Scielo RSS <![CDATA[Revista médica del Hospital General de México]]> vol. 85 num. 1 lang. es <![CDATA[SciELO Logo]]> <![CDATA[Intensive therapy and critical medicine]]> <![CDATA[Experience in the management of injuries from dog bite in the plastic and reconstructive surgery service at the general hospital of Zacatecas]]> Abstract Background: Dog bite wounds are a public health problem present in our environment. We find them from superficial wounds to large wounds with devitalization and significant loss of tissues, in addition to presenting complications such as infections, aesthetic and functional sequelae that require specialized surgical treatment. Objective: To describe the experience of 3 years in the management of dog bite wounds in the plastic and reconstructive surgery service at the General Hospital of Zacatecas “Luz González Cosío”. Methods: A retrospective study was carried out in which all the records of patients with dog bite wounds between March 2018 and February 2021 were included. The variables collected were sex, age, anatomical location, characteristics of the wound, and therapeutic management. Results: A total of 27 patients were obtained. 70.3% of the injuries occurred in children under 15 years of age. The most frequent location was the face and skull (44.4%). In 22 cases they were resolved only with cleaning, surgical debridement and primary closure. In 5 cases (18.6%) some specialized reconstructive process was required, 18.6% of the patients were hospitalized. All patients received antibiotic treatment (Amoxicillin/Clavulanic acid). Conclusions: Complex wounds should be managed in a second or third level center with plastic and reconstructive surgery. Timely management of dog bite wounds improves the prognosis of patients. Most dog bite wounds can be treated with surgical grooming, debridement, and primary closure. <![CDATA[Clinical identification and severity in patients with COVID-19]]> Abstract The clinical evaluation of the patient with COVID-19 allows better care, application of safety criteria and preventive measures. The disease progresses from mild to severe and critical. In this work, is evaluated in patients with COVID-19 clinical format to identify moderate to severe stages of the disease. Following a cohort of male and female patients over 18 years of age admitted to the Infectology Service of the General Hospital of Mexico. Each patient is studied using the “COVID-19 Infectology” clinical format and in the first 24 hours of admission, a real-time RT-PCR molecular test is performed for SARS-CoV-2 infection. 65 patients classified as severe COVID-19 were studied, the RT-PCR was positive in 60 patients and negative in 5, clinical data did not differ from the positive ones and the 5 negative were considered false negative cases of the molecular test. There were no differences between positives and negatives with Fisher’s test, and no difference in age, comorbidities, or prognostic evaluation with Student’s t test. The conclusion is that the clinical format “COVID-19 Infectology” allows to recognize the cases and identify those that are in a severe evolution. <![CDATA[Clinical results of limbal stem cell graft of cadaveric donor in patients with bilateral limbal stem cell deficiency]]> Abstract Objectives: To describe the clinical results of limbal stem cell graft of cadaveric donor in patients with bilateral limbal stem cell deficiency (LSCD). Materials and methods: Prospective, longitudinal and observational study where patients with bilateral LSCD undergoing surgery using cadaveric donor limbal stem cell graft were evaluated. Visual acuity, symblepharon, conjunctivalization, neovascularization, keratinization and corneal opacity were evaluated before and after surgery, with a follow-up to 6 months. We considered a successful treatment with improvement of 4 of 6 criteria. Limbal stem cells graft was obtained from remaining sclerocorneal caps of cadaveric donors, from corneal transplant surgeries. Results: We included 6 patients with bilateral LSCD and 1 patient with unilateral deficiency. The average age was 34.1 (range 16-59 years). The most common etiology was corneal burn (57.14%) followed by Stevens Johnson Syndrome (42.86%). Using the statistical analysis of chi2, no significant difference was observed in visual acuity (p = 0.504), however a significant difference was observed in symblepharon (p = 0.007), neovascularization (p = 0.009), opacity (p = 0.016), conjunctivalization (p = 0.004) and keratinization (p = 0.001) both from baseline to 6 months follow-up. Conclusions: This is a pilot and exploratory study, which analyzes the results of the limbal stem cells graft from cadaveric donors being a successful and reliable technique to improve the ocular surface conditions in bilateral LSCD but not in visual acuity. It could be useful for future studies where the number of patients is expanded and followed up for at least one year. <![CDATA[Uses of magnesium sulfate in anesthesiology]]> Abstract Introduction: Magnesium sulfate heptahydrate (MgSO4 7H2O) is a divalent cation, pharmacologically its mechanism has been as a reversible blocker of the N-methyl-D-aspartate receptor (NMDAR) and therefore has been proposed in the use of anesthesiology. Objective: to describe its properties, its mechanism of action, the uses and the doses in anesthesiology. Methodology: A bibliographic review was carried out with keywords: anesthesia, magnesium sulfate, analgesia, muscle relaxation and organ protection in: PubMed, Science Direct, Embase and Cochrane Library. The articles considered most relevant and with the greatest evidence were selected. Results: A total of 244 articles were obtained, 210 were eliminated, a total of 34 articles remained. The bibliography reports the use of MgSO4 7H2O as an adjunct in sedation, analgesia, neuromuscular relaxation, motor relaxation in neuraxial anesthesia, prophylaxis for postoperative nausea and vomiting, as well as in pathologies that require its application prevenient to or during the anesthetic event (alterations in serum levels of Mg++, patients with treatment based on MgSO4 7H2O, bronchospasm, hypertensive uncontrolled, excessive bleeding and cardiac arrhythmias). Conclusions: The use of MgSO4 7H2O has shown useful pharmacokinetic and pharmacodynamic qualities in the management of the surgical patient patient such as analgesia, sedation, hemodynamic stability, decrease in PONV and decrease in the consumption of opioids and hypnotics, and it can also be applied as treatment of the patient's own pathologies. <![CDATA[MiRNAs involved in the signaling pathways associated to the pathogenesis of idiopathic pulmonary fibrosis]]> Abstract Idiopathic Pulmonary Fibrosis (IPF) is a progressive and multifactorial interstitial lung disease whose pathophysiology remains unclear. The process initiates by repeated epithelial lung injuries followed by basal membrane destruction occasioning the activation of the epithelial mesenchymal transition (EMT) and myofibroblasts which carry out an excessive synthesis of extracellular matrix (ECM) proteins. Several studies have associated microRNAs (miRNAs) to the biogenesis and development of IPF because miRNAs participate in the processes of apoptosis, proliferation, differentiation and interaction between cells thanks to their role as activators or inhibitors of different receptors in the signaling pathways of TGF-β, Wnt/β-catenin and PI3K-Akt-FOXO3a-mTOR, which are the main and most studied pathways involved in lung fibrosis. In this context, the knowledge on the altered miRNAs expression and even more their role in the different signaling pathways in IPF will shed light on new therapeutic targets for this lung disease. <![CDATA[Dysphagia rehabilitation in post-COVID patients: Review of the literature]]> Abstract COVID-19 causes acute respiratory failure syndrome (SIRA), leading patients to require intubation in the intensive care unit (ICU). A common complication of this ventilatory support is dysphagia, which has a prevalence of up to 30%. This work aims to describe rehabilitation methods in patients with coronavirus infection based on levels of evidence according to the GRADE System, so a systematic review of the literature was carried out. The selected articles were divided into the following subtopics: diagnosis of dysphagia and rehabilitation in COVID patients. The gold standard for the diagnosis of dysphagia is the videofluoroscopic swallowing study (VFS). Fiberoptic Evaluation of Swallowing Assessment (FEES) has high sensitivity and specificity, although they have the disjunction of an aerosol-generating procedure (AGP); however, in a pandemic situation, the study of choice in the literature is VF. Once the diagnosis is made, it is necessary to initiate rehabilitation as soon as possible, even from hospitalization in patients who have hemodynamic stability to prevent long-term effects and promote normal swallowing even before discharge. In patients with COVID-19 infection dysphagia, the risk-benefit of assessment tools and therapy used for diagnosis should be decided to help to maintain social distancing. It becomes imperative to carry out clinical studies with high levels of evidence that allow us to generate Clinical Practice Guides for the benefit of our patients. <![CDATA[Thevetia peruviana intoxication and electrocardiographic manifestations: a case series]]> Abstract The use of herbal compounds for weight reduction, such as Thevetia peruviana, has toxic (or cardiotoxic) effects that cause various cardiac arrhythmias or atrioventricular block. Three cases of cardiac arrhythmias after ingestion of Thevetia peruviana and its management with activated charcoal are presented. <![CDATA[Boarding of two ports by transthoracical route without endotracheal intubation. A line of inquiry]]> Abstract The approach to mediastinal injuries is one of the most exciting procedures for the chest surgeon. Lateral thoracotomy or sternotomy is usually used, although there are other procedures. With the development of thoracoscopic surgery implemented by Jacoveus, it has been perfected above all with better equipment and technological implements, although it has become clear to our work group in which cases it should be used and in which cases it should not. In some mediastinal lesions the endoscopic approach is possible and not feasible in others. In this work group, we have been able to implement the two-port surgical approach for the resection of some mediastinal lesions, as in this case, which is already in addition to the technique proposed in this Service.