was to evaluate the frequency of the habit of bruxism and its relationship with the type of dental occlusion in a group of teenagers. A total of 278 teenagers enrolled in undergraduate level were examined. A questionnaire and an oral examination were conducted for the epidemiological survey. For this purpose, an examiner was previously standardized (malocclusion kappa=0.89, bruxism kappa=0.93). A 51.5 percent of the adolescents presented bruxism. It was more frequent in the category of the 17-year-olds, with no significant differences by sex. An 81.4 percent showed a type of dental malocclusion, of which 57.6 percent were cases of Class I malocclusion, 21.4 percent of Class II and 2.4 percent of Class III, without a relationship between bruxism and these categories of dental malocclusion. Conclusion. Bruxism frequency was high, with similar distribution by sex. No association with the type of dental occlusion or with dental malocclusion frequency was found.

El bruxismo es un hábito parafuncional que se caracteriza por la acción incesante de rechinar y apretar los dientes de manera inadecuada, el cual puede ser desarrollado cuando la oclusión dental se encuentra alterada debido a los contactos prematuros entre los dientes e interferencias oclusales excursivas, características que pueden influir en la frecuencia, intensidad y duración como es adoptado. El objetivo del estudio fue evaluar la frecuencia del hábito de bruxismo y su relación con el tipo de oclusión dental, en un grupo de adolescentes. Se examinaron un total de 278 adolescentes inscritos a nivel de bachillerato. Para la encuesta epidemiológica se aplicó un cuestionario y se realizó un examen bucal, para tal fin una examinadora fue previamente estandarizada (maloclusión kappa=0,89, bruxismo kappa=0,93). El 51,5 por ciento de los adolescentes presentó bruxismo, siendo más frecuente en la categoría de 17 años de edad, sin diferencias por sexo. El 81,4 por ciento mostró algún tipo de maloclusión dental, de los cuales, el 57,6 por ciento fueron casos de maloclusión Clase I, el 21,4 por ciento Clase II y el 2,4 por ciento Clase III, sin que se observara relación alguna entre el hábito del bruxismo con estas últimas categorías de maloclusión dental. La frecuencia de bruxismo fue alta, con distribución similar por sexo, sin que se observara asociación alguna con el tipo de oclusión dental, o bien, con la frecuencia de maloclusión dental.

Parafunctional oral habits and itsrelationship with family structure in a Mexican preschoolers group, 2013 / Hábitos orales parafuncionales y su relación con la estructura familiar en un grupo de preescolares mexicanos, 2013

Introduction. Habit is any act acquired through experience and performed regularly and unconsciously. Parafunctional habits are resulting from the perversion of a normal function, acquired by repeated practice of an act that is not functional or necessary, may be signs of adjustment problems or inappropriate emotional expression. Its importance lies in the fact that they can interfere with the development of dental occlusion. Objective. To evaluate the prevalence of parafunctional oral habits and their possible association with the type of family, in a group of preschool children from eastern Mexico City. Methodology. Observational, descriptive and cross-sectional study was carrying on. Preschool children group and their parents were surveyed before an examiner calibration (k =0.87, p=0.001). The detection of different parafunctional habits was conducted in two stages: 1) application of a parent questionnaire and 2) clinical assessment of the child. Results and discussion. 57.7 percent of the studied population had at least one parafunctional oral habit. Onycophagia habit was the most prevalent. The relationship between prevalence of parafunctional habits with family type was significant (X2=87.439, p=0.0001). Conclusions. The prevalence of parafunctional habits was high which was associated with family type also the most frequent parafunctional habit onycophagia.

Introducción. Un hábito es cualquier acto adquirido mediante la experiencia y realizado regular e inconscientemente. Los hábitos bucales parafuncionales son los que resultan de la alteración de una función normal, o los que se adquieren por la práctica repetida de un acto que no es funcional ni necesario, pudiendo ser signos de problemas de adaptación o de expresión emocional inadecuada. Su importancia radica en el hecho de que pueden interferir con el desarrollo de la oclusión dental, razón por la cual el objetivo del presente estudio fue evaluar la prevalencia de hábitos bucales parafuncionales y su posible relación con la estructura familiar, en un grupo de preescolares de un Centro de Desarrollo Infantil del oriente de la Ciudad de México. Metodología. El estudio fue de carácter observacional, descriptivo y transversal, en el que 111 preescolares y sus padres fueron encuestados previa calibración de una examinadora (k=0.87, p=0.001). La detección de los diferentes hábitos bucales parafuncionales se realizó en dos etapas: 1) aplicación de un cuestionario al padre de familia y 2) valoración clínica del niño. Resultados y discusión. El 57.7 por ciento de la población estudiada presentó, al menos un hábito bucal parafuncional. La onicofagia fue el hábito de mayor prevalencia. La relación entre la prevalencia de hábitos parafuncionales con la estructura familiar resultó ser significativa (X2=87.439, p=0.0001). Conclusiones. La prevalencia de hábitos bucales parafuncionales fue alta la cual estuvo relacionada con la estructura familiar, asimismo, el hábito parafuncional más frecuente fue la onicofagia.