Revista Científica CMDLT

Type 2 diabetes mellitus with positive anti-glutamic acid decarboxylase antibodies

2023-09-12T01:24:50+00:00

Differential diagnosis between the different types of diabetes in the age group between 25 and 45 years is complex. In type 1 and 2 diabetes, other even less documented varieties occur, in which genetic predisposition, immunological findings and unstable insulin secretion overlap. Starting from this premise, two clinical cases are discussed where the presence of autoimmunity against beta cells is demonstrated in two patients who developed hypoglycemia after pharmacological treatment and required only metformin to maintain their metabolic control. Moving from the binary perception of an entity that has demonstrated syndromic behavior is a task that must begin to be prioritized to achieve precision in the diagnosis and treatment of adult diabetes.

Atypical demyelination, a clinical challenge: sero-negative MOGAD. About a case.

2025-02-14T13:21:53+00:00

INTRODUCTION: MOGAD is an autoimmune demyelinating disorder of the CNS that is associated with a serological antibody directed against MOG, a glycoprotein located on the surface of myelin and found exclusively in the CNS. The clinical spectrum includes optic neuritis, myelitis, acute demyelinating encephalomyelitis, cortical encephalitis, brainstem syndromes and hyperintense FLAIR lesions in encephalitis with associated seizures. CLINICAL CASE: 59-year-old female patient with 03 months of evolution: thermal increases, ophthalmoplegia, dysphagia and left hemicranial headache, later, paresthesias in the right hemibody; she came to the emergency department with decreased visual acuity, ataxic gait, diplopia, dysarthria and right hemiparesis hours prior to admission. Brain MRI: diffuse hyperintense lesions in T2 and FLAIR, hypointense in T1 that restrict diffusion, with high cervical medullary involvement, anterolateral region of the bulb, posterior bridge and mesencephalic with predominance of cerebral peduncles. Cerebrospinal fluid studies: non-infectious inflammatory fluid. Serum AQP4-IgG and Ac-Anti MOG negative. Glucocorticoid is administered, obtaining satisfactory therapeutic response. DISCUSSION: The positivity of serum antibodies is directly related to the time of sampling in view of the kinetics of disease evolution; however, it should be taken into account that not all patients present these antibodies and that there may be other factors involved in their pathogenesis. CONCLUSION: MOGAD is a relatively new and still poorly understood disease with a wide variety of phenotypes, which constitutes a diagnostic challenge due to its clinical and paraclinical difficulty.

Acute pseudotumoral hemicerebelitis in children: A case report

2024-02-21T18:31:29+00:00

Introduction: Acute Pseudotumoral Hemicerebellitis is an uncommon type of cerebellitis in childhood, often presenting with an absence of cerebellar dysfunction. Delayed diagnosis can lead to symptoms of intracranial hypertension, cranial nerve involvement, and even fatal outcomes. There have been no reported cases in Venezuela. Case report: A case of Pseudotumoral Hemicerebellitis in an eight-year-old boy presenting with a severe recurrent headache that did not response with regular treatment. A multidisciplinary team evaluated the patient. A spinal tap and cranial Magnetic Resonance Imaging (MRI) were performed, cerebrospinal fluid showed alterations, and the MRI reported injury in the right cerebellar hemisphere. The patient did not present symptoms of cerebellar dysfunction. Discussion and Conclusion: Pseudotumoral Hemicerebellitis is a rare type of acute cerebellitis that mimics a space-occupying lesion in the posterior fossa, without cerebellar symptoms clinically. It has a course that is usually benign, but early diagnosis and treatment are a must since it could be fatal. A cranial MRI is necessary for a definitive diagnosis.

UNUSUAL METASTASES IN GYNECOLOGICAL CANCER.

2024-10-29T17:58:25+00:00

Gynecological cancer is among the leading causes of death worldwide, however, advances in medicine have led to an increase in the survival of these patients and consequently a higher incidence of metastatic disease. An exhaustive review of 9900 histories of oncological gynecology consultation of the medical teaching center La Trinidad and the medical institute La Floresta between 2000-2020 was carried out and 4 patients were found: primary cervix with liver metastasis, primary colon with metastasis to the cervix, primary cervix with metastasis in the right supraclavicular lymph node, primary ovary with metastasis to the breast. These conditions are becoming more and more frequent in the population and a multidisciplinary team is needed to guarantee a good prognosis.

A hidden giant: Presentation of a large sublingual Pleomorphic Adenoma

2025-07-02T12:18:08+00:00

INTRODUCTION: Minor salivary gland neoplasms are an extremely rare finding, characterized by tumors that are mostly malignant (>70-90%), especially in the sublingual glands, with a greater prevalence in adults over 40 years of age, of uncertain etiology. Some factors such as cigarettes, radiation, trauma, genetics and others are associated with its development. CLINICAL CASE: a young patient of 20 years of age with a submental mass of 5 years of evolution, which occupies the entire floor of the mouth, reporting progressive dysphagia and sensation of a foreign body when swallowing; On physical examination, he presented dysphonia, elevation of the base of the tongue, contacting the lingual surface of the epiglottis due to a soft, mobile, non-painful mass. In contrast-enhanced neck tomography, a space-occupying lesion measuring 8*7cm was observed, rounded, well-defined, heterogeneous, with hypodense images inside. Inconclusive fine needle aspiration puncture was performed. Oncological resection of the floor of mouth tumor was performed, reporting histopathological findings: cellular pleomorphic adenoma without findings of malignancy. CONCLUSION: Early diagnosis and complete surgical removal are essential for a good prognosis. Long-term follow-up is important to detect recurrence or malignant transformation.

A vote against the non-selective technique of laser photocoagulation of communicating vessels in twin-twin transfusion syndrome

2025-04-05T11:33:52+00:00

Resumen

El síndrome de transfusión intergemelar resulta de un intercambio desbalanceado de sangre a través de anastomosis vasculares entre las circulaciones de ambos fetos en embarazos monocoriales. La fotocoagulación láser fetoscópica de vasos comunicantes se ha utilizado para revertir el síndrome. Algunos autores han propuesto que los vasos que cruzan la membrana divisoria intergemelar son “sospechosos” de participar en el desarrollo del síndrome y que la fotocoagulación láser de éstos es capaz de revertir el trastorno. Presentamos dos casos de síndrome de transfusión intergemelar, tratados exitosamente con fototocoagulación láser selectiva de anastomosis, en los cuales los vasos comunicantes no cruzaban la membrana divisoria. Se concluye que solo la técnica selectiva de fotocoagulación láser es capaz de revertir el síndrome en estos casos.

Functional hypothalamic amenorrhea: hormonal changes as an adaptive response to an energy deficit

2024-09-02T21:25:23+00:00

Functional Hypothalamic Amenorrhea (FHA) is a reversible disorder characterized by suppression of the hypothalamic-pituitary-ovarian (HPO) axis in response to stress and low energy availability. Growth hormone, corticotropic hormone, kisspeptins and thyroid hormones participate as part of an adaptive response. AHF occurs frequently in female athletes and in patients with anorexia nervosa, and may be caused by stressful situations. It is accompanied by changes in bone mineral density, infertility and emotional disorders, generating deterioration in the quality of life of women. Knowing and acting on the stressor agent and the energetic imbalance are part of the therapeutic strategy to recover ovulatory menstrual cycles.

Marginal fit of fixed prostheses obtained through conventional versus digital workflows. Systematic review.

2024-09-28T15:22:04+00:00

Precision in marginal adaptation is essential for the success of fixed prostheses. In conventional techniques, different materials have been used to obtain the negative of prepared teeth. In recent years, technology has evolved considerably, and with this, restorative dentistry has taken a leap, becoming digital dentistry. Digital dentistry aims to perfect the process, inducing different techniques and materials which aim to obtain restorations with greater precision and detail. Objective: Determine the accuracy of the marginal adaptation of fixed prostheses generated from conventional workflows versus digital workflows. Materials and methods: A search was carried out in the Pubmed and Google schoolar database, under the inclusion criteria: systematic review and meta-analysis type studies published between 2018 and 2023. Results: from 1778 studies identified in the database, 12 articles that met the inclusion criteria were selected. It was demonstrated with 50% of the results that the digital workflow is superior in terms of marginal adaptation to conventional methods. In 40% there are no significant differences between both workflows, and only 10% of the studies favor the conventional workflow. Conclusions: The digital workflow offers reliable prosthetic results, in turn, it provides better marginal adaptation in fixed prostheses compared to conventional workflows. However, further studies are recommended.

Artificial Intelligence Agents in Medicine: Optimization and Enhancement of Academic Writing for Scientific Dissemination

2025-05-02T18:23:53+00:00

This article examines the integration of Artificial Intelligence (AI) agents in the field of medicine and its impact on academic writing for scientific dissemination. The transformative role of AI, which has infiltrated everyday life through automated content generation and digital assistance, is addressed, highlighting both its benefits and the ethical challenges it poses. Specific applications in medicine are described, such as the use of deep learning algorithms—including convolutional neural networks and generative models—for medical imaging, pathology detection, and personalized medicine, based on genetic and predictive analysis, exemplified by tools such as Google DeepMind's AlphaFold. The use of AI to optimize the production of academic writings is also highlighted, significantly reducing the processing time of large volumes of information and enhancing collaboration and updating in scientific research. However, it underscores the imperative need to maintain rigorous human oversight, transparently declare the use of these tools, and ensure the protection of sensitive data, in order to mitigate associated risks such as bias, hallucinations, and privacy violations. In conclusion, AI is presented as an essential complementary tool in the advancement of knowledge in health sciences, provided that it is applied within an appropriate ethical and regulatory framework.