[Aswer to "Comment on article "Bibliometric analysis of scientific publications on COVID-19 elaborated by staff of the Instituto Mexicano del Seguro Social""]. / Respuesta a "Comentario al artículo "Análisis bibliométrico de las publicaciones científicas sobre COVID-19 realizadas por personal IMSS"".

We thank the group headed by Jorge Valencia Alonso for taking the time to review in detail and prepare the letter about our article entitled: " Bibliometric analysis of scientific publications on COVID-19 elaborated by staff of the Instituto Mexicano del Seguro Social", which has recently been published in the Medical Journal of the Mexican Social Security Institute. Based on your observations and comments, we allow ourselves to make the following clarifications following the same sequence of your letter to the Editor.

Agradecemos al grupo encabezado por Jorge Valencia Alonso por tomarse el tiempo para revisar con detalle y elaborar la carta sobre nuestro artículo titulado: "Análisis bibliométrico de las publicaciones científicas sobre COVID-19 por personal del IMSS", que recientemente se ha publicado en la Revista Médica del Instituto Mexicano del Seguro Social. De acuerdo con sus observaciones y comentarios, nos permitimos realizar las siguientes aclaraciones siguiendo la misma secuencia de su carta al Editor.

A Multimodal Strategy to Reduce the Risk of Hospitalization/death in Ambulatory Patients with COVID-19.

BACKGROUND: Different interventions have been implemented worldwide for the house-hold monitoring of patients with mild COVID-19 to reduce the burden of healthcare systems and guarantee quality of care. Telephone follow up and treatment kits have not been evaluated in the context of a national-wide primary care program. AIM OF THE STUDY: To compare the risk of hospitalization and death for COVID-19 between ambulatory patients who received and those who did not receive a treatment kit and telephone follow-up in a developing country METHODS: A two-group comparative analysis was conducted using data from the medical information systems of the Mexican Institute of Social Security. We included a total of 28,048 laboratory-confirmed SARS-CoV-2 patients: 7,898 (28.2%) received a medical kit and 20,150 (71.8%) did not. The incidence rates of hospitalization and death combined were calculated. To identify significant associations between hospitalization or death and treatment medical kits, we calculated the risk ratios using a multivariate logistic model. RESULTS: The incidence of hospitalization was 6.14% in patients who received a kit and 11.71% in those who did not. Male sex, age, and a medical history of obesity, hypertension, diabetes, immunosuppression, or kidney disease were associated with increased risk of hospitalization or death. The risk rates were reduced in patients who received a medical kit or telephone follow-up. In the multivariate model, receiving a medical kit was associated with a lower risk of hospitalization or death from COVID-19: adjusted risk ratio 0.41 (95% confidence interval 0.36-0.47). CONCLUSION: Use of a multimodal strategy may reduce the risk of hospitalization and death in adult outpatients with mild COVID-19.

[Bibliometric analysis of scientific publications on COVID-19 elaborated by staff of the Instituto Mexicano del Seguro Social]. / Análisis bibliométrico de las publicaciones científicas sobre COVID-19 realizadas por personal IMSS.

Background: Since the beginning of the pandemic, new knowledge about COVID-19 obtained by research has been disseminated in medical and scientific journals, but the large number of publications that have been generated in such a short time has been impressive. Objective: To perform a bibliometric analysis of the published articles in medical-scientific journals carried-out by the Mexican Social Security Institute (IMSS) personnel on COVID-19. Material and methods: Systematic review of the literature, identifying the publications included in the PubMed and EMBASE databases, up to September 2022. Articles on COVID-19 were included, in which at least one author had IMSS affiliation; there was no restriction on the type of publication, so original articles, review articles, clinical case reports, etc. were included. The analysis was descriptive. Results: 588 abstracts were obtained, of which 533 full length articles met the selection criteria. Most were research articles (48%), followed by review articles. Mainly clinical or epidemiological aspects were addressed. They were published in 232 different journals, with a predominance of foreign journals (91.8%). Around half of the publications were carried out by IMSS personnel together with authors from other institutions, national or foreign. Conclusions: The scientific contributions prepared by IMSS personnel have contributed to understanding clinical, epidemiological and basic aspects of COVID-19, which has had an impact on improving the quality of care for its beneficiaries.

Introducción: desde el inicio de la pandemia los nuevos conocimientos sobre COVID-19 han sido difundidos en revistas médico-científicas, y ha sido impresionante la gran cantidad de publicaciones que se ha generado en tan poco tiempo. Objetivo: realizar un análisis bibliométrico de los artículos publicados en revistas médico-científicas elaborados por personal del Instituto Mexicano del Seguro Social (IMSS) sobre COVID-19. Material y métodos: revisión sistemática de la literatura, identificando las publicaciones incluidas en las bases de datos PubMed y EMBASE, hasta septiembre de 2022. Se incluyeron los artículos sobre COVID-19 en los que al menos un autor tuviera adscripción IMSS, sin restricción del tipo de publicación, por lo que se incluyeron artículos originales, de revisión, reportes de casos clínicos, etc. El análisis fue de tipo descriptivo. Resultados: se obtuvieron 588 resúmenes, de los cuales 533 artículos cumplieron con los criterios de selección. La mayoría correspondió a artículos de investigación y revisión. Principalmente se abordaron aspectos clínicos o epidemiológicos. Se publicaron en 232 revistas diferentes, predominando revistas extranjeras (91.8%). Alrededor de la mitad de las publicaciones fueron realizadas por personal del IMSS en conjunto con autores de otras instituciones, nacionales o extranjeras. Conclusiones: las aportaciones científicas elaboradas por personal del IMSS han contribuido a conocer aspectos clínicos, epidemiológicos y básicos sobre COVID-19, lo cual ha impactado en la mejora de la calidad de atención de sus derechohabientes.

[Validation of a clinical nutritional sucking scale]. / Validación de una escala clínica de la succión nutricia.

OBJECTIVE: Suck dysfunction in breastfeeding infants has an impact on their appropriate nutrition. The objective was to build and validate one clinical nutritional sucking scale in the components of sucking, swallowing, and respiration. METHODS: The scale was carried out in two phases: face-validity and psychometric validity. The first was done by expert consensus. For the second phase, 179 infants (153 healthy newborn and 26 infant less than 6 month of age) and 86 infants with high risk for abnormal sucking were evaluated with the new scale. Three observers evaluated all patients during their feeding. With an initial scale of 10 items we calculated the inter-observer concordance and the internal consistence. With an analysis of the mail components and a discrimination index we reduced to pertinent items. Each component of the scale was compared with clinical variables. RESULTS: We reached a 7 items scale, which showed high reliability (Cronbach's alpha of 0.77 and inter-observer concordance of 0.98. The suck component correlated positively with the ingested volume (Ro = 0.61), the swallow component with the peripheral oxygen saturation (Ro = 0.24), and the breath component with the respiratory frequency (Ro = 0.50). With this scale, we can establish different patterns of sucking abnormalities related with history of neurological abnormalities, hemodynamic alteration and immaturity. CONCLUSIONS: In this study the clinical nutritional scale showed to be reliable and valid for its use in sucking problems classification. More studies are required to evaluate its application for oral stimulation therapies.

Introducción: la disfunción de la succión nutricia de los lactantes incide en la eficiencia de su alimentación. El objetivo fue construir y validar una escala clínica para evaluar la succión nutricia en sus componentes de succión-deglución-respiración. Métodos: se llevó a cabo en dos fases: validación de apariencia y validación psicométrica. La primera se validó por consenso de expertos. La segunda con su aplicación en 179 lactantes (153 recién nacidos sanos y 26 lactantes < seis meses de edad) y 86 lactantes con alto riesgo de alteración de la succión. Todos fueron valorados por tres evaluadores durante una alimentación. Con una escala inicial de 10 ítems se calculó la concordancia interobservador y la consistencia interna. Se determinaron los ítems más pertinentes. Cada componente de la escala se comparó con variables clínicas. Resultados: se obtuvo una escala de siete ítems, la cual mostró alta consistencia (alfa de Cronbach de 0.77) con una concordancia interobservador de 0.98. El componente de la succión se correlacionó positivamente con el volumen ingerido (Ro = 0.61); el de la deglución, con la saturación periférica (Ro = 0.24), y el de la ventilación, con la frecuencia respiratoria (Ro = 0.50). Con la escala se establecieron patrones de alteración según antecedentes de afección neurológica, estabilidad hemodinámica e inmadurez. Conclusión: esta escala es consistente y válida para la clasificación de problemas de la succión. Se requieren más estudios para evaluar su aplicación en la evaluación de terapias de estimulación oral.

Economic evaluation of the use of exogenous pulmonary surfactants in preterm newborns in a Mexican population.

OBJECTIVE: To estimate the cost-effectiveness ratio of surfactant rescue treatment of premature infants with respiratory distress syndrome (RDS) who are covered by the Medical Insurance for a New Generation. MATERIALS AND METHODS: A cost-effectiveness evaluation was conducted from the third-payer perspective. Comparisons were made between the use of bovine surfactant (BS) therapy and without BS therapy. A decision tree model with a lifetime horizon was used where the measurements of effectiveness were life years gained (LYG) and quality-adjusted life years (QALYs). A 5% discount rate was considered for costs and health outcomes. All costs are expressed in Mexican pesos 2009. RESULTS: Incremental cost-effectiveness ratios (ICER) were MXN$136,670 per LYG and MXN$125,250 per QALY. CONCLUSION: Surfactant therapy was confirmed as a cost-effective strategy in accordance with World Health Organization criteria of three per capita gross domestic product (GDP) per QALY in premature infants with RDS in Mexico.

Tendencia mundial de la supervivencia en pacientes pediátricos con leucemia linfoblástica aguda: Revisión de las últimas cuatro décadas / Global trend of survival in pediatric acute lymphoblastic leukemia: a review of the last four decades

Introducción. La leucemia linfoblástica aguda es la neoplasia maligna más frecuente en la infancia. En la actualidad, el impacto de la quimioterapia ha resultado en una mayor supervivencia, aunque los resultados son diferentes entre los países. Metodología. Se revisó la literatura médica disponible en Medline sobre el informe de supervivencia global y supervivencia libre de enfermedad en niños con leucemia linfoblástica aguda, desde finales de los años setenta hasta el 2007. Se analizó la supervivencia de acuerdo con el desarrollo económico del país (países desarrollados y en vías de desarrollo), y por edad, sexo, tipo celular y cuenta leucocitaria al diagnóstico. Resultados. En países desarrollados se ha observado un incremento en la supervivencia global a cinco años, de 60% en 1984 a 83.5% en el 2007, y en la supervivencia libre de enfermedad, de 48.5% a 83.5%. En los países en desarrollo, hasta el 2006, el promedio de supervivencia global y libre de enfermedad continuaba en, aproximadamente, 60%. La supervivencia con respecto a la edad es más favorable en los niños de 1 a 9 años (>80%) que en los mayores de 10 años (70-80%). Con respecto al sexo es 5% mayor en las mujeres que en los varones; con respecto al tipo celular es 10% mayor en leucemias de células B que en células T y, de acuerdo con la cifra de leucocitos, cuando la cifra resulta <10,000 mm³ al diagnóstico es 20% mayor que cuando los valores son >10,000 mm³. Existe escasa información para los países en desarrollo. Conclusiones. La supervivencia de los pacientes con leucemia linfoblástica aguda sigue en aumento, sobre todo la supervivencia libre de enfermedad. Los factores pronóstico de edad, sexo, tipo celular y celularidad continúan siendo válidos. Es necesario realizar más estudios en países en vías de desarrollo.

Background. Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. The impact of chemotherapy has resulted in improved survival, although results have not been the same for all countries. Methods. We reviewed the available medical literature in Medline on reports of overall and disease-free survival in children with ALL from the late 1970s to 2007. Survival was analyzed according to economic development (developed and developing countries) and according to age, sex, cell type and leukocyte count at diagnosis. Results. In developed countries there has been an increase in overall 5-year survival from 60% in 1984 to 83.5% in 2007 and for disease-free survival from 48.5% to 83.5%. This was not registered in developing countries where until 2006 the average overall survival and disease-free survival was ~60%. At diagnosis, prognostic factors related with higher survival rates are age (1 to 9 years), sex (females), type of leukemia (B-cell leukemia) and leukocyte count <10,000 mm³. Information regarding survival rates is very scarce. Conclusions. Survival of children with ALL is increasing, particularly disease-free survival rates. Prognostic factors related to survival are age, sex, cell type and leukocyte count. Further studies are needed in developing countries.

Economic evaluation of the use of exogenous pulmonary surfactants in preterm newborns in a Mexican population / Evaluación económica de la utilización de surfactantes pulmonares exógenos en recién nacidos pretérmino en población mexicana

OBJECTIVE: To estimate the cost-effectiveness ratio of surfactant rescue treatment of premature infants with respiratory distress syndrome (RDS) who are covered by the Medical Insurance for a New Generation. MATERIALS AND METHODS: A cost-effectiveness evaluation was conducted from the third-payer perspective. Comparisons were made between the use of bovine surfactant (BS) therapy and without BS therapy. A decision tree model with a lifetime horizon was used where the measurements of effectiveness were life years gained (LYG) and quality-adjusted life years (QALYs). A 5% discount rate was considered for costs and health outcomes. All costs are expressed in Mexican pesos 2009. RESULTS: Incremental cost-effectiveness ratios (ICER) were MXN$136670 per LYG and MXN$125250 per QALY. CONCLUSION: Surfactant therapy was confirmed as a cost-effective strategy in accordance with World Health Organization criteria of three per capita gross domestic product (GDP) per QALY in premature infants with RDS in Mexico.

OBJETIVO: Estimar la razón de costo efectividad incremental del tratamiento de surfactante de rescate en pacientes pretérmino con Síndrome de Dificultad Respiratoria (SDR) cubiertos por el Seguro Médico para una Nueva Generación. MATERIAL Y MÉTODOS: Evaluación de costo-efectividad desde la perspectiva del tercer pagador. Los comparadores fueron la terapia de surfactante bovino y la alternativa de no emplear ésta. Se utilizó un árbol de decisión que consideró la esperanza de vida como horizonte temporal y las medidas de efectividad fueron los años de vida ganados (AVG) y los años de vida ajustados por calidad de vida ( AVAC).Resultados en pesos mexicanos del 2009. RESULTADOS: Las RCEI por AVG y AVAC fueron de MXN$136670 y MXN$125250. CONCLUSIÓN: La razón de costo por AVG y AVAC para la terapia de surfactantes en pacientes prematuros con SDR en México fue menor a tres veces el PIB per cápita, por lo que es una estrategia costo-efectiva según los criterios de la OMS.

[The pediatric patient at the end-of-life. A challenge for its identification and treatment. A survey in pediatricians and medical residents]. / El paciente pediátrico en etapa terminal: un reto para su identificación y tratamiento. Encuesta a médicos pediatras y residentes.

BACKGROUND: Identification of pediatric patients at the end-of-life is not easy because criteria used are based on adults' criteria. OBJECTIVES: In this survey we explore the children end-of-life definition pediatricians have, as well as to determine which interventions they use when caring a patient at end-of-life. SETTING: Tertiary referral pediatric hospital. PARTICIPANTS: Staff pediatricians (SP) and medical residents (MR). METHODS: A self-administrated questionnaire was built and validated. It contains five vignettes of pediatric patients: Two with WHO criteria for an end-of-life condition (EC) and three without an end-of-life condition (NEC). PARTICIPANTS identified each patient with or without an end-of-life condition, and which palliative actions they would perform accordingly Their responses were recorded in a 4-option Likert scale. Ordinal regression was used to assess if some of the participants' characteristics were related to the identification of an end-of-life condition. RESULTS: Response rate was 84.2% (128/152); of whom 63 were SP and 65 MR. EC cases were well identified in 90 and 93%, while NEC in 30 and 40%, respectively Palliative actions were more according in EC patients, but around 20% would not provide them. Among NEC patients, there were more disparities of palliative actions to be delivered, and it was statistically significantly. Ordinal regression showed that some participants' characteristics are associated to the appropriate identification of end-of-life patients; however, these factors were not consistent across the five scenarios. CONCLUSIONS: Among pediatricians, criteria of end-of-life conditions are not well established, neither the palliative actions. Educational interventions are needed to improve the quality of life of these children.

[Systematic review to assess the effectiveness and safety of parecoxib]. / Revisi6n sistemática para determinar la efectividad y seguridad de parecoxib.

OBJECTIVES: Conduct a meta-analysis of randomized clinical trials to assess the effectiveness and safety of parecoxib as analgesic for orthopedic surgery. MATERIAL AND METHODS: The search strategy included Medline, Embase and Cochrane. Two independent investigators selected the trials. The meta-analyses were performed using the RevMan v.5.0 software. Calculations were based on the similarity of the trials considering the parecoxib dose (20 or 40 mg) and the type of comparator (placebo, other analgesics). RESULTS: A total of 1253 titles were reviewed and 10 trials that assess parecoxib for hip, knee and spine surgery and bunionectomy were selected. In 6/10 trials parecoxib 40 mg did better in the overall assessment versus the placebo (OR 0.20; 95% CI, 0.13-0.31), in the frequency of rescue analgesic use (OR 0.18; 95% CI, 0.07-0.47) as well as in the use of morphine and in pain intensity at 48 hours (p < 0.001). Three trials did not show any difference between parecoxib and ketorolac, morphine, metamizole or paracetamol. Regarding safety, the frequency of adverse events with parecoxib was similar to the placebo or other analgesics. CONCLUSIONS: Parecoxib 40 mg is an effective and safe analgesic choice during the postoperative period in orthopedic surgery.

Security and maximal tolerated doses of fluvastatin in pediatric cancer patients

Background. The role of cholesterol in neoplasic cell growth and its inhibition by drugs has recently been studied. Cholesterol biosynthesis inhibitors have been used as adjuvants in the treatment of cancer and possibly as prophylactic in carcinogenesis. objetive. The objetive of the study was to determine the maximal tolerated doses (MTD) and toxic effects of fluvastatin in pediatric cancer patients. Methods. This study was carried out in a thirid level Social Security Hospital in Mexico City. We included pediatric patients from april 1996 to May 1997. All were terminal cancer patients who did not respond to conventional therapies. Fluvastatin was give p.o. at doses of 2 mg/kg/day dor 14 days every 4 weeks in three patients. Subsequent cohorts of three patients each had increments of 2 mg/kg/day of the drug until maximal tolerated doses were found. Toxic effects of the drug were evaluated by physical exploration, laboratory assays and a questionnaire given to each patient. Results. Twelve patients were included. Diagnoses included two osteosarcomas, eight central nervous system tumors, one lung tumor, and one Ewing's sarcoma. Ten patients died within 1 to 18 months. Two are aolive 22 months after inclusion into the study, both with anaplasic astrocytoma. A total of 27 courses wer administered. The MTD was 8 mg/kg/day. Toxic effects were insomnia, nausea, vomiting, abdominal distention and myalgias. Txocicity was dose-dependent. Laboratory assays demonstrated no significant changes during treatment. Conclusions. Fluvastatin can be safely used at doses of 8 mg/kg/day in pediatric patients with cancer. This dose should be used in additional trials

Impacto del Programa Hospitalario Amigo del Niño y de la Madre en un hospital del Instituto Mexicano del Seguro Social / Impact of the Program Hospital Fried of the Child and Mother at an Institutes of Social Security (Mexico) Hospital

La frecuencia de lactancia en nuestro país varía entre 13 y 80 por ciento y se ha observado que existe una tendencia a la diminución con el transcurso del tiempo. Uno de los propósitos del Programa Hospital Amigo del Niño y de la Madre (PHANM) es favorecer la lactancia pero hasta el momento no se ha evaluado su impacto. Se comparó la frecuencia de lactancia entre las madres que recibieron el PHANM y las que no lo recibieron, en el área de influencia del HGZ 1-A "Los Venados", e identificar los factores que pudieron haber influido para la lactancia. Se realizó un estudio transversal analítico, con madres que tenían un hijo entre 6 y 12 meses de edad, que acudieron a la consulta externa del HGZ 1-A y las UMNF 10, 15 y 43, durante el periodo de estudio. A las madres se les invitó a participar para llevar a cabo una entrevista donde se investigó la edad de la madre, estado civil, nivel socioeconómico, escolaridad y número de hijos. Se interrogó sobre el sitio de atención de la resolución del últim embarazo, sobre los puntos del PHANM, si se amamantó, el tiempo de amamantamiento, las causas de no realizarlo, además de algunos conocimientos sobre la lactancia. El cuestionario en una primera fase se validó para que fuera comprensible al momento de su aplicación y se llevó a cabo por una sola persona. En el momento de la entrevista no se conocía si la madre había amamantado o no. Se calculó el tamaño de muestra con 261 madres. El análisis estadístico fue de tipo descriptivo; para comparación de promedio se utilizó, para la comparación de proporciones chi-cuadrada y cálculo de razón de momios con IC al 95 por ciento. Se entrevistaron 262 madres. La entrevista se realizó en 211/262 (80.5 por ciento) en la UMF y el resto en el HGZ. Mediana de edad 26 años, 78.6 por ciento eran casadas, mediana de escolaridad, ocho años; 74 por ciento, nivel socioeconómico bueno ; 70 por ciento amas de casa. El número de hijos varió de 1 a 6, 48 por ciento tenían sólo un hijo; la edad promedio del último hijo al momento de la entrevista, 11 meses. La resolución del último embarazo ocurrió en el 76.3 por ciento en un hospital del IMSS...