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Permanent pacemakers are a frequently used therapeutic modality. Its use has had a great impact on the morbidity and mortality and quality of life of patients with heart rhythm disturbances, with an exponential increase observed in recent decades. The use of this strategy presents different phases, in which follow-up throughout the useful life of the device is a fundamental and determinant pillar of the efficacy and safety of this therapeutic modality. This review seeks to provide a clear and structured update of the fundamental aspects to consider in the follow-up of all patients with pacemakers. The follow-up of the patient with a pacemaker must follow a complete, systematic and periodic protocol, evaluating aspects and parameters related to the patient and the pacemaker, in order to ensure the proper and safe operation of the device adapted to the person.

Los marcapasos permanentes son una modalidad terapéutica de uso frecuente. Su empleo ha tenido un gran impacto en la morbimortalidad y calidad de vida de los pacientes con alteraciones del ritmo cardiaco, observándose en las últimas décadas un incremento exponencial. El empleo de esta estrategia presenta diferentes fases, que inician con la indicación de la estimulación, la selección del sistema de marcapaso apropiado, el procedimiento de implantación, la programación inicial y el seguimiento posterior, en la cual el seguimiento a lo largo de la vida útil del dispositivo es un pilar fundamental y determinante de la eficacia y seguridad de esta modalidad terapéutica. La presente revisión busca proporcionar una actualización clara y estructurada de los aspectos fundamentales a considerar en el seguimiento de todo paciente portador de marcapasos. El seguimiento del paciente con marcapasos debe seguir un protocolo completo, sistemático y periódico, evaluando aspectos y parámetros relacionado con el paciente y el marcapaso, con la finalidad de garantizar un funcionamiento adecuado y seguro del dispositivo adaptado a la persona.

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Introducción: la monitorización hemodinámica constituye un conjunto de técnicas y parámetros que permiten valo rar si la función cardiovascular es la adecuada para mantener la perfusión y la oxigenación tisular que permita sa tisfacer las demandas metabólicas del organismo, valorar el estado y el comportamiento del sistema cardiovascular, orientando sobre la mejor estrategia terapéutica. La presente revisión busca proporcionar una descripción general e integrada de las diferentes técnicas de monitorización, así como aspectos fisiológicos relevantes para su entendi miento y empleo terapéutico. La monitorización hemodinámica acompañada de un adecuado conocimiento de la fisiología cardiovascular permite determinar el estado del sistema cardiovascular, la condición hemodinámica del paciente y la estrategia terapéutica requerida. Su interpretación debe partir de la integración y la correlación de diversos parámetros hemodinámicos.

Introduction: hemodynamic monitoring is a set of techniques and parameters that allow evaluating whether cardio vascular function is adequate to maintain tissue perfusion and oxygenation to satisfy metabolic demands of the or ganism, assess the condition and behavior of the cardiovascular system, providing guidance on the best therapeutic strategy. This review seeks to provide a general and integrated description of the different monitoring techniques, as well as physiological aspects relevant to their understanding and therapeutic use. Hemodynamic monitoring accompanied by an adequate knowledge of cardiovascular physiology allows to determine the state of the cardiovascular system, hemodynamic condition of the patient and therapeutic strategy required, its interpretation must start from the integration and correlation of different hemodynamic parameters.

Introdução: a monitorização hemodinâmica constitui um conjunto de técnicas e parâmetros que permitem avaliar se a função cardiovascular é adequada para manter a perfusão e oxigenação tecidual que permite satisfazer as exi gências metabólicas do organismo, avaliar o estado e comportamento do sistema cardiovascular, orientando sobre a melhor estratégia terapêutica. Esta revisão procura fornecer uma descrição geral e integrada das diferentes técnicas de monitorização, bem como aspectos fisiológicos relevantes para a sua compreensão e utilização terapêutica. A monitorização hemodinâmica acompanhada de um conhecimento adequado da fisiologia cardiovascular permite determinar o estado do sistema cardiovascular, a condição hemodinâmica do doente e a estratégia terapêutica neces sária, a sua interpretação deve partir da integração e correlação de vários parâmetros hemodinâmicos.

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Background: Ebstein's anomaly is a rare complex congenital heart disease, first described in 1866 by physician Wilhelm Ebstein, characterized by anatomical and functional malformations of the tricuspid valve and the right ventricle because of inadequate delaminization of the tricuspid valve tissue. By presenting a clinical case and reviewing the literature, we analyzed the approach of an adult patient with Ebstein anomaly with ventricular preexcitation. Clinical case: We describe the case of a 34-year-old male patient, with a clinical history of palpitations and dyspnea, and his paraclinics documented Ebstein type B anomaly associated with patent foramen oval and paroxysmal supraventricular tachycardia, Successful radiofrequency ablation was performed and tricuspid valvuloplasty was proposed. Conclusion: It is concluded that Ebstein's anomaly is complex with clinical, morphological and physiopathological heterogeneous spectrum. Manifested from severe symptomatic forms in the neonatal period to asymptomatic or minimally symptomatic ones detected incidentally. Its diagnosis is based on clinical suspicion and confirmed by echocardiography or imaging studies. The therapeutic strategy may be based on medical management in its mild asymptomatic forms up to surgical interventions that include tricuspid valvuloplasty, palliative surgery, valve replacement or cardiac transplantation.

Introducción: la anomalía de Ebstein es una cardiopatía congénita compleja infrecuente, descrita por primera vez en 1866 por el médico Wilhelm Ebstein, caracterizada por malformaciones anatómicas y funcionales de la válvula tricúspide y del ventrículo derecho a consecuencia de una inadecuada deslaminización del tejido valvular tricuspídeo. Mediante la presentación de caso clínico y revisión de la literatura analizamos el abordaje de un paciente adulto con anomalía de Ebstein con preexcitación ventricular. Caso clínico: describimos el caso de un paciente masculino de 34 años, con historial clínico de palpitaciones y disnea, en sus paraclínicos se documentó anomalía de Ebstein tipo B asociado a foramen oval permeable y taquicardia paroxística supraventricular, como tratamiento se realizó ablación por radiofrecuencia exitosa y proponiéndose valvuloplastia tricuspídea. Conclusión: la anomalía de Ebstein es compleja de espectro clínico, morfológico y fisiopatológico heterogéneo, manifestada desde formas graves sintomáticas en el periodo neonatal hasta asintomáticas o mininamente sintomáticas detectadas de forma incidental. Su diagnóstico parte de la sospecha clínica confirmándose a partir de ecocardiografía o estudios de imagen. La estrategia terapéutica puede estar basada en manejo médico en sus formas leves asintomáticas hasta intervenciones quirúrgicas que incluyen valvulo-plastia tricuspídea, cirugía paliativa, reemplazo valvular o trasplante cardiaco.

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BACKGROUND: Sheehan's syndrome is a hypopituitarism secondary to necrosis of the pituitary gland caused by massive postpartum bleeding. The presentation is frequently amenorrhea and agalactia; hypoglycemia as a solitary presentation is uncommon. CASE REPORT: 68-year-old female with a history of postpartum hemorrhage 35 years ago. She had two episodes of hypoglycemia. During her hospital stay, panhypopituitarism was detected and the empty sella was confirmed by magnetic resonance imaging. CONCLUSIONS: It is recommended that medical personnel suspect Sheehan´s syndrome in any woman with nonspecific hypoglycemia and no history of chronic degenerative disease.

ANTECEDENTES: El síndrome de Sheehan es un hipopituitarismo secundario a necrosis de la glándula hipófisis causado por una hemorragia posparto. La presentación frecuentemente es como amenorrea y agalactia; la hipoglucemia como presentación solitaria es infrecuente. CASO CLÍNICO: Mujer de 68 años con antecedente de hemorragia posparto hace 35 años. Cursó con dos episodios de hipoglucemia. Durante su hospitalización se detecta panhipopituitarismo y se corrobora por resonancia magnética la silla turca vacía. CONCLUSIONES: Es recomendable que el personal médico sospeche un síndrome de Sheehan ante cualquier mujer con hipoglucemia inespecífica y sin antecedente de enfermedad crónica degenerativa.

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INTRODUCTION: People who live in highly allergenic regions have a greater risk of being sensitized; therefore, these areas have a higher prevalence of mono and polysensitized patients. The aim of the present study was to investigate the allergen sensitization profiles in patients with asthma in an agricultural zone in Mexico. METHODS: An analytical cross-sectional study was conducted in a secondary care hospital in Obregon City, Mexico. The allergen sensitization pattern profiles were analyzed through a skin prick test (SPT) in 294 patients. Data was collected before SPT: asthma control was classified according to the Global Initiative for Asthma Criteria, nutritional status was assessed with the Body Mass Index (BMI) using Quetelet's index (BMI = weight/height2), and comorbidities, asthma, and smoking habits were collected from the patients' medical records. RESULTS: In this study, in a group of adults with asthma, the prevalence of sensitization was 77%. The most frequent categories of aeroallergens were in indoors, in zones with weeds and abundant trees. A low proportion of monosensitized patients (2%) was observed. House dust mites were the most common allergens. CONCLUSIONS: Our study describes the sensitization pattern among asthma patients. This study will help identify the panel of most common allergens in this region of Mexico, and aid in selection of specific treatment through immunotherapy.

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BACKGROUND: During the COVID-19 pandemic, healthcare professionals use personal protective equipment (PPE) on a constant basis and for extended periods, leading to adverse dermatological reactions, a situation little known and studied despite its relevance. OBJECTIVE: To determine the risk factors associated with the development of adverse dermatological reactions in health workers using PPE during the COVID-19 pandemic. MATERIAL AND METHODS: An observational, cross-sectional, analytical study conducted through an online survey that evaluated the association between dermatological reactions and the use of PPE through a descriptive and inferential statistical analysis. RESULTS: There was a sample of 171 healthcare professionals. It was reported a high prevalence of adverse reactions (59%) and the most affected sites were the facial region and hands. The use of PPE > 6 hours, a history of dermatological disease, female gender, use of plastic overalls and the use of a respirator were documented as risk factors. CONCLUSIONS: Being an infectious disease, COVID-19 forces healthcare professionals to use accessories as a form of personal protection, implying potential health risks; for this, effective preventive strategies and treatment are required.

INTRODUCCIÓN: durante la pandemia por COVID-19, los trabajadores de la salud utilizan equipos de protección personal (EPP) de forma constante y por periodos prolongados, lo cual propicia reacciones adversas dermatológicas, situación poco conocida y estudiada a pesar de su relevancia. OBJETIVO: determinar los factores de riesgo asociados al desarrollo de reacciones adversas dermatológicas en trabajadores de la salud que utilizan EPP durante la pandemia por COVID-19. MATERIAL Y MÉTODOS: estudio observacional, transversal, analítico, realizado mediante una encuesta en línea, que evaluó la asociación entre reacciones dermatológicas y el uso de EPP a partir de un análisis estadístico descriptivo e inferencial. RESULTADOS: se recabó una muestra de 171 trabajadores de la salud. Se reportó una alta prevalencia de reacciones adversas (59%) y los sitios más afectados fueron la región facial y las manos. El uso de EPP > 6 horas, el antecedente de enfermedad dermatológica, el género femenino, el uso de overol de plástico y el uso de respirador se documentaron como factores de riesgo. CONCLUSIONES: al ser una enfermedad infectocontagiosa, la COVID-19 condiciona que los trabajadores de salud utilicen aditamentos para su protección personal, lo cual implica potenciales riesgos para la salud; por tanto, se requieren estrategias preventivas y tratamientos eficaces.

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In late December 2019, a group of patients with "atypical pneumonia" of viral etiology was reported in Wuhan, China. We now know that coronavirus disease 2019 (COVID-19) is caused by the new coronavirus SARS-CoV-2 that produces an acute disease with respiratory predilection and high contagiousness, whose origin is the result of natural selection between species. The World Health Organization declared this event as a public health emergency of global concern. The clinical presentation is diverse, from asymptomatic or mildly self-limiting upper respiratory tract disease to the development of severe and progressive interstitial pneumonia with the development of multiple organ failure and death. To date there is no specific treatment. Epidemiological measures of social distancing, hand washing and the use of personal protective equipment reduce the spread of this virus in the population. The aim of this review was to describe the existing information about SARS-CoV-2 and the COVID-19 pandemic, which allows health personnel to better understand the origin, epidemiology, clinical evolution, diagnosis, and current experimental treatments for this new disease. Therefore, it was carried out an evaluation of the bibliographic information with the terms coronavirus, COVID-19, and SARS-CoV-2 in the specialized databases in English and Spanish.

A fines de diciembre de 2019, se informó en Wuhan (China) sobre un grupo de pacientes con "neumonía atípica" de etiología viral. Ahora sabemos que la enfermedad por coronavirus 2019 (COVID-19) es provocada por el nuevo coronavirus SARS-CoV-2, que produce una enfermedad aguda con predilección respiratoria y de elevada contagiosidad, cuyo origen es resultado de una selección natural entre especies. La Organización Mundial de la Salud declaró este evento como una emergencia de salud pública de interés global. La presentación clínica es diversa y se manifiesta en personas asintomáticas o con enfermedad leve autolimitada del tracto respiratorio superior hasta aquellas que desarrollan una neumonía intersticial progresiva y grave, con evolución a insuficiencia multiorgánica y muerte. No se cuenta a la fecha con tratamiento específico. Las medidas epidemiológicas de distanciamiento social, lavado de manos y uso de equipo de protección personal disminuyen la diseminación de este virus entre la población. Esta revisión tuvo la finalidad de hacer una descripción de la información existente acerca del SARS-CoV-2 y la pandemia de COVID-19 que permita al personal de salud comprender mejor el origen, la epidemiología, el cuadro clínico, el diagnóstico y los tratamientos experimentales actuales para esta nueva enfermedad, para lo cual se realizó una evaluación de la información bibliográfica con los términos coronavirus, COVID-19 y SARS-CoV-2 en las bases de datos especializadas en idioma inglés y español.

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Background: The evaluation of quality of life related to health (HRQOL) has become an important prognostic indicator in HIV/AIDS. The aim of this study was to determine the impact of socio-demographic, clinical and psychological factors in HRQOL in a group of subjects with HIV/AIDS in northwestern Mexico and determine which variables best predict HRQOL. Methods: In a cross-sectional study with a sample of 87% of patients receiving care at a clinic for HIV/AIDS in northwestern Mexico between November 2010 to June 2011, we measure the HRQOL using the Tool Medical Outcomes Study HIV Health Survey (MOS-HIV). A model of multiple linear regression was performed to identify variables that allow us to predict HRQOL in this population. Results: In a sample of 54 subjects with HIV/AIDS. Patients had an average age of 43 ± 9 years, 83% were men with a mean time of 6.5 ± 4.5 years from diagnosis. HRQOL scores of physical and mental health of the participants were 57 ± 6 and 57 ± 13 respectively. In multivariate analysis, the variables that influenced the physical health punctuation were gender, marital status, sexual orientation, time since diagnosis and viral load (log). Conclusions: Prospective studies are needed to better explain the influence of the factors that predict changes or trends in HRQOL in patients with HIV/AIDS.

Introducción: la evaluación de la calidad de vida relacionada con la salud (CVRS) se ha convertido en un importante indicador pronóstico en el enfermo con VIH/SIDA. El objetivo de este estudio fue determinar el impacto de los factores sociodemográficos, clínicos y psicológicos en la CVRS de un grupo de pacientes portadores de VIH/SIDA del noroeste de México, así como determinar qué variables predicen mejor la CVRS. Métodos: estudio transversal con una muestra del 87% de los pacientes que recibían atención en una clínica de VIH/SIDA en el noroeste de México, entre noviembre del 2010 y junio del 2011, se midió la CVRS utilizando el instrumento Medical Outcomes Study HIV Health Survey (MOS-HIV). Se realizó un modelo de regresión lineal múltiple para identificar aquellas variables que permiten predecir la CVRS en esta población. Resultados: en una muestra de 54 sujetos con VIH/SIDA que tenían una edad de 43 ± 9 años, 83% eran hombres con un tiempo de 6.5 ± 4.5 años desde el diagnóstico. Las puntuaciones de CVRS de salud mental y física de los participantes fueron de 57 ± 6 y 57 ± 13 respectivamente. En el análisis multivariado, las variables que influyeron en la puntuación de salud física fueron el género, el estado civil, la orientación sexual, el tiempo transcurrido desde el diagnóstico y la carga viral (log). Conclusiones: es necesario realizar estudios prospectivos para explicar mejor la influencia de los factores que predicen cambios o tendencias en la CVRS en pacientes con VIH/SIDA.

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INTRODUCTION: Three-vessel coronary artery disease is an advanced manifestation of atherosclerosis, with high prevalence in Mexico. OBJECTIVE: The aim of this study was to describe coronary risk factors in a group of patients with three-vessel coronary artery disease in Northwest Mexico. METHODS: A cross sectional study was conducted on a population with three-vessel coronary artery disease from May 2015 to February 2016. The disease was defined when ≥70% stenosis was present in each major epicardial coronary artery. Anthropometric and biochemical parameters were measured in each patient. Ankle-Brachial Index was measured with vascular ultrasound, and Syntax score calculation with an on-line application. Statistical analysis for qualitative differences was performed using Pearson X2 test, with p<0.05 being considered as significant. RESULTS: The study included 100 patients, of whom 75 were male (mean age 63±9 years) and 25 female (mean age 69±9 years). The coronary risk factors observed were diabetes (58%), hypertension (86%), smoking (68%), dyslipidaemia (100%), metabolic syndrome (71%), and obesity/overweight (75%). Diabetes and metabolic syndrome prevalence was higher in women (p=0.03), but smoking was higher in men (76%, p=0.003). Ankle-Brachial Index was abnormal in 58% of patients, the mean Syntax score was in 36.9±11.5, and the prevalence of left main coronary heart disease was 36%. CONCLUSIONS: This group of patients with complex coronary lesions has a high prevalence of coronary risk factors, which could represent a worse prognosis.

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Infections, ulcerations, gangrene and, in severe cases, extremity amputation, are common complications among diabetic subjects. Various biomaterials have been utilized for the treatment of these lesions. Chitosan is an amino sugar with a low risk of toxicity and immune response. In this study, we evaluated chitosan topical gel and film treatments for subjects with diabetic ulcerations and wounds associated with diabetes mellitus. In a pre-experimental design, we described the result of chitosan gel and film treatment for wounds and skin ulcers among patients with long-standing diabetes mellitus. We studied 8 diabetic patients with wounds and skin ulcers (long duration and Wagner degree 1-2). Initially, most lesions had some degree of infection, tissue damage and ulceration. At the end of the treatment (topical chitosan) period, the infections were cured. All patients experienced a significant improvement in the initial injury and developed granulation tissue and a healthy skin cover. This report represents one of the few published clinical experience regarding the chitosan for the treatment of skin lesions among diabetic subjects. These results are relevant and promising for the treatment of this disease.