Breastfeeding Practices and Postpartum Depression in Mexican Women during the COVID-19 Pandemic: A Cross-Sectional Study.

Background: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an infant's first months of life. Since the onset of the COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of feelings, which may make isolation challenging in terms of maternal health. This study focused on the prevalence of breastfeeding practices and postpartum depression (PPD) among Mexican women during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 586 postpartum women who completed an online survey 4-8 weeks after delivery from April to December 2020 in Guadalajara, Mexico. The aim was to identify potentially depressed mothers according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their breastfeeding practices. Results: The mean maternal age was 30.4 ± 4.6 years, the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with a lower prevalence of PPD during the first 48 h (p = 0.015) and after the first 48 h (p = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 (65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it was in those not practicing SSC (40.3%) (p = 0.001). A higher percentage of mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) (p = 0.012 and 0.001, respectively). Conclusions: Results suggest that the pandemic emergency and restrictions imposed on the population significantly affected the well-being of mothers after birth, and that these effects may have posed risks to the mental health and emotional stability of postpartum mothers. Therefore, encouraging BF or EBF and SSC may improve or limit depressive symptoms in postpartum mothers.

Treatment of melasma with platelet-rich plasma: A self-controlled clinical trial.

Melasma is a common circumscribed hypermelanosis of sun-exposed areas of the skin. Platelet-Rich Plasma therapy has been evidenced to inhibit melanin synthesis in animals and humans. To determine the effectiveness of platelet-rich plasma as a treatment for melasma. Twenty female patient with melasma were involved in this study. The intervention included three Platelet-Rich Plasma application sessions at 15-day intervals. Patients were evaluated before and after treatment. Variables measured included the facial melanin concentration using the melasma area and severity index score, melasma quality of life scale satisfaction grade, and histologic changes. Mean age was 41 ± 7 years. An initial MELASQOL score of 42 ± 14.8 and final score of 16.6 ± 7.2 (p = 0.008) were reported; the initial and final MASI score were 15.5 ± 8.4 and 9.5 ± 7.2 (p = 0.001), respectively. The dermatoscopy examination revealed a decrease in pigmentation after intervention (p = 0.001). Histopathologic improvement was detected in reductions in cutaneous atrophy (14 [70%] vs. 11 [55%]), solar elastosis (15 [75%] vs.11 [55%]), and inflammatory infiltrate (9 [45%] vs. 6 [30%]), before and after treatment, respectively. The intervention was associated with decreased intensity of the melasma patch and improved skin quality, shown by the MELASQOL and MASI scores.

Differences in Postoperative Pain, Nausea, and Vomiting After Elective Laparoscopic Cholecystectomy in Premenopausal and Postmenopausal Mexican Women.

BACKGROUND: Postoperative symptoms and pain after laparoscopic cholecystectomy (LC) are common in women. However, there is no evidence of differences in incidence and severity among different age groups. We evaluated whether adverse postoperative symptoms were more common in younger than in older women after LC. METHODS: One hundred and fifty premenopausal (mean age 37.6 ± 3.6 y) and 145 postmenopausal women (59 ± 5.2 y) were included in this retrospective cohort study. Clinical and anthropometric parameters were analyzed. Study endpoints were the incidences of postoperative nausea and vomiting (PONV) and pain, and the additional analgesics and antiemetics needed after surgery. RESULTS: Body mass index was normal in 42.7% of patients in the younger group and 64.8% in the older group (P < 0.001). Reported pain was more frequent and intense in the younger group throughout the study period (P < 0.01). Additional narcotics were required in 18% of premenopausal versus 7.6% of postmenopausal women (P = 0.001), and the doses used to reduce pain were higher for premenopausal women (P = 0.02). PONV was more frequent in the younger group at 1 and 6 h after surgery (P < 0.005). Rescue antiemetics were required in 29 premenopausal and 13 postmenopausal women (P = 0.01). Hospital stay was shorter for the older patients (P = 0.01). Minor morbidity was observed in both groups (0.7% and 2.1%). There was no mortality. CONCLUSIONS: Early PONV and pain after LC were more frequent in premenopausal women, who also required more rescue analgesic and antiemetic medication.

Effects of Oral Zafirlukast, Sildenafil, or Pirfenidone on the Formation of Postsurgical Intra-Abdominal Adhesions in an Experimental Rat Model.

INTRODUCTION: Intra-abdominal adhesions' main etiology is surgical procedures that commonly require reintervention. Oral treatments with sildenafil, zafirlukast, and pirfenidone have yielded decreased severity of fibrotic phenomena secondary to the introduction of foreign material. This study aimed to evaluate the efficacy of oral zafirlukast, sildenafil, or pirfenidone treatment on reducing or preventing intra-abdominal adhesions in an experimental rat model. METHODS: Four groups, each of 10 male Wistar rats weighing 250-300 g, were used. A midline laparotomy was used to excise an area of 1.5 × 1.5 cm and reconstructed with polypropylene mesh fixed to the abdominal wall. After 12 h, oral doses of zafirlukast (1.25 mg/kg, group B), sildenafil (15 mg/kg, group C), or pirfenidone (500 mg/kg, group D) were given every day for 8 days. The control group, A, received no treatment. At day 9, animals were reoperated. The implant was resected after ethically approved euthanasia, and specimens were fixed in 10% formaldehyde for histopathology. RESULTS: Control group A yielded adhesions with greater fibrovascular density and neighboring organ involvement than the other groups (p = 0.001), as well as intense inflammatory infiltrates and numerous granulomas (p = 0.04). Adhesions in group C had less fibrovascular density (p = 0.03) with decreased serosal injuries (p = 0.001) and less organ involvement. Group D had reduced adhesions without organ involvement (p < 0.01) and less inflammatory infiltrates, collagen fibers, and foreign body granulomas than group B or C (p < 0.01). CONCLUSIONS: Oral administration of these agents did not prevent adhesions but ameliorated them. Oral pirfenidone offered the best performance and could be recommended for human use.

Effects of Oral Pirfenidone on Colon Anastomosis Healing and Adhesion Formation in Rats.

INTRODUCTION: Many experimental studies have examined multiple drugs or treatments to improve the healing of intestinal anastomoses. Synthetic prostacyclin analogs, immunosuppressants, erythropoietin, growth hormone, insulin-like growth factor type 1, synthetic metalloproteinases inhibitors, and hyperbaric oxygen therapy have produced promising results in low-risk models of anastomosis dehiscence. However, in high-risk models, only hyperbaric oxygen therapy has been shown to be useful. Pirfenidone (PFD), a commonly used antifibrosing drug, has not been shown to be effective for this purpose. Our objective was to evaluate the effects of PFD on anastomosis healing and adhesion genesis in a low-risk rat model of dehiscence of colonic anastomosis. METHODS: An experimental study was conducted on 40 healthy Wistar rats randomly assigned to the control group or PFD experimental group (20 rats in each group). Colon anastomosis was performed 3 cm above the peritoneal reflection using the same technique in all animals. Mechanical resistance was studied by measuring bursting pressure. Adhesions were evaluated macroscopic and histologically using common staining techniques. Animals received the first PFD dose 12 h after surgery at a dose of 500 mg/kg one a day (SID) for 5 consecutive days. On day 6, the animals were reoperated on to measure the bursting pressure in situ and to classify adhesions macroscopically, and the anastomosed colon was resected for histological analysis. RESULTS: There were no deaths, complications, or anastomosis dehiscence in either group. The mean bursting pressure was 120.8 ± 11 mm Hg and 135.5 ± 12.4 in the control and PFD groups, respectively (p < 0.001). The adhesions were less dense and had less inflammatory cell infiltration in the PFD group (p < 0.02 and 0.002, respectively). Collagen content was slightly higher in the PFD group (p = 0.04). CONCLUSIONS: Our results revealed favorable effects of PFD in this low-risk colon anastomosis model; for example, the bursting pressure was higher, and the macroscopic adhesions were soft and exhibited less inflammatory infiltration and higher collagen content in the PFD group than in the control group. The results showing that PFD treatment was associated with better healing of minor adhesions seem to be paradoxical because the therapeutic indications for this drug are directed at treating fibrosing diseases.

[Cholelithiasis during pregnancy and postpartum: prevalence, presentation and consequences in a Referral Hospital in Baja California Sur]. / Colelitiasis en el embarazo y posparto. Prevalencia, presentación y consecuencias en un hospital de referencia en Baja California Sur.

INTRODUCTION: Pregnancy and the postpartum period are risk factors for developing biliary sludge, gallstones, and any of their complications. OBJECTIVE: To determine the prevalence, presentation, and consequences of cholestasis during pregnancy and postpartum in a referral hospital of Baja California Sur. MATERIAL AND METHODS: This was a retrospective, observational study that enrolled pregnant or postpartum patients diagnosed with gallstones with any presentation. RESULTS: 137 patients were included, with 22 ± 4 years of age; 33 were pregnant and 104 in the postpartum period. Only 14% of the group had a history of cholelithiasis, and overweight/obesity was observed in 66.7 and 66.3% of pregnant and postpartum patients, respectively (p = 0.94). Of pregnant patients, 33.3% presented with acute cholecystitis, a condition observed in 16.3% of the postpartum patients (p = 0.04). Pancreatitis and choledocholithiasis were slightly more common in pregnant women (21.23% vs. 19.2%; p = 0.56). There was no maternal mortality and one case of spontaneous abortion was exclusively observed. CONCLUSIONS: It is a priority to diagnose and monitor cholelithiasis in pregnant women because the acute cases observed occurred more frequently, but choledocholithiasis and pancreatitis occurred similarly in both groups.

[Critical points to implement an antibiotic form for management of surgical wound infection]. / Puntos críticos para implementar un formulario de antibióticos para el manejo de infección de herida quirúrgica.

Background: Surgical site infection (SSI) is a major complication of surgical procedures and contributes to morbidity, mortality, and healthcare costs. It is commonly caused by Gram-negative bacteria and should be monitored in hospital units. Objective: To identify critical points to implement an antibiotic form for surgical wound infection management. Material and methods: Descriptive observational study in 100 cultures of wounds with SSI. The most common diagnosis, the microorganism involved, sensitivity to antibiotics and prescription consistency were identified. In addition, demographic variables were assessed and a questionnaire was applied to surgeons in order to identify the critical points to implement a local formulary of antibiotics. Results: 37% of cultures came from female patients. The most common diagnosis was hollow viscus perforation in 31%. The most common microorganism was Escherichia coli ESBL in 20% and 55% of these were sensitive to imipenem. The critical points observed were consistency in the prescription of antimicrobials, which reached only 29%, and that surgeons did not actively participate in strategies for the rational use of antibiotics. Conclusions: As a critical point to implement the antibiotic form, little involvement of surgeons with the hospital infection control team was found. The incidence of SSI was 2.4%, predominantly in emergency surgery. The presence of E. coli ESBL is frequent, with resistance to broad-spectrum antimicrobials.

Introducción: las infecciones del sitio quirúrgico (ISQ) son una complicación importante de los procedimientos quirúrgicos y contribuyen a la morbilidad, la mortalidad y los costos sanitarios. Comúnmente son causadas por bacterias Gram-negativas y deben ser monitoreadas en las unidades hospitalarias. Objetivo: identificar puntos críticos para implementar un formulario de antibióticos para el manejo de infección de herida quirúrgica. Material y métodos: estudio observacional descriptivo en 100 cultivos de heridas con ISQ. Se identificó el diagnóstico más común, el microorganismo involucrado, la sensibilidad a los antibióticos y la congruencia de la prescripción. Además, se evaluaron variables demográficas y se aplicó un cuestionario a cirujanos para identificar los puntos críticos para implementar un formulario local de antibióticos. Resultados: el 37% de los cultivos procedieron de pacientes mujeres. El diagnóstico más común fue perforación de víscera hueca en el 31%. El microrganismo más común fue Escherichia coli BLEE en el 20% y el 55% de estos fueron sensibles a imipenem. Los puntos críticos observados fueron la congruencia en la prescripción de antimicrobianos que alcanzó solo 29% y que los cirujanos no participaron activamente en las estrategias del uso razonado de antibióticos. Conclusiones: como punto crítico para implementar el formulario de antibióticos se encontró poca participación de los cirujanos con el equipo hospitalario de control de infecciones. La incidencia de ISQ fue del 2.4% y preedominaron en la cirugía de urgencia. La presencia de E. coli BLEE es frecuente, con resistencia en antimicrobianos de amplio espectro.

Quality of sexual life in Mexican men after spinal cord injury.

OBJECTIVE: To evaluate the quality of sexual life in men with spinal cord injury. DESIGN: Cross-sectional analytical study. PATIENTS: Males with a history of spinal cord injury who attended an outpatient rehabilitation service. METHODS: An analytical study examined adult male patients with complete spinal cord injury in rehabilitation. A modified Sexual Life Quality Questionnaire (SLQQ) examined quality of sexual life, with scores below 50 suggesting significant sexual dysfunction and dissatisfaction. The assessment evaluated age, occupation, marital status, comorbidities, and treatment methods. RESULTS: A total of 80 patients were included; 33 (41%) had a thoracic spinal cord injury, and 47 (59%) had a lumbar spinal cord injury. Thirty-seven patients (46%) were dissatisfied with the quality of their sexual life; 29 patients (88%) with thoracic spinal cord injury and 8 patients (17%) with lumbar spinal cord injury were dissatisfied with the quality of their sexual life (p = 0.001). Patients with higher education level experienced less sexual dissatisfaction (p = 0.03). CONCLUSION: Human sexuality involves numerous interconnected elements that impact on general health. Sexual pleasure, self-esteem, and personal relationships are crucial for patients with spinal cord injury to identify rehabilitation needs. These results indicate the importance of supporting sexual well-being in recovery. Further studies of sexual enjoyment and quality of life for patients with spinal cord injury are needed, using larger and more diverse populations.

SARS-CoV-2 Variants of Concern and Clinical Severity in the Mexican Pediatric Population.

The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants of concern (VOCs) presents global heterogeneity, and their relative effect on pediatric severity is still limited. In this study, we associate VOCs with pediatric clinical severity outcomes in Mexico. Bioinformatics methods were used to characterize VOCs and single amino acid (aa) mutations in 75,348 SARS-CoV-2 genetic sequences from February 2020 to October 2022. High-predominance VOCs groups were calculated and subsequently associated with 372,989 COVID-19 clinical pediatric outcomes. We identified 21 high-frequency mutations related to Omicron lineages with an increased prevalence in pediatric sequences compared to adults. Alpha and the other lineages had a significant increase in case fatality rate (CFR), intensive critical unit (ICU) admission, and automated mechanical ventilation (AMV). Furthermore, a logistic model with age-adjusted variables estimated an increased risk of hospitalization, ICU/AMV, and death in Gamma and Alpha, in contrast to the other lineages. We found that, regardless of the VOCs lineage, infant patients presented the worst severity prognoses. Our findings improve the understanding of the impact of VOCs on pediatric patients across time, regions, and clinical outcomes. Enhanced understanding of the pediatric severity for VOCs would enable the development and improvement of public health strategies worldwide.

[Comparison of the Pap smear with conventional technique versus modified technique]. / Comparación del Papanicolau con técnica convencional frente a técnica modificada.

Background: Despite the fact that the Papanicolaou technique is the most effective method of prevention and detection of cervical cancer, the precision of this tool remains controversial; Because of this, there are medical and scientific efforts to improve the quality of the procedure. Objective: Compare the quality of sampling between the conventional and modified technique. Material and methods: Descriptive and comparative observational study in 150 cervical cytology samples (75 conventional technique samples and 75 in modified technique) in women aged 25 to 64 years. Demographic variables, characteristics of the cervix and quality of the sample were analyzed. Descriptive statistics and association measures were performed. Study with risk greater than the minimum. All participants signed an informed consent. Results: The quality of the sample was satisfactory in 92.0% for the conventional technique vs 89.3% for the modified technique. The main cause of unsatisfactory samples was insufficient cellularity 6.7% in conventional technique vs 12% of the modified technique, with no significant difference between both techniques p = 0.575 (1.37; 0.45-4.1), findings that reject the working hypothesis. Conclusions: There was no significant difference when using both tests, the samples with satisfactory quality were similar between both techniques.

Introducción: a pesar de que la técnica de papanicolaou es el método más eficaz para la prevención y detección del cáncer cervicouterino, la precisión de esta herramienta sigue siendo controversial; debido a esto, existen esfuerzos médicos y científicos para mejorar la calidad del procedimiento. Objetivo: comparar la calidad en la toma de muestra entre la técnica convencional y la modificada. Material y métodos: estudio observacional descriptivo y comparativo en 150 muestras de citología cervical (75 muestras técnica convencional y 75 en técnica modificada) en mujeres de 25 a 64 años. Se analizaron variables demográficas, características del cérvix y calidad de la muestra. Se realizó estadística descriptiva y medidas de asociación. Estudio con riesgo mayor que el mínimo. Todas las participantes firmaron consentimiento informado. Resultados: la calidad de la muestra fue satisfactoria en el 92% para la técnica convencional frente al 89.3% para la técnica modificada. La causa principal de muestras insatisfactorias fue la celularidad insuficiente, la cual se presentó en el 6.7% de las muestras con técnica convencional frente al 12% de la técnica modificada, sin diferencia significativa entre ambas técnicas p = 0.575 (1.37; 0.45-4.1), hallazgos que rechazan la hipótesis de trabajo. Conclusiones: no hubo diferencia significativa al utilizar ambas pruebas, las muestras con calidad satisfactoria fueron similares entre ambas técnicas.

Substance Use and Psychological Distress in Mexican Adults during COVID-19 Pandemic: A Cross-Sectional Study.

OBJECTIVES: This observational cross-sectional study examined changes in substance use during the coronavirus disease 2019 (COVID-19) pandemic in the Mexican population and evaluated whether depression or anxiety was associated with these new consumption patterns. METHODS: An online survey was distributed to the general population. Participants were questioned about their demographics, situation during the COVID-19 pandemic, and substance consumption patterns. The Patient Health Questionnaire-9 for depression and the Coronavirus Anxiety Scale were used. RESULTS: A total of 866 individuals completed the survey. The mean scores for the Patient Health Questionnaire-9 and Coronavirus Anxiety Scale were 8.89 ± 6.20 and 3.48 ± 3.22, respectively. The preferred substances were alcohol (19%), tobacco (16.5%), and marijuana (5.6%). Consumption of alcohol (p = 0.042) significantly increased during the pandemic and it was higher in women than in men (p = 0.040). CONCLUSIONS: Substance use patterns were affected by the pandemic, with an increase in the number of users and consumption rate, as well as the reported psychiatric symptoms.

Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer.

BACKGROUND: Dexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy. METHODS: In this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (n = 35) or placebo (n = 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded. RESULTS: Demographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% vs. 60%; p = 0.02) and at 6 h (17.2% vs. 45.8%; p = 0.03). More patients in the placebo group required additional antiemetic medication (21 vs. 8; p = 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 vs. 5.83 ± 2.00; p = 0.004), at 6 h (3.03 ± 1.20 vs. 4.17 ± 1.24; p < 0.0005) and at 12 h (2.09 ± 0.85 vs. 2.54 ± 0.98; p = 0.04). Analgesics were required in more patients of the control group (21 vs. 10; p = 0.008). There were no adverse events, morbidity or mortality. CONCLUSIONS: Preoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer. TRIAL REGISTRATION NUMBER: NCT01116713.

Perception of humanized childbirth in patients in the puerperium period. / Percepción del parto humanizado en pacientes en periodo de puerperio.

BACKGROUND: The patient's perception of humanized childbirth care is important to identify and avoid data suggestive of obstetric violence, which is all conduct, action or omission, performed by health personnel that affect the body and the reproductive processes of women, expressed in dehumanized treatment. OBJECTIVE: To know the level of perception of humanized childbirth in patients in the postpartum period in the OB-Gyn Service at the Hospital General de Zona No. 1 from the Instituto Mexicano del Seguro Social. MATERIAL AND METHODS: Observational study in 190 patients in the immediate puerperium. Demographic variables were measured and the level of perception of humanized delivery was analyzed (inadequate: 18-32 points; regular: 35-53 points; adequate: 54-72 points). Descriptive statistics and association measures were used. Informed written consent of the participants was signed and authorized with the registration number R-2018-301-020. RESULTS: The overall perception of humanized delivery was inadequate in 56.8%, regular in 34.7% and adequate in 8.4%. CONCLUSION: The perception of humanized childbirth in patients who are in immediate postpartum in our hospital is inappropriate, since they were not provided with the appropriate guidance, information on pain management, choosing a position of labor, and having the possibility that a companion is present during the process.

INTRODUCCIÓN: La percepción de las pacientes sobre la atención del parto humanizado es importante para identificar y evitar datos que sugieran violencia obstétrica, que es toda conducta, acción u omisión realizada por personal de la salud que afecte el cuerpo y los procesos reproductivos de las mujeres, expresada en un trato deshumanizado. OBJETIVO: Conocer el nivel de percepción de parto humanizado en las pacientes en periodo de puerperio en el servicio de ginecoobstetricia del Hospital General de Zona No. 1 del Instituto Mexicano del Seguro Social. MATERIAL Y MÉTODOS: Estudio observacional en 190 pacientes en -puerperio inmediato. Se midieron variables demográficas y se -analizó el nivel de percepción de parto humanizado (inadecuado: 18-32 puntos; regular: 35-53; adecuado: 54-72). Se utilizaron estadística descriptiva y medidas de asociación. Se recabó el consentimiento informado por escrito de las participantes y fue autorizado con el número de registro R-2018-301-020. RESULTADOS: La percepción global de parto humanizado fue inadecuada en el 56.8%, regular en el 34.7% y adecuada en el 8.4%. CONCLUSIÓN: La percepción de parto humanizado en las pacientes que están en puerperio inmediato en nuestro hospital es inadecuada, ya que no se les proporcionaron la orientación adecuada, la información sobre el manejo del dolor, la elección de la posición del trabajo de parto ni la posibilidad de que un acompañante estuviera presente durante el proceso.

[Anxiety in the presence of food in schoolchildren of Baja California Sur]. / Ansiedad en presencia de alimentos en escolares de Baja California Sur.

INTRODUCTION: Introduction: many obese children will be obese adults unless they adopt and maintain healthy eating and physical activity patterns. Anxiety has been described in overweight and obese children with dysfunctional family environments, with impact on their quality of life; risk for some eating disorder was also found. Objective: to identify anxiety in the presence of food in schoolchildren in Baja California Sur. Material and methods: a cross-sectional study in 406 schoolchildren, from 8 to 13 years of age, was performed: nutritional status calculation, measurements of attitudes towards food (cut-off point > 20), socioeconomic level, type of family, and intake of junk food were collected. Descriptive statistics and association measures were performed using Student's t-test and the chi-squared test. Parents provided their informed consent, and children provided their assent. Results: a total of 406 schoolchildren were evaluated, with ages of 10.4 ± 1.2. Of these, 53 % had healthy weight, 44 % had overweight or obesity, and 3 % were underweight. Functional families predominated at 67 %. A middle socioeconomic level was found in 64 %. In all, 94 % consumed junk food. There is an association between anxiety in the presence of food and socioeconomic status, and anxiety in the presence of food and nutritional status (p = 0.01). In overweight and obese schoolchildren no association was found between study variables. There is anxiety in the presence of food in 40 % of the sample due to external factors, in 5 % because of tiredness or boredom, in 11 % because of negative feelings. Conclusion: there is an association between anxiety, socioeconomic status, and nutritional status. Anxiety in the presence of food occurred in 54.7 % of cases.

INTRODUCCIÓN: Introducción: muchos niños obesos serán adultos obesos a menos que adopten y mantengan patrones saludables de alimentación y actividad física. Se han descrito: ansiedad en niños con sobrepeso y obesidad en ambientes de familias disfuncionales, repercusión en la calidad de vida y riesgo de algún desorden alimenticio. Objetivo: identificar la ansiedad en presencia de alimentos en escolares de Baja California Sur. Material y métodos: estudio de tipo encuesta trasversal en 406 escolares de 8 a 13 años de edad; se realizó un cálculo del estado nutricional y se efectuó una medición del test de actitudes hacia la alimentación (punto de corte de > 20); se recopilaron el nivel socioeconómico, el tipo de familia y la ingesta de comida chatarra. Se realizó una estadística descriptiva con medidas de asociación mediante la prueba t de Student y prueba de chi2. Se obtuvieron el consentimiento informado de los padres y el asentimiento del menor. Resultados: se evaluaron 406 escolares con edades de 10,4 ± 1,2. El 53 % presentaron peso saludable, el 44 % sobrepeso y obesidad, y el 3 % bajo peso. Predominó la familia funcional con un 67 %. Se consttó un nivel socioeconómico medio en el 64 %. El 94 % consumen alimentos chatarra. Existe asociación entre ansiedad en presencia de alimentos y nivel socioeconómico, y entre ansiedad en presencia de alimentos y estado nutricional (p = 0,01). En los escolares con sobrepeso y obesidad no se encontró asociación entre las variables del estudio. Existe ansiedad en presencia de alimentos en el 40 % por factores externos, en el 5 % por cansancio o aburrimiento y en el 11 % por sentimientos negativos. Conclusión: existe asociación entre ansiedad, nivel socioeconómico y estado nutricional. La ansiedad en presencia de alimentos se presentó en el 54,7 % de los casos.

Effect of a preoperative single-dose steroid on pulmonary function and postoperative symptoms after modified radical mastectomy: results of a randomized clinical trial.

BACKGROUND: Evidence suggests that a preoperative single-dose steroid improves lung function and decreases the incidence of postoperative symptoms; however, this has not been sufficiently proved in modified radical mastectomy for cancer. This study aimed to evaluate the efficacy of preoperative single-dose steroid administration for postoperative lung function and postoperative symptoms in women undergoing modified radical mastectomy for breast cancer. METHODS: In this controlled clinical trial, conducted between June 2014 and October 2018, we examined 81 patients. Patients received a preoperative single dose of 8 mg dexamethasone (n=41; treatment group) or placebo (sterile injectable water; n=40; control group). We obtained data on postoperative nausea and vomiting and pain intensity and performed spirometry 1 h before and 1, 6, 12, and 24 h after surgery. The use of additional analgesic or antiemetic drugs was recorded. We followed up patients 30 days after discharge and recorded any surgical or medical complications. RESULTS: The age distribution and anthropometric variables of the two groups were similar. Almost 50% of the patients in each group also underwent breast reconstruction. In the treatment group, pain intensity was always lower, the incidence of postoperative nausea and vomiting was lower at 6, 12, and 24 h, and additional analgesics or antiemetics were required less frequently (P<0.05 for all). Both treatment and control groups demonstrated a restrictive ventilatory pattern immediately after surgery, which in the treatment group was reversed after 24 h. However, the reconstructed patients had a more intense and prolonged restrictive pattern (P<0.05). Surgical morbidity included one seroma observed in the control group. No infections occurred at the surgical site or at any other level, and no patient developed any metabolic disorder. No mortality was observed in either group. CONCLUSIONS: This study establishes that a single preoperative dose of dexamethasone markedly decreased the incidence of postoperative nausea and vomiting and pain, improved respiratory parameters, and decreased the need for additional postoperative analgesic or antiemetic drugs. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT02305173).

[Subarachnoid blockade with ropivacaine versus bupivacaine in urologic and orthopedic surgery]. / Bloqueo raquídeo subaracnoideo con ropivacaína versus bupivacaína isobárica en cirugía urológica y ortopédica.

OBJECTIVE: To compare the effects of intrathecal isobaric ropivacaine (IR) versus isobaric bupivacaine (IB) in a dose ratio of 3:2 in non-ambulatory urologic and orthopedic surgery. METHODS: One hundred and seventeen patients scheduled for surgery were randomized and assigned in a double-blind fashion to receive either 15 mg of IR (n = 58) or 10 mg of IB (n = 59) into the subarachnoid space. RESULTS: There were no differences about age, sex distribution, body mass index, type of surgical interventions and operative time. Both groups were similar respect to latency time and extension of sensory block. Complete motor blockade was reached in more than 90 % of patients of both groups ten minutes after the intrathecal injection and the length was significantly longer in the IB group (226.4 +/- 22.3 minutes versus 266.5 +/- 29.5, p < 0.001). There was no significant hypotension or bradicardia during the transoperative period. Three and a half hours after the end of the surgery, more patients of the IB group required intravenous analgesics and opiaceous derivates (p < 0.001). CONCLUSIONS: The motor blockade was longer in the IB group but postoperative analgesia was better in the IR group.

[Association between wound size after open cholecystectomy with severity of iatrogenic biliary tract lesions]. / Efecto del tamaño de la incisión en la gravedad de la lesin de la vía biliar iatrogénica posterior a colecistectomía abierta.

BACKGROUND: Transoperative biliary tract injury during open or laparoscopic cholecystectomy is a catastrophic event associated with significant morbidity and mortality. Our objective was to determine if wound size during open cholecystectomy is associated with more complex biliary tract injuries. METHODS: Prospective cohort study performed between March 2006 and February 2007. Sixty-six patients with biliary tract injuries after open cholecystectomy were included. Wound size was analyzed. RESULTS: Sixty six patients were included, 70% were female with a median age of 44. Seventy four percent were treated for acute cholecystitis. Most participants were overweight or had various degrees of obesity. Biliary tract injuries were not recognized during the primary surgical procedure in 76% of cases. All patients with severe biliary tract injuries (Strasberg E-3 and E-4) had a wound size less than 10 cm in length. Wound size was associated with unrecognized injuries (p=0.000), as well as with injury severity (p=0.000). We were notable to demonstrate a statistically significant association between biliary tract injuries and elective or emergency surgical procedures and midline or subcostal surgical incision for cholecystectomy. CONCLUSIONS: Our findings suggest that minor surgical access during open cholecystectomy may constitute a risk factor since smaller incisions were associated with more severe biliary tract injuries and an inability to observe this damage during the surgical procedure. We suggest to adhere strictly to the guidelines of an adequate surgical exposure during open cholecystectomy to prevent biliary tract injuries.

Factores asociados con la recidiva de cáncer de mama en pacientes con cirugía conservadora / Factors associated with breast cancer recurrence in patients with conservative surgery

Resumen OBJETIVO: Identificar los factores asociados con la recidiva de cáncer de mama en pacientes con cirugía conservadora. MATERIALES Y MÉTODOS: Estudio observacional, de cohorte retrospectiva, efectuado a partir de expedientes de pacientes con cáncer de mama en estadios tempranos e intervenidas con cirugía conservadora. Parámetros de estudio: estadio, subtipo histológico, perfil de expresión de receptores hormonales, tiempo de seguimiento, recidiva y periodo libre de enfermedad. La tasa de recidiva, el periodo libre de enfermedad y la identificación de los factores asociados con recidiva se hicieron con análisis estadístico. RESULTADOS: Se estudiaron 53 pacientes con edad media de 51.0 ± 9.4 años. El subtipo histopatológico más frecuente fue el ductal en 49 de las 53 pacientes; en 48 de ellas los tumores fueron positivos para receptores de progesterona, en 7 de 53 para Her-2 y en 3 de 53 triple negativo. La tasa de recidiva de cáncer de mama fue de 13.2% (es decir: 7 de 53 pacientes). El tiempo libre de enfermedad en quienes recayeron fue de 30.6 ± 24.8 meses. En el análisis bivariado se asociaron significativamente con recidiva: los ganglios linfáticos positivos, la expresión de receptores de progesterona y de estrógenos, los tumores triple negativo y el tratamiento complementario con quimioterapia. En el análisis multivariado solo se asociaron con recidiva: tener un tumor triple negativo (OR = 51.8; IC95%: 4.9- 548.4; p = 0.001) y recibir quimioterapia (OR = 8.0; IC95%: 1.4-46.1; p = 0.020). CONCLUSION: Los factores asociados con la recidiva fueron los ganglios linfáticos positivos, la expresión de receptores de progesterona y de estrógenos, tumores triple negativo y recibir quimioterapia.

Abstract OBJECTIVE: To identify factors associated with breast cancer recurrence in patients undergoing conservative surgery. MATERIALS AND METHODS: Observational, retrospective cohort study conducted on the records of patients with early-stage breast cancer who underwent conservative surgery. Study parameters: stage, histologic subtype, hormone receptor expression profile, follow-up time, recurrence and disease-free period. Statistical analysis was performed to estimate recurrence rate and disease-free period and to identify factors associated with recurrence. RESULTS: Fifty-three patients with a mean age of 51.0 ± 9.4 years were evaluated. The most common histopathologic subtype was ductal in 49 of 53 patients; tumors were progesterone receptor positive in 48, Her-2 positive in 7 of 53, and triple negative in 3 of 53. The breast cancer recurrence rate was 13.2% (i.e., 7 of 53 patients). Disease-free time in those who relapsed was 30.6 ± 24.8 months. In bivariate analysis, positive lymph nodes, progesterone and estrogen receptor expression, triple-negative tumors, and adjuvant chemotherapy were significantly associated with recurrence. In multivariate analysis, only having a triple-negative tumor (OR = 51.8; 95%CI: 4.9-548.4; p = 0.001) and receiving chemotherapy (OR = 8.0; 95%CI: 1.4-58.4; p = 0.001) were associated with recurrence. CONCLUSION: Factors associated with recurrence were positive lymph nodes, expression of progesterone and estrogen receptors, triple-negative tumors, and receipt of chemotherapy.

Tiempo de espera para el diagnóstico final de BI-RADS 4 y 5 / Waiting time for the final diagnosis of BI-RADS 4 and 5

Resumen Objetivo: Medir el tiempo de espera en otorgar un diagnóstico final a las derechohabientes con BIRADS 4 y 5 de 40 a 69 años, en el Hospital General de Zona, Medicina Familiar No.1 en La Paz, Baja California Sur, México. Material y métodos: Estudio observacional, descriptivo, con la revisión de 36 registros de control de mastografías del área de radiología, con resultados de BI-RADS 4 y 5. Se midieron variables demográficas y los tiempos de espera del proceso desde la solicitud de la mastografía hasta el diagnóstico final. Se realizó estadística descriptiva. Estudio considerado sin riesgo de acuerdo a la Ley General de Salud. Fue autorizado por los comités de ética e investigación de la unidad hospitalaria. Resultados: Se analizaron un total de 36 expedientes de tamizaje en mujeres entre los 40 y los 69 años, con una media de 51.86 + 8.28 años. El promedio de días trascurridos desde la solicitud de la mastografía hasta el diagnóstico final fue 125.05 + 66.23. En el 13.9% de los casos, se logró concluir el proceso diagnóstico en el tiempo normalmente previsto; para el 86.1% restante, se necesitó un tiempo mayor a 30 días para concluir el protocolo diagnóstico. Las causas del tiempo prolongado fueron atribuibles a la demora en la atención en segundo nivel, (consulta de especialidades y área de patología). Conclusiones: Se necesita generar estrategias en todos los pasos del proceso, para asegurar que se cumpla con el tiempo de espera normado en flujograma, tanto en primero como en el segundo nivel de atención; para mejorar el pronóstico de pacientes con cáncer de mama.

Abstract Objective: To measure the waiting time in granting a final diagnosis to the rights holders with BI RADS 4 and 5 from 40 to 69 years old, in the General Hospital of the Zone + Family Medicine No.1 in La Paz, Baja California Sur, Mexico. Material and methods: Observational, descriptive study, with the review of 36 mammography control records from the radiology area, with BI RADS 4 or 5 results. Demographic variables and waiting times for the process were measured from mammography request until the final diagnosis. Descriptive statistics were performed. Study considered without risk according to the General Health Law. It was authorized by the ethics and research committees of the hospital unit. Results: A total of 36 screening files were analyzed in women between 40 and 69 years old, with a mean of 51.86 + 8.28 years. The average number of days elapsed from the request for the mammography to the final diagnosis was 125.05 + 66.23. In 13.9% of the cases, the diagnostic process was concluded in the normal scheduled time; for the remaining 86.1%, it took more than 30 days to complete the diagnostic protocol. The causes of the prolonged time were attributable to the delay in care at the second level (consultation of specialties and pathology area). Conclusions: It is necessary to generate strategies in all the steps of the process, to ensure that the waiting time regulated in the flowchart is complied with, both in the first and second level of care; to improve the prognosis of patients with breast cancer.

Beneficios obtenidos con la consulta de teledermatología en Guerrero Negro, Baja California Sur / Benefits obtained with the tele dermatology consultation in Guerrero Negro, Baja California Sur

Resumen: Objetivo: Identificar y describir los beneficios en ahorro logrado y tiempo diferido de duración por teleconsulta de dermatología, en pacientes atendidos en Guerrero Negro, Baja California Sur. Materiales y métodos: Estudio observacional de costos unitarios. Se revisaron 58 expedientes de pacientes atendidos en la teleconsulta de dermatología en Guerrero Negro. Se analizaron variables demográficas, motivo de atención, unidad de referencia y los indicadores de ahorro logrado y tiempo de espera. Este estudio fue clasificado sin riesgo y se autorizó por el comité de ética e investigación. Resultados: El 81.6% fueron mujeres, predominó el grupo de edad de 31 a 50 años en el 29.3% de los casos, de acuerdo a la ocupación, predominaron las amas de casa en un 24.1%, el principal diagnóstico fue la dermatosis, el 50% de los casos pertenecían a la Unidad de Medicina familiar número 35. El tiempo real para obtener una teleconsulta versus consulta presencial fue de 638.50 + 879.05 versus 1,165.71+ 671.69 horas (p=0.000; IC 95% 0.000 - 0.050). Se comparó el costo en pesos mexicanos del traslado de la teleconsulta versus consulta presencial $302.08 ± 695.62 versus $5,014±$5,377.28 (p=0.003 IC 95% 0.000 - 0.050). Conclusiones: En este trabajo se muestra que el uso de la tecnología de la información y comunicación son útiles al servicio de la salud. Existe beneficio en los indicadores que se midieron: tiempo diferido de la consulta al obtener una consulta en máximo 10 días, al comparar de 45 a 60 días para una atención presencial, además del ahorro logrado en los costos unitarios al tener un gasto máximo de $302.00 pesos por concepto de traslado de las unidades periféricas a Guerrero Negro, comparado con $5,014.00 necesarios para acudir a la consulta presencial.

Abstract: Objective: Identify and describe the benefits in savings achieved and deferred duration of dermatology teleconsultation in patients treated in Guerrero Negro, Baja California Sur. Materials and methods: Observational study of unit costs. Fifty-eight files of patients treated at the dermatology teleconsultation in Guerrero Negro were reviewed. Demographic variables, reason for care, unit of reference, and indicators of savings achieved and waiting time were analyzed. This study was classified without risk and was authorized by the ethics and research committee. Results: 81.6% were women, the age group of 31 to 50 years prevailed in 29.3% of cases, according to occupation, housewives predominated in 24.1%, the main diagnosis was dermatosis, 50% of the cases belonged to Family Medicine Unit number 35. The real time to obtain a tele consultation versus face-to-face consultation was 638.50 + 879.05 versus 1.165.71 + 671.69 hours (p = 0.000; 95% CI 0.000 - 0.050). The costin Mexican pesos of the transfer of teleconsultation versus face-to-face consultation was $ 302.08 ± 695.62 versus $ 5,014 ± $ 5,377.28 (p = 0.003 95% CI 0.000 - 0.050). Conclusions: This work shows that the use of information and communication technology is useful in the service of health. There is benefit in the indicators that were measured: deferred time of the consultation when obtaining a consultation in a maximum of 10 days, when comparing 45 to 60 days for face-to-face care, in addition to the savings achieved in unit costs by having a maximum expenditure of $302.00 pesos for the transfer of peripheral units to Guerrero Negro, compared to the $ 5,014.00 needed to attend the face-to-face consultation.