Preventive measures against the COVID-19 pandemic in Mexico: A cross-sectional study.

Introduction: Understanding how Mexicans behave during the pandemic could present a complete picture of the phenomenon in our country and provide better management of it. Objective: This study aimed to analyze the Mexican population's behavior and preventive measures. Methods: This was a cross-sectional study in which a total of 4,004 participants from the general population responded to the survey. Results: Almost 99% of the participants mentioned knowing the symptoms of COVID-19. Although 77.5% of participants considered that they followed proper social distancing measures, 60% of them mentioned that they knew at least six individuals who did not follow social distancing measures. Furthermore, 96.2% of participants reported using preventive measures at least 50% of the time. Only 51.3% used a certified mask. Conclusion: The COVID-19 pandemic outcomes in Mexico are the result of multiple negative factors, such as high rates of comorbidities, high number of people living together at home, many people breaking social isolation, and most of the population using non-certified preventive measures that may not be effective enough.

Depression, anxiety, and academic performance in COVID-19: a cross-sectional study.

Depression and anxiety are common after months of social isolation, and they can have a negative impact on anyone's quality of life if they are not treated promptly and appropriately. The aim of this study was to determine if the change to online modality courses and the presence of depression or anxiety symptoms during the COVID-19 pandemic was associated with a difference in the college student's academic achievement. This study was a cross-sectional survey in which we used the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). Also, we examined the students' perceptions of their academic performance using the Academic Self-Concept Scale (ASCS). A total of 610 students responded to the survey. The average score on the Academic Self-Concept Scale was 2.76 ± 0.35, the students presented a risk of 61.5% for possible depressive disorder and 52.1% for possible generalized anxiety disorder. The intensity of depression and anxiety symptoms had a significant effect on Academic Self-Concept Scale scores (p < 0.001 and p < 0.05, respectively). The findings indicate that the COVID-19 pandemic has had a direct effect on students' mental health and academic performance.

Changes in intensive care unit nurse involvement in end of life decision making between 1999 and 2016: Descriptive comparative study.

OBJECTIVE: Comparison of nurse involvement in end of life decision making in European countries participating in ETHICUS I- 1999 and ETHICUS II- 2015. METHODOLOGY: This was a prospective observational study of 22 European ICUs included in the ETHICUS-II and I. Data were collected as per the ETHICUS-I and ETHICUS-II protocols. Four questions within the ETHICUS protocols related to nurse involvement in end of life decision making were analyzed. This is a comparison of changes in nurse involvement in end of life decisions from 1999 to 2015. SETTING: International e-based questionnaire completed by an intensive care clinician when an end of life decision was performed on any patient. SUBJECTS: Intensive care physicians and nurses, no interventions were performed. MEASUREMENTS: A 20 question survey was used to describe the decision making process, on what basis was the decision made, who was involved in the decision making process, and what precise decisions were made. RESULTS: A total of 4592 cases from 22 centres are included. While there was more agreement between nurses and physicians in ETHICUS-I compared to ETHICUS-I, fewer discussions with nurses occurred in ETHICUS-II. The frequency of end of life decisions that were discussed with nurses decreased in all three regions between ETHICUS-I and ETHICUS-II. CONCLUSION: Based on the results of the current study, nurses should be further encouraged to increase their involvement in end of life decision-making, especially those in southern Europe.

Effect of a preoperative single-dose steroid on pulmonary function and postoperative symptoms after modified radical mastectomy: results of a randomized clinical trial.

BACKGROUND: Evidence suggests that a preoperative single-dose steroid improves lung function and decreases the incidence of postoperative symptoms; however, this has not been sufficiently proved in modified radical mastectomy for cancer. This study aimed to evaluate the efficacy of preoperative single-dose steroid administration for postoperative lung function and postoperative symptoms in women undergoing modified radical mastectomy for breast cancer. METHODS: In this controlled clinical trial, conducted between June 2014 and October 2018, we examined 81 patients. Patients received a preoperative single dose of 8 mg dexamethasone (n=41; treatment group) or placebo (sterile injectable water; n=40; control group). We obtained data on postoperative nausea and vomiting and pain intensity and performed spirometry 1 h before and 1, 6, 12, and 24 h after surgery. The use of additional analgesic or antiemetic drugs was recorded. We followed up patients 30 days after discharge and recorded any surgical or medical complications. RESULTS: The age distribution and anthropometric variables of the two groups were similar. Almost 50% of the patients in each group also underwent breast reconstruction. In the treatment group, pain intensity was always lower, the incidence of postoperative nausea and vomiting was lower at 6, 12, and 24 h, and additional analgesics or antiemetics were required less frequently (P<0.05 for all). Both treatment and control groups demonstrated a restrictive ventilatory pattern immediately after surgery, which in the treatment group was reversed after 24 h. However, the reconstructed patients had a more intense and prolonged restrictive pattern (P<0.05). Surgical morbidity included one seroma observed in the control group. No infections occurred at the surgical site or at any other level, and no patient developed any metabolic disorder. No mortality was observed in either group. CONCLUSIONS: This study establishes that a single preoperative dose of dexamethasone markedly decreased the incidence of postoperative nausea and vomiting and pain, improved respiratory parameters, and decreased the need for additional postoperative analgesic or antiemetic drugs. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT02305173).

Associations between stressors and difficulty sleeping in critically ill patients admitted to the intensive care unit: a cohort study.

BACKGROUND: Patients admitted to the intensive care unit (ICU) experience sleep disruption caused by a variety of conditions, such as staff activities, alarms on monitors, and overall noise. In this study, we explored the relationship between noise and other factors associated with poor sleep quality in patients. METHODS: This was a prospective cohort study. We used the Richards-Campbell Sleep Questionnaire to explore sleep quality in a sample of patients admitted to the ICU of a private hospital. We measured the noise levels within each ICU three times a day. After each night during their ICU stay, patients were asked to complete a survey about sleep disturbances. These disturbances were classified as biological (such as anxiety or pain) and environmental factors (such as lighting and ICU noise). RESULTS: We interviewed 71 patients; 62% were men (mean age 54.46 years) and the mean length of stay was 8 days. Biological factors affected 36% and environmental factors affected 20% of the patients. The most common biological factor was anxiety symptoms, which affected 28% of the patients, and the most common environmental factor was noise, which affected 32.4%. The overall mean recorded noise level was 62.45 dB. Based on the patients' responses, the environmental factors had a larger effect on patients' sleep quality than biological factors. Patients who stayed more than 5 days reported less sleep disturbance. Patients younger than 55 years were more affected by environmental and biological factors than were those older than 55 years. CONCLUSIONS: Patient quality of sleep in the ICU is associated with environmental factors such as noise and artificial lighting, as well as biological factors related to anxiety and pain. The noise level in the ICU is twice that recommended by international guides. Given the stronger influence of environmental factors, the use of earplugs or sleeping masks is recommended. The longer the hospital stay, the less these factors seem to affect patients' sleep quality.

Association between HEXACO personality traits and medical specialty preferences in Mexican medical students: a cross-sectional survey.

BACKGROUND: Medical specialty is a critical choice in a physician's life because it determines their professional future and medical practice. While some are motivated to choose a specific specialty based on the monetary gain it can provide, others are inspired by seeing the work performed by a physician or by a patient's recovery. It is common to stereotype doctors' personalities by their specialty. METHODS: This was a cross-sectional survey study in which we administered the 100-item HEXACO Personality Inventory-Revised to 292 medical students between September 2018 and March 2019. We evaluated six different domains of personality traits. We also included questions about their medical specialty of choice, their least preferred specialty, and the motivation behind these choices. The participants included 175 women (59.9%) and 117 men (40.1%). RESULTS: When the participants were asked about their preferred type of medical specialty, 52.4% indicated a preference for surgical specialties (surgical group) vs 47.6% who preferred clinical specialties (clinical group). We found that the surgical group showed significantly higher scores for Extraversion and Organization domains, while the clinical group showed significantly higher scores on the Honesty-Humility, Emotionality, and Agreeableness domains. We identified critical differences within the overall group of medical students by their medical specialty preference. CONCLUSIONS: Some classical stereotypes were confirmed by our results, such as surgical specialists tending to be more extroverted and organized, whereas clinical specialists were prone to being more introverted, anxious, and more emotionally attached to their patients.

Burnout syndrome prevalence during internship in public and private hospitals: a survey study in Mexico.

Burnout syndrome is a psychological condition that commonly affects health professionals, medical students, and others in professions with long shifts. It is defined by a high amount of emotional exhaustion, depersonalization, and low personal job satisfaction. We aimed to determine the prevalence of burnout syndrome in medical interns and establish the relationships between this condition and the time and type of hospital at which students worked during their medical internship. This was a survey study in which we used the Maslach Burnout Inventory, applied to fifth-year medical students on an internship at private and public hospitals in Mexico. The participants were 96 women (54.5%) and 80 men (45.5%), with ages ranging from 21 to 34 years old. We found burnout syndrome in 20% of these medical students 22% of the women and 18.6% of the men in the sample. Second-semester interns suffered burnout at a rate of 29%, in contrast to 15% of first-semester students. Emotional exhaustion and depersonalization scores were higher in second-semester interns who worked in public hospitals. However, the prevalence did not differ between public and private hospitals. Our study reports a higher prevalence of burnout syndrome during the second semester of internship. Students who practiced their internship in a public hospital showed higher scores in emotional exhaustion and depersonalization than those who practiced in a private hospital.

A tip from the nose: rhinocerebral mucormycosis in a patient with alcoholic liver cirrhosis and cocaine abuse, an uncommon association.

We present the case of a 28-year-old man with a long-standing history of cocaine abuse and Child-Pugh class C alcoholic liver cirrhosis who developed severe lower respiratory tract infection complicated with septic shock and multiple organ dysfunction. He was managed in the intensive care unit. On the eighth day after admission, he developed a nose discolouration, which was initially thought to be associated with high-dose vasopressors. Despite the reduction of vasopressors, the lesion progressed rapidly. It was later diagnosed as rhinocerebral mucormycosis. Amphotericin B was administered, but unfortunately the patient succumbed to the complications postinfection. The association between alcoholic liver cirrhosis and rhinocerebral mucormycosis should be known and prompt recognition warrants immediate treatment.

Sexuality Among Women Treated for Breast Cancer: A Survey of Three Surgical Procedures.

BACKGROUND: The quality of life of Mexican patients with breast cancer has been studied, but female sexual function has only been explored superficially. The Female Sexual Function Index (FSFI) questionnaire has been validated as a tool to measure sexual function among women with cancer. However, no study in Mexico has been published. PURPOSE: To evaluate and compare female sexuality of breast cancer survivors treated with three surgical procedures. MATERIALS AND METHODS: This is a cross-sectional questionnaire survey applied in patients without active disease and free of any oncologic treatment who underwent conservative mastectomy, and mastectomy with and without reconstruction. Patients included in this study had no evidence of active disease after at least 2 years of postoperative follow-up and agreed to complete the FSFI questionnaire during a surveillance visit. RESULTS: Seventy-four patients were included: 37.8% had undergone conservative mastectomy, 29.7% radical mastectomy, and 32.4% radical mastectomy plus reconstruction. Patients in the radical mastectomy group were older than those in the other groups (p = 0.002). Female sexual dysfunction was observed in 34% of patients, but in patients who underwent radical mastectomy, it was 63% by contrast with 14 and 29% in women treated with conservative mastectomy and radical mastectomy with reconstruction (p = 0.001). CONCLUSIONS: We found a lower prevalence of female sexual dysfunction in patients treated with conservative mastectomy or reconstruction after radical mastectomy. Alternatively, radical mastectomy was offered to older patients, a condition that could contribute together with a loss of female perception to a higher prevalence of sexual dysfunction. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .