Mexican Journal of Medical Research ICSA

Title

Mario Isidoro — 2023-01-05

Editorial Committe

Mario Isidoro — 2023-01-05

Immune response in pregnancy: An evolutionary challenge against external and internal stimuli

Raquel Cariño-Cortés — 2023-01-05

Several studies from the 1990s found that adverse effects on the fetal environment, such as poor maternal nutrition, can lead to an increased risk of developing chronic diseases in adulthood.

These findings led to the fetal origins of disease hypothesis, commonly known as the Barker hypothesis, which proposes that exposures to insults during critical or sensitive windows of development can permanently reprogram physiological responses, thereby giving rise to metabolic and hormonal diseases and disorders later in life.1,2

Pregnancy remains one of the most vulnerable periods in terms of morbidity and mortality, certainly for the fetus, but also for the mother. According to the INEGI, in 2020 there were 22,637 fetal deaths, which corresponds to a national rate of 6.7 per 10,000 women of childbearing age. 82.9% of fetal deaths occurred before delivery, 15.6% during delivery, and in 1.5% of cases was not specified.3

The main complications, which cause 75% of maternal deaths, are: severe bleeding (mostly after childbirth); infections (usually after childbirth); gestational hypertension (preeclampsia and eclampsia); childbirth complications; unsafe abortions (performed clandestinely, in unsuitable conditions and by untrained personnel).4

Interactions between the product of conception and the mother are bidirectional: the fetoplacental tissues need nutrition and a suitable environment under homeostatic conditions, while the mother, influenced by placental factors, adapts her metabolism and immune system to ensure tolerance, which include embryonic and fetal, placental and maternal elements.5 At the maternal-fetal interface, the placenta contains cells of the immune system and mediators, such as uterine NK cells (uNK, 70%), macrophages (20%), T cells (including CD4+, CD8+, γδ T cells, and regulatory T cells) (10 %), dendritic cells, and few B cells. The numbers of these cells and the roles they play vary at different stages of pregnancy. It has been suggested that there may be several local and systemic modifications related to the protection of the developing fetus against attack by the maternal immune system, mainly the expression of unique human leukocyte antigens (HLA) by trophoblasts, the influence of female sex hormones and the bias of citokines.6

As soon as the embryo makes contact with the maternal endometrium, trophoblast cells fuse with the attachment site, forming a syncytium called a syncytiotrophoblast.7 This tissue and the cytotrophoblast do not express complex major histocompatibility (MHC) class I or class II molecules. In contrast, the extravillous cytotrophoblast does express non-classical MHC molecules (HLA-G or HLA-E), which inhibit the activation of uNK cells, favoring immunological tolerance.8

During the first trimester, uNK cells represent up to 50–70% of decidua lymphocytes. Differently from peripheral-blood NK, these are poorly cytolytic, and they release cytokines/chemokines that induce trophoblast invasion, tissue remodeling, embryonic development, and placentation. NK cells can also shift to a cytotoxic identity and carry out immune defense if infected in utero by pathogens. At late gestation, premature activation of NK cells can lead to a breakdown of tolerance of the maternal–fetal interface and, subsequently, can result in preterm birth.9 HLA-G interacts with receptors ILT2 and KIR2DL4 on macrophages and NK cells to enhance the production of proangiogenic cytokines and and enhance trophoblast integrity, invasion of decidua, thereby promoting spiral artery remodeling. In addition, HLA-G binds to ILT2, ILT4, and KIR2DL4 on NK cells, T cells and macrophages, inhibits the cytotoxicity of NK cells and CD8+ T cells, and causes an increase in the percentage of Treg cells in the population, and thereby contributes to immune tolerance.

The abnormal expression and polymorphisms of HLA-G are related to adverse pregnancy outcomes such as preeclampsia (PE) and recurrent spontaneous abortion (RSA).10

Cytokine bias is associated with the predominance of Th2-type immunity, while Th1-type responses are considered potentially dangerous for the continuation of the pregnancy.11 Sex hormones have profound effects on the immune system and play a critical role in shaping Th cell immunity throughout stages of pregnancy. Androgens are considered to promote anti-inflammatory responses whereas estrogens can exhibit both pro- and anti-inflammatory roles depending on the relative expression of estrogen receptor isoforms.12 However, significantly high doses of estrogens such as those observed in pregnancy typically suppress immune responses. Pregnancy levels of estardiol also influence CD4+ T cell polarization through enhanced expression of Th2 associated (GATA3, IL-4) and Treg associated genes (Foxp3, PD-1, IL-10, and TGF-β) while suppressing the expression of Th1 associated (T-bet, IL-2, TNF-α, IFN-γ) and Th17 associated genes (ROR-γt, IL-6, IL-17, IL-23).12,13 During pregnancy progesterone induces anti-inflammatory responses and promotes tolerance through the selectively inducing the differentiation of naive CB T cells into Tregs, while suppressing their differentiation into inflammatory Th17 cells, potentially through suppression of the IL-6 receptor expression, and a systemic decline in its concentration prior to the onset of labor in most animal models.14 In conclusion, both allogeneic and hormonal stimulation are responsible for a harmonious regulation of the immune system leading to a successful pregnancy.

Obstetric-Neonatal Complications of Gestational Diabetes: A Systematic Review

Stivalitt Esmeralda Valdez Vargas — 2023-01-05

Analyse the evidence provided regarding neonatal and obstetric complications derived from gestational diabetes. A systematic search of the scientific literature, PUBMED, ScienceDirect was carried out with various search strategies guaranteeing the completeness and reproducibility of the phases of the PRISMA guide. 13 studies were included, 10 simultaneously evaluated obstetric and neonatal complications, the rest (3) evaluated only neonatal complications. The prevalence of GDM (gestational diabetes mellitus) was 12.5% (65,852 of 527,351) Obstetric complications include: emergency caesarean section (OR 1.1 to 2.37), preeclampsia with an OR range of 1.1 to 2.96, and prematurity (OR 1.1 to 2.3). The most frequent neonatal complications are: macrosomia with an OR range of 1.2 to 5.2, with a prevalence of 10.3%; while hypoglycaemia is the one with the highest risk (OR 3.19-11.97), other complications include greater height for gestational age OR 1.3 to 3.43; perinatal asphyxia (OR 1.2-3.4); shoulder dystocia (OR 1.3-2.56); respiratory distress (OR 1.3-2) and hyperbilirubinemia (OR 1.02-1.39). No increased risk of perinatal death was found, the reported OR range is 0.7-0.8. Both obstetric and neonatal gestational diabetes complications are very prevalent and may require intensive care, being a highly relevant public health problem. Although an efficient screen for the early detection of gestational diabetes has been established, greater efforts are required to comply with it and to avoid these complications.

Indole as a regulator of bacterial physiology

Rubi Joseline Castillo-Juárez — 2023-01-05

During the last years, indole has been the subject of study, this is chemically defined as an aromatic bicyclic heterocycle, from the synthesis of tryptophan after its degradation by tryptophanase (TnaA); in turn has been implicated as a signalling molecule used by several bacteria to establish multiple behaviours. Most studies have focused mainly on Escherichia coli (E. coli), which produces a small amount of indole during the transition from exponential to stationary phase. According to the literature review, indole plays a fundamental role in many bacterial processes, mainly: biofilm formation, virulence, acid resistance, antibiotic resistance and persistent cell formation; the concentrations of this molecule play an important role in regulating these mechanisms; on this basis, indole could control undesired bacterial physiological processes, offering us a new therapeutic alternative to different behaviours of microorganisms. The objective of this bibliographic review is to expand the area of knowledge about indole as a regulator of diverse bacterial mechanisms, and thus motivate further research on this molecule and its therapeutic use.

Fear in the COVID-19 context

Ana G. Olvera-Cruz — 2023-01-05

The COVID-19 pandemic has affected the entire population worldwide, defined by the World Health Organization as an "infectious disease" caused by a new SARS-CoV-2 coronavirus, which has managed to spread unexpectedly, causing high morbidity and mortality rates and negatively impacting multiple aspects of human life, not only physical health but also mental health; In this regard, psychosocial factors such as fear, depression, stress and anxiety are common manifestations in any situation that puts the life of the individual at risk, since, according to the National Survey of Mental Health, 18% of the population between 15 and 64 years of age suffers from some mood disorder. In view of this, the objective of this article is to carry out a literature review on the affectations that the world population has suffered as a response to the COVID-19 pandemic, specifically, on fear, which is an experience that produces an unstable emotional effect derived from the valuation of a potentially dangerous situation and that one has no control over it, as well as on its affectations that the world population has suffered as a response to the COVID-19 pandemic.

Association of periodontal disease and diabetic retinopathy

Erik L. García-Hernández — 2023-01-05

The main problem of type II diabetes is that excessive levels of glucose in the blood damage the vascular endothelium causing complications, such as periodontal disease (PD) that, in people with diabetes, can compromise the patient's ability to maintain normal function. adequate metabolic control. Therefore, it is important to analyse the effect of PD status on complications in patients with type II diabetes; Previous studies have reported that there is a bidirectional relationship between PD and diabetic complications, but it has not been clarified whether PD affects the presence of complications such as diabetic retinopathy (DR). DR is a microvascular complication and is considered the main cause of visual loss worldwide, similarly, periodontitis is a microvascular chronic inflammatory condition that compromises the dental support tissues. This article was prepared as an update for health professionals and also to analyse PE and how it is related to the presence of DR. Based on the literature, we can conclude that the number of teeth is an independent risk factor for DR, greater bleeding on probing could affect the presence of DR, and that patients with DR seem to show greater susceptibility to PD. The bibliography also mentions that more studies should be carried out with large samples, adequate models that adjust confounding variables such as obesity, hypertension, other chronic-degenerative diseases, use of substances such as alcohol or cigarettes, also carrying out prospective analyses of the conditions of periodontitis and DR.

Approaching grief during the pandemic by COVID-19

Karen Cruz León — 2023-01-05

At the end of December 2019, the outbreak of coronavirus disease 19 (COVID-19) emerged in the city of Wuhan, China, due to the rapid spread of the disease, in March 2020 a pandemic was declared by the World Health Organization and the International Committee on Taxonomy of Viruses. As the COVID-19 disease ravages the world, a high rate of infection and mortality has been evidenced in a short time. To reduce the spread of COVID-19, governments have introduced prevention policies, such as lockdowns and social distancing, among others. This resulted in potential psychosocial changes that affected many aspects of daily life, including how to die and cope with the death of a loved one, with limited opportunities to shape funeral rituals and difficulty receiving support. Social. A large number of people who died alone due to these policies, in turn the relatives experienced situations of impotence and frustration, since they were limited in the care of their loved one, in visits to the hospital and even could not say goodbye. The objective of this article is to provide various strategies compiled in documents that help to deal with grief in people who had the loss of a loved one in times of pandemic, among which communication and psychological and social support stand out.

Osteoma in the temporomandibular joint (Case report)

Eder Y. Monroy-Mendoza — 2023-01-05

Osteomas are benign slow growing osteogenic tumors mostly arising in the craniofacial region and characterized by the deposition of differentiated and mature either or both cancellous and compact bone. Osteoma accounts for 2-3% of all bone primary tumors with an incidence of 10-12% among all benign skeletal neoplasms. Objective: The objective of this work is to describe a clinical case of an osteoma in the temporomandibular joint diagnosed in the maxillofacial surgery service of the General Hospital of Pachuca in the State of Hidalgo, Mexico. Clinical Case: A 39-year-old female patient who comes to the General Hospital Pachuca, Mexico due to pain and noises in the right preauricular region of 6 years of evolution, with facial asymmetry, mandibular deviation to the left and limited mouth opening. Clinically, facial asymmetry, mandibular deviation to the left, right posterior crossbite, anterior open bite mainly on the affected side, preauricular pain, joint sounds, and limitation of mandibular movements were observed. Radiographic examination revealed a trapezoidal mass measuring 2.5 by 2.0 cm, with alteration of the condyle-mandible anatomy on the right side. An insertional biopsy is performed, reporting an osteoma, and surgical intervention is continued. Conclusion: The osteoma in the temporomandibular joint is a rare lesion, its timely value is essential for its treatment. Surgical resection is the gold standard treatment, which is based on a radical excision that extends to the altered normal bone, with the contextual objective of achieving an optimal aesthetic result by choosing the least invasive surgical treatment possible.

Gaseous mediators (H2S, NO and CO) a new approach in gastrointestinal protection

Elizabeth Arlen Pineda-Peña — 2023-01-05

Gastrointestinal damage is generated by a wide range of harmful agents, and is the result of the activation of inflammatory, oxidant and cytotoxic mechanisms, that together overwhelm the “mucosa defense” of the gastrointestinal (GI) tract. It is currently known that the mechanisms by which gastric damage is generated are slightly different from those that generate intestinal damage. The treatments available on the market such as citoprotectors, the use of selective Ciclooxigenase 2 (COX-2) inhibitors, the co-prescription of acid suppressive agents and the use of prostaglandin analogues are mainly focused on the mechanisms of gastric damage, and their use has begun to be limited due to its adverse effects at intestinal and cardiovascular level. Due to its multifactorial origin, the prevention and treatment of GI damage requires effective therapies that can protect both gastric and intestinal level modulating more than one mechanism. Recently, has been reported the contribution of gaseous mediators nitric oxide (NO), hydrogen sulfide (H₂S) and carbon monoxide (CO) in many physiological processes in the gastrointestinal tract, including the maintenance of GI mucosal barrier integrity. Experimental evidence has shown promising results regarding the gastric safety of these gasotransmitters, especially those coupled to NSAIDs. This review will try to give a general overview of the mechanisms of gastric and intestinal damage, their main differences, the existing therapies for their treatment and the information available on gas transmitters with a brief description of roles of each of these gaseous molecules.

Bone mineral density in a sample of Mexican trans women

Luis Luis Ortiz Hernández — 2023-01-05

Introduction: Trans people represent a vulnerable group, and their health conditions are poorly understood. A trans woman is a person who at birth has the biological sex of a man, but identifies and expresses herself as feminine. Objectives: to evaluate bone mineral density (BMD) and its associations with health habits and body composition in Mexican trans women (TW). Material and methods: A cross-sectional study was carried out with a convenience sample of thirty trans women, residents of Toluca City, Mexico. Bone mineral density (BMD) was evaluated by densitometry (DXA) and body composition by electrical bio-impedance, using reference values for Mexican-American men. A questionnaire on socio-demographic characteristics, physical activity, health-related habits, and use of gender-affirmative hormone therapy was applied. Results: The mean age of the participants was 28 years (SD = 6.9); 20% of the participants had low BMD. Low socioeconomic status was related to lower BMD in the hip (p = 0.043). The trans women with heavier bodies had a higher BMD in the spine (for weight, p= 0.004; for fat mass, p = 0.047; for fat-free mass, p = 0.004); furthermore, fat-free mass was associated with higher BMD in the hip (p = 0.050). No statistically significant relationships were found with other variables. Conclusions: Trans women had low BMD, which was associated with socioeconomic status and body composition. The findings suggest that trans women represent a vulnerable group and require the design of strategies oriented to health and nutrition problems.

Overview of Organ Donation

Karla Jiménez Oliver — 2023-01-05

Organ and tissue donation is defined as the transfer of human cells, tissues and organs from a donor to a recipient; it is the only therapeutic option that helps to improve the quality of life and prevent the death of people with tissue or organ failure. However, this process is hampered due to the discrepancy between organ supply and demand worldwide, which increases clinical deterioration and mortality rates on the waiting list of patients with chronic or acute multi-organ failure. The aim of this article is to provide relevant information about the process of organ and tissue donation, highlighting the importance of understanding the process, providing information to the general population, with emphasis on essential groups for its dissemination, mainly health professionals who have the ability to positively influence society's perception of this issue by providing health education during primary care, This is the first contact and an important link in the attention of the potential donor, considering medical units as the closest source of information due to recurrent access, and not least children and young people, as it has been shown that this action increases the acceptance rate, turning this section of the population into agents of social change, generating with this manuscript, a positive impact on the perception and understanding of the subject for society, seeking to increase the availability of donors.

Self-medication in ophthalmologic problems. What is known about it?

Arely Ballesteros Hernández — 2023-01-05

Self-medication (SM) refers to any practice for curative purposes that is not prescribed by a physician. It includes the use of conventional or allopathic medicine (CM) and complementary and alternative medicine (CAM). In the case of ophthalmologic ailments, this division can also be seen, within CM, the use of anesthetics, analgesics and topical antibiotics, for the treatment of mainly traumatic pathologies, to save time and money, advised by their close circle, but always with the risk of not improving, abusing the medication, producing toxicity, masking the condition and giving an incorrect treatment. CAM highlights the use of biological therapies due to the variety of products that have been documented, such as chamomile, tea leaves, garlic, sage, etc. But also the use of mind-body therapies, manipulative and body-based methods; and energy therapies such as acupuncture; there are many more pathologies for which they are used compared to CM, and they resort to it precisely because of the lack of results of CM, the sources of information are usually similar and although they seem harmless, they are not innocuous. In general, it is a subject that is little addressed, but is relevant due to the risks involved. This manuscript seeks to provide an overview so that medical personnel remain expectant and in each intervention detect the areas of opportunity that reduce this practice.