Prevalence and characterization of undiagnosed arterial hypertension in the eastern zone of Mexico.

Arterial hypertension is considered a public health problem with severe consequences at an individual and public health levels. However, there is a lack of information regarding its characterization in Mexico. The objective of this study is to estimate the proportion of undiagnosed arterial hypertension (UAH) and the overall prevalence and clinical management of arterial hypertension within the Eastern Zone of Mexico. Additionally, we explore associated factors related with both UAH and uncontrolled arterial hypertension. We obtained information from the May Measure Month (MMM) 2019 study. People were asked for cardiovascular risk factors and blood pressure was measured according to the protocols of the European Society of Hypertension (ESH). Data from 5901 subjects were extracted: 76.04% from the Eastern Zone of the State of Mexico. The overall prevalence of hypertension was 32.4% (95% CI 31.2-33.6). From all subjects living with hypertension, 28.3% had UAH, 22.1% had previous diagnosis but were untreated; 29.3% were treated but had uncontrolled hypertension. Younger men adults living in the State of Michoacán had increased proportion of UAH and untreated hypertension. We observed that male sex, age, obesity, living at Michoacán were risk factors for UAH. Finally, male sex, diabetes, and living at Michoacán were related risk conditions for having uncontrolled arterial hypertension. In summary, there is a high proportion of UAH in Easter Zone of Mexico. Younger adults had higher proportion of UAH and untreated hypertension profiles. Efficient actions are required to make a timely diagnosis in the young adult population to prevent long-term complications.

Human-Wildlife Conflicts in the Southern Yungas: What Role do Raptors Play for Local Settlers?

Wildlife persecution due to human-wildlife conflict has become a serious concern for biodiversity conservation, especially for many endangered species. In this context, conservation approaches need to consider the socio-ecological dimensions of each particular situation. The aim of this study was to evaluate the existence, extent and social characteristics of Human-Raptor Conflicts (HRC) in the Southern Yungas region in northwestern Argentina. We conducted 115 semi-structured interviews in 21 sites and analyzed attitudes and associations between sociodemographic variables and the existence of HRC. Forty percent of interviewees showed negative attitudes towards raptors, mainly with those species considered livestock predators rather than poultry predators. A total of 11 species were regarded as conflictive because of predation on domestic animals, of which Andean condors showed the highest conflict. The only socio-demographic factor affecting conflicts was livestock and poultry rearing, independently of age, gender and occupation of interviewees. The fact that only 8.7% of interviewees reported taking direct actions towards conflictive species indicates a relatively peaceful coexistence of people with raptors. Nevertheless, negative attitudes towards Andean condor together with their extreme susceptibility to any increase in non-natural mortality indicate the need of an integral conservation approach to tackle future threats for this species' conservation in the area.

Assessing ADHD symptoms in clinical public practice: Is a reliable final diagnosis possible?

INTRODUCTION: Attention deficit and hyperactivity disorder (ADHD) rates vary between 1% and 20% depending on the type of diagnosis guide used, the test used in the assessment, psychosocial factors, and professional in charge of the assessment. GOAL: to describe and compare current clinical ADHD assessment processes in public health system in two cohorts and analyze variables related to final diagnosis. DESIGN: Descriptive, multicenter, longitudinal (retrospective-prospective). LOCATION: primary care (PC) centers in Oviedo, Asturias (Spain). PARTICIPANTS: a Spanish clinical ADHD symptomatic sample (n=134) from two cohorts (2004 and 2009). VARIABLES: clinical professional in charge of ADHD assessment (PC, mental health professional [MH], neuropediatrician [NP]), type of test used in the assessment, confirmation/disconfirmation of ADHD diagnosis, and final diagnosis. RESULTS: the use of symptoms checklists and the assessments in charge of primary care (PC) and neuropediatrician (NP) professionals show an upward trend from 2004 to 2009. ADHD final diagnosis shows low inter-professional (NP-MH) reliability (kappa=0.39). Final diagnoses for the same symptoms are different depending on the professional (NP or MH). DISCUSSIONS: the professional in charge of the assessment appears to be a relevant variable for the final diagnosis. ADHD diagnosis criteria seem not to be clear. This data suggests that ADHD diagnosis must be used with caution to ensure good quality clinical standards when assessing and treating ADHD symptoms. Assessments supported by symptoms checklists and performed by NP or PC could be contributing factors to an ADHD over-diagnosis tendency.

Medicines in the forest: Ethnobotany of wild medicinal plants in the pharmacopeia of the Wichí people of Salta province (Argentina).

ETHNOPHARMACOLOGICAL RELEVANCE: This article presents the results of a study on wild plant pharmacopeia and medical ethnobotany of the Wichí people of the South American Gran Chaco region, where native forest still persist. Few previous works on the former subjects exist, with only partial information. Traditionally, shamans are in charge of healing serious diseases and wild plants are used for treating minor problems. Some ethnobotanists believe that much of the present pharmacopeia of native peoples of the Gran Chaco comes from the Criollos (local non-native people) and that medicinal plants and uses would have been much fewer in the past. AIMS OF THE STUDY: The study aims to: a) document the wild medicinal plants used by the Wichís and the associated ethnobotanical knowledge, b) discuss the use of medicinal plants in the current sanitary, epidemiological and ethnomedical context of the Wichís, and c) analyse the similarities between the medicinal plants and uses of the Wichís and those reported for the Criollos of the study area, for the We'enhayek (Wichís of Bolivia) and for other indigenous peoples of the Gran Chaco. All of them will help to answer a general research question: are medicinal wild plants of the Wichís present pharmacopoeia long-dated or are they relatively new adquisitions? MATERIALS AND METHODS: Original data were obtained between 2005 and 2017 from 51 informants through open and semi-structured interviews, participant observation, "walks-through-the-forest" technique and gathering of plant vouchers. Consensus of Use (CU) per species, use, ailment and use-category were calculated. Species and uses of the Wichís and those reported for other groups of the region were compared confronting the data, a similarity index (Sorensen) was calculated and a cluster analysis was carried out. An interpretative analysis of the results was performed. RESULTS: Original data consist of 408 applications for which 115 plants of 48 botanical families are used for treating 68 ailments or symptoms. Species are mainly used for treating prevalent health disorders in Wichí epidemiological context (skin and digestive disorders, fever, respiratory affections) and feminine issues. CONCLUSIONS: The similarity of the current Wichí pharmacopoeia with the other ethnic groups of the region seem to respond more to a geographical proximity than to cultural affinity. Much (but not all) of their pharmacopoeia seem to be novel, resulting from a permanent seek for solutions to both old and new health problems in the native forests. Many medicinal plants, but not specific uses, seem to come from the neighbouring Criollos, whilst traditional remedies seem to be simultaneously preserved. Hence, I propose that the ethnobotanical "diversification hypothesis", slightly modified, applies in the case of wild medicinal plants of the Wichís, as new wild medicines are being added to the old ones to fill therapeutic vacancies that for several sociocultural and historical reasons appear in their traditional pharmacopoeia. Altogether, results provide novel information of interest for ethnopharmacology, medical ethnobotany and related disciplines, expand the knowledge of Wichí pharmacopoeia and constitute a baseline for future diachronic and cross-cultural studies in the Gran Chaco region.

ANÁLISIS DE LA EXPERIENCIA SUBJETIVA EN MUJERES CON CÁNCER DE MAMA / SUBJECTIVE EXPERIENCE ANALYSIS IN WOMEN WITH BREAST CANCER

En este artículo se analiza la experiencia y necesidades psicológicas presentes en el discurso de las participantes durante una intervención psicoterapéutica grupal dirigida a mujeres con cáncer de mama. Se transcriben las sesiones del grupo y se realiza un análisis del discurso, recogiendo los temas más prevalentes. Las principales dificultades psicológicas recogidas son el cambio en su imagen corporal y su sexualidad, la nueva vivencia de las relaciones interpersonales, las repercusiones del discurso social sobre la importancia de las emociones positivas, el miedo a la recidiva, las relaciones con el personal sanitario y los cambios tras la enfermedad. Se recogen aspectos que las pacientes consideran factores de ayuda en el grupo (sentirse comprendidas, ver a las compañeras como modelos de afrontamiento o cambiar su relación con la enfermedad). Se apuntan implicaciones clínicas para una mejora en la atención integral a las pacientes con cáncer de mama.

In this article the psychological experience and needs shown in the discourse of women diagnosed with breast cancer in a psychological group intervention were analyzed. The sessions are transcribed and a discourse analysis is performed, selecting the most prevailing topics. The main psychological difficulties perceived by the participants are the following: body identity change, sexuality changes, new quality of interpersonal relationships, implications of positive thinking culture, fear of recurrence, the relationship with the hospital staff, and change after diagnosis. The aspects that the group considered helpful are also addressed, i.e. feeling understood by the others, seeing the rest of participants as coping models, changing their relationship with the illness. Several clinical implications are highlighted in order to improve a comprehensive care.

[Life style and metabolic control in DiabetIMSS program]. / Estilo de vida y control metabólico en diabéticos del programa DiabetIMSS.

OBJECTIVE: To compare the lifestyle and metabolic control of diabetes patients included and not included in the DiabetIMSS program. METHODS: Subjects with diabetes in the DiabetIMSS program and the general clinic were divided into three groups: group 1 first attended the program, group 2 were enrolled during the study, and group 3 had not been included the program. Demographic and clinical aspects were measured and the IMEVID instrument was applied. RESULTS: We included 539 type-2 diabetes patients, predominantly females (73.3%), mainly of primary school level, and more frequently on double-drug therapy. There were clinical differences between the three groups for program leavers in terms of weight, waist, blood pressure, fasting glucose, HbA1c, triglycerides, and IMEVID qualification, all p < 0.05; correlation analysis of the variables with the qualification of IMEVID was significant at p < 0.05. The higher number of variable control targets was for leavers (71% of group); those who were enrolled in the study was 32%, and who had not was 17.2%. CONCLUSIONS: There are significant differences in lifestyle and control target parameters in subjects who completed the DiabetIMSS program.

Linfomas cutáneos primarios: Parte I / Primary cutaneous lymphomas: Part I

Realizamos una revisión de la bibliografía sobre los linfomas cutáneos primarios tomando como base la nueva clasificación donde EORTC y OMS aunaron conceptos y criterios para ella. Destacamos que los linfomas cutáneos de células T tienen una mayor agresividad, tienen tendencia a lesiones más generalizadas y agresivas, y dentro de los más frecuentes del grupo se encuentran la micosis fungoide con todas sus variantes y el síndrome de Sézary. El linfoma T paniculítico con fenotipo alfa/beta debe ser considerado como tal, siendo la forma gamma/delta CD4- y CD8- con coexpresión CD56 incluido en la categoría de linfoma T gamma/delta. Los linfomas cutáneos de células B son menos agresivos y sus lesiones tienen preferencia por la zona de cabeza y cuello. En ellos se debe investigar por serología, infecciones previas, en especial por Borrelia burgdorferi. Las nuevas aclaraciones sobre los diferentes linfomas B, principalmente en los primarios difusos y en los perifoliculares, facilita la elección de una terapéutica más o menos agresiva. Se avanza cada día más en el estudio de estas patologías, debiéndose realizar un estudio exhaustivo clínico y laboratorial donde se incluya el estudio inmunohistoquímico e inmunogenético, sin los cuales no se llega a realizar un acertado diagnóstico. Cada entidad definida como linfoma tiene como característica el hecho de presentar un inmunofenotipo, un inmunogenotipo y un conjunto de anormalidades moleculares que la hacen diferenciable de otro tipo de linfoma, lo que permite diagnosticarlo, estadificarlo y predecir su comportamiento biológico. Múltiples terapéuticas en uso y/o en fase de investigación cambiarán en un futuro cercano la evolución de los linfomas cutáneos primarios. Podemos mencionar los anticuerpos monoclonales. Los anti CD20 (rituximab) son los más efectivos y los más estudiados. Dentro de otros se encuentran ya en estudios avanzados alemtuzumab (anti CD52), epratuzumab (anti CD22), apolizumab (anti HLA-DR) y galiximab...

We have a bibliographic revision of primary cutaneous limphomas using the EORTC and WHO new classification in order to unify concepts. Cutaneous T cell like lymphomas (C+CL) have a higher aggressiveness with a generalized and aggressive tendency; being the most frecuents all varieties of micosys fungoide (MF) and Sézary sindrome. Those lymphomas with a/ß phenotype must be estrictly considered as a subcutaneous panniculiticlike + cell lymphoma; and those with ?/d phenotype as +/NK cell lymphoma; wich has a very agressive clinical course. Cutaneous B cell lymphomas are less aggressive and its lesions are preferably situated in head and neck, in this cases previous infections must be investigated, specially Borrelia burgdoferi infections. The new classifications of diferents B lymphomas, principally betwen primary cutaneous and folliculars, facilitates the selection of a correct therapy. The study of these pathologies advances every day. It is very important to include immunihistochemical, immunogenetic and immunophenotype studies so as rech bo the correct diagnosis and classification of the lymphomas. New therapies and new combination of therapies will offer a promising future.

Lupus eritematoso neonatal: presentación de un caso / Neonatal erythematous lupus: presentation of a case

El lupus eritematoso neonatal (LEN) es una enfermedad poco frecuente del recién nacido debida al paso transplacentario de anticuerpos maternos anti RO/SSA, anti LA/SSB y/o anti U1RNP, en la cuál las afectaciones cutáneas y cardíacas son las más destacadas. Presentamos un caso de una niña con manifestaciones dermatológicas y cardíacas tratadas en el Hospital General de Niños Pedro de Elizalde, hija de madre asintomática.