Efficacy of the Mechanistic Score and COVID-19 Mortality Risk scales to assess the risk of mortality in patients hospitalized for COVID-19.

INTRODUCTION: Chronic diseases are associated with a higher risk of mortality from COVID-19. OBJECTIVE: To compare the efficacy of the Mechanistic Score and COVID-19 Mortality Risk scales for assessing the risk of mortality in patients hospitalized for COVID-19. METHODS: Comparative, observational, retrospective study. The mortality rate of COVID-19-positive patients was assessed by comparing both scales, according to information obtained from the records of patients hospitalized for COVID-19 in a specialty hospital. RESULTS: Two-hundred and twenty-one patients were evaluated, out of whom 61% were men and 39% were women; 89% had comorbidity: obesity (88%), hypertension (40%), diabetes mellitus (31%) and cancer (6%). At discharge, 65% survived. The COVID-19 Mortality Risk scale showed a sensitivity of 79% and specificity of 88% for predicting mortality risk. In patients with low risk, the Mechanistic Score showed a sensitivity and specificity of 24 and 97%, respectively; in cases with mild risk, 44 and 97%; with moderate risk, 57 and 77%; with high risk, 95 and 91%; and with remarkably high risk, 100 and 100%. CONCLUSION: The COVID-19 Mortality Risk scale has higher efficacy than the Mechanistic Score for assessing mortality risk in patients with COVID-19.

INTRODUCCIÓN: Las enfermedades crónicas se asocian a riesgo mayor de mortalidad por COVID-19. OBJETIVO: Comparar la eficacia de las escalas Mechanistic Score y COVID-19 Mortality Risk para evaluar el riesgo de mortalidad en pacientes hospitalizados por COVID-19. MÉTODOS: Estudio comparativo, observacional, retrospectivo. Se valoró la tasa de mortalidad de los pacientes positivos a COVID-19, mediante la comparación de las dos escalas, de acuerdo con información de los expedientes de pacientes hospitalizados por COVID-19 en un hospital de especialidades. RESULTADOS: Se evaluaron 221 pacientes, 61 % hombres y 39 % mujeres; 89 % presentó alguna comorbilidad: obesidad (88 %), hipertensión (40 %), diabetes mellitus (31 %) y cáncer (6 %). Al egreso, 65 % sobrevivió. La escala COVID-19 Mortality Risk presentó sensibilidad de 79 % y especificidad de 88 % para predecir riesgo de mortalidad. Respecto al riesgo bajo, Mechanistic Score presentó sensibilidad y especificidad de 24 y 97 %, respectivamente; 44 y 97 % respecto al riesgo leve, 57 y 77 % en el riesgo moderado, 95 y 91 % en el riesgo alto y 100 y 100 % en el riesgo muy alto. CONCLUSIÓN: La escala COVID-19 Mortality Risk presenta eficacia mayor que Mechanistic Score para evaluar el riesgo de mortalidad en pacientes con COVID-19.

[The experience of a medical emergency team belonging to the Mexican Social Security Institute during the earthquake in Mexico in September 2017Experiência de uma equipe médica de emergência do IMSS no terremoto do México em setembro de 2017]. / Experiencia de un equipo médico de emergencia del IMSS durante el sismo en México en setiembre de 2017.

The objective of this article is to describe the actions undertaken by the emergency medical team (EMT) of the Mexican Social Security Institute (MSSI) during the emergency caused by the earthquake of September 7, 2017 (magnitude 8.2; epicenter 133 km southwest of Pijijiapan, Chiapas, Mexico). After the initial intersectoral assessment of the emergency had been conducted, the health sector stepped in. As part of this response effort, and once it was determined that a large number of people had been injured and that the health risks facing the affected population were substantial, the MSSI deployed an EMT equipped and trained to provide support in the medical and surgical treatment of injured people. The actions of the EMT, composed of specialists in medical and surgical emergencies and disaster situations, included providing medical care to 252 patients, managing the transfer of 57 patients, and helping to set up an emergency hospital. To improve response efforts during disaster situations, it is necessary to follow the process of forming, registering, and training EMTs at the national and international levels.

O propósito deste artigo é descrever as ações empreendidas pela equipe médica de emergência (EMT) do Instituto Mexicano de Seguro Social (IMSS, instituição pública que presta serviços de saúde) na crise de emergência causada pelo terremoto de 7 de setembro de 2017, com magnitude de 8,2 graus e epicentro a 133 km a sudoeste de Pijijiapan, Chiapas, México. Após a avaliação intersetorial inicial de emergência, o setor da saúde foi ativado. Como parte da resposta, diante do elevado número de feridos e alto risco para a saúde pública da população afetada, o IMSS mobilizou uma EMT na região, capacitada e treinada para dar apoio à resposta de atendimento médica e cirúrgica das vítimas. A EMT, formada por especialistas em emergências médico-cirúrgicas e desastres, prestou atendimento médico a 252 pacientes, coordenou a transferência de 57 pacientes e também colaborou na preparação de um hospital provisório. A fim de melhorar a resposta a desastres, é necessário prosseguir com o processo de integração, cadastramento e capacitação das EMT ao nível nacional e internacional.

[Hospitales del Instituto Mexicano del Seguro Social durante los sismos de septiembre de 2017. Análisis desde la perspectiva del Programa Hospital Seguro].

INTRODUCTION: The function of hospitals during major emergency or disaster is vital. Their response capacity depends on their geographic location, adequate organization, structural safety and safety of non-structural elements. After September 2017 earthquakes, self-assessment and Safe Hospital Program assessment results were compared in disabled hospitals belonging to the Mexican Institute of Social Security. OBJECTIVE: To compare the Hospital Safety Index (HIS) with self-assessments carried out by the units. METHOD: HIS and the Pan-American Health Organization/World Health Organization checklist were used. The comparison was carried out in 3 hospitals that were disabled after September 2017 earthquakes. RESULTS: Variability was observed in HIS, which revealed self-assessment biases: no hospital obtained a HIS score lower than 0.35, although all 3 were disabled in the immediate phase after the seismic events. CONCLUSIONS: Result variability depends on who applies the instrument. Quick HIS assessment provides an immediate idea of the probability for a hospital to continue functioning in case of disaster and allows determining mitigation actions to increase health facilities' resilience and safety.

INTRODUCCIÓN: La función de los hospitales durante una emergencia mayor o desastre es vital. Su capacidad de respuesta depende de su ubicación geográfica, adecuada organización, seguridad estructural y seguridad de elementos no estructurales. Después de los sismos de septiembre de 2017 se compararon los resultados de las autoevaluaciones y la evaluación del Programa Hospital Seguro en los hospitales inhabilitados pertenecientes al Instituto Mexicano del Seguro Social. OBJETIVO: Comparar el Índice de Seguridad Hospitalaria (ISH) contra las autoevaluaciones realizadas por las unidades. MÉTODO: Se utilizó el ISH y la Lista de Verificación de la Organización Panamericana de la Salud/Organización Mundial de la Salud. La comparación se realizó en tres hospitales inhabilitados posterior a los sismos de septiembre de 2017. RESULTADOS: Se observó variabilidad en los ISH, lo que evidenció sesgos en la autoevaluación: ningún hospital obtuvo una calificación inferior a 0.35 en su ISH aunque tres quedaron inhabilitados en la fase inmediata posterior a los eventos sísmicos. CONCLUSIONES: La variabilidad en los resultados depende de quien aplica el instrumento. La evaluación rápida con ISH proporciona una idea inmediata de la probabilidad de que un hospital continúe funcionando en caso de desastre y permite determinar las acciones de mitigación para incrementar la resiliencia y seguridad de las instalaciones de salud.

[Direct cost of primary care of mild traumatic brain injury in adults by GRD in third level of care]. / Costo directo de la atención primaria del traumatismo craneoencefálico (TCE) leve en adultos mediante grupos relacionados por el diagnóstico (GRD) en el tercer nivel de atención médica.

OBJECTIVE: To describe the direct cost of primary health care for patients with mild traumatic head injury in a third level medical facility. DESIGN: Cross-sectional study in 219 patients with mild traumatic brain injury (GRD 090 S06.0 ICD-10 including uncomplicated concussion without complication and increased comorbidity). LOCATION: A medical unit of tertiary care in the State of Puebla, Mexico. MAIN MEASUREMENTS: Direct costs were taken from ACDO.AS3.HCT.280115 / 7.P.DF Agreement and its annexes in Mexican pesos, the variables analyzed were age, gender, shift attention, laboratory, radiographic and tomographic studies, length of stay, specialist consultations, emergency care, medicines, and treatment materials. Descriptive statistics on SPSS program IBM v22. RESULTS: 53.4% male, 46.6% female; average age 31.9 years; morning shift attention 58.4%, evening 23.3%, and nightly 18.3%. The cost: $ 1,755 laboratory, plain radiographs $ 202,794, tomographic studies $ 26,720, consultation with neurosurgeon $ 279,174, emergency care $ 501,510; curing material: single steri drape $8,326.38, Micropore $1,307.43, infusion equipment $790.59, venipuncture needle $7,408.77; drugs: diclofenac $946.08, Ketorolac $724.89, 1000 ml. intravenous solution $1,561.47, total cost $ 1,032,293.72, average/patient: 4,713.66 Mexican pesos. CONCLUSION: The direct cost of primary health care of patients with mild traumatic head injury is high; sticking to the correct handling decreases the cost of attention.

[Usefulness of an online education platform for the medical and surgical emergencies specialty in Mexico]. / Utilidad de una plataforma educativa en línea para la especialidad de urgencias médico-quirúrgicas en México.

OBJECTIVE: Determine the usefulness of a Moodle-type education platform for knowledge development with residents in the medical and surgical emergencies (MSE) specialty. METHODS: This quasi-experimental study compared the departmental evaluations of MSE residents in two Mexican hospital units after they did their academic work using different educational strategies. The control group used a traditional format (classroom-style teaching with guided discussion), while the comparison group had access to a variety of resources (forums, chat, wikis, downloaded files) on a Moodle-type platform. Nonparametric statistics were used. The study was conducted during the 2010 - 2011 and 2011 - 2012 academic years. Three versions of the course were made available online, geared to the academic level of the residents (first, second, or third year). RESULTS: There were statistically significant differences in the mid-year evaluations, and improvements were even greater in the evaluations at the end of the academic year, especially for the third-year residents. In both academic years, the mid-year evaluations reported that only one resident in the control group performed within the average range, while the majority were in the lower range. The resources most used with the platform Moodle were downloaded files (77%) and the forum (63%). Still, 46.4% of the residents said that they encountered some type of limitation when they used the platform, the main one being lack of time (76.9%). CONCLUSIONS: The Moodle-type education platform appears to be useful and to offer greater opportunities for knowledge development compared with the traditional strategies. It is recommended that educational strategies based on Moodle-type platforms be implemented for MSE and other medical specialties.

Análisis del coste directo de la atención médica y quirúrgica del cáncer de mama. Estudio comparativo entre etapas temprana y tardía en tercer nivel de atención.

BACKGROUND: Management of breast cancer is increased by late diagnoses. OBJECTIVE: To analyse direct costs of breast cancer in early and advanced stage in a third level medical facility at Mexican Social Security Institute. METHOD: Observational study, direct costs of care in breast cancer in initial and advanced clinical stages are compared. Variables analysed were laboratory and diagnostic imaging studies, drugs, as well as hospitalization costs. The evaluated period included from the first care to the completion of the treatment. Costs were determined according to the table of Unit Costs by Level of Medical Care for the year 2019 of the Mexican Social Security Institute. Student's t test was used to determinate differences between groups, as well as descriptive statistics. RESULTS: The advanced stage compared to the initial stage, causes a greater number of laboratory-cabinet studies, surgeries, day/bed and interconsultations. The average cost of breast cancer care per patient is $99,280.36 (US$5,230.78) and $148,023.60 (US$7,789.92) for the initial and advanced stages, respectively (p = 0.024). CONCLUSIONS: Cost of medical attention in the initial stage is lower than that of the advanced stage.

ANTECEDENTES: Los diagnósticos tardíos elevan los costes de atención del cáncer de mama. OBJETIVO: Analizar los costes directos de la atención del cáncer de mama en etapa temprana y avanzada en el tercer nivel de atención en el Instituto Mexicano del Seguro Social (IMSS). MÉTODO: Estudio observacional que compara los costes directos de atención en cáncer de mama en estadios clínicos inicial y avanzado. Los datos analizados fueron estudios de laboratorio, gabinete, tratamiento y hospitalización. El tiempo evaluado incluyó desde la primera atención hasta la finalización del primer tratamiento. Se determinaron los costes de acuerdo con la tabla de Costes Unitarios por Nivel de Atención Médica para el año 2019 del IMSS. Se utilizó la prueba t de Student para diferencias entre grupos, así como estadística descriptiva. RESULTADOS: El estadio avanzado, comparado con el estadio inicial, ocasiona un número mayor de estudios de laboratorio-gabinete, cirugías, día/cama e interconsultas. El coste promedio de la atención del cáncer de mama por paciente es $99,280,36 (US$5,230.78) y $148,023.60 (US$7,789.92) para los estadios inicial y avanzado, respectivamente (p = 0.024). CONCLUSIONES: El coste de la atención médica del estadio inicial es menor que el del estadio avanzado.

[Cognition in medical residents with and without anxiety in a specialist training hospital]. / Cognición en médicos residentes con y sin ansiedad en un hospital formador de especialistas.

Background: The resident doctor plays an important role in people's health care. Objective: To compare the cognition of medical residents with/without anxiety in a specialist training hospital. Material and methods: Comparative, prospective, cross-sectional study. Medical residents of any grade and specialty were included, who signed informed consent. Those with a diagnosis of cognitive impairment were excluded, and who did not complete the tests were eliminated. AMAS-A test was applied to assess anxiety and NEUROPSI: Attention and memory test for cognitive characteristics. Mann-Whitney's U and Spearman's rho were used, p≤0.05 was considered significant. Results: 155 residents were evaluated, 55.5% men, mean age 32.4 years. Internal Medicine was the predominant specialty (25.2%). AMAS-A identified 94.19% residents with anxiety. NEUROPSI reported Attention and memory domain (38.7%) in normal classification, Memory (34.2%) in high normal, and Attention and executive functions (32.3%) in severe alteration as predominant assessments. Only Memory showed a significant difference between residents with and without anxiety (p=0.015). Attention and executive functions-Physiological anxiety (r=-0.21, p=0.009) and Attention and memory-Social concern (r=-0.268, p=0.001) correlations were significant. Conclusions: The percentage of anxiety and cognitive alterations in residents physicians is high. Anxiety decisively affects memory capacity in these medical doctors.

Introducción: el médico residente desempeña un papel importante en la atención a la salud de los pacientes. Objetivo: comparar la cognición de médicos residentes con y sin ansiedad en un hospital formador de especialistas. Material y métodos: estudio comparativo, prospectivo, transversal, en médicos residentes de cualquier grado y especialidad, que firmaron consentimiento informado. Se excluyeron aquellos con diagnóstico de alteración cognitiva y se eliminaron los que no completaron las pruebas realizadas. Se aplicaron AMAS-A para evaluar ansiedad y NEUROPSI: Atención y memoria para características cognitivas. Se utilizaron U de Mann-Whitney, y rho de Spearman. Se consideró significativa una p ≤ 0.05. Resultados: se evaluaron 155 residentes, 55.5% hombres, edad media 32.4 años. Medicina Interna fue la especialidad predominante (25.2%). Se identificó ansiedad en el 94.19% de los residentes. Predominaron los dominios Atención y memoria en clasificación normal (38.7%), Memoria en normal-alto (34.2%) y Atención y funciones ejecutivas en alteración severa (32.3%). Memoria mostró diferencia significativa entre residentes con y sin ansiedad (p = 0.015). Las correlaciones de Atención y funciones ejecutivas-Ansiedad fisiológica (r = -0.21, p = 0.009) y Atención y memoria-Preocupación social (r = -0.268, p = 0.001) resultaron significativas. Conclusiones: el porcentaje de ansiedad y alteraciones cognitivas en residentes es alto. La ansiedad afecta decisivamente la capacidad de memoria en estos médicos.

[Transculturation and validation of a Questionnaire Factors Influencing Organ Donation]. / Transculturación y validación del cuestionario Factores que influyen en la Donación de Órganos.

Background: There are validated questionnaires in Spanish that evaluate the factors that influence organ donation, but they are not designed for the open population or do not delve into various aspects such as the one proposed. Objective: Validate an instrument to evaluate the factors that influence organ donation in Mexico. Material and methods: Phase 1: Development of the instrument. Translation into Spanish of the questionnaire "Factors Inffluencing Organ Donation in Qatar", adapted by experts in donation and clinimetry. Simultaneously, the definitive version of the questionnaire "Factors that Influence Organ Donation" (FIDO) and the questionnaire "International Donor Collaborative Project" were applied to patients, relatives and staff of a tertiary hospital in Puebla, Mexico. Mind a week after 200 respondents. Cronbach's Alpha (AC) (internal consistency), Intraclass Correlation Coefficient (ICC) (external consistency), and Phi (Phi) and Chi square Coefficient (concurrent validity in intention to donate) were obtained. Results: AC and ICC by domain: Knowledge 0.625 and 0.372; Attitudes 0.776 and 0.761; Beliefs 0.649 and 0.633; Intentions 0.126 and 0.123; Phi: 0.976, Chi square: 2.358 (p = 0.125). Conclusions: The FIDO questionnaire is valid and consistent to assess knowledge, attitudes, beliefs and intentions in organ donation in the general Mexican population.

Introducción: existen cuestionarios validados en español que evalúan los factores que influyen en la donación de órganos, pero no están diseñados para población abierta o no exploran aspectos diversos como el propuesto. Objetivo: validar un instrumento para evaluar los factores que influyen en la donación de órganos en México. Material y métodos: fase 1: Elaboración del instrumento. Traducción al español del cuestionario Factors Influencing Organ Donation in Qatar, adaptado por expertos en donación y clinimetría. Se realizaron pruebas piloto hasta lograr acuerdo en dos rondas consecutivas. Fase 2: Validez y consistencia. Simultáneamente se aplicó la versión definitiva del cuestionario Factores que Influyen en la Donación de Órganos (FIDO) y el cuestionario Proyecto Colaborativo Internacional Donante a pacientes, familiares y personal de un hospital de tercer nivel de Puebla, México. Se reaplicó telefónicamente una semana después a 200 respondientes. Se utilizó alfa de Cronbach (AC) (consistencia interna), coeficiente de correlación intraclase (CCI) (consistencia externa), y coeficiente de Phi (Phi) y Chi cuadrada (validez concurrente en intención de donar). Resultados: AC y CCI por dominio: Conocimiento 0.625 y 0.372; Actitudes 0.776 y 0.761; Creencias 0.649 y 0.633; Intenciones 0.126 y 0.123; Global 0.774 y 0.675, respectivamente (p = 0.000); Phi: 0.976, Chi cuadrada: 2.358 (p = 0.125). Conclusiones: el cuestionario FIDO es válido y consistente para explorar: conocimiento, actitudes, creencias e intenciones en donación de órganos en población general mexicana.

Analysis of the Direct Cost of Medical and Surgical Care for Testicular Cancer in Early and Advanced Stages in a Third Level Medical Facility of the Mexican Social Security Institute.

BACKGROUND: The testicular cancer prevails in the third decade of life, the care cost increases with higher staging of the disease. OBJECTIVE: Compare the direct costs of medical and surgical attention for testicular cancer in early and advanced stages in a Third Level Medical Facility. MATERIAL AND METHODS: Process study, direct costs of medical attention are evaluated. Number of laboratory studies, imaging studies, and medical and surgical treatment were analyzed. The patients were divided into 2 groups: group 1 early stages and group 2 advanced stages. Mann Whitney U test was used for the difference between groups. RESULTS: There were 10 patients in each group, Group 1: 8 (80%) seminomas and 2 (20%) non-seminoma, Group 2: 4 (40%) seminomas and 6 (60%) non-seminomas. The average cost of care in Group 2 is higher than in Group 1, $288,827.90 and $145,911.70 Mexican pesos respectively (p=0.00578). CONCLUSIONS: The direct cost of medical attention is higher in the advanced stages compared to the early stages.

Analysis of the economic effects on biopsychosocial homeostasis from a three-dimensional probability measurement system.

OBJECTIVE: Describes the economic effects on bio-psychosocial homeostasis from a three-dimensional analysis of the joint interaction of biological, psychological and economic-social comorbidities, in order to know the probabilities of occurrence of these conditions simultaneously. METHOD: It is a cross-sectional study and random quota sampling. 353 men and women over 20 years of age participated, and answered a 27 questions application (bio-psycho-economic-social), the data was analyzed three-dimensionally in order to know the probability of occurrence of the variables studied and their possible location in the probabilistic unit cube. RESULTS: Based on the unit cube proposal, it can be observed that in the block of people with incomes from 2200 to 6600 pesos in the group of men there is a probability of 12.9 per 1000 inhabitants of presenting debt problems, overweight and severe depression, while in the case of women, the probability is 2.08 per 1000 inhabitants. CONCLUSIONS: There is a priority axis that determines the change of the remaining variables, in this case it is the economic axis the one that determines the biological and psychological conditions.

OBJETIVO: Describir los efectos económicos en la homeostasis biopsicosocial a partir de un análisis tridimensional de la interacción conjunta de la comorbilidad biológica, psicológica y económico-social, con la finalidad de conocer las probabilidades de ocurrencia a partir de estas condiciones de forma simultánea. MÉTODO: Estudio transversal y muestreo aleatorio por cuotas. Participaron 353 hombres y mujeres mayores de 20 años que contestaron un cuestionario con 27 preguntas (biopsicosociales-económicas). Se analizaron los datos tridimensionalmente con la finalidad de conocer la probabilidad de ocurrencia de las variables estudiadas y su posible localización en el cubo unitario probabilístico. RESULTADOS: Con base en la propuesta del cubo unitario se obtiene que, en las personas con ingresos de 2200 a 6600 pesos, en los hombres existe una probabilidad de 12.9 por cada 1000 habitantes de presentar deudas, sobrepeso y depresión grave; en las mujeres, la probabilidad es de 2.08 por cada 1000 habitantes. CONCLUSIONES: Existe un eje prioritario que determina el cambio de las variables restantes, en este caso el eje económico que determina las condiciones biológicas y psicológicas.

[Security protocols adapted to COVID-19 in elective surgery thru 2021]. / Protocolos de seguridad adaptados a COVID-19 en cirugía electiva durante 2021.

Background: Medical personnel are among the populations with the most infections and morbidity and mortality during the COVID-19 pandemic worldwide. Objective: To evaluate patient and health personnel safety in anesthetic procedures of elective surgeries during COVID-19 pandemic in a 3rd level care Hospital in Puebla, Mexico. Material and methods: Descriptive, prospective, analytical study in a 3rd level care unit of the Mexican Social Security Institute in Puebla, Mexico. Elective surgeries from all shifts and any specialty, whose staff signed informed consent, were included. The modified surgical safety checklist for COVID 19, from the World Federation of Societies of Anesthesiologists, was applied. Results: 170 surgeries were evaluated, the predominant specialties were oncosurgery (39.41%), urology (25.29%) and general surgery (14.71%). The most used anesthetic technique was general anesthesia (47.05%); 10.12% accomplished safe intubation/extubation protocols, presence of essential personnel in 6.34%. The use of personal protective equipment decreased during the stages of the pandemic, the use of face masks by medical personnel/patients is the most frequent (100%). Conclusions: Security measures have decreased. Adequate security protocols must be continued to avoid new infections. Basic protection measures, the use of personal protective equipment and other protection strategies must persist.

Introducción: el personal médico ha sido de las poblaciones con mayor número de contagios y morbimortalidad durante la pandemia de COVID-19 en todo el mundo. Objetivo: evaluar la seguridad del paciente y del personal de salud en procedimientos anestésicos de cirugías electivas en tiempos de COVID-19 en un hospital de tercer nivel de atención en Puebla, México. Material y métodos: estudio descriptivo, prospectivo, analítico, en una unidad de tercer nivel de atención del Instituto Mexicano del Seguro Social en Puebla, México. Se incluyeron cirugías electivas de todos los turnos y de cualquier especialidad, cuyo personal firmó consentimiento informado. Se aplicó la lista de verificación de seguridad quirúrgica modificada para COVID-19 de la Federación Mundial de Sociedades de Anestesiólogos. Resultados: se evaluaron 170 cirugías, las especialidades predominantes fueron Oncocirugía (39.41%), Urología (25.29%) y Cirugía general (14.71%). La técnica anestésica más utilizada fue la anestesia general (47.05%); el 10.12% cumplió con los protocolos de intubación/extubación segura, mientras que la presencia de personal esencial se cumplió en el 6.34%. El uso de equipo de protección personal disminuyó durante las etapas de la pandemia, el uso de cubrebocas por personal médico/pacientes es el más frecuente (100%). Conclusiones: las medidas de seguridad han disminuido. Se debe continuar con los protocolos de seguridad adecuados para evitar contagios nuevos. Las medidas de protección básicas, el uso de equipo de protección personal y demás estrategias de protección deben persistir.

[Clinical guideline for diagnosis and treatment of high blood pressure]. / Guía de práctica clínica. Diagnóstico y tratamiento de la hipertensión arterial.

Hypertension is a disease with numerous etiologies which consequences led to systemic vascular damage leading to other cardio-vascular diseases increasing morbi-morbility. Clinically it goes through a prolonged asymptomatic phase that prevents early diagnosis. Today, a high prevalence is reported in our country so that it is considered a public health issue. The purpose of this guide is to be a useful tool to be used to define the Arterial Hypertension or high blood pressure concept, its epidemiology, prevalence, classification and, according to these concepts, in order to establish a proper treatment program emphasizing the preventive side of the disease in primary care units.

Sarcoma de células dendríticas foliculares. Informe de un caso.

ANTECEDENTES: El sarcoma de células dendríticas foliculares es una enfermedad rara, caracterizada principalmente en sitios nodales como la cabeza, el cuello y la orofaringe, aunque puede ser extranodal, como en el bazo y el hígado. En la mayoría de los casos cursa asintomática, pero puede presentar síntomas generales, dolor abdominal o fiebre. La inmunohistoquímica es indispensable para llegar a un diagnóstico definitivo. PRESENTACIÓN DEL CASO: Mujer de 40 años, con abultamiento submaxilar en el cuello, región frontoparietooccipital derecha, y sequedad de mucosa oral. Se manejó inicialmente como un síndrome de Sjögren, que fue descartado por el resultado histopatológico de la biopsia de glándula salival. Posteriormente se realizó biopsia de ganglio del cuello, que reportó sarcoma de células dendríticas foliculares con expresión inmunohistoquímica positiva para CD23 y negativa para CD21 y ACL. Se manejó con samario y tuvo una sobrevida de 3 meses desde el diagnóstico. CONCLUSIONES: el sarcoma de células dendríticas foliculares es raro y la sobrevida es corta. BACKGROUND: Follicular dendritic cell sarcoma is a rare pathology, it occurs mainly in nodal sites such as head, neck, oropharynx, although extranodal presentation such as spleen and liver may occur. In most cases it is asymptomatic but may present general symptoms, abdominal pain or fever. Immunohistochemistry is essential to make a definitive diagnosis. CASE PRESENTATION: Forty year-old woman, with submaxillary lesion, in the neck, right fronto-parieto-occipital region with dry oral mucosa. It was initially managed as a Sjögren's syndrome ruled out by the histopathological result of salivary gland biopsy. Subsequently, a neck ganglion biopsy was performed that reported follicular dendritic cell sarcoma, with positive immunohistochemical expression for CD23 and negative for CD21 and LCA. It was managed with samarium with a survival of 3 months from the time of its diagnosis. CONCLUSIONS: Follicular dendritic cell sarcoma is rare and its global survival is short.

Quality of life and erectile dysfunction in patients with benign prostatic hyperplasia.

ANTECEDENTES: La patología de la próstata más frecuente es la hiperplasia prostática benigna. A los 50 años, el 50% de los hombres son diagnosticados y a los 80 años aumenta hasta al 90%. La prevalencia de disfunción eréctil en conjunto con hiperplasia prostática benigna es del 5.2-40%, y los pacientes con hiperplasia prostática benigna es 1.33-6.24 veces más frecuente que tengan disfunción eréctil que aquellos sin hiperplasia prostática benigna. Ambas afecciones repercuten en la calidad de vida. OBJETIVO: Identificar la calidad de vida y el grado de disfunción eréctil en pacientes con hiperplasia prostática benigna. MÉTODO: Estudio transversal, descriptivo, en pacientes con crecimiento prostático benigno a los cuales se les aplicaron dos cuestionarios: SF-12 para calidad de vida e Índice Internacional de Función Eréctil versión 5 para disfunción eréctil. RESULTADOS: Fueron 101 pacientes, edad media de 66.5 ± 8.5 años, promedio físico de 38.68, promedio mental de 43.35, 14 de ellos sin disfunción eréctil y 38 con disfunción eréctil leve, 33 leve a moderada, 15 moderada y 1 grave. CONCLUSIONES: Los pacientes con hiperplasia prostática benigna tienen una salud física mala y una salud mental buena. El 70.3% de los pacientes muestran grado leve o leve-moderado de disfunción eréctil. BACKGROUND: The most frequent prostatic pathology is benign prostatic hyperplasia. By the age of 50, 50% are diagnosed with it and by the age of 80, it increases to 90%. The erectile dysfunction prevalence along benign prostatic hyperplasia is 5.2%-40%. Patients with benign prostatic hyperplasia are 1.33-6.24 times more likely to have erectile dysfunction tan without benign prostatic hyperplasia. OBJECTIVE: To identify quality of life and to grade erectile dysfunction in patients with benign prostatic hyperplasia. METHOD: A transversal, descriptive study was conducted in patients with benign prostatic hyperplasia. Two questionnaires were applied: SF-12 for quality of life and IIEF-5 for erectile dysfunction. RESULTS: 101 patients, mean age 66.5 ± 8.5 years, mean physical aspect 38.68, mean mental aspect 43.35, 14 without erectile dysfunction, 38 mild grade, 33 mild to moderate, 15 moderate and 1 severe. CONCLUSIONS: Benign prostatic hyperplasia patients have poor physical health and good mental health. 70.3% of patients have a grade of erectile dysfunction between mild and mild-moderate.

Validation of a faces pain scale in postsurgical geriatric patients.

ANTECEDENTES: Los pacientes geriátricos presentan dificultad progresiva para expresar el dolor. Es muy importante establecer un parámetro preciso para manejar el dolor posoperatorio. OBJETIVO: Determinar la validez de la escala facial del dolor (EFD) en pacientes geriátricos posquirúrgicos. MÉTODO: Estudio comparativo, observacional, prolectivo, en un hospital de segundo nivel de atención. Fase 1: se presentaron las caras de la escala desordenadas a personas ≥ 60 años, con Glasgow íntegro, previa firma de consentimiento, para ordenarlas ascendentemente. Fase 2: se incluyeron pacientes ≥ 60 años, de cualquier sexo, sometidos a cualquier procedimiento quirúrgico, con Glasgow íntegro, previa firma de consentimiento informado. Se eliminaron los que no cooperaron o no completaron ambas escalas. A cada paciente se aplicó, antes de recibir analgesia, la escala visual numérica (EVN), y 5 minutos después la EFD, y nuevamente 30 minutos tras la analgesia. Se utilizó estadística descriptiva, tamaño del efecto, t pareada y Spearman. RESULTADOS: Fase 1: todas las caras fueron ubicadas correctamente (75-100%). Fase 2: participaron 142 pacientes, 76 (53.5%) hombres y 66 (46.5%) mujeres. Promedios preanalgesia: EFD 3.4, EVN 7.9; posanalgesia: EFD 1.8, EVN 4.8. Tamaño del efecto (EFD): 2.389; t pareada 17.231 (p < 0.002); Spearman 0.654 (p = 0.016) preanalgesia, 0.798 (p = 0.004) posanalgesia. CONCLUSIÓN: La EFD es válida para evaluar la intensidad del dolor posoperatorio en pacientes geriátricos. BACKGROUND: Geriatric patients present progressive difficult to assess pain. Getting a precise parameter to approach postsurgical pain is a very important issue. OBJECTIVE: To explore Faces Pain Scale (EFD) validity in geriatric post-surgical patients. METHOD: Comparative, observational, prolective study in patients from a second level attention unit. Phase 1: faces were disorderly presented to ≥ 60 years old persons, Glasgow scale scored 15, signed authorization, to place them in ascending order. Phase 2: ≥ 60 years old patients, any sex, who received any surgical procedure, Glasgow scale scored 15, signed authorization were recruited. Those who did not cooperate/complete scales application were eliminated. Numeral Visual Scale (EVN) and 5 minutes after EFD were applied to each patient, before analgesia, and again 30 minutes after analgesia. Descriptive statistical data, effect-size, Student paired-t and Spearman tests were used. RESULTS: Phase 1: every face was correctly placed (75-100%). Phase 2: 142 patients participated, 76 (53.5%) male, 66 (46.5%) female. Pre-analgesia media scores: EFDA 3.4, EVN 7.9; post-analgesia media scores: EFD 1.8, EVN 4.8. EFD effect-size test scored 2.389, paired-t scored 17.231 (p < 0.002); Spearman scores: 0.654 (p = 0.016) pre-analgesia, 0.798 (p = 0.004) post-analgesia. CONCLUSION: EFD is a valid scale to evaluate postoperative pain intensity in geriatric patients.

Uretroplasty with oral mucosal graft in patients with anterior urethral stenosis. Comparative study with conventional treatment.

ANTECEDENTES: El manejo con uretroplastía de la estenosis uretral es una opción quirúrgica fundamental, y comparar la uretroplastía con injerto de mucosa oral con la uretroplastía término-terminal tiene trascendencia para conocer la diferencia entre ambas técnicas. OBJETIVO: Comparar la uretroplastía con injerto de mucosa oral con la uretroplastía término-terminal en pacientes con estenosis uretral tipo Jordan C, D y E. MÉTODO: Cuasiexperimento realizado en pacientes con estenosis uretral anterior operados de uretroplastía con anastomosis término-terminal o con injerto de mucosa bucal. RESULTADOS: Veintinueve pacientes con una media de edad de 50.7 años, 6 diabéticos, 9 hipertensos, longitud media de la estenosis de 3.6 cm, 19 operados con uretroplastía termino-terminal (grupo 1) y uretroplastía con mucosa bucal (grupo 2). El Índice Internacional de Síntomas Prostáticos promedio preoperatorio fue grave en la mayoría de los pacientes (93%). Hubo mejoría significativa en el posoperatorio en ambos grupos (p = 0.0001 y p = 0.0011), así como en los resultados uroflujométricos (p = 0.0046 y p = 0.00062). CONCLUSIONES: Ambos procedimientos lograron mejorías significativas en la sintomatología urinaria a los 6 meses en comparación con los valores preoperatorios. BACKGROUND: Urethroplasty management of urethral stricture is a fundamental surgical option, and comparing urethroplasty with oral mucosal graft with end-to-end urethroplasty is important to know the difference between both techniques. OBJECTIVE: To compare urethroplasty with oral mucosal graft with end-to-end urethroplasty in patients with urethral stricture type Jordan C, D and E. METHOD: Quasi-experiment performed in patients with anterior urethral stricture operated with urethroplasty with end-to-end anastomosis or with oral mucosal graft. RESULTS: Twenty-nine patients with a mean age of 50.7 years, 6 diabetic, 9 hypertensive, mean stenosis length of 3.6 cm, 10 with end-to-end urethroplasty (group 1) and 19 operated with urethroplasty with buccal mucosa (group 2). The average preoperative International Prostatic Symptom Index was severe in most patients (93%). There was significant improvement postoperatively in both groups (p = 0.0001 and p = 0.0011), as well as in uroflowmetric results (p = 0.0046 and p = 0.00062). CONCLUSIONS: Both procedures achieved significant improvements in urinary symptomatology at 6 months compared to preoperative values.

[Procedures performed by emergency medicine residents in a Mexico City medical facility]. / Procedimientos realizados por residentes de la especialidad de urgencias en una sede de México.

OBJECTIVE: To determine the amount and type of procedures performed by three groups of emergency medicine residents in an emergency service in a Mexico City campus. METHODS: We carried out an observational study using a sampling type census with the authorization of the local internal review board (IRB). We followed 33 emergency medicine residents working in Mexico City during the 2007-2008 academic year. We registered the procedures performed and skills displayed by participants in a daily, weekly and monthly format. We included age, gender, academic degree and rotation service. Using descriptive statistics we calculated frequencies, means and standard deviations. RESULTS: All 33 residents (100%) participated in the study; 33.36% were first year, 33.36% second and 27.27% third year resident. Mean age was of 26.2 +/- 3.5 year and 81.81% were male. Eighteen services where residents carried out their duties were assessed. We recorded a total of 12,075 different procedures and grouped skills under 20 subtypes. 33.30% were performed by first-year, 38.29% by second-year, and 28.42% by third-year. The most common procedures included advanced handling of the aerial route (2,376), central venous accesses (2,307), and resuscitation maneuvers (1,624). CONCLUSIONS: The number of procedures carried out at this medical facility is high with a heavier work load than the one reported in the international literature. We should monitor and compare data among different sites in order to have a clearer picture of the status of emergency medicine specialists in Mexico.

[An e-learning educational strategy for skills development on the prevention, diagnosis and treatment on influenza A H1N1]. / Estrategia educativa en línea durante el brote de influenza A H1N1.

OBJECTIVE: To determine the clinical competence with influenza A H1N1 after an e-learning educational strategy based on the influenza A H1N1 clinical practice guideline. METHODS: An observational analytical study which included 860 students who responded to the assessment instrument (consistency of 0.89) at the beginning and end of phases IV to VII of the e-learning mode course about the prevention, diagnosis and treatment of influenza A H1N1. Nonparametric statistics were used. RESULTS: We included 25% of students admitted to phases IV to VII of the course. There was no statistical difference between the groups at the beginning evaluation. The 94.76% of the students were in the lower ranks. After the educational intervention 54.64% of students were located at intermediate or higher values. Critics to previous actions of colleagues and commitment of iatrogenic events were indicators that did not show an increase. A raise in the initial score was shown in 646 students, 122 declined and 88 remained unchanged. CONCLUSIONS: An e-learning strategy seems to develop adequate skills for the prevention, diagnosis and treatment of influenza A H1N1.

Evaluación funcional y del dolor en pacientes con deformidad espinal manejados quirúrgicamente.

BACKGROUND: The degenerative spine has an incidence greater than 60% in people over 60 years old. Functionality and pain is assessed by the Oswestry Disability Index (ODI) and the visual analogue pain scale (VAPS), respectively. OBJECTIVE: To evaluate the functionality and pain one year after surgery, in patients with degenerative spine. METHOD: Comparative, longitudinal study, in patients with degenerative spine surgically managed during 2016 to 2018. Functional aspects and pain were evaluated before surgery and one year later using ODI and VAPS. Descriptive statistics, measures of central tendency and dispersion, Student's t were used for the difference between the pre and postoperative values of both scales. RESULTS: There were 18 patients. Of these, 15 completed the follow-up; 8 were men and 7 women. The average age was 63.5 ± 4.8 years; 13 presented moderate post-surgical functional limitation, 2 intense functional limitation. There were statistically significant differences between the pre and postoperative values for ODI and VAPS (p = 0.011 and p = 0.017, respectively). CONCLUSIONS: Functionality and pain evaluated one year after surgery, have a statistically significant difference compared to evaluations before surgery in patients with spine deformity surgically treated.

ANTECEDENTES: La columna vertebral degenerativa tiene una incidencia > 60% en los mayores de 60 años. La funcionalidad y el dolor se evalúan con el Oswestry Disability Index (ODI) y la Escala Visual Análoga (EVA), respectivamente. OBJETIVO: Evaluar la funcionalidad y el dolor en pacientes con columna vertebral degenerativa a 1 año de operados. MÉTODO: Estudio comparativo y longitudinal de pacientes con columna vertebral degenerativa manejados quirúrgicamente durante 2016 a 2018, a quienes se evaluaron aspectos funcionales y el dolor antes de la cirugía y 1 año después mediante ODI y EVA. Se utilizaron estadística descriptiva, medidas de tendencia central y dispersión, y prueba t de Student para la diferencia entre los valores preoperatorios y posoperatorios de ambas escalas. RESULTADOS: De 18 pacientes, 15 completaron seguimiento (8 hombres y 7 mujeres). La edad promedio fue de 63.5 ± 4.8 años. Trece presentaron limitación funcional posquirúrgica moderada y dos limitación funcional intensa. Hubo diferencias estadísticamente significativas entre el preoperatorio y el posoperatorio para el ODI y la EVA (p = 0.011 y p = 0.017, respectivamente). CONCLUSIONES: La funcionalidad y el dolor evaluados 1 año después de la cirugía tienen diferencia estadísticamente significativa en comparación con las evaluaciones antes de la cirugía.

Academic-assistance activities registered by the graduates of the specialty of Emergency of the Regional Hospital No. 25 of the Instituto Mexicano del Seguro Social (1991-2018).

OBJECTIVE: To describe the academic-assistance activities of the graduates of the specialty of emergencies in the Regional General Hospital 25 of the Mexican Institute of Social Security. METHOD: Observational descriptive type study in which the 25 generations graduated from the specialty will be analyzed. The scientific, teaching and care productivity of its graduates was analyzed, as well as the subsequent training and the managerial positions held. RESULTS: From 1991 to 2018 238 residents entered, of which 88.65% concluded the specialty. 57.34% are male. 78.67% of the graduates work exclusively in the IMSS and 68.72% do it in more than one institution. 72% of them have certification. They published 112 scientific articles and 4 books. 12.32% of the graduates attended a second specialty, being the predecessor of patient care in the critical state (84.61%). Among the main achievements of the headquarters are in the first emergency room of the country in the Quality Postgraduate Program of Consejo Nacional de Ciencia y Tecnología. 53% of these specialists work or perform in management positions. CONCLUSIONS: This office is considered a reference in the specialty of emergencies in Latin America.

OBJETIVO: Describir las actividades académico-asistenciales de los egresados de la especialidad de urgencias en el Hospital General Regional 25 del Instituto Mexicano del Seguro Social (IMSS). MÉTODO: Estudio observacional de tipo descriptivo en el que se analizaron las 25 generaciones egresadas de la especialidad. Se analizó la productividad científica, docente y asistencial de sus egresados, así como la formación posterior y los puestos directivos desempeñados. RESULTADOS: De 1991 a 2018 ingresaron 238 residentes, de los cuales el 88.65% concluyó la especialidad. El 57.34% son de sexo masculino. El 78.67% de los egresados laboran exclusivamente en el IMSS y el 68.72% lo hacen en más de una institución. El 72% cuentan con certificación. Publicaron 112 artículos científicos y 4 libros. El 12.32% de los egresados cursaron una segunda especialidad, siendo la predominante la de Atención del Paciente en Estado Crítico (84.61%). Entre los logros principales de la sede están el de ser la primera sede de urgencias del país en ser incluida en el Programa de Posgrados de Calidad del Consejo Nacional de Ciencia y Tecnología. El 53% de estos especialistas se desempeñan o han desempeñado en puestos directivos. CONCLUSIONES: Esta sede se constituye como un referente dentro de la especialidad de urgencias en Latinoamérica.