[The clinical guidelines of practice project at the Instituto Mexicano del Seguro Social]. / Proyecto para el desarrollo de guías de práctica clínica en el Instituto Mexicano del Seguro Social.

The advance in the knowledge and technology is growing quickly and greater quantity, so it is difficult for the health professional to access to whole information that is generated every day on diagnostic and therapeutic strategies more effective, so the clinic practice guidelines (CPG) is a resource to support the updating of the health professional and support them in making clinical decisions. The CPG is also a better support to the manager of health services in making decisions regarding the strategies that have performed for the patient and less risk to the individual and collective health. They also support the response capacity of the medical units and hospitals and guide the planning of services to the optimization of the resources. This paper summarizes the methodology of a national project for the development of GPC coordinated by the Mexican Social Security Institute with the collaboration of more than 1200 health professionals of the institution in a great effort institutional update and make information accessible to the entire health sector, which also defines the steps to upgrade and maintain the updating of knowledge and technology expressed in them.

PSEN1 mutation carriers present lower cerebrospinal fluid amyoid-ß42 levels than sporadic early-onset Alzheimer's disease patients but no differences in neuronal injury biomarkers.

Most cases of early-onset Alzheimer's disease (EOAD) are sporadic. A minority of EOAD are caused by specific genetic defects in PSEN1, PSEN2, or AßPP genes. Magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) biomarker comparisons between sporadic and monogenic EOAD are practically inexistent. CSF and MRI data from 14 amnestic-onset sporadic EOAD (sEOAD) subjects were compared with data from 8 symptomatic PSEN1 mutation carriers (PSEN1) and 14 age-matched cognitively-preserved controls. CSF concentrations of amyloid-ß (Aß)(42), total tau (t-tau), and phosphorylated tau (p-tau) were determined. Cortical thickness (CTh) and grey matter loss were compared between groups and correlated with CSF biomarkers. PSEN1 had significantly lower CSF Aß(42) levels compared to sEOAD (mean 244.8 pg/ml versus 381.4 pg/ml; p = 0.006), but no differences in t-tau or p-tau. Both sEOAD and PSEN1 showed widespread CTh loss in AD target areas when compared with controls. No differences were found in the direct comparison between sEOAD and PSEN1 CTh after adjusting for age and Mini-Mental Status Examination scores. Neither was a correlation found between Aß(42) levels and CTh. CTh in the left superior parietal and caudal middle frontal areas was negatively correlated with t-tau values. In conclusion, PSEN1 had lower Aß(42) CSF levels compared with sEOAD, suggesting a greater cerebral deposition of Aß(42). These differences in Aß(42) deposition were not significantly reflected in the brain structure, and CTh was only correlated with total tau. The lack of significant differences in relation to t-tau and p-tau levels and to the severity of CTh or grey matter loss suggests a similar level of neuronal injury despite higher Aß(42) load in PSEN1.

Survey on physicians' knowledge and attitudes towards clinical practice guidelines at the Mexican Institute of Social Security.

OBJECTIVE: A survey was organized to determine the general level of knowledge and attitudes of medical personnel towards clinical practice guidelines (CPG). METHODS: A questionnaire modified from two validated instruments was used. Multi-stratified sampling was applied, and 1782 questionnaires were completed. RESULTS: A total of 80.4% of physicians had regular employment contract, 8.6% managerial post and 9.3% temporary work contract. Average age and working time were 43.7 and 15 years respectively; 64.3% were male. It was reported that 47.9% participated in academic activities, 70.8% belonged to a medical association, 40.3% identified CPG as steps towards arriving at a diagnosis and/or treatment and 14.9% thought that CPG were norms. A total of 10.7% of the physicians believed that guidelines are based on scientific evidence, 10% perceived them as supporting tools, 10.8% had no knowledge of them, 65% said that they used them, 76.7% thought that personal experience was as important as CPG recommendations and 57.4% thought that CPG were necessary for good medical practice. Physicians preferred that CPG be produced by personnel from outside the Mexican Institute of Social Security, or who had followed validity criteria. CONCLUSIONS: The majority of physicians considered CPG to be useful tools. It was evident that few knew where to acquire CPG, and this would lead to their limited use. Findings from this study enabled procuring a broader idea of the level of knowledge and attitudes of Mexican Institute of Social Security physicians towards CPG. This information is relevant when planning strategies for the purpose of sharing and implementing CPG.

Clinical-genetic correlations in familial Alzheimer's disease caused by presenilin 1 mutations.

We describe the clinical phenotype of nine kindred with presenile Alzheimer's disease (AD) caused by different presenilin 1 (PS1) point mutations, and compare them with reported families with mutations in the same codons. Mutations were in exon 4 (Phe105Val), exon 5 (Pro117Arg, Glu120Gly), exon 6 (His163Arg), exon 7 (Leu226Phe), exon 8 (Val261Leu, Val272Ala, Leu282Arg), and exon 12 (Ile439Ser). Three of these amino acid changes (Phe105Val, Glu120Gly, and Ile439Ser) had not been previously reported. Distinct clinical features, including age of onset, symptoms and signs associated with the cortical-type dementia and aggressiveness of the disease, characterized the different mutations and were quite homogeneous across family members. Age of onset fell within a consistent range: some mutations caused the disease in the thirties (P117R, L226F, V272A), other in the forties (E120G, H163R, V261L, L282R), and other in the fifties (F105V, I439S). Associated features also segregated with specific mutations: early epileptic activity (E120G), spastic paraparesis (V261L), subcortical dementia and parkinsonism (V272A), early language impairment, frontal signs, and myoclonus (L226F), and late myoclonus and seizures (H163R, L282R). Neurological deterioration was particularly aggressive in PS1 mutations with earlier age of onset such as P117R, L226F, and E120G. With few exceptions, a similar clinical phenotype was found in families reported to have either the same mutation or different amino acid changes in the same codons. This series points to a strong influence of the specific genetic defect in the development of the clinical phenotype.

Eventos adversos en cirugía / Adverse events in surgery

Objetivo: Analizar los eventos adversos reportados en el Sistema de Notificación de Evento Centinela, Evento Adverso y Cuasifalla ''VENCER II'' del Instituto Mexicano del Seguro Social. Sede: Unidad de Atención Médica Instituto Mexicano del Seguro Social. Diseño: Estudio transversal, retrospectivo, observacional, descriptivo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Material y métodos: Se presenta una revisión de los eventos adversos reportados durante un mes. En esta investigación fueron incluidos dos apartados, eventos adversos relacionados con procedimientos quirúrgicos y procesos infecciosos. Resultados: Total de eventos adversos 78, el grupo de edad más afectado fue de 16 a 45 años (49%), el género predominante fue el femenino con 66%, en el turno en el que ocurrieron con mayor frecuencia fue el matutino con 77%, especialidad de mayor incidencia fue cirugía general con el 51%. En relación al origen, la infección en sitio quirúrgico correspondió al 69%, otras infecciones nosocomiales 1.5% y causas no infecciosas 29.5% (lesión de órgano), la severidad moderada en el 71% de los casos y el personal involucrado con mayor frecuencia fue el médico con el 57%. Conclusión: El sistema prevé retroalimentación permanente, análisis para identificar la causa raíz y las acciones de mejora tendientes a reducir y prevenir los eventos adversos.

Objective: To analyze the adverse events reported to the Notification System of sentinel event, adverse event, and quasi-failure ''VENCER II'' of the Mexican Institute of Social Security (IMSS, for its initials in Spanish). Setting: Medical Care Unit, IMSS Design: Cross-sectional, retrospective, observational, descriptive study. Statistical analysis: Percentages as summary measure for qualitative variables. Material and methods: We present a review of the adverse events reported in one month. In this investigation, we included two types of events: those related to surgical procedures and those to infectious processes. Results: Total of adverse events, 78, the most affected age group was that of 16 to 45 years (49%), the predominating gender was the female with 66%; the shift during which they occurred most frequently was the morning shift with 77%, the specialty with the highest incidence was general surgery with 51%. In regard to origin, infections of the surgical site corresponded to 69%, other nosocomial infections represented 1.5%, and non-infectious cases corresponded to 29.5% (organ lesion); severity was moderate in 71%, and the medical personnel was the most infrequently involved with 57%. Conclusion: The system provides permanent feedback, as well as an analysis to identify the root cause and the improvement actions to reduce and prevent adverse events.