Browsing by Autor "Natalia M Barron-Cervantes"

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Delayed Gastric Emptying and Other Adverse Outcomes in Patients Undergoing Classic Whipple Versus Pylorus-Sparing Pancreatoduodenectomy
(Cureus, Inc., 2024) Cynthia Martinez‐Cabrera; Alejandro Martinez-Esteban; Natalia M Barron-Cervantes; Alfonso Bandín-Musa; Carlos H.F. Chan
Background and objective Pancreatoduodenectomy (PD), or the Whipple procedure, has many variants. There is a lack of data in the literature in terms of comparing various types of this procedure. This study aimed to compare the classic Whipple procedure with the pylorus-sparing Transverso-Longmire technique, focusing on postoperative complications and delayed gastric emptying (DGE). Methodology We conducted a retrospective observational study including 97 adult patients who underwent either the classic Whipple procedure or the pylorus-sparing technique at Hospital Médica Sur from 2016 to 2021. Data on patient demographics, comorbidities, type of surgery, clinical presentation, and postoperative complications were collected. DGE was defined according to the International Study Group of Pancreatic Surgery (ISGPS) criteria. Results Among the 97 patients, 50.5% were men, and the median age of the cohort was 65 years. Almost all patients underwent surgery for malignancy (96.9%). The classic Whipple group had fewer cases of DGE (9.8% vs. 30.6%, p=0.01), shorter hospital stays (7 vs. 11 days, p=0.001), and lower readmission rates (13.1% vs. 33.3%, p=0.017). The pylorus-sparing PD was associated with a lower incidence of bile leak [odds ratio (OR)=0.62, 95% confidence interval (CI): 0.53-0.73]. However, this technique was associated with a higher incidence of DGE (OR=4, 95% CI: 1.34-12.1), overall hospital admission rates (OR=3.3, 95% CI: 1.2-9.2), and admissions that resulted in a surgical event (OR=1.9, 95% CI: 1.21-2.96). DGE was associated with the need for a second surgery (OR=10.5, 95% CI: 2.8-39.5) and hospital readmission (OR=10, 95% CI: 3.1-32.3). Conclusions While the pylorus-sparing technique is associated with reduced bile leaks, it results in a higher incidence of DGE, prolonged hospital stays, and increased readmissions. Clinicians opting for the pylorus-sparing technique should ensure careful patient selection and rigorous postoperative monitoring.
Guillain-Barré Syndrome in an Immunocompromised Patient: A Case Report
(Cureus, Inc., 2024) Enrique Piña-Rosales; Jimena González-Salido; Natalia M Barron-Cervantes; Jimena Colado-Martínez; Raúl A Garcia- Santos; Luis Guevara- Arnal
Guillain-Barré syndrome (GBS) in post-transplant patients is a rare clinical presentation. Although in the literature this neurological condition has been mainly associated with viral infections secondary to immunosuppression, GBS should not only be suspected in patients with an acute condition. It is essential to always rule out a viral or bacterial cause, looking for the most common sources, i.e., urinary, respiratory, and gastrointestinal. The diagnosis of GBS is clinically based, and its management is based on the use of intravenous immunoglobulin (IVIG) or plasma exchange. Its timely diagnosis allows treatment to be started early, thus improving the prognosis of these patients and reducing the time of hospitalization and complications associated with it. This report shows how an interdisciplinary approach is vital in such cases, as both the precipitant and the disease must be managed to decrease the morbidity and mortality associated with this condition. It is crucial to evaluate the benefits and risks of withdrawing immunosuppressive treatment in post-transplant patients, and being able to recognize when restarting them is indicated.
Ischemic Stroke as an Initial Manifestation of Antiphospholipid Syndrome in an Adolescent: A Case Report
(Cureus, Inc., 2024) Jimena González-Salido; Natalia M Barron-Cervantes; Jimena Colado-Martínez; Sara Fernanda Arechavala Lopez; Virna L Mosqueda-Larrauri; Juan L Ortiz-Herrera; Enrique Piña-Rosales; Javier Martinez-Bautista
Cerebrovascular diseases in pediatric patients are relatively rare. Ischemic stroke in adolescents is associated with a poor prognosis. The most common causes include systemic diseases, such as heart disease and hypercoagulation disorders. It is important to mention that one of the most common acquired hypercoagulation states is the antiphospholipid syndrome (APS). Patients with this disease may present stroke as the first clinical manifestation, which not only increases morbidity in these patients but presents a diagnostic challenge. This case presents one example of how APS can present as a pediatric stroke. The diagnostic approach should always be through the presence of specific antibodies accompanied by the presence of a thromboembolic episode proven by catheterization or an imaging study. In the brain, the preferred imaging study is magnetic resonance imaging. Management is based on anticoagulation therapy and continuous monitoring in the intensive care unit.
Pathological Thoracic Vertebral Fractures Secondary to Achromobacter denitrificans: A Case Report
(Cureus, Inc., 2024) Gerardo Romero-Luna; Natalia M Barron-Cervantes; Jimena González-Salido; Jimena Colado-Martínez; Gustavo Anaya-Delgadillo; Pedro Pablo De Juambelz-Cisneros
Reactive Arthritis as a Consequence of Infection by Clostridium difficile in a Pediatric Patient
(Cureus, Inc., 2024) Natalia M Barron-Cervantes; Jimena González-Salido; Jimena Colado-Martínez; Emily Retana-Estrada; Humberto O Bibiano-Escalante
Reactive arthritis (RA) is the development of a sterile inflammatory arthritis usually associated with a previously known infection, most commonly from the gastrointestinal or urogenital tract. The diagnosis is clinical, based on the presence of acute oligoarticular arthritis of larger joints developing within two to four weeks of the infection. However, in some cases where the infection is not clear, the diagnosis is a challenge, like in the case presented here. We must always rule out past infections as a cause of arthritis by directly asking about the presence of symptomatology associated with it, presented in the past few weeks. It's important to emphasize that human leukocyte antigen B27 (HLA-B27) should not be used as a diagnostic tool, and it always needs to be correlated with the clinical features. There is no confirmed evidence in the literature that is in favor of prescribing antibiotic therapy during an acute presentation of RA as it usually presents after the infection is cured.