Melany Mejia-Mora

Background: nephrocolic, renocolic, or colorenal fistulas are a rare condition, generally associated with inflammatory processes of infectious, traumatic, or neoplastic origin involving the kidney. Their clinical presentation is often nonspecific, and diagnosis is primarily based on complementary imaging studies. Although various triggering factors for this pathology have been identified, no previous cases caused by an abscessed renal cyst following a low-height fall have been reported. Case report: an 81-year-old female patient with a history of hypertension, diabetes mellitus under treatment, and a previously diagnosed simple renal cyst in the left kidney presented with fatigue and anorexia following a low-height fall. She was referred to our institution from a local hospital, where tomography revealed findings consistent with emphysematous pyelonephritis and a complex renal cyst in the left kidney, prompting the decision for surgical intervention. During surgery, a fistula between the abscessed renal cyst and the colon was identified and treated with fistulectomy and primary suture repair of the splenic flexure of the colon, along with drainage of the left renal cyst abscess. The procedure yielded favorable results and a positive prognosis. The causes of nephrocolic fistulas are often linked to inflammatory kidney processes complicated by urinary tract infections. In this case, the association between a pre-existing renal cyst and trauma from the fall should be considered. The treatment for this condition involves surgical closure of the fistulous tract. In conclusion, renocolic fistulas are generally caused by inflammatory, infectious, or traumatic renal processes. Their clinical presentation is highly variable, and management requires surgical intervention, including fistulous tract resection.

The management of heart failure (HF) in patients with type 2 diabetes has significantly evolved with the introduction of sodium-glucose cotransporter 2 (SGLT2) inhibitors. This article aims to consolidate existing knowledge on the efficacy of these inhibitors in managing HF in this patient population. Major medical databases, including PubMed, Scopus, and Web of Science, were reviewed, prioritizing research from the last decade. The results of this review highlight the mechanisms of action of SGLT2 inhibitors, their clinical benefits, challenges in patient management, and outcomes associated with their use. These medications were found to not only improve glycemic control but also offer significant cardiovascular and renal benefits, reducing cardiovascular mortality and major adverse cardiovascular events. However, challenges and knowledge gaps persist, particularly regarding long-term effects and safety in diverse populations. The conclusions of this review underscore the importance of updating clinical guidelines to incorporate these findings and propose the need for future research to address existing gaps and optimize the use of SGLT2 inhibitors in clinical practice.

Non-ischemic dilated cardiomyopathy (NIDCM) is a form of heart failure with a poor prognosis and unclear optimal management. The aim of the study was to systematically review the literature and assess the efficacy and safety of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in the management of chronic heart failure secondary to NIDCM and explore their putative mechanisms of action. Studies from 1990 to 2023 were reviewed using PubMed and EMBASE, focusing on their effects on left ventricular ejection fraction (LVEF) in NIDCM patients, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Beta-blockers showed a significant beneficial effect on LVEF improvement in NIDCM, with an overall effect size of Cohen’s d = 1.30, 95% confidence interval (CI) (0.76, 1.84), high heterogeneity (Tau² = 0.90; Chi² = 162.05, df = 13, P < 0.00001; I² = 92%), and a significant overall effect (Z = 4.72, P < 0.00001). ACE inhibitors also showed a beneficial role, but with less heterogeneity (Tau² = 0.02; Chi² = 1.09, df = 1, P = 0.30; I² = 8%) and a nonsignificant overall effect (Z = 1.36, P = 0.17), 95% CI (-0.24, 1.31). The study highlights the efficacy of carvedilol in improving LVEF in NIDCM patients over ACE inhibitors, recommends beta-blockers as first-line therapy, and advocates further research on ACE inhibitors.

Shifts from deep to moderate hypothermic circulatory arrest (HCA) in aortic arch surgery necessitate an examination of their differential impacts on neurocognitive functions, especially structured verbal memory, given its significance for patient recovery and quality of life. This study evaluates and synthesizes evidence on the effects of deep (≤20.0 °C), low-moderate (20.1–24.0 °C), and high-moderate (24.1–28.0 °C) hypothermic temperatures on structured verbal memory preservation and overall cognitive health in patients undergoing aortic arch surgery. We evaluated the latest literature from major medical databases such as PubMed and Scopus, focusing on research from 2020 to 2024, to gather comprehensive insights into the current landscape of temperature management during HCA. This comparative analysis highlights the viability of moderate hypothermia (20.1–28.0 °C), supported by recent trials and observational studies, as a method to achieve comparable neuroprotection with fewer complications than traditional deep hypothermia. Notably, low-moderate and high-moderate temperatures have been shown to support substantial survival rates, with impacts on structured verbal memory preservation that necessitate careful selection based on individual surgical risks and patient profiles. The findings advocate for a nuanced approach to selecting hypothermic protocols in aortic arch surgeries, emphasizing the importance of tailoring temperature management to optimize neurocognitive outcomes and patient recovery. This study fills a critical gap in the literature by providing evidence-based recommendations for temperature ranges during HCA, calling for ongoing updates to clinical guidelines and further research to refine these recommendations. The implications of temperature on survival rates, complications, and success rates underpin the necessity for evolving cardiopulmonary bypass techniques and cerebral perfusion strategies to enhance patient outcomes in complex cardiovascular procedures.

Comparative Efficacy of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in the Treatment of Ischemic Heart Disease: A Systematic Review and Meta-Analysis of Recent Randomized Controlled Trials

Los avances en Tomografía por Emisión de Positrones (PET) y Tomografía Computarizada (CT) han transformado la imagenología médica, proporcionando una combinación única de información anatómica y funcional para mejorar el diagnóstico y seguimiento terapéutico. La presente investigación se desarrolló en base a una metodología de revisión bibliográfica, empezando en la búsqueda exhaustiva de artículos científicos, revisiones sistemáticas y metaanálisis publicados en bases de datos como PubMed, Scopus y Web of Science. Se utilizaron términos de búsqueda específicos relacionados con aplicaciones clínicas y futuras perspectivas en imagenología médica utilizando PET y CT. Actualmente, se utilizan en una variedad de aplicaciones clínicas, desde la detección temprana del cáncer hasta la evaluación de enfermedades neurodegenerativas. Las futuras perspectivas incluyen la integración de tecnologías como PET/MRI, nuevos radiotrazadores y el uso de inteligencia artificial, lo que promete una mayor precisión diagnóstica y tratamiento más personalizado. Además, la teranóstica ofrece una nueva frontera al combinar diagnóstico y tratamiento en una sola plataforma. En resumen, estos avances están conduciendo hacia una imagenología médica más avanzada y precisa.