Twenty-year trends in all-cause mortality of patients with systemic lupus erythematosus in Mexico: Results from a nationwide health registry.

OBJECTIVE: Regional variations in systemic lupus erythematosus (SLE) mortality may be due to different spectra of local environmental factors. The aim of this study was to assess mortality trends in adults with SLE using a nationwide health registry. METHODS: Data came from the Dynamic Cubes of the General Direction of Health Information for 1998-2017 for mortality. In patients aged ≥15 years, SLE as the principal cause of death was defined according to ICD-10 code M32 and was classified by sex and age. Joinpoint trend analyses of annual age-standardized mortality rates (ASMR) for SLE patients and non-SLE people were made. RESULTS: We identified 11 449 SLE deaths and 9,989,874 non-SLE deaths. The SLE ASMR increased more than the non-SLE ASMR, with a 98.2% cumulative increase in the ratio of SLE to non-SLE deaths. Whereas the non-SLE ASMR remained relatively stable throughout the study period (overall and by sex), the SLE ASMR significantly increased between 1998 and 2009, non-significantly decreased between 2009 and 2013 and non-significantly increased thereafter. Both women and men had a large cumulative increase in the SLE ASMR/non-SLE ASMR ratio (73.9 and 191.3%, respectively). The Southeast region had the largest cumulative increases in the ratio of SLE to non-SLE ASMR (108.8%). Of the 11,449 deaths, 445 (3.8%) were in geographical areas where ≥40% of the population is indigenous. CONCLUSION: SLE mortality rates have increased since 1998 and remain high compared with non-SLE mortality: significant sex and regional disparities persist.

Self-image, self-esteem and depression in children and adolescents with and without obesity.

INTRODUCTION: In Mexico, the prevalence of childhood obesity is 35%, and it continues to increase. OBJECTIVE: To determine the correlation between self-image, self-esteem and depression in children aged 8 to 14 years with and without obesity. METHODS: Cross-sectional, comparative study of 295 children: 116 with overweight/obesity (group 1) and 179 with normal weight (group 2). Body mass index, scholarship, school achievement, school problems, socioeconomic status, self-image (current, desired), satisfaction, self-esteem and presence of depression were recorded. Descriptive statistics, Spearman's rho and Mann-Whitney's U-test were used; a p-value ≤ 0.05 was considered significant. RESULTS: In group 1, 53.4% perceived themselves as with normal weight, and in 77.6%, the desired self-image was normal weight; 67.2% wanted to be slimmer; in 53.4%, self-esteem was high, and 75.9% had no depression. In group 2, current self-image was normal weight in 79.3%, and the desired self-image was normal weight in 85.5%; 35.2% wanted to be slimmer; self-esteem was high in 49.7% and 77.1% had no depression. Significant correlations were observed for self-esteem-depression (r = 0.228) and self-esteem-socioeconomic status (r = 0.130). CONCLUSIONS: Current self-image and body satisfaction are different with and without obesity. The relationship between self-esteem and depressive symptoms begins at school age.

INTRODUCCIÓN: La obesidad infantil es un problema de salud pública mundial. En México, la prevalencia es de 35 % y continúa ascendiendo. OBJETIVO: Determinar la correlación entre autoimagen, autoestima y depresión en niños de ocho a 14 años con y sin obesidad. MÉTODOS: Estudio transversal comparativo de 295 niños: 116 niños con sobrepeso u obesidad (grupo 1) y 179 sin obesidad (grupo 2). Se registró índice de masa corporal, escolaridad, aprovechamiento escolar, conflictos escolares, nivel socioeconómico, autoimagen (actual, deseada), satisfacción, autoestima y presencia de depresión. Se utilizó estadística descriptiva, rho de Spearman y U de Mann-Whitney; p ≤ 0.05 se consideró significativa. RESULTADOS: En el grupo 1, 53.4 % de los niños se autopercibió con normopeso y en 77.6 % la autoimagen deseada era normopeso; 67.2 % deseaba ser más delgado; en 53.4 % la autoestima era elevada; 75.9 % se observó sin depresión. En el grupo 2, en 79.3 % la autoimagen actual era normopeso y la autoimagen deseada en 85.5 % fue normopeso; 35.2 % deseaba ser más delgado; la autoestima era elevada en 49.7 % y 77.1 % no presentaba depresión. Se identificaron correlaciones significativas en autoestima-depresión (r = 0.228) y autoestima-nivel socioeconómico (r = 0.130). CONCLUSIONES: La autoimagen actual y la satisfacción corporal son diferentes en niños y adolescentes con y sin obesidad. La relación de la autoestima y síntomas depresivos inicia desde la edad escolar.

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.

Validity and consistency of an outpatient department user satisfaction rapid scale.

BACKGROUND: User satisfaction is key to define and assess the quality of care; however, there is no patient satisfaction rapid scale in Mexico. Our objective was to determine the validity and consistency of an outpatient department user satisfaction rapid scale (ERSaPaCE). METHOD: Comparative, observational, cross-sectional, prolective study. In phase 1, a rapid scale model was developed, which was submitted to experts in medical care for assessment; the instrument was pilot-tested in 10-patient groups, using as many rounds as required until it obtained 20 approvals. In phase 2, the resulting questionnaire and the Outpatient Service User Satisfaction (SUCE) scale were applied to outpatient department users. ERSaPaCE was reapplied by telephone 10 days later. Descriptive statistics, Cronbach's a, Spearman's correlation and intra-class correlation coefficient (ICC) were used. RESULTS: Two-hundred patients were recruited, out of which 53 % were aged 31-60 years; 51.5 % were women and 48.5 % men, all of them users of the outpatient services from 13 specialties. Cronbach's a for ERSaPaCE was 0.608, whereas ICC was 0.98 (p = 0.000). Convergent validity was 0.681 (p = 0.000) using Spearman's rho. CONCLUSION: ERSaPaCE was a valid and consistent instrument for the assessment of outpatient department user satisfaction.

ANTECEDENTES: La satisfacción del usuario es clave para definir y valorar la calidad de la atención, sin embargo, no existe una escala rápida de satisfacción del paciente en México. El objetivo fue determinar la validez y consistencia de la Escala Rápida de Satisfacción del Paciente de Consulta Externa (ERSaPaCE). MÉTODO: Estudio comparativo, observacional, transversal, prolectivo. En la fase 1 se elaboró un modelo de escala rápida, que se sometió a la valoración de expertos en atención médica; se realizaron pruebas piloto con 10 pacientes por ronda, tantas veces como fuera necesario hasta lograr 20 aprobaciones. En la fase 2 se aplicó el cuestionario resultante y la escala de Satisfacción del Usuario de Consultas Externas (SUCE) a usuarios de consulta externa; la ERSaPaCE se reaplicó telefónicamente siete a 10 días después. Se utilizó estadística descriptiva, a de Cronbach, Spearman y coeficiente de correlación intraclase (CCI). RESULTADOS: Se reclutaron 200 pacientes, 53 % con edad de 31 a 60 años, 51.5 % mujeres y 48.5 % hombres de la consulta externa de 13 especialidades; a de Cronbach de ERSaPaCE = 0.608, CCI = 0.98 (p = 0.000) y validez convergente = 0.681 (p = 0.000) por rho de Spearman. ­. CONCLUSIONES: ERSaPaCE fue un instrumento válido y consistente para evaluar la satisfacción del usuario de consulta externa.

TAC y PET/TC con 18-FDG para evaluar la respuesta al tratamiento en linfoma de Hodgkin y no Hodgkin.

INTRODUCTION: The assessment of lymphoma response to treatment is based on imaging studies. OBJECTIVE: To correlate the assessment of lymphoma treatment response by computed tomography (CT) and by positron emission tomography/computed tomography (PET/CT). METHOD: Cross-sectional, observational study, where records of patients with lymphoma under surveillance by CT and PET/CT were reviewed. RESULTS: The study population consisted of 43 patients with a mean age of 32.7 ± 22.4 years; 26 (60.5 %) had a diagnosis of Hodgkin's lymphoma and 17 (9.5 %) had non-Hodgkin lymphoma. By CT, 34 (79.1 %) were diagnosed with disease and nine (20.9 %) without disease. The criteria used to assess the response was radiologist experience in 39 (90.7 %) and RECIST 1.1 criteria in four (9.3 %). The diagnosis by 18-FDG PET/CT was no response to treatment or partial response-recurrence in 32 (74.4 %) and response to treatment in 11 (25.6 %); with PERCIST criteria in 13 (30.2 %) and Deuaville criteria in 30 (69.8 %). When the diagnosis by CT versus 18-FDG PET/CT was compared, out of 11 patients with complete response on PET/CT, three had a similar CT diagnosis. Of the 34 patients with data consistent disease diagnosed by CT, 26 had similar results by 18-FDG PET/CT (p = 0.54). CONCLUSION: The value of lymphoma treatment response on CT does not agree with that obtained by 18-FDG PET/CT.

INTRODUCCIÓN: La evaluación de la respuesta al tratamiento de linfoma se basa en estudios de imagen. OBJETIVO: Correlacionar la evaluación de la respuesta al tratamiento de linfoma mediante tomografía axial computarizada (TAC) y tomografía por emisión de positrones/tomografía computarizada (PET/TC). MÉTODO: Estudio observacional transversal en el que se revisaron expedientes de pacientes con linfoma en vigilancia mediante TAC y PET/TC. RESULTADOS: La población de estudio estuvo constituida por 43 pacientes con edad media de 32.7 ± 22.4 años; 26 (60.5 %) tenían diagnóstico de linfoma de Hodgkin y 17 (9.5 %), de linfoma no Hodgkin. Por TAC se diagnosticaron 34 (79.1 %) con enfermedad y nueve (20.9 %) sin enfermedad. El criterio para evaluar la respuesta fue la experiencia del médico imagenólogo en 39 (90.7 %) y RECIST 1.1 en cuatro (9.3 %). Por PET/TC con 18-FDG se diagnosticó falta de respuesta al tratamiento o respuesta parcial-recurrencia en 32 pacientes (74.4 %) y con respuesta al tratamiento en 11 (25.6 %); con los criterios PERCIST en 13 (30.2 %) y con los de Deuaville en 30 (69.8 %). Al comparar el diagnóstico por TAC contra PET/TC, de 11 pacientes con respuesta total, tres tuvieron diagnóstico tomográfico similar. De los 34 pacientes con datos de enfermedad diagnosticados por tomografía, 26 tuvieron resultados similares por PET/TC con 18-FDG (p = 0.54). CONCLUSIÓN: El valor de la respuesta al tratamiento por TAC en linfoma no concuerda con el obtenido mediante PET/TC con 18-FDG.

Incidence of Vertebral Fractures in Women with Systemic Lupus Erythematosus After 8 Years of Follow-Up.

The aim of this study was to evaluate possible associations between potential risk factors and the occurrence of established vertebral fractures (VF) in Mexican patients with systemic lupus erythematosus (SLE). Consecutive patients with SLE were enrolled in a prospective, observational study from 2006 to 2015. Information on potential risk factors, including demographics, clinical data, and bone mineral density (BMD) at the lumbar spine and hip on dual-energy X-ray absorptiometry was collected at baseline and follow-up. Semiquantitative analysis was used to determine incident VF on lateral thoracic and lumbar radiographs, defined as any vertebral body graded normal at baseline and at least mildly deformed (20-25% reduction or more in any vertebral height) during follow-up. Differences in baseline characteristics were assessed in patients with and without new radiographic VF. Of 110 SLE patients included, with a median follow-up of 8 (IQR 8-9) years, 22 (20%) had radiographic VF at baseline; 35 (32%) patients had a new VF. The annual incidence rate of new morphometric VF was 3.5 (95% CI 2.4-4.91) per 100 patient/years. Most fractures were mild or moderate and biconcave shaped. Incident VF were significantly associated with baseline BMD at the total hip and longer disease duration. Cumulative glucocorticoid dose, postmenopausal status, and previous prevalent VF were not associated with VF. In this SLE cohort in daily clinical practice, new VF were frequently present in SLE patients, especially those with longer disease duration and low-hip BMD.

[Quality of life in patients with psoriasis]. / Calidad de vida en el paciente con psoriasis.

INTRODUCTION: Psoriasis is a chronic inflammatory skin disease, in which an autoimmune mechanism participates, triggering an accelerated keratopoiesis. Its etiology is unknown; environmental factors, trauma, and infections are involved. The aim of this paper is to present the correlation between the index of severity of psoriasis and quality of life in patients with psoriasis. METHODS: This was a cross-sectional study in 72 patients with psoriasis, older than 15 years old, who agreed to participate in the study. We applied the Dermatology Life Quality Index and the Psoriasis Severity Index; descriptive statistics, measures of central tendency, dispersion, and correlation measures were used. RESULTS: Patients (n = 72), were 43% male, 57% female, with a mean age 51.22 (15-77) ± 14.05 years. Education: bachelor's degree 23.6%, housework occupation 26.4%, duration of the disease 12.25 (1-50) ± 10.58 years. Psoriasis plaques occurred in 88.9%, the Psoriasis Severity Index was mild in 70.8%. The result of the impact on quality of life was moderate in effect in 33.3%, the difference between the degree of involvement of the disease and the impact on quality of life was p = 0.104, and correlation between the quality of life and degree of psoriasis was p = 0.463. CONCLUSION: Quality of life is independent of the degree of disease in patients with psoriasis.

Detection of beta-tubulin in the cytoplasm of the interphasic Entamoeba histolytica trophozoites.

It is known that the microtubules (MT) of Entamoeba histolytica trophozoites form an intranuclear mitotic spindle. However, electron microscopy studies and the employment of anti-beta-tubulin (ß-tubulin) antibodies have not exhibited these cytoskeletal structures in the cytoplasm of these parasites. The purpose of this work was to detect ß-tubulin in the cytoplasm of interphasic E. histolytica trophozoites. Activated or non-activated HMI-IMSS-strain E. histolytica trophozoites were used and cultured for 72 h at 37 °C in TYI-S-33 medium, and then these were incubated with the anti-ß-tubulin antibody of E. histolytica. The anti-ß-tubulin antibody reacted with the intranuclear mitotic spindle of E. histolytica-activated trophozoites as control. In contrast, in non-activated interphasic parasites, anti-ß-tubulin antibody reacted with diverse puntiform structures in the cytoplasm and with ring-shaped structures localized in the cytoplasm, cellular membrane and endocytic stomas. In this work, for the first time, the presence of ß-tubulin is shown in the cytoplasm of E. histolytica trophozoites.

[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.

Addressing the unmet needs of women with breast cancer in Mexico: a non-randomised pilot study of the digital ePRO intervention.

OBJECTIVES: This study aimed to explore the acceptability, feasibility, usability, and preliminary effect of an electronic patient-reported outcome (ePRO) intervention for patients with breast cancer in Mexico. DESIGN: We conducted a multimethod non-randomised pilot study. We used a pre-test/post-test design for quantitative assessment of the intervention's effect on patients' supportive care needs and quality of life. We conducted in-depth interviews (IDIs) with participants and healthcare workers to explore the intervention's benefits and barriers and understand its feasibility. PARTICIPANTS: 50 women aged 20-75 diagnosed with stage I-III breast cancer were enrolled within 2 weeks of starting neoadjuvant or adjuvant treatment with chemotherapy or radiotherapy. We excluded illiterate women and those with visual impairment, cognitive disability or severe depression. IDIs were conducted with 18 participants and 10 healthcare providers. SETTING: Oncology services in three public hospitals of the Mexican Social Security Institute. INTERVENTION: The ePRO intervention consisted of a responsive web application for weekly symptom reporting combined with proactive follow-up by nurses guided by predefined clinical algorithms for 6 weeks. RESULTS: 50 women were enrolled out of 66 eligible patients approached (75.8%). All 50 completed the 4-week follow-up assessment (100% retention). Completion of the symptom registry declined from 100% in week 1 to 66% in week 6. Participants experienced decreases in supportive care needs and increased quality of life. The ePRO application was rated highly usable. Participants and health professionals both perceived intervention benefits. Drawbacks included poor fit for women receiving radiotherapy and challenges using the application for women with low digital literacy or experiencing severe symptoms. CONCLUSIONS: This pilot study provided evidence of the high usability and potential efficacy of a web-based ePRO intervention. We revised recruitment during the pilot to include multiple facilities, and we will further revise for the randomised trial to address barriers to successful ePRO implementation. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID: NCT05925257.

Implementation of a roadmap for the comprehensive diagnosis, follow-up, and research of childhood leukemias in vulnerable regions of Mexico: results from the PRONAII Strategy.

The main objective of the National Project for Research and Incidence of Childhood Leukemias is to reduce early mortality rates for these neoplasms in the vulnerable regions of Mexico. This project was conducted in the states of Oaxaca, Puebla, and Tlaxcala. A key strategy of the project is the implementation of an effective roadmap to ensure that leukemia patients are the target of maximum benefit of interdisciplinary collaboration between researchers, clinicians, surveyors, and laboratories. This strategy guarantees the comprehensive management of diagnosis and follow-up samples of pediatric patients with leukemia, centralizing, managing, and analyzing the information collected. Additionally, it allows for a precise diagnosis and monitoring of the disease through immunophenotype and measurable residual disease (MRD) studies, enhancing research and supporting informed clinical decisions for the first time in these regions through a population-based study. This initiative has significantly improved the diagnostic capacity of leukemia in girls, boys, and adolescents in the regions of Oaxaca, Puebla, and Tlaxcala, providing comprehensive, high-quality care with full coverage in the region. Likewise, it has strengthened collaboration between health institutions, researchers, and professionals in the sector, which contributes to reducing the impact of the disease on the community.

Gut-joint axis: Gut dysbiosis can contribute to the onset of rheumatoid arthritis via multiple pathways.

Rheumatoid Arthritis (RA) is an autoimmune disease characterized by loss of immune tolerance and chronic inflammation. It is pathogenesis complex and includes interaction between genetic and environmental factors. Current evidence supports the hypothesis that gut dysbiosis may play the role of environmental triggers of arthritis in animals and humans. Progress in the understanding of the gut microbiome and RA. has been remarkable in the last decade. In vitro and in vivo experiments revealed that gut dysbiosis could shape the immune system and cause persistent immune inflammatory responses. Furthermore, gut dysbiosis could induce alterations in intestinal permeability, which have been found to predate arthritis onset. In contrast, metabolites derived from the intestinal microbiota have an immunomodulatory and anti-inflammatory effect. However, the precise underlying mechanisms by which gut dysbiosis induces the development of arthritis remain elusive. This review aimed to highlight the mechanisms by which gut dysbiosis could contribute to the pathogenesis of RA. The overall data showed that gut dysbiosis could contribute to RA pathogenesis by multiple pathways, including alterations in gut barrier function, molecular mimicry, gut dysbiosis influences the activation and the differentiation of innate and acquired immune cells, cross-talk between gut microbiota-derived metabolites and immune cells, and alterations in the microenvironment. The relative weight of each of these mechanisms in RA pathogenesis remains uncertain. Recent studies showed a substantial role for gut microbiota-derived metabolites pathway, especially butyrate, in the RA pathogenesis.

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.

[Rapunzel syndrome: Radiological diagnosis]. / Síndrome de Rapunzel: diagnóstico radiológico.

Background: Rapunzel syndrome is a rare presentation of trichobezoar, secondary to the ingestion of hair known as trichophagia. This bezoar has been found mainly in women, it invades the stomach and extends to the small intestine. Clinically, patients present weight loss and chronic obstructive symptoms at the intestinal level. A case of Rapunzel syndrome is presented. Clinical case: A 13-year-old female presented with a weight loss of 10kg in two months, chronic constipation, predominantly nocturnal vomiting, and abdominal pain of seven days' duration. Physical examination revealed decreased peristalsis and a palpable mass in the epigastrium. Laboratories taken on admission: normal blood count, kidney function tests, and liver function tests. The abdominal X-ray showed opacity in the fundus, body and gastric antrum, the abdominal ultrasound showed non-specific findings in the epigastrium, later an abdominal tomography was performed with a swallow of water-soluble contrast medium and showed occupation in the gastric lumen. She underwent exploratory laparotomy and the finding was a trichobezoar in the stomach with extension to the duodenum and part of the jejunum, which was removed without complications. The evolution of the patient was favorable. Conclusions: For the diagnosis of Rapunzel Syndrome, the use of contrast imaging studies is necessary, and the treatment of choice is surgical.

Introducción: el síndrome de Rapunzel es una presentación poco frecuente de tricobezoar, secundario a la ingesta de cabello conocida como tricofagia. Este bezoar se ha encontrado principalmente en mujeres, invade estómago y se extiende a intestino delgado. Clínicamente, los pacientes presentan pérdida de peso y síntomas crónicos de tipo obstructivo a nivel intestinal. Se presenta un caso de síndrome de Rapunzel. Caso clínico: paciente mujer de 13 años que se presenta con pérdida de peso de 10 kg en dos meses, estreñimiento crónico, vómito de predominio nocturno y dolor abdominal de siete días de evolución. A la exploración física, se encontró peristalsis disminuida y masa palpable en epigastrio. Laboratorios tomados a su ingreso: biometría hemática, pruebas de función renal y hepáticas normales. La radiografía de abdomen mostró opacidad en fundus, cuerpo y antro gástrico, la ecografía de abdomen mostró hallazgos inespecíficos en epigastrio, posteriormente se realizó tomografía abdominal con trago de medio de contraste hidrosoluble y mostró ocupación en la luz gástrica. Se sometió a laparotomía exploradora y el hallazgo fue un tricobezoar en estómago con extensión a duodeno y parte de yeyuno, fue removido sin complicaciones. La evolución de la paciente fue favorable. Conclusiones: para el diagnóstico del síndrome de Rapunzel es necesario el uso de estudios de imagen contrastados y el tratamiento de elección es quirúrgico.

Pictograms to assess bloating and distension symptoms in the general population in Mexico: Results of The Rome Foundation Global Epidemiology Study.

BACKGROUND: There is no term for bloating in Spanish and distension is a very technical word. "Inflammation"/"swelling" are the most frequently used expressions for bloating/distension in Mexico, and pictograms are more effective than verbal descriptors (VDs) for bloating/distension in general GI and Rome III-IBS patients. However, their effectiveness in the general population and in subjects with Rome IV-DGBI is unknown. We analyzed the use of pictograms for assessing bloating/distension in the general population in Mexico. METHODS: The Rome Foundation Global Epidemiology Study (RFGES) in Mexico (n = 2001) included questions about the presence of VDs "inflammation"/"swelling" and abdominal distension, their comprehension, and pictograms (normal, bloating, distension, both). We compared the pictograms with the Rome IV question about the frequency of experiencing bloating/distension, and with the VDs. KEY RESULTS: "Inflammation"/"swelling" was reported by 51.5% and distension by 23.8% of the entire study population; while 1.2% and 25.3% did not comprehend "Inflammation"/"swelling" or distension, respectively. Subjects without (31.8%) or not comprehending "inflammation"/"swelling"/distension (68.4%) reported bloating/distension by pictograms. Bloating and/or distension by the pictograms were much more frequent in those with DGBI: 38.3% (95%CI: 31.7-44.9) vs. without: 14.5% (12.0-17.0); and in subjects with distension by VDs: 29.4% (25.4-33.3) vs. without: 17.2% (14.9-19.5). Among subjects with bowel disorders, those with IBS reported bloating/distension by pictograms the most (93.8%) and those with functional diarrhea the least (71.4%). CONCLUSIONS & INFERENCES: Pictograms are more effective than VDs for assessing the presence of bloating/distension in Spanish Mexico. Therefore, they should be used to study these symptoms in epidemiological research.

[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.

Timely radiographic detection of developmental dysplasia of the hip in family medicine residents. Educative intervention.

BACKGROUND: Developmental dysplasia of the hip (DDH) is a complex clinical entity that is usually underdiagnosed, if not detected and managed early, will turn the affected individual into a disabled being, with negative social, economic and emotional effects. OBJECTIVE: To determine the capacity for the timely radiographic detection of DDH before and after an educational intervention. METHOD: An educational intervention is carried out in family medicine resident, where they are given training on detection in DDH radiographic projections. Pre- and post-training evaluation is carried out. Statistical analysis is performed using Student's t and χ2, taking p ≤ 0.05 as significant. RESULTS: 94 residents participated. In the pre-intervention evaluation, 87.2% had no knowledge of the early detection protocol (p = 0.525). It was observed that 98.9% incorrectly drew the Perkins line (p = 0.427), 96.8% the Hilgenreiner line (p = 0.177) and 87.2% did not consider the data of bilateral dysplasia (p = 0.956). After the educational intervention, 87.2% correctly drew the Perkins line (p = 0.926), 97.8% the Hilgenreiner line (p = 0.325) and 78.7% if they considered the data of bilateral dysplasia (p = 0.826). CONCLUSIONS: After this training, 80% of family medicine residents were able to detect DDH in a timely manner.

ANTECEDENTES: La displasia del desarrollo de la cadera (DDC) constituye una entidad clínica compleja que suele ser infradiagnosticada que, de no ser precozmente detectadas y manejadas, convertirán al individuo afectado en un ser discapacitado, con efecto negativo social, económico y emocional. OBJETIVO: Determinar la capacidad para la detección radiográfica oportuna de la DDC antes y después de una intervención educativa en médicos residentes de medicina familiar. MÉTODO: Se realizó una intervención educativa en residentes de medicina familiar, en la que se les dio capacitación sobre detección de DDC en proyecciones radiográficas. Se realizó una evaluación previa y posterior a la capacitación. El análisis estadístico se realizó mediante pruebas t de Student y χ2, tomando como significativo un valor de p ≤ 0.05. RESULTADOS: Participaron 94 residentes. El 87.2% dijeron no conocer el protocolo radiológico de detección. En la evaluación preintervención, el 87.2% no tenían conocimiento del protocolo (p = 0.525). Se observó que el 98.9% trazaron de manera incorrecta la línea de Perkins (p = 0.427), el 96.8% la línea de Hilgenreiner (p = 0.177) y el 87.2% no consideraron los datos de displasia bilateral (p = 0.956). Posterior a la intervención educativa, el 87.2% trazaron de manera correcta la línea de Perkins (p = 0.926), el 97.8% la línea de Hilgenreiner (p = 0.325) y el 78.7% sí consideró los datos de displasia bilateral (p = 0.826). CONCLUSIONES: Tras la capacitación, el 80% de los médicos residentes de medicina familiar fueron capaces de detectar oportunamente la DDC.

[Pain after panretinal photocoagulation: 50-millisecond pulse versus conventional pulse]. / Dolor posterior a panfotocoagulación retiniana: impulso de 50 milisegundos frente a impulso convencional.

Background: Diabetic retinopathy is a progressive disfunction of blood vessels of the retina secondary to chronic hyperglycemia. There are several treatments, out of which panretinal photocoagulation (PRP) stands out. Objective: To compare the level of pain in patients undergoing PRP with different impulse. Material and methods: Comparative, cross-sectional study that compared the level of pain in patients undergoing PRP with a 50-millisecond pulse (group A) versus conventional 200 milliseconds pulse (group B). Mann-Whitney U test was used. Results: There were 26 patients, 12 (46.16%) female and 14 (53.84%) males. The median age was 58.73 ± 7.31 (40-75) years. 40 eyes were studied, 18 (45%) right and 22 (55%) left. The mean level of glycated hemoglobin was 8.15 ± 1.08 (6.5-12) %. The mean laser power was 297 ± 53.61 (200-380) and 214.5 ± 41.73 (170-320) milliwatts; the mean fluence was 18.85 ± 5.28 (12-28) J/cm2 and 65.9 ± 12.87 (52-98) J/cm2; the mean level of pain was 3.1 ± 1.33 (1-5) and 7.5 ± 1.23 (6-10) points for group A and B, respectively, and there was statistically significant difference (p ˂ 0.001) in the level of pain. There were no complications in any group. Conclusion: The application of retinal 50-millisecond pulse PRP causes less pain and side effects than 200-millisecond pulse PRP.

Introducción: la retinopatía diabética es una disfunción progresiva del sistema vascular de la retina que es secundaria a una hiperglucemia crónica. Hay varias opciones de tratamiento, entre las que destaca la panfotocoagulación. Objetivo: comparar el nivel de dolor en pacientes sometidos a panfotocoagulación retiniana con diferente impulso. Material y métodos: estudio comparativo, transversal, que comparó el nivel de dolor en pacientes sometidos a panfotocoagulación con impulso de 50 milisegundos (grupo A) frente a impulso convencional de 200 milisegundos (grupo B). Se utilizó U de Mann Whitney. Resultados: fueron 26 pacientes, 12 (46.16%) mujeres y 14 (53.84%) hombres. La edad mediana fue 58.73 ± 7.31 (40-75) años. Se estudiaron 40 ojos, 18 (45%) derechos y 22 (55%) izquierdos. El nivel medio de hemoglobina glucosilada fue 8.15 ± 1.08 (6.5-12)%. La potencia láser media fue 297 ± 53.61 (200-380) y 214.5 ± 41.73 (170-320) miliwatts, la fluencia media fue 18.85 ± 5.28 (12-28) J/cm2 y 65.9 ± 12.87 (52-98) J/cm2, el nivel medio de dolor fue 3.1 ± 1.33 (1-5) y 7.5 ± 1.23 (6-10) puntos para el grupo A y B, respectivamente y hubo diferencia estadísticamente significativa (p ≤ 0.001) en el nivel de dolor. En ningún grupo hubo complicaciones. Conclusión: la aplicación de panfotocoagulación retiniana con impulso de 50 milisegundos provoca menos dolor y efectos secundarios que la panfotocoagulación con impulso de 200 milisegundos.

[Clinical and histopathological characteristics of malignant colon tumors by location]. / Características clínicas e histopatológicas de los tumores malignos de colon por localización.

Background: The colon has two different embryological origins, which is why it can be divided into right and left with different characteristics each one; therefore, neoplastic lesions have a different clinical picture and are also associated with different pathologies. Objective: To describe the clinical and histopathological characteristics of malignant colon tumors acording to their location. Material and methods: Descriptive, retrospective study with 94 patients diagnosed with colon cancer. Descriptive statistics were performed with the calculation of frequencies and percentages, and chi-squared tests were calculated. Results: Mean age was 61.3 years, 49 (52.1%) were women; 53 (56.4%) were left-sided and 41 (43.6%) right-sided. The main symptom was hematochezia in 32 (60.4%), in patients with left cancer; and diarrhea in 20 (48.8%), in patients with right-sided colon cancer. The presentation of stage I tumors and polyps, p = 0.044 and p = 0.043, respectively, was more frequent on the right side compared to the left side; in the left, hematochezia (p = 0.001), narrow stools(p = 0.05), and a history of type 2 diabetes mellitus (T2DM) (p= 0.036) were more frequent compared to the opposite site. Conclusions: Stage I and the presence of polyps were more frequent in right-sided cancer compared to left-sided cancer; T2DM, as well as hematochezia and narrow stools were more associated with the left side compared to the right side.

Introducción: el colon tiene dos orígenes embriológicos distintos, con lo que se puede dividir en derecho e izquierdo y cada uno tiene características diferentes; por tanto, las lesiones neoplásicas tienen un cuadro clínico diferente y se asocian también a diferentes patologías. Objetivo: describir las características clínicas e histopatológicas de los tumores malignos de colon según su localización. Material y métodos: estudio descriptivo, retrospectivo con 94 pacientes con diagnóstico de cáncer de colon. La estadística descriptiva se realizó con el cálculo de frecuencias y porcentajes, y se aplicaron pruebas de chi cuadrada. Resultados: la edad media fue 61.3 años, 49 (52.1%) fueron mujeres; 53 (56.4%) casos fueron izquierdos y 41 (43.6%) derechos. El síntoma principal fue hematoquecia en 32 (60.4%), en pacientes con cáncer izquierdo; y diarrea en 20 (48.8%), en pacientes con cáncer derecho. La presentación de tumores en estadio I y pólipos, p = 0.044 y p = 0.043, respectivamente, fue más frecuente en el lado derecho comparado con el lado izquierdo; en el izquierdo fueron más frecuentes la hematoquecia (p = 0.001), la disminución del grosor de las heces (p = 0.05) y el antecedente de diabetes mellitus 2 (p= 0.036) respecto al sitio contrario. Conclusiones: el estadio I y la presencia de pólipos fueron más frecuentes en el cáncer derecho comparado con el izquierdo; la diabetes mellitus 2, así como la hematoquecia y la disminución en el grosor de las heces se asociaron más al lado izquierdo en comparación con el derecho.

[Comparison of protective colostomy vs. ileostomy in rectal cancer surgery]. / Comparación de colostomía frente a ileostomía de protección en cirugía de cáncer rectal.

Background: Rectal cancer (RC) is the 3rd most frequent one in Mexico. Protective stoma in resection and anastomosis is controversial. Objective: To compare quality of life (QoL), functional capacity (FC) and complications in rectal cancer (RC) patients with low and ultralow anterior resection (LAR and ULAR) with loop transverse colostomy (LTC) versus protective ileostomy (IP). Material and methods: Comparative, observational study in patients with RC and LTC (Group 1) or IP (Group 2) from 2018-2021. FC pre and postoperative, complications, hospital readmission (HR) and assessment by other specialty (AS) were assessed; QoL was assessed with EQ-5D by telephone. Student-t test, Chi-squared test, Mann-Whitney-U test were used. Results: Group 1: 12 patients: mean preoperative FC: ECOG 0.83, Karnofsky 91.66%; postoperative: ECOG 1, Karnofsky 89.17%. Mean postoperative QoL: index value 0.76 and health status 82.5%; HR: 25%; AS: 42%. Group 2: 10 patients: mean preoperative FC: ECOG 0.80, Karnofsky 90%; postoperative: ECOG 1.5, Karnofsky 84%. Mean postoperative QoL: index value 0.68 and health status 74%; HR: 50%; AS: 80%. Complications: 100% of sample. Conclusion: The differences in QoL, FC and complications between LTC and IP in RC patients operated with LAR/ULAR were not significant.

Introducción: el cáncer rectal (CR) es el tercero más frecuente en México. El estoma de protección en la resección y anastomosis es controversial. Objetivo: comparar calidad de vida (CV), capacidad funcional (CF) y complicaciones (COMP) en pacientes con CR con resección anterior baja (RAB) y ultrabaja (RAUB) con colostomía de transverso en asa (CTA) frente a ileostomía de protección (IP). Material y métodos: estudio comparativo, observacional, en pacientes con CR con CTA (Grupo 1) o IP (Grupo 2) atendidos en 2018-2021. Se evaluó CF (escalas ECOG y Karnofsky) pre y posquirúrgicas, COMP, reingreso hospitalario (RH) y valoración por otra especialidad (VE). Se evaluó CV con la encuesta EQ-5D vía telefónica. Se utilizó t de Student, Chi cuadrada y U de Mann-Whitney. Resultados: grupo1: 12 pacientes; CF media prequirúrgica ECOG: 0.83, Karnofsky: 91.66%; posquirúrgica ECOG: 1, Karnofsky: 89.17%. CV posquirúrgica medias valor índice: 0.76 y estado funcional: 82.5%; RH: 25%, VE: 42%. Grupo 2: 10 pacientes; CF media prequirúrgica ECOG: 0.80, Karnofsky: 90%; CF media postquirúrgica ECOG: 1.5, Karnofsky: 84%; CV medias valor índice: 0.68, estado funcional: 74%; RH: 50%, VE: 80%. COMP: 100% de la muestra. Conclusiones: las diferencias en CV, CF y COMP entre CTA e IP en pacientes con CR con RAB/RAUB no fueron significativas.