Health-related quality of life in adults with irritable bowel syndrome in a Mexican specialist hospital. A cross-sectional study.

BACKGROUND: Evidence shows the negative impact of irritable bowel syndrome on the quality of life of patients who suffer from the condition as compared to the general population. OBJECTIVE: The objective of this study was to determine the health-related quality of life in adults with irritable bowel syndrome who are receiving treatment at a specialist hospital. MATERIAL AND METHODS: The study had a cross-sectional prospective design. The study included consecutive patients diagnosed with irritable bowel syndrome under the Rome III criteria and attending outpatient appointments. The SF-36 questionnaire was applied in its standard Spanish version and the results were compared with population reference scores in Mexico. Statistical analysis was performed with the Student's t test, analysis of variance and the Chi-squared test, considering a significance of 0.05%. RESULTS: One hundred and fifty-four patients were included in the study, 137 (89%) women and 17 (11%) men, with an average age of 52.8 (SD 12.6). The constipation, diarrhea and mixed subtypes comprised 85 (55.2%), 27 (17.5%) and 42 (27.3%) patients, respectively. The quality of life of patients with irritable bowel syndrome vs the population reference scores in Mexico were 50 vs 79 for the physical health sub-scale and 59.1 vs 76.7 for the mental health sub-scale, respectively (p = 0.000). No significant difference was found in quality of life among the irritable bowel syndrome subtypes (p > 0.05). CONCLUSIONS: Health-related quality of life is lower in patients with irritable bowel syndrome in a population in the North East of Mexico compared to the data taken from a population reference study undertaken in the same country, enabling an inference in the female population and a cautious one from the results found in the small male sample studied. There was no significant difference found in the quality of life according to the clinical subtype of irritable bowel syndrome.

Recurrence of infection and diversity of Helicobacter pylori strains in an adult population in Mexico treated with empirical standard triple therapy.

BACKGROUND: After eradication treatment for Helicobacter pylori, infection could recur due to recrudescence or re-infection. The objective of this study was to determine the recurrence of Helicobacter pylori infection and identify virulent Helicobacter pylori strains one year after eradication with standard triple therapy. MATERIAL AND METHODS: A quasi-experimental study was performed that included a patient population with digestive diseases associated with Helicobacter pylori who had received standard triple therapy. Cultures and Polymerase Chain Reaction was performed on gastric biopsies for strain identification in all patients prior to eradication treatment and those with a positive carbon 14 breath test one year after eradication treatment. Statistical analysis was performed using the student T test and Fisher's exact test, statistical significance was set at 0.05. RESULTS: 128 patients were studied, 51 (39.8%) were male and 77 (60.2%) were female with an average age of 54.8 years (DE 13.8). There was an annual recurrence of Helicobacter pylori infection in 12 (9.3%) patients. An annual re-infection and recrudescence occurred in 9 (7 %) and 3 (2.3%) patients respectively. The recrudescence rate for cagA was 1/30 (3.3%) patients and 2/112 (1.8%) patients for vacA. The re-infection rate for cagA was 3/30 (10%) patients and 6/112 (5.3%) patients for vacA. CONCLUSIONS: The recurrence of infection in this study was higher than that recorded in developed countries with a low prevalence of H. pylori and lower than that recorded in developing countries with a higher prevalence of H. pylori. The cagA or vacA s2/m2 strains were isolated after re-infection and recrudescence.

Regression of gastric intestinal metaplasia after the eradication of Helicobacter pylori infection in a hospital in Mexico.

BACKGROUND: Intestinal metaplasia is a precursor lesion of gastric cancer. Infection by Helicobacter pylori is the principal cause of metaplasia. While evidence of the regression of metaplasia after treatment to eradicate this infection has been demonstrated, controversy remains with regard to this subject. OBJECTIVE: The objective of this study was to determine the frequency of the regression of gastric intestinal metaplasia one year after the eradication of Helicobacter pylori. METHODS: A prospective longitudinal designed study was carried out. The population studied in this research consisted of patients attending the Endoscopy Unit to undergo an upper endoscopy, in whom various symptoms indicated intestinal metaplasia associated with Helicobacter pylori, and who received standard empiric triple therapy to eradicate the bacteria. An upper endoscopy was performed in which four gastric biopsy samples were taken (two from the antrum and two from the body) before and after the eradicating treatment, with the endoscopic and histological findings studied after one year of monitoring. The statistical analysis was conducted using the Fisher's exact test and the McNemar's test. RESULTS: Forty-six patients were studied, of whom 20 (43.5%) were men and 26 (56.5%) were women, with an average age of 58.9 (DE 11.2). Intestinal metaplasia was found in 46 (100%) patients before treatment and in 21 (45.7%) patients post-eradication. Complete intestinal metaplasia (type I) was found in 35 patients (76.1%) before treatment and in 11 (23.9%) patients post-eradication (p = 0.000), while incomplete intestinal metaplasia (type II) was found in 10 (21.7%) patients before treatment and in 10 (21.7%) patients post-eradication. Non-atrophic chronic gastritis was found in 35 (76.1%) patients before treatment and in 32 (69.6%) patients post-eradication. CONCLUSIONS: In this study, gastric intestinal metaplasia associated with Helicobacter pylori infection showed a regression of 54.3% one year after the eradication of this microorganism. This treatment could modify the natural history of the development of gastric cancer.

[Concordance among invasive diagnostic procedures for Helicobacter pylori infection in adults]. / Concordancia entre procedimientos diagnósticos invasivos para la infección por Helicobacter pylori en adultos.

OBJECTIVE: Compare the strength of concordance between culture, histology, rapid urease test for diagnosis of Helicobacter pylori infection and histopathological findings relationship and frequency of positivity among such diagnostic procedures. MATERIALS AND METHODS: Diagnostic test study. The study population were subjects with endoscopy and take samples of gastric antral. Rapid urease test (one sample), histology (two samples) and culture (two samples), and histopathological findings of gastric mucosa were performed. Statistical design with Student's t, Fisher exact test, Kappa coefficient. RESULTS: We reviewed 108 subjects, 28 (25.9%) men, 80 (74.1%) women, mean age was 49.1 years (SD 15.1). The Kappa coefficient was 0.729 and 0.377 between culture with histology and rapid urease test, respectively; likewise the Kappa coefficient was 0.565 between histology and rapid urease test. CONCLUSIONS: The strength of concordance was higher between histology with culture and rapid urease test; the most recommended being histology in clinical practice for the detection of Helicobacter pylori infection.

Inadequate prescription of chronic consumption of proton pump inhibitors in a hospital in Mexico. Cross-sectional study.

INTRODUCTION: PPIs have been an enormous therapeutic advance in acid-related diseases. However, it has been detected an abuse in its consumption. The aim of this study was to determine the frequency of inadequate prescription of chronic use of PPIs in outpatients in a speciality hospital. MATERIAL AND METHODS: we performed a cross-sectional descriptive study review. The study population were patients, chronic users of proton pump inhibitors (PPIs), attending outpatient consult in a hospital of government workers. We defined as chronic user of PPIs that patient that takes medication daily for over a year and inappropriate prescription, that one that has not been approved by the clinical guidelines. A simple random sampling was utilized. The following parameters were investigated: diagnosis and prescription of PPIs, time of use, at which level of care PPIs were prescribed (primary care or specialist), self-medication, with or without endoscopy. Forthe statistical analysis, we used Student´s t-test and Chi-square, 95 % confidence intervals and significance 0.05 %. RESULTS: we reviewed 153 patients, 40 (26.1 %) men and 113 (73.9 %) women, mean age 58 ± 11.4 years. The prescription of chronic treatment with PPIs was adequate in 64.7 % of patients and inadequate in 35.3 %. The most common appropriate prescription (31.3 %) of chronic use of PPIs was due to gastroesophageal reflux disease. The most common inadequate prescription was absence of diagnosis (22.2 %), polypharmacy without nonsteroidal anti-inflammatory drugs (16.6 %) and chronic gastritis (16.6 %). History of endoscopy were not statistically significant. CONCLUSIONS: the frequency of inappropriate prescriptions of chronic use of PPIs was high, around 35.3 %, similar to those reported in hospitals in developed countries.

Refractive errors among children, adolescents and adults attending eye clinics in Mexico.

AIM: To assess the proportion of refractive errors in the Mexican population that visited primary care optometry clinics in fourteen states of Mexico. METHODS: Refractive data from 676 856 patients aged 6 to 90y were collected from optometry clinics in fourteen states of Mexico between 2014 and 2015. The refractive errors were classified by the spherical equivalent (SE), as follows: sphere+½ cylinder. Myopia (SE>-0.50 D), hyperopia (SE>+0.50 D), emmetropia (-0.50≤SE≤+0.50), and astigmatism alone (cylinder≥-0.25 D). A negative cylinder was selected as a notation. RESULTS: The proportion (95% confidence interval) among all of the subjects was hyperopia 21.0% (20.9-21.0), emmetropia 40.7% (40.5-40.8), myopia 24.8% (24.7-24.9) and astigmatism alone 13.5% (13.4-13.5). Myopia was the most common refractive error and frequency seemed to increase among the young population (10 to 29 years old), however, hyperopia increased among the aging population (40 to 79 years old), and astigmatism alone showed a decreasing trend with age (6 to 90y; from 19.7% to 10.8%). There was a relationship between age and all refractive errors (approximately 60%, aged 50 and older). The proportion of any clinically important refractive error was higher in males (61.2%) than in females (58.3%; P<0.0001). From fourteen states that collected information, the proportion of refractive error showed variability in different geographical areas of Mexico. CONCLUSION: Myopia is the most common refractive error in the population studied. This study provides the first data on refractive error in Mexico. Further programs and studies must be developed to address the refractive errors needs of the Mexican population.

[Construction of an ultrasound clinical scale for the diagnosis of choledocolithiasis]. / Construcción de una escala clínica-ultrasonográfica para el diagnóstico de coledocolitiasis.

OBJECTIVE: to describe the construction of a clinical ultrasonographic scale for diagnosing choledocholithiasis. MATERIAL AND METHODS: A retrospective study of diagnostic tests, done through files of patients older than 18 years old with diagnosis related to having jaundice, who received care at three hospital facilities in Culiacan, Sinaloa, Mexico from 1998 to 1999, was carried out. Clinical, lab and cabinet data were collected. Gold standards were considered endoscopic retrograde cholangio-pancreatography as well as exploratory laparotomy. A diagnostic scale for choledocholithiasis was constructed through logistic regression and multivariate analysis using principal components. Sensitivity, specificity, prediction values, negative and positive likelihood ratio (LR) and ROC curves were estimated. The threshold model was applied for medical decision making. RESULTS: For detecting choledocholithiasis the scale's sensitivity was 98%, specificity was 95%, positive and negative predictive values were 95% and 97%, respectively. The estimated positive LR was 19.6 and negative 0.02. CONCLUSIONS: In adult patients up to 70 years with acute jaundice evolution, the scale can diagnose securely choledocholithiasis. The pretest prevalence and/ or probability do not affect importantly its accuracy for medical decision making.

Concordancia entre procedimientos diagnósticos invasivos para la infección por Helicobacter pylori en adultos / Concordance among invasive diagnostic procedures for Helicobacter pylori infection in adults

Objetivo. Comparar la concordancia entre cultivo, histología y prueba rápida de la ureasa para el diagnóstico de infección por Helicobacter pylori, así como la relación de hallazgos histopatológicos y frecuencia de positividad entre dichos procedimientos diagnósticos. Material y métodos. Estudio de pruebas diagnósticas. Población de sujetos con endoscopía digestiva y toma de muestras gástricas antrales en un hospital de especialidades en México. Se realizó prueba rápida de la ureasa (una muestra), histología (dos muestras) y cultivo (dos muestras). Análisis estadístico con coeficiente de Kappa. Resultados. Se estudiaron 108 sujetos: 28 (25.9%) hombres y 80 (74.1%) mujeres; la edad promedio fue 49.1 (DE 15.1) años. El coeficiente de Kappa fue 0.729 y 0.377 entre cultivo con histología y prueba rápida de la ureasa respectivamente; asimismo, el coeficiente de Kappa fue 0.565 entre histología y prueba rápida de la ureasa. Conclusiones. La fuerza de concordancia fue mayor entre histología con cultivo y la prueba rápida de la ureasa, por lo cual la histología es lo más recomendable en la práctica clínica para la detección de la infección por Helicobacter pylori.

Objective. Compare the strength of concordance between culture, histology, rapid urease test for diagnosis of Helicobacter pylori infection and histopathological findings relationship and frequency of positivity among such diagnostic procedures. Materials and methods. Diagnostic test study. The study population were subjects with endoscopy and take samples of gastric antral. Rapid urease test (one sample), histology (two samples) and culture (two samples), and histopathological findings of gastric mucosa were performed. Statistical design with Student's t, Fisher exact test, Kappa coefficient. Results. We reviewed 108 subjects, 28 (25.9%) men, 80 (74.1%) women, mean age was 49.1 years (SD 15.1). The Kappa coefficient was 0.729 and 0.377 between culture with histology and rapid urease test, respectively; likewise the Kappa coefficient was 0.565 between histology and rapid urease test. Conclusions. The strength of concordance was higher between histology with culture and rapid urease test; the most recommended being histology in clinical practice for the detection of Helicobacter pylori infection.