RESUMEN. Introducción: El síndrome de Rapunzel es una forma inusual de tricobezoar gástrico, se localiza desde el estómago llegando a traspasar el píloro y extendiéndose hasta el intestino delgado y/o colon derecho. Se le llama bezoar a la formación de cuerpos extraños, debido a la ingestión de uno o varios materiales no digeribles. El tricobezoar, uno de los bezoares que más se presentan en la práctica clínica consisten en una masa formada por cabello debido a la ingestión de este.Objetivo: describir la frecuencia de signos y síntomas del síndrome de Rapunzel en los reportes de caso y ofrecer una comparación en edad pediátrica y adulta.Método. Revisión sistemática en la base de datos PubMed, Google Académico, EBSCO y Scopus, empleando los términos “Rapunzel syndrome” AND “case report” OR “Clinical case”Resultados. Un total de 110 artículos de reporte de caso fueron analizados, encontrando diferencias por sexo y edad. La tricotilomanía se distribuyó sin predominancia por grupo de edad. Se identificaron diferencias en el reporte de algunas manifestaciones clínicas al analizarlas por grupo de edad, incluyendo diarrea, constipación, vómitos y dolor abdominal. Los casos recidivantes representaron un 9%.Conclusiones: El síndrome de Rapunzel es una entidad que se encuentra en pacientes con patologías psiquiátricas como la tricotilomanía y la tricofagia. Es más frecuente en mujeres que en hombres. La técnica diagnóstica por elección fue la endoscopía y el tratamiento elegido incluyó la remoción quirúrgica con psicoterapia. Palabras clave: síndrome de Rapunzel, signos y síntomas, bezoar, diagnóstico, tricotilomanía, adolescencia. Introduction: Rapunzel syndrome is an unusual type of gastric trichobezoar, which is located from the stomach through the pylorus and extends into the small intestine and/or right colon. Tricobezoar is a collection of foreign bodies that can form in the stomach, small intestine or colon, due to the ingestion of one or more indigestible materials. trichobezoar, one of the most present bezoars in Clinical practice consists of a mass formed by hair due to the ingestion of it, either consciously or unconsciously. Objective: To compile case reports to identify and analyze little-known aspects of Rapunzel syndrome, as well as patient characteristics along with the best and most documented methods of diagnosis and treatment. Method. Systematic review in the Pubmed, Google Scholar, EBSCO and Scopus databases using as search terms: "Rapunzel syndrome" AND "case report" OR "Clinical case" Results: A total of 110 case report articles were analyzed, finding differences by sex and age. Trichotillomania was distributed without predominance by age group. Differences were identified in the reporting of some clinical manifestations when analyzed by age group, including diarrhea, constipation, vomiting and abdominal pain. Recidivist cases were 9%. Conclusion: Throughout the review of reported cases, we found that part of the patient's recovery includes psychiatric treatment; Rapunzel syndrome is not a mental disorder, however, both trichotillomania and pica as factors of it. The entity is more frequent in women than in men, the technique for diagnosis by choice was the endoscopy and the chosen treatment included surgical removal with psychotherapy. Keywords: Rapunzel Syndrome, Signs and Symptoms, Bezoar, Diagnosis Trichotillomania, Adolescence.

Introduction: COVID-19 affected worldwide, causing to date, around 500,000 deaths. In Mexico, by April 29, the general case fatality was 6.52%, with 11.1% confirmed case mortality and hospital recovery rate around 72%. Once hospitalized, the odds for recovery and hospital death rates depend mainly on the patients' comorbidities and age. In Mexico, triage guidelines use algorithms and risk estimation tools for severity assessment and decision-making. The study's objective is to analyze the underlying conditions of patients hospitalized for COVID-19 in Mexico concerning four severity outcomes. Materials and Methods: Retrospective cohort based on registries of all laboratory-confirmed patients with the COVID-19 infection that required hospitalization in Mexico. Independent variables were comorbidities and clinical manifestations. Dependent variables were four possible severity outcomes: (a) pneumonia, (b) mechanical ventilation (c) intensive care unit, and (d) death; all of them were coded as binary Results: We included 69,334 hospitalizations of laboratory-confirmed and hospitalized patients to June 30, 2020. Patients were 55.29 years, and 62.61% were male. Hospital mortality among patients aged<15 was 9.11%, 51.99% of those aged >65 died. Male gender and increasing age predicted every severity outcome. Diabetes and hypertension predicted every severity outcome significantly. Obesity did not predict mortality, but CKD, respiratory diseases, cardiopathies were significant predictors. Conclusion: Obesity increased the risk for pneumonia, mechanical ventilation, and intensive care admittance, but it was not a predictor of in-hospital death. Patients with respiratory diseases were less prone to develop pneumonia, to receive mechanical ventilation and intensive care unit assistance, but they were at higher risk of in-hospital death.

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