Oasis of Hope Hospital

To evaluate clinical outcomes, treatment response and predictors of seizure freedom after vagus nerve stimulation in patients with drug-resistant epilepsy in a Mexican cohort. We conducted a retrospective multicenter cohort across 13 epilepsy centers in Mexico (2003-2024) including patients aged ≥4 years with drug-resistant epilepsy or epileptic encephalopathy. Treatment response was defined as at least 50% seizure reduction and Engel outcomes. Logistic regression identified predictors of seizure freedom. Model performance was assessed with receiver operating characteristic analysis, area under the curve, Hosmer-Lemeshow test, and a confusion matrix. Ninety-three patients (51 children, 42 adults) were included. At 1 year, median monthly seizure frequency decreased by 82.5% (40-7; p < .001). The incidence of status epilepticus declined by 92.8%, acute prolonged seizures by 80.9%, the burden of antiseizure medications by 25%, and epilepsy-related hospitalizations by 100% (all p < .001). Overall, 68.8% achieved ≥50% reduction and 11.8% became seizure-free. On univariate analysis, comorbidities, multiple seizure types, higher baseline seizure frequency, greater number of antiseizure medications, and magnet use were inversely related to seizure freedom, while normal brain MRI showed a direct relationship. On multivariable analysis, only baseline seizure frequency ≥30/month independently predicted seizure freedom (p = .047), corresponding to 97.7% lower odds. A predictive model incorporating comorbidities and number of antiseizure medications improved discrimination (p < .001) with 86.6% sensitivity and 81.8% specificity. Vagus nerve stimulation was associated with substantial seizure frequency reduction, lower morbidity, and less healthcare utilization, with a favorable safety profile. Baseline seizure burden emerged as the key predictor of seizure freedom and may guide patient selection, supporting earlier vagus nerve stimulation consideration in drug-resistant epilepsy.

Personalized medicine allows the selection of the drug and dose based on the patient's genetic information, which is imperative in the treatment of diabetes and hypercholesterolemia, diseases with high prevalence in Mexico. To integrate pharmacogenetic and genomic research on antidiabetic and antihypercholesterolemic drugs in Mexican patients. We integrated our research, relating it with similar research from national and foreign laboratories. For antidiabetic pharmacological treatments, variants in the ABCC8 and KCNJ11 genes were consistently associated with the response to sulfonylureas, while variants in the SLC47A1, SLC28A1 and ABCG2 genes explained up to 55% of the variability in the response to metformin. Regarding hypercholesterolemia, atorvastatin treatment is influenced by variants in the genes MTHFR, DRD3, GSTM3, TNFα MDR1, SLCO1BI, ABCB1, CYP2D6, CYP2B6, NAT2 and COMT. Our findings highlight the need to integrate pharmacogenetics into clinical practice to achieve greater therapeu tic success in diabetes and hypercholesterolemia.

The aim of this study was to analyze the characteristics of pyelonephritis with multidrug-resistant (MDR) bacteria in pregnant women in comparison to pyelonephritis with multidrug-sensitive bacteria in this particular patient group. We conducted a retrospective study over a period of three years on a study group of 17 pregnant patients with pyelonephritis with MDR bacteria and on a control group of 52 pregnant patients with pyelonephritis with multidrug-sensitive bacteria. We analyzed the demographic data, the potential risk factors, aspects of the clinical picture, the incidence and type of bacteria involved, and their sensitivity spectrum. The patients in the study group had pyelonephritis on the right side (N=10, 58.83%), were in the second and third trimesters of pregnancy (N=16, 94.12%), and had a high percentage of anemia (N=9, 52.94%), as did the control group. Unlike the patients in the control group, the patients in the study group had a higher incidence of antibiotic treatment (N=17,100% vs. N=14, 29.92%, p<0.001), previous urological surgery, especially ureteral catheterization with insertion of double-J catheters (N=9, 52.94% vs. N=9, 17.30%, p=0.003), and an increased incidence of urosepsis on admission (N=11, 64.70% vs. N=11, 21.15%, p<0.001). E. coli (N=8, 47.05% vs. N=28, 53.85%, p=0.626) and Klebsiella pn. (N=5, 29.41% vs. N=12, 23.07%, p=0.598)were predominant in both study groups. Also, the hospitalization days were significantly higher in the study group compared with the control group (N=7.38±2,91 vs. N=5.02±1,87, p=0.002). The spectrum of microbial resistance was increased in favor of the study group for all antibiotics tested, with the exception of ampicillin, where resistance was increased in both groups. The Gram-negative bacteria responsible for the pyelonephritis in both groups retained 100% sensitivity to carbapenems and piperacillin/tazobactam. Pregnant women in the second and third trimesters of pregnancy who have undergone right-sided double-J catheter insertion during pregnancy and/or who have received antibiotic treatment in the past are at increased risk for pyelonephritis with MDR. E. coli and Klebsiella pn.,bacteria are most commonly involved and maintain susceptibility to carbapenems and reserve penicillins.

to date, no standardized, evidence-based follow-up schemes exist for the monitoring of patients who underwent focal therapy (FT) and expert centers rely mainly on their own experience and/or institutional protocols. We aimed to perform a comprehensive review of the most advantageous follow-up strategies and their rationale after FT for prostate cancer (PCa). a narrative review of the literature was conducted to investigate different follow-up protocols of FT for PCa. Outcomes of interest were post-ablation oncological and functional outcomes and complications. Oncological success after FT was generally defined as the biopsy-confirmed absence of clinically significant PCa in the treated zone. De novo PCa in the untreated area usually reflects an inaccurate patient selection and should be treated as primary PCa. During follow-up, oncological outcomes should be evaluated with periodic PSA, multiparametric MRI and prostate biopsy. The use of PSA derivatives and new biomarkers is still controversial and therefore not recommended. The first MRI after FT should be performed between 6-12 months to avoid ablation-related artifacts and diagnostic delay in case of FT failure. Other imaging modalities, such as PSMA PET/CT scan, are promising but still need to be validated in the post-FT setting. A 12-month "for-protocol" prostate biopsy, including targeted and systematic biopsy, was generally considered the preferred biopsy method to rule out tumor persistence/recurrence. Subsequent mpMRIs and biopsies should follow a risk-adapted approach depending on the clinical scenario. Functional outcomes should be periodically assessed using validated questionnaires within the first year, when typically recover to a new baseline. Complications, despite uncommon, should be strictly monitored mainly in the first month. FT follow-up is a multifaceted process involving clinical, radiological, and histological assessment. Studies evaluating the impact of different follow-up strategies and ideal timings are needed to produce standardized protocols following FT.

HIV prevalence among transgender women (TW) in Tijuana, Mexico is estimated at 22%. Pre-exposure prophylaxis (PrEP) reduces the risk of HIV acquisition by > 90%, though uptake in Tijuana has been low due to limited availability. The interplay between PrEP and gender stigmas may also serve as a barrier to PrEP uptake among TW in Tijuana. Experiences of gender- and PrEP- stigmas were assessed quantitatively (Quan) among 110 HIV-negative TW and qualitatively (Qual) among 17 TW through semi-structured interviews guide by the Health Stigma and Discrimination Framework. Qual findings were triangulated with Quant data to identify factors that may support gender affirmation and reduce PrEP stigma in an explanatory sequential Quan → Qual fashion. Most participants were < 40 years of age (80%), while approximately half had at least a high school education (48.2%) and were accessing gender-affirming hormone therapy (56.4%). Mean expectations of gender stigma were greatest for endorsing negative future expectations from others (M = 17.69; possible range 0-36). PrEP stigma was prominent among those who associated negative stereotypes with PrEP users, such as poor judgment (M = 45.91; possible range 14-70) and high personal risk attributes (M = 28.61; possible range 12-60). While PrEP knowledge was low among the qualitative sample, participants identified gender-, PrEP-, and intersectional- stigmas as potential barriers to PrEP uptake. Participants suggested that resilience strategies used to combat gender stigma could also mitigate PrEP stigma. Enhancing resilience skills at the intersection of gender and PrEP stigma may reduce these barriers, facilitating greater PrEP uptake as it becomes more available in Mexico.

BackgroundPrevious evidence indicates associations between the female reproductive tract microbiome composition and reproductive outcome in infertile patients undergoing assisted reproduction. We aimed to determine whether the endometrial microbiota composition is associated with reproductive outcomes of live birth, biochemical pregnancy, clinical miscarriage or no pregnancy.MethodsHere, we present a multicentre prospective observational study using 16S rRNA gene sequencing to analyse endometrial fluid and biopsy samples before embryo transfer in a cohort of 342 infertile patients asymptomatic for infection undergoing assisted reproductive treatments.ResultsA dysbiotic endometrial microbiota profile composed of Atopobium, Bifidobacterium, Chryseobacterium, Gardnerella, Haemophilus, Klebsiella, Neisseria, Staphylococcus and Streptococcus was associated with unsuccessful outcomes. In contrast, Lactobacillus was consistently enriched in patients with live birth outcomes.ConclusionsOur findings indicate that endometrial microbiota composition before embryo transfer is a useful biomarker to predict reproductive outcome, offering an opportunity to further improve diagnosis and treatment strategies.4s24pSLHML6tsFwrrAE7giVideo .