Acondroplasia severa con retraso del desarrollo y acantosis nigricans (SADDAN) / Severe achondroplasia with developmental delay and acanthosis nigricans (SADDAN)

RESUMEN La acondroplasia severa con retraso del desarrollo y acantosis nigricans (SADDAN) es una rara y letal displasia esquelética. Presentamos el primer caso detectado en Perú, en un infante de 13 meses con características fenotípicas de macrocefalia relativa, tórax estrecho, extremidades micromélicas y piel en acordeón; asimismo, un marcado retraso del desarrollo psicomotor en todos los hitos (prueba peruana) y acantosis nigricans. El paciente tuvo mala evolución clínica caracterizada por crisis convulsivas recurrentes, dificultad respiratoria progresiva, y falleció por insuficiencia respiratoria concomitante a neumonía. Esta entidad requiere del acceso a exámenes específicos como el panel de displasias esqueléticas, la cual no es parte de la oferta en la mayoría de los hospitales del Perú. Se requiere una mayor atención las enfermedades raras, a fin de proveer diagnósticos e información oportuna a los involucrados.

ABSTRACT Severe achondroplasia with developmental delay and acanthosis nigricans (SADDAN) is a rare and lethal skeletal dysplasia. We present the first case detected in Peru, in a 13-month-old infant with phenotypic characteristics of relative macrocephaly, narrow thorax, micromelic extremities and accordion skin; likewise, a marked delay in psychomotor development in all milestones (Peruvian test), and acanthosis nigricans. The patient had a poor clinical evolution characterized by recurrent seizures, progressive respiratory difficulty, dying from respiratory failure concomitant to pneumonia. This entity requires access to specific exams such as the skeletal dysplasia panel, which is not part of the offering in most hospitals in Peru. Greater attention is required for rare diseases, to provide timely diagnoses and information to those involved.

Natal teeth in premature neonates, products of twin gestation. A case report

Se presenta el caso de 02 recién nacidas gemelares, pre-términos tardíos, producto de gestación monocoriónica - biamniótica con presencia de dientes natales, los cuáles requirieron evaluación odontológica para definir la mejor conducta a seguir y con ello evitar riesgos o desenlaces fatales como la aspiración hacia bronquios. La evaluación evidenció escasa movilidad de piezas dentarias en ambos casos, por lo que se recomendó mantener los dientes; del mismo modo, se dio consejería a los padres sobre la higiene y cuidado de la salud bucal de sus hijas con control ambulatorio a los 3 meses.

We present the case of 2 twin newborns, late preterm, who were a product of monochorionic - diamniotic gestation and presented with natal teeth, which required a dental evaluation to define the best management strategy and thereby avoid risks or fatal outcomes such as bronchial aspiration. The evaluation showed little mobility of teeth in both cases, so it was recommended to keep the teeth. The parents were counseled on proper oral health care and hygiene for their daughters and scheduled for an outpatient follow-up at 3 months.

Primer caso de displasia tanatofórica tipo 1 en los andes peruanos con variante patogénica en el gen FGFR-3 / First case of thanatophoric dysplasia type 1 in the peruvian andes with pathogenic variant in the FGFR3 gene

RESUMEN La displasia tanatofórica tipo 1 es una forma de displasia esquelética letal, se caracteriza por desproporciones del esqueleto axial-apendicular además de talla baja, macrocefalia, prominencia frontal, tórax estrecho, arqueamiento femoral y micromelia. Dichas características fenotípicas son el resultado de variantes patogénicas en el gen del receptor 3 del factor de crecimiento de fibroblastos (FGFR-3), localizada en el cromosoma 4p16.3 Para su estudio la ecografía obstétrica, el examen físico y los hallazgos radiográficos son importantes. Sin embargo, se debe confirmar el diagnóstico mediante estudio genético a fin de descubrir variantes o asociaciones nuevas, así como dar a conocer su casuística real en una determinada región.

ABSTRACT Thanatophoric dysplasia type 1 is a form of lethal skeletal dysplasia, characterized by disproportions of the axial-appendicular skeleton in addition to short stature, macrocephaly, frontal prominence, narrow chest, femoral bowing, and micromelia. These phenotypic characteristics are the result of pathogenic variants in the fibroblast growth factor receptor 3 gene (FGFR-3), located on chromosome 4p16.3. For its study, obstetric ultrasound, physical examination, and radiographic findings are important. However, the diagnosis must be confirmed by genetic study in order to discover new variants or associations, as well as to make known its real casuistry in a given region.

Primer caso de displasia tanatofórica tipo 1 en la región central del Perú con variante patogénica en el gen FGFR3 / A case of coexistence of the FGFR3 and KIAA0753 gene mutation in thanatophoric dysplasia type 1

RESUMEN Introducción: La displasia tanatofórica tipo 1 es una forma de displasia esquelética letal, se caracteriza por desproporciones del esqueleto axial-apendicular además de talla baja, macrocefalia, prominencia frontal, tórax estrecho, arqueamiento femoral y micromelia. Reporte de caso: Neonato varón de 38 semanas, nacido de cesárea electiva debido a malformaciones esqueléticas y polihidramnios. La evolución clínica mostró deterioro progresivo en el tiempo y pese a los diferentes dispositivos se soporte oxigenatorio y ventilatorio. Conclusiones: Para su estudio la ecografía obstétrica, el examen físico y los hallazgos radiográficos son importantes. Sin embargo, se debe confirmar el diagnóstico mediante estudio genético a fin de descubrir variantes o asociaciones nuevas, así como dar a conocer su casuística real en una determinada región.

ABSTRACT Introduction: Thanatophoric dysplasia type 1 is a form of lethal skeletal dysplasia, it is characterized by disproportions of the axial-appendicular skeleton in addition to short stature, macrocephaly, frontal prominence, narrow thorax, femoral bowing and micromelia. Case report: 38-week-old male neonate, born by elective cesarean section due to skeletal malformations and polyhydramnios. The clinical evolution showed progressive deterioration over time and despite the different oxygenatory and ventilatory support devices. Conclusions: For its study, obstetric ultrasound, physical examination and radiographic findings are important. However, the diagnosis must be confirmed through a genetic study in order to discover new variants or associations, as well as to make known their real case mix in a certain region.

Feature Selection of Motor Activity in Intervals of Time with Genetics Algorithms for Depression Detection / Selección de Características de la Actividad Motora en Intervalos de Tiempo con Algoritmos Genéticos para la Detección de Depresión

Abstract It is estimated that depression affects more than 300 million people in worldwide. Unfortunately, the current method of psychiatric evaluation requires a great effort on the part of clinicians to collect complete information. The aim of this paper is determine the optimal time intervals to detect depression using genetic algorithms and machine learning techniques; from motor activity readings of 55 participants during a week at one-minute intervals. The time intervals with the best performance in detecting depression in individuals were selected by applying Genetic Algorithms (GA). Methodology. 385 observations of the study participants were evaluated, obtaining an accuracy of 83.0 % with Logistic Regression (LR). Conclusion. There is a relationship between motor activity and people with depression since it is possible to detect it using machine learning techniques. However, the changes in the variables of the time intervals could be established as key factors since, at different times, they could give good or bad results because the motor activity in the patients could vary. However, the results present a first approximation for developing tools that help the opportune and objective diagnosis of depression.

Resumen Se estima que la depresión afecta a más de 300 millones de personas en el mundo. Desafortunadamente, el método de evaluación psiquiátrica actual requiere un gran esfuerzo por parte de los médicos para recopilar información completa. Objetivo. Determinar los intervalos de tiempo óptimos para detectar depresión mediante algoritmos genéticos y técnicas de aprendizaje automático, a partir de las lecturas de actividad motora de 55 sujetos durante una semana en intervalos de un minuto. Los intervalos de tiempo con mejor desempeño en la detección de depresión en individuos fueron seleccionados aplicando algoritmos genéticos. Metodología. Se evaluaron 385 observaciones de los sujetos de estudio, obteniendo una precisión del 83.0 % con Regresión Logística (LR). Conclusión. Existe una relación entre la actividad motora y las personas con depresión ya que es posible detectarla utilizando técnicas de aprendizaje automático. Sin embargo, los cambios en las variables de los intervalos de tiempo podrían establecerse como factores clave ya que en diferentes momentos podrían dar buenos o malos resultados debido a que la actividad motora en los pacientes podría llegar a variar. No obstante, los resultados presentan una primera aproximación para el desarrollo de herramientas que ayuden al diagnóstico oportuno y objetivo de la depresión.

Validity and reliability of simple surrogate indexes to evaluate beta-cell function and insulin sensitivity

BACKGROUND: Simple surrogate indexes (SSI) to assess beta-cell function, insulin sensitivity (IS) and insulin resistance (IR) are an easy and economic tool used in clinical practice to identify glucose metabolism disturbances. AIM: To evaluate the validity and reliability of SSI that estimate beta-cell function, IS and IR using as a reference the parameters obtained from the frequently sampled intravenous glucose tolerance test (FSIVGTT). MATERIAL AND METHODS: We included 62 subjects aged 20-45 years, with a normal body mass index and without diabetes or prediabetes. SSI were compared with the acute insulin response to glucose (AIRg), insulin sensitivity index (Si) and disposition index (DI) obtained from the FSIVGTT using the minimal model approach. Half of the participants (n = 31) were randomly selected for a second visit two weeks later to evaluate the reliability of all the variables. RESULTS: HOMA1-%B and HOMA2-%B had a significant correlation with AIRg (Spearman Rho (rs) = 0.33 and 0.37 respectively, p 0.50) with Si were fasting insulin, HOMA1-IR, HOMA2-IR, HOMA1-%S, HOMA2-%S, QUICKI, and the McAuley index. The parameters that showed good reliability with an intraclass correlation coefficient (ICC) > 0.75 were AIRg, HOMA1-%S, HOMA2-%S, and QUICKI. Conclusions: Our results suggest that most of the SSI are useful and reliable.

ANTECEDENTES: Los índices simples subrogados (ISS) que evalúan la función de célula beta, sensibilidad a la insulina (SI) y resistencia a la insulina (RI) son herramientas sencillas y económicas que se usan en la práctica clínica para identificar alteraciones del metabolismo de la glucosa. OBJETIVO: Evaluar la validez y confiabilidad de ISS para estimar la función de célula beta, SI y RI usando como referencia los parámetros de la prueba de tolerancia a la glucosa intravenosa con muestreo frecuente (FSIVGTT). MATERIAL Y MÉTODOS: Se incluyeron 62 sujetos de 20-45 años, con índice de masa corporal normal y sin diabetes mellitus o prediabetes. Los ISS se compararon con la respuesta aguda de la insulina a la glucosa (AIRg), índice de sensibilidad a la insulina (Si) e índice de disposición (DI) obtenidos de la FSIVGTT en base al modelo mínimo. La mitad de los participantes (n = 31) se seleccionaron aleatoriamente para acudir dos semanas después y evaluar la confiabilidad de todas las variables. RESULTADOS: HOMA1-%B y HOMA2-%B presentaron una correlación significativa con AIRg (Rho de Spearman (rs) = 0,33 and 0,37, respectivamente, p 0,50) con Si fueron insulina en ayuno, HOMA1-IR, HOMA2-IR, HOMA1-%S, HOMA2-%S, QUICKI y el índice de McAuley. Los parámetros que tuvieron buena confiabilidad (coeficiente de correlación intraclase > 0,75) fueron AIRg, HOMA1-%S, HOMA2-%S y QUICKI. Conclusiones: La mayoría de los ISS son instrumentos útiles y confiables.

Identification of Glucose and Insulin Patterns during A 5-H Glucose Tolerance Test and Association with Cardiometabolic Risk Factors

ABSTRACT Background: Insulin resistance is key in the pathogenesis of the metabolic syndrome and cardiovascular disease. Objective: We aimed to identify glucose and insulin patterns after a 5-h oral glucose tolerance test (OGTT) in individuals without diabetes and to explore cardiometabolic risk factors, beta-cell function, and insulin sensitivity in each pattern. Methods: We analyzed the 5-h OGTT in a tertiary healthcare center. We identified classes using latent class trajectory analysis and evaluated their association with cardiometabolic risk factors, beta-cell function, and insulin sensitivity surrogates by multinomial logistic regression analysis. Results: We included 1088 5-h OGTT performed between 2013 and 2020 and identified four classes. Class one was associated with normal insulin sensitivity and secretion. Class two showed hyperglycemia, dysinsulinism, and a high-risk cardiometabolic profile (obesity, hypertriglyceridemia, and low high-density lipoprotein [HDL] cholesterol). Class three included older individuals, a higher proportion of males, and a greater prevalence of hypertension, hyperglycemia, hyperinsulinemia, and postprandial hypoglycemia. Finally, class four showed hyperglycemia, dysinsulinism, and hyperinsulinemia; this class had the worst cardiometabolic profile (a high proportion of males, greater age, hypertension, obesity, hypertriglyceridemia, and low HDL cholesterol, p < 0.001 vs. other classes). Conclusions: The latent class analysis approach allows the identification of groups with an adverse cardiometabolic risk factor, and who might benefit from frequent follow-ups and timely multidisciplinary interventions.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

resumen está disponible en el texto completo

Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica / Mexican clinical practice guideline for the diagnosis and treatment of dyslipidemias and atherosclerotic cardiovascular disease

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Abstract Background: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. Objective: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. Material and methods: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. Results: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. Conclusions: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

Enterocolitis alérgica neonatal, un diagnóstico subestimado. Reporte de caso / Neonatal allergic enterocolitis, anunderestimated diagnosis. Case report

La enterocolitis de tipo alérgica es una reacción no mediada por inmunoglobulina E producida por la proteína de leche de vaca, muestra un cuadro clínico grave caracterizado por: vómitos y diarrea profusa, palidez, letargia, acidemia, distensión abdominal y shock. Se presenta el caso de un neonato de 19 días de vida, con ingesta de fórmula maternizada y posterior desarrollo de síntomas compatibles con enterocolitis alérgica, presentó criterios de reproducibilidad y empeoramiento con mejoría clínica al retiro de fórmula maternizada. Su incidencia es sumamente desconocida e inusual en el periodo neonatal y en muchos casos suele ser confundida con la enterocolitis necrotizante. Sin embargo, debe ser considerada en las posibilidades diagnósticas por tratarse de un cuadro grave y manejo diferente

La enterocolitis de tipo alérgica es una reacción no mediada por inmunoglobulina E producida por la proteína de leche de vaca, muestra un cuadro clínico grave caracterizado por: vómitos y diarrea profusa, palidez, letargia, acidemia, distensión abdominal y shock. Se presenta el caso de un neonato de 19 días de vida, con ingesta de fórmula maternizada y posterior desarrollo de síntomas compatibles con enterocolitis alérgica, presentó criterios de reproducibilidad y empeoramiento con mejoría clínica al retiro de fórmula maternizada. Su incidencia es sumamente desconocida e inusual en el periodo neonatal y en muchos casos suele ser confundida con la enterocolitis necrotizante. Sin embargo, debe ser considerada en las posibilidades diagnósticas por tratarse de un cuadro grave y manejo diferente

Trends in the prevalence of metabolic syndrome and its components in Mexican adults, 2006-2018 / Tendencia en la prevalencia de síndrome metabólico y sus componentes en adultos mexicanos, 2006-2018

Abstract: Objective: To examine trends in the prevalence of metabolic syndrome (MS) and its components. Materials and methods: Data from 27 800 Mexican adults who participated in Ensanut 2006, 2012, 2016 and 2018 were analyzed. Linear regression was used across each Ensanut period to assess temporal linear trends in the prevalence of MS. Logistic regression models were obtained to calculate the percentage change, p-value for the trend and the association between the presence of MS and the risk of developing type 2 diabetes mellitus (T2DM) over 10 years using the Finnish Diabetes Risk Score (FINDRISC) and cardiovascular disease (CVD) using Globorisk. Results: The prevalence of MS in Mexican adults according to the harmonized definition was: 40.2, 57.3, 59.99 and 56.31%, in 2006, 2012, 2016 and 2018 respectively (p for trend <0.0001). In 2018, 7.62% of metabolic syndrome cases had a significant risk for incident DM2 and 11.6% for CVD. Conclusion: It is estimated that there are 36.5 million Mexican adults living with metabolic syndrome, of which 2 million and 2.5 million have a high risk of developing T2DM or cardiovascular disease respectively, over the next 10 years.

Resumen: Objetivo: Examinar las tendencias en la prevalencia del síndrome metabólico (SM) y de sus componentes. Material y métodos: Se analizaron datos de 27 800 adultos mexicanos que participaron en las Ensanut 2006, 2012, 2016 y 2018. Se utilizó regresión lineal en cada periodo de Ensanut para evaluar las tendencias lineales temporales en la prevalencia del SM. Se obtuvieron modelos de regresión logística para calcular el cambio porcentual, P para la tendencia y las asociaciones entre la SM con el riesgo de desarrollar en 10 años diabetes mellitus tipo 2 utilizando la Finnish Diabetes Risk Score (FINDRISC) y enfermedad cardiovascular utilizando Globorisk. Resultados: La prevalencia de SM en adultos mexicanos según la definición armonizada fue: 40.2, 57.3, 59.99 y 56.31%, en 2006, 2012, 2016 y 2018 respectivamente (p para tendencia <0.0001). En 2018, 7.62% de los casos de síndrome metabólico tenían un riesgo significativo de DM2 incidente y 11.6% de ECV. Conclusión: Se estima que los adultos mexicanos con síndrome metabólico son 36.5 millones; de ellos, dos millones tienen un alto riesgo de desarrollar DMT2 en los próximos 10 años y 2.5 millones enfermedades cardiovasculares.

Prevalence of diabetes and glycemic control in Mexico: national results from 2018 and 2020 / Prevalencia de diabetes y control glucémico en México: resultados nacionales 2018 y 2020

Abstract: Objective: To estimate the prevalence of diabetes (diagnosed and undiagnosed), glycemic control in Mexico, and its associated factors. Materials and methods: We used data from Ensanut 2018 (n=12 648) and 2020 (n=2 309). We defined diabetes as fasting glucose ≥126 mg/dl or HbA1c≥6.5% or previously diagnosed; glycemic control was defined as HbA1c<7%. We fitted Poisson regression models to assess the association between diabetes, glycemic control, and potential associated factors. Results: The total prevalence of diabetes was 16.8% in 2018 and 15.7% in 2020. In 2018, 38% of adults with diabetes were unaware of their disease, while in 2020 this figure was 29%. Glycemic control was observed in 42% of participants in 2018 and 39% in 2020. Longer disease duration was associated with lower glycemic control, while older age, having a diet, and being affiliated to IMSS, Pemex, Sedena, or private healthcare were associated with better control. Conclusion: Mexico is among the countries with the highest diabetes prevalence. A high proportion of adults with diabetes did not have a previous diagnosis, and the proportion with glycemic control is low. Strengthening screening to achieve a timely diagnosis, and improving glycemic control, should be key actions in the management of diabetes.

Resumen: Objetivo: Estimar la prevalencia de diabetes total (diagnosticada y no diagnosticada), control glucémico en México y sus factores asociados. Material y métodos: Se analizó información de la Ensanut 2018 (n=12 648) y 2020 (n=2 309). Se definió diabetes como glucosa en ayunas ≥126 mg/dl o HbA1c≥6.5% o diagnóstico previo; se consideró control glucémico si HbA1c<7%. Usando modelos de regresión de Poisson, se estimaron los factores asociados con diabetes y control glucémico. Resultados: La prevalencia de diabetes fue de 16.8% en 2018 y 15.7% en 2020. En 2018, 38% de los adultos con diabetes desconocían su enfermedad, en 2020 fue 29%. El control glucémico se observó en 42% de los participantes en 2018 y en 39% en 2020. Mayor tiempo de diagnóstico se asoció con descontrol glucémico mientras que mayor edad, seguir una dieta y estar afiliado al IMSS, Pemex/Sedena o privados se asoció con control glucémico. Conclusión: México se encuentra entre los países con mayor prevalencia de diabetes. Una alta proporción de adultos con diabetes no tenía un diagnóstico previo y la proporción con control glucémico es baja. Fortalecer la detección, el diagnóstico oportuno y el control glucémico es clave para el manejo de la diabetes.

Hemorragia digestiva alta. Una presentación inusual del síndrome de Rapunzel / Upper gastrointestinal bleeding. An unusual presentation of Rapunzel Syndrome

Los bezoares gastrointestinales son agregados no digeribles que fueron previamente ingeridos, el tricobezoar se sitúa dentro de la clasificación de éstos, su composición es de cabellos y restos alimentarios, tiene como ubicación más frecuente al estómago y rara vez se extiende hacia duodeno, yeyuno, íleon e incluso colon, condición entonces denominada síndrome de Rapunzel. Es una entidad rara, con incidencias que van desde 0.068% - 0.43%. Los pacientes a menudo muestran sintomatología digestiva inespecífica, como: dolor abdominal difuso, náuseas, vómitos, pobre ganancia de peso, ictericia obstructiva, enteropatía por pérdida de proteínas, masa abdominal y suele asociar además síntomas psiquiátricos . Se presenta el caso de una paciente de 7 años con hemorragia digestiva alta como debut de enfermedad, secundario a tricobezoar.

Gastrointestinal bezoars are indigestible aggregates that were previously ingested, the trichobezoar were placed within the disposition classification, its composition is hair and food remain, its most frequent location is the stomach and rarely extends to the duodenum, jejunum, ileum and even the colon, a condition then called Rapunzel syndrome. It is a rare entity, with incidences ranging from 0.068% - 0.43%. Patients often show digestive symptoms, such as: unexpected diffuse abdominal pain, nausea, vomiting, poor weight gain, obstructive jaundice, protein-loss enteropathy, abdominal mass, and often also associate psychiatric symptoms. We present the case of a 7-year-old patient with upper gastrointestinal bleeding as a disease debut, secondary to trichobezoar.

Bioethics in medical care rationing during the coronavirus disease-19 pandemic

ABSTRACT Background: Coronavirus (CoV) disease (COVID)-19 poses difficult situations in which the ethical course of action is not clear, or choices are made between equally unacceptable responses. Methods: A web search was performed using the terms “bioethics; COVID-19; ethics; severe acute respiratory syndrome CoV-2; emergent care; pandemic; and public health emergencies.” Results: Protection from COVID-19 has resulted in the cancellation of necessary medical interventions, lengthened suffering, and potential non-COVID-19 deaths. Prolonged lockdown reduced well-being, triggering or aggravating mental illnesses and violence, and escalated medical risks. Collateral damage includes restrictions on visitations to hospitals, alienation from the deceased relative, or lack of warm caring of patients. Finally, in a public health crisis, public health interest overrides individual rights if it results in severe harm to the community. Conclusion: Balancing ethical dilemmas are one more challenge in the COVID-19 pandemic. (REV INVEST CLIN. 2021;73(1):1-5)

Descripción de un servicio de visitas domiciliarias a pacientes adultos mayores confinados en sus hogares y análisis de los determinantes de su utilización / Description of a home visits service for elderly homebound patients and analysis of the determinants of its use

Introducción: Desarrollamos un servicio de visitas domiciliarias a pacientes confinados en sus hogares en un establecimiento de salud en Quito-Ecuador. Objetivos: (i) describir el proceso de atención en el servicio de visitas domiciliarias y evaluar su ajuste al modelo de atención primaria en salud, (ii) describir el flujo de procesos del servicio como una propuesta para replicar en otros ámbitos, (iii) identificar los determinantes de alta utilización del servicio; y (iv) validar un sistema de puntuación que incluya a esos determinantes como predictores de su uso. Sujetos y métodos: Estudio observacional longitudinal retrospectivo y desarrollo de un score. Se analizaron las características sociodemográficas y clínicas de los pacientes en la primera visita y contando el número de visitas domiciliarias por paciente 18 meses después. Mediante modelos de regresión binomial negativa se identificaron los determinantes de utilización de vivitas domiciliarias, cuyos ß-coeficientes ajustados y transformados en score, fueron validados internamente mediante el cálculo del área bajo la curva. Resultados: 120 pacientes recibieron 285 vistas domiciliarias después de 18 meses, 70% fueron mujeres con una media de edad de 83 años. Nueve pacientes recibieron 75 visitas domiciliarias. Edad, estado civil, multimorbilidad-polifarmacia y la realización inicial de procedimientos clínicos fueron determinantes independientes de ≥4 visitas domiciliarias por año. El área bajo la curva fue de 0.80 (IC 95%=0.78 a 0.82).Discusión y conclusión: Nuestro servicio de visitas domiciliarias a pacientes confinados se ajusta al modelo de atención primaria de salud. El flujograma podría adoptarse/adaptarse en contextos similares. Edad, estado civil, multimorbilidad-polifarmacia y requerimiento de procedimientos clínicos predijeron, de manera fiable, la utilización del servicio.

Background: We developed an innovative service of home health care visits (HV) for home-bound patients, assigned to a health care center in Quito-Ecuador.Objectives: (i) To describe the service and evaluate its adjustment to the primary care model, (ii) to describe the flow of service processes to subsequently adopt or adapt it in other healthcare facilities, (iii) to identify the determinants of HV utilization; and (iv) to internally validate the fiability of a scoring system, based on those determinants.Subjects and methods: We performed an observational longitudinal retrospective study and developing of a scoring system. We analyzed the sociodemographic and clinical charac-teristics of the patients during the first home visit and counted the number of home visits per patient 18 months later. Through negative binomial regression models, we identified the determinants of home visits utilization. The adjusted ß-coefficients were transformed into a score and validated internally by calculating the area under the curve.Results: 120 patients received 285 home visits after 18 months, 70% were women with a mean age of 83 years. Nine patients received 75 home visits. Age, marital status, multimorbi-dity-polypharmacy, and the initial performance of clinical procedures were independent deter-minants of ≥4 HV per year. The area under the curve score was 0.80 (95% CI = 0.78 to 0.82).Discussion y conclusion: Our home visit service to homebound patients resulted in an in-tervention that fit the primary care model. The flowchart allows it to be adopted or adapted in other health care facilities. Age, marital status, multimorbidity-polypharmacy and the perfor-mance of clinical procedures reliably predicted the service utilization.

Bioethics in the COVID-19 Pandemic Research: Challenges and Strategies

As all other aspects in times of the coronavirus disease (COVID)-19 pandemic, carrying-out quality clinical research has been challenging. Many well-established paradigms have shifted as a consequence of the rapid demand for new knowledge. New treatments are fast-moving, informed consent forms are difficult to obtain, a competitive invitation from researchers to participate in different studies is common, and non-COVID-19 research protocols are suffering continuity. However, these challenges should not imply taking shortcuts or accepting deficiencies in bioethical standards, but rather enhance the alertness for rigorous ethical approaches despite these less than ideal circumstances. In this manuscript, we point out some interrogates in COVID-19 research and outline possible strategies to overcome the difficult task to continue with high-quality research without violating the ethical principles. (REV INVEST CLIN. 2020;72(5):265-70)

Submuestra para el análisis de enfermedades crónicas con biomarcadores, Encuesta Nacional de Salud y Nutrición 2016 / Subsample for the analysis of chronic diseases with biomarkers, National Survey of Health and Nutrition 2016

Resumen Objetivo: Describir la submuestra de adultos para el análisis de biomarcadores de enfermedades crónicas, así como los tamaños de muestra (n) y la representatividad de las mismas en la Encuesta Nacional de Salud y Nutrición 2016. Material y métodos: Se calculó una submuestra con representatividad nacional para la obtención de sangre, suero y orina en adultos. Se comparó la prevalencia de variables de interés para las submuestras. Resultados: Las n obtenidas de suero y orina fueron de 4 000 y 3 782 adultos con al menos un valor en algún marcador bioquímico sérico y marcadores de orina, respectivamente. Esta n varió con el agrupamiento de marcadores y selección por horas de ayuno. No se observaron diferencias en la distribución de las variables de interés entre las muestras de hogar, sangre y orina. Conclusión: Los datos ponderados de las submuestras de marcadores en orina, suero y sangre son comparables con la muestra total de adultos de la encuesta. Los datos de las submuestras permitirán monitorear la distribución de enfermedades crónicas en México, incluidas las alteraciones en función hepática, renal, y consumo de sodio.

Abstract Objective: To describe the adult subsample for the analysis of biomarkers of chronic diseases, as well as the sample sizes (n) and representativity of the Encuesta Nacional de Salud y Nutrición (Ensanut) 2016. Materials and methods: An adult subsample with national representativity was calculated to obtain blood, serum and urine samples. The prevalence of variables of interest was compared for each subsample. Results: The n for at least one serum biomarker and urine samples were 4 000 and 3 782, respectively. The n varied depending on the grouping of biomarkers and fasting time selection. No differences were observed in the distribution of variables between the whole sample, urine and blood biomarkers samples. Conclusion: The weighted subsamples of urine, serum and blood biomarkers are comparable to the weighted sample of adults in the survey. The data of the subsample will allow to monitor the distribution of chronic diseases in Mexico, including altered function of liver and kidney, and sodium intake.

Universal masking during covid-19 pandemic - current evidence and controversies

ABSTRACT The emergence of coronavirus disease 19 pandemic and novel research on the high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised controversies over the use of face masks to prevent community transmission. Specific regulations need to be fulfilled to use a face mask as part of the personal protective equipment and high quality of evidence supporting its use to prevent respiratory viral infections, including SARS-CoV-2, is lacking. However, its widespread use is becoming a standard practice in some countries and discrepancies between health authorities on their policy have led to controversy. The aim of this review is to provide an outlook on recent research in this matter and areas of opportunity.