Effect of multi-component school-based program on body mass index, cardiovascular and diabetes risks in a multi-ethnic study.

BACKGROUND: Mexico occupies one of the first places worldwide in childhood obesity. Its Mestizo and Indigenous communities present different levels of westernization which have triggered different epidemiological diseases. We assessed the effects of a multi-component school-based intervention program on obesity, cardiovascular and diabetes risk factors. METHODS: A physical activity, health education and parent involvement (PAHEPI) program was developed and applied in six urban (Mestizo ethnic group) and indigenous (Seri and Yaqui ethnic groups) primary schools for 12 weeks. A total of 320 children aged 4-12 years participated in intervention program; 203 under Treatment 1 (PAHEPI program) and 117, only from Mestizo groups, under Treatment 2 (PAHEPI+ school meals). For Body Mass Index (BMI), cardiovascular and diabetes factors, pairwise comparisons of values at baseline and after treatments were done using Wilcoxon signed rank test. Generalized linear models were applied to assess the intervention effect by age, sex and nutritional status in relation to ethnicity and treatment. RESULTS: We observed improvements on BMI in children with overweight-obesity and in triglycerides in the three ethnic groups. The Mestizo ethnic group showed the largest improvements under Treatment 2. While Seris showed improvements only in cardiovascular risk factors, Yaquis also showed improvements in diabetes risk factors, though not in BMI. CONCLUSIONS: This study showed that the same intervention may have positive but different effects in different ethnic groups depending on their lifestyle and their emerging epidemiological disease. Including this type of intervention as part of the school curriculum would allow to adapt to ethnic group in order to contribute more efficiently to child welfare. TRIAL REGISTRATION: This study was retrospectively registered under the identifier NCT03768245 .

[Gestational diabetes adherence to treatment and metabolic control]. / Adherencia terapéutica y control glucémico en pacientes con diabetes gestacional bajo dos esquemas de tratamiento.

BACKGROUND: Adherence to treatment is a large obstacle in the management of chronic diseases. AIM: To evaluate therapeutic adherence and its relationship with glycemic control in patients with gestational diabetes using two types of treatment. MATERIAL AND METHODS: The Measurement of Treatment Adherence (MAT) questionnaire was applied to 93 patients with gestational diabetes. Fifty-two used metformin 41 were treated with insulin. Obstetric and socio-demographic data were collected. RESULTS: A higher therapeutic adherence was associated with a better glycemic control. Women with a higher education level had a better adherence to treatment. The adherence and metabolic control were higher in women treated with metformin. CONCLUSIONS: Therapeutic adherence is an important factor for adequate glycemic control.

[Tetanus, a current disease in pediatric population: Case report]. / Tétanos, una enfermedad vigente en población pediátrica: Reporte de un caso.

INTRODUCTION: Tetanus is an acute disease caused by a toxin produced by Clostridium tetanii. The disease can affect people of any age, and the fatality rate is high. Thanks to immunization the number of cases of the disease has decreased, although they are still present in isolation in countries with social and economic backwardness. OBJECTIVE: To describe a case of a pediatric patient with generalized tetanus to reinforce the relevance of prophylaxis and early detection. CASE REPORT: 6 years old female patient, with only one dose of pentavalent vaccine, 10 days after sharps injury by wood chips, starts with fever, muscle pain and generalized contractions, Tetanus was diagnosed by clinical symptoms and history. The management was based on the latest recommendations of the World Health Organization (WHO): Penicillin-Metronidazole antibiotic regimen, tetanus toxoid and tetanus high-dose gammaglobulin. After 2 years of follow-up under physiotherapy support, slight motor sequelae were observed. CONCLUSION: Tetanus is still presented in the pediatric population, associated with lack of vaccination. It is necessary to know the disease to provide proper diagnosis and management according to international lineaments.

[Waist-to-height ratio is an indicator of metabolic risk in children]. / Índice cintura-estatura como indicador de riesgo metabólico en niños.

INTRODUCTION: Abdominal fat, particularly visceral, is associated with a high risk of metabolic complications. The waist-height ratio (WHtR) is used to assess abdominal fat in individuals of all ages. OBJECTIVE: To determine the ability of the waist-to-height ratio to detect metabolic risk in mexican schoolchildren. PATIENTS AND METHOD: A study was conducted on children between 6 and 12 years. Obesity was diagnosed as a body mass index (BMI) ≥ 85th percentile, and an ICE ≥0.5 was considered abdominal obesity. Blood levels of glucose, cholesterol and triglycerides were measured. The sensitivity, specificity, positive predictive and negative value, area under curve, the positive likelihood ratio and negative likelihood ratio of the WHtR and BMI were calculated in order to identify metabolic alterations. WHtR and BMI were compared to determine which had the best diagnostic efficiency. RESULTS: Of the 223 children included in the study, 51 had hypertriglyceridaemia, 27 with hypercholesterolaemia, and 9 with hyperglycaemia. On comparing the diagnostic efficiency of WHtR with that of BMI, there was a sensitivity of 100% vs. 56% for hyperglycaemia, 93 vs. 70% for cholesterol, and 76 vs. 59% for hypertriglyceridaemia. The specificity, negative predictive value, positive predictive value, positive likelihood ratio, negative likelihood ratio, and area under curve were also higher for WHtR. CONCLUSIONS: The WHtR is a more efficient indicator than BMI in identifying metabolic risk in mexican school-age.

Sistema de presión negativa en loxoscelismo cutáneo-visceral. Reporte de un caso

Introducción: Las mordeduras por araña parda pueden manifestarse desde una simple lesión dérmica en el área de la mordedura, hasta formas graves, con falla orgánica múltiple. Caso Clínico: presentamos el caso de una paciente con mordedura por araña parda, quien presenta inicialmente lesiones dérmicas sin necrosis, evolucionando con áreas de necrosis y el desarrollo de síndrome compartimental de extremidad, sepsis, choque séptico y falla renal. Mejora tras manejo intensivo, anti veneno y colocación de terapia de presión negativa (TPN) en herida, conservando la extremidad afectada integra y recuperando la función renal. Discusion: Este caso en particular presenta los tres tipos de manifestaciones que se generan en el loxoscelismo, las cuales son una forma de presentación poco frecuente. El tratamiento con TPN se ha introducido como una terapia poderosa, no farmacológica para ayudar a acelerar el proceso de cicatrización de heridas y puede ser de utilidad en pacientes con mordedura de araña (loxoscelismo).

Introduction: The brown spider bites have the peculiarity of manifesting from a simple skin lesion in the area of the bite, to severe forms, with multiple organic failure. Clinical Case: We present the case of a patient with a brown spider bite, initially presenting dermal lesions without necrosis, evolving with areas of necrosis and the development of compartment syndrome of extremities, sepsis, septic shock and renal failure. Improvement after intensive management and installation in negative pressure therapy wound (NPT), keeping the affected limb integrated and recovering renal function. Discussion: This case in particular presents the three types of manifestations that are generated in loxoscelism, which are a rare form of presentation. The NPT treatment has been introduced as a powerful, non-pharmacological and physical therapy to help accelerate the wound healing process and may be useful in patients with spider bites.

[Risk factors related to cardiovascular complications in patients diagnosed with Kawasaki disease in northwestern Mexico]. / Factores de riesgo asociados a complicaciones cardiovasculares en pacientes con enfermedad de Kawasaki en el noroeste de México.

Background: Kawasaki disease (KD) is an acute systemic vasculitis of small and medium vessels, which occurs primarily in children; it manifests itself as a febrile syndrome coupled with vasculitis data and can cause coronary artery abnormalities in 25% of untreated patients. The objective of this study was to describe the clinical behavior and to identify risk factors for cardiovascular complications in pediatric patients with KD, in a second level hospital in Northwestern Mexico. Methods: Under a case series design, we studied pediatric patients with diagnosis of KD. We measured clinical variables, laboratory values and the presence of cardiac complications; the probability of risk was determined with odds ratio (OR) and the association with chi squared test. Results: 12 patients were included, and the female gender predominated; the mean age of presentation of KD was 2 years. The clinical presentation was complete in 100 % of the cases and patients also presented atypical manifestations. 50% of the patients studied had cardiovascular complications, the most common of which was coronary disease (33%). The variables male gender, age under 2 years and anemia reported OR of 5.5 and 10 to present cardiovascular complications. Conclusions: Cardiovascular complications of KD are frequent (more than 30%). Male gender, age under 2 years and anemia increase the probability of risk for the presence of cardiovascular complications.

Introducción: La enfermedad de Kawasaki (EK) es una vasculitis sistémica aguda de pequeños y medianos vasos, que se presenta principalmente en niños. Se manifiesta como síndrome febril aunado a datos de vasculitis, y puede causar anormalidades en las arterias coronarias en el 25% de los pacientes no tratados. El objetivo de este estudio fue describir el comportamiento clínico y la identificación de factores de riesgo para complicaciones cardiovasculares en pacientes pediátricos con EK atendidos en un hospital de segundo nivel del noroeste de México. Métodos: Bajo un diseño de serie de casos, se estudiaron pacientes pediátricos con diagnóstico de EK. Se midieron variables clínicas, de laboratorio y presencia de complicaciones cardiacas, y se estimó la probabilidad de riesgo con razón de momios (RM) y asociación con prueba de ji al cuadrado. Resultados: Se incluyeron 12 pacientes y predominó el sexo femenino; la edad media de presentación de la EK fue de 2 años. La presentación clínica fue completa en el 100% de los casos y hubo además manifestaciones atípicas. El 50% de los pacientes estudiados presentaron complicaciones cardiovasculares; la más común fue afección coronaria (33%). Las variables sexo masculino, edad menor de 2 años y anemia tuvieron RM de 5.5 y 10 de presentar complicaciones cardiovasculares. Conclusiones: Las complicaciones cardiovasculares de la EK son frecuentes (más del 30% de los pacientes). Las variables sexo masculino, edad menor de 2 años y anemia incrementaron la probabilidad de riesgo para la presencia de complicaciones cardiovasculares.

Value of protein concentration in cerebrospinal fluid in paediatric patients with Guillain-Barre syndrome. / Valor de la concentración de proteínas en el líquido cefalorraquídeo en pacientes pediátricos con síndrome de Guillain-Barré.

INTRODUCTION AND OBJECTIVE: The albumin-cytologic dissociation in cerebrospinal fluid (CSF) supports the diagnosis of Guillain-Barre syndrome (GBS) but does not support the prognosis, so the aim of this study is to determine the usefulness of protein numbers in the CSF to predict progression in paediatric patients. PATIENTS AND METHODS: A diagnostic test was performed in paediatric patients with GBS, analysing sociodemographic, clinical and protein variables in CSF as well as electromyography. The presence of dysautonomia was also documented. RESULTS: Data were analysed from 23 patients, predominantly males (87%), school age (43.5%) and history of digestive infection (73.9%). Using the ROC curve, an area under the curve of 0.966 with best CSF protein cut-off point of 87-92 proteins/mm was found for the presence of dysautonomias and to evaluate the poor response to treatment with 0.969 intravenous immunoglobulin with better cut-off point in 157 proteins/mm. CONCLUSION: The amount of proteins in the CSF can be used as a prognostic indicator and severity, such that proteins greater than 100 in CSF translate into a torpid evolution and with greater complications.

[Clinical profile of pediatric patients diagnosed with food allergy in Northwestern Mexico]. / Perfil clínico de pacientes pediátricos con diagnóstico de alergia alimentaria en el noroeste de México.

BACKGROUND: Food allergy is an adverse reaction secondary to a specific immune response after exposure to a food. Knowing the natural course of food allergies is essential for opportune diagnosis and treatment. OBJECTIVE: To know the clinical profile of children diagnosed with food allergy attended to at the pediatric allergology department of a secondary care hospital. METHODS: Cross-sectional study of medical records of children with a confirmed diagnosis of food allergy. The type of food allergy, initial clinical presentation, history of familial atopy, time of breastfeeding, ablactation age and positive food allergens per patient, among others, were assessed. Descriptive analysis was performed and association was searched with the chi-square test. RESULTS: Females were predominant among 95 patients. Milk, soy, wheat and egg were the foods with more allergic responses. Predominant clinical manifestations were gastrointestinal. The time from symptoms' onset to definitive diagnosis was 3.2 years. Food allergy was associated with an ablactation age ≥ 6 months, milk and soy with respiratory and gastrointestinal symptoms, egg with respiratory and dermatological symptoms, and wheat with gastrointestinal symptoms. CONCLUSIONS: Food allergies in our population appeared mainly as gastrointestinal symptoms and there was an association between clinical presentation and allergenic foods.

Antecedentes: La alergia alimentaria es una reacción adversa secundaria a una respuesta inmune específica tras la exposición a un alimento. Conocer el curso natural de las alergias alimentarias es esencial para el diagnóstico y tratamiento oportunos. Objetivo: Conocer el perfil clínico de niños con diagnóstico de alergia alimentaria, atendidos en el servicio de alergología pediátrica de un hospital de segundo nivel. Métodos: Estudio transversal de expedientes de niños con diagnóstico confirmado de alergia alimentaria. Se estudió tipo de alergia alimentaria, cuadro clínico inicial, antecedentes de atopia familiar, tiempo de alimentación al seno materno, edad de ablactación, alimentos alérgenos positivos por paciente, entre otros. Se realizó análisis descriptivo y búsqueda de asociación con chi cuadrada. Resultados: De 95 pacientes estudiados, predominaron las mujeres. Leche, soya, trigo y huevo fueron los alimentos con más respuestas alérgicas. Las manifestaciones clínicas más comunes fueron gastrointestinales. El tiempo de inicio de los síntomas al diagnóstico definitivo fue de 3.2 años. La alergia alimentaria se asoció con edad de ablactación ≥ 6 meses; leche y soya con sintomatología respiratoria y gastrointestinal, huevo con respiratoria y dermatológica y trigo con gastrointestinal. Conclusiones: Las alergias alimentarias se manifestaron principalmente con síntomas gastrointestinales y existió asociación entre cuadro clínico y alimentos alérgenos.

[Aneurisma de arteria testicular: reporte de un caso y revisión de la literatura]. / Testicular artery aneurysm: case report and review of the literature.

Background: Aneurysm of the testicular artery is a rare entity; the term is described as the dilation of any blood vessel in the body. Case report: An 18-year-old patient with a left testicular artery aneurysm, with no family or personal history of medical importance, presented for consultation due to a volume increase of long evolution in the inguinal region, accompanied by sporadic pain with no other symptoms. The testicular artery aneurysm was not detectable preoperatively by ultrasound, which only reported data compatible with left inguinal hernia and varicocele. The diagnosis was made postoperatively by a histopathological study. This case highlights the presentation of a true aneurysm of the testicular artery and the result after definitive surgical treatment. Conclusions: The etiology of the aneurysm and pseudoaneurysm reported in the literature is described after a testicular trauma and, a few cases of congenital origin. The clinical manifestations are pain and an inguinal mass, which can be frequently confused with inguinal hernias or an aggregated pathology. Therefore, the approach of patients with inguinal or testicular pathology should be protocolized and include aneurysm within the differential diagnoses.

Introducción: El aneurisma de la arteria testicular es poco frecuente; el término se describe como la dilatación de cualquier vaso sanguíneo en el cuerpo. Caso clínico: Se presenta el caso de un paciente de 15 años con un aneurisma de la arteria testicular izquierda sin ningún antecedente de importancia familiar ni personal, quien se presentó a consulta por aumento de volumen en la región inguinal de larga evolución, acompañado de dolor esporádico y sin más síntomas. Se diagnosticó hernia inguinal y se procedió a cirugía. El diagnóstico se realizó de manera posoperatoria por medio de estudio histopatológico. En este caso, se destaca la presentación de un aneurisma verdadero de la arteria testicular y el resultado después del tratamiento quirúrgico definitivo. Conclusiones: La etiología del aneurisma y del pseudoaneurisma reportada en la literatura se describe posterior a un traumatismo testicular, y en pocos casos de origen congénito. Las manifestaciones clínicas pueden ser dolor y una masa inguinal, y muchas de las veces pueden confundirse con hernias inguinales o ser una patología agregada, por lo que el abordaje de los pacientes con patología inguinal o testicular debe ser protocolizado e incluir el aneurisma dentro de los diagnósticos diferenciales.

Agranulocitosis secundaria a uso de vancomicina en pediatría. reporte de caso / Agranulocytosis secondary to vancomycin use in pediatrics. Case report

La vancomicina es un antibiótico de uso común en pacientes hospitalizados. Se han descrito múltiples efectos adversos relacionados a este fármaco, de los cuales la agranulocitosis es una entidad poco frecuente pero potencial mente grave. Este caso muestra una consecuencia médica secundaria al uso prolongado de este antibiótico, generando una neutropenia profunda posterior a 24 días de tratamiento, presentándose clínicamente con un pico febril aislado. Se asume que esta situación es consecuencia de una respuesta inmunológica inadecuada del huésped, por lo que la suspensión del agente etiológico es la clave del tratamiento. Existen pocos reportes de estos casos en la población pediátrica y debe considerarse un efecto secundario que requiere vigilancia estrecha para evitar repercusiones clínicas.

Vancomycin is a commonly used antibiotic in hospitalized patients. Multiple adverse effects related to this drug have been described, of which agranulocytosis is a rare but potentially serious entity. This case shows a medical consequence secondary to the prolonged use of this antibiotic, generating profound neutropenia after 24 days of treatment, presenting clinically with an isolated feverish peak. It is assumed that this situation is the consequence of an inadequate immunological response of the host, for which reason the suspension of the etiological agent is the key to treatment. There are few reports of these effects in the pediatric population and should be considered a side effect that requires close monitoring to avoid clinical repercussions.

[Evans syndrome in infants]. / Síndrome de Evans en lactantes.

BACKGROUND: Evans syndrome is characterized by the reduction of at least two blood cell lineages in the absence of other diagnoses; it was previously described as the simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia with unknown etiology. An incidence of 37% and mortality rate of 10% were reported for Evans syndrome. CLINICAL CASES: We report the clinical presentation and evolution of Evans syndrome in two infants who were initially diagnosed with immune thrombocytopenia. The clinical diagnosis was supported on complementary studies, where hematological disorders were corroborated. Both cases received treatment with steroids and intravenous immunoglobulin. CONCLUSIONS: For the management of children with thrombocytopenia, the pediatrician must analyze for other cell lineage disorders. In the cases that we report here, we found the presence of autoimmune hemolytic anemia and monocytosis. Therefore, infectious and immunological studies must be included. The first-line treatment of choice are steroids, and intravenous immunoglobulin can be considered if severe immune thrombocytopenia is associated, as observed in these cases.

[Active form of vitamin D in overweight and obese pediatric patients in northwest Mexico]. / Forma activa de la vitamina D en pacientes pediátricos con sobrepeso y obesidad en el noroeste de México.

BACKGROUND: Low levels of vitamin D have been associated with a range of clinical conditions such as obesity, insulin resistance, and diabetes mellitus, among others. There are few studies that measure the active form of vitamin D (1,25 (OH)2 vitamin D) in obese children. However, published data are inconclusive. The aim of this study was to determine the active levels of vitamin D in obese and overweight children and to find an association between low levels of vitamin D, obesity and impaired glucose metabolism. METHODS: A cross-sectional, analytical study was conducted in 6 to 12-year-old children with excess adiposity determined by waist-stature index and body mass index. Levels of glucose, insulin, complete lipid profile, homeostatic model assessment and the active form of vitamin D were measured in each patient. Levels < 30 pg/ml were considered as low levels of vitamin D. RESULTS: The prevalence of low levels of active vitamin D was 36%. A significant association between low levels of active vitamin D and high levels of insulin was found. No significant association was found between vitamin levels and adiposity measures. CONCLUSIONS: Low levels of active vitamin D were found in 36% of the population studied. A significant association with insulin resistance and hyperinsulinemia was demonstrated.

Asociación entre niveles séricos de vitamina D y factores de riesgo cardiometabólicos en pacientes pediátricos del noroeste de México

RESUMEN Introducción: Actualmente se ha observado que la hipovitaminosis D y la obesidad pueden influir en el desarrollo de enfermedad cardiovascular en el futuro. Objetivo: Identificar la asociación entre deficiencia de vitamina D y factores de riesgo cardiometabólicos en los pacientes pediátricos del noroeste de México. Materiales y métodos : se incluyeron niños de 6 a 15 años, se les midieron variables somatométricas, niveles séricos de colesterol total, C-HDL, C-LDL, triglicéridos, glucosa, insulina, vitamina D e índice HOMA-IR. Se identificó la asociación de factores de riesgo cardiometabólicos y la deficiencia de vitamina D, mediante la prueba de Chi cuadrado. Resultados: De los 114 pacientes evaluados, se detectó eutrofia en 42.1%, sobrepeso en 12.3%, obesidad en 41.2% y desnutrición en 4.4%. La prevalencia de deficiencia en vitamina D, insuficiencia y suficiencia fueron 18.4%, 27.2% y 54.4% respectivamente. La deficiencia de vitamina D mostró mayor predominio en pacientes con obesidad (27 %). La hipertrigliceridemia se asoció estadísticamente con deficiencia de vitamina D (p 0.041). Se observaron correlaciones inversas entre niveles de vitamina D con HOMA (r=-0.191; p=0.41), score Z IMC (r=-0.210; p=0.025) e insulina (r=-0.227; p=0.015). Conclusiones: La deficiencia de vitamina D se asocia en niños con un IMC elevado y resistencia a la insulina, lo cual puede acelerar el desarrollo de síndrome metabólico, diabetes mellitus tipo 2 y enfermedad cardiovascular.

ABSTRACT Introduction: It has currently been observed that hypovitaminosis D and obesity can influence the future development of cardiovascular disease. Objective: To identify the association between vitamin D deficiency and cardiometabolic risk factors in pediatric patients from northwestern Mexico. Materials and methods: Children aged 6 to 15 years were included, somatometric variables, serum levels of total cholesterol, HDL-C, LDL-C, triglycerides, glucose, insulin, vitamin D and HOMA-IR index were measured. The association of cardiometabolic risk factors and vitamin D deficiency was identified using the Chi square test. Results: Of the 114 patients evaluated, normal body-mass index was detected in 42.1%, 12.3% were overweight, 41.2% were obese and 4.4% were malnourished. The prevalence of vitamin D deficiency, insufficiency and sufficiency were 18.4%, 27.2% and 54.4% respectively. Vitamin D deficiency was more prevalent in obese patients (27%). Hypertriglyceridemia was statistically associated with vitamin D deficiency (p = 0.041). Inverse correlations were observed between vitamin D levels with HOMA (r = -0.191; p = 0.41), BMI Z score (r = -0.210; p = 0.025) and insulin (r = -0.227; p = 0.015). Conclusions: Vitamin D deficiency is associated with a higher BMI and insulin resistance in children, which can accelerate the development of metabolic syndrome, type 2 diabetes mellitus and cardiovascular disease.

[Total immunoglobulin E as marker of allergy at Northeast of Mexico]. / Inmunoglobulina E total como marcador de alergia en el noroeste de México.

BACKGROUND: Relationship of total serum IgE and allergy has been studied to determine if it could be a useful complement allergy diagnosis. OBJECTIVE: To determine whether serum total IgE is a useful tool in diagnosis of allergy in pediatric population attending outpatient pediatric allergy Regional General Hospital No. 1, Ciudad Obregón, Sonora, Mexico. MATERIAL AND METHOD: An epidemiological, observational, retrospective, transversal and analytical study of diagnostic test was done including files of children 3-15 years 11 months old, treated in pediatric allergy. For statistical analysis SPSS V-22 was used and through tetrachoric table, sensitivity, specificity of IgE for allergy diagnosis were determined, taking skin tests as a gold standard for diagnosing allergies; p value between the study variables was determined using Student t test. RESULTS: 248 records were studied; male gender was more frequent (59%). IgE sensitivity was 85% and specificity was 20%, cutoff point found was 148 IU/mL, elevated levels of IgE in skin tests to airborne allergens and presence of respiratory symptoms. CONCLUSION: IgE determination is a useful initial screening test in patients with suspected allergy.

Antecedentes: la relación entre IgE total en suero y alergia se ha estudiado para determinar si puede ser un complemento útil para el diagnóstico de alergia. Objetivo: conocer si la IgE sérica total es una herramienta útil en el diagnóstico de alergia en la población pediátrica que acude a la consulta externa de Alergología pediátrica del Hospital General Regional 1, Ciudad Obregón, Sonora. Material y método: estudio epidemiológico, observacional, retrospectivo, transversal y analítico de prueba diagnóstica, en el que se revisaron los expedientes de niños entre 3 y 16 años de edad, atendidos en el servicio de Alergología pediátrica. Para el análisis estadístico se utilizó el programa SPSS versión 22 y por medio de una tabla tetracórica se determinó la sensibilidad y especificidad de IgE para el diagnóstico de alergias; se tomaron pruebas cutáneas como patrón de referencia para el diagnóstico de alergias. Se determinó el valor de p entre las variables de estudio con la prueba t de Student. Resultados: se estudiaron 248 expedientes, el género masculino fue más frecuente (59%). La sensibilidad de IgE fue de 85% y la especificidad de 20%; el punto de corte encontrado fue de 148 UI/mL, concentraciones elevadas de IgE en pruebas cutáneas para aeroalergenos y existencia de síntomas respiratorios. Conclusiones: la determinación de IgE es una prueba útil de tamizaje inicial en pacientes con sospecha de alergia.

[Pulmonary complications associated with mechanical ventilation in neonates]. / Complicaciones pulmonares asociadas a ventilación mecánica en el paciente neonatal.

BACKGROUND: To determine the incidence of0 associated with mechanical ventilation in patients admitted to a service in a second level hospital NICU. METHODS: Retrospective analytical study records of newborns admitted to NICU room and receiving mechanical ventilation in a secondary hospital health care. Demographic data, of mechanical ventilation, intubation and complications reported in the clinical record were collected and analyzed in SPSS 20. RESULTS: 53 patients selected a total of 40 complications found. The annual incidence of pulmonary complications associated with mechanical ventilation in the area of service neonatology NICU, at a second level hospital at Sonora was 49.05% (95% CI 0.35 to 0.62). The most frequent pulmonary complications were atelectasis 35%, pneumonia 27.5%, pneumothorax 15%, bronchopulmonary dysplasia 15%, pneumomediastinum 15% and pulmonary hemorrhage 2.5%. CONCLUSIONS: The presentation of pulmonary complications secondary to mechanical ventilation in neonatal patients is similar to that reported in developing countries. Atelectasis is the most common pulmonary complication in neonatal patients undergoing mechanical ventilation.

Prevalencia de Cistatina C elevada en pacientes con sobrepeso y obesidad en el noroeste de México

RESUMEN Introducción: en los últimos años se ha reportado un incremento en la prevalencia de obesidad infantil, siendo este un factor de riesgo para enfermedades crónico-degenerativas como la Enfermedad Renal Crónica; por ende, se requieren de biomarcadores endógenos para detectar las alteraciones en el filtrado glomerular, siendo la Cistatina C uno de ellos. Objetivo: Identificar la frecuencia de Cistatina C elevada en pacientes con sobrepeso y Obesidad del noroeste de México. Material y Métodos: se estudió un grupo de infantes de 6 a 12 años, a los cuales según antropometría se clasificó en normopeso, sobrepeso u obesidad. Se obtuvo la somatometria y los niveles de Cistatina C de cada uno de ellos para el cálculo del filtrado glomerular y clasificar la función renal y se buscó asociación entre estas dos condiciones mediante prueba de chi cuadrado. Resultados: de un grupo de 80 pacientes el 51.3% presentó sobrepeso/obesidad; de estos en el 46.3% se reportaron niveles altos de Cistatina C, de acuerdo con el rango de referencia propuesto por Filler 2003. La media para Tasa de Filtración Glomerular (TFG) en el grupo con sobrepeso/obesidad fue de 103.1 ml/min/1.73 m2, comparada con el grupo normopeso de 121.2 ml/min/1.73 m2. La frecuencia de niveles altos de Cistatina C en población con sobrepeso/obesidad fue de 62.9% comparado con un 26.6% en normopeso. Conclusiones: Los Niños de 6 a 12 años con exceso de peso presentan mayor frecuencia de nivel elevado de Cistatina C.

ABSTRACT Introduction: in recent years an increase has been reported in the prevalence of childhood obesity, which is a risk factor for chronic degenerative diseases such as Chronic Kidney Disease; therefore, endogenous biomarkers are needed to detect alterations in glomerular filtration, Cystatin C being one of them. Objective: To identify the frequency of elevated Cystatin C in overweight and obese patients in northwestern Mexico. Materials and Methods: a group of infants aged 6 to 12 years was studied, who according to anthropometry were classified as normal weight, overweight or obesity. Somatometry and Cystatin C levels were obtained from each of them to calculate glomerular filtration rate and classify renal function, and an association between these two conditions was sought using the chi-square test. Results: of a group of 80 patients, 51.3% were overweight / obese; Of these, 46.3% had high levels of Cystatin C, according to the reference range proposed by Filler 2003. The mean Glomerular Filtration Rate (GFR) in the overweight / obese group was 103.1 ml / min / 1.73 m2, compared to the normal weight group of 121.2 ml / min / 1.73 m2. The frequency of high levels of Cystatin C in the overweight / obese population was 62.9% compared to 26.6% in normal weight. Conclusions: Children from 6 to 12 years of age with excess weight have a higher frequency of high levels of Cystatin C.

Desempeño diagnóstico del modelo FullPIERS como predictor de complicaciones perinatales en pacientes con preeclampsia / Diagnostic performance of FullPIERS model as predictor of perinatal complications in patients with preeclampsia

Resumen OBJETIVO: Determinar el desempeño diagnóstico del modelo FullPIERS como predictor de complicaciones perinatales en pacientes con preeclampsia atendidas en un hospital público del Noroeste de México. MATERIALES Y MÉTODO: Estudio retrospectivo, para evaluación de una prueba diagnóstica, efectuado en pacientes con diagnóstico de preeclampsia atendidas en un hospital público de segundo nivel entre octubre de 2018 y febrero 2019. Criterios de inclusión: expedientes con datos suficientes para introducirlos en la calculadora FullPIERS (saturación de oxígeno, recuento de plaquetas, creatinina, aspartato, transaminasa y existencia o no de disnea). Criterios de exclusión: pacientes con diagnóstico previo de padecimientos hepáticos agudos, pulmonares o renales. Se comparó el porcentaje de riesgo al ingreso de cada paciente versus la cantidad de pacientes con y sin complicaciones. Se calcularon: sensibilidad, especificidad y valores predictivos del modelo. RESULTADOS: Se estudiaron 100 expedientes de pacientes con preeclampsia: 11 con resultados positivos según la calculadora Full PIERS (más de 5% de riesgo), en 7 de 11 fue verdadero positivo. Para el modelo Full PIERS se obtuvieron: sensibilidad de 58.3% y especificidad de 95.5%, valor predictivo positivo de 59%, y valor predictivo negativo de 95% para la predicción de complicaciones de la preeclampsia, con área bajo la curva de 0.799. CONCLUSIÓN: La calculadora FullPIERS es una herramienta útil para predecir complicaciones a corto plazo y poder indicar el tratamiento adecuado a cada paciente.

Abstract OBJECTIVE: To determine the diagnostic performance of the FullPIERS model as a predictor of perinatal complications in patients with preeclampsia from a public hospital in Northwest Mexico. MATERIALS AND METHODS: Retrospective study, for the evaluation of a proper diagnosis, performed in patients with diagnosis of preeclampsia attended at a second-level public hospital between October 2018 and February 2019. Inclusion criteria: sufficient data to introduce them into the FullPIERS calculator (saturation of oxygen, platelet retreat, creatinine, aspartate, transaminases and the existence of dysnea). Exclusion criteria: patients with previous diagnosis of acute, pulmonary or renal liver diseases. It is compared to the percentage of the ingrowth risk of each patient versus the number of patients with complications. Calculated: sensitivity, specificity and predictive values of the model. RESULTS: If 100 patients were studied with preeclampsia: 11 with positive results according to the Full PIERS calculator (over 5% risk), and 7 out of 11 were true. For the Full PIERS model, it was obtained: 58.3% sensitivity and 95.5% specificity, 59% positive predictive value, and 95% negative predictive value for the prediction of complications of preeclampsia, with a curve area of 0.799. CONCLUSION: The FullPIERS calculator is a useful tool for predicting complications to cut and can indicate the appropriate treatment for each patient.

Adherencia terapéutica y control glucémico en pacientes con diabetes gestacional bajo dos esquemas de tratamiento / Gestational diabetes adherence to treatment and metabolic control

Background: Adherence to treatment is a large obstacle in the management of chronic diseases. Aim: To evaluate therapeutic adherence and its relationship with glycemic control in patients with gestational diabetes using two types of treatment. Material and Methods: The Measurement of Treatment Adherence (MAT) questionnaire was applied to 93 patients with gestational diabetes. Fifty-two used metformin 41 were treated with insulin. Obstetric and socio-demographic data were collected. Results: A higher therapeutic adherence was associated with a better glycemic control. Women with a higher education level had a better adherence to treatment. The adherence and metabolic control were higher in women treated with metformin. Conclusions: Therapeutic adherence is an important factor for adequate glycemic control.

Efecto de una estrategia de intervención para conocer las habilidades de los residentes de Ginecología y Obstetricia en reanimación cardiopulmonar básica de la paciente embarazada / Effect of the intervention strategy to know the skills of residents of Gynecology and Obstetrics in basic cardiopulmonary resuscitation of the pregnant patient

Resumen OBJETIVO: Determinar qué repercusión tienen en la supervivencia de la paciente con paro cardiorrespiratorio las estrategias de intervención y las habilidades para la reanimación cardiopulmonar básica, por parte del residente de Ginecología y Obstetricia, en un hospital de segundo nivel de atención. MATERIALES Y MÉTODOS: Estudio prospectivo, transversal, analítico y comparativo efectuado entre los meses de marzo a agosto de 2018 en residentes de Ginecología y Obstetricia del Hospital General Regional 1 de Ciudad Obregón, Sonora, a quienes se evaluó antes y después de una intervención de soporte vital básico en pacientes embarazadas. Para observar las diferencias en conocimientos clínicos entre los grupos se aplicó la prueba de Kruskal-Wallis, para medir la diferencia entre los grupos se utilizó U de Mann Whitney y para el análisis estadístico descriptivo se utilizaron medidas de tendencia central. RESULTADOS: Se evaluaron de manera inmediata 20 residentes y solo 1 no aprobó. En la evaluación final mediata 16 de 19 aprobaron. CONCLUSIONES: Se demostró un efecto favorable de la estrategia de intervención aplicada a los residentes de Ginecología y Obstetricia pues se obtuvieron resultados estadísticamente significativos.

Abstract OBJECTIVE: To determine the impact of the intervention strategy and basic cardiopulmonary resuscitation skills on the part of the resident of Gynecology and Obstetrics on the survival of the patient with cardiorespiratory arrest in a second-level care hospital. MATERIALS AND METHODS: Prospective and cross-sectional study, carried out in the period from March to August 2018, including all the resident physicians of the specialty of Gynecology and Obstetrics of HGR 1 of Ciudad Obregón, who underwent pre and post intervention evaluation of Vital Support Basic in the pregnant patient. To observe the differences in the level of clinical knowledge between the groups, Kruskal-Wallis was used and to measure the difference between the groups, the Mann Whitney U was used. For the descriptive statistical analysis, measures of central tendency were used. RESULTS: In the immediate final evaluation, there were 20 residents evaluated, 19 (95%) approved and 1 non-approving (5%). Average final evaluation, of 19 residents evaluated, 16 (84%) approved, and 3 (16%) did not approve. CONCLUSION: A favorable effect of the intervention strategy applied to residents of Gynecology and Obstetrics was demonstrated, since statistically significant results were obtained.