The Revista de Sanidad Militar. Mexico, is the official quarterly publication of the General Directorate of Health of the Secretariat of National Defense. Its publication began in 1948 and has been uninterrupted since then. Each issue publishes two to four research articles, two to six clinical case reports, one to three papers on medical education, and abstracts of works presented at academic events. The Revista de Sanidad Militar accepts articles in Spanish and English.
Dirección General de Sanidad, Secretaría de la Defensa Nacional
Slow coronary flow and anatomical-functional discordance in patients with myocardial ischemia detected by SPECT
Myocardial ischemia detected by single-photon emission computed tomography (SPECT) does not always correlate with the degree of epicardial coronary stenosis, suggesting the involvement of functional mechanisms such as coronary slow flow (CSF). This study aimed to estimate the prevalence of CSF and evaluate its mismatch with epicardial stenosis severity in patients with moderate or severe myocardial ischemia documented by SPECT who underwent diagnostic coronary angiography. A cross-sectional, observational, and retrospective study was conducted in 71 adult patients with moderate or severe ischemia on SPECT and available diagnostic coronary angiography, evaluated between January and November 2023 at the Central Military Hospital. Clinical and angiographic variables were analyzed using descriptive statistics, exact tests for categorical variables, and Spearman correlation. The mean age was 65.4 ± 9.6 years, with a male predominance and a high prevalence of cardiovascular comorbidities. Significant stenosis (≥70 %) was present in 60.6 % of patients. Moderate ischemia was the most common finding, with no significant association with the degree of coronary obstruction (p = 0.546). CSF was identified in 28.2 % of patients (95 % CI: 17.7–38.6 %), estimated using a binomial confidence interval. CSF was more frequent in the <50 % stenosis group (60.0 %) and less frequent in the ≥70 % stenosis group (11.6 %) (Fisher’s exact test, p < 0.001). These findings suggest a marked anatomical–functional mismatch and position CSF as a clinically relevant phenomenon, possibly associated with microvascular dysfunction, highlighting the need for physiological assessment beyond angiographic findings in patients with functionally documented ischemia.
Myocardial Ischemia without Significant Obstruction
Non-Obstructive Coronary Artery Disease (NOCAD)
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Assessing corneal cell counts before and after advanced cataract surgery: a comparative analysis of horizontal PHACO CHOP AND MILOOP® techniques
Objective: to compare changes in visual acuity and corneal endothelial cell density in patients undergoing cataract surgery using phacoemulsification with the Horizontal Phaco Chop and miLOOP® techniques. Methods: an observational, retrospective, and comparative study was conducted in 19 patients (22 eyes) treated at the Central Military Hospital. Surgical outcomes were compared between Horizontal Phaco Chop and miLOOP®. Visual acuity was assessed 24 hours and one month after the procedure, as well as cell density. Results: patients, of both sexes and aged between 52 and 82 years, showed a 48.0 % decrease in corneal endothelial cell density with Horizontal Phaco Chop and a 49.0 % decrease with miLOOP®. Visual acuity improved by 33.9 % with Horizontal Phaco Chop and by 44.5 % with miLOOP® at 24 hours, remaining similar after one month. Limitations: small sample size and short follow-up, limiting the generalization and evaluation of the real impact of both techniques. Originality: directly comparing Phaco Chop and miLOOP® provides novel evidence on visual recovery and endothelial damage. Conclusions: both techniques produced comparable reductions in corneal endothelial cell density. However, miLOOP® showed an advantage in early visual recovery (first 24 hours), which was not sustained in the long term. This suggests that miLOOP® could be a favorable alternative for achieving initial visual recovery, even
Sublingual mucoepidermoid carcinoma. Clear cell variant.Case report and literature review
Mucoepidermoid carcinoma is the most common malignant tumor of the salivary glands, accounting for 10-15 % of all salivary gland neoplasms and 30 % of all salivary malignancies, followed by adenoid cystic carcinoma. Tumor stage and grade have historically been important predictors of survival. The objective of this article is to present a clinical case diagnosed in the Dental Specialties Unit of SEDENA and to carry out a review of the literature to highlight its particularities. This is a 52-year-old woman who has increased volume in the floor. of the mouth, in which an excisional biopsy was performed and whose histopathological findings correspond to a high-grade mucoepidermoid carcinoma with the presence of clear cells, a rare variant reported in the literature. Both the clinical presentation on the floor of the mouth and the histopathological diagnosis stand out for their infrequency reported in ifferent publications and highlight the importance of making a timely accurate diagnosis and adequate treatment.
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Infrared thermography as an adjunct to ICG (IndocyanineGreen) angiography for the assessment of perfusion in DIEP(Deep Inferior Epigastric Perforator) flaps: a pilot study ofcorrelation and concordance
Background: loss of tissue perfusion and fat necrosis in DIEP (Deep Inferior Epigastric Perforator) flap econstruction, secondary to hypoperfusion, remains a cause of morbidity. ICG (Indocyanine Green) angiography is the current gold standard for intraoperative assessment but may overestimate ischemia. imilarly, infrared thermography technologies can estimate the risk of necrosis and perfusion success. However, their combined use has not been studied. The objective of this study was to evaluate the correlation and concordance etween the thermographic hotspot and ICG angiography. Materials and methods: a pilot study was conducted on 12 patients undergoing breast reconstruction with a DIEP flap. Intraoperatively, flap perfusion was assessed with thermography using a thermal camera, and with ICG using the SPY-Q software scale. Results: dual verification with ICG and the thermographic hotspot allowed for the detection of one case (8.7 %) with immediate postoperative ischemia that required a new arterial anastomosis. At the 12-month follow-up, the patient presented no major complications. The correlation between both technologies was significant for zones I and III p<0.05). Their concordance for estimating the zones used for perfusion diagnosis was significant, yet weak (Kappa=0.25, p=0.019). Conclusions: despite a weak statistical concordance, the combined use of thermography and ICG angiography in a dual-verification model proved to be clinically effective for minimizing fat necrosis. This dual strategy represents a promising tool for optimizing intraoperative decision-making.
Application of the Nursing Care Process in intra and extra-hospital simulation by military nursing students in Argentina
1. The objetive of this work is to analyze the effectiveness of the application of the Nursing Care Process (NCP) in a simulated clinical situation of Cardiopulmonary Resuscitation (CPR), comparing its adequacy in the in-hospital and out-of-hospital settings in Argentinian military nursing students. 2. A cross-sectional study was carried out applying a 2x2 random factorial quasi-experimental desing whose independent variable was the type of nursing care situation and the dependent variable was the application and adecuancy of the NCP and the CPR technique in a simulator. The sample was made up of third and fourth years cadets of the Barchelor's Degree in Nursing from the Military College of the Nation. Two random groups were fomed: a) in-hospital setting (n = 22) and b) out-of-hospital setting (n = 22). 3. The results indicated that the application of the NCP was significantly more appropiate in the out-of-hospital setting simulated. 4. The limited number of the population limits the sampling possibilities and the consequent generalization of the results. 5. The study contributes to the improvement of the training of military nurses, who make up front-line health agents in action in emergency and catastrophe events. 6. It is concluded that it is relevant to continue developing simulated practices, in order to strengthen their clinical skills to effectively resolve in-hospital situations such as catastrophe situations, articulating the use of NCP with specific nursing techniques or procedures (e.g., CPR, placement of venous accesses, etc.), in situations of great uncertainty regarding the critically ill patient.
Cardiopulmonary thromboembolism and Raynaud’ssyndrome in a patient with SARS-CoV-2: case report
Introduction: SARS-CoV-2 can activate autoimmune responses. Increasing evidence points to a central role of endothelial cells in SARS-CoV-2 infection, causing increased expression of vascular and inflammatory factors. These markers are associated with pulmonary and systemic pathologies. Case Report: a 39-year-old male, with a history of COVID-19, entered our service presenting with hemoptysis, dyspnea on small exertion, saturation of 97 % and Raynaud’s syndrome. A CT angiography was performed showing massive pulmonary thromboembolism with right heart failure secondary to thrombus in the right ventricle. The patient was managed with monoclonal antibodies and a thrombolysis plan.
Ventana analgésica y antiemética post-operatoria
Forty-five patients underwent abdominal hysterectomy under balanced general anesthesia. They were classified into three groups to compare postoperative pain control, nausea, and vomiting. The first group received analgesics only upon request, and ondansetron was administered if they experienced nausea or vomiting. The second group received analgesics immediately after anesthetic emergence, regardless of pain complaints, and the antiemetic only if needed. The third group represented the analgesic and antiemetic window; they were prescribed the medications before the end of the anesthetic procedure. In 40% of the patients (18), a single dose of buprenorphine combined with scheduled dipyrone was sufficient for pain control; of these, 12 patients (26.5%) belonged to the third group. The therapeutic effect of ondansetron was clearly demonstrated by its ability to suppress nausea and vomiting in patients from the first and second groups, while its prophylactic action was evident in women from the third group. Drowsiness was the most common side effect (58%), which contributed to the calm recovery of our patients and strongly supports the absence of these postoperative complications.
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Evolución del Servicio de Sanidad a partir de la Revolución Mexicana de 1910
In Mexico, as in almost every country on Earth, medicine is as old as the world itself and existed long before physicians appeared on the stage of human societies. Long before there were individuals specifically dedicated to alleviating ailments, people were already experiencing pain and illnesses, which they sought to prevent or at least relieve.
La mujer embarazada agredida por trauma y su atención prehospitalaria
Trauma during pregnancy has increased in recent years, reaching up to 7%. It has been associated with a high risk of fetal loss. The main cause is motor vehicle accidents, and the most common type is blunt trauma. For proper prehospital care, it is necessary to consider the physiological changes that occur during pregnancy, such as blood pressure, pulse, blood volume, and positional changes of the uterus, bladder, heart, etc. The effects of trauma may include, among others, shock, placental abruption, uterine rupture, direct fetal injuries, and fetomaternal hemorrhage. Management should be carried out with the same level of aggressiveness as for a non-pregnant patient, while taking into account the physiological changes and prioritizing maternal resuscitation. Since apparently stable maternal signs may not reflect the true condition, rapid transport to a trauma center is essential.
Procedimientos, técnicas e información La psicoterapia de grupo y el concepto de "enlace" en el contexto hospitalario
The group psicotherapy (GP) was addressed by Joseph Pratt in 1904 in a general hospital and it was intended for chronic tuberculous patients. Afterwards it was applied by Lazell for psycotic patients. Currently it is considered as a common application for patients who have malignancy, AIDS, cardiovascular diseases, diabetes, nephropathy and others. The conception of "linking" appears in 1930 based upon the old complex mínd-body; it facilitates the conection to other medical specialties and with tbe family medical care. Diverse ways of "linking" sucb as intersconsultation, the linking itself, the psychiatric bridge, the hybrid model or the autonomous model can be elicited all inside a general hospital as the sub-speciality of "linking" are merging up. Pre-requisites for an eft'ective application of the ''linking" methodoly include: programming in time, setting up on precise objetives and estimation of the regression deprees. This paper is a trial designed in order to achieve the optimal intercommunication between the mental and other medicai disciplines in the standars of a general hospital.
Manifestaciones orales del paciente con síndrome de inmunodeficiencia humana.
This article describes the oral lesions oí a lDV iníected female patient who was treated at the Millitary Central Hospital. Oral examination was carried out once the lDV iníection was confirmed. The oral status of thís patient was that expected for those HIV infected individuals who receive attention at a dental oflice with or without knowledge oí their dísease.
Hepatitis crónica C, Vll-1 y síndrome de Sjögren
The Sjügren's syndrome is an autoimmune limpho-exocrinopathy of unknown ethiology. The two forms of presentation are: 1) primary form and 2) associated to several autoimmunes diseases. Many viroses have a role in the genesis of this syndrome (EpsteinBarr, cytomegalovirus, herpes simplex, retrovirus). It has currently been related to the hepatitis C virus and associated with chronic hepatitis, primary biliar cirrhosis and autoimmune trombocitopeny. We present the case of one patient with chronic hepatitis C and mv se ropositive reaction who later developed Sjügren's syndrome.
Tuberculosis primaria en la amígdala palatina.
The tuberculosis is the infection produced by Mycobacterium tuberculosis in the lungs, lymphatic nodes, meninges, kidneys, bones and seldom in the oral cavity. The lesions are ulcers, gums, fissures, hypertrophic gingivitis, tuberculoma, velvety ulcerations and granulomas in the mouth. This is the case of a male patient of 30 years with tuberculosis in the right side palatine tonsil as primary lesion as well as the ipsilateral lymphatic node affection, admitted to the Millitary Central Hospital. He was treated by ryfampicin 600 milligrams and isoniazid 300 milligrams daily PO, during 9 months, with good response.
A 73-year-old man with a 7-year history of tuberculosis developed an hemoptysis episode. The bronchial angiography revealed a hypervascular lesion of 6 x 7 cm in size and multiple arteriovenous flstulae. The embolization attempts failed to resolve the problem because of the high risk of the lesion. Patient was not operated on because of the high risk of their lesion. He was discharged with drug treatment for tuberculosis. Pulmonary aneurysm resulting from arterial erosion in cavitary tuberculosis is uncommon. It was described in detail by Fearn, Leannec aod Rasmussen in the past century. Its recognition is essential since the natural outcome for the vast majority of these aneurysms is the fatal rupture.
Validation of the Vitroveil® self-sampling device for cervical cancer screening
Objective: to demonstrate the validity of this new screening method (self-sampling) for cervical cancer, increasing the screening capacity to prevent cervical cancer based on its accessibility, ease of use, and favorable cost/benefit ratio. Design, methodology or approach: cross sectional observational study, with a cohort of 186 patients attended at the Military Hospital of Women’s Specialties and Neonatology, aged between 25 and 65 years. For each patient, two tests were analyzed: a self-sample vaginal specimen taken by the patient herself and a cervical brush sample using a vaginal speculum taken by the physician. The cervical samples were processed using the laboratory’s routine protocol for HPV based on PCR. Both the cervical and self-sample vaginal specimens were analyzed with the automated solution HPV 360 Test HPV Screening and genotyping. The concordance, sensitivity, and specificity of each method were evaluated, as well as patient acceptability through a satisfaction survey. Study limitation or implications: the use of self sampling limits the possibility of clinical assessment of the external female genital tract Originality or value: the self-sampling method increases the possibility of broader screening due to its practicality, lower pain, and greater accessibility, as it does not require hospital infrastructure for sample collection. Findings or conclusions: the device demonstrated a sensitivity (96 %) and specificity (93 %) in detecting high-risk HPV compared to the traditional sample taken by healthcare personnel. Regarding user satisfaction, the self-sampling method showed high acceptability, mainly due to its comfort and ease of use. These results suggest that self-sampling could be a useful tool in cervical cancer screening, especially in populations with limited access to healthcare.
Trastorno psicótico agudo como síntoma inicial de anemia perniciosa: reporte de un caso
A case of a patient with psychotic symptoms diagnosed with pernicious anemia as the underlying cause of their condition is reported. The literature is reviewed.
El médico audiólogo y foniatra, una visión general
Specializing in Audiology, Otoneurology, and Phoniatrics is are little known among the people, even among physicians. lt is very important to publicize it broadly due to the fact that it is a medical specialty with a wide field of action and which impact on the recovery of the quality of life on patients is beyond a shadow of a doubt.
HiperCKemia idiopática. Presentación de un caso y revisión bibliográfica
A 34 years old male patient came to the emergency department with myalgias in the proximal area of inferior limbs, he started with symptoms 72 hrs. before his arrival. He said, he had been drinking alcohol the week before without reaching drunkenness and he took drugs to lose weight. The physical exploration did not show any muscle weakness, just pain with flexion movements from inferior limbs and a little pain with deep palpation on both quadriceps. The laboratory results with increase of creatine kinase of 17,000 U/L, for that reason the hospitalization was necessary with a parenteral hydration plan, urine alkalinization and complementary studies in order to find the etiology. A muscle biopsy was necessary and the result was reported normal, the viral profile for herpes virus type 1 and 2 (lgM) was positive. We thought that the creatine kinase elevation was related to the alcohol consume, drugs to lose weight and the probable viral infection.
Acromegalia-gigantismo: reporte de un caso y revisión bibliográfica
Acromegaly and gigantism due to pituitary adenomas are very rare, where description of the disease is limited to small group of cases reported, because of its lower prevalence. Both related to excessive production of Growth Hormone (GH), characterized by progressive disfigurement, which affects men and women equally and is often diagnosed four to more years later after its onset because of its slow progression. Diagnosis is clinical but needs to be confirmed by another biochemical and imaging studies in order to determine tumor volume and extension. Treatment is principally focused on excising lesion and on reducing GH and IGF-1 (Insulin-like Growth Factor) levels, to normal values. Transesphenoidal surgery is often the first line treatment, but radiotherapy can be used, concomitant with pharmacological treat- ment. However, even if patients are cured, sequelaes often remain. There´s the importance of this case, to emphasize on disease diagnosis and multidisciplinary approach.
The sarcoma of Kaposi (KS) is associated to the AIDS, it is a tumor vascular systemic characterized by nodules purplish-blue-red and for secondary edema to lymphatic obstruction. The coetaneous lesions of the KS frequently begin in form of stain equimotic. The lesions in general are asymptomatic. The lesions can sometimes be ulcerated and to bleed with easiness. The sarcoma of Kaposi intraoral can be the initial manifestation of at least 60% of these reported cases. The biopsy is necessary for a definitive diagnosis. The KS is important to detect it early, the treatment it avoids complications and it allows that the patient with AIDS lives more time.
Intoxicación aguda por alcohol. Guía de certificación médica en el Ejército Mexicano
Acute alcohol intoxication intoxication is a serious public health problem in our country that annually represents significant economic losses, absenteeism, fatalities, disability, family breakdown, among others; This situation is no stranger to the reality of the Mexican Army and Air Force. The primary intent of this study corresponds to the Mexican military providing specific medical criteria for medical certification of the state of acute alcohol intoxication (intoxication level) and physical examination format that allows unify the clinical trial for these cases.
Abordaje diagnóstico de la enfermedad ósea metastásica
Metastatic bone disease results interesting and relevant due to high incidence of tumors and the morbidly and mortality associated, being breast cancer and prostate cancer the primary tumors with highest frequency. This article pretends to do a review of actual literature about bone affectation produced by oncologic diseases, to determinate a diagnostic guideline in the Medical Services of the Mexican Army Forces, and to have standard criteria in order to avoid unnecessary use of diagnostic resources. Our conclusion is that it is not any diagnostic modality able to be the only one with the sensibility and specificity to use like gold standard, however, we suggest an algorithm when EOM is suspected that could have impact in opportunity and individualization of the patients management.
Evaluación de la reactividad vascular pulmonar con iloprost inhalado en pacientes con hipertensión arterial pulmonar en la sala de hemodinamia del Hospital Central Militar
lloprost has been used to test acute pulmonary vasoreactiv- ity and identify responders patients to treatment with calcium antagonists in Pulmonary Arterial Hypertension (PAH).
Reflejo de Moro. Concordancia interobservador en la evaluación de recién nacidos menores de 48 horas de vida
Primitive reflexes like Moro reflex allow establishing early the integrity of the nervous system in infants, but its valuation depends on the observer training.
La influencia de la cultura organizacional en el desempeño hospitalario
This research analyses the connection that leadership, strategic objec- tives, system of incentives, and other factors included in cultural organization have with the performance in acute hospital.
Experiencia en trasplante de microbiota fecal en el Hospital Central Militar
Fecal microbiota transplantation is the application of feces from healthy human digestive tube to another one with a specific disease, like pseudomembranous colitis due to Clostridium diMÄJilL infection. In the last decades, the importance of the fecal microbiota and its relation with some diseases has been recognized.
Correlación entre estrés, depresión y rasgos de personalidad en estudiantes de la Escuela Médico Militar durante los dos primeros años de adiestramiento
Identify the correlation between levels of depression, perceived stress, and personality traits during the first two years of training at the Military Medical School.
Eficacia de la angioplastia primaria con balón overthewire versus dispositivos de aspiración como tratamiento del trombo intracoronario
To evaluate a new technique developed by the laboratory personnel interventional cardiology favoring conventional percutaneous coronary intervention by reducing the burden intracoronary thrombus, distal embolism and reperfusion injury, using the long ball over the wire.
Acute myocardial infarction with ST segment elevation
Aspectos demográficos en lesión de vía biliar en un periodo de 8 meses en colecistectomía laparoscópica en el Hospital Central Militar
Laparoscopic cholecystectomy through the times to established itself as the gold standard for gallbladder cancer disease, but the consequence is the increase of bile duct injures documented.
Incidencia acumulada de eventos cardiovasculares adversos mayores en pacientes con enfermedad del tronco de la arteria coronaria izquierda asociada con enfermedad coronaria multivascular tratados
Evaluate the 5 years cumulative incidence of MACE in pa- tients with LM.C.AD associated to multivessel coronary artery disease treated with PCI and stent implantation.