Manuel Gea Research Articles

Pilomatrixomas: 31 years of experience in population under and over 18 years of age.

Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a benign cutaneous neoplasm that demonstrates differentiation towards the matrix portion of hair follicles. It is the most common benign cutaneous neoplasm in childhood and youth, although it can occur at any age. With a general incidence ranging from 0.001% to 0.0031% of all cutaneous tumors. There is a slight predilection for females, with a female-to-male ratio of 1.15:1. Observational, descriptive, retrospective, and cross-sectional study conducted using the electronic database of the dermatopathology department of Dr. Manuel Gea González General Hospital, from January 1992 to July 2023. Only cases with a histopathological diagnosis of pilomatrixoma, pilomatricoma, and Malherbe's calcifying epithelioma were included. A total of 200 pilomatrixomas were recorded in 177 patients. The tumor predominantly affected females in the pediatric age group, with an average age of 22.98 years in the studied population. The most common location was the head (periorbital region), followed by the upper extremities and trunk. Upon separating the population into pediatric and adult groups, 111 and 89 cases were identified, respectively. We present a detailed study on pilomatrixomas with a comprehensive overview of the demographic, clinical, and epidemiological characteristics of this benign cutaneous neoplasm. The results revealed robust statistical data highlighting the distribution by age, gender, topography, morphology, accompanying symptoms, and frequency of clinical differential diagnoses. This study significantly contributes to the existing knowledge of pilomatrixomas and serves as a valuable reference for future research and clinical practice.

International Microsurgery Club and World Society for Reconstructive Microsurgery Webinar: Career Building in Microsurgery

AbstractCareer building can be challenging for young surgeons, especially when topics such as lifestyle, work–life balance and subspecialization arise. Suggestions and advice from senior colleagues is very valuable but many young surgeons do not have such opportunities or are limited to a few senior surgeons. The International Microsurgery Club (IMC), in collaboration with the World Society of Reconstructive Microsurgery, organized a combined webinar for this topic and invited world renowned microsurgery masters polled by the IMC members to join, including Prof. Peter Neligan (Emeritus from University of Washington, United States), Prof. Raja Sabapathy (Ganga Hospital, India), Dr. Gregory Buncke (The Buncke Clinic, United States), Prof. Isao Koshima (Hiroshima University Hospital, Japan), Prof. David Chwei-Chin Chuang (Chang Gung Memorial Hospital, Taiwan), and Prof. Eric Santamaria (Hospital General Dr. Manuel Gea Gonzalez, Mexico) on May 1, 2022. Prof. Joon-Pio Hong (Asan Medical Center, South Korea) and Prof. Fu-Chan Wei (Chang Gung Memorial Hospital, Taiwan) were also selected but unfortunately could not make it and were therefore invited to another event in April 2023, summarized in a recently published paper.There is ample literature reporting on different aspects of developing a microsurgical career but the goal of this session was to offer an opportunity for direct exchange with experienced mentors. Moreover, insights from experienced microsurgeons from different part of the world were more likely to offer different perspectives on aspects such as career building, failure management, and team culture. This webinar event was moderated by Dr. Jung-Ju Huang (Taiwan), Dr. Susana Heredero (Spain), and Dr. Wei F. Chen (United States).

COVID-19 and Acute Kidney Injury Outcomes in Hospitalized Patients Following SARS-CoV-2 Vaccination: A Case-Control Study

Background: Acute kidney injury (AKI) is a frequent complication associated with severe COVID-19 and has been linked to increased mortality. While vaccination against SARS-CoV-2 has shown effectiveness in reducing severe COVID-19 outcomes, its impact on the development of AKI among hospitalized patients remains unclear. Objective: To evaluate the effect of SARS-CoV-2 vaccination on the incidence and severity of AKI and 28-day mortality among hospitalized patients with severe COVID-19. Design: Retrospective case-control study. Setting: Conducted at the Internal Medicine Department of Hospital General Dr. Manuel Gea González, Mexico, from April 2020 to December 2021. Patients: 413 patients over 18 with confirmed severe COVID-19 were included. Patients were categorized based on their vaccination status before COVID-19 infection. Measurements: Key outcomes included the incidence of AKI, progression to AKI stage 3, and 28-day mortality. AKI was defined according to the KDIGO criteria. Methods: Data were analyzed using univariate and logistic regression models to assess the association between vaccination status and the studied outcomes. Covariates included age, sex, BMI, type 2 diabetes, hypertension, and inflammatory markers. Results: Among the 413 patients, 70% developed AKI, with a median hospital stay of 10 days (range 6-17). Vaccinated patients had a significantly lower incidence of AKI compared with nonvaccinated patients (48.7% vs 74.9%; P < .001). After adjusting for confounding factors, vaccination was associated with lower odds of AKI (OR: 0.252, 95% CI: 0.140-0.452), AKI stage 3 (OR: 0.448, 95% CI: 0.205-0.981), and 28-day mortality (OR: 0.187, 95% CI: 0.064-0.544). Limitations: As a single-center retrospective study, generalizability is limited. In addition, vaccination data were obtained from medical records, and the completeness of vaccination could not be independently verified. Conclusions: SARS-CoV-2 vaccination was independently associated with a reduced risk of AKI, AKI stage 3, and 28-day mortality in hospitalized patients with severe COVID-19. These findings highlight the potential protective effects of vaccination against severe kidney complications in this population.

Proliferating Pilar Tumors in the Scalp Over a Period of 23 Years in a General Hospital in Mexico City.

Proliferating pilar tumors are an unusual skin tumor, and they have a cystic component with trichilemmal keratinization and epithelial proliferation. These arise from the outer root sheath of hair follicles. It mainly affects women. The scalp is the most affected area. Diagnosis can be made by biopsy. Surgical excision is the best treatment option. Report the frequency of proliferating pilar tumors in the scalp in general hospital in Mexico over a period of 23 years. The authors reviewed the database of the dermatopathology service of the General Hospital "Dr Manuel Gea González" from 1999 to August 2022, selecting diagnosticated cases of proliferating pilar tumor, pilar cyst, trichilemmal cyst, or proliferating trichilemmal cyst in the scalp. The authors discovered 17 cases, 13 were women, the average age was 54.9 years, all the tumors affecting the scalp, and just 3 cases were reported as malignant. In comparison with the existing data, the authors can observe that most of their patients were women and the scalp is the most affected area. Most did not present associated symptoms. As the authors can see, most are benign and long-lasting: however, the authors cannot ignore that a small percentage can be malignant.

An Overview on Research in a University Hospital, Using a Payback Framework Categorization Approach.

Little information is available on how to assess the impact of research studies conducted in government hospitals in Latin America and specifically in Mexico. We aimed to determine the returns on investment of the research projects that were carried out in the Hospital General "Dr. Manuel Gea Gonzalez" (HGMGG), a general university hospital located in Mexico City, using a categorization model. We conducted a study including bibliometric analyses of publications associated with all research studies performed during the period 2016-2019 in the HGMGG and investigator interviews, according to the payback framework categorization model. All studies analyzed had a positive impact based on outcomes in 5 "payback categories": (1) knowledge; (2) research targeting, capacity building, and absorption; (3) policy and product development; (4) health benefits; and (5) broader economic benefits. To date, it has not been possible to establish a set of indicators that show the results of the investigations carried out by medical specialists in training, who carry out the bulk of medical care in general hospitals and in the National Institutes of Health in Mexico. We identified, in the 5 categories of the payback framework model, different areas of opportunity to improve the benefits of the hospital's medical services through the development of scientific research projects.

Use of enhanced recovery after surgery protocol in laparoscopic cholecystectomy in patients with symptomatic cholelithiasis.

The objective of the study was to determine the success rate of ambulatory laparoscopic cholecystectomy with an enhanced recovery after surgery (ERAS) protocol, in patients with symptomatic cholelithiasis. Prospective cohort of patients with symptomatic cholelithiasis underwent elective surgery at the General and Endoscopic Surgery Division of the General Hospital "Dr. Manuel Gea González" from July 2015 to September 2017. 160 patients were included, the mean age was 36.8 years (15-73 years), and 83.7% were women. We obtained a success rate of 95.6% with this protocol. Two patients required postoperative unplanned hospitalization (1.2%), one of them had surgical treatment (0.6%). Five patients presented post-operative complications (3.1%): one with acute pancreatitis (0.6%) and four (2.5%) were diagnosed with surgical site infection. Overall satisfaction with procedure was close to 99%. The performance of ambulatory laparoscopic cholecystectomy with an ERAS protocol in patients with symptomatic cholelithiasis has an adequate success rate, as well as postoperative evolution. Our study shows its safety, reliability, and possibility for routinely implementation without presenting a significant number of complications.

Variaciones horizontales, verticales y transversales en la Relación Céntrica (RC) en pacientes con Disfunción Temporomandibular (DTM) y Síntomas Otológicos (SO)

El objetivo del estudio fue evaluar la magnitud de las variaciones horizontales, verticales y transversales en la relación céntrica (RC) en pacientes con Disfunción Temporomandibular (DTM) y síntomas otológicos (SO) comparando con pacientes que no presenten DTM ni SO, mediante el uso del articulador MG2, fueron valorados en la División de Estomatología-Ortodoncia del Hospital General “Dr. Manuel Gea González” (HGMGG). En un periodo comprendido del 2005 al 2006, con rango de edad entre 20 a 60 años.Para la realización de este estudio, se incluyeron 27 pacientes con DTM y SO, y 15 pacientes sin DTM ni SO.Los resultados de este estudio mostraron que los pacientes con DTM y SO presentan una discrepancia horizontal, vertical y transversal en relación a la máxima intercuspidación (MI) y la relación céntrica (RC), significativa. Presentándose en 15 de los 27 casos estudiados variaciones anteroposteriores. Siendo menos significativa las variaciones verticales presentándose solo en 10 de los casos estudiados.

Probiotic Effect on SARS‐CoV2 Immunity Is Associated to Type‐1 Interferons: A Post‐Hoc Analysis of a Randomized, Placebo‐Controlled Trial

Objectives and HypothesisGut microbiota has been reported to protect from lung viral infection in animal models by stimulating type‐I interferon signaling. Type‐I interferons can have direct antiviral activity while also stimulating antibody‐producing B cells. Antibodies against Severe Acute Respiratory Syndrome coronavirus 2 (SARS‐CoV2) have been correlated to faster infection clearance and protection against reinfection. A specific 4‐strain probiotic combination (Pediococcus acidilactici CECT7483 plus Lactoplantibacillus plantarum CECT7484, CECT7485 and CECT30292) was recently studied in a randomized, quadruple‐blinded, placebo‐controlled trial in 300 SARS‐CoV2‐infected, symptomatic ambulatory patients (NCT04517422). Study subjects did not receive corticosteroids or antivirals. Compared to placebo, probiotic intervention (2x109cfu/day for 30 days) achieved faster symptom clearance and increased SARS‐CoV2‐specific immunoglobulins M and G (IgM and IgG). We hypothesize these effects could be related to increased type‐I interferon signaling.MethodsA random subset of 70 subjects (35 probiotic and 35 placebo) was selected out of the 300 participants in the clinical study. Stored serum samples collected on day 0 (baseline), 15 and 30 (end of intervention) were analyzed for interferon‐alpha 2a (IFNa) and interferon‐beta 1a (IFNb) using enzyme‐linked immunosorbent assay. Demographic data, baseline viral load, symptom duration and SARS‐CoV2‐specific IgM and IgG serum titers were retrieved from patient case report forms. Differences between probiotic and placebo were compared using Mann‐Whitney or Chi‐squared tests, as appropriate. Correlations between type‐I interferons and other variables were assessed by Spearman correlation. All procedures on study subjects had been approved by the Internal Review Board of Hospital General Dr. Manuel Gea (Mexico City) and adhered to Helsinki Declaration.Summary of ResultsIn the selected subset of patients, study groups were comparable at baseline (all p>0.10, Table 1). Probiotic treatment was associated to a larger increase of IFNa on day 30 (p=0.007) and of IFNb on days 15 and 30 (both p<0.001), compared to placebo (Figure 1). Similarly, SARS‐CoV2‐specific IgM and IgG were higher on days 15 and 30 (all p<0.001) and duration of fever, cough, headache and myalgia were shorter (all p<0.05) in probiotic compared to placebo. Increase in IFNb across the study correlated to increase in SARS‐CoV2‐specific IgM (rho=0.55, p<0.001) and IgG (rho=0.61, p<0.001), and inversely correlated to duration of cough (rho=‐0.26, p=0.033) and fever (rho=‐0.24, p=0.042). Conversely, increase in IFNa correlated to increase in SARS‐CoV2‐specific IgM (rho=0.33, p=0.005) only. Neither increase in IFNa nor IFNb correlated to age, number of metabolic comorbidities or days from onset of symptoms.ConclusionCompared to placebo, oral administration of a specific 4‐strain probiotic combination resulted in significant increase in type‐I interferons in serum, especially IFNb, correlating to higher SARS‐CoV2‐specific IgM and IgG antibodies and faster clearance of some symptoms.

POS-324 ASSOCIATION OF VOLTAGE-DEPENDENT CALCIUM CHANNEL POLYMORPHISMS 1.3 WITH THE DEVELOPMENT OF DIABETIC NEPHROPATHY, DIABETIC RETINOPATHY AND DIABETIC NEUROPATHY

One of the main characteristics of type 2 diabetes (T2D) is the lack of insulin secretion, this process is regulated by several proteins, within these are voltage-gated calcium channels, mainly CaV1.3 channels, whose single nucleotide polymorphisms (SNPs) have been associated in other populations with the presence of microvascular complications such as nephropathy, retinopathy and neuropathy in patients with T2D. Objective: To determine the association of the polymorphisms of the gene that codes for CaV1.3 with the risk of developing nephropathy, retinopathy and diabetic neuropathy. A case-control, comparative, observational, ambispective and cross-sectional study was carried out, in which men and women between 30 and 90 years of age participated, including patients with T2D according to the guidelines of the American Association. of Diabetes, with and without microvascular complications (nephropathy, retinopathy and neuropathy), treated in the outpatient clinic of the Internal Medicine Service, General Hospital “Dr. Manuel Gea González ”, from March to August 2020, from whom peripheral blood samples were taken for the extraction of genomic DNA by the phenol / chloroform method and subsequent genotyping, with the iPLEX Assay system that requires the design of specific oligonucleotides , amplification by polymerase chain reaction and finally detection of SNPs by mass spectrometry. A total of 200 patients participated in this study, 125 (62.5%) men and 75 (37.5%) women, within which 100 cases were divided into two groups (with a diagnosis of type 2 diabetes and the presence of nephropathy, retinopathy and neuropathy) and 100 controls (with a diagnosis of type 2 diabetes and absence of microvascular complications). A total of 4 polymorphisms of the CACNA1D gene were studied. Wild alleles were the most frequent in all groups. Within the polymorphisms analyzed in the binary logistic regression, rs9841978 GA (OR, 6.2; CI95%: 1.15-13.48, p = 0.03) and rs312486 CC (OR, 6.6; CI95%: 4.60-9.45, p = 0.002) with a Wald significance level of 4.51 and 9.51 respectively. In the multinomial logistic regression model, in diabetic retinopathy the variables were age (OR, 1.12; 95% CI: 1.03-1.22, p = 0.01), HT (OR, 5.92; 95% CI: 4.55-7.11, p = 0.002), rs9841978 GA (OR, 9.72; 95% CI: 3.62-10.72, p = 0.002) and rs312486 CC (OR, 1.09; 95% CI: 1.0004-1.19, p = 0.003). In diabetic nephropathy and neuropathy, the variable was the polymorphism rs9841978 GA, with OR, 12.55; CI95%: 4.80- 32.80, p = 0.03 and OR, 6.18; 95% CI: 2.90-13.16, p = 0.03, respectively. Our study demonstrated the association of well-established genetic variants of the polymorphisms of the CACNA1D gene with the presence of microvascular complications in patients with type 2 diabetes, showing that these SNPs, specifically rs9841978 GA and rs312486 CC, may represent important markers in the development of these complications of the disease, mainly nephropathy and retinopathy, and they are a predisposing factor due to the high frequency and strength of association observed in our study population, representing this the first study in Latin America. This suggests that our population is highly susceptible to developing not only T2D but also complications such as nephropathy and retinopathy that in the medium or long term could represent the cause of death in this sector when these SNPs are present.

Human leukocyte antigen Class II alleles associated with acral lentiginous melanoma in Mexican Mestizo patients: A case-control study.

Background Melanoma is an aggressive cutaneous cancer. Acral lentiginous melanoma is a melanoma subtype arising on palms, soles, and nail-units. The incidence, prevalence and prognosis differ among populations. The link between expression of major histocompatibility complex Class II alleles and melanoma progression is known. However, available studies report variable results regarding the association of melanoma with specific HLA Class II loci. Aims The aim of the study was to determine HLA Class II allele frequencies in acral lentiginous melanoma patients and healthy Mexican Mestizo individuals. Methods Eighteen patients with acral lentiginous melanoma and 99 healthy controls were recruited. HLA Class II typing was performed based on the sequence-specific oligonucleotide method. Results Three alleles were associated with increased susceptibility to develop acral lentiginous melanoma, namely: HLA-DRB1*13:01; pC = 0.02, odds ratio = 6.1, IC95% = 1.4-25.5, HLA-DQA1*01:03; pC = 0.001, odds ratio = 9.3, IC95% = 2.7-31.3 and HLA-DQB1*02:02; pC = 0.01, odds ratio = 3.7, IC95% = 1.4-10.3. Limitations The small sample size was a major limitation, although it included all acral lentiginous melanoma patients seen at the dermatology department of Dr. Manuel Gea González General Hospital during the study period. Conclusion HLA-DRB1*13:01, HLA-DQB1*02:02 and HLA-DQA*01:03 alleles are associated with increased susceptibility to develop acral lentiginous melanoma in Mexican Mestizo patients.

Characteristics of fingertip injuries and proposal of a treatment algorithm from a hand surgery referral center in Mexico City.

Fingertips are the most commonly injured anatomical structures in the upper extremity. The aim of this work is to present our experience in the management of fingertip injuries. All patients with fingertip injuries managed by Plastic and Reconstructive Surgery Division of Hospital General &#8220;Dr Manuel Gea Gonzalez&#8221; in Mexico from July 2010 to June 2015 were included; their demographic characteristics were described, as well as patterns of injury and management. Atotal of 1,265 patients were included in the study, 75% were males. The mean age of presentation was 20.5 ± 16.46 years; the age group most commonly affected was younger than 15 years (46.7%). Right and left-sided injuries were almost equally prevalent (51 vs. 49%). The most commonly injured fingers were the third (27.2%), and second (25.8%). Eighty-seven percent of the patients presented with single-digit injuries. Fingertip amputations were the most common type of injury with 620 cases (49%), followed by simple fingertip lacerations (574 cases, 45%), and nail bed injuries in 71 cases (5.6%). Surgical management was necessary in 95.8% of the cases. Fingertip injuries remain the most common reason for consultation in hand emergencies. Astructured approach for their treatment is necessary to obtain the best clinical outcomes.

649. Evaluation of the NG-Test CARBA 5® in Enterobacteriaceae and P. aeruginosa from Clinical Isolates

Abstract Background Identification of carbapenemase-producing organisms like Enterobacteriaceae and P. aeruginosa is important for treatment decisions and infection control. Identification methods require time and technical training. Lateral flow immunoassay NG-Test CARBA 5® exempt these needs. In Mexico there is no evaluation of it on clinical isolates. It is important to define their diagnostic accuracy. Methods We collected 103 clinical strains of Enterobacteriaceae and P. aeruginosa resistant to carbapenems, from 2019 to 2020 from: National Institute of Rehabilitation (INR), National Institute of Cancerology, General Hospital Dr. Manuel Gea González and Hospital Civil de Guadalajara Fray Antonio Mayor. Analyzed in INR’s microbiology laboratory, resistance was corroborated with broth Microdilution Method (CLSI 2020). The carbapenemases was demonstrated by phenotypic methods (CLSI 2021). A homemade PCR was done and sequencing for encoding genes: NDM, KPC, GES, VIM, IMP and OXA-48-like. We analyzed concordance of the NG-Test CARBA 5® versus PCR with kappa coefficient. Results Seven discarded, 96 strains entered the analysis: Enterobacteriaceae (73%), P. aeruginosa (27%) (Table1). The carbapenemase-producing organisms were: 1) 56 Enterobacteriaceae, 30% Class B; 2) 23 P. aeruginosa, 90% Class B. NG-Test CARBA 5® for Enterobacteriaceae demonstrated greater sensitivity, specificity, and NPV (table 2). Kappa coefficient of concordance was 0.92 for Enterobacteriaceae and 0.59 for P. aeruginosa (table 2), and discrepancies in table 3. Sequencing of carbapenemase-producing organisim can be find in table 4. Title 1. Clinical isolates by hospital N: No carbapenem-producing, Gea: General Hospital Dr. Manuel Gea González, Civil GDL: Hospital Civil de Guadalajara, INCAN: National Institute of Cancerology, INR: National Institute of Rehabilitation. Table 3. Discrepancies Enzyme gene secuencing Conclusion The most frequent enzyme were Ambler Class B, consistent with national reports. Sensitivity and specificity was like reported in other series. In P. aeruginosa, errors have already been reported in IMP-type enzymes, ours mainly with IMP-75. To our knowledge there are no reports of the following enzyme variants identified by NG-Test CARBA 5®: KPC-82, VIM-67, IMP-62, and IMP-75. NG-Test CARBA 5® showed high concordance with PCR for Enterobacteriaceae, it has the advantage of being a quick and easy-to-use detection tool. In P. aeruginosa despite the results without solid evidence, we recommend complementing the test with other phenotypic identification tests. Table 2. Kappa Concordance Coefficient of NG-Test CARBA 5® and PCR Se: sensitivity, Sp: specificity, PPV: positive predictive value, NPV: negative predictive value Disclosures All Authors: No reported disclosures

830. Central Nervous System Involvement in Disseminated Mycobacterium avium Complex Infection in Patients with Newly Diagnosed HIV

BackgroundDisseminated Mycobacterium avium complex (MAC) infection occurs in 20-40% of patients with < 50 CD4/mm3. Data describing central nervous MAC involvement (CNS-MAC) in disseminated infection is scarce. MethodsWe conducted a retrospective case series in the outpatient infectious diseases clinic in the hospital “Dr. Manuel Gea Gonzales” in Mexico City. We reviewed all records from October 2020 to May 2021 and identified all culture proven MAC infections.ResultsWe found 7 cases of MAC, with disseminated infection (positive bone marrow cultures) with 3 out of those 7 meeting our definition for CNS-MAC (positive cerebrospinal fluid culture). All cases of CNS-MAC infection occurred in patients with < 50 CD4/mm3 and recent HIV diagnosis (1-4 months) that were referred to our institution with consumptive syndrome and fevers. All patients were receiving antiretroviral treatment (ART) with BIC/FTC/TAF and initiated ART in less than 1 month since HIV diagnosis. Opportunistic infections were ruled-out at the moment of CNS-MAC diagnosis (criptococcal meningitis, cytomegalovirus retinitis, tuberculosis and histoplasmosis). All patients exhibited non-specific neurologic symptoms at arrival (headache and bradipsiquia) mixed with more severe symptoms (one case of ataxia, one case of vertigo, one case of III nerve palsy). All patients were treated with Clarithromycin/Levofloxacin/Ethambutol. Two patients achieved symptom remission and 1 patient was lost to follow-up. Of important note, all CSF analysis and CNS imaging studies carried-out were normal. No MAC bacilli were identified with direct Ziel-Neelsen staining of CSF.ConclusionWe found a high proportion of CNS-MAC in patients with disseminated MAC infection (42.8%) during the study period. All patients presented CNS symptoms and normal CSF characteristics. In our setting, patients with suspected disseminated MAC infection CD4 counts < 50 cells/mm3 might represent a specific population that could benefit from routine targeted diagnostic test at presentation in order to establish CNS involvement.Disclosures All Authors: No reported disclosures

Testicular microlithiasis, a rare and little-known disease: Case reports and a literature review

Objective: The aim of the present work was to review the cases of testicular microlithiasis revealed by ultrasound and carry out a review of the literature.&#x0D; Design: Testicular ultrasounds that identified testicular microlithiasis in patients seen at the Hospital “Dr. Manuel Gea González”, within the time frame of 2011 and 2018, were reviewed. Age, study indication, and laterality were among the variables analyzed.&#x0D; Results: Twenty-one ultrasounds revealed testicular microlithiasis in patients ranging from 6 to 24 years of age, with a mean of 16 years. Both testes were affected in 81% of the patients, and the left testis was affected in 29%. The indication for ultrasound was testicular pain in 33% (7 cases), testicular tumor in 14% (3 cases), and testicular torsion in 10% (2 cases). Other causes were varicocele, testicular abscess, and testicular trauma.&#x0D; Study limitations: The conclusions were relative, given the study’s retrospective, observational design. &#x0D; Originality: Microlithiasis has a reported prevalence of 2.4% to 3.8% in children. It is associated with testicular tumors and can cause infertility. A possible cause is nanobacteria that induce testicular calcifications. The study of the disease could modify its treatment and prevent its appearance. &#x0D; Conclusions: Testicular microlithiasis is a rare and little-known disease that can be associated with cancer and infertility. Its etiology appears to be nanobacterial infection. More research on the disease should be carried out.

Microlitiasis testicular una patología rara y poco conocida. Reporte de casos y revisión de literatura

Objetivo: El objetivo del presente trabajo es hacer una revisión de los casos reportados por ultrasonido de microlitiasis testicular y hacer una revisión de la literatura.&#x0D; Diseño: Se realizó una revisión de los ultrasonidos testiculares en los que se reportó microlitiasis testicular en el periodo comprendido del 2011 a 2018 en el Hospital “Dr. Manuel Gea González”, las variables que se analizaron fueron: edad, motivo del estudio, lado afectado y otros hallazgos.&#x0D; Resultados: Fueron 21 ultrasonidos con microlitiasis testicular con rango de edad de 6 a 24 años con promedio de 16 años. En el 81% afecto a ambos testículos, y en el 29% afecto el lado izquierdo. En el motivo del estudio el dolor testicular se encontró en el 33 % (7 casos), 14 % por tumor testicular (3 casos), torsión testicular 10% (2 casos), otras causas fueron varicocele, absceso y trauma testiculares.&#x0D; Limitaciones del estudio: Al tratarse de un estudio observacional retrospectivo, las conclusiones obtenidas son relativas.&#x0D; Originalidad: La microlitiasis tiene una prevalencia informada entre el 2.4% y el 3.8% en niños, se asocia a neoplasias testiculares y puede causar infertilidad. Se considera como posible etiología algunas nanobacterias que inducen las calcificaciones testiculares por lo tanto el estudio de esta patología podría modificar su tratamiento y prevenir su aparición. &#x0D; Conclusiones: La microlitiasis testicular es una patología rara y poco conocida que puede estar asociada a cáncer e infertilidad y al parecer su etiología puede ser infecciosa ocasionada por nanobacterias. Es una patología abierta a la investigación.

Long-term follow-up of minimally invasive surgery for the management of major bile duct injury due to cholecystectomy

Presenter: Gabriel Rangel-Olvera MD, MSc | Hospital General "Dr. Manuel Gea Gonzalez" Background: The post-cholecystectomy bile duct injury (BDI) is a life threatening condition, where severe cases require surgical intervention with a bilioenteric reconstruction. The results from minimally invasive (MI) approaches for the BDI repair studies have proven short term safety and feasibility; however they lack of middle long term follow-ups. The aim of the study is to show the patency and follow-up after 5 years of MI BDI repair. Methods: This is a retrospective comparative study of our prospectively collected database of patients with BDI who underwent robotic or laparoscopic hepaticojejunostomy; demographic and surgical variables were collected. Follow-up medical appointments were made at one month, three months, six months, 1 year, and then every year. At each appointment patency evaluation was done by evaluating the patient general condition, signs of cholangitis, stenosis, liver function tests and other postoperative complications. Results: Forty-six bile duct repairs(37, 80.43% by laparoscopic and 9, 19.57% by robotic-assisted approach) treated from June of 2012 to February of 2016 that have completed at least 5 year follow-up were evaluated. 37(80.43%) were female and 9(19.57%) male, the mean age was 41.28(19-77). The types of BDI were as follow: E1 (3,6.52%), E2 (11,23.91%), E3 (17,36.96%), E4 (12,26.09%) and E5 (3,6.52%); dividing the BDI by severity 31(67.39%) were Grade 2 and 15(32.61%) were Grade 3; also 11(23.91%) presented arterial injury and 4(8.7%) bilioenteric fistula (3 to the duodenum and one to the colon). All patients achieved the primary patency after the 90 days of the index treatment; during the follow-up. Three patients lost their primary patency, two of them requiring endoscopic intervention and 1 surgical re-intervention; achieving secondary patency after this intervention and maintaining this condition during the rest of the follow-up. Conclusion: The present study demonstrates good long-term results of bile duct injury reconstructions using laparoscopic and robotic surgery. These approaches are safe and effective alternative giving the benefits of MIS even in this complex entity.

Manejo postoperatorio de catéter doble J en ureteroscopias, síntomas y complicaciones

Antecedentes: Actualmente el 70% de los pacientes operados de ureteroscopia reciben colocación de catéter doble j debido a que se cree que disminuye la obstrucción secundaria a edema ureteral o a fragmentos de lito, pero la colocación no es inocua, ya que conlleva una gran variedad de efectos secundarios como frecuencia, urgencia, hematuria, disuria y tenesmo, así como un impacto económico. Nuestro objetivo es evaluar el manejo actual del catéter doble j en pacientes posoperados de ureteroscopia y los síntomas posquirúrgicos asociados.&#x0D; Materiales y métodos: Estudio retrospectivo de ureteroscopias realizadas en el Hospital Dr. Manuel Gea González durante el 2017 en pacientes mayores a 18 años. Se analizaron las frecuencias en readmisiones al servicio de urgencias durante la primera semana posoperatoria y los síntomas asociados al uso de catéter doble j, así como complicaciones posoperatorias.&#x0D; Resultados: Se registraron 105 ureteroscopias. El sexo masculino fue el predominante en hasta 55%; las ureteroscopias semirrígidas fueron las más prevalentes con un 71%. Se colocó preoperatoriamente catéter doble j en 69 pacientes y posoperatoriamente se colocaron en 41 pacientes. Durante el seguimiento los pacientes con colocación de catéter jj refirieron síntomas asociados a la colocación del catéter, lo cual ameritó visita a urgencias, encontrando únicamente asociación significativa para polaquiuria (p=0.001). Se obtuvo un total de 95 pacientes libre de litiasis, de los cuales a 61 (64.2%) se les colocó catéter doble j y 2 quedaron con litiasis residual y sin catéter.&#x0D; Conclusiones: De los 61 pacientes que se les colocó catéter doble j, 57 (82%) presentaron al menos un síntoma relacionado con el catéter; el 64.2% fueron ureteroscopias no complicadas a las cuales se les colocaron catéter doble j, por lo que creemos necesario realizar un estudio prospectivo y aleatorizado con un mayor número de pacientes para confirmar los resultados previamente reportados y establecer de manera más clara y objetiva las indicaciones para el uso del catéter doble j en nuestro hospital.

Morbidity in Patients With Separation of Cartilaginous Framework: Temporoparietal Fascia Flap and Treatment With Dermal Regeneration Template.

The full creation of an ear requires 2 reconstruction stages. In the second stage of reconstruction, the cartilaginous framework placed at first stage is separated from the head creating an auriculocephalic sulcus. Then a piece of rib cartilage is placed in the sulcus to maintain this separation and is covered with tissue that allows the integration of a full-thickness skin graft. A descriptive study based on the pre and postoperative medical records and photographic archives of patients diagnosed with microtia who underwent separation of the cartilaginous framework from February 2010 to July 2015 in the Plastic and Reconstructive Surgery Department at Hospital General Dr. Manuel Gea González. Fifty-four patients met the selection criteria. The temporoparietal fascial flap was performed on 85% (n = 46), and 8 cases with random occipito-temporal fascial flap in association to a dermal regeneration template. The average time at the operating room was 177 minutes in patients with temporoparietal fascial flap versus 84.5 minutes in dermal regeneration template. The complication rate was 25.9% (n = 14), being similar rate with both techniques. Coverage with dermal regeneration template and random occipito-temporal fascia flap as an alternative use instead of temporoparietal fascial flaps, offers good postoperative results, lower operating times, and similar rate of complications, with the advantage of producing no visible scars and reserve the temporoparietal fascial flap for possible exposure of the cartilaginous framework.

Modelo de gestión del cuidado: innovación de enfermería para garantizar el bienestar de los pacientes, en el Hospital General “Dr. Manuel Gea González”, en la Cd. de México.

La gestión del cuidado de enfermería implica la aplicación de juicios profesionales en la planeación, organización, integración, dirección y control para brindar con la planeación estratégica, cuidados oportunos, seguros e integrales que garanticen la continuidad de la atención para obtener el bienestar y la salud de las personas. Este bienestar se logra me­diante el proceso humano y social de alteridad entre un sujeto que es el profesional de en­fermería y otro sujeto, que es la persona sana o enferma con algún quebrante de salud. Para proporcionar el cuidado, los profesionales de enfermería realizan gestiones de interacción interdisciplinaria con otros profesionales de la salud y adaptaciones de factores humanos y recursos físicos, materiales y financieros que buscan garantizar la continuidad día a día de la calidad de los cuidados. En esta nueva gestión de la Subdirección de Enfermería (2017- 2022) consciente de la nueva responsabilidad y el compromiso institucional del cuidado, se ha creado un Modelo de gestión del cuidado de Enfermería, en el que se plasma una innovación administrativa que permite mediante una representación gráfica (Modelo de gestión) evidenciar el importante trabajo que realiza el personal de Enfermería del Hospital General “Dr. Manuel Gea González”, para garantizar la calidad del cuidado. El Modelo de Gestión sienta sus bases teórico-metodológicas en 4 dimensiones: administración de los servicios, salud, cuidado y persona. Específicamente, la enfermería desarrolla también en este modelo, sus principales funciones: servicios, docencia, administración e investigación, lo que le permite interactuar y coordinarse con el equipo interdisciplinario de salud para proporcionar cuidados integrales para individuos sanos y enfermos.

Nursing now: commitment of nursing at the "Dr. Manuel gea gonzález" general hospital

Nursing now: commitment of nursing at the "Dr. Manuel gea gonzález" general hospital