Computed tomography is a feasible method for quantifying bone density in Macaca mulatta.

Osteopathologies are a result of advanced age and decreased bone density and represent a global health problem. It is therefore important to generate models for longitudinal studies of the pathophysiology in order to improve early diagnosis and develop preventive therapies. For this kind of research, the use of computed tomography (CT) to evaluate bone health offers advantages over other techniques since it provides more complete information. The aim of this prospective, pilot study was to obtain measurements of the left femur from a population in captivity of 32 rhesus monkeys (Macaca mulatta) in order to standardize the model for future research. Healthy subjects from 5 to 28 years old were chosen. Three groups with different ages were formed as follows: (1) 5-9 years, (2) 10-19 years, and (3) 20-28 years. Semi-automatic segmentation by threshold defined the regions of interest, which were subdivided in the range of 300-700 Hounsfield units (HU) for trabecular bone and >700 HU for cortical bone. Then, the proportional ratios of the volumes of trabecular bone and cortical bone were obtained. Significant differences (analysis of variance test) in the averages of Hounsfield units, cortical, and trabecular bone proportions from each age group proved that a decrease in bone density begins at approximately 20 years of age. The values presented here, as well as the method to obtain them from CT scans, can be used as a baseline in a primate model for long-term research in bone pathology diagnosis and treatment.

Absence of the right wing of the ilium generated a compensatory scoliosis in rhesus monkey in captivity: diagnostic imaging and its alteration on the SEPNT.

BACKGROUND: Congenital scoliosis (CS) is defined as lateral curvatures of the spine provoked by the anomalous development of the vertebral bodies. It is associated with neuromuscular anomalies, which can be genetic, caused by the compensation of discrepancies in the length of the extremities or intrarachidian anomalies. METHODS: This study was carried out in 2-year-old female, showed alterations in the gait, mainly in the hind limbs, a clumsy gait and a slight claudication in the right hindlimb. To perform the imaging study were: X-Ray projections and Computerized Axial Tomography, neurophysiological evaluation was performed by means somatosensory-evoked potentials of the tibial nerve (SEPTN). RESULTS: The results showed an enlargement of the latencies from the L5 to the cortex, mainly in the left afference, correlated with the imaging studies. CONCLUSIONS: There is no doubt that the concurrent use of different diagnostic tools complements knowledge regarding the physiopathogenesis of these osteopathologies.

Changes in blood parameters in rhesus monkeys (Macaca mulatta) during the first trimester of gestation.

BACKGROUND: Regarding the good practice in the laboratory work, it is essential to have a broad spectrum of biochemical and hematological references in pregnant females to determine the health status of the colony. OBJECTIVE: To establish reference values to reveal changes in hematology and blood chemistry in pregnant rhesus monkeys (Macaca mulatta) in their first trimester of pregnancy. METHODS: Twenty-eight females in reproductive stage were used, divided into two groups: 14 pregnant macaques in their first trimester and 14 non-pregnant used as the control group. Blood samples were collected for the hematological test and blood chemistry. RESULTS: The results showed significant difference in the blood chemistry for the following parameters: glucose, total bilirubin, and total protein. The hematological evaluation revealed significant difference in leukocytes and neutrophils. CONCLUSIONS: These findings offer a reference range and provide a basis for improvement in techniques and refinement of clinical processes in these specimens.

Obesity and Hyperandrogenemia in Polycystic Ovary Syndrome: Clinical Implications.

Polycystic ovary syndrome (PCOS) is often accompanied with metabolic disturbances attributed to androgen excess and obesity, but the contribution of each has not been defined, and the occurrence of metabolic disturbances is usually not investigated. Ninety-nine women with PCOS and forty-one without PCOS were evaluated. The clinical biomarkers of alterations related to glucose (glucose, insulin, and clamp-derived glucose disposal - M), liver (aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase), and endothelium (arginine, asymmetric dymethylarginine, carotid intima-media thickness, and flow-mediated dilation) metabolism were measured; participants were categorized into four groups according to their obesity (OB) and hyperandrogenemia (HA) status as follows: Healthy (no-HA, lean), HA (HA, lean), OB (no-HA, OB), and HAOB (HA, OB). Metabolic disturbances were very frequent in women with PCOS (≈70%). BMI correlated with all biomarkers, whereas free testosterone (FT) correlated with only glucose- and liver-related indicators. Although insulin sensitivity and liver enzymes were associated with FT, women with obesity showed lower M (coef = 8.56 - 0.080(FT) - 3.71(Ob); p < 0.001) and higher aspartate aminotransferase (coef = 26.27 + 0.532 (FT) + 8.08 (Ob); p = 0.015) than lean women with the same level of FT. Women with obesity showed a higher risk of metabolic disorders than lean women, independent of hyperandrogenemia. Clinicians are compelled to look for metabolic alterations in women with PCOS. Obesity should be treated in all cases, but hyperandrogenemia should also be monitored in those with glucose-or liver-related disturbances.

[Short-term morbidity in newborns of the late preterm period]. / Morbilidad a corto plazo de recién nacidos en el periodo pretérmino tardío.

BACKGROUND: Preterm birth is the most common cause of antepartum hospitalization. Currently little is known about neonatal morbidity in late preterm period. OBJECTIVE: To compare the short-term morbidity of infants born at term (37 0/7-41 0/7 weeks gestational age) of low-risk pregnancies with newborns in the late preterm period (34 0/7 to 36 6/7 weeks gestational age) of low-risk pregnancies. MATERIAL AND METHOD: retrospective study of births in the Hospital Metropolitano, Secretaria de Salud del Estado de Nuevo León (Mexico) between January 1, 2005 to December 31, 2007. The study included preterm births in the late period of low risk pregnancies in spontaneous labor, and three control cases matched at term of the same features for each of the late preterm. Neonatal complications were compared among those born in the late preterm period to term infants. RESULTS: Late preterm births accounted for 2.2% of births and had higher incidences of respiratory distress syndrome, longer hospital stay, jaundice requiring phototherapy and hypoglycemia than those born at term. CONCLUSION: Late preterm births are a vulnerable group with significant neonatal morbidity. It is necessary to design strategies to improve neonatal outcomes in late preterm group.

[Necrotizing fasciitis and group A streptococcal toxic shock syndrome in two patients without risk factors]. / Fascitis necrotizante y choque tóxico en infección por estreptococo grupo A.

Necrotizing fasciitis associated to group A streptococcus (S. pyogenes) infection is a deep-seated infection of the subcutaneous tissue that results in progressive destruction of fascia and fat, with a high mortality rate due to a rapid progression of the illness to shock and multiple organ dysfunction. The challenge is to perform a prompt diagnosis because it is often confused with a minor soft-tissue infection. This infection should be aggressively treated with systemic antimicrobials, surgical debridement, and critical care. We present two cases of necrotizing fasciitis associated to infection with Streptococcus pyogenes patients developed myonecrosis and toxic shock syndrome within the following 24 hours after admission. In addition, we reviewed the pathogenic mechanism, diagnosis and treatment of this syndrome and discuss published treatment recommendations.

[Elevated liver enzymes, impaired fasting glucose and undiagnosed diabetes]. / Enzimas hepáticas elevadas, glucosa anormal de ayuno y diabetes no diagnosticada en medicina familiar.

BACKGROUND: emerging evidence suggests that elevated liver enzymatic activity is associated with diabetes. The purpose was to investigate the prevalence of elevated liver enzymes and its relationship between impaired fasting glucose (IFG) and undiagnosed diabetes in family medicine practice. METHODS: a cross-sectional prospective analytic study was conducted in a representative sample of 100 patients aged 25 to 60 years who underwent to a screening for diabetes. Risk factors, BMI, waist circumference, blood pressure, fasting glucose, lipid profile, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT) and C-reactive protein were evaluated. The relationships between liver enzymes, undiagnosed diabetes and IFG were analyzed through c(2) and Student's t test to identify differences in continuous variables. RESULTS: the prevalence found in undiagnosed diabetes were ALT 16.9 %, AST 15.8 % and GGT 20.6 % and in IFG were 76.3 %, 68.4 % and 77.8 % respectively. The relationships between elevated ALT (0.001) and GGT (0.000) with undiagnosed diabetes and IFG were statistically significant. CONCLUSION: elevated ALT or GGT raise the possibility of undiagnosed type 2 diabetes mellitus in family practice.

Citrulline supplementation improves spatial memory in a murine model for Alzheimer's disease.

OBJECTIVES: Alzheimer's disease (AD) correlates with the dysfunction of metabolic pathways that translates into neurological symptoms. An arginine deficiency, a precursor of nitric oxide (NO), has been reported for patients with AD. We aimed to evaluate the effect of citrulline oral supplementation on cognitive decline in an AD murine model. METHODS: Three-month citrulline or water supplementation was blindly given to male and female wild-type and 3 × Tg mice with AD trained and tested in the Morris water maze. Cerebrospinal fluid and brain tissue were collected. Ultra-performance liquid chromatography was used for arginine determinations and the Griess method for NO. RESULTS: Eight-month-old male 3 × Tg mice with AD supplemented with citrulline performed significantly better in the Morris water maze task. Arginine levels increased in the cerebrospinal fluid although no changes were seen in brain tissue and only a tendency of increase of NO was observed. CONCLUSIONS: Citrulline oral administration is a viable treatment for memory improvement in the early stages of AD, pointing to NO as a viable, efficient target for memory dysfunction in AD.

Replication of Integrative Data Analysis for Adipose Tissue Dysfunction, Low-Grade Inflammation, Postprandial Responses and OMICs Signatures in Symptom-Free Adults.

We previously reported preliminary characterization of adipose tissue (AT) dysfunction through the adiponectin/leptin ratio (ALR) and fasting/postprandial (F/P) gene expression in subcutaneous (SQ) adipose tissue (AT) biopsies obtained from participants in the GEMM study, a precision medicine research project. Here we present integrative data replication of previous findings from an increased number of GEMM symptom-free (SF) adults (N = 124) to improve characterization of early biomarkers for cardiovascular (CV)/immunometabolic risk in SF adults with AT dysfunction. We achieved this goal by taking advantage of the rich set of GEMM F/P 5 h time course data and three tissue samples collected at the same time and frequency on each adult participant (F/P blood, biopsies of SQAT and skeletal muscle (SKM)). We classified them with the presence/absence of AT dysfunction: low (<1) or high (>1) ALR. We also examined the presence of metabolically healthy (MH)/unhealthy (MUH) individuals through low-grade chronic subclinical inflammation (high sensitivity C-reactive protein (hsCRP)), whole body insulin sensitivity (Matsuda Index) and Metabolic Syndrome criteria in people with/without AT dysfunction. Molecular data directly measured from three tissues in a subset of participants allowed fine-scale multi-OMIC profiling of individual postprandial responses (RNA-seq in SKM and SQAT, miRNA from plasma exosomes and shotgun lipidomics in blood). Dynamic postprandial immunometabolic molecular endophenotypes were obtained to move towards a personalized, patient-defined medicine. This study offers an example of integrative translational research, which applies bench-to-bedside research to clinical medicine. Our F/P study design has the potential to characterize CV/immunometabolic early risk detection in support of precision medicine and discovery in SF individuals.

[Catheter-associated bloodstream infections. Review of five-year surveillance among hospitalized patients]. / Bacteriemia asociada con catéter venoso central. Revisión de cinco años de vigilancia en pacientes hospitalizados.

BACKGROUND: Catheter related infections (CRI) and bloodstream infection (BSI) associated to central venous catheter (CVC) is cause of frequent hospital-acquired infection (HAI) and a major reason of morbidity and mortality among patients and it is itself an indicator of quality health care. OBJECTIVE: To determine the incidence of CRI and BSI and to identify the hospital areas where they occurred over a five-year period. METHODS: A prospective study from 2004 to 2008 in a population of hospitalized patients who required the use of CVC was made. The HAI team detected the appearance of CRI during a daily routine surveillance. RESULTS: During the period of observation, 176 BSI were detected, accounting for 11 % of all HAI, and represented the third place in frequency. Incidence rate for 1000 catheter-days varied from 2.7 in 2006 to 5.4 in 2008; 57 % of these BSI were detected in the intensive care units. Candida spp. accounted as the more frequently isolated microorganism with predominance of C. parapsilosis. CONCLUSIONS: Our results and the incidence rate found in our study occurred within rates established in other studies.

Shortening in the Tp-e/QTc ratio after angioplasty in patients with acute coronary syndrome. / Acortamiento en la relación Tp-f/QTc tras angioplastia en pacientes con síndrome isquémico coronario agudo.

Objetivo: La dispersión transmural de la repolarización ventricular (DTMRV) es un factor de riesgo para muerte en pacientes con síndrome isquémico coronario agudo (SICA). Con el objetivo de conocer el efecto de la realización de angioplastia sobre la DTMRV, se estudió la relación Tp-f/QTc en pacientes con SICA sometidos a angioplastia. Método: Se diseñó un estudio observacional, retrospectivo y descriptivo. Se incluyeron 150 pacientes (N = 150) con diagnóstico de SICA. Se valoró la relación Tp-f/QTc inicial y se evaluó su acortamiento posangioplastia. Como objetivo secundario, se comparó la asociación de dichos cambios en la relación Tp-f/QTc con la mortalidad cardiovascular y los eventos adversos cardiovasculares. Resultados: El promedio en la relación Tp-f/QTc inicial fue de 0.2529, mientras que posangioplastia fue de 0.2397. Por medio de prueba de rangos de Wilcoxon se evidenció un descenso significativo en la relación Tp-f/QTc posterior a la angioplastia, con un valor Z de -2.051 y una p < 0.04. En el análisis secundario se encontró que una Tp-f/QTc ≥ 0.29 posangioplastia es factor de riesgo para presentación de los siguientes eventos adversos: muerte intrahospitalaria (7.4 vs 0%; p < 0.003), nuevo SICA en seguimiento a 1 año (25.9 vs. 18.5%; p < 0.006) y reintervención en seguimiento a 1 año (29.6 vs. 15.0%; p < 0.002). Conclusiones: Existe un acortamiento significativo en la relación Tp-f/QTc posangioplastia en pacientes con SICA. Esta medida de la DTMRV puede servir como un predictor de muerte intrahospitalaria, eventos cardiovasculares y reintervención a 1 año en pacientes con SICA tratados con angioplastia. Objective: Transmural Dispersion of Repolarization (TDR) is a Risk factor for Death in patients with Acute Coronary ­Syndrome (ACS). In order to know the effect of angioplasty on TDR, the Tp-e/QTc ratio was studied in patients with ACS undergoing angioplasty. Method: An observational, retrospective and descriptive study was designed. 150 patients (N = 150) with diagnosis of ACS were included. The initial Tp-e/QTc ratio was assessed and then its post-angioplasty shortening was evaluated. As a secondary objective, we compared the association of these Tp-e/QTc ratio changes with cardiovascular mortality and cardiovascular adverse events. Results: The average in the initial Tp-e/QTc ratio was 0.2529, while post-angioplasty was 0.2397. Through a Wilcoxon rage test, a significant decrease in the Tp-e/QTc ratio after angioplasty was observed, with a Z value of −2.051 and p < 0.04. In the secondary analysis, it was found that a Tp-e/QTc ≥ 0.29 post-angioplasty is a risk factor for presenting the following adverse events: in-hospital death (7.4 vs. 0%; p < 0.003), new ACS in 1-year follow-up (25.9 vs. 18.5%; p < 0.006), and reintervention in 1-year follow up (29.6 vs. 15%; p < 0.002). Conclusions: There is a significant shortening in the Tp-e/QTc ratio post-angioplasty in patients with ACS. This measure of TDR can serve as a predictor of in-hospital death, cardiovascular events and 1-year reintervention in patients with ACS treated initially by angioplasty.

Towards precision medicine: defining and characterizing adipose tissue dysfunction to identify early immunometabolic risk in symptom-free adults from the GEMM family study.

Interactions between macrophages and adipocytes are early molecular factors influencing adipose tissue (AT) dysfunction, resulting in high leptin, low adiponectin circulating levels and low-grade metaflammation, leading to insulin resistance (IR) with increased cardiovascular risk. We report the characterization of AT dysfunction through measurements of the adiponectin/leptin ratio (ALR), the adipo-insulin resistance index (Adipo-IRi), fasting/postprandial (F/P) immunometabolic phenotyping and direct F/P differential gene expression in AT biopsies obtained from symptom-free adults from the GEMM family study. AT dysfunction was evaluated through associations of the ALR with F/P insulin-glucose axis, lipid-lipoprotein metabolism, and inflammatory markers. A relevant pattern of negative associations between decreased ALR and markers of systemic low-grade metaflammation, HOMA, and postprandial cardiovascular risk hyperinsulinemic, triglyceride and GLP-1 curves was found. We also analysed their plasma non-coding microRNAs and shotgun lipidomics profiles finding trends that may reflect a pattern of adipose tissue dysfunction in the fed and fasted state. Direct gene differential expression data showed initial patterns of AT molecular signatures of key immunometabolic genes involved in AT expansion, angiogenic remodelling and immune cell migration. These data reinforce the central, early role of AT dysfunction at the molecular and systemic level in the pathogenesis of IR and immunometabolic disorders.

Palliative Care Needs in an Acute Internal Medicine Ward in Mexico.

BACKGROUND: Palliative care is an evolving but underdeveloped practice in Mexico. OBJECTIVE: The primary end point of this prospective observational study was to identify internal medicine inpatients fulfilling advanced criteria within a second-level hospital. Secondary end points were symptom burden, treatment, resource utilization, and one-year survival. DESIGN AND MEASUREMENTS: The 390-sample size calculation was based on previous studies where 15% of inpatients fulfilled palliative care needs. Consecutive admissions were assessed to identify patients with any of the following: cancer, cardiac, renal, hepatic insufficiency, COPD, AIDS, stroke, or fragility until sample size was completed. After obtaining informed consent, interview to patient, attending physician, and chart review was completed to identify any of the following advanced disease criteria in each patient: (1) Surprise question to attending physician of the possibility of the patient dying in the following year, (2) Palliative Performance Scale (PPS) <50, and (3) Advanced disease specific criteria. Interview also included presence of symptoms, functional capacity, and previous resource utilization. Treatment offered was analyzed only on day of admission. One-year follow-up to assess survival was done through the state death certificates. RESULTS: Out of 390 patients, 131 (34%) had any of the diseases studied. Out of 131 patients, 86 (66%) had at least one of the three inclusion criteria for advanced disease. Out of 86 patients, 70 (81%) advanced disease patients died after one-year follow-up. Comparison between patients with no advanced disease (no criteria) versus advanced disease (at least one criteria) showed a significant difference in mean PPS, nutrition status, survival days, inhospital death, weight loss, dependency on activities of daily living, and previous multiple emergency room visits. Advanced disease patients with no death at one year follow-up had significantly more new admissions to that hospital. CONCLUSIONS: The number of patients requiring palliative care in internal medicine wards may be excessive to the current palliative care structures available.

MGIT and other methods for diagnosing tuberculosis in a private hospital system with low incidence / MGIT y otros métodos para diagnosticar tuberculosis en un sistema hospitalario privado con baja incidencia

Background: Tuberculosis (TB) is still a threat to public health; in 2014 caused 1.5 million deaths worldwide; in hospitals where the prevalence of TB is low, it is appropriate to evaluate the effectiveness of tests to diagnose it. Methods: We reviewed reports of airway clinical specimens sent for studies of tuberculosis to the microbiology laboratory from Tec Salud System private hospitals (400 beds) in the metropolitan area of ​​Monterrey, NL, from May 2012 to December 2015. In conjunction with Ziehl-Neelsen (ZN) stain, and solid Lowenstein-Jensen medium (LJ), our laboratory resources also include fluorescent LED microscopy (Carl Zeiss Microscopy Products), MGIT 320 (Mycobacteria Growth Indicator Tube liquid culture detection system, Becton Dickinson), and recently incorporated a real-time PCR system the Xpert MTB/RIF test (Cepheid, Sunnyvale, CA). Results: In 731 respiratory specimens from 510 patients, M. tuberculosis was isolated from 78 samples belonging to 50 patients on LJ and MGIT LJ 42 (84%) and MGIT 49, (98%) of the samples. From 41 patients identified, 26 (63.4%) were positive to fluorescein, and 25 (60.9%) with Ziehl-Neelsen stain. Real time PCR (Xpert TB) was positive in 13 out of 17 patient-airway samples (76.4%). Conclusions: Usefulness of liquid culture (MGIT) and solid culture (LJ) is shown; the first can significantly cut incubation times.

Introducción: la tuberculosis (TB) aún es una amenaza para la salud pública; en 2014 causó 1.5 millones de muertes a nivel mundial. En hospitales donde la prevalencia de TB es baja, resulta conveniente evaluar la efectividad de las pruebas para diagnosticarla. Métodos: revisamos los informes de resultados de muestras de vías respiratorias enviadas para estudios de tuberculosis de mayo de 2012 a diciembre de 2015 al laboratorio de Microbiología del Sistema Tec Salud (400 camas) en el área metropolitana de Monterrey. Además de la tinción de Ziehl-Neelsen (ZN) y cultivo sólido de Lowenstein-Jensen (LJ); se realizó fluorescencia LED, cultivo en medio líquido MGIT 320 y más recientemente el Xpert MTB/RIF test. Resultados: se cultivaron en LJ y MGIT 731 muestras de vías respiratorias de 510 pacientes; en las muestras de 50 de ellos se identificó M. tuberculosis, 49 en MGIT (98%) y 42 en LJ (84%). De las muestras correspondientes a 41 pacientes, 26 (63.4%) fueron positivas con fluoresceína, y 25 (60.9%) con ZN. En las muestras de 17 pacientes se hizo PCR en tiempo real (Xpert MTB), 13 fueron positivas (76.4%). Conclusiones: se demuestra la utilidad del cultivo en medio liquido (MGIT) y del LJ en medio sólido; el primero, además de ser más sensible, permite acortar en forma importante los tiempos de incubación.

Deep Multi-OMICs and Multi-Tissue Characterization in a Pre- and Postprandial State in Human Volunteers: The GEMM Family Study Research Design.

Cardiovascular disease (CVD) and type 2 diabetes (T2D) are increasing worldwide. This is mainly due to an unhealthy nutrition, implying that variation in CVD risk may be due to variation in the capacity to manage a nutritional load. We examined the genomic basis of postprandial metabolism. Our main purpose was to introduce the GEMM Family Study (Genetics of Metabolic Diseases in Mexico) as a multi-center study carrying out an ongoing recruitment of healthy urban adults. Each participant received a mixed meal challenge and provided a 5-hours' time course series of blood, buffy coat specimens for DNA isolation, and adipose tissue (ADT)/skeletal muscle (SKM) biopsies at fasting and 3 h after the meal. A comprehensive profiling, including metabolomic signatures in blood and transcriptomic and proteomic profiling in SKM and ADT, was performed to describe tendencies for variation in postprandial response. Our data generation methods showed preliminary trends indicating that by characterizing the dynamic properties of biomarkers with metabolic activity and analyzing multi-OMICS data it could be possible, with this methodology and research design, to identify early trends for molecular biology systems and genes involved in the fasted and fed states.

Patient and technique survival in continuous ambulatory peritoneal dialysis in a single center of the west of Mexico.

INTRODUCTION: In Mexico, CAPD survival has been analyzed in few studies from the center of the country. However, there are concerns that such results may not represent what occurs in other province centers of our country, particularly in our geographical area. AIM: To evaluate the patient and technique survival on CAPD of a single center of the west of Mexico, and compare them with other reported series. DESIGN: Retrospective cohort study. SETTING: Tertiary care, teaching hospital located in Guadalajara, Jalisco. PATIENTS: Patients from our CAPD program (1999-2002) were retrospectively studied. Interventions. Clinical and biochemical variables at the start of dialysis and at the end of the follow-up were recorded and considered in the analysis of risk factors. MAIN OUTCOME MEASURES: Endpoints were patient (alive, dead or lost to follow-up) and technique status at the end of the study (June 2002). RESULTS: 49 patients were included. Mean patient survival (+/- SE) was 3.32 +/- 0.22 years (CI 95%: 2.9-3.8 years). Patients in the present study were younger (39 +/- 17yrs), had larger body surface area (1.72 +/- 0.22 m2), lower hematocrit (25.4 +/- 5.2%), albumin (2.6 +/- 0.6g/dL), and cholesterol (173 +/- 44 mg/dL), and higher urea (300 +/- 93 mg/dL) and creatinine (14.9 +/- 5.6 mg/ dL) than those in other Mexican series. In univariate analysis, the following variables were associated (p < 0.05) to mortality: pre-dialysis age and creatinine clearance, and serum albumin and cholesterol at the end of follow-up. In multivariate analysis, only pre-dialysis creatinine clearance (RR 0.66, p = 0.03) and age (RR 1.08, p = 0.005) significantly predicted mortality. Mean technique survival was 2.83 +/- 0.24 years (CI 95%: 2.4-3.3). Pre-dialysis age (p < 0.05), peritonitis rate (p < 0.05), and serum phosphorus at the end of follow-up (p < 0.05) were associated with technique failure in univariate analysis, while in multivariate analysis, only pre-dialysis age (RR 1.07, p = 0.001) and peritonitis rate (RR 481, p < 0.0001) were technique failure predictors. CONCLUSIONS: Patients from this single center of the west of Mexico were younger, had higher body surface area and initiated peritoneal dialysis with a more deteriorated general status than patients reported in other Mexican series; in spite of the latter, patient and technique survival were not different. In our setting, pre-dialysis older age and lower CrCl significantly predicted mortality, while older predialysis age and higher peritonitis rate predicted technique failure.

[Role of anaerobic blood culture in the simultaneous blood culture taking for the diagnosis of bacteremia]. / Papel del hemocultivo anaeróbico en la toma simultánea de hemocultivos para el diagnóstico de bacteriemia.

BACKGROUND: Harboring a high mortality, the incidence of sepsis is increasing; thus detection, identification and susceptibility tests of the involved microorganisms become urgent. METHODS: We reviewed the records from January 2013 until July 2014 of a total of 4110 blood culture bottles taken from adult patients in a private tertiary hospital. RESULTS: Growth of microorganisms was observed in 559 bottles (12.6%). We emphasize that 2648 blood cultures (60%) were taken in two paired aerobic and anaerobic bottles drawn at the same time (1324 pairs); from these, growth was observed in 182 inoculated bottles drawn from two different sites at the same time from 135 patients (13.7%). In 86 pairs of bottles with samples from 54 patients (40%), growth occurred only in the aerobic blood culture bottles. Also, growth of microorganisms was observed only in anaerobic bottles in 24 pairs (13.19%), corresponding to 21 patients (15.5%, p<0.05%). In blood cultures from 32 out of 60 patients with growth in both media (53%), microbial growth was detected first in the anaerobic bottle. CONCLUSIONS: The usefulness of blood cultures for anaerobes for the identification of obligate anaerobic bacteremia which rarely occur is low (2.2% of patients with bacteremia); however, in 15.55% of the patients the risk of completely overlook bacteremia was present, and in 53% of patients with positive cultures, bacteremia was established earlier, and thus permitted earlier and accurate decision making.

Introducción: la frecuencia de la septicemia va en aumento y su mortalidad es alta; por lo tanto, su detección, la identificación del microorganismo causal y su susceptibilidad son perentorias. Metodos: se revisaron los registros de 4110 botellas de cultivo de sangre obtenida de enero de 2013 a julio de 2014 de pacientes adultos en un hospital privado de tercer nivel. Resultados: se observó crecimiento de microorganismos en 559 cultivos (12.6 %). En 2648 hemocultivos (60 %) inoculados en pares de frascos uno con medio aeróbico y el otro anaeróbico (1324 sets), se detectó crecimiento en 182 frascos a los que les fueron inoculadas las muestras tomadas al mismo tiempo a 135 pacientes (13.7 %). En 86 pares de frascos con las muestras de 54 pacientes (40 %), el crecimiento solamente se dio en el frasco aeróbico (47.5 %); en 24 pares de frascos (13.19 %) tomados a 21 pacientes (15.5 %, p < 0.05), solamente hubo crecimiento en el frasco anaeróbico. En los hemocultivos de 32 de 60 pacientes con crecimiento en ambos frascos (53 %), el crecimiento se detectó primero en el frasco anaeróbico. Conclusiones: los hemocultivos anaeróbicos tienen una utilidad baja para la detección de bacteriemias por anaerobios estrictos; no obstante, en el 15.55 % de los pacientes estuvo presente el riesgo de pasar por alto la presencia de bacteriemia, y en 53 % de los pacientes con hemocultivos positivos, el diagnóstico de bacteriemia pudo establecerse de manera más temprana, lo que permitió anticipar con mejor precisión la toma de decisiones.

[Breastfeeding counseling and early mother-child contact are associated with exclusive maternal breastfeeding. A hospital-based-case-control study]. / La consejeria en lactancia y contacto temprano en parejas madre-hijo están asociados a la lactancia materna exclusiva. estudio hospitalario de casos y controles no pareados.

BACKGROUND: The aim of this study was to assess the association between exclusive breastfeeding (EBF) and some factors that may influence breastfeeding in a closely related population attending a private hospital sponsored by a major Mexican brewing company. MATERIALS AND METHODS: We carried out a retrospective hospital-based unmatched case-control study. A sample of 124 mother-newborn couples was interviewed in a private medical unit in Monterrey, Mexico, from January 2001 to January 2002. The association between EBF and 11 explanatory factors was analyzed by logistic regression analysis. RESULTS: Counseling and early contact between mother-newborn couples were positively associated with EBF. CONCLUSION: Counseling and early contact improve EBF practice. We believe these two practices would favor better adherence to EBF in other populations.

Acortamiento en la relación Tp-f/QTc tras angioplastia en pacientes con síndrome isquémico coronario agudo / Shortening in the Tp-e/QTc ratio after angioplasty in patients with acute coronary syndrome

Resumen Objetivo: La dispersión transmural de la repolarización ventricular (DTMRV) es un factor de riesgo para muerte en pacientes con síndrome isquémico coronario agudo (SICA). Con el objetivo de conocer el efecto de la realización de angioplastia sobre la DTMRV, se estudió la relación Tp-f/QTc en pacientes con SICA sometidos a angioplastia. Método: Se diseñó un estudio observacional, retrospectivo y descriptivo. Se incluyeron 150 pacientes (N = 150) con diagnóstico de SICA. Se valoró la relación Tp-f/QTc inicial y se evaluó su acortamiento posangioplastia. Como objetivo secundario, se comparó la asociación de dichos cambios en la relación Tp-f/QTc con la mortalidad cardiovascular y los eventos adversos cardiovasculares. Resultados: El promedio en la relación Tp-f/QTc inicial fue de 0.2529, mientras que posangioplastia fue de 0.2397. Por medio de prueba de rangos de Wilcoxon se evidenció un descenso significativo en la relación Tp-f/QTc posterior a la angioplastia, con un valor Z de −2.051 y una p < 0.04. En el análisis secundario se encontró que una Tp-f/QTc ≥ 0.29 posangioplastia es factor de riesgo para presentación de los siguientes eventos adversos: muerte intrahospitalaria (7.4 vs 0%; p < 0.003), nuevo SICA en seguimiento a 1 año (25.9 vs. 18.5%; p < 0.006) y reintervención en seguimiento a 1 año (29.6 vs. 15.0%; p < 0.002). Conclusiones: Existe un acortamiento significativo en la relación Tp-f/QTc posangioplastia en pacientes con SICA. Esta medida de la DTMRV puede servir como un predictor de muerte intrahospitalaria, eventos cardiovasculares y reintervención a 1 año en pacientes con SICA tratados con angioplastia.

Abstract Objective: Transmural Dispersion of Repolarization (TDR) is a Risk factor for Death in patients with Acute Coronary Syndrome (ACS). In order to know the effect of angioplasty on TDR, the Tp-e/QTc ratio was studied in patients with ACS undergoing angioplasty. Method: An observational, retrospective and descriptive study was designed. 150 patients (N = 150) with diagnosis of ACS were included. The initial Tp-e/QTc ratio was assessed and then its post-angioplasty shortening was evaluated. As a secondary objective, we compared the association of these Tp-e/QTc ratio changes with cardiovascular mortality and cardiovascular adverse events. Results: The average in the initial Tp-e/QTc ratio was 0.2529, while post-angioplasty was 0.2397. Through a Wilcoxon rage test, a significant decrease in the Tp-e/QTc ratio after angioplasty was observed, with a Z value of −2.051 and p < 0.04. In the secondary analysis, it was found that a Tp-e/QTc ≥ 0.29 post-angioplasty is a risk factor for presenting the following adverse events: in-hospital death (7.4 vs. 0%; p < 0.003), new ACS in 1-year follow-up (25.9 vs. 18.5%; p < 0.006), and reintervention in 1-year follow up (29.6 vs. 15%; p < 0.002). Conclusions: There is a significant shortening in the Tp-e/QTc ratio post-angioplasty in patients with ACS. This measure of TDR can serve as a predictor of in-hospital death, cardiovascular events and 1-year reintervention in patients with ACS treated initially by angioplasty.