Introduction: The umbilical cord (UC) typically contains two arteries and one vein. The presence of a single umbilical artery (SUA) is the most common anomaly associated with the umbilical cord and is linked to various congenital conditions. However, SUA can also appear as an isolated condition (ISUA), occurring without any accompanying fetal structural or chromosomal abnormalities.

Left atrium and coronary sinsus fistulous connection is rare anonaly with devastating consequence leading to alteration in hemodynamic of blood flow. We present a case of 50 years old male who presented for evaluation of chest pain whose TMT was positive for reversible ischmia and coronary CT showed abnormal connection between coronary sinus and left atrium.

Introduction Distal femur periprosthetic fractures are a challenging complication following total knee arthroplasty (TKA). Primary surgical approaches are Revision Arthroplasty (RA) and Open Reduction Internal Fixation (ORIF). RA replaces unstable prosthetic components, while ORIF preserves the prosthesis. This review aims to evaluate the outcomes of RA and ORIF.

Background: AI systems for melanoma detection have shown considerable potential. Although, dermoscopy has become a widely utilized non-invasive method for diagnosing skin tumors. However, the variability in diagnosis caused by subjective interpretation of dermatological findings can affect both accuracy and consistency. Therefore, we conducted this study to review the accuracy, sensitivity, and specificity of Convolutional Neural Network (CNN) based on dermoscopy imaging in diagnosing melanoma.

Introduction: Brachydactyly (BD) is considered a genetic malformation that can cause disproportionately short fingers and toes. The incidence ranges from 0.0% up to 0.05%, with a predilection for females. On the other hand, the Walant anesthetic technique is safe and effective and uses epinephrine, lidocaine, and sodium bicarbonate.

Introduction: Wound dressing is a fundamental aspect of modern healthcare, encompassing a diverse range of materials and techniques aimed at optimizing the healing process while safeguarding against infection and further injury. By understanding the specific benefits of different types of wound dressings, healthcare professionals can optimize the healing process and improve patient outcomes

Introduction: Favism is a genetic disease-causing hemolytic anemia in Mexico, primarily due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Factors triggering favism include infections, pregnancy, certain drugs, and eating beans. The disease is inherited recessively and is more common in men. Diagnosing and managing favism during pregnancy is crucial, as it can lead to severe hemolytic anemia and neonatal jaundice.

Background: Hypoplastic Left Heart Syndrome (HLHS) represents one of the most severe congenital cardiac malformations, characterized by underdevelopment of left-sided heart structures, necessitating a complex surgical and medical management strategy. Despite advancements in staged palliation and neonatal care, outcomes remain suboptimal for a significant subset of patients. Recent progress in molecular biology, regenerative medicine, and surgical innovations offers novel approaches that may transform the clinical trajectory of these patients.

Introduction: Sporotrichosis is a mycosis caused by the fungus of the genus Sporothrix, of which six species related to human sporotrichosis are recognized, being the S. schenkii complex the most related to transmission in humans. The entry of the agent occurs by contact between the injured skin and the fungal spores, subsequently the fungal conidia are deposited in the host tissue and when introduced, become yeast. The fungus, now in its yeast-like phase, may remain at the site of entry or spread to other sites following the lymphatic vessels (1).

Vitiligo is a depigmentation disorder characterized by the distinct macules or depigmented patches, which are often asymptomatic. Age and geographic location have an impact on the prevalence of vitiligo. This condition affects 0.5-2% of the global population and is caused by a combination of factors, including clinical symptoms and therapeutic outcomes. Methods: The research material was taken from the medical record of vitiligo patients in the Outpatient Clinic Dermatovenerelogy Bali Mandara General Hospital from 2021-2022. The data were analyzed descriptively using SPSS program version 26 for Windows. Result: This study collected 198 visits from vitiligo patients at the Bali Mandara General Hospital Dermatovenereology outpatient clinic. The predominant gender is female (55.1%), with late adolescents comprising 36.4%, students accounting for 38.4%, and the development of vitiligo occurring within 1-5 years for 54% of cases; 63.1% of patients lacked a familial history of vitiligo. The predominant clinical kind is non-segmental vitiligo (59.1%), and the most frequently used treatment is excimer light phototherapy (85.9%). Conclusion: Vitiligo patients at Bali Mandara hospital, Denpasar, mostly female aged 17-25 years old, with non-segmental vitiligo . The most common therapies given are excimer light phototherapy.

Background: Gynecological conditions account for a significant number of surgical procedures performed worldwide, with complication rates reported between 0.2-34%. In Mexico, complication rates range from 2.15% to 15.06%. Factors such as age, obesity, comorbidities (hypertension, diabetes), and prolonged surgical time are associated with a higher risk of complications, including postoperative infections.

Myelodysplastic Syndromes (MDS) encompass a variety of bone marrow disorders characterized by insufficient production of healthy blood cells. Myelodysplastic Syndromes (MDS) represent a cluster of bone marrow conditions where theres a deficiency in generating a sufficient quantity of healthy blood cells. Patients with MDS often exhibit an asymptomatic nature. The clinical manifestations of MDS vary widely depending on the cellular line involved. Infections, bleeding, and anemia are common features of the MDS, while unusual findings include hepatomegaly, splenomegaly and lymphadenopathy. However, the situation changes when the patient progresses to acute myeloid leukemia (AML), leading to a transformation into thrombocytosis. During the process of improving the general condition, on the third day of treatment, the patient experienced a deterioration and unfortunately passed away. The lack of medical and healthcare personnel in Indonesia and the unequal distribution of them are the reasons why patients with rare cases are still far from obtaining their health rights. An important challenge in clinical practice involves distinguishing between primary myelofibrosis and other conditions, as misidentification can delay treatment, potentially leading to patients not receiving necessary healthcare and possibly resulting in fatalities.

Methodology: 180 cases of intracranial hemorrhage (108 male and 72 female), diagnosed on computed tomography and aged >18 years were enrolled in the study. Cases with known history of trauma and previous intracranial hemorrhage were excluded. CT scan of head was performed in 128 slice Multidetector Philips CT scan Machine using 120 kV and auto mA with multiplanar reconstruction on dedicated workstation. Size and site of hematoma was noted. Intracranial hemorrhage was classified into different types- intraparenchymal, intraventricular, subarachnoid, subdural and epidural. Presence or absence of perilesional oedema was noted separately. SPSS 20 was used for the entry and analysis of the collected data.

This research aimed to 1) assess health literacy levels 2) evaluate diabetes prevention behaviors and 3) analyze the influence of health literacy on diabetes prevention behaviors among residents in Sai Mai District communities, Bangkok. This cross-sectional survey research included 317 participants aged 35 years and above, selected through stratified random sampling. Data were collected from June to September 2024 using questionnaires with content validity and reliability (Cronbachs alpha coefficient = 0.87). Data were analyzed using descriptive statistics and multiple regression analysis.

A 50-year-old man with polycystic kidney disease had living donor kidney transplant. Simultaneous right sided native nephrectomy was done to give a space for graft kidney. He developed three episodes of urinary tract infections within 2 months after transplant; one episode was associated with septic shock and rise serum creatinine. Two urine culture results taken two weeks apart revealed Klbsiella pneumoniae. It was sensitive to amikacin and resistant to nearly all antibiotics including quinolone, imepenum, colistin, cefepime and tigecycline. The remaining left native kidney was removed as the cysts were nidus to hide bacteria; no more recurrence after second nephrectomy.

Primary retroperitoneal mucinous cystadenoma (PRMC) is a rare pathology. Until our last update literature review there is 49 cases published. We present the case number 50 to the scientific literature. A 43-years-old female that presented to our clinic with abdominal pain was diagnosed as retroperitoneal cystic lesion by computed tomography scan. She underwent laparoscopic resection with no complications. The histopathology reveled a PRMC with no malignancy futures. These rare cystic lesions should be included as differential diagnosis at the preoperative stage. The best management option is the complete surgical excision with no intraoperative spillage.

Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome characterized by preserved left ventricular systolic function, diastolic dysfunction, and systemic inflammation, often coexisting with metabolic and hemodynamic disorders. Primary hyperaldosteronism (PHA), a condition marked by excessive aldosterone secretion, is increasingly recognized as a pivotal contributor to the pathophysiological mechanisms underpinning HFpEF. This review explores the intricate relationship between hyperaldosteronism and HFpEF, emphasizing the role of aldosterone in myocardial remodeling, endothelial dysfunction, and systemic inflammation. Additionally, it highlights emerging evidence on aldosterone antagonists as potential therapeutic agents in mitigating HFpEF-related morbidity. By integrating clinical findings with molecular insights, we aim to elucidate how hyperaldosteronism exacerbates HFpEF phenotypes and propose strategies for targeted management. This synthesis underscores the need for tailored interventions in patients with concomitant hyperaldosteronism and HFpEF.

Introduction: Mesenteric cysts are rare, benign intra-abdominal cystic lesions that arise from the mesentery, the tissue fold attaching the intestines to the abdominal wall. They can develop from the duodenum to the rectum. Mesenteric cysts have various histological origins, with lymphangiomas being more common in children and mesothelial cysts in young to middle-aged women. While they can remain asymptomatic, they may also cause complications such as intestinal obstruction or perforation. Complete resection is the preferred treatment due to its lower recurrence rate.

Skin metastases from endometrial adenocarcinoma, particularly cutaneous lymphangitis carcinomatosis, are rare. We present two cases of endometrial adenocarcinoma that recurred as lymphangitic carcinomatosis after presumed complete resection. Case 1 is a 71-year-old woman with a history of breast adenocarcinoma, who developed painful erythematous lesions and a verrucous plaque in the pubic area three months after surgery for endometrial adenocarcinoma. A skin biopsy confirmed carcinomatous lymphangitis, and she died four months later. Case 2 is a 56-year-old woman with stage IIB endometrioid adenocarcinoma, who developed erythematous plaques and lymphedema on the left thigh a year after treatment. A biopsy confirmed cutaneous lymphangitis carcinomatosis, and she died five months later. Cutaneous lymphangitis carcinomatosis is an uncommon form of skin metastasis, typically seen in breast cancer but rarely in endometrial adenocarcinoma. Early recognition is essential, as it can mimic benign dermatologic conditions. The prognosis is poor, with treatment often being palliative and ineffective. These cases highlight the importance of considering skin metastasis in patients with a history of gynecological cancer presenting with new cutaneous lesions.

Taussig-Bing syndrome, a rare and complex congenital cardiac malformation characterized by double outlet right ventricle (DORV) with subpulmonary ventricular septal defect (VSD), poses significant challenges for neonatal management. Traditional surgical approaches often involve extensive cardiopulmonary bypass procedures and staged correction, which may increase perioperative risk and prolong recovery. Hybrid strategies combining surgical and interventional cardiology techniques have emerged as an innovative alternative to address the unique anatomical and physiological complexities of this condition.

Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by intermittent upper airway obstruction, resulting in recurrent hypoxemia, hypercapnia, and sleep fragmentation. Emerging evidence highlights a significant association between OSA and persistent atrial fibrillation (AF), a complex arrhythmia with substantial morbidity and mortality. This relationship is underpinned by multifaceted pathophysiological mechanisms, including autonomic nervous system dysregulation, structural and electrical cardiac remodeling, systemic inflammation, and heightened oxidative stress. Patients with coexistent OSA and AF exhibit a more challenging clinical course with higher rates of arrhythmia recurrence and resistance to conventional therapies such as antiarrhythmic drugs and catheter ablation.

Achondroplasia is a low prevalence genetic disorder characterized by disproportionate short stature and skeletal dysplasia, caused primarily by mutations in the fibroblast growth factor receptor 3 (FGFR3) gene associated with disturbances in bone growth. It is the most common form of dwarfism characterized by rhizomelic shortening of the limbs, macrocephaly with frontal bossing and spinal alterations, which presents significant challenges in the anesthetic management of pregnant women due to anatomical and physiological alterations, such as predictors of difficult airway, thoracic restriction due to bone dysplasias, spinal deformities and the multiple physiological changes characteristic of pregnancy. Achondroplasia has an increased incidence of menstrual disorders, infertility, amenorrhea, so conception is rare.

Venezuelan migrants in a situation of temporary shelter in Ciudad Juárez, Chihuahua, Mexico, maintain processes of adaptability in the face of legal and assistance conditions of transit due to their migratory trajectory to the United States of America. The economic conditions and situations of violence in their country of origin have made it possible to establish themselves as the main reasons for mobility. Various studies indicate that Venezuelan migrants have inadequate physical and mental health conditions in the face of experiences of victimization and vulnerability during their migratory journey. The main objective of the study was to analyze the general health indicators of Venezuelan migrants in a situation of temporary shelter in Ciudad Juárez. Using a descriptive approach with a quantitative, empirical-analytical perspective of non-experimental cross-sectional temporality, 80 Venezuelan migrants with informed consent participated with non-probabilistic sampling by volunteer subjects to analyze the General Health Questionnaires [GHQ-28] according to the reasons for migration. The results indicated that there were significant indicators of anxiety, depression and somatic symptoms in one-sixth of the participating migrants related to economic conditions in their country of origin to a greater extent than situations of violence as reasons for migrating. Even so, the social resources for the construction of support networks are relevant but are associated with general health conditions with inadequate psych affective conditions as a survival and adaptation strategy that allows achieving the goal of migrating to the global north of America.

Background: Urolithiasis is the condition of stone formation in the urinary tract, which remains a significant health issue worldwide. The incidence of cases is higher in men than women. Flank pain is the most common manifestation in patients with urolithiasis. The management of urolithiasis includes conservative treatment, lifestyle modifications, medication therapy, medical intervention, and surgical procedures. Complications of urolithiasis may include urinary tract infection and urinary tract obstruction, both of which have the potential to cause acute kidney injury.

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms originating from the interstitial cells of Cajal in the gastrointestinal tract. They can manifest anywhere along the GI tract but are most commonly found in the stomach. GISTs are often asymptomatic, but when symptoms do occur, they may include abdominal pain, gastrointestinal bleeding, or signs of obstruction. In this case, we report on a 70-year-old male who presented with upper gastrointestinal bleeding caused by gastric ulceration over an intraluminal GIST located at the fundus of the stomach. The patient had a history of occasional painless melena over the past month, anemia symptoms, and a significant drop in hemoglobin levels. Despite prior difficulties with anesthesia due to challenging intubation, successful surgical excision of the tumor was achieved after meticulous preoperative preparation. The postoperative course was uneventful, and histopathological examination confirmed a spindle cell type GIST. The patient was subsequently managed according to GIST guidelines with long-term oncological follow-up. This case highlights the clinical presentation, diagnostic challenges, and management strategies for upper gastrointestinal bleeding due to an intraluminal GIST.

Infertility defined as the inability of a couple to achieve conception after one year of sexual intercourse without contraceptive protection, or after 6 months in patients older than 35 years. According to the WHO, 10-15% of couples have some fertility problem and 25-50% of this is due to anovulatory female infertility, which could be due to insulin resistance, especially in overweight and obese patients, since 75% of obese patients suffer from IR, added to the fact that overweight and obesity have a high prevalence in the Mexican population, where a prevalence of up to 35% has been reported, it is important to consider it as a causal factor in patients with infertility. In 2021, 413 first-time patients with a diagnosis of infertility were received at the Gynecology-Obstetrics UMAE of CMNO IMSS; of these, 245 have a diagnosis of anovulation and about 40% are overweight or obese, however, there is no report on reproductive outcomes of these patients who undergo medical treatment, some cases achieve clinical pregnancy and of these some result in term births, preterm, miscarriage and / or death.

Background: Constipation has a prevalence in the Mexican population of up to 14.4% (Remes-Troche 2018). Posterior tibial electrostimulation from L4 to S3 modulates sacral roots through multiple afferent pathways in the spinal cord via a spinal and supraspinal somatovisceral reflex that activates sympathetic nerve flow, increasing rectal distensibility, improving rectal sensory thresholds and favoring anterograde and retrograde colonic propagation sequences through stimulation of S2 and S3 thus improving the defecation mechanism.

Pregnancy loss is a traumatic event that deeply affects the mental health of women, predisposing them to the development of disorders such as perinatal grief, anxiety, post-traumatic stress and depression. This study aimed to evaluate the psychological impact on obstetric women with a history of pregnancy loss. An observational and prospective study was conducted at the UMAE Hospital de Gíneco-Obstetricia CMNO. Of the patients initially included, 51 completed the evaluation at the first and third month after the loss. Instruments such as the Perinatal Grief Scale, the Checklist for Post-Traumatic Stress Disorder and the Hamilton scales for depression and anxiety were applied. The results at the first month showed a high prevalence of active (98%) and complicated (94.1%) grief, along with anxiety (84.4%), post-traumatic stress (31.4%) and moderate depression (62.8%, according to the Hamilton scale). At three months, active grief persisted in 88.2% of patients, while depression remained in 60.8%, mostly at moderate levels. Anxiety was the most frequent disorder, presenting in 84.4% of patients with active grief. These findings highlight the need for an early and multidisciplinary psychological approach, especially for those women with active or complicated grief, given its strong association with other mental disorders.

Introduction: Calcaneus fractures are the most common tarsal bone fractures, affecting patients quality of life due to osteoarthrosis and a rigid gait. Management must be individualized based on fracture line characteristics, physical activity, and patient life expectancy. Clinical case: A 70-year-old Mexican woman with a history of osteopenia fell, imaging showed traces of a multi-fragmentary fracture, including involvement of the subtalar joint and widening and displacement of the posterior tuberosity of the calcaneus. Open surgery was scheduled 72 hours later, and the patient underwent early mobilization of the ankle, knee, and hip without support.

Acral lentiginous melanoma (ALM) is a distinct and aggressive subtype of melanoma that disproportionately affects individuals with darker skin tones, representing a unique clinical and biological entity within the broader spectrum of cutaneous melanoma. Although ALM accounts for a relatively small percentage of melanomas globally, it is the most common subtype in non-Caucasian populations. The pathogenesis of ALM is characterized by genetic alterations distinct from other melanoma subtypes, often involving mutations in KIT and focal amplifications, rather than BRAF or NRAS mutations. Clinically, ALM frequently arises on acral surfaces, including palms, soles, and subungual regions, often presenting at an advanced stage due to delayed diagnosis. This review aims to provide a detailed examination of the epidemiology, molecular pathophysiology, clinical manifestations, and diagnostic approaches of ALM, while also highlighting emerging therapeutic strategies, including surgical management, targeted therapy, and immunotherapy. Recognizing the unique challenges associated with ALM is critical for improving early detection, tailoring treatment strategies, and ultimately enhancing patient outcomes.

For the anesthesiologist the management of a difficult airway is crucial to avoid serious complications that can endanger the life of a patient, so multiple strategies and tools have been developed to prevent mishaps. In this case report we present a patient with a diagnosis of inferior alveolar ridge carcinoma who presents with modifications in the head and neck anatomy, due to a history of previous surgical interventions and radiotherapy and chemotherapy treatment. The patient was scheduled to undergo surgery to take and apply a free graft in the neck, which was successfully performed with rapid sequence intubation in an awake patient. The Royal College of Anesthesias fourth National Audit Project (NAP4) conducted a study in which it was reported that approximately 40% of patients presenting with an airway complication during anesthesia were related to head and neck tumors, so the following is an analysis of predicted difficult airway management.

Gold weight implantation is a widely used surgical technique for managing lagophthalmos caused by facial nerve paralysis. This procedure involves placing a gold weight in the upper eyelid to facilitate passive closure, thereby protecting the cornea from exposure-related complications such as keratitis and ulceration. Advancements in implant design, such as elliptical shapes with suture holes for enhanced fixation, have reduced complications like migration, extrusion, and infection. Techniques including retrograde implantation and supratarsal fixation further improve placement accuracy and reduce postoperative morbidity.

Diabetes mellitus (DM) is a metabolic disease that involves inappropriately elevated blood glucose levels. Suspicion of diabetes mellitus can be done by checking two hours postprandial blood glucose. Glimepiride is a drug used in the treatment of diabetes mellitus that belongs to the sulfonylurea group. However, like other sulfonylureas, the administration of glimepiride in patients with diabetes mellitus can trigger side effects in the form of hypoglycaemia due to increased insulin secretion. One of the plants that can be utilized as an antidiabetic drug is papaya leaf. Research in the form of experimental Randomized Controlled Trial (RCT) with Pretest-Posttest Only Group Design research design using male wistar strain white rats for 38 days, with 35 rats. The administration of papaya leaf extract at a dose of 150mg/kg and 200mg/kg in group IV and V rats is proven to have the small effect of lowering two hours postprandial blood glucose in male Wistar rats. In conclusion depend on the dose the administration of papaya leaf had a small effect in changing two-hours postprandial blood glucose.

Childhood, particularly toddlerhood, is a period of rapid growth. Feeding difficulties are a common challenge faced by most parents, which can lead to nutritional deficiencies in children. One approach to improving childrens dietary habits, with the goal of enhancing community nutrition, especially for toddlers, is to utilize local food ingredients in the form of alternative complementary foods. This study focused on Bole Mortel, a traditional food with a specially formulated recipe for toddlers aged 12-59 months. This research employed functional foods based on local ingredients, namely catfish, soybean tempeh, chicken, and carrots, as the primary raw materials. The study utilized a quantitative approach with an experimental design, employing a Completely Randomized Design (CRD) to assess the impact of catfish and soybean tempeh substitution on the nutritional quality, protein quality, and organoleptic properties of Bole Mortel. The study involved one factor, catfish and tempeh substitution with four different formulations. Each formulation was evaluated for preference by 30 semi-trained panelists and subjected to a descriptive analysis by 10 trained panelists. The results demonstrated that the nutritional quality of Bole Mortel in each formulation met 10-15% of the nutritional requirements for children aged 12-59 months. Theoretical digestibility and Net Protein Utilization for all formulations >90%. Moreover, the amino acid score for all formulations was 100. The proportion of catfish and soybean tempeh did not significantly influence taste, aroma, color, or texture. The P3 formulation, with a catfish : soybean tempeh ratio of 30:70, exhibited the highest preference and was deemed the most suitable. Toddlers aged 12-23 months can consume 60 grams (approximately 4-5 pieces) of Bole Mortel, while those aged 25-59 months can consume 80 grams (approximately 6-7 pieces). These serving sizes can fulfill 10-15% of a toddlers daily nutritional needs according to age, as outlined in the 2023 Technical Instructions for Providing Additional Food.