Experimental evidence in mice models has demonstrated that a high regulator of G-protein signaling 2 (RSG2) protein levels precede an insulin resistance state. In the same context, a diet rich in saturated fatty acids induces an increase in RGS2 protein expression, which has been associated with decreased basal metabolism in mice; however, the above has not yet been analyzed in humans. For this reason, in the present study, we examined the association between RGS2 expression and insulin resistance state. The incubation with palmitic acid (PA), which inhibits insulin-mediated Akt Ser473 phosphorylation, resulted in the increased RGS2 expression in human umbilical vein endothelial-CS (HUVEC-CS) cells. The RGS2 overexpression without PA was enough to inhibit insulin-mediated Akt Ser473 phosphorylation in HUVEC-CS cells. Remarkably, the platelet RGS2 expression levels were higher in type 2 diabetes mellitus (T2DM) patients than in healthy donors. Moreover, an unbiased principal component analysis (PCA) revealed that RGS2 expression level positively correlated with glycated hemoglobin (HbA1c) and negatively with age and high-density lipoprotein cholesterol (HDL) in T2DM patients. Furthermore, PCA showed that healthy subjects segregated from T2DM patients by having lower levels of HbA1c and RGS2. These results demonstrate that RGS2 overexpression leads to decreased insulin signaling in a human endothelial cell line and is associated with poorly controlled diabetes.

Background: The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal. Aims: The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit. Methods: We identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases ''stress ulcer'', ''stress ulcer bleeding prophylaxis'', and ''stress-related mucosal bleeding'' in combination with ''intensive care unit''. Results: The incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies. Conclusions: Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis. Profilaxis para sangrado por ulceras de estrés en la unidad de cuidados intensivos ResumenAntecedentes: El paciente críticamente enfermo puede desarrollar erosiones gástricas y, en ocasiones, úlceras por estrés con sangrado gastrointestinal grave que puede ser fatal. Objetivos: El propósito de esta revisión fue proporcionar información actualizada acerca de la fisiopatología, factores de riesgo y profilaxis por sangrado del tubo digestivo causado por ulceras de estrés en la unidad de cuidados intensivos. Métodos: Identificamos artículos a través de una búsqueda en PubMed, que abarcaba de los años 1970 a 2013. Los artículos más relevantes fueron seleccionados utilizando las frases de búsqueda «úlceras de estrés», «profilaxis de sangrado por úlceras de estrés» y «sangrado de la mucosa relacionado con el estrés» en combinación con «unidad de cuidados intensivos». Resultados: La incidencia de sangrado clínicamente significativo ha disminuido drásticamente desde 1980. Los factores de riesgo más importantes son el fallo respiratorio y las coagulopatías. Los inhibidores de la bomba de protones (IBP) o los antagonistas de receptores H2 (H2RA) se utilizan en la profilaxis de sangrado por úlceras de estrés. Ambos medicamentos han mostrado ser superiores al placebo en la reducción del riesgo de sangrado gastrointestinal, y los IBP son por lo menos tan efectivos como los H2RA. Se ha mostrado que la alimentación enteral temprana reduce el riesgo de sangrado por úlceras de estrés, aunque solo en estudios retrospectivos. Conclusiones: La hospitalización en la unidad de cuidados i...

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Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis.

645 www.medicinainterna.org.mx caso clínico Med Int Méx. 2018 julio-agosto;34(4):645-648. Síndrome de seno cavernosoResumen La trombosis del seno cavernoso es una enfermedad poco común, pero puede ser fatal. Se vincula con infecciones faciales, sinusitis o asépticas. El reconocimiento oportuno en pacientes con fiebre, cefalea y alteraciones en la exploración de movimientos oculares es importante para un buen pronóstico. Se comunica el caso de un paciente con síndrome de seno cavernoso, con meningitis por contigüidad.PALABRAS CLAVE: Síndrome del seno cavernoso; meningitis. AbstractCavernous sinus thrombosis (CST) is a rare, life-threatening disorder that can complicate facial infection. Early recognition of cavernous sinus thrombosis in patients with fever, headache, eye findings such as periorbital swelling and ophthalmoplegia is critical for good outcome. We present the case of a patient with cavernous sinus syndrome with contiguous meningitis. Este artículo debe citarse comoJaramillo-Ramírez HJ, Yocupicio-Yocupicio FM, Angulo-Preciado A, Espinoza-Rodríguez CR. Síndrome de seno cavernoso. Med Int Méx. 2018 julio-agosto;34(4):645-648.

Background: Guillain-Barré Syndrome is a progressive autoimmune polyradiculoneuropathy characterized by symmetrical flaccid paralysis accompanied by areflexia, hyporeflexia or hyperreflexia on rare occasions. Worldwide, it remains the first cause of flaccid paralysis. It is usually associated with infectious disease history; however, there are various clinical variants, each with a different outcome. Prognosis is usually good, although 20% of patients could suffer a severe clinical variant of Guillain-Barré Syndrome and 5% will die despite treatment. Methods: This is a cross-sectional study, including the records of hospitalized patients with Guillain- Barré Syndrome at Mexicali’s General Hospital within a five-year period. Results: In a five-year span there were 64 patients with Guillain-Barré Syndrome, most of the patients were men (70.3%), with age ranging 1 to 76 years. A total of 8 (12.5%) patients died, from which 7 (87.5%) required mechanical ventilation during hospitalization. Immunoglobulin therapy was provided to 56 (87.5%) patients, and 6 (10.7%) of them perished due to acute kidney injury. Conclusion: Guillain-Barré Syndrome is a common disease among male population, with no dominating onset age, however, leaning for the young and elder. Most of the patients that were hospitalized at the General Hospital of Mexicali had a history of previous infection (gastrointestinal, respiratory, or other infectious diseases). The need for mechanical ventilation represents a higher severity index, nonetheless, this does not mean that assisted ventilation is directly associated with mortality. As for treatment, immunoglobulin is the most common choice for therapy, though some of the patients died from acute kidney injury.

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