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Albarran-Sanchez A, Noyola-García ME, Calderón-Vallejo A, Guízar-García LA, Rosales-Dueñas FDJ, Barrientos-Flores CDJ, Segura-Mendez NH, Herrera-Sánchez DA, Cuevas-García C. [Neurological manifestations in patients with severe COVID-19 in a tertiary care center]. Rev Med Inst Mex Seguro Soc 2021; 59:545-550. [PMID: 34910416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/25/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The SARS-CoV-2 disease, called COVID-19, emerged in China has acquired pandemic dimensions. According to the WHO situational report of March 15, 2021, the global fatality rate is 2.2%; in Mexico, around 194 944 deaths have been confirmed by COVID-19. Studies in China identified that patients with severe COVID-19, when compared with those who had non-severe COVID-19, presented more severe neurological manifestations. OBJECTIVE To determine the frequency of neurological symptoms and manifestations in patients with severe COVID-19 in a tertiary care center. MATERIAL AND METHODS A cross-sectional, observational and analytical study was carried out at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI, in patients hospitalized with severe COVID-19. RESULTS 183 cases were analyzed, of which 130 were men (71%). The median age was 55 years (IQR: 44-65). The neurological symptoms were: headache, anosmia and dysgeusia. Neurological manifestations occurred in 27 patients (16%), the most frequent was ischemic-type cerebrovascular disease (CVD) in 12 (44%), in patients older than 76.5 years vs. 54 years (p = 0.000), with history of cardiovascular disease. CONCLUSIONS The most frequent neurological symptoms were headache, anosmia and dysgeusia. The most frequent neurological manifestation was ischemic CVD that appeared in older patients with severe COVID-19 with a history of cardiovascular disease.
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Affiliation(s)
- Alejandra Albarran-Sanchez
- Instituto Mexicano de Seguro Social. Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio Medicina Interna. Ciudad de México, México
| | - Maura Estela Noyola-García
- Instituto Mexicano de Seguro Social. Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio Medicina Interna. Ciudad de México, México
| | - Alejandra Calderón-Vallejo
- Instituto Mexicano del Seguro Social. Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Neurología. Ciudad de México, México
| | - Luis Alberto Guízar-García
- Instituto Mexicano de Seguro Social. Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio Medicina Interna. Ciudad de México, México
| | - Felipe de Jesús Rosales-Dueñas
- Instituto Mexicano de Seguro Social. Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio Medicina Interna. Ciudad de México, México
| | - Corazón de Jesús Barrientos-Flores
- Instituto Mexicano de Seguro Social. Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio Medicina Interna. Ciudad de México, México
| | - Nora Hilda Segura-Mendez
- Instituto Mexicano del Seguro Social. Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Inmunología y Alergia. Ciudad de México, México
| | - Diana Andrea Herrera-Sánchez
- Instituto Mexicano del Seguro Social. Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Dirección. Ciudad de México, México
| | - Carlos Cuevas-García
- Instituto Mexicano del Seguro Social. Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Dirección. Ciudad de México, México
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Abstract
The clinical manifestations of COVID-19 are reminiscent of those of acute respiratory distress syndrome induced by cytokine release syndrome and secondary hemophagocytic lymphohistiocytosis that is observed in patients with other coronaviruses such as SARS-CoV and MERS-CoV. Neurologists face the challenge of assessing patients with pre-existing neurological diseases who have contracted SARS-CoV-2, patients with COVID-19 who present neurological emergencies, and patients who are carriers of the virus and have developed secondary neurological complications, either during the course of the disease or after it. Some authors and recent literature reports suggest that the presence of neurological manifestations in patients who are carriers of SARS-CoV-2 may be associated with a greater severity of the disease.
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Affiliation(s)
- Carlos Cuevas-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Ciudad de México, México.
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Balcázar-Hernández L, Vargas-Ortega G, González-Virla B, Cruz-López M, Rodríguez-Gómez R, Espinoza-Pérez R, Cuevas-García C, Mendoza-Zubieta V. Biochemical Characteristics of Bone Mineral Metabolism before and throughout the First Year after Kidney Transplantation, Persistent Hyperparathyroidism, and Risk Factors in a Latin Population. Int J Endocrinol 2020; 2020:6913506. [PMID: 32256576 PMCID: PMC7085843 DOI: 10.1155/2020/6913506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/22/2020] [Accepted: 02/10/2020] [Indexed: 11/18/2022] Open
Abstract
Bone mineral metabolism disease, which included persistent hyperparathyroidism, is common after successful kidney transplantation (KT) and is related with negative outcomes in kidney transplant recipients. There is a lack of information about bone mineral metabolism, persistent hyperparathyroidism, and its risk factors in Latin kidney transplant recipients (KTRs). Material and Methods: A retrospective study was conducted in 74 patients aged 18-50 years with evolution of 12 months after KT and estimated glomerular filtration rate (eGFR) >60 ml/min; biochemical data of bone mineral metabolism before and at 1, 3, 6, and 12 months of KT were registered. Results. Age was 33 (IQR 27-37) years; 54% (n = 40) were men. Before KT, all patients had hyperparathyroidism, 40% (n = 30) hypocalcemia, 86% (n = 64) hyperphosphatemia, and 42% (n = 31) hyperphosphatasemia. After KT, an increase of calcium and a diminution of PTH, phosphorus, and alkaline phosphatase were corroborated (p=0.001). All patients had hypovitaminosis D (deficiency: 91% (n = 67); insufficiency: 9% (n = 7)); 40% (n = 30) had persistent hyperparathyroidism at 12 months. Hyperphosphatasemia before KT (OR = 4.17 (95% CI: 1.21-14.44); p=0.04), hyperparathyroidism at 6 months (OR = 1.84 (95% CI; 1.67-2.06); p=0.02), hypovitaminosis D at 6 months (OR = 3.94 (95% CI: 1.86-17.9); p=0.01), and hyperphosphatasemia at 6 months (OR = 1.47 (95% CI: 1.07-2.86); p=0.03) were risk factors for persistent hyperparathyroidism at 12 months after KT. Conclusion. Persistent hyperparathyroidism at 6 months, hypovitaminosis D, and hyperphosphatasemia are risk factors for persistent hyperparathyroidism at 1 year of KT in Latin population.
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Affiliation(s)
- Lourdes Balcázar-Hernández
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Guadalupe Vargas-Ortega
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Baldomero González-Virla
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Martha Cruz-López
- Kidney Transplant Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Raúl Rodríguez-Gómez
- Kidney Transplant Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Ramón Espinoza-Pérez
- Kidney Transplant Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Carlos Cuevas-García
- Kidney Transplant Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
| | - Victoria Mendoza-Zubieta
- Endocrinology Department, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Colonia Doctores, 06720 México City, Mexico
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Abstract
Multiple sclerosis is the most common inflammatory, chronic and degenerative condition of the central nervous system, and represents the first cause of disability in young adults. In Mexico, 11 to 20 out of every 100 000 people suffer from this disease. The causes of multiple sclerosis remain unknown, but several theories have been proposed: the interaction of environmental factors, viral infectious factors and genetic and immune susceptibility of each individual patient, which induce an autoimmune response and promote neuronal/axonal degeneration. In this review, the immune reaction main components and neurodegeneration present in multiple sclerosis are analyzed, as well as the inflammatory cascade associated with demyelination. Available treatments' main purpose is to modulate aspects related to the adaptive immune response (B and T cells). The therapeutic challenge will be antigen-specific immune-tolerance induction, for example, with the use of tolerance protocols with peptides or DNA or nanoparticles vaccines. Future therapies should aim to control innate components (microglia, macrophages, astrocytes) and to promote remyelination. To optimize the treatment, a combined therapeutic approach targeting the control of inflammatory and neurodegenerative components of the disease and monitoring of biomarkers will be necessary.
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Affiliation(s)
- Carlos Cuevas-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Dirección General, Ciudad de México, México.
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Molina-Ayala M, Rodríguez-González A, Albarrán-Sánchez A, Ferreira-Hermosillo A, Ramírez-Rentería C, Luque-de León E, Bosco-Garate I, Laredo-Sánchez F, Contreras-Herrera R, Mac Gregor-Gooch J, Cuevas-García C, Mendoza-Zubieta V. [Clinical and biochemical characteristics of patients with morbid obesity at the time of hospital admission and one year after undergoing bariatric surgery]. Rev Med Inst Mex Seguro Soc 2016; 54 Suppl 2:S118-S123. [PMID: 27561014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Three percent of Mexicans suffer from morbid obesity. Comorbidities associated to this condition diminish quality of life, increase mortality and health care costs. Despite bariatric surgery has specific indications and risks, it is the only treatment with effective long-term results. The aim of the study was to evaluate biochemical and clinical patient characteristics, both preoperatively and a year after they underwent bariatric surgery. METHODS We carried out a quasi-experimental study that evaluates a sample of patients in the Clínica de Obesidad at Hospital de Especialidades (a third level hospital) between March 2011 and October 2015. RESULTS A total of 150 patients were analyzed (60 % were women). Mean age was 41 ± 9 years and mean body mass index (BMI) was 48 kg/m2 (42-53 kg/m2). Before surgery, type 2 diabetes mellitus (T2DM) was present in 31 %, hypertension in 60 % and 30 % of the patients were "metabolically healthy obese". A year after surgery, the percentage of excess body weight loss was 66 %, T2DM and hypertension remission was 70 % and 50 %, respectively. CONCLUSION Bariatric surgery is an effective treatment to reduce excess weight. It improves biochemical, and clinical parameters in extreme obese patients.
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Affiliation(s)
- Mario Molina-Ayala
- Clínica de Obesidad y Cirugía Bariátrica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Pérez-de la Torre RA, Calderón-Vallejo A, Morales-Briceño H, Gallardo-Ceja D, Carrera-Pineda R, Guinto-Balanzar G, Magallón-Barajas E, Corlay-Noriega I, Cuevas-García C. [Deep brain stimulation in Parkinson's disease. Preliminary outcomes]. Rev Med Inst Mex Seguro Soc 2016; 54 Suppl 2:S124-S131. [PMID: 27561015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Parkinson's disease justifies the use of deep brain stimulation (DBS) in certain patients who suffer from this condition. We present mid-term and long-term post-surgical outcomes in a cohort of 60 patients, who underwent DBS in the Hospital de Especialidades at Centro Médico Nacional Siglo XXI, in Mexico City. METHODS Patients underwent conventional stereotactic surgery with FrameLink software (Medtronics Inc). This technique consisted in the presurgical evaluation, the placement of stereotactic frame, imaging studies, preoperative planning procedure, microrecording, macrostimulation, as well as the placement of electrodes and generators in two phases. The variables were included in a data platform for Excel management. It was also included a variety of measurement instruments for data comparison. As a standard measure, it was used the Unified Parkinson Disease Rating Scale (UPDRS) before the surgery and at 3, 12, and 36 months. RESULTS 60 patients underwent surgery: 41 men and 19 women, with an average age of 56.5 years (39-70). There were good results in the majority of patients with preoperative UPDRS and at 3, 12 and 36 months of 79.57, 66.85, 65.29 and 58.75, respectively (p < 0.0001). There were complications in nine patients (15 %) and they were managed in a conservative manner. CONCLUSIONS Postsurgical outcomes were from good to excellent in the majority of patients. Complications were minimal and conservatively managed. We propose the use of this procedure in a selected group of Parkinson's patients.
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Affiliation(s)
- Ramiro Antonio Pérez-de la Torre
- Servicio de Neurocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Cuevas-García C. [The Hospital de Especialidades "Bernardo Sepúlveda Gutiérrez", and the generation of knowledge]. Rev Med Inst Mex Seguro Soc 2016; 54 Suppl 2:S116-S117. [PMID: 27561013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The history of the Hospital de Especialidades "Bernardo Sepúlveda Gutiérrez," formerly called Hospital General del Centro Médico Nacional, has been marked by ups and downs, as well as by the development of cutting-edge medical knowledge. In this supplement we show a series of articles, whose authors belong in their entirety to that hospital.
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Affiliation(s)
- Carlos Cuevas-García
- Dirección General, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Cuevas-García C, Vega-Gaxiola S, Rivera-Nava C, Márquez-Rocha ML. [A thirty five year old male with campimetric defect and spinal cord alterations]. GAC MED MEX 2004; 140:541-5. [PMID: 15559236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Affiliation(s)
- Carlos Cuevas-García
- Servicio de Neurología, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social.
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