Bcl-2 expression in a diabetic embryopathy model in presence of polyamines.

The frequency of congenital malformations is 3-5 times higher in mothers with pregestational diabetes mellitus than in general population. Apparently, this problem is due to change in the expression of apoptotic and antiapoptotic genes induced by the oxidative stress derived from the diabetes/hyperglycemia. One of these genes is Bcl-2, which is associated with the control and inhibition of apoptosis. The purpose of the present work was to study the effect of polyamine addition over expression of Bcl-2 gene in a model of diabetic embryopathy. For this, gestational day 10.5 (GD10.5) rat embryos were incubated at 37°C for 24 h in control medium, medium with high glucose, or medium with high glucose and supplemented with spermidine or spermine. Post-cultured embryos were harvested and observed to obtain morphological scores; some of them were subjected to molecular biology studies: DNA isolation plus conventional PCR or RNA isolation plus RT-PCR; other embryos were fixed with paraformaldehyde and used for immunohistochemical detection of Bcl-2 protein. Although Bcl-2 mRNA was similarly expressed in all rat embryo treatments, Bcl-2 protein was found only in control-incubated embryos. In conclusion, it seems that the inhibition of Bcl-2 gene expression induced by glucose was not reversed by polyamines.

Automated peritoneal dialysis as a lifesaving therapy in an emergency room: report of four cases.

The present article describes four cases of patients with chronic kidney disease who arrived at the emergency room in critical condition, needing acute dialysis for severe hyperkalemia and metabolic acidosis. These four patients were treated acutely with automated peritoneal dialysis (APD) using a Tenckhoff catheter placed percutaneously at the bedside in the emergency room. All patients were discharged in good condition and with APD as their chronic renal replacement therapy (RRT). APD is a RRT, that may be considered a frontline acute therapy option for renal failure patients in an emergency room. Coordinated teamwork between emergency and nephrology medical and nursing staff is the key to a successful outcome in these life threatening situations.

Diferencias en el metabolismo mineral óseo hiperparatiroidismo primario normocalcémico respecto al hiperparatiroidismo primario clásico / Differences in bone mineral metabolism normocalcemicprimary hyperparathyroidism with respect to classicalprimary hyperparathyroidism

OBJETIVO: El hiperparatiroidismo primario normocalcémico es una variedad menos conocida del hiperparatiroidismo primario clásico. Presentamos en este estudio sus manifestaciones clínicas y los datos relacionados con el metabolismo mineral óseo, tanto desde el punto de vista analítico como densitométrico, comparando los mismos con un grupo de pacientes afectos de hiperparatiroidismo primario clásico, con hipercalcemia. MATERIAL Y MÉTODOS: Estudio de casos y controles donde consideramos caso a pacientes afectos de hiperparatiroidismo primario normocalcémico (n=25) y control (n=25) a pacientes con hiperpartiroidismo primario con hipercalcemia (hiperparatiroidismo primario clásico). Se les efectuó una evaluación clínica completa con recogida de datos clínicos y realizándose determinaciones analíticas en sangre y orina de 24h, así como la estimación de la densidad mineral ósea y el trabecular bone score por densitometría (absorciometría radiológica dual, DXA) y los parámetros ultrasonográficos en el calcáneo. RESULTADOS: En el estudio clínico, los pacientes afectos de hiperparatiroidismo primario clásico solo muestran una mayor prevalencia de urolitiasis (OR: 9,333; IC 95%: 1,50-82,7) en comparación con los pacientes que sufren un hiperparatiroidismo primario normocalcémico. En todos los demás parámetros clínicos, analíticos, densitométricos y ultrasonográficos, no se aprecian diferencias estadísticamente significativas entre ambos grupos. CONCLUSIONES: Con la excepción de los niveles séricos de calcio y la prevalencia de urolitiasis, el hiperparatiroidismo normocalcémico cursa de manera indistinguible del hiperparatiroidismo clásico

OBJECTIVE: Normocalcemic primary hyperparathyroidism is a less known variety of classical primary hyperparathyroidism. In this paper, we present its clinical expression and data related to bone mineral metabolism, both analytically and densitometrically, comparing them with a group of patients with classic primary hyperparathyroidism, with hypercalcemia. MATERIAL AND METHODS: Study of cases and controls where we consider case of patients with normocalcemic primary hyperparathyroidism (n=25) and control (n=25) of patients with primary hyperpartyroidism with hypercalcemia (classical primary hyperparathyroidism). A complete clinical assessment was carried out with clinical data collection and24h blood and urine analytical determinations were performed, as well as estimating bone mineral density and trabecular bone score by densitometry (dual x‐ray absorptiometry, DXA) and ultrasound parameters in the calcaneus. RESULTS: In this clinical study, patients with classic primary hyperparathyroidism only show a higher prevalence of urolithiasis (OR: 9.333; 95% CI: 1.50‐82.7) compared to patients suffering from a normocalcemic primary hyperparathy‐roidism. In all other clinical, analytical, densitometric and ultrasonographic parameters, there are no statistically significant differences between the two groups. CONCLUSIONS: Apart from serum calcium levels and the prevalence of urolithiasis, normocalcemic hyperparathyroidism is indistinguishable from classical hyperparathyroidism

Prevalence of multiple sclerosis in Lanzarote (Canary Islands)

In the island of Lanzarote of the Province of Las Palmas, which is part of the Spanish archipelago of the Canary Islands, the prevalence of multiple sclerosis is 15 per 100,000. The prevalence of MS in Lanzarote seems related more to ethnic conditions than to geography.

H-ras and Nm23-H1 gene expression and proteolytic activity in squamous cell carcinoma of the uterine cervix.

BACKGROUND: The invasive and metastatic potential of malignant cells results from complex interactions of numerous factors not yet fully understood. Genomic alterations such as ras overexpression and nm23-H1 inhibition have been found to be frequently associated with increased invasiveness in various cancers. On the other hand, secretion of different proteinases are necessary for malignant cells to traverse a network of matrix macromolecules, but the relationship between the genomic alterations and the proteolytic phenotype is still unclear. Our aim was to investigate whether the appearance of the proteolytic phenotype had any correlation with the expression of H-ras and nm23-H1 genes in carcinoma of the uterine cervix. METHODS: Twenty-five samples from patients with carcinoma of the uterine cervix at different clinical stages were studied. Cathepsin B1, plasminogen activator, and collagenase activity were assessed in tissue cytosols using specific synthetic oligopeptides as substrates. The expression of H-ras and nm23-H1 was investigated by means of immunohistochemistry and in situ hybridization. RESULTS: Our results showed that cathepsin B1 was the most consistently elevated proteinase, demonstrating a linear correlation with clinical staging. H-ras expression was found elevated in 40% of the cases. Nm23-H1 protein immunoreactivity was positive in 40% of the cases. No correlation was found among H-ras, cathepsin B1 activity, and survival rate. Among cases with high cysteine proteinase activity, a different clinical behavior depending on the expression of Nm23-H1 was observed. The cases with Nm23-H1 protein had a markedly better survival rate than those lacking this protein. In contrast, the absence of Nm23-H1 in association with high cathepsin B1 activity was a clear indicator of a poor prognosis. CONCLUSIONS: These findings suggest a complex interaction between the proteolytic phenotype and the expression of H-ras and nm23-H1 genes in carcinoma of the cervix that influences the clinical behavior of the tumor.

Factors associated with non-use of Pap test. A population survey.

BACKGROUND: Cervical cancer is the most important cancer in Mexican women. Early detection is possible by means of the Papanicolaou (Pap) test; however, the coverage in Mexico is low. METHODS: A cross-sectional survey was carried out in a representative sample of women from the Tlalpan area of Mexico City. Social, reproductive and health care factors associated with the lack of use of the Pap test with respect to adequate use and misuse were identified. Both bivariate and logistic regression analyses were used for the adjustment of variables. RESULTS: Of 1,215 women studied, 22.5% had never had a Pap smear, 42% had misused the test (< 90% of triennial performance), and 35.5% had adequately used the test (> or = 90% of triennial performance). The main factors related to the lack of use were the following: not knowing about the Pap test (ORa = 35.16, 95% C.I. = 17.4-70.9); having fewer than 6 years of education (ORa = 4.5, 95% C.I. = 2.5-8.4); women younger than 30 years of age (ORa = 3.4 95% C.I. = 2.3-5.1); use of contraceptives (ORa = 0.4, 95% C.I. = 0.2-0.8); history of sexually transmitted diseases (ORa = 0.3, 95% C.I. = 0.1-0.8), and the principal informant about the Pap test, i.e., the health services personnel (ORa = 0.02, 95% C.I. = 0.0008-0.05). CONCLUSIONS: The lack of use and the misuse of Pap smears vary importantly among the different social and reproductive factors. But the principal reasons for lack of use were not knowing about the Pap test and a low educational level. We propose a greater diffusion on the benefits of the test in the Mexican population, through massive means of communication and health services.

[Morbidity and mortality of osteoporotic proximal femoral fracture after one year follow-up]. / Morbilidad y mortalidad de la fractura osteoporótica de la extremidad proximal del fémur tras un año de seguimiento.

BACKGROUND: The aim of the present study was to follow for a year all the osteoporotic proximal femoral fractures that happened in the island of Gran Canaria during 1990 and to analyze: a) mortality; b) the degree of functional capacity; c) their destination after being attended from the fracture. METHODS: Personal interviews were performed in almost every patient (68%), either directly to them or the relatives who were at their care (23.5%), after excluding those patients who died during the acute phase (7.6%) a year after the fracture. Two patients were missed (0.9%). We had the collaboration of every public and private center in the island. 209 patients (154 women and 55 men) were interviewed. Age mean of the patients was 77.1 +/- 10.9 years. The degree of functional capacity was determined by Karnofsky scale. RESULTS: Mortality within the acute phase was 7.6%, rising to 20.8% 6 months later and to 30.7% after a year. There was an important disability in 30.7% of the remainder living patients. In the postsurgical period, 18% of the patients were transferred to a center for chronic care and 25% to a rehabilitation center. Although 48.9% of the patients are discharged to their homes from the hospital, surprisingly, when they die, only 15% do so in their homes, while 59% of the patients die in a center for chronic care. CONCLUSIONS: Osteoporotic proximal femoral fracture produces an important mortality within the first year after fracture, and also an important deterioration of functional capacity. Most of the patients are admitted later on and die in a center for chronic care.

[Scintigraphy with 99mTc-MIBI for assessment of tumor response to preoperative chemotherapy in patients with osteosarcoma]. / Centelleografía con 99mTc MIBI para valorar la respuesta tumoral a la quimioterapia preoperatoria en pacientes con osteosarcoma.

In osteogenic sarcoma an increase in patient survival has been observed due to improvement of diagnostic and treatment methods. The objective of the investigation was to determine the usefulness of scintigraphy with 99mTc-MIBI in comparison to clinical revaluation, in order to assess tumor response (sarcoma) to chemotherapy previous to surgery. Patients with histopathological osteogenic sarcoma that received chemotherapy were included, clinical and scintigraphy response was assessed previous to the surgery. The gold standard for comparison was the degree necrosis histopathological analysis of the surgical specimen with measurement. Twelve patients met the inclusion criteria. A was observed a higher correlation between the 99mTc-MIBI and the histopathology. vs. clinical evaluation (0.89 vs. 0.59 respectively). Likewise the sensitivity (Se) and specificity (Sp) were superior (Se and Sp = 100% vs. Se 66.6% and Sp 75%) when therapeutically responses good and null were compared. We may conclude that scintigraphy with 99mTc-MIBI used to asses the response to presurgery chemotherapy in patients with osteogenic sarcoma, together with the clinical assessment, help the physician to make therapeutically decisions with more objectivity and certainly.

[Diagnostic performance of immunologic tests in amebic liver abscess using receiver operating characteristic curves]. / Rendimiento diagnóstico de las pruebas inmunológicas en absceso hepático amibiano a través de curvas de características operantes del receptor.

Objectives. 1) To identify the tests of immunological diagnosis with a high diagnostic efficiency in amebic liver abscess. 2) To determine the ideal cutoff point for such tests. 3) To identify the influence degree of the antigen used over the test efficiency. Design. Comparative survey. Study units. Analysis of 24 articles identified in the medical literature about tests of immunological diagnosis in amebic liver abscess. Measurements. Starting from the articles, operating characteristics curves (ROC) were established derived from the test application to patients with amebic liver abscess. Results. A great variability in the diagnostic efficiency was identified between the various tests, even when the analysis was focused on the investigations of a specific test. It was not possible to conclude which test had a major degree of efficiency due to such variability. The cutoff level considered as relevant was higher than the one traditionally used for indirect hemagglutination and it had concordance with the one presently accepted for the fluorescence antibodies test. By maintaining steady the spectrum of the study patients and the type of test, variability among the tests persisted. This was due to the use of different antigens. Conclusions. A great variation in the diagnostic efficiency of the analyzed tests was identified. The variation source was the type of test, the antigen used and probably the illness spectrum.

[Classification by levels of clinico-epidemiological research designs]. / Clasificación en niveles de los diseños de investigación clínico-epidemiológicos.

The objective was to identify the characteristics of epidemiologic designs enabling their classification. A critical review of the literature in the clinical epidemiologic area was done to establish the main differences between designs. A meeting with experts to discuss this controversial topic and obtain criteria by consensus was organized. We propose an integral classification based on levels with two fundamental shafts: intervention and explanatory reasoning.

[Characteristics of medical care related to autopsy authorization in a pediatric hospital]. / Características de la atención médica relacionadas con la autorización de autopsias en un hospital pediátrico.

OBJECTIVE: To identify some differences of patients and medical characteristics related to autopsy authorization. DESIGN: Observational, cross-sectional study. SETTING: Third-level medical care in a pediatric hospital. METHODS: A specific mortality questionnaire was analyzed by members of the mortality staff, because they reviewed deaths which occurred between January 1994 and December 1995. Descriptive statistic and non-parametric tests (X2) were calculated to analyze data. RESULTS: A total of 408 deaths were evaluated, in which 116 autopsies were done (28.4%). Children less than 18 months of age had the highest frequencies of autopsies (33.3%-30.7%). The patients referred by other units and the autopsy application done by a medical resident, had the highest frequencies of acceptance (32.5%, 35.3%, p < 0.05). The detection of diagnostic and therapeutic problems were related with high frequencies of autopsies (37.7%, 36% p < 0.05). CONCLUSIONS: The results show us that some medical care factors are related to higher frequencies of autopsies. It is important to consider them in order to increase the capacity of teaching that a postmortem study has.

[Instrument to measure quality of life based on daily performance in pediatric patients with leukemia]. / Un instrumento para medir la calidad de vida por medio del desempeño diario en pacientes pediátricos con leucemia.

The objective of this study was to determine the validity of a questionnaire to measure daily performance as an evaluation of quality of life in pediatric leukemia patients. A questionnaire of the daily activities of a child according to Lickert's criteria was done. A pilot survey was performed in patients without a chronic or disabling disease in order to assess its validity. The impression of the medical attendance of each pediatric patient with leukemia, of their daily performance, was compared with the results of the instrument. A trained nurse applied the questionnaire to 60 mothers of patients (29 female/31 male) as outpatients during the clinical review. Fifteen questionnaires were applied twice to evaluate its consistency. According to the results, 77% of the patients were in remission. 15% in relapse, and 8% during induction to remission. The mean age of the patients was 9 = 3.6 years, ranging from 2-16 years. One hundred percent of the patients obtained a satisfactory grade greater than 35 points. In conclusion, the questionnaire identified adequately the level of the daily performance in addition to the specific affected areas of the patients with leukemia. Our findings are that their level of performance is satisfactory and is not affected because of the disease or the phase of the treatment.

Melorreostosis: presentación de un caso clínico / Melorheostosis: presentation of a clinical case

La melorreostosis es una forma de hiperostosis que afecta tanto al tejido óseo como a las partes blandas adyacentes. Su incidencia es variable aunque es mayor en la segunda y tercera décadas de la vida debido al carácter lentamente progresivo de la enfermedad. Generalmente cursa con dolor que puede llegar a provocar una limitación funcional importante. Para su diagnóstico nos podemos apoyar en la imagen radiológica característica que semeja "cera fundida deslizándose por el lateral de una vela". Se presenta un caso de melorreostosis con hallazgos clínicos y radiológicos característicos. El paciente había sido diagnosticado previamente de enfermedad ósea de Paget, por lo que planteamos el diagnóstico diferencial de esta patología (AU)

Melorheostosis is a form of hyperostosis which affects both bone and the adjacent soft tissues. Its incidence is variable, although it is higher in the second and third decades of life due to the slowly progressive nature of the disease. It generally presents with pain which may cause significant functional limitation. We may be assisted in its diagnosis by its characteristic radiological image which resembles "wax melting down the side of a candle". A case of melorheostosis is presented with clinical findings and radiological characteristics. The patient had previously been diagnosed with Paget’s disease of bone, so we proposed a differential diagnosis of this pathology (AU)

¿Son válidos los criterios quirúrgicos actuales del hiperparatiroidismo primario asintomático? / Are the current surgical criteria for asymptomatic primary hyperparathyroidism valid?

El HPTP es una patología muy frecuente que a menudo cursa de manera asintomática. Siendo la intervención quirúrgica el único tratamiento curativo de la enfermedad, existen unos criterios de indicación de cirugía que no siempre se ajustan a la realidad del paciente, pues se basan en la existencia de complicaciones clínicas (osteoporosis, insuficiencia renal, urolitiasis, fracturas por fragilidad). Presentamos el caso clínico de una paciente que no cumplía ninguno de los requisitos para ser intervenida quirúrgicamente según los documentos de posición, y que fue operada tras demostrarse la existencia de un deterioro de la estructura trabecular ósea, determinada por la técnica TBS (trabecular bone score), y localizarse el adenoma por gammagrafía. Se discute la posible utilidad de estas técnicas, no observadas en los documentos de posición, como complemento de la decisión de cirugía (AU)

HPTP is a very frequent pathology which often develops asymptomatically. Surgical intervention being the only curative treatment for this disease there are some criteria for the indication of surgery, but these do not always fit the reality of the patient since they are based on clinical complications (osteoporosis, renal insufficiency, urolithiasis, fragility fractures). We present the clinical case of a patient who did not meet any of the requirements for having surgical intervention according to the position documents, and who was operated on after the existence was shown of a deterioration of the trabecular bone structure, determined by the TBS (trabecular bone score) technique, and located in the adenoma using gammagraphy. The possible use of these techniques, not seen in the position documents, to complement the decision regarding surgery, is discusse (AU)

Uso inadecuado de inhibidores de la bomba de protones y riesgo de fractura por fragilidad. Estudio preliminar / Inappropriate use of proton-pump inhibitors and fragility fracture risk. A preliminary study

Introducción: Los inhibidores de la bomba de protones (IBP) son fármacos ampliamente utilizados, si bien esto conlleva a un sobreuso que no es acorde con las indicaciones aceptadas en España y en el resto de Europa. Por otro lado, algunos autores han establecido una posible implicación de los IBP en el riesgo de fractura. Con este trabajo hemos pretendido efectuar una primera aproximación al conocimiento del consumo de IBP en nuestro medio y analizar para qué indicación son prescritos, a la vez que estudiar su posible asociación con un mayor riesgo de fractura por fragilidad entre sus consumidores. Material y método: Estudio observacional, transversal, abierto, descriptivo, en el que se entrevistó aleatoriamente a un número de pacientes que fueron atendidos en diferentes ámbitos sanitarios: consultas externas hospitalarias, servicios de urgencias, consulta de Atención Primaria y pacientes ingresados en planta hospitalaria. Resultados: De los 411 pacientes entrevistados, el 54% de los pacientes recibían IBP, y cuya edad media era de 63,3 años, frente al 46% que no los tomaban y que eran más jóvenes, con una edad media de 50,9 años. La distribución por sexos fue similar. La principal razón de utilizar el IBP era como “protector gástrico”, en el 39,8% de los pacientes, indicación no existente en la ficha técnica de este grupo de fármacos. Los consumidores de IBP tenían una mayor prevalencia de todas las fracturas por fragilidad. Conclusiones: Más de la mitad de la población encuestada consume IBP, y de ella cerca del 40% sin una indicación médica correcta. Por esto, unido a la mayor prevalencia de fracturas por fragilidad que presentan -que nos hace pensar en un posible mayor riesgo de fractura entre sus usuarios- consideramos la necesidad de un uso más racional de estos fármacos. Estas conclusiones son preliminares pero, a la vista de estos resultados, creemos que puede ser interesante realizar más estudios dirigidos a comprobar de manera más firme la relación entre los IBP y el riesgo de fractura osteoporótica (AU)

Introduction: Proton-pump inhibitors (PPIs) are widely used drugs, though it should be noted that excessive use is not in line with the accepted indications in Spain and throughout Europe. Furthermore, some authors have established a possible PPI link to the risk of fracture. In this paper, we make an initial approach to knowledge into PPI consumption and analyze what indication is prescribed. We also studied the drugs’ possible association with increased risk of fragility fracture in users. Material and method: An observational, transversal, open and descriptive study in which a number of randomly-chosen patients were interviewed. These patients had been treated in outpatient, emergency and primary care centers. Some had also been treated in hospital wards. Results: Of the 411 patients interviewed, 54% received PPIs. The average age was 63.3 years, compared with 46% that did not take them and who were younger presenting a mean age of 50.9 years. Gender distribution was similar. PPIs were mainly used as a “gastric protector”, in 39.8% of the patients, with no indication appearing in the technical specifications for this group of drugs. Consumers of PPIs presented a higher prevalence of all fragility fractures. Conclusions: More than half of the population surveyed consumed PPI. Of this group, about 40% did so without proper medical advice. Therefore, in addition to the higher prevalence of fragility fractures that suggest a possible increased risk of fracture among its users, we consider the need for a more rational use of these drugs. These preliminary findings point to a need for further studies to confirm the relationship between PPIs and the risk of osteoporotic fracture (AU)

[Guide for the prevention and treatment of glucocorticoid-induced osteoporosis of the Spanish Society of Internal Medicine]. / Guía de prevención y tratamiento de la osteoporosis inducida por glucocorticoides de la Sociedad Española de Medicina Interna.

Our objective has been to elaborate an updated Clinical Guide of the Spanish Society of Internal Medicine (SEMI) for the prevention and treatment of glucocorticoids-induced osteoporosis (GIO), identifying and measuring the grade of evidence that supports the given recommendations. For this, we reviewed studies performed on pathophysiology, diagnosis, prevention and treatment of GIO and after analyzing them we elaborated the present recommendations. This was done after a pre-specified and reproducible process that included an accepted model for the evaluation, and the reference of the evidence that supported it. Once the Scientific Committee elaborated the draft of the Clinical Guide, it was reviewed by all the members of the Working Group on Osteoporosis of the SEMI, and by an External Committee who included experts of many different specialities. Pathophysiology of GIO is complex and yet unknown. Bone effects of glucocorticoids are determined by multiple factors although accumulated doses seems to be the most important one. The best method to diagnose GIO is Dual X-Ray Absorptiometry (DXA), although WHO criteria defined for the diagnosis of postmenopausal osteoporosis are not applicable in GIO. The presence of a T-score lower than -1.5 Tscore indicates the necessity of treatment in any patient who receives or is going to receive more than 3 months treatment with glucocorticoids at a dose higher than 2.5 mg/day (in postmenopausal women) and 5 mg/day (in premenopausal women and men). DXA is also useful to follow up the patients, who can be done annually. Treatment must be prescribed to any patient who is receiving glucocorticoids or is going to receive them at doses higher than 7.5 mg/day for more than 3 months and 5 mg/day if the patient is a postmenopausal woman or has suffered from previous fragility fractures. Risedronate and alendronate are the drugs of election, always together with calcium and vitamin D supplements and general measurements usually prescribed in the treatment of osteoporosis. In very ill patients, parathyroid hormone can be used. The treatment for GIO should be maintained while glucocorticoid therapy is used.

Human papillomavirus-specific viral types are common in Mexican women affected by cervical lesions.

Cervical cancer (CC) is the most common in Mexican female population. The human papillomavirus (HPV) 16 and 18 frequencies in worldwide may be different due to geographical distribution. We analyzed the prevalence of HPV types and determinated their association in cervical lesion in a Mexican population. One hundred fifty-nine normal cervical smears, 95 low-grade squamous intraepithelial lesions (LGSIL), 59 high-grade squamous intraepithelial lesions (HGSIL), and 108 CC samples of the patients were collected. HPV types were determined by sequencing. We detected 11 high-risk types, four low-risk types, three not determinated, and two probably high risk. HPV were present in 12%, 57%, 88%, and 92% from normal, LGSIL, HGSIL, and CC samples, respectively. HPV 16 was the most common in all cervical lesions (71.6% in CC). HPV 58 was present in 18.6% of HGSIL, and the HPV 18 in 4.6% of CC. The 76% of all detected viruses belong to A9 species branch. Control women showed high percentage of HPV high-risk infection, suggesting that this is a high-risk group. High frequency of HPV 16 compared with a low incidence of HPV 18 was observed. HPV 58 is frequently detected in HGSIL but low frequency is found in CC. These findings might be considered for HPV screening.

[Usefulness of residuals in clinical research]. / Utilidad de los residuales en la investigación clínica.

The simple linear regression analysis, multiple linear regression and logistic regression constitute powerful statistical analysis tools widely used in clinical research. These kinds of analyses are based upon mathematical models which at the same time are established on certain basic assumptions. The regression analysis assumptions are basically: a) that the model is really linear, b) that the distribution of data is normal (from a statistical point of view), c) that the variances of the employed data are homogeneous (homocedastics) and that the included data are independent. The regression diagnostic has become popular as a form to evaluate if the assumptions have been accomplished, one of its most important techniques is the residual analysis. A residual can be defined as the value which measures the distance between the regression line and the corresponding value of the variable "y". Among these kinds of residuals used to evaluate the assumptions of regression are: the crude residual, the standardized, of student and the jackknife. The most useful among them is the jackknife residual. The usefulness and limitations of the residuals in the evaluation of the regression analysis assumptions are described, basically referring to the identification and handling of extreme values (outliers).

[The consistency and validity of a measurement in clinical pediatric research. Its definition, evaluation and interpretation]. / Consistencia y validez de una medición en la investigaciíon clínica pediátrica. Definición, evaluación y su interpretación.

In clinical pediatric research as in all research, one of the fundamental characteristics is the measurement of the studied features, either clinical, of laboratory or cabinet. A measurement must have two fundamental characteristics, for it to be considered as scientific: consistency and validity. The first one is centered on the variability of the measurement, which is due to the measuring instrument, to the subject or entity which is measured and to the individual or individuals who carry out the measuring, this is known as intra or interobserver variability, respectively. Validity is the fact of "actually" measuring what we want to measure. Both characteristics of measurement, are often mixed, between them and with other concepts, and this is the reason of not having a clear idea of what is the real meaning. This paper discusses the different terms that have been used for consistency and validity of a measurement. Also it points out how to assess consistency, from the validity, taking into account the measuring scale of the variables and the number of observers. Easy examples are used for the application of different formulas and for the interpretation of the results.

[The initial clinical probability in the diagnosis of the hospitalized pediatric patient]. / Probabilidad clínica inicial en el diagnóstico del paciente pediátrico hospitalizado.

OBJECTIVES: 1. To determine the degree of correlation among different physicians concerning their initial diagnosis and 2. identify the degree of correlation between the probability that physicians assing an initial diagnosis and the number of days the patient is hospitalized, laboratory test and X-rays taken of the patient. DESIGN: A comparative questionnaire. STUDY SITE: Pediatric hospitalization Unit of a third level medical care ward of the Mexican Social Security Institute. STUDY UNITS: All new admissions or non-programmed readmitted patients to the hospital during the months of November and December 1990. MAIN MEASUREMENTS: The treating physicians (Staff pediatricians (MB) and third (R3) and second (R2) year residents) were each asked to independently assign a probability (0 to 100) to each of the diagnosis emitted on the day the patient was admitted. When the patient was discharged, the number of days hospitalized as well as the number of laboratory tests and X-rays taken of the patient were added. RESULTS: 106 patients were evaluated, a correlation was gathered between MBs and R3s of 0.79 (P less than 0.001) and among MBs and R2s of 0.83 (P less than 0.001). The correlation between resident physicians was discretely less 0.60 (P less than 0.01). When relating the probability assigned by the physicians and the number of days the patients were hospitalized, associations were observed of 0.31 (P less than 0.05), 0.15 (P less than 0.05) and 0.19 (P = 0.04) for the MB, R3 and R2s respectively. In the case of laboratory test a correlation of 0.38, 0.06 and 0.04 (MB, R3, R2 respectively) was found. None of these correlations were statistically significant. The X-rays showed a significant correlation in cases of the MBs (0.50, P less than 0.05). CONCLUSIONS: The probabilities assigned by the staff physician as well as the resident doctors are closely related and a lesser grade of association is seen when comparing the residents among each other. No tendencies were identified in the correlation of the probability assigned by the residents and the variables analyzed. A consistent relation was seen between the staff physician and high probabilities, longer stays, and greater number of laboratory tests and X-rays.