Clotilde Fuentes-Orozco

Background: Acute pancreatitis (AP) is an acute inflammatory condition with high metabolic demands; however, early detection of nutritional risk is underestimated and there is no universal consensus on which is most effective for predicting nutritional risk. Objectives: To compare the level of agreement of nutritional screening methods with subjective global assessment (SGA) in identifying nutritional risk in patients with AP. Methods: This study was conducted as a prospective observational cohort in hospitalized patients diagnosed with mild or moderate AP. Screening tools: nutritional risk screening-2002 (NRS-2002), malnutrition universal screening tool (MUST), short nutritional assessment questionnaire (SNAQ), malnutrition screening tool (MST) and clinical assessment via SGA were performed. Results: Nutritional risk was found in 55.3% patients via SGA assessment, 43.2% in MST, and 38.6% in NRS-2002 and SNAQ and 10.6% in MUST scales. Patients without nutritional risk exhibited a significantly higher mean BMI than at-risk patients (p = 0.026). Patients with moderate AP exhibited a 3.93 increased risk of nutritional risk compared to those with mil AP (p = 0.02). The NRS-2002 and SNAQ scales achieved the highest agreement compared with SGA. Conclusions: Nutritional risk is highly prevalent in patients with mild and moderate AP, showing a significant increase as clinical severity progresses. The NRS-2002 and SNAQ scales had more agreement and better performance when compared with SGA.

Chronic respiratory diseases (CRDs) are heterogeneous disorders in which nutritional status, body composition, systemic inflammation, and metabolic dysfunction can influence clinical trajectories. Precision nutrition aims to move beyond uniform dietary recommendations by incorporating individual clinical, nutritional, behavioral, metabolic, and microbial characteristics. This chapter critically examines the emerging intersection of precision nutrition, the gut–lung axis, microbiota, and nutraceuticals in CRDs. It reviews current concepts of respiratory and intestinal microbial ecology, mechanisms of gut–airway communication, and disease-specific evidence in chronic obstructive pulmonary disease, asthma, bronchiectasis, and interstitial lung diseases. Nutritional phenotypes, including malnutrition, sarcopenia, obesity, and frailty, are considered as potential modifiers of respiratory outcomes and treatment response. Evidence for dietary patterns, fiber, omega-3 fatty acids, vitamin D, polyphenols, protein-directed strategies, probiotics, prebiotics, synbiotics, and postbiotics is evaluated according to the strength of human clinical data and biological plausibility. Although microbiome and multi-omics approaches may eventually improve patient stratification, current evidence does not support routine microbiome-guided nutritional therapy outside research settings. Translation will require standardized methods, validated biomarkers, and adequately powered clinical trials using meaningful respiratory and nutritional outcomes.

Background: Epilepsy is a neurological disorder affecting over 50 million people worldwide, with a global incidence of 7.6 per 1,000 individuals. Mesial temporal lobe epilepsy (MTLE) is characterized by recurrent, unprovoked seizures originating in the temporal lobe. The standard surgical treatment is anterior temporal lobectomy; however, many patients are not suitable candidates due to the risk of adverse effects, including significant memory impairment, language deficits, bilateral temporal involvement, or reluctance to undergo resective surgery. This study aimed to evaluate the anticonvulsant effect of linear accelerator (LINAC)-based radiosurgery in patients with drug-resistant unilateral MTLE. Methods: A prospective, single-center, exploratory pilot case series was conducted from March 1, 2017, to March 1, 2020, at the Hospital de Especialidades, Centro Médico Nacional de Occidente. Patients aged 18–65 years with a confirmed diagnosis of drug-resistant unilateral MTLE were enrolled. The primary outcome was defined as the achievement of complete freedom from disabling seizures (Engel Class I and ILAE Class 1) at 24 months post-radiosurgery. Secondary efficacy outcomes included achieving a ≥ 50% reduction in seizure frequency. The prescribed dose of 22 Gy was normalized to the 50% isodose line at the isocenter, ensuring ≥ 90% target coverage (V100 ≥ 90%) and a dose gradient < 10%, targeting the hippocampal head and anterior body. Results: Seven patients were included. Median seizure frequency decreased from 12 seizures/month at baseline to 3.5 seizures/month at 24 months, corresponding to a median reduction of 75.6%.Longitudinal analysis demonstrated a significant reduction in seizure frequency over time (Friedman χ ² = 14.62, p = 0.006), with significant differences between baseline and all follow-up periods (p = 0.018). No patient achieved seizure freedom. Kaplan–Meier analysis demonstrated that 71.4% of patients maintained a clinically meaningful seizure reduction (≥ 50% from baseline) throughout the 24-month follow-up. Patients with preoperative auras exhibited a median aura reduction of 60%, whereas de novo auras developed in three previously aura-free patients. Adverse events included visual field deficits in three patients (42.8%), psychiatric complications in two (28.6%), and clinically significant memory decline in one patient with pre-existing cognitive impairment. Conclusions: LINAC-based stereotactic radiosurgery targeting the hippocampal head and anterior body achieved a clinically meaningful reduction in seizure frequency in selected patients with drug-resistant MTLE. However, complete seizure freedom was not achieved, and delayed adverse events were observed. Trial registration: The study was approved by the ethics committee of the Hospital de Especialidades, Centro Médico Nacional de Occidente (approval number R-2017–1301-57).

Background: Acute pancreatitis (AP) is an acute inflammatory condition with high metabolic demands; however, early detection of nutritional risk is underestimated and there is no universal consensus on which is most effective for predicting nutritional risk. Objectives: To compare the effectiveness of different nutritional screening tools in identifying nutritional risk in patients with AP. Methods: A cross-sectional analytical study was conducted at Civil Hospital of Guadalajara "Fray Antonio Alcalde" between May 2023 and May 2025. Hospitalized patients diagnosed with mild to moderate AP were included. Nutritional screening tools and anthropometric, demographic, clinical, and biochemical variables were also recorded. Results: Nutritional risk was found in 55.3% patients with SGA, 43.2% in MST, and 38.6% in NRS-2002 and SNAQ and 10.6% in MUST scales. Overweight was present in 43.2% of patients and obesity in 24.2%. Significant BMI difference was observed between groups (p = 0.02). Moderate patients with AP had 4.07 times higher probability of nutritional risk compared to those with mild AP (p = 0.02). The NRS-2002 and SNAQ scales achieved the highest diagnostic performance with moderate agreement (κ = 0.55 and κ = 0.52). Conclusions: Nutritional risk is highly prevalent in patients with AP, showing a significant increase as clinical severity progresses. The NRS-2002 and SNAQ scales proved to be the most effective screening tools in concordance with SGA. While higher BMI may seem protective, it could act as a confounding factor for nutritional risk during the acute phases of the disease.

Background/Objectives: Albuminuria is an important marker of kidney and cardiovascular risk in adults with type 2 diabetes mellitus (T2DM). Regional data from Mexico remain limited among patients with preserved estimated glomerular filtration rate (eGFR) and no previous diagnosis of diabetic kidney disease. This study aimed to describe albuminuria categories observed at a single screening assessment and to explore clinical factors associated with higher urinary albumin-to-creatinine ratio (uACR) categories in adults with T2DM receiving care at a regional hospital in western Mexico. Methods: This exploratory single-center cross-sectional study included 119 adults with T2DM (mean age, 53.3 ± 11.7 years), preserved eGFR (≥60 mL/min/1.73 m²), and no previous diagnosis of diabetic kidney disease. Albuminuria was classified from a single first-morning uACR measurement as A1 (300 mg/g). Exploratory multivariable ordinal logistic regression evaluated factors associated with higher uACR categories. A secondary exploratory binary model evaluated screen-detected uACR ≥ 30 mg/g (A2/A3 versus A1). Results: A1 was observed in 67 patients (56.3%), A2 in 40 (33.6%), and A3 in 12 (10.1%); 52 patients (43.7%) had uACR ≥ 30 mg/g at screening. The median uACR was 25.6 mg/g, the median HbA1c was 11.2%, and the median fasting glucose was 280 mg/dL. In the exploratory ordinal model, longer T2DM duration (OR 1.51 per 5 years; 95% CI 1.09–2.10; p = 0.012), higher HbA1c (OR 1.18 per 1% increase; 95% CI 1.01–1.38; p = 0.036), and lower eGFR (OR 0.69 per 10 mL/min/1.73 m² increase; 95% CI 0.55–0.88; p = 0.003) were associated with higher uACR categories after adjustment for the measured covariates. In the secondary binary model, longer T2DM duration and lower eGFR were associated with screen-detected uACR ≥ 30 mg/g. Conclusions: A single screening assessment identified uACR ≥ 30 mg/g in 43.7% of this selected regional cohort. These findings represent screen-detected albuminuria and do not establish persistent albuminuria, diabetic kidney disease, temporality, or causality. Confirmation with repeated uACR measurements and validation in larger longitudinal multicenter studies with detailed medication data are required.

Background: Nutritional abnormalities, alterations in body composition, and impaired muscle function are increasingly recognized as clinically relevant features in patients with Systemic Lupus Erythematosus (SLE). However, the relationship between multidimensional nutritional assessment and disease activity remains incompletely characterized. This study aimed to evaluate the associations between nutritional status, body composition, muscle strength, nutritional risk indices, and disease activity in patients with SLE. Materials and Methods: This exploratory retrospective study included hospitalized patients with SLE. Clinical data, anthropometric measurements, and nutritional status were assessed using the body mass index (BMI), prognostic nutritional index (PNI), controlling nutritional status (CONUT), and nutritional risk index (NRI). Muscle function was evaluated using the SARC-F scale. Disease activity was measured using the SLE Disease Activity Index 2000 (SLEDAI-2K). Multivariable linear regression models were constructed to assess the independent association between nutritional indices and disease activity, adjusting for age, sex, glucocorticoid exposure, and immunosuppressive therapy. Correlation analyses were performed between nutritional indices and disease activity-related variables, and supplementary exploratory Spearman correlations were performed between the SARC-F score and SLEDAI-2K, CRP, complement C3, complement C4, and ESR. False discovery rate correction using the Benjamini–Hochberg procedure was applied to exploratory correlation analyses. Results: A total of 67 patients were included. Nutritional indices (BMI, PNI, CONUT, and NRI) were not independently associated with SLEDAI-2K in multivariable regression analyses. In correlation analyses, after FDR adjustment, the PNI remained significantly associated with SLEDAI-2K, lymphocyte counts, and complement C3 levels, while CONUT remained significantly associated with lymphocyte count and C3 levels. The BMI and NRI were not significantly associated with disease activity or inflammatory markers after correction. SARC-F showed a weak positive correlation with SLEDAI-2K (r = 0.328; p = 0.008; qFDR = 0.040), which remained statistically significant after FDR correction. No significant correlations were observed between SARC-F and CRP, complement C3, complement C4, or ESR after FDR adjustment. Conclusions: Nutritional indices showed limited independent association with disease activity in SLE after adjustment for available confounders. Although the PNI and CONUT retained selected correlations with disease activity-related or immunological markers after FDR correction, these associations should be interpreted cautiously, as albumin- and lymphocyte-based indices may reflect inflammatory activity or disease burdens rather than nutritional status alone. SARC-F remains significantly associated with disease activity (SLEDAI-2K) after FDR adjustment. These findings should be validated in future prospective studies with a larger number of patients.

Background/Objectives: Diuretic resistance is a recognized complication in patients with heart failure (HF) and is associated with worse clinical outcomes; however, information regarding its frequency and associated factors in hospitalized patients in Mexico is limited. This study aimed to describe the frequency of diuretic resistance in patients hospitalized with HF in a hospital unit in western Mexico and to identify factors associated with diuretic resistance. Methods: This retrospective study used data obtained from clinical records. Patients older than 18 years with decompensated HF whose complete clinical records included the variables of interest were included. Patients were classified according to the presence or absence of diuretic resistance. Bivariate and multivariate analyses were performed to evaluate factors associated with diuretic resistance. Results: A total of 76 patients were analyzed, and the frequency of diuretic resistance was 35.5% (n = 27). In bivariate analysis, type 2 diabetes mellitus, chronic kidney disease, elevated creatinine, urea, blood urea nitrogen (BUN), and urine protein levels, decreased glomerular filtration rate (GFR) and serum albumin, and prior treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and angiotensin-converting enzyme inhibitors/angiotensin II receptor antagonists (ACEI/AARII) were significantly associated with diuretic resistance. In the multivariate logistic regression model, prior ACEI/AARII treatment, history of type 2 diabetes mellitus, BUN levels, and serum albumin levels remained independently associated with diuretic resistance classification. Conclusions: Diuretic resistance was frequent in this cohort of patients hospitalized with decompensated heart failure, and several clinical and biochemical factors were independently associated with its occurrence. These findings may help identify patients at higher risk of diuretic resistance, although they should be confirmed in future prospective studies.

Resumen Introducción: el priapismo es un trastorno en el que el pene mantiene una erección prolongada y rígida, sin estimulación sexual previa, con potenciales consecuencias físicas y psicosociales. Afecta a hombres de cualquier edad, con picos de incidencia en la infancia y en la adultez joven. Su manejo varía según la etiología, con el objetivo de evitar complicaciones. Objetivo: describir las características epidemiológicas y clínicas, así como el manejo y las complicaciones posquirúrgicas en pacientes con priapismo isquémico. Métodos: estudio transversal analítico en pacientes con diagnóstico de priapismo isquémico, a los que se documentaron datos epidemiológicos, comorbilidades, manejo y complicaciones posoperatorias durante un mes. Resultados: se incluyeron 20 pacientes, con edades entre 25 y 78 años, con una mediana de 32.5 años. El tiempo de evolución osciló entre 10 y 120 horas (± 31.8 horas). En cuanto a los antecedentes, 12 (60%) presentaban tabaquismo, 10 (50%) consumo de alcohol y 3 (15%) consumo de drogas ilícitas. Respecto a las comorbilidades, 10 (50%) presentaban hipertensión arterial, 3 (15%) diabetes mellitus tipo 2 y 1 (5%) dislipidemia. En cuanto al manejo inicial, la punción y drenaje de los cuerpos cavernosos fue el procedimiento más frecuente, realizado en 18 (90%) pacientes. La disfunción eréctil fue la complicación más común, observada en 7 (38.8%) pacientes durante el primer mes de seguimiento. Conclusiones: en nuestra población, la mayoría de los casos de priapismo presentaron antecedente de consumo de medicamentos, particularmente antihipertensivos. Solo un bajo porcentaje acudió dentro del tiempo de evolución adecuado, lo cual puede explicar la elevada frecuencia de disfunción eréctil observada.

Resumen Introducción: la neuropatía periférica inducida por quimioterapia (NPIQ) es la principal complicación en los pacientes supervivientes de cáncer, causando dolor y otras alteraciones sensitivas. La electroterapia con estimulación nerviosa eléctrica transcutánea (TENS) es un recurso no farmacológico para el manejo del dolor, que consiste en aplicación superficial de corriente eléctrica alterna a través de electrodos cutáneos; siendo una alternativa segura, económica y portátil. Objetivo: evaluar el efecto de la TENS en el dolor neuropático y otros síntomas sensitivos causados por la NPIQ secundaria a platinos en los pacientes con cáncer de colon o recto. Material y métodos: estudio cuasiexperimental, se intervino con 10 sesiones de rehabilitación con TENS y reeducación sensorial a este grupo de pacientes. Se evaluó el dolor neuropático, las alteraciones sensitivas superficiales, profundas y dolorosas, además del equilibrio monopodal con ojos abiertos y cerrados, antes y después de la intervención del tratamiento. Resultados: se reclutaron 14 pacientes, todos recibieron tratamiento con oxaliplatino. Se encontró mejoría en relación al dolor neuropático (p < 0.001), las alteraciones sensitivas (p < 0.001) y equilibrio monopodal de ambos pies con ojos abiertos (p < 0.001) y cerrados (p < 0.05). Conclusiones: la rehabilitación con TENS y la reeducación sensorial en pacientes con NPIQ secundaria a oxaliplatino disminuyó el dolor neuropático, las alteraciones sensitivas (superficiales, profundas, dolorosas) y el tiempo de equilibrio monopodal en ambos pies con los ojos abiertos y cerrados.

Se sabe muy poco sobre la función sexual femenina en pacientes con antecedente de diagnóstico de cáncer de mama. Los tratamientos para el cáncer de mama pueden ocasionar daños estructurales y funcionales en diferentes niveles, afectando negativamente la calidad de vida y el bienestar emocional de las pacientes. Estas secuelas pueden manifestarse como dolor, disminución del deseo sexual y dificultades en la intimidad, asociadas a procedimientos como la mastectomía, lumpectomía, radioterapia, quimioterapia y terapia hormonal. evaluar la función sexual femenina en pacientes en remisión de cáncer de mama estudio observacional y transversal realizado en pacientes con remisión de cáncer de mama que acuden a consulta al servicio de Medicina Física y Rehabilitación, durante el periodo de agosto a octubre 2024 a quienes se les realizó el cuestionario Índice de Función Sexual Femenina. se incluyeron 129 pacientes. Se encontró un alto índice de disfunción sexual en 104 casos (80.6%), a pesar de tener parejas estables y/o estar casadas. Entre las pacientes sometidas a mastectomía radical sin reconstrucción, solo 14 (18.6%) presentaron una función sexual adecuada. En contraste, las pacientes que fueron sometidas a mastectomía con reconstrucción obtuvieron las puntuaciones más altas en el Índice de Función Sexual Femenina. la mayoría de las pacientes sometidas a mastectomía sin reconstrucción presentaron disfunción sexual. En cambio, aquellas que recibieron reconstrucción posterior a la mastectomía radical mostraron, en su totalidad, una función sexual adecuada.