The complex scenario of obesity, diabetes and hypertension in the area of influence of primary healthcare facilities in Mexico.

INTRODUCTION: Among non-communicable chronic diseases (NCCD), diabetes and hypertension are the main cause of adult mortality worldwide. Among the members of the Organization for Economic Cooperation and Development, Mexico is first in prevalence of diabetes and second in obesity. To face this problematic situation of NCCDs the Ministry of Health declared a national epidemiological alert against the overweight, obesity and diabetes. The target of this study is to characterize the status of obesity, diabetes and hypertension in the adult population in the area of influence of primary health facilities located in high social marginality areas. METHODS: We conducted a cross-sectional observational study and used a convenience sample. A survey was conducted on a population of 18 years old and above in four primary health facilities in four Mexican States. The survey explored sociodemographic characteristics, the presence of chronic diseases, the access to healthcare services, risk factors and life styles. We also applied a complementary questionnaire to 20% of the participants, in order to explore food consumption during the last week and physical activity (International Physical Activity Questionnaire). We based our analysis on descriptive statistics and logistic multivariate regression to analyze factors associated with diabetes and hypertension. RESULTS: 73% (n = 7531, CI 0.72-0.74) percent of the population reported being diabetic, hypertensive and/or overweight. The majority of them receive healthcare in public health services. People over 40 years old, are 11 times more probable of living with diabetes and 8.7 times more probable of living with hypertension. Both conditions affect mostly women, whose main activity is to be a housewife. People who have lunch and dinner out of home are more likely to develop diabetes. People who perform intense physical activity are less likely to live with hypertension. CONCLUSION: According to the self-report, more than 70% of adult population living in areas with high social marginality suffer diabetes, hypertension and obesity. However, the percentage of people who live with these chronic conditions and are not aware of them, is unknown. The Mexican health system needs a primary healthcare that emphasizes on health promotion, timely detection of risk factors of Non Communicable Diseases and prevention of their complications.

Review article: colorectal cancer surveillance in ulcerative colitis - what should we be doing?

Different societies have published guidelines for colorectal cancer (CRC) surveillance in ulcerative colitis (UC). While it would seem that most gastroenterologists and endoscopists agree with these guidelines, different studies have shown that in clinical practice, the concept of dysplasia is not fully understood, and therefore, the guidelines are not always followed. According to some studies, the reason why gastroenterologists do not follow the recommendations is inadequate education. The main advance in recent years in this subject is in endoscopic diagnosis of dysplasia. The magnification and chromoendoscopy allow targeted biopsies to be taken. Some studies indicate that nontargeted biopsies are not useful in ruling out dysplasia. It is also important to realize that most dysplasia is visible in conventional colonoscopy. In colonoscopy, it is not only significant to detect dysplasia-associated lesions or masses; the endoscopist should also be trained to detect, in the course of conventional exploration, subtle changes in colour or in mucosal surfaces that imply dysplasia. Adherence to guidelines had been extensively assessed in other disease conditions (asthma, hypertension, etc.). According to our knowledge there are no such data regarding CRC surveillance in UC. Some barriers that may affect physicians include: (i) knowledge (lack of awareness or lack of familiarity); (ii) attitudes (lack of agreement, lack of self-efficacy, lack of outcome expectancy, or the inertia of previous practice) and (iii) behaviour (external barriers). In conclusion, we need new guidelines for CRC surveillance in UC, which must take into account the advances in risk factors of dysplasia and new technologies to study colon dysplasia.

[Implantation of a hospital registry of hereditary nonpolyposis colorectal cancer]. / Implantación de un registro hospitalario de cáncer colorrectal hereditario sin poliposis.

INTRODUCTION: Identification of patients with hereditary nonpolyposis colorectal cancer (HNPCC) can allow colorectal cancer (CRC) prevention through colonoscopy and polypectomies. The purpose of this study was to report the clinical characteristics of HNPCC families in our registry. PATIENTS AND METHOD: HNPCC was identified using the Amsterdam criteria. Familial clustering of CRC and extracolonic cancers were investigated in families. Individuals at risk were offered annual colonoscopy, starting from the age of 25 years. RESULTS: Twelve HNPCC families were identified. There were 46 cases of CRC in 38 patients. The mean age at diagnosis of CRC was 45.4 +/- 12.7 years (range 25-73 years). In patients with documented disease, right-sided tumors predominated. Eleven patients with extracolonic cancer were identified (six tumors located in the endometrium). Of 43 at-risk individuals, 29 accepted surveillance. CONCLUSIONS: Our data confirm the importance of the family history in identifying HNPCC. This study confirms previously described characteristics in HNPCC, namely, early age at onset of CRC, right-sided predominance, multiple synchronous and metachronous neoplasms, and increased extracolonic cancers. This is the first study of clinical data in a Spanish HNPCC registry.

Renal function in full-term newborns following neonatal asphyxia. A prospective study.

A prospective study of full-term infants with neonatal asphyxia was performed to evaluate possible alterations in renal function. Twenty-one newborns with an Apgar score less than or equal to 3 at 1 minute after birth and a control group of 20 normal infants were included. Oliguria of 12 hours or more (less than 1 ml/Kg/h) during the first 24 hours after birth was considered indication for a volume challenge test and use of diuretic. The study of renal function was effected between 24 and 48 hours after birth for asphyxiated and control infants (Period I), and was repeated between 48 and 72 hours (Period II) for the asphyxiated group only. Intrinsic acute renal failure was diagnosed in two patients, one of whom died. In 10 cases, prerenal oliguria responded promptly to volume expansion with improvement of biochemical indices in Period II. In nine cases, urine volume was not altered, and all functional parameters were comparable with those of control.

[Tropical chronic pancreatitis in a young patient]. / Pancreatitis crónica tropical en una paciente joven.

Tropical chronic pancreatitis is a form of idiopathic chronic pancreatitis that has not previously been described in Spain. Typically it is related to dietary factors and malnutrition, although genetic factors may also play a significant role in the development of the disease. We report a case of chronic tropical pancreatitis in a 27-year-old woman from the Dominican Republic domiciled in Spain since 1992. The patient was admitted to our hospital for acute pancreatitis that fulfilled the diagnostic criteria (clinical and radiological) for chronic tropical pancreatitis. This case has led us to review this uncommon entity. Because of the increasing number of immigrants from tropical countries, chronic tropical pancreatitis will probably need to be taken into account in the differential diagnosis of chronic pancreatitis in our patients.

[Osteomatous jaw lesions in familial adenomatous polyposis]. / Osteomas mandibulares en la poliposis adenomatosa familiar.

The first aim of this study is to assess the frequency of osteomatous jaw lesions in patients with a diagnosis of familial adenomatous polyposis (FAP), and a group of FAP-relatives from the FAP registry of Majorca (Balearic Islands, Spain). The second aim is to study the predictive significance of osteomatous jaw lesions in families with FAP. The study included forty-two people. Twenty-five patients and seventeen relatives. All individuals underwent pantomography. Osteomatous jaw lesions were diagnosed in 68% of FAP-patients, and 6% of FAP-relatives. The difference was statistically significant (p < 0.001). The sensitivity was 68%, the specificity 94% and positive predictive value 94%. This frequency of osteomatous jaw lesions agree with previous studies of FAP-patients (57-82%), but differ from these of the previous studies of FAP-relatives (16-18%). The available method detect APC (adenomatous polyposis coli) gene mutations in 48-82% of FAP families. In the families without detected mutation, non-informative study or non-available study, the screening is based in seriated sigmoidoscopy and study of the extraintestinals lesions of the FAP syndrome. The frequency of osteomatous jaw lesions in FAP-patients is greater than the observed in FAP-relatives (p < 0.001). Osteomas in families with FAP are of predictive significance.

[Endoscopic management of foreign bodies in the esophagus. Results of a retrospective series of 501 cases]. / Abordaje endoscópico de los cuerpos extraños esofágicos. Resultados de una serie retrospectiva de 501 casos.

We present the results of a retrospective study of endoscopic management (with flexible endoscopy) in 501 patients admitted for suspected ingestion of a foreign body between 1977 and 1997. The mean age of the patients was 55.73 19.38. Foreign bodies were found in the esophagus in 322 patients (64.3%) and endoscopic removal was successful in 307 (95.35%). More experienced endoscopists, with more than 45 cases, had a higher success rate (98.1%) than did less experienced endoscopists (87.9%) (p < 0.01). The most frequent type of foreign body in our series was meat bolus (32.8%). Underlying disease was found in 38.9%, and peptic stenosis was the most frequent. The only severe complication found was esophageal perforation in one patient (0.3%). Emergency flexible endoscopy is the most effective method for managing patients admitted for suspected ingestion of a foreign body and for the removal of foreign bodies located in the esophagus.

[Lactose malabsorption in ulcerative colitis. A case-control study]. / Malabsorción de lactosa en la colitis ulcerosa. Estudio de casos y controles.

BACKGROUND: The role of lactose malabsorption in ulcerative colitis is controversial. The aim of this study was to compare the prevalence of lactose malabsorption in a group of ulcerative colitis patients and a control group and to modify lactose consumption in view of the results. METHODS: Lactose malabsorption was studied using the hydrogen breath test in 52 patients with ulcerative colitis and 34 controls after ingestion of 25 g of lactose. A questionnaire on ingestion of milk products was also administered. RESULTS: Of the 52 patients with ulcerative colitis, 13 (25%) presented lactose malabsorption compared with 11 of the 34 (32%) controls (p = 0.45). Twenty-four patients (46%) had been advised to completely eliminate lactose from their diets. Twenty-seven of the 39 patients without malabsorption had reduced or eliminated lactose consumption after being diagnosed with ulcerative colitis. CONCLUSIONS: No significant differences in the prevalence of lactose malabsorption was found between patients with ulcerative colitis and controls. We believe that systematic elimination of lactose from the diets of these patients is erroneous. In our environment, we recommend the hydrogen breath test only in patients with symptoms of lactose intolerance.

Case report: uncommon radiological and pathological features of giant colonic diverticula.

A case of multiple giant sigmoid diverticula is described in which a barium enema revealed two giant diverticula communicating with the sigmoid lumen. Both diverticula were located on the mesenteric border of the sigmoid colon, and histologic examination showed mucosal and serosal layers with no evidence of smooth muscle. The pathogenesis, pathology, radiological manifestations and differential diagnosis of this rare condition are discussed.

Estimulacion sensorial programada en lactantes de bajo nivel socioeconomico. / Programed sensorial stimulation in infants of low socio-economical back-ground

Se estudiaron dos grupos de ninos sanos de bajo nivel socio-economico, beneficiarios del Servicio de Salud de Valdivia, desde su nacimiento hasta el primer ano de vida con el fin de probar la eficacia de la aplicacion de un programa de estimulacion temprana. Para ello un grupo permanecio en sus condiciones ambientales habituales y el otro recibio el programa de estimulacion. Al comparar los coeficientes de desarrollo de ambos grupos aplicando un analisis de regresion minimo cuadratica se encontraron diferencias significativas entre los valores de ambos grupos siendo mayores los indices de coeficiente de desarrollo en el grupo de estudio, sin embargo el incremento del coeficiente de desarrollo no fue significativamente distinto entre los dos grupos. Con respecto a variables de crecimiento como peso, talla, perimetro craneano no hubo diferencias en el incremento en los ninos estudiados