Hospital Angeles Pedregal

Early diagnosis of premalignant gastric condition, such as chronic atrophic gastritis and intestinal metaplasia, allow us to assess and stratify the risk of gastric cancer. Gastric mucosal cleaning, mucosal exploration, photo-documentation, and advanced technologies like optical enhancement, electron chromoendoscopy and magnification endoscopy improve lesion detection rates. This study compares the detection rate of premalignant gastric lesions between biopsies guided Electron chromoendoscopy combined with optical enhancement and magnification endoscopy versus random biopsies (Sydney Protocol) with optical enhancement. This is a prospective, observational, blinded comparative study. Outpatients were divided into two groups: group 1 (162 patients), biopsies were performed either under Electron chromoendoscopy combined magnification endoscopy guidance; and group 2 (160 patients), biopsies were performed under blinded mapping (updated Sydney system) with optical enhancement. The following clinical outcomes were assessed in each group: age, gender, adequate gastric clearance rate, gastric atrophy rate, intestinal metaplasia rate. A total of 322 patients were randomized, where 76 were excluded from the study. Detection rate for Intestinal metaplasia was significantly higher with Electron chromoendoscopy combined with optical enhancement and magnification endoscopy (37.6% versus 23.7%; p < 0.0001). Extensive Intestinal metaplasia was significantly more prevalent with Electron chromoendoscopy combined magnification endoscopy compared to mapping with optical enhancement (p = 0.029; p = 0.048, respectively). Electron chromoendoscopy combined with optical enhancement and magnification endoscopy demonstrated a comparative superiority over Sydney System random biopsy protocol in the identification of patients with premalignant gastric conditions. By enabling more precise endoscopic targeting, directed biopsies help reduce sampling error; however, in high-risk populations, a complementary approach integrating both targeted and systematic random biopsies remains advisable to optimize diagnostic accuracy.

Abstract: INTRODUCTION: There is an ongoing controversy on the predictive value of the disperse variables involved in cerebral aneurysm rupture. A better understanding of how such variables interact with each other is needed. OBJECTIVES: The initial aim of the study was to propose how exactly, into a hemodynamic model, such morphologic variables might work together to optimize such predictive rupture value. METHODS: We hypothesized, based on previous research, that the aneurysm rupture phenomenon might be related to hemodynamic interference. Hence, we selected the Helmholtz’s resonator equation because its resemblance to aneurysm morphology and that it may also be used on elastic walls. We collected the morphologic data (transverse area of the neck diameter, the length of the neck, the aneurysm height, length, and width radius) from the unique large enough published series ( n = 425) for ruptured ( n = 140) and no ruptured ( n = 285) aneurysms that included all the required variables by the equation on the same sample. Given that the Helmholtz’s equation also requires as an input variable the speed of the pulse wave (PW), we collected these data from the published series that provides this information by age. This proposed arrangement provided the cerebral aneurysm resonance frequency (the hemodynamic vibratory frequency range, in Hertz, where aneurysms might adsorb most of the oscillating PW energy) for ruptured and no ruptured aneurysms (RAs) by age. Hence, at this point, the working hypothesis was to figure out the predictive value for rupture when the aneurysm resonant frequency (maximal vibratory energy absorption) in Hertz equals the PW frequency range of maximal vibratory energy transmission of 225–275 Hz. RESULTS: What we found is that the mean of the resonance frequency values of the RA series almost entirely matches into the PW frequency range of 225–275 Hz (α &lt; 0.016, β = 0.4, and power = 0.6). Interestingly, the mean of the resonance frequency values for the no RA series barely intersects such PW frequency range (α &lt; 0.024, β = 0.4, and power 0.6). In synthesis, we propose a novel multivariate hemodynamic vibratory interference phenomenon for aneurysm rupture that is activated when the PW frequency matches the resonant frequency of a cerebral aneurysm. The results turned out to have a 99.04% of negative predictive value. DISCUSSION: We hope that a better understanding of this phenomenon might preclude superior treatment strategies. This manuscript aims to provide additional predictive value to better detect patients on a crash course with aneurysm rupture. The required input parameters may be swiftly acquired during an individualized assessment. With this model, PW frequency and hemodynamic interference seem to emerge as novel arterial-damaging factors. CONCLUSION: The Specifity of 97.54%, reflects the ability of the model to correctly identify individuals with lower risk of cerebral aneurysm rupture.

Stroke is an unusual condition in young adults, but when it presents in this population, there are specific causes that differ from those in older adults. When this occurs, it is necessary to make an extensive assessment to establish a final diagnosis. One of these causes, as in the case presented, is antiphospholipid syndrome (APS), which can present as venous or arterial thrombosis. There are conditions that act as triggers for the formation of antiphospholipid antibodies (aPL) and the development of APS. This report illustrates these points by presenting a young patient who developed APS after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that acted as a trigger, along with probable genetic susceptibility factors, and was diagnosed in accordance with guidelines 12 weeks after initial presentation. He was successfully treated with rescue mechanical thrombolysis, with favorable outcomes.

A cerebellar abscess due to Streptococcus intermediusis an uncommon clinical entity that may present with features resembling a neoplastic lesion, making early recognition challenging. S. intermedius, a member of the Streptococcus anginosus group, has a marked ability to induce tissue destruction and trigger a pronounced inflammatory response, ultimately leading to the formation of purulent collections with peripheral enhancement on neuroimaging. Although gram-positive cocci are recognized causes of brain abscesses, involvement of the cerebellum by this organism is rare.Awareness of this atypical clinical presentation is critical, since its pseudotumoral behavior may obscure the underlying infectious etiology and delay appropriate therapy. Integrating clinical manifestations, radiological characteristics, and microbiological confirmation is therefore essential for timely diagnosis and favorable clinical outcomes.

Artificial intelligence (AI) is increasingly transforming health care, particularly in solid organ transplantation, where it addresses complex challenges such as organ allocation, graft rejection prediction, and immunosuppressive management. This bibliometric analysis evaluated the scientific impact and evolution of AI applications in kidney, liver, heart, and lung transplantation. A comprehensive search across PubMed, Scopus, and Web of Science identified 2384 publications from 1989 to 2025, of which 815 met inclusion criteria after double-blind screening with Rayyan AI. Coauthorship, keyword co-occurrence, and collaboration networks were analyzed using VOSviewer and Bibliometrix. The United States led in publications, citations, and collaboration strength, with Mayo Clinic emerging as the most productive institution, followed by China. Machine learning, expert systems, and deep learning were the most frequently applied AI techniques, whereas kidney and liver transplantation were the most extensively studied. Thematic clusters included rejection prediction, patient survival, organ allocation, postoperative monitoring, and immunosuppression personalization. Artificial intelligence–driven models integrate clinical, immunological, histological, and imaging data to enhance predictive accuracy, support clinical decision making, and improve graft and patient outcomes. Although many of these models remain under validation, early findings indicate strong potential to optimize patient care and surgical outcomes. This study highlights global research trends and emphasizes the need for interdisciplinary collaboration to develop context-specific AI tools. Moreover, promoting bibliometric literacy among health care professionals may strengthen evidence-based research and accelerate the responsible integration of AI into transplant medicine.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed among plastic surgery patients for obesity and overweight. Agents such as dulaglutide, liraglutide, semaglutide, and tirzepatide differ in pharmacology and dosing, directly influencing perioperative safety, particularly due to their effects on gastric motility and the high frequency of gastrointestinal (GI) adverse events that raise concerns about aspiration and postoperative morbidity in urgent or elective procedures.A narrative review was conducted using PubMed, Embase, and the Cochrane Library (2010-2025). Randomized controlled trials, meta-analyses, prospective studies, case reports, and perioperative guidelines were analyzed.We reviewed each agent along with the administration route, half-life, average weight loss, and recommended discontinuation prior to surgery: dulaglutide: weekly injection, half-life of approximately five days, weight loss of 3%-5%, and discontinuation at >1 week before surgery; liraglutide: daily injection, half-life of approximately 13 hours, weight loss of 5%-7%, gastrointestinal (GI) adverse events up to 40%, and discontinuation at 24-48 hours before surgery; semaglutide (weekly): Efficacy and Safety of Once-Weekly Semaglutide Versus Exenatide Extended Release (ER) in Subjects With Type 2 Diabetes (SUSTAIN-3) showing superior glycated hemoglobin (HbA1c) reduction and weight loss compared with exenatide, GI adverse events including nausea (22%), diarrhea (11%), and vomiting (7%), and discontinuation at >1 week preoperatively; semaglutide (oral): Peptide Innovation for Early Diabetes Treatment (PIONEER) trials showing 4.4 kg weight loss at 26 weeks, GI adverse events of 15%-20%, and discontinuation at 24-48 hours prior; and tirzepatide: weekly dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GIP/GLP-1) agonist, weight loss of up to 20% in SURMOUNT-1, half-life of approximately five days, and discontinuation at >1 week before surgery.Prospective ultrasound studies show a higher prevalence of residual gastric content in GLP-1 RA users, particularly during dose escalation or when GI symptoms are present. Case reports document perioperative aspiration in semaglutide users, including episodes of hypoxemia and reintubation despite guideline-concordant fasting.Perioperative risk is now supported by prospective evidence and case reports. Weekly formulations show the strongest association with delayed gastric emptying and aspiration. Pharmacovigilance data and FDA/European Medicines Agency (EMA) alerts also describe rare cases of suicidal ideation and self-harm behaviors, especially in weight-loss therapy.GLP-1 RAs are commonly used among plastic surgery patients, and their use has grown exponentially over the years. There are concerns about delayed gastric emptying and gastrointestinal intolerance that pose a perioperative challenge that demands proactive perioperative management by the plastic surgery team.Plastic surgeons must lead the development of tailored, evidence-based, risk-stratified protocols that safeguard patients while preserving the benefits of these therapies. We share the protocol that we believe can help the plastic surgery team standardize safety strategies to be considered prior to elective surgery in patients who are treated with GLP-1 RA. More prospective studies are needed to validate and concentrate all guidelines and refine best practices in the era of metabolic pharmacology.