Genetic gains in IRRI's rice salinity breeding and elite panel development as a future breeding resource.

KEY MESSAGE: Estimating genetic gains and formulating a future salinity elite breeding panel for rice pave the way for developing better high-yielding salinity tolerant lines with enhanced genetic gains. Genetic gain is a crucial parameter to check the breeding program's success and help optimize future breeding strategies for enhanced genetic gains. To estimate the genetic gains in IRRI's salinity breeding program and identify the best genotypes based on high breeding values for grain yield (kg/ha), we analyzed the historical data from the trials conducted in the IRRI, Philippines and Bangladesh. A two-stage mixed-model approach accounting for experimental design factors and a relationship matrix was fitted to obtain the breeding values for grain yield and estimate genetic trends. A positive genetic trend of 0.1% per annum with a yield advantage of 1.52 kg/ha was observed in IRRI, Philippines. In Bangladesh, we observed a genetic gain of 0.31% per annum with a yield advantage of 14.02 kg/ha. In the released varieties, we observed a genetic gain of 0.12% per annum with a 2.2 kg/ha/year yield advantage in the IRRI, Philippines. For the Bangladesh dataset, a genetic gain of 0.14% per annum with a yield advantage of 5.9 kg/ha/year was observed in the released varieties. Based on breeding values for grain yield, a core set of the top 145 genotypes with higher breeding values of > 2400 kg/ha in the IRRI, Philippines, and > 3500 kg/ha in Bangladesh with a reliability of > 0.4 were selected to develop the elite breeding panel. Conclusively, a recurrent selection breeding strategy integrated with novel technologies like genomic selection and speed breeding is highly required to achieve higher genetic gains in IRRI's salinity breeding programs.

A longitudinal prospective study of active tuberculosis in a Western Europe setting: insights and findings.

PURPOSE: This study investigates the potential of inflammatory parameters (IP), symptoms, and patient-related outcome measurements as biomarkers of severity and their ability to predict tuberculosis (TB) evolution. METHODS: People with TB were included prospectively in the Stage-TB study conducted at five clinical sites in Barcelona (Spain) between April 2018 and December 2021. Data on demographics, epidemiology, clinical features, microbiology, and Sanit George Respiratory Questionnaire (SGRQ) and Kessler-10 as Health-Related Quality of Life (HRQoL) were collected at three time points during treatment. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil/lymphocyte, and monocyte/lymphocyte ratios (NLR and MLR), complement factors C3, C4, and cH50, clinical and microbiological data, and HRQoL questionnaires were assessed at baseline, 2 months, and 6 months. Their ability to predict sputum culture conversion (SCC) and symptom presence after 2 months of treatment was also analysed. RESULTS: The study included 81 adults and 13 children with TB. The CRP, ESR, NLR, and MLR values, as well as the presence of symptoms, decreased significantly over time in both groups. Higher IP levels at baseline were associated with greater bacillary load and persistent symptoms. Clinical severity at baseline predicted a delayed SCC. Kessler-10 improved during follow-up, but self-reported lung impairment (SGRQ) persisted in all individuals after 6 months. CONCLUSIONS: IP levels may indicate disease severity, and sustained high levels are linked to lower treatment efficacy. Baseline clinical severity is the best predictor of SCC. Implementing health strategies to evaluate lung function and mental health throughout the disease process may be crucial for individuals with TB.

Prognostic Impact of Atrial Fibrillation Pattern and other Clinical Biomarkers in Patients with Stroke Admitted in a Tertiary Hospital in Cebu City from 2015-2022.

Background: The effect of atrial fibrillation (AF) patterns and clinical biomarkers among patients with AF-related stroke is still controversial. Objectives: The objective of this study is to determine the association of the pattern of AF and markers on routine blood tests with the outcome of patients after an AF-related stroke. Methods: This is a retrospective cohort study of patients with stroke and AF admitted in a tertiary hospital in Cebu City from 2015-2022. Patients' baseline characteristics, laboratory tests, ECG, and radiologic data were collected. Descriptive statistics such as mean and frequency were computed. The Kaplan-Meier method and the log-rank test were used to calculate the incidence time. The Cox regression analysis was used to determine factors associated with survival. A stepwise regression technique was used in model building. Results: The mortality rate of patients with AF-related stroke was 0.02. A Kaplan Meier survival estimate shows that patients with paroxysmal AF have better survival. Upon model building of variables, age, red cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet count, low density lipid cholesterol (LDL-C), and pattern of AF were predictive of mortality in patients with AF-related stroke. Conclusions: Among AF-related stroke patients admitted at a tertiary hospital in Cebu City, pattern of AF, age, RDW, NLR, platelet count, and LDL-C were associated with mortality. The parameters associated with increased mortality could be easily assessed using an ECG, CBC, and lipid profile. These are all readily available and cost-efficient.

Predictors for Hemorrhagic Transformation among Patients with Ischemic Stroke Admitted in a Tertiary Hospital in the Philippines from July 2018-July 2019.

Background: Among the multiple scoring systems for hemorrhagic transformation, only few of these address spontaneous hemorrhagic transformation after an ischemic stroke, with most done with Western population data. Objectives: This study aims to identify the predictors for hemorrhagic transformation among patients with ischemic stroke admitted in a tertiary hospital in Cebu City, Philippines. Methods: This is a retrospective cohort study of patients with ischemic stroke admitted in a tertiary hospital in Cebu City. Patients' baseline characteristics, clinical, and radiologic data were collected. Chi square test and t-test were used to determine which variables were significantly different between patients with and without hemorrhagic transformation. Odds ratio (OR) and 95% confidence interval (CI) were determined to measure the association between the different variables and hemorrhagic transformation. Results: A total of 500 ischemic stroke patients were included in the study. There were 28 (6%) ischemic stroke patients with Hemorrhagic Transformation. The mean age of these patients is 66.93 ± 12.42 years, 48.8% male, 10.8% had atrial fibrillation, and 2.4% had myocardial infarction. Controlling for the effect of confounders, white blood cell count (OR 1.11; 95% CI 1.03-1.19), myocardial infarction (OR 5.25; 95% CI 1.13-24.34), and presence of brain edema (OR 2.86; 95% CI 1.05-7.80) were significant predictors of hemorrhagic transformation. Conclusion: White blood cell count, presence of brain edema, and myocardial infarction were significantly associated with hemorrhagic transformation among ischemic stroke patients.

Combined application of entomopathogenic fungi and predatory mites for biological control of Tetranychus urticae on chrysanthemum.

BACKGROUND: Most studies on efficacy of fungal pathogens and predatory mites against Tetranychus urticae have been done on individual species in the laboratory. We evaluated fungi and predatory mites separately and together against glasshouse populations of T. urticae on chrysanthemum plants. First, effectiveness of the fungal pathogens Beauveria bassiana (Bb88) and Metarhizium anisopliae (Ma129) was compared; then, effectiveness of the predatory mites Phytoseiulus persimilis and Neoseiulus californicus. Based on the results, N. californicus and isolate Ma129 were selected and evaluated in combination. In all experiments, treatment effects were assessed for eggs and motile stages of T. urticae. RESULTS: The first experiment showed no significant effect of either fungal isolate on T. urticae populations, except on plants initially infested with 20 mites, where more eggs were found in the control compared to the fungal treatments. In the second experiment, both predatory mites were equally effective at reducing T. urticae populations compared with the control, regardless of initial T. urticae population density. The last experiment demonstrated that populations of T. urticae were reduced most when M. anisopliae (Ma129) and N. californicus were applied together, compared with the control and when each natural enemy was applied separately. CONCLUSIONS: Metarhizium anisopliae (Ma129) and B. bassiana (Bb88) isolates did not have a significant effect on reducing T. urticae populations. Both predatory mites reduced T. urticae populations, regardless of T. urticae density. Combined application of M. anisopliae (Ma129) and N. californicus were more effective against T. urticae than the control or when each agent was applied separately. © 2024 Society of Chemical Industry.

Types of Temporary Immersion Systems Used in Commercial Plant Micropropagation.

Technological innovation in the design and manufacture of temporary immersion systems (TIS) has increased in the past decade. Innovations have involved the size, fitting, and replacement of components, as well as manufacturing materials. Air replacement by compressor has also been substituted by air replacement by preset tilting/rotation of culture bottles. This design modification aims to increase the biological yield (number of shoots) produced in these bottles and reduce manufacturing costs. However, the operative principle has remained unchanged through time: promote an environment where explant immersions in the culture medium are programmable. The changes in the TIS design involve advantages and disadvantages, generating the efficiency of one type over another. However, validation to identify the most effective type of TIS should be carried out for each plant species. This chapter lists the different types of temporary immersion available on the market, emphasizing the advantages and disadvantages of each when used for plant micropropagation.

Propuesta para manejo de la coagulopatía asociada a la COVID-19 en adultos / A proposal for the management of COVID-19-induced coagulopathy in adults

Resumen La infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) es la causante de la pandemia de enfermedad por coronavirus 2019 (COVID-19), con un índice de letalidad alto. La mayoría de los pacientes graves desarrollan un tipo especial de coagulopatía no descrito hasta ahora y la cual se considera ahora la principal causa de muerte. Por esta razón, el tratamiento anticoagulante se ha convertido en una de las piedras angulares del tratamiento de esta infección. Sin embargo, la velocidad con la que se genera la evidencia respecto al uso de anticoagulantes es muy rápida y, en ocasiones difícil de interpretar y contradictoria. Luego de hacer una revisión extensa de la literatura publicada, se hace esta propuesta para el uso del tratamiento anticoagulante tomando en cuenta los recursos disponibles en México.

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the cause of the coronavirus disease 2019 (COVID-19) pandemic, which has a high case fatality rate. Most severely ill patients develop a special type of coagulopathy that had not been described before and that is now considered the main cause of death. For this reason, anticoagulant treatment has become one of the cornerstones of the treatment of this infection. However, the rate at which the evidence regarding the use of anticoagulants is generated is quite fast, and sometimes it is difficult to interpret and conflicting. After having performed an extensive review of the published literature, this proposal for the use of anticoagulant treatment is made, taking into account available resources in Mexico.

Ectasia ductal mamaria, una entidad poco frecuente en la edad pediátrica: A propósito de un caso / Duct ectasia, an infrequent condition in childhood: A case report

La secreción sanguínea a través del pezón (telorragia) es un síntoma muy poco frecuente y que genera gran alarma en pediatría por su relación con el carcinoma en la edad adulta. La entidad más frecuente asociada en edades tempranas, de naturaleza benigna y autolimitada, es la ectasia ductal mamaria. Se caracteriza por la dilatación del conducto mamario, fibrosis e inflamación periductal. La etiología es desconocida y multifactorial. Son pocos casos los descritos en la literatura científica. Se presenta a un lactante de 5 meses con telerragia por ectasia ductal mamaria, cuya resolución fue espontánea a las 4 semanas. Nuestro objetivo es facilitar el rápido reconocimiento por parte de los médicos, dar a conocer esta patología tan poco frecuente y, así, evitar estudios y tratamientos agresivos e invasivos innecesarios.

Bloody discharge from the nipple (thelorrhagia) is a rare symptom in childhood and is a cause of great concern due to the association with carcinoma in adults. The most common cause in children is mammary duct ectasia, which is a benign and self-limiting condition. It is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation. The etiology has not been identified and is multifactorial. Up to date, only isolated case reports have been published. Therefore, we present a review of the literature and we report a case of a fivemonth- old male infant that resolves spontaneously. We aimed to improve physicians’ diagnosis accuracy, the knowledge of this condition and to avoid aggressive studies and treatments.

Un caso inusual de síndrome de enterocolitis inducida por proteínas alimentarias / Unusual case of food protein-induced enterocolitis syndrome

El síndrome de enterocolitis inducido por proteínas alimentarias es un síndrome de hipersensibilidad gastrointestinal a alimentos no mediado por inmunoglobulina E, que, en su forma aguda, se manifiesta con vómitos repetitivos, palidez e hipotonía, que puede acompañarse o no de diarrea y producir un cuadro grave de deshidratación y letargia. Una prueba de provocación oral controlada es, en ocasiones, realizada para confirmar el diagnóstico y el tratamiento consiste en la eliminación del alimento causante. Se presenta el caso de un lactante de 3 meses con varios episodios de síndrome de enterocolitis tras la toma de biberón de leche de fórmula de inicio con tolerancia de otra marca comercial. Se encontraron diferencias en los ingredientes de su composición que podrían ser el origen de la sensibilización.

Food protein-induced enterocolitis syndrome is a nonimmunoglobulin E mediated gastrointestinal food hypersensitivity that manifests as profuse, repetitive vomiting, pallor and hypotonia, often with diarrhea leading to severe dehydration and lethargy (sepsis-like symptoms) in the acute setting. An oral food challenge is sometimes performed to confirm the diagnosis and treatment consists of elimination of the food trigger(s) from the diet. We report a case of a 3-months-old infant with several episodes of food protein-induced enterocolitis syndrome after taking infant formula milk with tolerance of another trademark. Differences in the composition of its ingredients could be the cause of the sensitization.

Acceso oportuno al test de Elisa en el nivel primario de salud: una mirada desde los profesionales de salud / Timely access to ELISA test in the primary health level: a health professionals' view

Introdución: el Sindrome de Inmunodeficiencia Adquirida (VIH) sigue siendo un importante problema de salud pública a nivel mundial, ya que ha causado más de 34 millones de muertes hasta la fecha. Objetivo: conocer las barreras y facilitadores de un grupo personas que solicitan el test Elisa para el diagnóstico del Virus de Inmunodeficiencia Adquirida (VIH) en la atención primaria de salud, desde la perspectiva de los profesionales de la salud que trabajan en estos lugares. Métodos: estudio cualitativo descriptivo basado en el enfoque de análisis de contenido descrito por Krippendorff. Se realizaron entrevistas en profundidad a 30 profesionales de la salud que trabajan en dos Centros de Salud Familiar (CESFAM) de la comuna de La Pintana, Santiago de Chile. Para mantener el rigor metodológico se utilizaron los criterios de Guba & Lincoln. Resultados: se identificaron factores asociados al acceso oportuno al test de Elisa percibidas por los profesionales, entre ellos algunos que dificultan y otros que facilitan (Estigma social del VIH, burocracia en el proceso de toma del test de Elisa y falta de privacidad en la solicitud del test, relación de confianza entre usuario y profesional, y centralización del examen en los CESFAM). Conclusiones: el conocimiento de los factores tanto que facilitan como que dificultan mencionado por los profesionales que trabajan en centros donde se realiza la toma del test de Elisa debe ser considerada en el diseño e implementación de nuevas estrategias y en la modificación de las existentes, con la finalidad de aumentar el número de personas que accedan al test y con esto mejorar la calidad del cuidado y la satisfacción usuaria(AU)

Introduction: The Acquired Immunodeficiency Syndrome (HIV) continues to be a critic health concern for the worldwide public health, since it has caused up to date more than 34 million deaths. Objective: Know the obstacles and facilitators of a group of people who request the ELISA test for diagnosing the acquired immunodeficiency virus (VIH) in primary health care, from the perspective of the health professional who works in this sites. Methods: Qualitative descriptive study based on the content analysis approach described by Krippendorff. In-deep interviews were conducted on 30 health professionals who work in two Family Health Centers (CESFAM) of La Pintana Town, Santiago de Chile. The Guba & Lincoln criteria were used, in order to maintain the methodologic rigor. Results: We identified factors associated with the timely access to ELISA tests as perceived by the professionals, among then some that make difficult and others that facilitate (HIV social stigma, bureaucracy in taking the ELISA test and the lack of privacy in requesting the test, confidence relationship between the user and the professional, and centralization of the test in the CESFAM's). Conclusions: Knowing both the facilitating and hindering factors mentioned by the professionals who work in centers where the ELISA tests are made should be considered in the design and implementation of new strategies and in the modification of the existing ones, with the aim to increase the number of people who can access the tests and thus to improve the quality of care and the users' satisfaction(AU)

Violencia escolar y consumo de alcohol en adolescentes en etapa de secundaria. Monterrey, México / Scholar violence and alcohol consumption in junior high school stage adolescents. Monterrey, Mexico

Conocer la violencia escolar en estudiantes de secundaria del estado de Nuevo León y como estas conductas se relacionan con el consumo de alcohol. Material y métodos: diseño descriptivo correlacional, con una muestra aleatoria de 420 estudiantes de secundaria. Se utilizó una cédula de datos personales y de prevalencia de consumo de alcohol, para medir la violencia escolar se utilizó la Escala Indicadores de la Calidad de la Convivencia en Educación Secundaria Obligatoria y para determinar el tipo de consumo de alcohol se utilizó el Cuestionario de Identificación de Desórdenes por el Uso de Alcohol AUDIT. Resultados: el 42.4% de los participantes se vio involucrado en alguna situación de violencia escolar, además no se encontraron diferencias estadísticamente significativas en función al género para la violencia escolar. El 23% presentó un consumo dependiente y un 14% un consumo sensato. Conclusiones: la violencia escolar y el consumo de alcohol presentaron una relación positiva y significativa...

knows the scholar violence in junior high school students from Nuevo Leon state and how these behaviors are related alcohol use. Material and methods: correlational descriptive design, with a random sample of 420 junior high school students. Was used a charter of personal data and alcohol use prevalence, for measure the scholar violence was used the Quality Indicators scale of Coexistence in Secondary Education and for determinate the kind of alcohol use, was used the Alcohol Use Disorders Identification Test AUDIT. Results: 42.4% from participants were involved in any scholar violence issue, also did not were found statistically significant differences according to gender for the scholar violence. 23% had a dependent consumption and 14% a sensible consumption. Conclusions: the scholar violence and the alcohol use showed a positive and significant relationship...

Análisis genómico del resistoma de la cepa de Acinetobacter baumannii ABIBUN 107m multi-resistente y persistente en hospitales colombianos / Genomic analysis of the resistome of the strain of Acinetobacter baumannii ABIBUN 107m multi-resistant and persistent in colombian hospitals

Acinetobacter baumannii es una bacteria, causante de infecciones asociadas a la atención en salud como neumonía, septicemia, meningitis e infecciones urinarias entre otras. Se caracteriza por su capacidad para desarrollar y acumular rápidamente una gran variedad de mecanismos de resistencia a antibióticos. En esta investigación se realizó el análisis genómico de una cepa de A. baumannii ABIBUN 107m que forma parte de un clon persistente en hospitales colombianos, resistente a los antibióticos carbapenémicos (imipenem y meropenem), antibióticos de elección en el tratamiento infecciones causadas por este microorganismo. El genoma de esta bacteria fue secuenciado utilizando técnicas de alto rendimiento, ensamblado y anotado, obteniéndose un genoma constituido por 3954000 pb con 56 contigs; consta de 4256 genes con un tamaño promedio de 912 pb; 3796 CDS de los cuales por anotación 2884 se asignaron a COG; 57 tRNA y un porcentaje de GC de 38,74%. A. baumannii ABIBUN 107m es resistente a β-lactámicos, aminoglicósidos, quinolonas, tetraciclina, sulfonamida y colistina. En su genoma se localizaron genes asociados con el perfil de resistencia ya que presenta serin β-lactamasas (blaADC-38, blaOXA-64, blaOXA-23, bla ampC-like, bla amp(H)-like), metalo β-lactamasa_B; proteínas de unión a penicilina de elevada masa molecular, secuencias de inserción tipo ISAba1; mutaciones en los genes de DNA girasa y topoisomerasa IV subunidad A (gyrA y parC); enzimas modificadoras de aminoglicósidos (aphA-like, aad -like); cloranfenicol aciltransferasa (cat) y dehidropteroato sintasa (sul-1). Se identificaron genes pertenecientes a cinco familias de sistemas de eflujo (RND, MATE, MSF, ATP, SMR).

Acinetobacter baumannii is a bacterium causing health care associated infections such as pneumonia, septicemia, meningitis and urinary infections amongst others. It has great capacity to quickly develop and gather a big variety of drug resistance mechanisms. In this research, the genome of strain A. baumannii ABIBUN 107m was analyzed wich forms part of a persistent clon in Colombian hospitals and it’s also resistant to carbapenems (imipenem and meropenem), which are the election antibiotics for treatment of infections caused by this microorganism. The genome was sequenced using high performance technology, assembled and annotated. As a result, we obtained a 3954000 bp genome, with 56 contigs; 4256 genes with average size of 912 bp; 3796 CDS; 2884 were assigned to COG; 57 tRNA and GC percentage of 38,74%. The A. baumannii strain ABIBUN 107m, is resistant to the following antibiotic groups: β-lactams, aminoglycosides, quinolones, tetracycline, sulfonamide and colistin. Genes associated with this resistance profile were found in A. baumannii ABIBUN 107m genome serino β-lactamases (blaADC-38, blaOXA-64, blaOXA-23, bla ampC-like, bla amp(H)-like), metallo β-lactamase_B; High Molecular Mass penicillin binding proteins, ISAba1 type insertion sequences, mutations of DNA gyrase and topoisomerase IV subunit A (gyrA and parC); aminoglycoside modifying enzymes (aphA-like, aadA-like); choramphenicol acyltransferase (cat) and dehydropteroate synthase (sul-1). Genes belonging to five different efflux systems were identified (RND, MATE, MSF, ATP, SMR).

Estudio de costo-efectividad del tratamiento de la esquizofrenia en México / Cost effectiveness study of schizophrenia a management in Mexico

Introduction Schizophrenia is a disorder that causes significant disability. In addition, its treatment is expensive because the increased prescription of atypical antipsychotics with associated high costs. In a recent 14-country study on disability associated with physical and mental conditions, active psychosis was ranked the third most disabling condition in general population, more than paraplegia and blindness. In the global burden of disease study, schizophrenia accounted for 1.1% of the total Disability-adjusted life years (DALYs) and 2.8% of Years of lived with disability (YLDs). The economic cost of schizophrenia for society is also high. The study of the burden of schizophrenia for society, whether expressed in epidemiological or costs terms, is an insufficient basis for setting priorities for resources allocation. Thus, increasingly sophisticated economic models have been developed. Such is the case of cost-effectiveness studies, which show the relationship between resources used (costs) and benefit achieved (effectiveness) of an intervention compared with others. In Mexico, there is only one study that evaluated the cost-effectiveness of different antipsychotics to treat schizophrenia, but it was a specific approach (not generalized), and did not include psychological interventions. The present study is part of a World Health Organization's initiative labeled WHO-CHOICE: CHOosing Interventions that are Cost-Effective. WHO-CHOICE methodology involves the evaluation of interventions based on a generalized measure: DALYs, which allows carrying out several and important comparisons. The main objective was to determine the cost-effectiveness of different interventions for the treatment of schizophrenia in Mexican communitarian settings. Method Schizophrenia was modeled as a serious chronic disorder with a high level of disability, excess mortality from natural and unnatural causes, and a low rate of remission. The incidence, prevalence, and the fatality rate were estimated based on the study of the Global Burden of Disease and a review of the epidemiological literature. As the first episode of schizophrenia is currently not preventable, the occurrence represents how the epidemiological situation would be without intervention. In relation to the referral and the fatality, we did not found evidence that these rates change by a specific effect of the treatment; thus, they were kept as constants for the scenarios with or without treatment. Community-level interventions assessed were: 1. typical traditional antipsychotics (haloperidol), 2. new atypical antipsychotics (risperidone), 3. traditional antipsychotics + psychosocial treatment (family therapy, social skills training and cognitive behavioral therapy), 4. new antipsychotics + psychosocial treatment, 5. traditional antipsychotics + psychosocial treatment + case management, and 6. new antipsychotics + psychosocial treatment + case management. The effectiveness of the treatments referred to the control of positive and negative symptoms and associated levels of disability. To calculate the improvement in disability compared with natural history (when the disease is not treated), the effect sizes reported in controlled clinical trials were converted to a weight change of disability. Efficacy and extrapyramidal effects of typical and atypical antipsychotics compared to placebo were estimated from the meta-analysis of controlled clinical trials, with the score of the BPRS severity scale and the need anti-Parkinson drugs as efficacy measures. From another meta-analysis we obtained an estimate of the magnitude of the effect by adding psychosocial interventions. As an ad hoc Cochrane systematic review that found case management did not had a significant impact on clinical or psychosocial outcomes, only a minimal addition effect size when added to the combination of pharmacologic-psychosocial treatment was observed. Costs included those of the patient, the program and the training required to implement the intervention. The provision of community-based services, daily administration of antipsychotics and anticholinergics, and laboratory tests were taken into account. For psychological interventions were envisaged from 6 to 12 sessions: in primary care from 6 to 12 visits, in outpatients services a visit per month for 20-50% of cases, and in day care communitarian attention from 1-2 times a week for 20-50% of cases. A 3% discount by the process of converting future values to present ones and an age adjustment giving less weight to year lived by young were included. Finally, the cost of DALYs averted for each intervention was estimated to determine their cost-effectiveness. Results The main findings of the study are, in relation to the costs of interventions: 1. the largest share corresponds to those generated by medication, 2. the current intervention is the cheapest, and 3. the combination of new atypical antipsychotics, psychological treatment and proactive case management is the most expensive intervention. Concerning the effectiveness of interventions, the one available today, with a coverage of 50%, prevents 68 222 DALYs. Increasing coverage to 80%, the number of DALYs averted is almost doubled with the use of typical antipsychotics. The effect of psychological interventions makes the number of DALYs averted three to four times higher. Finally, in regard to cost effectiveness, the combination of typical antipsychotics, psychosocial intervention and proactive case management was the treatment with the best relation. The cost per DALY averted was $390,892 Mexican pesos, which corresponds to one third of the cost of DALY averted in the current scenario ($1,313,120 Mexican pesos). Conclusions The resources for the attention of a public health issue involve a social investment rather than an expense budget, but they are also finite and must be chosen properly to be allocated. Cost-effectiveness studies of available interventions are an essential tool for making such important decisions. Our Mexican study of cost-effectiveness of interventions to treat schizophrenia in communitarian settings suggests, in general terms: 1. That while the current situation is the one with the lowest cost, it is the least efficient, 2. all alternatives involve an additional cost to the current situation because they assume an expansion of coverage; however, the extra cost in not excessive, and 3) that within a model of community-based care, the least expensive option is treatment with typical antipsychotics combined with psychological intervention. Thus, for a modest extra cost it is possible to yield a major impact on disability. Recently, the Mexican Federal Government has included schizophrenia in the catalog of diseases covered by the program called <>, that provides a health insurance to general population, especially to the poorest and unemployed ones. The planned actions include four specialty consultations in an interval of two months and annual psychopharmacological treatment. Clearly the addition of haloperidol, trifluoperazine and risperidone to the list of available medications should be considered a success. However, schizophrenia also requires a proactive case monitoring of long-term for best control of symptoms and a successful rehabilitation. Moreover, consistent with our findings, case management has proven to be cost-effective when compared with routine care in the community. Among the limitations of the study it is important to note that it was based on modeled parameters obtained from the international literature. In this sense, the challenge is the data generation directly from studies in Mexico.

Introducción La esquizofrenia es un trastorno que produce una importante discapacidad, y su costo para la sociedad es muy elevado. El estudio de la carga que impone la esquizofrenia sobre la sociedad, ya sea expresada en términos epidemiológicos o de costos, es una base insuficiente para establecer las prioridades para la asignación de recursos, por lo que se han desarrollado modelos económicos cada vez más elaborados. Tal es el caso de los estudios de costo-efectividad, que muestran la relación entre los recursos empleados (costos) y los beneficios logrados (efectividad) de una intervención comparada con otra(s). El presente trabajo forma parte de la iniciativa de la Organización Mundial de la Salud (OMS) para la elección basada en evidencia de intervenciones costo-efectivas denominada WHO-CHOICE, Choosing Interventions that are Cost-Effective, que implica la determinación de una medida general que posibilita comparaciones internacionales: los años de vida vividos con discapacidad (AVISAs o DALYs, de las siglas de Disability-adjusted life years). Objetivo Fue determinar la relación costo-efectividad en México de diferentes intervenciones que han demostrado ser efectivas para el tratamiento comunitario de la esquizofrenia. Método Se evaluaron las siguientes intervenciones: 1. Antipsicóticos tradicionales típicos (haloperidol), 2. Antipsicóticos nuevos atípicos (risperidona), 3. Antipsicóticos tradicionales + tratamiento psicosocial (terapia familiar, entrenamiento en habilidades sociales y terapia cognitivo conductual), 4. Antipsicóticos nuevos + tratamiento psicosocial, 5. Antipsicóticos tradicionales + tratamiento psicosocial + manejo de caso, y 6. Antipsicóticos nuevos + tratamiento psicosocial + manejo de caso. La efectividad relativa de los tratamientos se refirió al control tanto de los síntomas positivos y negativos así como de los niveles asociados de discapacidad. Se consideraron los costos del paciente, del programa y del entrenamiento, así como un descuento de 3% por el proceso de convertir valores futuros a presentes, y un ajuste de edad, otorgando menos peso a los años vividos por los jóvenes. Finalmente, se calculó el costo por AVISA evitado por cada intervención para determinar su costo-efectividad. Resultados Los principales hallazgos del estudio son, en relación con los costos de las intervenciones: 1. que la mayor proporción corresponde a los generados por los medicamentos; 2. que la intervención actual resulta la más barata; y 3. que la combinación de antipsicótico nuevo o atípico con intervención psicosocial y manejo proactivo de caso es la más cara. En cuanto a la efectividad de las intervenciones, la disponible en la actualidad, con cobertura de 50%, evita 68 222 AVISAs. Aumentando la cobertura a 80%, el número de AVISAs evitados casi se duplica con el empleo de antipsicóticos típicos. El efecto de las intervenciones psicosociales hace que el número de AVISAs evitados sea tres a cuatro veces mayor. Finalmente, en lo que respecta a costo-efectividad, la combinación de antipsicóticos típicos, intervención psicosocial y manejo proactivo de caso fue el tratamiento con la mejor relación. El costo por AVISA evitado fue de $390,892, que corresponde a un tercio del costo de AVISA evitado en el escenario actual ($1,313,120). Conclusiones Los hallazgos del estudio sugieren, en términos generales: 1. Que aunque la situación actual es la de menor costo, es la menos eficiente; 2. Que todas las alternativas implican un costo adicional a la situación actual porque asumen una ampliación de la cobertura, sin embargo, ese costo extra no es excesivo; y 3. Que dentro de un modelo de atención basado en la comunidad, la opción menos costosa es el tratamiento con antipsicóticos típicos combinados con intervención psicosocial. Por un costo extra modesto se obtendría un impacto importante en la discapacidad. Entre las limitaciones del estudio destaca que fue producto de un modelado con parámetros obtenidos de la bibliografía internacional. En este sentido, el reto es la generación de datos derivados directamente de estudios realizados en México.

Recursos disponibles para el tratamiento del cáncer de mama en México / Available resources for the treatment of breast cancer in Mexico

OBJECTIVE: Describe the resources for the treatment of breast cancer in Mexico. METHODS: Information was obtained from 23 Centros Estatales de Cáncer (State Cancer Centers, CEC), two federal hospitals and Cancerología. This study was performed in Mexico City in August/September of 2008. RESULTS: These 23 centers provide medical care for breast cancer including surgery, chemotherapy and radiotherapy; all of them validated by the Seguro Popular. The costs were defined according to clinical stage and ranged from $27,500.00 pesos for clinical stage 0 to $480,00.00 in the advanced stage. A total of 2 689 women with breast cancer have been treated; only 1 percent was reported with in situ carcinoma. CONCLUSIONS: An adequate medical infrastructure is in place to treat breast cancer in Mexico. The costs are high due to late diagnosis of the disease. Early detection of breast cancer is a high priority for optimal control of this disease in Mexico.

OBJETIVO: Describir los recursos existentes para el tratamiento del cáncer de mama en México. MATERIAL Y MÉTODOS: Se recolectó información de 23 Centros Estatales de Cáncer (CEC), dos hospitales federales y el Instituto Nacional de Cancerología. Este estudio se realizo en México, DF, en agosto y septiembre del año 2008. RESULTADOS: Los 23 CEC ofrecen atención médica para el cáncer de mama, incluidos cirugía, quimioterapia y radioterapia, todos ellos acreditados por el Seguro Popular. Las cuotas de recuperación se definieron por etapa clínica, desde 27 500 pesos para la etapa clínica cero hasta 480 000 pesos en pacientes con enfermedad avanzada. Se ha atendido a 2 689 pacientes con cáncer de mama; sólo 1 por ciento se presentó con carcinoma in situ CONCLUSIONES: Se tiene la infraestructura y los recursos médicos para el óptimo tratamiento, pero los costos son altos debido al diagnóstico tardío. La detección oportuna del cáncer de mama es una prioridad para el óptimo control de esta enfermedad en México.

Aspectos relevantes de las publicaciones de la Revista ADM a lo largo de la historia / Relevant aspects of Revista ADM publications throughout its history

La Revista ADM se ha publicado desde 1943, y en sus páginas se pueden encontrar una gran cantidad de los aspectos relevantes de la odontología nacional a lo largo de más de 60 años. Objetivo realizar un análisis de los artículos presentados en la Revista, desde su fundación hasta el año de 2004, mediante la revisión de todos los volúmenes disponibles en la Biblioteca de la ADM, recopilando información del año donde aparecieron: número de autores y género del primer autor, tipo de artículo, área temática, adscripción y nacionalidad del primer autor, número de páginas y de referencias bibliográficas. En el análisis de los resultados se puede apreciar la evolución de las publicaciones, en relación con los temas abordados, el perfil de los diversos autores, conformación de grupos académicos adscritos a las instituciones educativas y de salud, incremento en la presencia de mujeres que publican, entre otros datos de interés, que confirman la importancia y solidez que la Revista ADM ha tenido en el gremio odontológico.

Predicción del desarrollo mental a los 20 meses de edad por medio de la evaluación del desarrollo psicomotor a los seis meses de vida en niños sanos / Psychomotor development at six months predicts mental development at 20 months in healthy children

Introduction The study of the possible protector factors and the risk factors can favour or harm women during pregnancy, and so, the infant during the pre- and post-natal periods, has today become a necessary and a high priority objective of world health. In agreement with this proposal, carrying out follow-up programs to prevent, detect and treat consequences in infant development is one of the objectives of Early Care (EC). The follow-up is the way to verify whether the development of the child is occurring within the guidelines of normalcy, or if there is a suspicion that he may be suffering from delays. In order to do this in an appropriate way, one of the necessary conditions is to have access to the tables and instruments that include up-to-date parameters of the course of overall development in the normal population. If the detection and follow-up of risk populations is a key task in the context of early attention, so are the longitudinal studies that use the normal population as the focus of their study. Currently, in various countries in the European Union, important follow-up studies are being carried out of a multi-disciplinary nature (EARNEST Project, NUHEAL Project, and Spanish INMA Network), with the purpose of evaluating the development of the child in general and, specifically, his mental development. These studies take into account, among others, a series of parameters that contemplate the eating habits of the mother, exposure to environmental contaminants, styles of care and the physical, mental and social follow-up of the development of the children up to ages that include adolescence. One of the factors associated with mental development is psychomotricity. The psychomotor development refers to the acquisition of skills observed in the child in a continuous way throughout childhood, and it is associated, on the one hand, with the maturing of the Central Nervous System (proliferation of the dendrites, synaptogenesis and the myelinazation of the axons) from the first months of life up to the age of two. This maturation process has a pre-established order and a clear and predictable sequence: the progress is in a cephalocaudal sense and from proximal to distal. On the other hand, the psychomotor development is also associated with the learning done by the baby and the child in their interactions with themselves and their surroundings, with the affective links they establish based on the affect and stability of the care received and the perception of everything around them (people, images, sounds, movement…). These conditions are determinants in the emotional development, communicative functions, adaptive behaviours and attitude toward learning. It has been proposed that the psychomotor development precedes the mental development and forms the base on which it is established. And although it must be kept in mind that there are degrees of individual variation in normal psychomotor development, depending on the interaction between genetic and environmental factors, it can be said that full term babies who are born healthy follow a pattern of development or skills acquisition. This pattern is clear, and basic milestones have been defined that are easy to measure and that make it possible to know when a child is progressing satisfactorily. In these children, the rhythm of psychomotor development in the first two years of life is quite rapid. At six to seven months, they can sit and crawl; at eight to nine months, they stand up; and at 10 to 12 months, they walk with help. Through their movements and manipulations, they are exploring, imitating, learning and understanding. It is important to observe and rigorously follow the way the psychomotor development is occurring and being established in children because it may provide us with early indications of possible consequences in some parameters of their mental development. Another factor that is related to the mental development, in addition to the psychomotor development, is the somatic growth or development of the child. Numerous studies show how the weight, length and cephalic perimeter are predictors of disorders in development in the case of a risk, high-risk and/or clinical population with established problems and diverse associated pathologies. Therefore, these measures of growth constitute essential parameters to keep in mind for an early intervention in the deviations and disorders in development. In this study, it has been proposed the need to verify whether this relationship of prediction between somatic growth and psychomotor and mental development also occurs in populations of healthy children. The main objective of this study was to describe the evolution of the neurodevelopment in healthy children from the sixth to the 20th month of life. We now present the results of a part of the follow-up from the NUHEAL Project. Material and method The sample studied was composed of 66 (32 boys/34 girls) full-term, healthy infants, with a weight at birth appropriate for their gestational age, born at the San Cecilio Clinical University Hospital in Granada. All of their mothers were participants in the NUHEAL project, and they did not received docosahexaenoic acid and eicosapentaenoic acid supplements. To evaluate the neurodevelopment of the infants, the Bayley Scales of Infant Development (BSID) were used at six months (6.22±0.29) (n:66) and at 20 months (19.56±1.17) (n:56). The evaluation was performed by a psychologist who had been trained for this. The BSID evaluates three aspects of development: motor development, mental development and the behaviour of the child. It provides an index of mental development (MDI) and an index of psychomotor development (PDI). In addition, an evaluation of the somatic or anthropometric development was also performed by an expert paediatrician, taking into account the following variables: weight, height, cephalic and thoracic perimeter at birth, at six months of age and at 20 months. The local Ethical Committee of the University Clinical Hospital "San Cecilio" of Granada approved the study protocol. After a careful explanation of the study details, written informed consent was obtained from all participating women. Results The preliminary data obtained in this study showed that the psychomotor development of the children was greater than the mental development, at both six and 20 months of age, with the mean from the Psychomotor Development Index (PDI) being (107.95±11.70 vs 125.39±10.51) at six and 20 months, respectively, and the mean from the Mental Development Index (MDI) being (97.73±9.14 vs. 119.64±12.41) at six and 20 months of age. The results showed that the MDI at 20 months was greater in those children who had a greater PDI at six months, (F(1. 52)= 4.27; p<0.044). No statistically significant relationships were found between the anthropometric data at six months and the EBDI development indices (MDI and PDI) at 20 months of age.

Introducción El estudio de los posibles factores tanto protectores como de riesgo que puedan favorecer o dañar a la mujer durante el embarazo y, por tanto, al niño en el período prenatal y postnatal, se ha convertido hoy en una necesidad y en un objetivo prioritario de salud mundial. Uno de los objetivos de la Atención Temprana es la realización de programas de seguimiento para prevenir, detectar y tratar secuelas en el desarrollo infantil. El seguimiento es el modo de comprobar si el desarrollo se está produciendo dentro de unas pautas de normalidad. Si la detección y el seguimiento de poblaciones de riesgo son unas tareas claves en la atención temprana, no lo son menos la realización de estudios longitudinales que toman a la población normal como objeto de estudio. Actualmente, en diversos países de la Comunidad Europea se están llevando a cabo importantes estudios aleatorizados con seguimiento longitudinal (proyectos NUHEAL, EARNEST, Red de Excelencia INMA) para evaluar el desarrollo global de los niños sanos y el desarrollo mental, en particular. Dentro de los factores asociados al desarrollo mental se encuentran el desarrollo psicomotor y el desarrollo somático. Numerosos estudios muestran que el peso, la talla y el perímetro cefálico son predictores de trastornos del desarrollo cuando se trata de una población de alto riesgo o con alguna patología. El objetivo principal de este estudio es describir la evolución del neurodesarrollo en niños sanos desde el sexto al vigésimo mes de vida. En este artículo se presentan parte de los resultados del Proyecto Europeo NUHEAL. Material y método Se estudiaron 66 bebés sanos (32 niños / 34 niñas), nacidos a término, con peso al nacimiento apropiado para la edad gestacional, que fueron reclutados en el Hospital Clínico Universitario "San Cecilio" en Granada y cuyas madres eran participantes del proyecto NUHEAL pero que no recibieron suplementación de ácido docosahexaenoico y ácido eicosapentanoico. Se les realizó evaluación del neurodesarrollo a los seis (n:66) y 20 (n:56) meses de edad utilizando las Escalas Bayley de Desarrollo Infantil (EBDI). Estas escalas proporcionan un índice de desarrollo mental (IDM) y un índice de desarrollo psicomotor (IDP). Igualmente se realizó evaluación del desarrollo somático, mediante el estudio antropométrico de las siguientes variables: Peso, talla, perímetro cefálico y torácico al nacimiento, a los seis y 20 meses de edad. El protocolo del presente estudio fue aprobado por el Comité Ético local del Hospital Clínico Universitario <> de Granada. Resultados Los datos mostraron que la población estudiada tenía mayor desarrollo psicomotor que mental tanto a los seis como a los 20 meses de edad, siendo la media del Indice de Desarrollo Psicomotor (IDP) (107.95±11.70 vs 125.39±10.51) a los seis y 20 meses respectivamente, y la media del Índice de Desarrollo Mental (IDM) (97.73±9.14 vs 119.64±12.41) para los seis y 20 meses de edad. Los resultados también muestran que el IDM a los 20 meses es mayor en aquellos niños que tenían un IDP mayor a los seis meses (F (1.52)= 4.27; p<0.044). No se encontraron relaciones estadísticamente significativas entre las variables somatométricas a los seis meses y el IDM e IDP a los 20 meses de edad. Discusión Los resultados de este estudio indican que los niños incluidos en este trabajo de investigación se encuentran dentro de la normalidad. Los niños mostraron un buen desarrollo mental y psicomotor en ambas edades, aunque el desarrollo psicomotor era superior al mental tanto a los 6 como a los 20 meses. El IDP a los seis meses resultó ser un buen predictor del IDM a los 20 meses. Estos resultados corroboran los datos publicados por diversos autores que afirman que el desarrollo psicomotor precede al desarrollo mental, siendo el desarrollo psicomotor un factor protector y una base esencial para el establecimiento de las funciones mentales superiores. Respecto a los datos obtenidos de que ninguna variable somatométrica a los seis meses resultó predictora del desarrollo psicomotor y mental posterior a los 20 meses, probablemente sea debido a que los niños incluidos en este estudio eran niños sanos; si bien esta relación sí parece cumplirse cuando se trata de niños con antecedentes patológicos o en poblaciones de niños de alto riesgo.

Nuevas perspectivas en el síndrome de QT largo / New perspectives in long QT syndrome

Long QT Syndrome (LQTS) is a cardiac channelopathy characterized by prolonged ventricular repolarization and increased risk to sudden death secondary to ventricular dysrrhythmias. Was the first cardiac channelopathy described and is probably the best understood. After a decade of the sentinel identification of ion channel mutation in LQTS, genotype-phenotype correlations have been developed along with important improvement in risk stratification and genetic guided-treatment. Genetic screening has shown that LQTS is more frequent than expected and interestingly, ethnic specific polymorphism conferring increased susceptibility to drug induced QT prolongation and torsades de pointes have been identified. A better understanding of ventricular arrhythmias as an adverse effect of ion channel binding drugs, allow the development of more safety formulas and better control of this public health problem. Progress in understanding the molecular basis of LQTS has been remarkable; eight different genes have been identified, however still 25% of patients remain genotype-negative. This article is an overview of the main LQTS knowledge developed during the last years.

El síndrome de QT largo (SQTL) es una canalopatía que genera grave alteración en la repolarización ventricular predispone a arritmias malignas y muerte súbita. Fue la primera canalopatía arritmogénica descrita y quizá la mejor entendida hasta ahora. Transcurrida ya más de una década de la identificación de la primera mutación asociada al SQTL, se ha hecho evidente que este trastorno es mucho más frecuente de lo que inicialmente se pensaba; los avances en el conocimiento de la fisiopatología molecular de esta enfermedad han permitido hacer una correlación genotipo-fenotipo, optimizando el tratamiento y permitiendo estratificar el riesgo en forma precisa. Se ha logrado entender con mayor detalle los efectos adversos de distintas drogas que interactúan con los canales iónicos, permitiendo así generar fármacos más seguros y, en su defecto, monitorizar de cerca aquellos que a pesar de tener este efecto adverso, es necesaria su administración. Los avances son importantes pero no todo está dicho, 25% de los casos no tienen mutaciones en los genes descritos hasta la fecha, por lo que el SQTL continúa siendo motivo de investigación. El presente artículo constituye un resumen de los principales conceptos desarrollados en los últimos diez años que han sido cruciales en el manejo de esta enfermedad.