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.

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.

[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.

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.

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.

[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.

[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.

[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.

Galectin-9 Expression is Correlated to Cervical Squamous Cell Carcinoma Progression and Overall Survival.

Purpose: To determine whether galectin-9 gene (LGALS9) expression is correlated with cervical cancer progression, clinicopathological characteristics, and overall survival. To determine the biological processes and the abundance of tumour infiltrating immune cells related to the expression of LGALS9. Patients and Methods: The study was conducted in two phases: 1) The expression level of LGALS9 was determined using the data of 193 squamous cell carcinoma (SCC) samples from The Cancer Genome Atlas (TCGA) database. Biological processes and tumour infiltrating cells associated to LGALS9 expression were evaluated using gene set enrichment analysis (GSEA) and tumour immune estimation resource (TIMER). 2) Independently, galectin-9 was identified in 40 SCC samples by immunohistochemistry and optical density quantified using ImagePro® software. Results: The LGALS9 gene showed increased expression in cervical cancer samples. A higher expression level in SCC was related to better overall survival and to early clinical stages. GSEA showed that tumours with higher expression of LGALS9 were enriched in immune pathways such as interferon_alpha_response, and complement, the analysis of TIMER database showed a positive correlation between the expression level of LGALS9 and the abundance of tumour infiltrating immune cells. In addition, higher expression of galectin-9 was found in biopsies of SCC patients at early clinical stages, showing a trend of better survival. Conclusion: Higher expression levels of LGALS9 and galectin-9 in SCC were related to early clinical stages and better prognosis. GSEA and TIMER analysis suggested that galectin-9 could play an antitumor role in cervical SCC.

[Transculturation and validation of a Questionnaire Factors Influencing Organ Donation]. / Transculturación y validación del cuestionario Factores que influyen en la Donación de Órganos.

Background: There are validated questionnaires in Spanish that evaluate the factors that influence organ donation, but they are not designed for the open population or do not delve into various aspects such as the one proposed. Objective: Validate an instrument to evaluate the factors that influence organ donation in Mexico. Material and methods: Phase 1: Development of the instrument. Translation into Spanish of the questionnaire "Factors Inffluencing Organ Donation in Qatar", adapted by experts in donation and clinimetry. Simultaneously, the definitive version of the questionnaire "Factors that Influence Organ Donation" (FIDO) and the questionnaire "International Donor Collaborative Project" were applied to patients, relatives and staff of a tertiary hospital in Puebla, Mexico. Mind a week after 200 respondents. Cronbach's Alpha (AC) (internal consistency), Intraclass Correlation Coefficient (ICC) (external consistency), and Phi (Phi) and Chi square Coefficient (concurrent validity in intention to donate) were obtained. Results: AC and ICC by domain: Knowledge 0.625 and 0.372; Attitudes 0.776 and 0.761; Beliefs 0.649 and 0.633; Intentions 0.126 and 0.123; Phi: 0.976, Chi square: 2.358 (p = 0.125). Conclusions: The FIDO questionnaire is valid and consistent to assess knowledge, attitudes, beliefs and intentions in organ donation in the general Mexican population.

Introducción: existen cuestionarios validados en español que evalúan los factores que influyen en la donación de órganos, pero no están diseñados para población abierta o no exploran aspectos diversos como el propuesto. Objetivo: validar un instrumento para evaluar los factores que influyen en la donación de órganos en México. Material y métodos: fase 1: Elaboración del instrumento. Traducción al español del cuestionario Factors Influencing Organ Donation in Qatar, adaptado por expertos en donación y clinimetría. Se realizaron pruebas piloto hasta lograr acuerdo en dos rondas consecutivas. Fase 2: Validez y consistencia. Simultáneamente se aplicó la versión definitiva del cuestionario Factores que Influyen en la Donación de Órganos (FIDO) y el cuestionario Proyecto Colaborativo Internacional Donante a pacientes, familiares y personal de un hospital de tercer nivel de Puebla, México. Se reaplicó telefónicamente una semana después a 200 respondientes. Se utilizó alfa de Cronbach (AC) (consistencia interna), coeficiente de correlación intraclase (CCI) (consistencia externa), y coeficiente de Phi (Phi) y Chi cuadrada (validez concurrente en intención de donar). Resultados: AC y CCI por dominio: Conocimiento 0.625 y 0.372; Actitudes 0.776 y 0.761; Creencias 0.649 y 0.633; Intenciones 0.126 y 0.123; Global 0.774 y 0.675, respectivamente (p = 0.000); Phi: 0.976, Chi cuadrada: 2.358 (p = 0.125). Conclusiones: el cuestionario FIDO es válido y consistente para explorar: conocimiento, actitudes, creencias e intenciones en donación de órganos en población general mexicana.

[Training about breastfeeding in pregnant women: Effect six months after birth]. / Capacitación sobre lactancia materna en embarazadas: efecto a seis meses posteriores al nacimiento.

Background: Inadequate breastfeeding is associated to more comorbidities in children under 5 years old. One reason is deficient information in mothers. Objective: To asses immediate effect of an educational intervention about breastfeeding in pregnant women, and 6 months after child birth, and compare them with other mothers without educational intervention. Material and methods: Quasi-experimental, analytical, longitudinal study, carried out in a first level of care in Puebla with 100 pregnant patients between 36 and 40 weeks of gestation. Two groups 50 patients each were recruited. Group 1 received an educational theorical-practical intervention about breastfeeding. Group 2 preferred not receiving educational intervention. Knowledge, attitudes and practices about breastfeeding were assessed before and after training, and 6 months after child birth (Group 1), and before and 6 months after child birth (Group 2). Patients and children were attended by consulting Family Doctors. Descriptive data and Mann Whitney U test were used, p ≤ 0.05 value was considered significant. Results: Knowledge, attitudes and practices about breast feeding before training between groups were not different. Differences before and after training and 6 months after child birth in Group 1, and 6 months after child birth between groups were significant improvement (p ≤ 0.05). Conclusions: An educational theorical-practical intervention in mothers at the end of pregnancy improves breastfeeding practice during 6 months after child birth.

Introducción: la lactancia materna inadecuada se asocia a mayor morbimortalidad en menores de 5 años. Uno de los principales obstáculos es el conocimiento deficiente en la madre. Objetivo: evaluar el efecto inmediato de una intervención educativa sobre lactancia materna en embarazadas y a seis meses del nacimiento del producto, y compararlas con madres sin intervención. Material y métodos: estudio cuasiexperimental, analítico, longitudinal en pacientes embarazadas de 36 a 40 semanas de gestación, en un primer nivel de atención en Puebla, México. Se reclutaron 2 grupos de 50 pacientes. Grupo 1: recibieron una intervención educativa teórico práctica sobre lactancia materna. Grupo 2: prefirieron no recibir la intervención educativa. Se evaluaron conocimiento, actitudes y prácticas sobre lactancia materna: pre y postintervención, y seis meses después del nacimiento (grupo 1), y antes y 6 meses después del nacimiento (grupo 2). Las pacientes y sus productos fueron atendidos en consulta de Medicina Familiar. Se utilizó estadística descriptiva y U de Mann-Whitney; p ≤ 0.05 se consideró significativa. Resultados: los conocimientos, la actitud y la práctica sobre la lactancia materna preintervención no fueron diferentes entre ambos grupos. Las evaluaciones pre y postintervención y seis meses después del nacimiento en el grupo 1, y seis meses después del nacimiento entre ambos grupos mostraron mejoría significativa (p ≤ 0.05). Conclusiones: una intervención educativa teórico-práctica a madres al final del embarazo favorece la práctica de la LM durante los 6 meses posteriores al nacimiento del hijo.

Analysis of the Direct Cost of Medical and Surgical Care for Testicular Cancer in Early and Advanced Stages in a Third Level Medical Facility of the Mexican Social Security Institute.

BACKGROUND: The testicular cancer prevails in the third decade of life, the care cost increases with higher staging of the disease. OBJECTIVE: Compare the direct costs of medical and surgical attention for testicular cancer in early and advanced stages in a Third Level Medical Facility. MATERIAL AND METHODS: Process study, direct costs of medical attention are evaluated. Number of laboratory studies, imaging studies, and medical and surgical treatment were analyzed. The patients were divided into 2 groups: group 1 early stages and group 2 advanced stages. Mann Whitney U test was used for the difference between groups. RESULTS: There were 10 patients in each group, Group 1: 8 (80%) seminomas and 2 (20%) non-seminoma, Group 2: 4 (40%) seminomas and 6 (60%) non-seminomas. The average cost of care in Group 2 is higher than in Group 1, $288,827.90 and $145,911.70 Mexican pesos respectively (p=0.00578). CONCLUSIONS: The direct cost of medical attention is higher in the advanced stages compared to the early stages.

Absence of association between nailfold capillary findings and mild cognitive dysfunction in systemic lupus erythematosus.

OBJECTIVE: The role of vascular damage in cognitive dysfunction (CD) in SLE is not entirely understood. Nailfold capillaroscopy (NFC) is a noninvasive method that may aid the description of further vascular contributions to CD in SLE. Therefore, the aim of our study was to examine and compare finger nailfold capillary morphology in subjects with SLE with and without CD. METHODS: We conducted a cross-sectional study in patients with SLE. Demographic, clinical, and laboratory characteristics were collected. We evaluated nailfold capillary findings including avascular zones, hemorrhage, dilated and tortuous capillaries, disarrangement, crossing, subpapillary venular plexus, branched loops, and shortened loops by NFC. The Montreal Cognitive Assessment (MoCA) scale was used to screen cognitive function. CD was defined as a score < 26/30. RESULTS: Sixty-five females (97.0%) and 2 males (3%) with SLE were analyzed. Means of age and disease duration were 44.3 ± 12.0 years and 15.5 ± 7.6 years, respectively. Thirty-five (54.7%) patients had CD. The rate of patients with ≥ 1 NFC abnormality was 50% in both patients with and without CD (P = 0.14). Eight (22.8%) patients with CD compared to 1 without (3.5%) displayed dilated capillaries (P = 0.036). Other NFC abnormalities differed between patients with and without CD, but the possible relationships between dilated capillaries and CD disappeared after adjusting by age, diabetes, and hypertension. CONCLUSIONS: NFC findings were not associated with mild CD in patients with SLE. Our exploratory data do not support systemic microvasculopathy measured by NFC related to CD in patients with SLE.

[Dioptric power of intraocular lens and dilatation in patients with cataract]. / Poder dióptrico del lente intraocular y dilatación en pacientes con catarata.

Background: Cataract surgery with intraocular lens implant is, nowadays, the most frequent surgical procedure in all the world. Its success depends on a lot of factors, one of the most important is the calculation of the exact dioptric power of intraocular lens. Objective: To compare the calculation of dioptric power of intraocular lens with and without dilatation in patients with cataract. Material and methods: Longitudinal study, the calculation of the dioptric power of the intraocular lens was determined in patients without and with pupillary dilation. The variables were age, gender, eye to study, keratometry, axial length, anterior chamber depth and dioptric power of the intraocular lens. Descriptive statistics and Student t test were performed. Results: There were 37 patients, 23 females and 14 males. The average age was 68 + 7.87 years. Sixty-four eyes were studied, 30 were right and 34 left. Statistically, there was only significant difference in K2 of the ocular biometry between patients without and with pupillary dilation when obtaining a value of p < 0.05. Conclusion: There are no changes in the calculation of the dioptric power of the Intraocular lens without and with pupillary dilation.

Introducción: la cirugía de catarata con implante de un lente intraocular es, hoy en día, el procedimiento quirúrgico más frecuente en todo el mundo. Su éxito depende de muchos factores, uno de los más importantes es el cálculo exacto del poder dióptrico del lente intraocular. Objetivo: comparar el cálculo del poder dióptrico del lente intraocular en los pacientes sin y con dilatación pupilar. Material y métodos: estudio longitudinal, en el que se determinó el cálculo del poder dióptrico del lente intraocular en pacientes con y sin dilatación pupilar. Las variables de estudio fueron: edad, género, ojo a estudiar, queratometría, longitud axial, profundidad de cámara anterior y poder dióptrico del lente intraocular. Se realizó estadística descriptiva y t de Student. Resultados: se estudiaron 37 pacientes, 23 mujeres y 14 hombres. La edad promedio fue de 68 ± 7.87 años. Se estudiaron 64 ojos, 30 fueron derechos y 34 izquierdos. Estadísticamente solo hubo diferencia significativa en K2 de la biometría ocular entre pacientes sin y con dilatación pupilar al obtenerse un valor de p ≤ 0.05. Conclusión: no existen cambios en el cálculo del poder dióptrico del LIO sin y con dilatación pupilar.

[Security protocols adapted to COVID-19 in elective surgery thru 2021]. / Protocolos de seguridad adaptados a COVID-19 en cirugía electiva durante 2021.

Background: Medical personnel are among the populations with the most infections and morbidity and mortality during the COVID-19 pandemic worldwide. Objective: To evaluate patient and health personnel safety in anesthetic procedures of elective surgeries during COVID-19 pandemic in a 3rd level care Hospital in Puebla, Mexico. Material and methods: Descriptive, prospective, analytical study in a 3rd level care unit of the Mexican Social Security Institute in Puebla, Mexico. Elective surgeries from all shifts and any specialty, whose staff signed informed consent, were included. The modified surgical safety checklist for COVID 19, from the World Federation of Societies of Anesthesiologists, was applied. Results: 170 surgeries were evaluated, the predominant specialties were oncosurgery (39.41%), urology (25.29%) and general surgery (14.71%). The most used anesthetic technique was general anesthesia (47.05%); 10.12% accomplished safe intubation/extubation protocols, presence of essential personnel in 6.34%. The use of personal protective equipment decreased during the stages of the pandemic, the use of face masks by medical personnel/patients is the most frequent (100%). Conclusions: Security measures have decreased. Adequate security protocols must be continued to avoid new infections. Basic protection measures, the use of personal protective equipment and other protection strategies must persist.

Introducción: el personal médico ha sido de las poblaciones con mayor número de contagios y morbimortalidad durante la pandemia de COVID-19 en todo el mundo. Objetivo: evaluar la seguridad del paciente y del personal de salud en procedimientos anestésicos de cirugías electivas en tiempos de COVID-19 en un hospital de tercer nivel de atención en Puebla, México. Material y métodos: estudio descriptivo, prospectivo, analítico, en una unidad de tercer nivel de atención del Instituto Mexicano del Seguro Social en Puebla, México. Se incluyeron cirugías electivas de todos los turnos y de cualquier especialidad, cuyo personal firmó consentimiento informado. Se aplicó la lista de verificación de seguridad quirúrgica modificada para COVID-19 de la Federación Mundial de Sociedades de Anestesiólogos. Resultados: se evaluaron 170 cirugías, las especialidades predominantes fueron Oncocirugía (39.41%), Urología (25.29%) y Cirugía general (14.71%). La técnica anestésica más utilizada fue la anestesia general (47.05%); el 10.12% cumplió con los protocolos de intubación/extubación segura, mientras que la presencia de personal esencial se cumplió en el 6.34%. El uso de equipo de protección personal disminuyó durante las etapas de la pandemia, el uso de cubrebocas por personal médico/pacientes es el más frecuente (100%). Conclusiones: las medidas de seguridad han disminuido. Se debe continuar con los protocolos de seguridad adecuados para evitar contagios nuevos. Las medidas de protección básicas, el uso de equipo de protección personal y demás estrategias de protección deben persistir.

Temporal Trends in Mortality in Patients with Systemic Sclerosis in Public Hospitals Across Mexico from 1998-2017.

OBJECTIVE: To investigate national temporal trends over time in mortality rates in patients with systemic sclerosis (SSc) in Mexico between 1998 and 2017. METHODS: Deaths between 1998 and 2017 were extracted from General Board of Health Information (DGIS) Open Access datasets. 2We identified all persons aged ≥15 years with a diagnosis of SSc (ICD-10 code M34). We calculated the age-standardized mortality rate (ASMR) for SSc and non-SSc (information provided by the National Institute of Statistics, Geography, and Informatics). A Joinpoint regression model was used to determine mortality trends by sex and geographic regions. Annual percentage change (APC) and average APC (AAPC) were calculated using Joinpoint analysis. RESULTS: From 1998 to 2017, the overall ASMR of SSc increased (AAPC = 2.5%), whereas the ASMR for non-SSc remained stable. By subpopulations, females, and males with SSc had a significant uptrend in the ASMR (APC = 4.6 and 4.4%, respectively), between 1998 and 2008 for the former and between 1998 and 2010 for the later. Females had a non-significant ASMR uptrend between 2008 and 2017 and males a non-significant ASMR decline between 2010 and 2017. Women had a higher SSc-ASMR to non-SSc-ASMR ratio than males. The relative cumulative change between 1998 and 2017 differed between females (78.1%) and males (50.8%), and residents of the Southern region had the largest cumulative change (147.8%). CONCLUSIONS: SSc mortality rate increased in Mexico between 1998 to 2017, with SSc mortality higher than non-SSc mortality. However, the SSc mortality rate steeply increased in the first ten years but has plateaued in the last 10 years of the study period. Variations by sex and geographic regions were also identified.