Chronic viral hepatitis C micro-elimination program using telemedicine. The Mexican experience.

BACKGROUND: hepatitis C virus (HCV) infection is a global health problem. Chronic infection induces the development of fibrosis and cirrhosis together with all the related complications. The use of direct-acting antiviral (DAA) drugs has proven highly effective. Telemedicine is a present-day resource that brings treatment closer to distant areas and may result in cost savings. OBJECTIVE: to implement a microelimination program for HCV using DAAs with the support of a telemedicine program to minimize expenses. PATIENTS AND METHODS: the program was developed at the Medical Services department of Petróleos Mexicanos (SMPM) with a national coverage; patients diagnosed with chronic hepatitis C were included. These were classified into locals and outsiders. Treatment for foreign patients was indicated, monitored and completed via telemedicine. Thus, avoiding their travel to the country's capital city, in order to save on transportation costs and travel allowances. RESULTS: a total of 136 patients, 74 locals and 62 outsiders, participated in the study. Transfer was avoided for 62 patients (45.5 %), which meant that telemedicine resulted in savings of 3,176.20 USD per patient, with overall savings of 196,924.40 USD from cost minimization. A total of 30 patients remained untreated due to lack of medication, hence the coverage amounted to 86 %. Sustained virological response (SVR) was achieved in 99 % of cases. Only two patients had treatment failure. Adverse events included headache and fatigue in 5 % of the cohort. CONCLUSIONS: with the aid of a telemedicine approach, significant savings were achieved by minimizing costs, since nearly half of patients were outsiders. Coverage reached 86 % and treatment with DAAs was successful for 99 % of our cases.

Differential production of insulin-like growth factor-binding proteins in liver fibrosis progression.

Noninvasive methods for liver disease diagnoses offer great advantages over biopsy, but they cannot be utilized in all cases. Therefore, specific indicators for chronic liver disease management are necessary. The aim was to assess the production of insulin-like growth factor-binding proteins (IGFBPs) 1-7 and their correlation with the different stages of fibrosis in chronic hepatitis C (CHC). A prospective, cross-sectional, multicenter study was conducted. CHC patients were categorized by FibroTest® and/or FibroScan®. Serum concentrations of IGFBPs 1-7 were determined through multiple suspension arrangement array technology. Significant differences were validated by the Kruskal-Wallis and Mann-Whitney U tests. Logistic regression models were performed to assess the association between the IGFBPs and fibrosis stages. The association was determined utilizing odds ratios (ORs), and receiver operating characteristic (ROC) curves were constructed to distinguish the IGFBPs in relation to the diagnosis of fibrosis. IGFBP-1 and IGFBP-7 concentrations were higher in CHC than in the healthy individuals, whereas IGFBP-3, IGFBP-5, and IGFBP-6 were downregulated in the patients. An apparent increase of all the IGFBPs was found at fibrosis stage F4, but with different regulations. IGFBP-2, -4, -6, and -7 had the best OR, showing the relation to fibrosis progression. The ROC curves showed that IGFBP-7 was the only protein that distinguished F1 from F3 and F2 from F3. IGFBPs participate in liver fibrosis progression and could be employed as circulating novel protein panels for diagnosis and as possible therapeutic targets in liver fibrosis progression.

A low frequency of post infection-IBS in patients attended in a tertiary referral center in México.

BACKGROUND: PI-IBS prevalence is around 10.1%-14.5% ≥ 12 months after infectious gastroenteritis in North America, Europe and Asia. However, there are no studies from Latin America. Two previous studies in Mexico suggest a low incidence of 5%. AIMS: to determine the prevalence of PI-IBS in patients attended in a tertiary-care center, as well as IBS subtypes, severity, other digestive symptoms and red flags vs nPI-IBS. METHODS: seventy IBS patients screened for immunological research completed the Rome III, Spiller's for PI-IBS and IBS-SSS questionnaires. PI-IBS prevalence was determined according to three criteria sets. C1: ≥ 2 episodes of sudden onset, onset while traveling, initial illness with any of the following symptoms, fever, vomiting, bloody diarrhea and a positive stool culture. C2: sudden onset and > 2 episodes of fever, diarrhea, vomiting and bloody diarrhea. C3: sudden onset after an infectious episode such as a positive culture or onset with ≥ 2 episodes of fever, vomiting, diarrhea, rectal bleeding and foreign travel. Items were dichotomized as present or absent and compared using the Fisher's exact and Mann-Whitney U tests. RESULTS: PI-IBS prevalence was as follows. C1: 5.7%, C2: 0 and C3: 1.4%. There were no IBS-C or IBS-M cases. In the C1 group, one case was mild and three were moderate IBS, which was similar to the non PI-IBS group. One case in the C3 group had mild IBS. There were no differences in the frequency of esophageal, gastroduodenal, anorectal, bloating/distension and red flags between PI-IBS and non PI-IBS groups (analyzed only for C3). CONCLUSIONS: in Mexico, there is a very low prevalence of PI-IBS in patients from a tertiary-referral center. However, it varies according to the surrogate-criteria used. The later needs to be taken into account when performing PI-IBS studies.

Parasomnias related to shift work disorder among medical residents during the first year of training in Mexico.

Shift work disorder (SWD) may affect medical residents because their workload, academic demands and extended work hours. This condition set residents at risk of more sleep disorders. The study compared parasomnias among residents with and without shift work disorder (SWD) and weighed their relative risk (RR) for each parasomnia. One hundred twenty-six residents participated in the study. The Munich Parasomnia Screening questionnaire and the Barger Questionnaire for SWD were used for the screening of parasomnias and SWD, respectively. Means and percentages of studied variables were compared between groups. Relative risk (RR) was calculated for each type of parasomnia. The more frequent parasomnias in residents with SWD the RR (and 95% confidence intervals) were: sleep terrors, 5.60 (1.84-17.01); confusional arousals, 3.73 (1.84-7.56); sleep paralysis, 3.27 (1.53-6.93); hypnagogic/hypnopompic hallucinations, 2.55 (1.03-6.28); somniloquies, 2.45 (1.21-4.92); and nightmares, 2.01 (1.54-2.62). Our data suggest that residents who experience SWD may be at risk of having lower threshold for the occurrence of rapid eye movement (REM) and non-REM (NREM) sleep parasomnias. Additional research is needed to confirm these results, and to further identify the contribution to this association.

Error related negativity and multi-source interference task in children with attention deficit hyperactivity disorder-combined type.

OBJECTIVE: To compare performance of children with attention deficit hyperactivity disorders-combined (ADHD-C) type with control children in multi-source interference task (MSIT) evaluated by means of error related negativity (ERN). METHOD: We studied 12 children with ADHD-C type with a median age of 7 years, control children were age- and gender-matched. Children performed MSIT and simultaneous recording of ERN. RESULTS: We found no differences in MSIT parameters among groups. We found no differences in ERN variables between groups. We found a significant association of ERN amplitude with MSIT in children with ADHD-C type. Some correlation went in positive direction (frequency of hits and MSIT amplitude), and others in negative direction (frequency of errors and RT in MSIT). CONCLUSION: Children with ADHD-C type exhibited a significant association between ERN amplitude with MSIT. These results underline participation of a cingulo-fronto-parietal network and could help in the comprehension of pathophysiological mechanisms of ADHD.

Error related negativity and multi-source interference task in children with attention deficit hyperactivity disorder-combined type / La negatividad relacionada al error en una tarea de interferencia multifuente en niños con trastorno por déficit de atención-hiperactividad tipo combinado

Objective To compare performance of children with attention deficit hyperactivity disorders-combined (ADHD-C) type with control children in multi-source interference task (MSIT) evaluated by means of error related negativity (ERN). Method We studied 12 children with ADHD-C type with a median age of 7 years, control children were age- and gender-matched. Children performed MSIT and simultaneous recording of ERN. Results We found no differences in MSIT parameters among groups. We found no differences in ERN variables between groups. We found a significant association of ERN amplitude with MSIT in children with ADHD-C type. Some correlation went in positive direction (frequency of hits and MSIT amplitude), and others in negative direction (frequency of errors and RT in MSIT). Conclusion Children with ADHD-C type exhibited a significant association between ERN amplitude with MSIT. These results underline participation of a cingulo-fronto-parietal network and could help in the comprehension of pathophysiological mechanisms of ADHD. .

Objetivo Comparar el rendimiento de un grupo de niños con trastorno por déficit de atención-hiperactividad de tipo combinado (TDAH-C), con niños controles, en la tarea de interferencia multi-fuente (TIMF), evaluado por la negatividad relacionada al error (NRE). Método Estudiamos 12 niños con TDAH-C con una mediana de 7 años, los controles estuvieron pareados por edad y género. Los niños realizaron la TIMF con registros simultáneos de NRE. Resultados No encontramos diferencias en los parámetros de la TIMF entre grupos. No encontramos diferencias en las variables de la NRE entre grupos. Encontramos asociaciones significativas entre la amplitud de la NRE en niños con TDAH-C. Una correlación fue en dirección positiva: (frecuencia de aciertos y amplitud de TIMF), y otras fueron en dirección negativa (frecuencia de errores y el tiempo de respuesta en la TIMF). Conclusión Los niños con TDAH-C presentan una asociación significativa entre la amplitud de la NRE con la TIMF. Los resultados sugieren la participación de la red cíngulo-fronto-parietal y pueden ayudar en la comprensión de los mecanismos fisiopatológicos del TDAH-C. .

A middle-aged female serial killer.

The case of a 48-year-old woman accused of killing at least 12 elderly women and attempting to kill another one during the last 3 years is presented. Extensive neuropsychological, electrophysiological, and neuropsychiatric testing showed no evidence of a DSM-IV-TR Axis I diagnosis, but a decrease in executive functions and abnormalities in the processing of affective stimuli were found. Behavioral and psychophysiological studies revealed dissociation between knowing how to behave and actually behaving in socially acceptable ways. According to the woman, killing was just her response to "humiliating situations." Two potentially significant conditions in her past history are found: (i) childhood abuse; and (ii) multiple head injuries. It is conjectured that the nature of her crimes, paranoid and personality traits, a probable frontal brain dysfunction, as well as a specific demographic and social context represent unusual factors accounting for her violent behavior.