Torsion of the omentum. A rare cause of acute abdomen.

OBJECTIVE: To describe the clinical aspects, treatment and evolution of acute abdomen caused by torsion of the greater omentum. METHODS: Retrospective analysis study consisted of a group of eleven patients with acute abdomen caused by torsion of the greater omentum. The variables included were age, sex, body mass index (BMI), clinical picture, evolution time, laboratory tests, radiology and treatment. Descriptive statistical analysis was employed. RESULTS: Seven (63.6%) women and four (36.36%) men; mean age 33 (20 to 58) years; BMI > 25.0 in nine (81.81%); average evolution 6.54, SD 3.47 days. All presented abdominal pain, six (54.5%) abdominal distension, four (36.3%) walking difficulty, three (27.27%) general malaise, ten (90.9%) slight leucocytosis, five (45.4%) previous surgery. In all cases diagnosis was made by laparotomy, treatment was resection of the affected segment, and no complications were seen. CONCLUSIONS: Segmental torsion of the greater omentum is a rare cause of acute abdomen. Pain is the most frequent symptom, and the condition resembles acute appendicitis. It is often discovered during surgery and is treated by the removal of the affected omentum segment.

[Impact of participative education strategy compared with a traditional education in the control of patients with type 2 diabetes]. / Control de pacientes con diabetes. Impacto de la educación participativa versus educación tradicional.

OBJECTIVE: To compare the impact of participative education (PE) and traditional education (TE) in the knowledge about diabetes, adherence to treatment, quality of life and control of the illness of patients with type 2 diabetes mellitus (DM2). METHODS: 202 patients with DM2 (both sexes from 20 to 60 years of age) were randomly assigned to groups, the TE or control group, and the PE or expe-rimental group. The group control attended to a monthly meeting in four occasions and the experimental group to six meetings during a week. Both groups were evaluated before and after the intervention, using two instruments; one that evaluates knowledge about diabetes and adherence to treatment, and another for the quality of life and control of the illness with the average of the last four plasmatic glucose levels. The results were analyzed with Student t. RESULTS: The baseline status of both groups was similar. Grades based on knowledge of the illness at the end of the intervention were 4.05 points higher (p = 0.0001) with PE and 0.09 points higher (p = 0.78) with TE. For adherence to treatment there was an increase of 0.71 (p < 0.0001) with PE, and a decrease of 0.39 (p = 0.50) with TE. As to quality of life, the PE group showed an increase of 10.5 (p = 0.0001), and a decrease of 2.93 (p = 0.002) the TE group. Average serum glucose levels were reduced 46.5 mg/dL (p = 0.0001) after PE and 16.68 mg/dL (p = 0.018) after TE. CONCLUSIONS: The PE intervention is superior to TE for improving knowledge, adherence to treatment and control of the illness in patients with DM2.

[Factors related to subjective evaluation of quality of life of diabetic patients]. / Factores relacionados con la percepción subjetiva de la calidad de vida de pacientes con diabetes.

OBJECTIVE: To determine the relationship between some clinical and psychosocial factors and the quality of life of a group of diabetic patients. METHOD: A cross sectional study was done with diabetic patients attending a primary care unit. Quality of life was evaluated with a verbal global scale. The clinical and psychosocial factors studied were: type of diabetes, duration of the disease, type of treatment, associated diseases, complications, metabolic control (glycosylated hemoglobin), treatment compliance, coping styles, negative attitude to disease, social support, and socioeconomical level. RESULTS: We interviewed 173 patients, most women (739%), most type 2 (95%). We found that being a woman was a factor negatively related to quality of life. Of clinical variables, only duration of disease was slightly correlated with quality of life (-0.14). Psychological and social variables were significantly correlated with quality of life. We performed a stepwise multiple regression analysis and we found that seven psychosocial variables explained 30% of variance of quality of life. CONCLUSIONS: Our results indicate that clinical factors did not correlate with quality of life. It is the way the patient lives with diabetes and not the diabetes by itself what affects the quality of life of diabetic patients. Some psychological and social variables were significantly related to quality of life of these patients.

Experiencia a 12 años en el manejo antitrombótico de la ectasia coronaria en el Instituto Nacional de Cardiología Ignacio Chávez de México / A 12-year experience with antithrombotic management of patients with coronary ectasia at the Cardiological Institute "I. Chavez" from Mexco

Introducción: No hay lineamientos establecidos acerca del correcto anejo antitrombótico de pacientes con ectasia coronaria. Objetivos: Describir el manejo de pacientes con ectasia coronaria durante 12 años en el Instituto Nacional de Cardiología en la Ciudad de México, México. Métodos: Estudio retrospectivo, observacional. Se analizó una base de datos de 484 pacientes ingresados con síndrome coronario agudo, diagnosticado por angiografía de ectasia coronaria. Se obtuvo la clasificación de Markis y el anejo de los pacientes al alta, así como el seguimiento durante 12 años. La estadística fue descriptiva. Resultados: 14.6% de los pacientes recibieron monoterapia, el mas común fue el ácido acetil salicílico en el 7,8% seguido de acenocumarina en el 4.8% de los pacientes; el 25% fueron manejados con acenocumarina y ácido acetil salícíco más clopidogrel, 5,8% con terapia triple. La más común fue acenocumarina, acido acetil salicílico y clopidogrel en el 5%. conclusión: Solo hay recomendaciones con nivel de evidencia C. El tratamiento al alta de los pacientes con ectasia coronaria conel Instituto Nacional de Cardiología Ignacio Chávez es heterogénico y no está bien estandarizado, es necesario revisar las Guías de Práctica Clínica para estandarizarlo

Introduction: There are no established guidelines about the correct antibrombotic management of patients with coronary ectasia. Objectives: To describe the management of patients with coronary ectasia in a lapse of time of 12 years at the "Instituto Nacional de Cardiología Ignacio Chávez" Mexico. Methods: Observational retrospective study. We analyzed a database of 484 patients admitted to the INCICh diagnosed with coronary acute syndrome and angiographic diagnosis of coronary ectasia. We obtained information about the Markis classification and the treatment at the hospital discharge in a period of time of 12 years. Descriptive statistic was used. Results: 14.6% received monotherapy, the most common was aspirin in 7.8%, followed by acenocoumarin in 4.8% of patients. 25% of the total patients received acenocoumarin , aspirin and clopidogrel in 5%. Conclusions: There are only recommendations about the coronary artery disease treatment with a C level of evidence. The treatment in the Instituto Nacional de Cardiología Ignacio Chavez is heterogneous and is not well standardized

Etapas de cambio para el ejercicio: estudio transversal en población de 20 a 59 años de edad / Step by step for exercising: transversal study in a 20 to 59 years population

Introducción: El ejercicio físico como conducta promotora de salud contribuye a mantenerla y prevenir enfermedades crónicas, sin embargo, la práctica de ejercicio en adultos es insuficiente. Objetivo: conocer las etapas de cambio de la conducta de ejercicio y su relación con la autoeficacia en adultos sanos de 20 a 59 años de edad. Métodología: Estudio transversal; la muestra la constituyeron 200 adultos sanos; con un muestreo no probabilístico. Para la medición se utilizaron el Cuestionario de Etapas de Cambio de Ejercicio Forma Corta y la Escala Autoeficacia de Ejercicio; los datos se analizaron con el estadístico ANOVA de una vía, se determinó la existencia de diferencias estadísticamente significativas, y se utilizó la prueba de Tuckey como prueba post hoc. Resultados: los hombres mostraron mayor autoeficacia y se ubicaron en etapas de ejercicio en comparación con las mujeres (p < 0.05); 64.5 % de los adultos sanos se ubicaron en las etapas de contemplación y preparación. Existen diferencias significativas de auto eficacia por etapas de cambio [F (3,196) = 28.850, p < 0.001]; la prueba post hoc de Tuckey mostró que a medida que las etapas de cambio avanzan el nivel de auto eficacia es mayor. Conclusiones: este estudio permitió verificar parcialmente el modelo transteórico en una muestra de adultos sanos de la ciudad de Puebla, México; ya que la creencia de poder llevar a cabo una conducta (autoeficacia) determina el cambio hacia comportamientos saludables mantenidos a largo plazo.

Background: physical exercise as an encouraging health conduct, contribute to maintain and prevent chronic diseases, however, the practice of exercising by adults ¡s insufficient. Objective: to know the steps of change of the conduct regarding exercise and is related with self-efficacy in healthy adults from 20 to 59 years. Methodology: transversal study; the sample was 200 healthy adults; with a non-probabilistic sampling. The Questionnaire of Phases of Change for exercising, short form and the Scale of Self-efficacy of exercising were utilized; the data were analyzed with ANOVA of one via; and the Tuckey's test was used as a post hoc test. Results: men showed greater self-efficacy and were placed ¡n phases of exercise compared with women (p < 0.05); 64.5 % of healthy adults were placed in the phases of contemplation and preparation. There are significant differences of self-efficacy for phases of change [F(3,196) = 28.850, p < 0.001]; the Tuckey's test showed that as long as the phases of change improve, the level of self-efficacy ¡s greater. Conclusions: this study verified the trans-theoretical model in a sample of healthy adults since the belief of carrying out a conduct (self-efficacy) determines a change throughout healthy behaviors that are maintained for a long term.

Factores relacionados con la percepción subjetiva de la calidad de vida de pacientes con diabetes / Factors related to subjective evaluation of quality of life of diabetic patients

Objective. To determine the relationship between some clinical and psychosocial factors and the quality of life of a group of diabetic patients. Method. A cross sectional study was done with diabetic patients attending a primary care unit. Quality of life was evaluated with a verbal global scale. The clinical and psychosocial factors studied were: type of diabetes, duration of the disease, type of treatment, associated diseases, complications, metabolic control (glycosylated hemoglobin), treatment compliance, coping styles, negative attitude to disease, social support, and socioeconómica! level. Results. We interviewed 173 patients, most women (73%), most type 2 (95%). We found that being a woman was a factor negatively related to quality of life. Of clinical variables, only duration of disease was slightly correlated with quality of life (-0.14). Psychological and social variables were significantly correlated with quality of life. We performed a stepwise multiple regression analysis and we found that seven psychosocial variables explained 30% of variance of quality of life. Conclusions. Our results indicate that clinical factors did not correlate with quality of life. It is the way the patient lives with diabetes and not the diabetes by itself what affects the quality of life of diabetic patients. Some psychological and social variables were significantly related to quality of life of these patients.

Objetivo. Determinar la relación de algunos factores clínicos y psicosociales con la percepción global de la calidad de vida de pacientes con diabetes. Material y métodos. Se realizó un escrutinio transversal, de pacientes con diabetes en una clínica de medicina familiar del Seguro Social. La calidad de vida se evaluó con una escala global verbal. Se evaluaron las siguientes variables clínicas: tipo de diabetes, tiempo de evolución, tipo de tratamiento, enfermedades asociadas, complicaciones y el control metabólico. Las variables psicosociales estudiadas fueron: el conocimiento de la enfermedad, el apego al tratamiento, las formas de contender con la enfermedad, el impacto emocional producido por la misma y el apoyo social. Los pacientes fueron entrevistados con instrumentos previamente validados. Se determinó la hemoglobina glucosilada. Resultados. Fueron entrevistados 173 pacientes (73% mujeres), con un promedio de edad de 50.5 años para las mujeres y 51.5 para los hombres. La mayoría (95%) tenía diabetes tipo 2. Se determinó la relación entre las variables estudiadas y la calidad de vida. En el análisis bivariado se encontró que las mujeres tenían significativamente una menor calidad de vida (62.8 vs. 69.5). De los factores sociales, el nivel socioeconómico, el apoyo social y tener una pareja, correlacionaron positivamente con la calidad de vida. De los factores psicológicos, las formas de contención (evitación y resignación), el rechazo a la enfermedad y el impacto emocional correlacionaron negativamente con la calidad de vida. De las variables clínicas, sólo el tiempo de evolución tuvo una correlación discreta (r = - 0.14). En el análisis multivariado, siete variables psicosociales explicaron 30% de la varianza en la calidad de vida. Conclusiones. Nuestros resultados indican que aparentemente los factores clínicos influyen poco sobre la calidad de vida. Consideramos que la calidad de vida, medida de forma global, subjetiva, depende en un gran porcentaje de la forma en la que los pacientes viven la enfermedad más que de las características de la misma.