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Coronavirus disease 2019 (COVID-19) has had a significant global impact due to the millions of deaths it has caused secondary to respiratory failure. However, the disease has also been associated with a wide array of manifestations in other organ systems. Among them, the presence of anosmia, which occurs in up to half the patients, has become a new sign of alarm to suspect the infection. Although up to 90% of affected patients will experience an improvement of their olfactory alterations within a month after the infection, the variety and severity of olfactory disturbances clearly cannot be summarized by the dichotomy of having anosmia or not. Parosmias are a type of olfactory dysfunction characterized by altered perception of odors, which can reflect both damage at some level of the olfactory tract, as well as the possibility of reversibility of said damage. The present manuscript describes possible olfactory disturbances associated with COVID-19, their pathophysiology, and potential clinical significance.La enfermedad por coronavirus 2019 (COVID-19) ha tenido un impacto mundial trascendente por los millones de muertes que ha causado secundarias a insuficiencia respiratoria. Sin embargo, la enfermedad también se ha asociado a una amplia gama de manifestaciones en otros sistemas. Entre ellas, la presencia de anosmia, la cual ocurre en hasta mitad de los pacientes, se ha vuelto un nuevo dato de alarma para sospechar la infección. Aunque hasta el 90% de los pacientes afectados presentarán mejoría de sus alteraciones olfatorias dentro del mes posterior a su cuadro, la variedad y gravedad de alteraciones olfatorias claramente no pueden resumirse en la dicotomía de tener o no anosmia. Las parosmias son un tipo de alteración olfatoria caracterizadas por percepciones alteradas de los olores, las cuales pueden reflejar tanto daño a algún nivel del tracto olfatorio, así como la posibilidad de reversibilidad de dicho daño. En el presente manuscrito se describen las posibles alteraciones olfatorias asociadas a COVID-19, su fisiopatología, y potencial significancia clínica.

El virus del Zika es un virus arn transmitido por mosquitos, fue aislado por primera vez en 1947 en los bosques de Zika, Uganda. El cuadro clínico se caracteriza por exantema, cefalea y fiebre, en algunas ocasiones hay compromiso articular así como la presencia de otras complicaciones. Actualmente el virus del Zika se encuentra extendido en la mayoría de países del continente americano, incluido México. Dado el impacto clínico que tiene este virus a nivel poblacional, en el presente trabajo se abordan cuatro puntos de importancia epidemiológica: cuadro clínico, diagnóstico, complicaciones y tratamiento y prevención.

The magnitude which sleep has on personal well-being is similar to the effects of diet and exercise. Sleep deprivation has severe negative effects on an individual's overall health, and this is usually overseen. From 30 to 40 % of the population has presented insomnia at a certain moment of life and from 9 to 15 % have evolved into a chronic and severe insomnia. Recent investigations have related sleep deprivation with obesity, metabolic disorders, heart disease, mental health problems and dementia. Recently, more investigations have focused on the multiple alterations suffered by the immune system in cases of sleep deprivation. In order to make an opportune diagnosis of insomnia, it is vital to obtain a detailed history of the patients' sleep habits. In the physical exam one must search for signs and symptoms which might suggest an organic cause that generates the patient's insomnia. One of the pillars in treatment of these patients consists in acquiring an adequate sleep hygiene based on the optimization of the environment and the behavior that are associated with sleep.La magnitud que tiene el sueño en el bienestar integral de una persona es similar a los efectos de la dieta y el ejercicio. La privación del sueño tiene efectos deletéreos graves en la salud del individuo y por lo general estos son ignorados. Entre un 30 y un 40 % de la población ha presentado insomnio en algún momento de su vida y del 9 al 15 % ha desarrollado insomnio crónico grave. Diversos estudios vinculan la falta de sueño con obesidad, enfermedades metabólicas, problemas cardiacos, desórdenes psiquiátricos y demencia. Existen actualmente grupos que se enfocan en las alteraciones en la respuesta inmune que genera la falta de sueño. Para realizar un diagnóstico oportuno de insomnio, es indispensable que durante la consulta se obtenga una historia clínica detallada de los hábitos del sueño. En la exploración física se debe enfatizar la búsqueda de signos y síntomas que sugieran una causa orgánica específica que contribuya a la alteración del sueño. Uno de los pilares del tratamiento es establecer en todos los pacientes una buena higiene del sueño con base en la optimización del ambiente y de las conductas asociadas con el mismo.

Intestinal pseudo-obstruction secondary to systemic lupus erythematosus (SLE) is a rare syndrome described in recent decades. There are slightly over 30 published cases in the English language literature, primarily associated with renal and hematological disease activity. Its presentation and evolution are a diagnostic challenge for the clinician. We present four cases of intestinal pseudo-obstruction due to lupus in young Mexican females. One patient had a previous diagnosis of SLE and all presented with a urinary tract infection of varying degrees of severity during their evolution. We consider that recognition of the disease is of vital importance because it allows for establishing appropriate management, leading to a better prognosis and avoiding unnecessary surgery and complications.

To correlate the sociostructural variables with the knowledge about pneumonia and to explore the social representations about the etiology, prevention, development and treatment in poor communities.A survey in 848 adults from seven Rural Health Centers affiliated to IMSS-Oportunidades Program in four States, was carried out.One-third of the sample did not understand the term pneumonia; 35 % of the patients with risk factors did not know its etiology; 43 % did not know about associated complications but 85 % considered that it causes death. The use of antibiotics was recognized as a therapeutic measure by 78 % and 20 % did not know how to prevent pneumonia.The findings showed a positive attitude to immunization but inadequate information about respiratory diseases. In neighborhoods with insufficient public services (purified water, electricity and paved roads) the ignorance about pneumonia tended to increase.

West Nile fever is a mosquito-borne febrile illness seen in Africa, Asia, and Europe, but reported in North America only once. West Nile virus is of the family Flaviviridae, genus Flavivirus. Several West Nile fever outbreaks were reported from Israel in the 1950s and in 1980. Since the mid-1990s, frequency and apparent clinical severity of West Nile virus outbreaks have increased. Outbreaks in Rumania (1996), Russia (1999), and Israel (2000) involved hundreds of persons with severe neurologic disease. In the summer of 1999, West Nile virus was recognized in the among Western Hemisphere for the first time when it caused an epidemic of encephalitis and aseptic meningitis among residents of greater New York City. Other outbreak occurred during the summer of 2000. West Nile fever in humans usually is a febrile, influenza-like illness characterized by abrupt onset. Occasionally (less than 15% of cases) are acute aseptic meningitis or encephalitis. Although human vaccines for West Nile virus are under development, the most effective to way reduce local population of mosquitoes is to eliminate sources of standing water and preventing vector mosquitoes from biting humans by using mosquito repellents and barrier methods.

Pericarditis is usually a complication of viral or bacterial infection. In addition, it can be associated to systemic diseases such as autoimmune disorders, rheumatic fever, cancer, tuberculosis and AIDS. It can also be related to familial Mediterranean fever, an autosomic recessive inflammatory disease, characterized by fever, abdominal pain, and pleuritis mainly seen in persons from the Mediterranean area. In this study, we described the evolution and treatment response to colchicine in three patients with pericarditis associated to familial Mediterranean fever. Two of the patients had a pericardiectomy showing in their biopsy nonspecified inflammatory changes. Later their diagnosis were confirmed by genetic markers, echocardiogram and EKG. They were treated with antiviral and antibiotics without any improvement; subsequently they had good results with colchicine.

Hepatic dysfunction caused by malignancy is uncommon and can be the result of primary hepatocellular carcinoma, liver metastasis, secondary malignancies, or a complication of chemotherapeutic agents. Hematological malignancies, as leukemia, non-Hodgkin lymphoma, and Hodgkin lymphoma, typically do not result in hepatic dysfunction and rarely manifest as fulminant liver failure.A 43 year-old male was referred with 2-week diarrhea, nausea and vague abdominal discomfort. He was treated with oral antibiotics. However, symptoms progressed and he was admitted with advanced liver failure. On admission the patient was jaundiced, agitated, with tachycardia and hypotension. There were echymosis around the eyes and chest, active bleeding at sites of vein punctures and macroscopic hematuria. The abdomen was tender with an enlarged liver. Admission laboratory findings were consistent with acute hepato-renal failure. Viral hepatitis serology was negative, antinuclear antibody screen was negative, and iron panel was normal. Abdominal ultrasound showed liver and spleen enlargement. He developed refrac- tory hypoglycemia, further increase in serum lactate and died 5 days after admission.Acute liver failure is uncommon as the presenting feature of lymphoma. This fact may delay diagnosis, contributing to the reported poor prognosis. Establishing a diagnosis of malignancy as the cause of acute liver failure is difficult and requires a high index of suspicion. Given the poor prognosis associated with late or missed diagnosis and the potential benefits of early chemotherapy, lymphoma should be considered in any patient presenting with acute liver failure without an obvious etiology and associated with lactic acidosis and hepatomegaly.

"Objetivo: correlacionar las variables socioestructurales con el conocimiento sobre la neumonía, con el fin de explorar las ideas más comunes (representaciones sociales) sobre sus causas, prevención, tratamiento y desenlace en zonas de marginación y pobreza. Métodos: se aplicó un cuestionario a 848 adultos en siete unidades médicas rurales del programa IMSS-Oportunidades de cuatro estados. Resultados: una tercera parte de la muestra no comprende el término neumonía; 35 % de las personas con factores de riesgo no conoce su etiología; 43 % no sabe si existen complicaciones, pero 85 % considera que puede causar la muerte; el uso de antibióticos es reconocido como medida terapéutica por 78 %; 20 % declara no saber cómo se previene. Conclusiones: los hallazgos de esta investigación muestran una actitud positiva hacia la inmunización, pero una difusión insuficiente sobre las enfermedades respiratorias. Donde los servicios públicos son insuficientes, el desconocimiento acerca de la neumonía tiende a aumentar."

"La pericarditis es una inflamación del pericardiodebida a infecciones virales y bacterianas; pue-de estar asociada a fiebre reumática, tuberculo-sis, cáncer, sida y fiebre mediterránea familiar,entre otras. La fiebre mediterránea familiar es unaenfermedad inflamatoria de carácter autosómicorecesivo caracterizada por fiebre, dolor abdomi-nal y pleuritis en personas con ascendencia depaíses del mediterráneo. El presente estudio des-cribe la evolución de tres pacientes con pericar-ditis asociada a fiebre mediterránea familiar, asícomo el resultado obtenido con colchicina. Serealizó pericardiectomía a dos de los pacientesque en la biopsia mostraron cambios inflamato-rios inespecíficos. Más tarde, en dos de ellos fuecorroborado el diagnóstico de fiebre mediterrá-nea familiar mediante marcadores genéticos,además de ecocardiograma y electroencefalogra-ma, que confirmaron el diagnóstico. Fueron ma-nejados con terapia antimicrobiana y antiviral sinmejoría evidente, posteriormente se consiguieronbuenos resultados terapéuticos con colchicina."

With the multiple advances in the field of medicine and the resulting increase in life expectancy, the population pyramid is showing a tendency towards inversion; each day it becomes more feasible to surgically treat elderly patients. These patients represent a challenge not only because of the comorbidity that generally is associated with the elderly patient, but because of the multiple endemic physiological changes that alter and usually diminish their ability to cope with stressful situations. The elderly also experience social, economic and motivational problems during their illnesses, which should be considered during the surgical period in order to optimize the results of surgery and contribute to improve the quality of life of our patients. The approach with patients65 years of age during the perioperative period should be multifactorial. It is necessary to acknowledge the physiological changes, poly-pathology, poly-pharmaceutical, and social situation of our elderly patients since these are factors that will determine their response to, and recuperation from, the surgical treatment.

"La incontinencia urinaria es uno de los síndromes geriátricos cardinales; representa gran impacto en la salud y calidad de vida del anciano y la gente con quien éste convive. Su etiología es multifactorial e intervienen factores físicos, cognitivos, funcionales y psicosociales. En la mayoría de los pacientes, una historia clínica y un buen examen médico bastan para el diagnóstico, requiriendo estudios de gabinete más complejos únicamente para la confirmación y clasificación de la misma. Es de suma importancia para todo médico de adultos el conocimiento de las nuevas opciones terapéuticas, ahora disponibles para el mejor manejo de nuestros pacientes."

We reviewed a case of cerebral venous thrombosis as the manifestation of systemic lupus erythematosus in a 27-year-old woman whose main symptom was headache, and in which subarachnoid hemorrhage was initially suspected. The angiography revealed thrombosis in the superior longitudinal sinus. The treatment with steroids was satisfactory, with complete resolution of symptoms. We also reviewed the reported cases in medical literature.

Con los múltiples avances en el campo de la medicina y el resultante aumento en la esperanza de vida y la evidente inversión de la pirámide poblacional, cada día es más frecuente el tratamiento quirúrgico en pacientes de la tercera edad. Estos pacientes representan un reto no sólo por la comorbilidad que generalmente les acompaña, sino por los múltiples cambios fisiológicos propios de la edad que alteran y habitualmente disminuyen su respuesta ante situaciones de estrés. Además, los ancianos se enfrentan durante su enfermedad con problemas de tipo social, económico y anímico, los cuales deberemos tomar en cuenta durante el perioperatorio para optimar los resultados de la cirugía y contribuir a mejorar la calidad de vida de nuestros pacientes. El abordaje del paciente quirúrgico mayor a 65 años de edad durante el perioperatorio deberá ser multifactorial. Será necesario conocer los cambios fisiológicos con los que éstos cursan y tomar en cuenta su polipatología, polifarmacia y entorno socioeconómico, factores que serán determinantes en su respuesta y recuperación al tratamiento quirúrgico.

Familial Mediterranean fever (MFF) is an autosomic recessive, inherited inflammatory disease principally seen in persons from the Mediterranean area. Clinical findings include fever, abdominal pain, and pleuritis. The most severe complication of MFF is renal amyloidosis, manifested as nephrotic syndrome, which evolves into chronic renal failure. In this study, we described clinical findings, evolution, and response to treatment in 52 patients diagnosed with MFF living in Mexico City in whom the most important clinical features were fever and abdominal pain. Differing from previous reported series of patients from the Mediterranean area, patient developed renal amyloidosis during the 20-year follow-up, which suggests that an environmental factor might have a significant influence in development of renal amyloidosis.

The authors present the case of a twenty-one-year-old woman with familial Mediter ranean fever who during her first pregnancy developed a primary antiphospholipid syn drome. This is an association not reported previously.

Background The use of protease inhibitors has revolutionized the treatment of HIV infection. These agents are well tolerated, although the Federal Drug Administration (FDA) has warned U.S. doctors that protease inhibitors may precipitate hyperglycemia and diabetes (DM), based on isolated reports from physicians. Methods Sixty-one patients with HIV infection with criterion of non-DM from the onset of the protease inhibitor therapy participated in the study. Plasma glucose levels were obtained every month during a 6-month period, with a basal determination prior to protease inhibitor therapy. Results All Mexican patients enrolled in this study had the same Hispanic-American ethnic origin. Four patients (6.55%) developed hyperglycemia related with saquinavir. One had family history of DM type II. These patients were controlled with diet. Conclusions Based on present data, we believe the benefits of these drugs to patients suffering from HIV infection outweigh the various risks of taking protease inhibitors. However, physicians who use these drugs have to be on the alert for hyperglycemia in the Mexican population, while patients should know the warning symptoms of hyperglycemia and diabetes.

Pyoderma gangrenosum is a rare cutaneous disorder frequently associated with systemic diseases. The authors report the case of a 28-year-old man with pyoderma gangrenosum and inferior cava vein syndrome due to thrombosis. The search for pyoderma gangrenosum-associated conditions (gastrointestinal, rheumatic, neoplasic, and infec tious diseases) was negative. A prolonged partial thromboplastin time and a positive test for circulating anticardiolipin antibodies strongly suggested the diagnosis of the antiphos pholipid syndrome. There are reports of at least three other cases of pyoderma gangrenosum associated with the antiphospholipid syndrome. This clinical case adds further evidence to the possible link between these disorders and warrants a search for anticardiolipin antibodies in patients with pyoderma gangrenosum.

Multiple and varied mechanisms have been proposed to underlie the difference in occurrence of amyloid nephropathy in patients with familial mediterranean fever (FMF). However, the precise mechanism(s) has, thus far, remained enigmatic.1 We have recently reviewed the 10-year follow-up of a group of 51 patients with FMF living in Mexico City. Thirty-five patients were male and 16 were female; thirty-eight patients had been born in Mexico City and the rest in Syria; the median age of the group was 39 years (range, 4 to 77 years); the median age at onset of symptoms was 17.54±12.54 years. The most frequent complaint was abdominal involvement (n=51), followed by fever (n=50), pleuritis (n=11), and arthritis (n=9). Abdominal involvement had been so severe that it led to surgical intervention in 46 of our patients. Urinalysis, done every 3 months in all but three patients, did not reveal protein urinary excretion during the 10-year