Association between abdominal pain and fecal impaction grade assessed through radiography in constipated patients at a pediatric emergency service. / Asociación entre el dolor abdominal y el grado de coproestasis mediante la evaluación radiográfica en pacientes estreñidos que acuden a los servicios de urgencias pediátricas.

INTRODUCTION AND AIM: Abdominal pain in children is a frequent cause of emergency room consultation. An important group of those patients presents with chronic constipation and fecal impaction. Plain abdominal x-ray is widely used for making a diagnosis and ruling out the need for surgical treatment. The present study examined the association between pain intensity and fecal impaction grade. MATERIALS AND METHODS: An analytic cross-sectional study was conducted that compared 2 radiographic scales to determine the association between the grade of fecal impaction observed and abdominal pain intensity in patients that sought medical attention at an emergency service within a 7-month period. The analysis was carried out by 2 different observers, utilizing 2 different radiographic scales to confirm their reproducibility. The degree of interobserver agreement was measured using the Kappa coefficient and the association between abdominal pain and fecal impaction grade was measured through the Spearman correlation coefficient. RESULTS: There was a significant association between pain intensity and the radiographic grade of fecal impaction (P<.05) for the radiographic scale by segments and its interobserver agreement was high, compared with the scale by percentage. CONCLUSIONS: Radiographic scales may be useful in the evaluation and treatment of patients with abdominal pain and constipation. The segmental scale showed less interobserver variability, suggesting its proposal as an alternative in the evaluation and follow-up of patients with chronic constipation.

Case­control study of Epstein­Barr virus and Helicobacter pylori serology in Latin American patients with gastric disease.

BACKGROUND: Chronic tissue damage induced by Helicobacter pylori (HP)-driven inflammation is considered the main risk of gastric carcinoma (GC). Epstein­Barr virus (EBV) infection has also been associated with GC. In this study, we aim to address the role of EBV in inflammatory GC precursor lesions and its added risk to HP infection. METHODS: Antibodies against EBV, HP and the bacterial virulence factor CagA were measured in sera from 525 Mexican and Paraguayan patients with gastric disease. Gastric samples were characterised according to the updated Sydney classification and associations were estimated between antibody responses and severity of both tissue damage and inflammation. RESULTS: We found significant associations (odd ratios and trends) between EBV and HP copositivity and premalignant lesions and intestinal-type GC. The EBV and HP coinfection was also significantly associated with increased infiltration of immune cells. No association was found between EBV and the less inflammation-driven diffuse-type GC. CONCLUSIONS: Our study suggests that EBV co-participates with HP to induce severe inflammation, increasing the risk of progression to intestinal-type GC.

Utilidad de SNOMED CT en el registro de la información clínica / The usefulness of SNOMED CT in recording clinical information

SNOMED CT es una terminología clínica comprensiva y detallda, en español, que puede utilizar para repesentar información puede utlizar para representar información clínica relevante de forma constante. El Hospital Universitario de Fuenlabrada ha adoptado SNOMED CT en sus sitemas de información mediante dos métodos. Se han selecciondo conceptos prioritarios de HCE: problemas, procedimientos, alertas y medicamentos, consturyéndose subconjuntos de los valoresposibles, que son implementados en interfce o como referenica con mapeos a los términos locales, dependiendo de las funcionalidades de las aplicaciones actuaes. Por otra parte, las especificaciones de datos clínicos detallados, como los formularios, se represenan mediante arquetipos y se enlazan con SNOMED CT (AU)

SNOMED CT is a comprehensive and detailed clinical terminology, in Spanish, which can be used to represent clinically relevant information consistently. The Fuenlabrada University Hospital adopted SNOMED CT in their information systems; this paper describes the implementation process and results (AU)

Historia Clínica electrónica: integración a la interoperabilidad / Electronic Medical Record: from integration to inter-operability

En los ámbitos administrativos y clínicos, el funcionamiento de un Hospital sin papel, exige previamente un esfuerzo estratégico de definición importante, donde tiene un peso considerable la integración de toda la información. Esto no evita la aparición, durante su utilización, de problemas de usabilidad, de seguridad e incluso de integridad de la información. La solución de estos problemas, dentro del propio hospital y cuando se pretende que la información esté disponible extramuros, es garantizar la interoperabilidad semántica para lo cual hay que recurrir a la utilización de estándares del modelo de referencia y de vocabularios controlados, preferiblemente dentro de una ontología (AU)

The operation of a Hospital completely without papers, in the administrative and clinical areas, requires carrying out a task of definition in order to ensure inter-operability through controlled standards of reference and vocabulary models, preferably within an established ontology capable of preventing any problems of usability and exchange of knowledge. This article explains the optimum process for introducing and using the Electronic Medical Record based on these precepts (AU)

Molecular detection of respiratory syncytial virus in postmortem lung tissue samples from Mexican children deceased with pneumonia.

BACKGROUND: Respiratory syncytial virus (RSV) is the major viral cause of severe respiratory infections in children younger than 2 years of age. Nevertheless there are not enough epidemiologic data about the role of RSV as a cause of infantile mortality from pneumonia, mainly in young children from developing countries Aim. To determine the frequency of RSV infection in lung tissue samples from Mexican children deceased with pneumonia, by reverse transcription (RT) and PCR. METHODS: Postmortem lung tissue samples from 98 children younger than 2 years of age who died of pneumonia during the period of 1989 to 1997 were studied. Paraffin was removed with xylene from 10-microm lung sections, the total RNA was extracted and complementary DNA was obtained by RT reaction. A nested PCR with the use of oligonucleotides specific for the F glycoprotein gene was developed. Samples negatives for RSV were tested for the absence of polymerase inhibitors and for complementary DNA integrity. RESULTS: Twenty-nine of the 98 (30%) children deceased with pneumonia were positive for RSV by RT-PCR; 8 were detected from 13 (62%) children with histopathologic diagnosis of viral pneumonia and 21 from 85 (25%) children with histopathologic diagnosis of bacterial pneumonia (P = 0.018). There was no significant difference in RSV infection according to age groups or seasonal pattern. CONCLUSIONS: RSV infection is frequent in Mexican children younger than 2 years of age who died of pneumonia. Although RSV was more common in viral pneumonia, mixed infections with RSV and bacterial pneumonia were also common.

[Bibliometric analysis of publications by the Mexican Social Security Institute staff]. / Análisis bibliométrico de las publicaciones realizadas por el personal del IMSS.

OBJECTIVE: To describe and analyze the general characteristics and methodology of indexed publications by the health staff of the Mexican Social Security Institute in 1997. MATERIAL AND METHODS: Original articles were evaluated. The primary sources included Index Medicus, Current Contents and the Mexican National Council of Science and Technology (CONACYT) index. The following information was gathered for each article: affiliation and chief activity of the first author; impact factor of the journal; research type; field of study; topic of study, and methodological conduction. This latter point included congruence between design and objective, reproducibility of methods, applicability of the analysis, and pertinence of the conclusions. RESULTS: A total of 300 original articles was published of which 212 (71%) were available for the present study: full-time investigators (FTI) generated 109 articles and investigators with clinical activities (CAI) wrote 103 articles. The median impact factor of the journals in which FTI published was 1.337 (0.341 to 37.297) and for CAI publications, 0.707 (0.400 to 4.237). Biomedical research predominated in the first group (41%) and clinical investigation in the second (66%). Statistically significant differences were identified for the methodological conduction between groups of investigators. CONCLUSIONS: Descriptive studies and publications in journals without impact factor predominated. The FTI group had the highest bibliographic production of original articles in indexed journals with an impact factor.

[The trend in pregnancies terminated by a cesarean operation in Mexico during 1991-1995]. / Tendencia de los embarazos terminados por operación cesárea en México durante el periodo 1991-1995.

In the last decades has been a worldwide trend to increase the number of cesarean sections as an alternative of obstetric resolution, phenomenon for which it was proposed a variety of explanation, this fact remains practically unknown in the institutions of the National Health System (NHS) in Mexico. To identify the trend of the pregnancy to end for cesarean sections during the years of 1991-1995 in the 32 states of de country, as well as of all the institutions of the National Health System. Descriptive, cross sectional and retrospective. We use the data of the Bureau of Statistics and Informatics of de Health Ministry of each one of the 32 states of the country, of the years 1991 to 1995, and of the number of cesarean sections made in the hospitals of the different institutions of the NHS. We started off with a data-base, to calculate frequency tables, and the specific rate of the cesarean section for each year, for each one of the states and institutions of the NHS. We calculate the secular trends using the annual rates of cesarean section, for each one of the states and institutions of the NHS. We also made bivariate analysis and estimated the odds ratio (OR) and 95% Confidence Interval (95% IC); and the statistic X2 for trend, setting the two tailed statistic significance level of 0.05. During the study period, there was 7,503,817 births in all hospitals of the NHS, of these births 1,929,865 (25.72%) was resolved by cesarean section. For the whole period it there was a clear trend to increment of the cesarean section, the rate for 1991 was 20.44%, and by 1995 was 28.58%, the raise for the period was 39.82%, with values of the OR for trend of 1.56; 95% IC (1.55-1.57). "P" < 0.05. The rate for institutions attending open population had an increment of 35.08% [OR trend 1.45; 95% IC (1.43-1.46), "p" < 0.05], of them the highest rate was for the State System of Health in 1995 with 29.78%, the rates for the remaining institutions varied from 16.57% for the IMSS/SOLIDARIDAD and 21.7% for the Health Ministry, all trends were statistically significant. In relation to the institutes attending closed population the raise was of 53.27% [OR trend 1.82; 95% IC (1.81-1.83), "p" < 0.05], with the highest rate for the National Defense Ministry which had a rate of 51-15%, the rates for the remaining institutions varied from 33.52% for the Mexican Institute of Social Security (IMSS) to 43.89% for the Institute of Safety and Social Services for the State Workers (ISSSTE), with exception of the Management of the Medical Services of the Mexican Oils (PEMEX) and the Marine Ministry (SECMAR), all trends were statistically significant. When the analysis of the cesarean section rates for the 32 states of the Mexican Republic was carried out, we found that in 1995, the national average rate was 28.58%, the lowest rate corresponded to the state of Zacatecas with 19.82% and the highest to the state of Nuevo León with 42.14%. There was a tendency to increment for all states which varied from 23.55% for the state Chiapas and 67.97% for the states of Querétaro, all increments were statistically significant. We conclude, that rates of cesarean section for both, institutions of NHS and states of the Mexican Republic, are of the highest in the world, no matter what big the interinstitutional and interstate variation are. The highest rates occurred in institutions attending closed population, and the states with a higher degree of socioeconomic development.

Effect of adverse drug reactions on length of stay in intensive care units.

The objective of the present study was to determine the frequency of adverse drug reactions (ADRs) in intensive care units (ICUs) and to evaluate their effect on the length of stay. We performed a prospective study to detect ADRs in 420 patients hospitalised in 10 predetermined beds in the ICU of our hospital between the months of March and December 1996. While the patients were staying in the ICU, data was gathered regarding suspected ADRs and on different variables related to the length of stay. 96 different ADRs were detected in 85 of the 420 patients seen [20.2%, 95% confidence intervals (95% CI) 16.5 to 24.4]. The ADRs were most frequently caused by the following drugs: nitrates (n = 25), opiates (n = 21) and ultrashort-acting benzodiazepines (n = 10). Eight ADRs were severe, the suspected medication had to be discontinued in 51 cases and new drugs were necessary to manage the ADRs in 73 cases. The crude estimation of the effect of the number of ADRs performed with a bivariant regression model indicated that each ADR was related to a 2.38-day increase (95% CI 1.31 to 3.45) in the length of stay. Although this estimation was reduced to 1.76 days (95% CI 0.72 to 2.79), when other confounding variables associated with the length of stay were considered, it was still important.In conclusion, the ADRs were a significant clinical problem in the ICUs and were responsible for a significant increase in the length of stay.

[Risk factors associated with the development of leukemia in children]. / Factores de riesgo asociados al desarrollo de leucemia en niños.

INTRODUCTION: Leukemia is the most frequent neoplasia in children; in our country it is the main cause of medical attention in children with cancer. The are different risk factors associated with the development of this kind of cancer. OBJECTIVE: To identify which of the already known factors described in the literature associated with the development of leukemia are most frequent in the pediatric population of Mexico City. MATERIAL AND METHODS: A protective case-control study was carried out using prevalent and incident cases. In two third level hospitals of Mexico City, a total of 81 children who had been diagnosed as suffering from different kind of leukemia, confirmed by biopsy of bone marrow, were select and studied. The control were 154 children from two different sources: 77 of them came from the same hospital where the cases received medical care, the selection criteria was not to have any kind of neoplasia; and 77 came from the same community where those diagnosed children cases lived, the selection criteria for this group was that they were healthy children. Both cases and community controls were visited at home and interview to complete precoded questionnaire with the different variables of the study. The information from the hospital controls was obtained during the time they stayed in the hospital. Odds ratio (OR's) for the different associations were calculated, as well as its confidence intervals at 95% (IC) accord to Cornfield and unconditioned logistic regression was carried out to control confounding variables. RESULTS: OR greater than 1 was found in those with familiar cancer background 1.93 (1.2-3.63); the mother being exposed to X-ray during pregnancy 1.89 (0.84-4.22); previous abortions before the child with leukemia was born 2.44 (1-06-5.68); being born from full term birth 2.42 (0.47-16.65); being born with weight greater that 3500 g 2.21 (1.04-4.33); being exposed to fertilizers 4.73 (1.04-24.14) and insecticides 1.93 (1.05-3.56). OR smaller than 1 was found in those who have been in a hospital because of an infectious disease during the first year of life 0.57 (0.17-1.74); to have suffered from chicken pox 0.59 (0.32-1.08). No association to parent's age or job was found. Multivariated analysis shows that the exposure to insecticide is the most important risk factor associated with the development of leukemia in children. CONCLUSIONS: We obtained positive associations to different risk factors described in the literature, having found that exposure to fertilizers is the most important risk factor and finding no association with the parent's occupation. This leads to the need of carrying out further studies to investigate, in more detail, the occupation of the father to confirm whether or not this is a risk factor.

[Residence close to high-tension electric power lines and its association with leukemia in children]. / Residencia cercana a fuentes eléctricas de alta tensión y su asociación con leucemia en niños.

INTRODUCTION: There are different risk factors which have been related to the presence of leukemia in children. In the past years one of these factors has become relevant, the risk of living in an area near to high electric voltage lines, generators of electromagnetic fields of low frequency (EMF), which can cause development of leukemia in children. OBJECTIVE: To learn whether living in an area close to EMF generator sources, electric transformers, high electric voltage distribution or transmission lines and electric substations, is a risk factor in the development of leukemia in children living in Mexico City. MATERIAL AND METHODS: A projective study of case-control was accomplished. The cases were obtained from hospitals of the third level. The diagnosis of leukemia in its different varieties was confirmed through biopsy of bone marrow. The controls were selected in the same hospital from inpatients and outpatients with different problems, except neoplasia. A total sample of 81 cases and 77 controls was analyzed. The residence of the controls and cases were visited using a questionnaire coded with the different study variables. To diminish the memory bias in relation to EMF, the subjects were shown different pictures pointing out the different sources of exposures, which were asked. Having obtained the information, different odds ratios (OR) were calculated for the different associations, as well as the confidence intervals at 95% and an unconditioned logistic regression was accomplished to know the adjusted OR. RESULTS: There were no differences between the cases and controls according to the relative who gave the information, the current age of children, the parents's age, the social class and the parent's occupation. It was found that all the generating sources of EMF, which were involved in the study, had and OR above 1. Being the highest, the ones living near the distribution or transmission wires of high voltage with an OR of 2.63 (1.26-5.36) and 2.5 (0.97-6.67) respectively. When the distance of exposure was controlled, the highest OR was for distribution lines (OR 2.12; 0.79-5.85). When the analysis was applied to persons who have moved from the residence, it was found that the OR was above 1 in all the associations, the highest being the distribution wires and with the distance the highest was the electric substations. Furthermore, the multivariate analysis showed that the risk continued only for the distribution wires. CONCLUSIONS: The EMF exposure was found positive, however this is not very precise, that is why it is necessary to carry out other studies to confirm the existence of the association and correct possible biases which could appear during the research.

[Evaluation of immunologic diagnostic tests in amebiasis: diagnosis or bias? A critical review of the literature]. / Evaluación de las pruebas de diagnóstico inmunológico en amibiasis: diagnóstico ó sesgo?

OBJECTIVE: 1. To describe the frequency of adherence to methodologic criteria proposed for assessment of diagnostic tests. 2. To identify potential bias. 3. To construct Receiver Operating Characteristic (ROC) curves based on data published on the assessed papers. DESIGN: Descriptive cross-sectional survey. STUDY MATERIAL: All papers listed under diagnosis and immunological headings of amebiasis in the Index Medicus from 1970 to 1988. STUDY UNITS: 80 papers. MEASUREMENT: a: Adherence to methodologic criteria proposed for assessment of diagnostic test. b: presence of potential bias. MAIN RESULTS: The adherence to methodologic criteria varied 1 to 55% of the papers. The comparison with a "gold standard" occurred in 40% the independent "blind" assessment occurred in 6% the setting for the study was described 1%. The study of an appropriate spectrum of disease was done in 11%. We were able to construct ROC curves with data from 37 papers and differences were observed among studies evaluating the same test. A high proportion of papers had potential bias. CONCLUSIONS: The adherence to methodologic standards is poor in the papers analyzed in this series. Consequently the frequency of potential bias was high.