Survival of Vascular Accesses in Chronic Hemodialysis Patients.

BACKGROUND/AIMS: Vascular access (VA) is the highest risk factor for blood infections, hospitalization, and mortality of patients undergoing hemodialysis (HD). The risk of mortality while using a catheter is greater than that while using grafts. The objective of this article is to know the survival rate in relation to the type of VA. METHODS: A retrospective cohort of HD patients was studied. The data gathered included age, gender, first VA at the surrogate site, days between the first and second access, number of accesses, and anatomical site of VA placement. Mean differences were estimated using χ2 or Student's t test. Survival was calculated using the Kaplan-Meier curves and included in tables. Statistical significance was established as p < 0.05. The statistical computer software package SPSSw v25 was used for the analysis. RESULTS: A total of 896 patients were included with a mean age of 47.88 years (SD ± 16.52), the duration of the first VA was 398.81 days (±565.79), the mean number of VAs used was 2.26 (±1.15), and the median time undergoing HD was 728.73 days. The duration of catheter placement was 330.42 days, and 728.60 days for fistula use (p = 0.001). The mean number of days of renal replacement was 611.59 days for catheter and 1,495.25 days for internal arteriovenous fistula (IAVF) patients (p = 0.001). CONCLUSIONS: The survival of the initial VA is greater for the IAVF, followed by the tunneled catheters and the lowest by the non-tunneled catheters, which continue to be frequently used in our setting.

Biochemical diagnosis of mucopolysaccharidosis in a Mexican reference center.

Mucopolysaccharidoses (MPS) are a group of genetic disorders, each resulting from the deficiency of one of the lysosomal enzymes that catabolizes mucopolysaccharides. For the accurate diagnosis of the disease, the quantification of a specific enzymatic activity is needed. In the present study, we analyzed seven MPS over several periods of time ranging from 2 to 5 years in a reference center in Mexico. During this time, a total of 761 samples belonging to 505 individuals with suspected MPS were analyzed. A total of 198 (26.01%) positive results were found. Among these, MPS IVA accounted for the highest frequency of positive results (49.10%), followed by MPS III (17.69%, IIIA: 11.80% and IIIB: 5.89%). Adjusting for the number of births per year, the estimated incidence per 100,000 births for MPS analyzed were as follows: MPS I: 0.19, MPS II: 0.15, MPS IIIA: 0.26, MPS IIIB: 0.13, MPS IVA: 1.10, MPS VI: 0.17 and MPS VII: 0.23, and the combined estimated incidence of MPS was 2.23 per 100,000 births; however, this incidence seems to be highly underestimated when compared with the results of newborn screenings.

Author Correction: Association between G1733A (rs6152) polymorphism in androgen receptor gene and recurrent spontaneous abortions in Mexican population.

The original version of this article unfortunately contained two mistakes in the Abstract and the Discussion sections that the authors would like to correct.

Association between G1733A (rs6152) polymorphism in androgen receptor gene and recurrent spontaneous abortions in Mexican population.

INTRODUCTION: Recurrent spontaneous abortion (RSA) is a multifactorial condition that occurs with a frequency of 0.2-5% in women of reproductive age. Among genetic factors, the single nucleotide polymorphism (SNP) G1733A in the androgen receptor (AR) gene has been associated with its presence in Greek and Iranian populations. Therefore, the aim of this study is to determine its possible association with RSA in this population. PATIENTS AND METHODS: A total of 156 Mexican RSA (with at least 2 consecutive abortions) unrelated patients and 152 unrelated healthy women were included, the presence of karyotype anomalies in the parents as well as uterine anomalies as well as antiphospholipid antibodies was excluded in patients; while all the controls presented at least two healthy pregnancies and no abortion. In all the included women, the presence of the SNP G1733A was determined by restriction fragment length polymorphism (RFLP) technique. RESULTS: No significant differences were observed in age between groups. The genotype GG, GA, and AA had a frequency of 0.70, 0.27, and 0.03 in patients and of 0.89, 0.10, and 0.01 in controls [corrected] (p < 0.001); while the A allele frequency was of 0.06 and 0.16 in controls and patients, respectively (p < 0.0001). The difference in allele frequency increased 10-15% when patients with primary RSA (with no live births) and with at least three abortions were included. CONCLUSIONS: The SNP G1733A of the AR gene is significantly associated with RSA in Mexican patients. These results coincide with previous reports in other populations.

Educational and evaluation strategies in the training of physician specialists / Estrategias educativas y de evaluación en la formación de médicos especialistas

Background: Teaching strategies have been defined as procedures, means or resources that teachers used to promote meaningful learning. Aim: Identify teaching strategies and evaluation used by the professor with residents in tertiary hospitals health care. Methods: This is a cross-sectional study conducted with full, associate and assistant professors of various medical specialties. A questionnaire was applied to evaluate the strategies used by professors to teach and evaluate students. Results: We included a sample of 90 professors in 35 medical specialties. The most frequent teaching activities were: organizing students to develop presentations on specific subjects, followed by asking questions on previously reviewed subjects, In terms of the strategies employed, the most frequent "always" option was applied to case analyses. The most frequent methods used for the evaluation of theoretical knowledge were: participation in class, topic presentation and exams. Conclusions: Teaching activities were primarily based on the presentation of specific topics by the residents. The most commonly used educational strategies were clinical case analyses followed by problem-based learning and the use of illustrations. Evaluation of the residents' performance in theory knowledge, hinged on class participation, presentation of assigned topics and exams.

Antecedentes: Las estrategias didácticas se han definido como procedimientos, medios o recursos que el docente utiliza para promover el aprendizaje significativo. Objetivo: Identificar las estrategias de enseñanza y de evaluación que utiliza el profesor con residentes en hospitales de tercer nivel de atención médica. Método: Estudio transversal, con profesores de diversas especialidades, en el Centro Médico Nacional La Raza. Se aplicó un cuestionario que valora las estrategias utilizadas en la enseñanza y la evaluación. Resultados: En una muestra de 90 profesores, 35 especialidades médicas con profesores ayudantes, adjuntos y titulares, las actividades de enseñanza que más realizan son organizar a los alumnos a exponer temas, seguido de realizar preguntas sobre temas vistos. Respecto a las estrategias educativas, la más frecuente fue análisis de casos y aprendizaje basado en problemas. Para evaluación del desempeño teórico, los métodos más utilizados fueron participación en clase, exposición de temas y exámenes. Conclusiones: las actividades de enseñanza están basadas en la exposición de temas por los médicos residentes. La estrategia educativa más utilizada fue llevar a cabo análisis de casos clínicos, seguido por aprendizaje basado en problemas. La evaluación del desempeño en aspectos teóricos se realiza a partir de la participación en clase, la exposición de temas y exámenes.

[Effects of occupational exposure to pesticides on semen quality of workers in an agricultural community of Merida state, Venezuela]. / Efectos de la exposición ocupacional a plaguicidas sobre la calidad del semen en trabajadores de una comunidad agrícola del estado Merida, Venezuela.

Numerous studies report adverse effects of pesticides on male reproductive health. The objectives of this study were to investigate whether there is a relationship between occupational exposure to pesticides and semen quality, and to determine whether chronic exposure to pesticides differentially affects semen quality in men of different ages. A comparative study of 64 farmers and 64 control men was performed. The farmers were interviewed to determine their occupational history and particularly, activities that may involve exposure to pesticides. Semen parameters were evaluated and a comparative analysis of semen variables between exposed and control groups, as well as between age groups: 18-29, 30-37 and 38-60 years was done. Significant alterations of some semen parameters in the exposed group were found, such as: decreases in sperm concentration, slow progressive motility and sperm membrane integrity; at the same time, increases in eosin Y positive and sperm DNA fragmentation index. The results obtained by age groups showed significant differences between exposed and control groups for the parameters of membrane integrity, eosin Y positive and sperm DNA fragmentation index, being the exposed group between 18-29 years that showed the highest altered cases of these parameters. Our results prove that occupational pesticide exposure is associated with alterations in sperm quality, creating a risk to farm workers in their reproductive capacity.

[Adenocarcinoid neoplasm of the colon. Case report]. / Tumor adenocarcinoide de colon. Informe de un caso.

BACKGROUND: adenocarcinoid tumor is a rare malignancy that combines clinical and histological features of epithelial origin (adenocarcinoma) and neuroendocrine (carcinoid), occupies less than 1 % of all colorectal cancer histology, occurring mainly in the appendix and its presence in the colon is rare. CLINICAL CASE: we present a case of a 41-year-old female with sigmoid colon tumor, who underwent an extended left hemicolectomy and anastomosis; having a good postoperative evolution, with hospital stay of seventh days. The final histopathological study reported was adenocarcinoid colon tumor with free margins of injuries and four positive nodes of adenocarcinoma. CONCLUSIONS: adenocarcinoid tumors are present in the appendix in 85 to 95 % of all cases and only 6 % are located in the colon (13 % in sigmoid). Early diagnosis is certainly the most important determinant of good prognosis, in these cases the five-year survival is 80 to 84 %, and 15 years of 60 %.

[Evaluation of the quality of the human spermatozoon: comparison between spermatic DNA integrity and semen variables]. / Evaluación de la calidad del espermatozoide humano: comparación entre la integridad del ADN espermático y variables del semen.

Semen analysis does not have an absolute predictive value on fertility, however it is a reflection of male fertility potential, which is related to its spermatozoa quality and other semen variables. Great variability in human semen parameters has been demonstrated within a single individual, an observation that could explain why a male with low semen quality can successfully fertilize an egg. Although conventional semen analysis, such as sperm concentration, motility and morphology, provide important information about the clinical status of male fertility, new procedures to predict the sperm functional capability have been developed in the last decade, such as analysis of nuclear DNA integrity, which have improved considerably the clinical diagnosis of male infertility, and increased the knowledge about spermatozoa function. DNA fragmentation consist in interruptions, both in single and double DNA strains, that frequently occur in sperm samples from infertile patients. We have conducted a clinical study in semen samples from patients who have attended the Andrology laboratory of the University of Los Andes, between March 2007 and March 2009. The aim of this study was to compare sperm DNA integrity, analyzed by flow cytometry, with traditional semen parameters. Our results show remarkable correlations between conventional human semen variables and sperm chromatin integrity, contributing to asses an integral evaluation of sperm quality allowing the analysis of its fertilizing potential in clinical studies.

Arylsulfatase A pseudodeficiency in Mexico: Enzymatic activity and haplotype analysis.

BACKGROUND: Metachromatic Leukodystrophy (MLD, OMIM 250100) is a neurodegenerative disease caused by mutations in the ARSA gene (OMIM 607574) that lead to deficiency in Arylsulfatase A (ASA). ASA pseudodeficiency (PD-ASA) is a biochemical condition that substantially diminishes ASA activity but is not associated with clinical manifestations. PD-ASA is associated with the c.1055A>G (p.Asn352Ser) (rs2071421) and c.*96A>G (rs6151429) variants, which have an estimated frequency of 2% in the population. OBJECTIVE: To determine the activity of Arylsulfatase A and to identify variants and haplotypes in the ARSA gene in Mexican individuals with pseudodeficiency. METHODS: Two-hundred apparently healthy individuals were included to determine the enzymatic activity of ASA in leukocytes by spectrophotometric analysis, and identification of the PD-ASA alleles was performed by PCR-RFLP assays. Genotypes were confirmed by semi-automated Sanger sequencing. Haplotypes were constructed using Arlequin v.10.04, and linkage disequilibrium analysis was performed with Cube X. RESULTS: The enzymatic activity of ASA was determined to be 1.74-2.09 nmol/mg protein/min and later correlated with genotypes and haplotypes. For the (p.Asn352Ser) variant, we found 126 (0.63) individuals with the AA genotype, 62 with AG (0.31) and 12 with GG (0.06); the frequency of the polymorphic allele was 0.215 (86 alleles, 21.5%), and the variant was in HWE (p = .2484). The variant c.*96A>G was also in HWE (p = .2105): 185 individuals (0.925) with the AA genotype, 14 (0.07) with AG, and 1 (0.005) with (GG), with a frequency of 0.04 (4%) for the polymorphic allele. The inference of haplotypes resulted in 312 (0.78) AA, 72 (0.18) GA, and 16 (0.04) GG haplotypes. The AG haplotype was not found. The variants were found to be in linkage disequilibrium (D' = 1). Of the nine possible diplotypes, AA/AG, AA/GG, and AG/GG were not found, in concordance with the hypothesis that the G allele of c.*96A>G does not occur in the absence of the G allele of c.1055A>G. We found a slight correlation between ASA biochemical activity and variants, mainly due to the G allele of c.*96A>G in either genotypes or haplotypes. CONCLUSIONS: In Northwestern Mexico, the presence of PD-ASA alleles was biochemically and molecularly determined, and the frequencies were found to be in HWE. The frequency of PD-ASA for the North Western Mexican mestizo is 8%.

Probiotics' effectiveness on symptoms, histological features and feeding tolerance in ulcerative colitis / Efectividad de probióticos sobre síntomas, histología y tolerancia alimentaria en colitis ulcerativa

Background: Probiotics have been used in the adjuvant treatment of Ulcerative Colitis (UC). Objective: To evaluate the role of a combination of probiotics on the clinical, histological changes and feeding tolerance in patients with UC. Methods: An open UC patients with mild to moderate activity and clinical trial was conducted. Patients were randomized to receive or a combination of 6 strains of probiotics for 3 months while continuing their drug treatment established. UC activity was assessed by Truelove and Witts scale and histological findings by Gupta index. Descriptive statistics, Chi square test and Student t test for comparison of the two groups was performed. Results: In each group 17 patients were included. An improvement was found in the disease activity (52.9% vs. 23.5%, p = 0.07) and in histologic index (82.3% vs. 41.1%, p = 0.03) in patients treated with probiotics compared to the control group. Improved food tolerance was also observed in patients treated with probiotics. Conclusion: The study shows a beneficial short-term effect on symptoms, histological findings and feeding tolerance with the administration of a combination of 6 strains of probiotics in patients with UC.

Introducción: los probióticos han sido utilizados en el tratamiento adyuvante de la colitis ulcerativa (CU). Objetivo: evaluar el papel de una combinación de probióticos sobre las manifestaciones clínicas, cambios histológicos y tolerancia alimentaria en pacientes con CU. Métodos: se realizó un ensayo clínico abierto de pacientes con CU y actividad leve a moderada. Los pacientes se aleatorizaron para recibir, o no, una combinación de 6 cepas de probióticos durante 3 meses, mientras continuaban con el tratamiento farmacológico establecido. Se evaluó la actividad de la CU mediante la escala de Truelove and Witts, y los hallazgos histológicos mediante el índice de Gupta. Se realizó estadística descriptiva, prueba de Chi cuadrada y t de Student para la comparación de ambos grupos. Resultados: se incluyeron 17 pacientes por grupo. Se encontró una mejoría en la actividad de la enfermedad (52.9% frente a 23.5%, p = 0.07) y en el índice histológico (82.3% frente a 41.1%, p = 0.03) en los pacientes tratados con probióticos en comparación con el grupo control. También se observó una mejor tolerancia alimentaria en los pacientes tratados con probióticos. Conclusión: el estudio muestra un efecto benéfico a corto plazo sobre los síntomas, hallazgos histológicos y tolerancia alimentaria con la administración de una combinación de 6 cepas de probióticos en pacientes con CU.

Splenectomy in systemic lupus erythematosus and autoimmune hematologic disease: a comparative analysis.

The objective of the study is to analyze the efficacy and safety of splenectomy in the management of refractory autoimmune thrombocytopenia (AT)/autoimmune hemolytic anemia (AIHA) associated or not with systemic lupus erythematosus. Thirty-four patients after splenectomy due to severe AT and/or AIHA were divided into group 1 (G1) 18 SLE/APS patients: 9 AT/SLE patients, 6 SLE/antiphospholipid syndrome (APS), and 3 primary APS. Group 2 (G2): 16 patients without SLE/APS: 2 Fisher-Evans syndrome and 14 AIHA. Surgery approach when (1) platelets ≤ 50,000/ml despite 2 weeks on medical therapy, (2) medically dependent, and (3) medically intolerant or after two hemolytic crises in AIHA patients. Splenectomy response: (1) complete (CR): ≥ 150,000 platelets/ml, (2) partial: 50,000-149,000/ml, or (3) none: ≤ 50,000/ml. CR for AIHA: hemoglobin ≥9 g/dl. STATISTICAL ANALYSIS: descriptive statistics and chi-square test. The mean age was 34.6 years; mean follow-up: 28.5 months. Open splenectomy in 15/34 vs laparoscopy in 19/34 (p = NS). CR in 15/34, G1: 4/18, G2: 11/16, (p = 0.006). Complications in 6/34, 5 from G2 vs 1 from G1 (p = 0.05). Relapse in 7/18 patients in G1 and 3/16 in G2 (p = 0.05). Open and laparoscopic splenectomies in SLE and AT patients are as effective as in those without SLE; however, patients with SLE and APS had more relapses.

[Molecular analysis of microdeletions of the Y chromosome in Venezuelan males with idiopathic infertility]. / Frecuencia de microdeleciones del cromosoma Y en hombres venezolanos con infertilidad idiopática.

Today infertility is a major health problem affecting about 10-20% of couples. A male factor is assumed to be responsible in about 50% of the infertile couples. The origin of reduced testicular sperm function is unknown in about 60-70% of cases. There are several causes of male infertility such as varicocele, spermatic duct obstruction, and endocrine disorders. Micro-deletions in the Yq are known to represent the pathogenic mechanisms for infertile males. Three different non-overlapping regions designated as AZFa, AZFb, and AZFc are located in interval 5-6 of Yq, and are associated with impaired spermatogenesis in humans. To determine the prevalence of Y chromosomal microdeletions in Venezuelan males with idiopathic infertility, chromosomal, seminal, histological and molecular analyses were carried out in 29 Venezuelan males with idiopathic azoospermia or oligoospermia. Y-microdeletions analyses were performed using a multiplex polymerase chain reaction (PCR)-based technique with 22 sequences-tagged-sites (STSs). One of 29 patients (3.4%) had Yq microdeletions on AZFc. The frequency of AZF microdeletions in Venezuelan patients was similar to other populations with different ethnical or geographical origin.

[Profile of maxillofacial trauma in bicycle accidents]. / Perfil del trauma maxilofacial en accidentes de bicicleta.

OBJECTIVE: To determine the maxillofacial trauma profile, concomitant results and treatment of those persons injured in bicycle accidents. Several variables were identified such as age, sex, mechanism, place, month, injury patterns and symptomatology, time for receiving medical care, and treatments. MATERIAL AND METHODS: This was an exploratory, descriptive, analytic, and retrospective study. All patients with maxillofacial trauma injury as a result of bicycle accidents were admitted to the emergency service in 2002 in the traumatology hospital Victorio de la Fuente Narváez, Mexican Institute of Social Security that covers the entire Federal District zone and some suburbs, without any distinction made as to injury specialty. RESULTS: Patients (127) with maxillofacial trauma from bicycle accidents were identified. Children aged 6 to 10 years were the most affected. There was more injury in soft tissue in the midfacial area, such as contusions, injuries dermabrasion and some fractures resulting in nose trauma. Most of the accidents happened in the streets by falling from the bicycles. Forty six persons had more than two maxillofacial injuries. Head trauma with cervically projected sprain was demonstrated as associated trauma. More than 50% of the patients received immediate treatment under local anesthesia by maxillofacial surgery or orthopedics and traumatology during the afternoon and night. CONCLUSIONS: Prevention programs for parents and children in homes, schools and medical care facilities should be established to encourage traffic education and the use of protective headgear.

[Depression, anxiety and suicide risk symptoms among medical residents over an academic year]. / Síntomas de depresión, ansiedad y riesgo de suicidio en médicos residentes durante un año académico.

BACKGROUND: One of the causes of dissatisfaction among residents is related to burnout syndrome, stress and depression. The aim of this study is to describe the prevalence of depression, anxiety and suicide risk symptoms and its correlation with mental disorders among medical residents over an academic year. METHODS: 108 medical residents registered to second year of medical residence answered the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Suicide Risk Scale of Plutchik: at the entry, six months later and at the end of the academic year. RESULTS: Residents reported low depressive symptoms (3.7 %), low anxiety symptoms (38 %) and 1.9 % of suicide risk at the beginning of the academic year, which increased in second measurement to 22.2 % for depression, 56.5 % for anxiety and 7.4 % for suicide risk. The statistical analysis showed significant differences between the three measurements (p < 0.001). The prevalence of depressive disorder was 4.6 % and no anxiety disorder was diagnosed. Almost all of the residents with depressive disorder had personal history of depression. None reported the work or academic environment as a trigger of the disorder. There was no association by specialty, sex or civil status. CONCLUSIONS: The residents that are susceptible to depression must be detected in order to receive timely attention if they develop depressive disorder.

Introducción: uno de los orígenes de la insatisfacción de los médicos residentes está relacionado con el síndrome de burnout, el estrés y la depresión. El objetivo es describir la prevalencia y las características clínicas de los síntomas de depresión, ansiedad y riesgo de suicidio y su correlación con trastorno mental en residentes de medicina a lo largo de un año académico. Métodos: se incluyeron 108 residentes de segundo año que respondieron el inventario de depresión de Beck, el inventario de ansiedad rasgo-estado y la escala de riesgo suicida de Plutchik al inicio del ciclo académico, así como seis y doce meses después. Resultados: en la primera medición se reportó una prevalencia de 3.7 % para síntomas de depresión, 38 % para síntomas de ansiedad y 1.9 % para riesgo de suicidio; a los seis meses la prevalencia aumentó a 22.2 % para depresión, 56.5 % para ansiedad y 7.4 % para riesgo de suicidio. El análisis estadístico mostró diferencias significativas entre las tres mediciones (p < 0.001). La prevalencia de trastorno depresivo fue de 4.6 %. Casi todos los residentes que desarrollaron trastorno depresivo tenían antecedente personal de depresión. El ambiente académico y laboral tuvo poca asociación con los trastornos. Conclusiones: es recomendable la detección de residentes con vulnerabilidad a la depresión con el objeto de que reciban atención oportuna en caso de que desarrollen trastorno depresivo.

[Frequency, clinical evolution and prognosis of toxic megacolon]. / Frecuencia, evolución clínica y pronóstico del megacolon tóxico.

INTRODUCTION: Toxic megacolon (MT) is a potentially lethal complication of inflammatory, ischemic and infectious colitis. Usually it is related to ulcerative nonspecific colitis or Crohn disease. Recently it has been observed an increased in pseudomembranous colitis as cause of TM. The aim of this study is to describe the frequency, clinical evolution and prognosis of patients with TM. METHODS: Retrospective study, from January 2009 to January 2014 1500 patients were hospitalized in the Department of Coloproctology. We included 13 of 1500 patients with diagnosis of TM according to Jalan criteria and surgically corroborated. To determine the averages descriptive statistics was used. RESULTS: We studied 13 patients with TM (79.9% male and 20.1% female), the average age was 47.69±18.3 years. The most frequently associated diseases were: nonspecific ulcerative colitis (30.8%), pseudomembranous colitis (30.8%), neutropenic colitis (23.1%), Crohn Disease (7.7%) and ischemic colitis (7.7%). Subtotal colectomy plus terminal ileostomy was done in 84.6%, extended right hemicolectomy with ileostomy plus mucous fistula in 7.7% and extended right hemicolectomy with ileostomy plus Hartmann pouch in 7.7%. The mortality was 61.5%. The prevalence in the 5 years was 13 of 1500 (0.86%) patients. CONCLUSIONS: The prevalence of TM is low with a high mortality. A prompt diagnosis and treatment can improve the poor prognosis in these patients.

Introducción: el megacolon tóxico (MT) es una complicación potencialmente mortal de la colitis infl amatoria, isquémica e infecciosa. Usualmente se relaciona con la colitis ulcerosa inespecífica y la colitis de Crohn. Recientemente, se ha observado un repunte de la colitis pseudomembranosa como causa del MT. El objetivo fue describir la frecuencia, evolución clínica y pronóstico de los pacientes con MT.Métodos: estudio retrospectivo de enero de 2009 a enero de 2014 se hospitalizaron 1500 pacientes en el departamento de Coloproctología. De estos pacientes, se incluyeron a 13 de ellos con diagnóstico de MT de acuerdo a los criterios de Jalan y corroborados por cirugía. Se utilizó estadística descriptiva.Resultados: se estudiaron 13 pacientes con MT. Las enfermedades más frecuentemente asociadas al MT fueron: colitis ulcerosa inespecífica, colitis pseudomembranosa y colitis neutropénica, enfermedad de Crohn y colitis isquémica. En el 84.6 % se realizó colectomía subtotal más ileostomía terminal; hemicolectomía derecha extendida con ileostomía más fístula mucosa en el 7.7 %, y hemicolectomía derecha extendida con ileostomía más bolsa de Hartmann en el 7.7 %. La mortalidad fue del 61.5 %. La prevalencia en los 5 años fue de 13/1500 pacientes (0.86 %).Conclusiones: la prevalencia del MT es baja, con alta mortalidad. El diagnóstico y tratamiento oportunos puede mejorar el mal pronóstico de estos pacientes.

[Duodenogastroesophageal reflux- and esophagitis-induced disease]. / Enfermedad por reflujo duodenogastroesofágico y esofagitis.

OBJECTIVE: Our objective was to determine the relationship between reflux of duodenogastric contents with different degrees of esophagitis, and its levels and activity, with regard to the severity of esophagitis-induced duodenogastroesophageal reflux disease (DGERD). MATERIAL AND METHODS: Our study design was prospective, transversal, descriptive, observational, and open. We took samples of gastric and esophageal juices from patients with a diagnosis of gastroesophageal reflux disease (GERD) and esophagitis during the period from March to August 2002. Sample material was placed in black rubber-covered assay tubes to prevent bilirubin degradation. In our Unit's central laboratory, these samples were centrifuged for 30 min, the dissolved material separated, and a reactive strip was introduced to measure the amount of bile pigment. Endoscopic study reports were provided by this Department on terminating the procedure. Univariate analysis was used to obtain results. RESULTS: In 60% of cases, the esophageal liquid was positive for total bilirubin; 40% presented stage II esophagitis, 27% chronic esophagitis, and 27%, stage I esophagitis. Specific quantifications of total bilirubin at different stages of esophagitis demonstrated in stage II 50% with levels of 0.1-1, 33% with a level of 2-3, in cases of chronic esophagitis 75% with levels of 0.1-1, and with stage I esophagitis, 25% with levels of 2-3 mg/dl. Measurement of gastric pH showed 18 (69%) <3 and esophageal pH of 20 (67%) > 4, with 10 (33%) referring occasional or asymptomatic dyspepsia. We determined presence of duodenal elements in esophagus by means of quantification of total bilirubin in 60% of patients, observing greatest frequency of stage II esophagitis. Low but continuous levels of duodenal, principally biliary, elements continued in patients with DGERD, producing greatest damage in esophageal mucosa.

[Preliminary report. Usefulness of computed tomographic angiography in the protocol of a kidney donor]. / Reporte preliminar. Utilidad de la angiotomografía renal en el protocolo del donador renal.

OBJECTIVE: To determine clinical correlation of reports of computed tomographic angiography renal (CT-AR) and surgical findings of the kidney donor patient. MATERIAL AND METHODS: Patients were submitted nephrectomy in the related live donor renal transplant program between January and December 2002 as paut of life to which he is made as he CT-AR study protocol. Statistical analysis was carried out by descriptive statistics. RESULTS: Anatomical characteristics of 35 kidneys of the same number of live donors (AD) submitted CT-AR were evaluated and comparison with report of surgical technique was made. Incidence of accessory renal arteries was 23%. As reported by CT-AR, the were 39 renal arteries (91%) compared with 43 arteries found during surgery. CT-AR identified four supernumerary renal arteries (50%) of eight identified during surgical technique; 36 hiliar arteries (90%) and three polar arteries were identified by CT-AR (100%). Only one a case report of early bifurcation of renal artery (20%) by CT-AR was recorded. Anatomical characteristics of veins were described in their totality. CT-AR is a useful instrument to identify alterations in anatomical structure of the renal vasculature, with results similar to other studies for description of renal arteries and veins. We propose ATR as the initial study for evaluation of the renal architecture of the live kidney (LKD).

Occupational exposure to organophosphate and carbamate pesticides affects sperm chromatin integrity and reproductive hormone levels among Venezuelan farm workers.

OBJECTIVES: Several reports suggest that chronic pesticide exposure may affect semen quality and male fertility in humans. The objective of this study was to evaluate the association between occupational exposure to organophosphate (OP) and carbamate (CB) pesticides and semen quality, as well as levels of reproductive and thyroid hormones of Venezuelan farm workers. METHODS: Thirty-five healthy men (unexposed group) and 64 male agricultural workers (exposed group) were recruited for clinical evaluation of fertility status. Fresh semen samples were evaluated for sperm quality and analyzed for DNA fragmentation index (DFI) by flow cytometry. Pesticide exposure was assessed by measuring erythrocyte acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE) with a Test-mate ChE field kit. Serum levels of total testosterone (Tt), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), thyroid stimulating hormone (TSH) and free thyroxine (FT4) were analyzed using enzyme immunoassay kits. RESULTS: Evidence of pesticide exposure was found in 87.5% of farmers based on AChE and BuChE inhibition. Significant increments were observed in sperm DFI with significant decreases in some semen parameters. DFI was negatively correlated with BuChE, sperm concentration, morphology and vitality in these workers. The levels of Tt, PRL, FT4 and TSH appeared to be normal; however, there was a tendency for increased LH and FSH levels in exposed workers. CONCLUSIONS: Our results confirm the potential impact of chronic occupational exposure to OP/CB pesticides on male reproductive function, which may cause damage to sperm chromatin, decrease semen quality and produce alterations in reproductive hormones, leading to adverse reproductive health outcomes.

[Surgical complications of gallbladder and the biliary tree in the elderly patients]. / Complicaciones quirúrgicas de la vesícula y la vía biliar en el paciente geriátrico.

BACKGROUND: the morbidity and mortality in surgery of gallbladder and biliary tract (SGBT) in the geriatric patient define the prognostic. The aim was to describe the perioperative and immediate post-operative complications of the geriatric patient undergoing SGBT. METHODS: A cross-sectional study with control group in patients older than 60 years was done. The patients were divided into two groups by age (I: 60-69 years and II: > 70 years). The variables analyzed were morbidity, anesthetic risk, type of surgery, perioperative and post-operative complications, conversion rate and length of hospital stay. RESULTS: a total of 236 patients were included: 65.2 % were females with a mean age 68.5 years. Chronic cholelithiasis accounted for 83 % and laparoscopic cholecystectomy was the procedure most commonly performed (72.8 %). Surgery was scheduled in 92 % cases and urgently in 8 %. In both groups, ASA rank was I-II in 76.2 % vs. 70.1 %; the conversion rate was 2.5 %. Complications were 13.5 %, of which 9.3 % were postoperative and 4.2 % of perioperative. Complications were higher in emergency surgery than elective surgery (36.8 % vs. 11.8 %). The average hospital stay was 4.2 days and there was no mortality. CONCLUSIONS: the age does not represent an increase in complications. The laparoscopic cholecystectomy is safe and applicable in elderly. Complications presented were related to the urgent nature of the surgery.

Introducción: en el anciano, la morbilidad posoperatoria en la cirugía de vesícula y vía biliar se relaciona con el pronóstico. Se describen las complicaciones trans y posoperatorias en el anciano sometido a esa cirugía. Métodos: estudio transversal descriptivo en pacientes mayores de 60 años. Se integraron dos grupos: I, pacientes de 60 a 69 años; II, mayores de 70 años. Se registraron comorbilidad, riesgo quirúrgico, tipo de cirugía, complicaciones trans y posoperatorias inmediatas, conversión y estancia hospitalaria. Resultados: se incluyeron 236 pacientes (65.2 % mujeres) con edad media de 68.5 años. La colecistitis crónica litiásica representó 83 % y la colecistectomía laparoscópica se utilizó en 72.8 %. La cirugía fue programada en 92 %. Se identificó ASA I-II en 76.2 y 70.1 % de los grupos I y II, respectivamente; la conversión fue de 2.5 %. Hubo complicaciones en 13.5 % (9.3 % en el posoperatorio y 4.2 % en el transoperatorio) y su proporción fue mayor en las cirugías urgentes (36.8 %) que en las programadas (11.8 %). La estancia hospitalaria fue de 4.2 días. No hubo mortalidad. Conclusiones: las complicaciones no se incrementaron con la edad pero sí con la urgencia de la cirugía. La colecistectomía laparoscópica es segura en geriatría.

Programa de prevención del suicidio, tratamiento de trastornos mentales y promoción de la salud mental para médicos residentes / Program for suicidal prevention, mental disorder treatment, and mental health development for resident doctors

La elevada demanda asistencial aunada a la carga académica de los cursos de especialización en medicina afecta la salud mental de los médicos residentes produciendo manifestaciones que van desde el simple malestar emocional hasta el desarrollo de trastornos afectivos en personas predispuestas. El suicidio de médicos ha generado programas para su atención en algunos países. Presentamos la primera clínica de salud mental para médicos residentes de un hospital de alta especialidad en México, centrada en la prevención del suicidio y depresión, tratamiento de trastornos mentales y promoción de la salud mental. A diferencia de los reportes de baja tasa de respuesta en otros países, hemos conseguido una participación mayor al 95%, proporcionamos tratamiento oportuno y seguimiento a los residentes identificados con trastorno mental, y no se han presentado suicidios consumados. Suponemos que la utilización de diferentes estrategias (escrutinio, adaptación de modelos de prevención del suicidio como entrenamiento por pares y entrenamiento gatekeeper, sesiones informativas de desestigmatización y promoción de la salud mental, intervenciones dirigidas a individuos y grupos con conflictos) ha sido de utilidad contra las barreras que impiden que los médicos identifiquen los signos de alarma de riesgo de suicidio, busquen ayuda por la presencia de trastorno mental y procuren mejorar su salud mental

High demand of care and the academic burden of courses of specialization in medicine affect the mental health of medical residents with events ranging from simple emotional discomfort to development of affective disorders in susceptible individuals. The suicide of physicians has produced programs for their attention in some countries. We present the fi rst mental health clinic for residents of a high specialty hospital in Mexico, focused on the prevention of suicide and depression, treatment of mental disorders and mental health promotion. Unlike the reports of other countries, we get participation of more than 95%, we provide appropriate treatment and follow-up to residents with mental disorder, and there has not been a consummate suicide. We assume that the use of different strategies (scrutiny, adapting models of prevention of suicide as a peer and gatekeeper training, informative sessions of mental health promotion and stigma, interventions targeted at individuals and groups with confl icts) has been useful against barriers that do not allow doctors to identify the risk of suicide warning signs, seek help for mental disorder, and seek to improve their mental health.