Revista Mexicana de Investigación Médica
In a constantly evolving world, the need for significant advancements in the field of medicine becomes increasingly urgent. It is in this context that we are pleased to present the Revista Mexicana de Investigación Médica, a platform dedicated to scientific excellence, continuous innovation, and a positive impact on global health. Our goal is to serve as a benchmark in the medical field, promoting interdisciplinary collaboration and the dissemination of cutting-edge scientific knowledge.
Editorial Universidad Popular Autónoma del Estado de Puebla
Clinical-functional results of patients with bilateral total hip arthroplasty in one stage vs two surgical stages in a tertiary orthopedic hospital
Total hip arthroplasty (THA) is performed in patients with advanced hip degenerative disease for whom palliative measures are ineffective. THA can be performed in a single surgical procedure or sequentially. The objective of this study was to describe the clinical-functional outcomes of patients who underwent bilateral THA in a single surgical procedure (THA1Q) versus a two-stage procedure (THA2Q). The study method was a retrospective observational study in patients with grade IV coxarthrosis who underwent bilateral THA. Clinical records were reviewed, assessing surgical time (TQ), intraoperative bleeding (TS), pain perception (VAS), radiological signs and areas of prosthetic loosening, and function using the HHS scale. Postoperative follow-up was six months. Statistical analysis was performed using Chi-square and Student’s t-tests. Statistically significant was P < 0.05. The sample consisted of 23 patients, with a mean age of 59±13 years. 1Q-ATCB was performed in 47.8% of patients and 2Q-ATCB in 52.2%. When comparing 1Q-ATCB vs. 2Q-ATCB, the TQ was 154 vs. 203 minutes and ST 560.8 vs. 783.6 ml. At six months, good to excellent functional results (HHS) were obtained in both groups (P=0.252). Radiologically, both groups showed adequate osseointegration. Both 1Q-ATCB and 2Q-ATCB obtained similar clinical-functional results at six months of follow-up.
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc-sa/4.0
Causes of maternal death in a second-level hospital: 5-year analysis
Introduction: In Mexico, obstetric hemorrhage has remained the leading cause of maternal death. In the state of Puebla, hypertensive disorders accounted for 37 deaths in 2022, also constituting a significant cause of maternal mortality. Objective: To describe the causes of maternal death in a second-level hospital in the state of Puebla over a five-year period. Materials and Methods: Retrospective study conducted at the General Hospital No. 20, Puebla, Mexico, between January 2018 and December 2022. Clinical records of maternal deaths classified as direct and indirect were analyzed. Sociodemographic variables, obstetric history, comorbidities, length of hospital stay and/or stay in the Intensive Care Unit (ICU), and cause of death were recorded. The analysis was descriptive. Results: Thirty-one maternal deaths were recorded. The average age was 26 years. Most had a high school education (14 cases), were employed (18), and were single (24). Twelve were primiparous, and 29 received prenatal care. Pregnancy was terminated by cesarean section in 19 cases. Nine patients had comorbidities. The median length of hospital stay was 3.5 days, and the median length of ICU stay was 1 day. The main causes of death were obstetric hemorrhage (8 cases), hypertensive disorders of pregnancy (6), and SARS-CoV-2 infection (6). There were 16 indirect and 15 direct deaths. Conclusion: Obstetric hemorrhage, SARS-CoV-2 infection, and hypertensive disorders were the main causes of maternal death. These findings underscore the need to strengthen obstetric care in second-level hospitals and improve surveillance of patients with risk factors.
Incidence of dengue in Puebla, Mexico: epidemiological characterization, trends, and projections 2020–2024
Dengue virus is the most epidemiologically relevant arbovirus worldwide. An ecological study was conducted using official data from the epidemiological surveillance system of the Ministry of Health. The objective of this study was to analyze the distribution and trends of confirmed dengue cases in the municipalities with the highest incidence in the state of Puebla, as well as at the state and national levels during that period. The municipalities with the highest incidence rates were analyzed and future trends were projected using least squares. The results showed an increase of more than 130% at the national level, reaching historical records between 2023 and 2024. Municipalities such as Santa Catarina Tlaltempan, Atzala and Coxcatlán showed abrupt increases linked to the possible circulation of serotype DENV-3. During the period of 2024, the introduction of viral serotype DENV-3 was recorded, which provoked an exacerbated immune response in populations previously exposed to other serotypes, intensifying the severity and frequency of cases. Projections suggest a sustained increase in several municipalities, especially Epatlán, which could maintain an upward trend towards 2026. Finally, it is concluded that phenotypic variability represents a key factor in the dynamics of dengue in Puebla and that its monitoring should be intensified to avoid future severe epidemics.
Clinical and sociodemographic characteristics of patients with diabetic foot using the Saint Elián classification in a family medicine clinic.
Introduction: Diabetic foot is a severe complication of diabetes mellitus, caused by neuropathy, vascular disease, and biomechanical alterations that predispose to ulcers, infections, and amputations. Factors such as advanced age, obesity, and poor glycemic control influence its development and progression. The Saint Elián classification, internationally validated, allows a comprehensive assessment of severity and clinical risk. This study describes the clinical and sociodemographic characteristics of patients with diabetic foot using this classification in a family medicine unit. Objective: To describe the clinical and sociodemographic characteristics of patients with diabetic foot according to the Saint Elián classification. Materials and Methods: A descriptive, cross-sectional, single-center study conducted during the second quarter of 2024 at the Family Medicine Unit 22 of the IMSS in Teziutlán. Ninety patients with type 2 diabetes mellitus without a history of amputation were included. The Saint Elián scale was applied to classify the clinical status of diabetic foot lesions. Results: Sixty-three women and twenty-seven men participated; 53.3% had been diagnosed with type 2 diabetes for more than five years. According to the Saint Elián classification, 95.7% of patients were classified as mild grade, 4.3% as moderate grade, and none as severe grade. Conclusions: The majority of patients presented mild lesions according to the Saint Elián scale.
Juvenile granulosa cell ovarian tumor. Case report
Granulosa cell tumors are a group of neoplasms of the sex cords, specialized gonadal stroma, and fibroblasts. They represent 2% of ovarian tumors and are rare in adolescents. This case report presents a 15-year-old adolescent who presented to the gynecology department with heavy menstrual bleeding and the passage of clots. Ultrasound revealed leiomyomas and physical examination revealed abdominal enlargement that was not tender to palpation. Additional tests revealed an ovarian tumor. Conservative surgery is the first line of treatment; however, ongoing follow-up is essential.
Level of knowledge about hypertension in patients, before and after an educational intervention
Introduction: Initially, hypertension is asymptomatic, it has a high prevalence without adequate treatment and control, leading to complications. The population can access information about the disease through educational interventions aimed at improving lifestyle and self-care, seeking to delay its progression and prevent complications. Objective: To identify the level of knowledge about hypertension before and after an educational intervention in hypertensive patients. Material and methods: Analytical, quasi-experimental, longitudinal and prospective study, applied to 190 hypertensive patients, assigned to the UMF 57 of the IMSS, during the time of April-December 2024, the Hypertension Questionnaire (CSH) was applied to measure their level of knowledge, before and after an educational intervention. The information obtained describes clinical and sociodemographic characteristics, which was analyzed with descriptive statistics and the Wilcoxon test, p values ≤ 0.05 were considered significant. Results: The mean age was 54.73 years (±10.96); 39.5% were men and 60.5% were women. 32.1% had technical schooling. The most common marital status was married (73.2%). T2DM was the most common comorbidity (47.4%), at 28.9%. Diagnosis was made between ages 6 and 10. At the time of measurement, 53.2% had elevated BP. Regarding the level of knowledge, the initial median was 13, and after the educational intervention, it was 21. The z score was also -11.978 and p = 0.000, indicating a statistically significant result. Conclusion: Applying an educational intervention modified knowledge about hypertension and improved knowledge about the disease in participants.
Neuropsychiatric symptoms at the end of life in dementia
Introduction: Neuropsychiatric symptoms (NPS) are frequent and complex manifestations in the terminal stages of dementia and represent a clinical challenge due to their impact on quality of life, caregiver burden, and end-of-life decision-making. Objective: The aim of this narrative review is to analyze recent evidence on the prevalence, classification, diagnostic approach, and comprehensive treatment of NPS in the context of terminal dementia. Materials and Methods: The main symptomatic domains (affective, psychotic, behavioral, and somatic-vegetative) are discussed, along with diagnostic tools such as the Neuropsychiatric Inventory (NPI) and other validated scales. Evidence-based, non-pharmacological interventions, and pharmacological options with risk-benefit considerations are also reviewed. Ethical aspects, such as advance directives, appropriate limitation of therapeutic effort, and palliative sedation, are addressed, recognizing the essential role of the geriatrician as the coordinator of the therapeutic plan and facilitator of interdisciplinary care. Results: NPS in terminal dementia require a proactive, empathetic, and evidence-based approach, with special attention to prognosis, continuous monitoring, and respect for patient dignity. Priority areas for future research include validation of prognostic tools and the effectiveness of culturally adapted interventions. Conclusion: Managing NPS is essential and requires a comprehensive, evidence-based approach. The role of the geriatrician is fundamental to ensuring quality care.
The genetic and symptomatic link of polycythemia vera. narrative review
Myeloproliferative neoplasms (MPNs), such as essential thrombocythemia (ET), primary myelofibrosis (PMF), and polycythemia vera (PV), are clonal hematologic disorders. PV is characterized by erythrocytosis, thrombophilia, and hemorrhagic diathesis, primarily attributed to the JAK2V617F mutation in the JAK2 gene, which is present in 90.7% of cases. This mutation induces hematopoietic proliferation, leading to thrombotic and hemorrhagic complications. The disease progresses slowly and may remain asymptomatic for years; however, the most common symptoms include: asthenia, aquagenic pruritus, skin redness, headache, hypertension, dizziness, dyspnea, peripheral neuropathy, idiopathic bruising, splenomegaly, hepatomegaly, and unexplained weight loss. This narrative review aimed to analyze advances in the understanding of PV from a molecular-biological perspective to aspects of medical care, in order to establish the relationship between phenotype and the identified genetic variations, thus allowing clinical correlations to be made and facilitating differential diagnosis with other hematologic conditions. The topics included in this review were: (1) Description of myeloproliferative neoplasms, (2) Epidemiology of PV, (3) Advances in the genetic and molecular understanding of PV, (4) Clinical manifestations and differential diagnosis, and (5) Therapeutic options and emerging therapies under investigation. Additionally, the importance of genetic diagnosis was emphasized to optimize therapeutic strategies and improve patient prognosis.
Enhancement of motor learning through the use of two different transcranial electrical stimulation protocols in healthy adults
The use of transcranial electrical stimulation (TES) to enhance motor learning is a topic of great interest in physical rehabilitation and the context of sports performance. The objetive was evaluate the effect of applying two different transcranial electrical stimulation protocols on motor learning in healthy adults. Materials and methods. The investigation consisted of two experiments; the first included 15 randomized control subjects assigned to three groups, each receiving different initial interventions. The first group started with transcranial direct current stimulation (tDCS), the second group started with transcranial random noise stimulation (tRNS), and the third group received a placebo stimulation. All subjects were evaluated using a Lafayette board, performing the four standardized tasks established by its authors. The total number of errors in each task was analyzed based on the experimental intervention. In the second experiment, 11 subjects were evaluated to determine the influence of timing (before or during the test) of the application of the modality that proved most effective in Experiment 1, using the Minnesota board. Results. In the first experiment, subjects who received tDCS and tRNS demonstrated better motor performance, making fewer errors compared to the placebo group (repeated measures ANOVA; p = 0.006). A large average effect size was found for tRNS (Hedge’s g = -0.8) and a moderate effect size for tDCS (Hedge’s g = -0.6). tRNS was more effective when applied during task execution (Hedge’s g = -0.64 vs. -0.33), but both modalities significantly reduced execution time (ANOVA, p = 0.0191). Conclusions. The application of tDCS and tRNS improved motor learning, particularly the application of tRNS during the execution of the experimental paradigm.
Gianotti-Crosti syndrome is a rare, benign, and self-limiting exanthem frequently seen in children under six years old. The objective of this study is to describe an unusual case in a pediatric patient. A 16-year-old adolescent presented with multiple acral, papulovesicular, erythematous, and pruritic lesions, with no other symptoms. Laboratory tests suggested an uncomplicated viral etiology, supporting the clinical diagnosis. Treatment included loratadine 10 mg/day and a moisturizing cream. Recognizing this disease is important, as it is often misdiagnosed and improperly treated.
Pathogens associated with hemodialysis catheter infections in patients with chronic kidney disease treated at the ’nephrology and dialysis’ clinic in querétaro; january 2022 - june 2023
In Mexico, the number of patients with kidney disease is increasing due to the fact that chronic degenerative diseases such as arterial hypertension and diabetes mellitus are common. In the long term, and when not adequately controlled, they condition the onset of Chronic Kidney Disease (CKD). End-stage CKD requires renal replacement therapy (RRT) either in peritoneal dialysis (PD) or hemodialysis (HD). Central venous catheter (CVC) placement is necessary for RRT with HD as it allows rapid access to the bloodstream. The main complication and cause of morbidity and mortality documented in HD patients is bacteremia (CRB). The objective of the present study was to review blood culture results in CVC for HD documented in the internal registry created by CODECIN (Committee for the Detection and Control of Nosocomial Infections) in a clinic in Querétaro. The methodology was analytical, cross-sectional, retrolective, and descriptive. A total of 337 catheters were analyzed and 207 blood cultures were obtained with suspected CRB associated with tunneled (permanent) and temporary catheters. The predominant microorganisms isolated were Gram positive: S. aureus 34.8% (72), S. epidermidis 17.9% (37), S. lugdunensis 2.9% (6). The type of catheter most affected by CRB (according to site of placement) was the right jugular temporal catheter with a total of 49.3% (102), the most affected sex was male, the month with the highest incidence was June 2023, and the most frequent age was 49-58 years.
Functional capacity and injury rates in upaep university soccer players at the beginning, during, and at the end of the first semester of the 2023 competition season
The physical and functional performance of a soccer player is a fundamental part of their performance in the sport, representing a significant challenge for them, their coaches, and health professionals. This research focuses on exploring the functional capacity and injury rates in university soccer players. This is a descriptive case-control study involving 23 university students who were part of the representative football team. Evaluations were conducted at the beginning, during, and at the end of the first semester of the 2023 competition season. The Functional Movement Screen (FMS) was used to assess functional capacity, and a survey method was applied to collect data from each player. Statistical analysis was performed using the SPSS software, version 27, employing the chi-square (x²) test for categorical variables and the Kruskal-Wallis test to compare game seasons. In the control group, 47.4% players presented some type of injury, and 100% of the cases did not complete the season. The football players did not demonstrate good functionality according to the FMS, although there was no significant difference (p=0.916), with a lower total score. Players with more minutes of play had a higher probability of injury (p=0.001), based on the comparison between the initial and final assessments. During the final evaluation, there was a higher report of injuries (p=0.054) in the case group compared to the control group. Based on these findings, the amount of playing time during each match was proposed as a potential risk factor for future injuries among soccer players. Additionally, the application of the Functional Movement Screen was suggested as a fundamental tool for training programming and dosage, with a lower score reflecting poor functional capacity as shown in the study.
Why conduct research? This is not a question that is often asked, perhaps because the answer seems obvious, or because consequentialist thinking is considered invalid. The research process is usually more important than its consequences. Research must be done, and done well. Whether or not the results are valuable and useful seems secondary; after all, there is no such thing as useless knowledge, and sooner or later it will find an application. The purpose of this paper is to focus on scientific research from a teleological perspective, that is, from the perspective of its results, consequences, outcomes, by-products, and applications, and in passing to explore some of the motivations that encourage dedication to research. Three aspects of the “why” of scientific research in medicine can be identified: 1. To generate knowledge. 2. As an educational strategy. 3. To take advantage of the incentives that promote it.
Medical-scientific evidence of fetal pain in the first trimester of pregnancy
It has been argued that embryos of fewer than 12 weeks of gestation do not feel pain; however, in this review where an analysis of the existing literature was carried out, different authors mention that fetal pain is difficult to assess because the main characteristic necessary to detect pain «is the subject’s ability to declare it». Nonetheless, for this premise, there is no scientific evidence to prove it. There are different structural elements of the development of the central nervous system in the embryo-fetus during the first trimester, such as the formation of peripheral nerves during week 4 and the development of the basic anatomy of the central nervous system at week 6 that suggest that fetal pain could be present. This is based on the fact that the primary development of the cerebral cortex is necessary for the perception of pain.
Copyright (c) 2024 https://creativecommons.org/licenses/by-nc-sa/4.0
Evaluation of knowledge of the algorithm and decision making upon Code H activation before and after an online educational intervention in gynecology and obstetrics residents
The American College of Obstetricians and Gynecologists (ACOG) defines as obstetric bleeding the loss of accumulated blood of more than 1000 ml, or bleeding associated with signs and symptoms of hypovolemia within 24 hours after the resolution of pregnancy, regardless of the birth route. In Mexico, obstetric hemorrhage is the second cause of maternal death, in 2019 with a percentage of 18.4%, so it is proposed to carry out an online educational intervention with pre- and post-evaluation in the residents of gynecology and obstetrics of the National Institute of Perinatology, with the aim of determining the knowledge and management before an activation of code H. It was carried out with a crosssectional, retrospective, descriptive study, which included 63 resident doctors of gynecology and obstetrics from the national institute of perinatology where 18 were of the first year, 15 of the second year, 16 of the third year and 14 of the fourth year, as a result the residents of the institute of the 3rd and 4th year obtained better grades because they are familiar with the actions to be carried out against an H code, however, in the final evaluation the four academic degrees improved, highlighting the 3rd year of residents with an average of 10.
Aerobic Exercise in Older Adults with Controlled Systemic Arterial Hypertension
High blood pressure has been identified as the most prevalent disease worldwide and the leading global cause of morbidity and mortality in adults. During 2020, the incidence rate of high blood pressure in Mexico was 334.3 cases per 100,000 inhabitants, where the group of older adults was the most affected, obtaining a prevalence of 63.9%. The objective of this study was to investigate the beneficial effects of 6 months of aerobic component training. This, hand in hand with pharmacological treatment, in older adults with controlled systemic arterial hypertension over their clinical condition, determined by the main variables studied (BP, BMI, and waist circumference). A population of 44 older adults who were classified into three groups of aerobic exercise was studied. Anthropometric data, vital signs, and statistical data were collected, evaluated, and compared between each exercise period. It was observed that the group with the highest percentage of patients who had a reduction in blood pressure was the swimming group, equaling 73% of the group. They also had a reduction in BMI and abdominal perimeter with 71% of the group experiencing the reduction at the end of the training period. Nevertheless, it was concluded that aerobic exercise constitutes a contributing clinical factor in the treatment and control of high blood pressure and cardiovascular risk factors. However, as it is a small sample, it could incur biases, which is why further research on sports medicine is suggested.
Anxiety, Depression and Burnout Syndrome in Students of Pilot Groups and Students form UPAEP Central Campus
According to the World Health Organization, the population suffering from a mental disorder is one in every eight people in the world. Mental disorders in medical students are of the utmost importance due to the consequences and lack of attention to the matter. The objective of this study was to prove the emotional burden of the UPAEP medical students in two study groups with two different environments with an impact on their emotions. This study was observational, cross-sectional, prospective, and comparative using the same study subjects and only numerators. It utilized two study centers and convenience sampling. Control group: students from 5th semester Pilot Groups with 26 students, and control group with 26 students from central campus from the same semester. Data collection includes the Beck Anxiety Inventory, Beck Depression Inventory, and Maslach Burnout Inventory, considering the variables: gender, physical activity, marital status, university scholarship, academic load, and additional job. It was found that the largest group with severe anxiety was from the central campus (2/26). Depression: females from central campus with 42.31%. Burnout syndrome was more frequent in Pilot Groups, with the female gender predominating at 30.7% (n=8). The pilot group member had a role with different characteristics from the central campus student. Due to the scenario in which they operate, they have contact with real patients during their academic day with the consequent rigor of this hurting the mental illnesses studied.
Follow up of 18 patients from the INCICh with pacemaker implantation in three different techniques: epicardial, endocardial and transvenous
Pacemaker placement is usually associated with adults. However, it is also a significant problem in pediatric patients. In children, the indications to place a pacemaker permanently are: symptomatic sinus bradycardia, Atrioventricular Block of the second or third degree, and prevention or eradication of arrhythmias. There are three different routes of pacemaker application: the endocardial route, the epicardial route and the transatrial route. There is no history of comparing these to identify the most efficient one. Therefore, our objective is to carry out an analysis of the three so that the medical area considers them and identifies the as the most effective. 18 patients from the «Ignacio Chávez National Institute of Cardiology» (INCICh) were evaluated in a retrospective study from 2011 to 2022. 15 patients were diagnosed with Atrioventricular Block and three with Long QT Interval Syndrome. All patients had pacemakers placed using the three different routes. The most used route was the endocardial route due to the history of efficiency at the institute with a total of eight patients. The rest of the patients weredivided equally. The result showed a positive balance with a total of five deaths, not associated with the placement of the pacemaker. Of the 13 living patients, eight of them presented parameter modifications, three presented implantation mode changes, one presented a complete pacemaker change and the last one did not require any modification.
Statistics of congenital heart disease diagnosed by echocardiography in adolescents and adults at the General Hospital Dr. Eduardo Vazquez N. in the pediatric cardiology service
Currently, the worldwide prevalence of congenital heart disease is about 9/1,000 births. Due to medical and surgical developments in recent decades, more people born with congenital heart disease survive to adulthood 1. This research aims to establish the statistics of adolescent and adult patients who were diagnosed with congenital heart disease by the pediatric cardiology service of the General Hospital Dr. Eduardo Vázquez N, from January 2020 to December 2022. This is a retrospective, observational study, in which 851 echocardiogram reports were reviewed. Sixty of them belonged to the selected age group, of these, 19 were discarded because they were detected to have structurally healthy hearts, and the rest (forty-one), were diagnosed with congenital heart disease. The most prevalent congenital heart diseases were interseptal defects such as ventricular septal defect and interatrial septal defect, followed by persistent ductus arteriosus, which corresponds to the prevalence of congenital heart diseases at the national level.
Burnout Syndrome and depression among employees of the Universidad Popular Autónoma del Estado de Puebla
Burnout syndrome is a state of chronic exhaustion that can occur in a wide range of work contexts in which employees experience psychophysical exhaustion, deterioration of personal relationships, a sense of professional inefficacy, and disillusionment. Depression symptoms are associated with the presence of burnout syndrome. In a sample of 121 participants, the association and risk of developing depression in collaborators with burnout syndrome were studied. Data were obtained through the Maslach Burnout Inventory (MBI-GS) and the Depression, Anxiety, and Stress Scale (DASS-21). Of the total sample, no participant reported feeling highly accomplished and competent in their area of work, and a high percentage suffer from emotional exhaustion. The risk of developing depression in those with burnout syndrome is higher than in those not exposed. To ensure the emotional well-being and professional development of workers, it is proposed to create an accessible and effective digital tool that serves as both screening and provides coping strategies.