Obstetric risk profiles and causes of death: Estimating their association with cesarean sections among maternal deaths in Mexico.

BACKGROUND: Maternal mortality is a critical indicator of healthcare quality, and in Mexico, this has become increasingly concerning due to the stagnation in its decline, alongside a concurrent increase in cesarean section (C-section) rates. This study characterizes maternal deaths in Mexico, focusing on estimating the association between obstetric risk profiles, cause of death, and mode of delivery. METHODS: Utilizing a retrospective observational design, 4,561 maternal deaths in Mexico from 2010-2014 were analyzed. Data were sourced from the Deliberate Search and Reclassification of Maternal Deaths database, alongside other national databases. An algorithm was developed to extract the Robson Ten Group Classification System from clinical summaries text, facilitating a nuanced analysis of C-section rates. Information on the reasons for the performance of a C-section was also obtained. Logistic regression and multinomial logistic regression models were used to estimate the relation between obstetric risk factors, mode of delivery and causes of maternal death, adjusting for covariates. RESULTS: Among maternal deaths in Mexico from 2010-2014, 47.1% underwent a C-section, with a significant history of previous C-sections observed in 31.4% of these cases, compared to 17.4% for vaginal deliveries (p<0.001). Early prenatal care in the first trimester was more common in C-section cases (46.8%) than in vaginal deliveries (38.3%, p<0.001). A stark contrast was noted in the place of death, with 82.4% of post-C-section deaths occurring in public institutions versus 69.1% following vaginal births. According to Robson's classification, the highest C-section rates were in Group 4 (67.2%, p<0.001) and Group 8 (66.9%, p<0.001). Logistic regression analysis revealed no significant difference in the odds of receiving a C-section in private versus other settings after adjusting for Robson criteria (OR: 1.21; 95% CI: 0.92, 1.60). A prior C-section significantly increased the likelihood of another (OR: 2.38; CI 95%: 2.01, 2.81). The analysis also indicated C-sections were significantly tied to deaths from hypertensive disorders (RRR = 1.25, 95% CI [1.12, 1.40]). In terms of indications, 6.3% of C-sections were performed under inadequate indications, while the indication was not identifiable in 33.1% of all C-sections. CONCLUSIONS: This study highlights a significant overuse of C-sections among maternal deaths in Mexico (2010-2014), revealed through the Robson classification and ana analysis of the reported indications for the procedure. It underscores the need for revising clinical decision-making to promote evidence-based guidelines and favor vaginal deliveries when possible. High C-section rates, especially noted disparities between private and public sectors, suggest economic and non-clinical factors may be at play. The importance of accurate data systems and further research with control groups to understand C-section practices' impact on maternal health is emphasized.

Expression of Mitochondrial Long Non-Coding RNAs, MDL1 and MDL1AS, Are Good Prognostic and/or Diagnostic Biomarkers for Several Cancers, Including Colorectal Cancer.

Non-coding RNAs provide new opportunities to identify biomarkers that properly classify cancer patients. Here, we study the biomarker status of the mitochondrial long non-coding RNAs, MDL1 and MDL1AS. Expression of these genes was studied in public transcriptomic databases. In addition, a cohort of 69 locally advanced rectal cancer (LARC) patients with a follow-up of more than 5 years was used to determine the prognostic value of these markers. Furthermore, cell lines of colorectal (HCT116) and breast (MDA-MB-231) carcinoma were employed to study the effects of downregulating MDL1AS in vitro. Expression of MDL1AS (but not MDL1) was significantly different in tumor cells than in the surrounding tissue in a tumor-type-specific context. Both MDL1 and MDL1AS were accurate biomarkers for the 5-year survival of LARC patients (p = 0.040 and p = 0.007, respectively) with promising areas under the curve in the ROC analyses (0.820 and 0.930, respectively). MDL1AS downregulation reduced mitochondrial respiration in both cell lines. Furthermore, this downregulation produced a decrease in growth and migration on colorectal cells, but the reverse effects on breast cancer cells. In summary, MDL1 and MDL1AS can be used as reliable prognostic biomarkers of LARC, and MDL1AS expression provides relevant information on the diagnosis of different cancers.

Structure-Guided Approach for the Development of MUC1-Glycopeptide-Based Cancer Vaccines with Predictable Responses.

Mucin-1 (MUC1) glycopeptides are exceptional candidates for potential cancer vaccines. However, their autoantigenic nature often results in a weak immune response. To overcome this drawback, we carefully engineered synthetic antigens with precise chemical modifications. To be effective and stimulate an anti-MUC1 response, artificial antigens must mimic the conformational dynamics of natural antigens in solution and have an equivalent or higher binding affinity to anti-MUC1 antibodies than their natural counterparts. As a proof of concept, we have developed a glycopeptide that contains noncanonical amino acid (2S,3R)-3-hydroxynorvaline. The unnatural antigen fulfills these two properties and effectively mimics the threonine-derived antigen. On the one hand, conformational analysis in water shows that this surrogate explores a landscape similar to that of the natural variant. On the other hand, the presence of an additional methylene group in the side chain of this analog compared to the threonine residue enhances a CH/π interaction in the antigen/antibody complex. Despite an enthalpy-entropy balance, this synthetic glycopeptide has a binding affinity slightly higher than that of its natural counterpart. When conjugated with gold nanoparticles, the vaccine candidate stimulates the formation of specific anti-MUC1 IgG antibodies in mice and shows efficacy comparable to that of the natural derivative. The antibodies also exhibit cross-reactivity to selectively target, for example, human breast cancer cells. This investigation relied on numerous analytical (e.g., NMR spectroscopy and X-ray crystallography) and biophysical techniques and molecular dynamics simulations to characterize the antigen-antibody interactions. This workflow streamlines the synthetic process, saves time, and reduces the need for extensive, animal-intensive immunization procedures. These advances underscore the promise of structure-based rational design in the advance of cancer vaccine development.

Terapia fotodinámica antimicrobiana sobre Candida albicans en superficies acrílicas de prótesis dentales. Estudio in vitro / Antimicrobial photodynamic therapy on Candida albicans on acrylic surfaces of dental prostheses. In vitro study

Frecuentemente, se hayan especies del género Candida en la microbiota oral de los humanos. Objetivo: comparar la efectividad antimicrobiana de la terapia fotodinámica sobre las cepas de Candida albicans en superficies acrílicas para prótesis dentales, empleando láser con 660nm de longitud de onda y azul de metileno como agente fotosensibilizador, con respecto a otros métodos terapéuticos. Metodología: estudio in vitro, empleando 60 discos de acrílico de termocurado sumergidos en una suspensión de C. albicans, generando una simulación de biofilm sobre la superficie de una prótesis dental. Luego se conformaron cinco grupos al azar de 12 unidades a los que se aplicó diferentes procedimientos terapéuticos: G1 (suero fisiológico), G2 (clorhexidi-na al 0,12%), G3 (nistatina en solución tópica en 0,001ml/ul), G4 (azul de metileno al 0,005% + láser diodo con λ=660nm, 100mW, 32J/cm2) y G5 (azul de metileno 0,01% + láser diodo con λ=660nm, 100mW, 321J/cm2). Resultados: Se observó una diferencia estadísticamente significativa al comparar los grupos G4 y G5 con respecto a los G1 y G3 (p<0,05). Conclusión: la eficacia en la reducción del número de UFC viables de C. albicans resultó superior en los grupos donde se empleó radiación láser con una longitud de onda de 660nm con diferentes concentraciones de azul de metileno. El uso de nistatina y de suero fisiológico tuvieron los menores valores de eficacia.

Species of the genus Candida are frequently found in the oral microbiota of humans. Objective: to compare the antimicrobial effectiveness of photodynamic therapy on Candida albicansstrains on acrylic surfaces for dental prostheses by using a 660nm wavelength laser and methyle-ne blue as a photosensitizing agent, with respect to other therapeutic methods. Methodology: in vitro study, using 60 thermosetting acrylic discs immersed in a suspension of C. albicans, gene-rating a biofilm simulation on the surface of a dental prosthesis. After that, five random groups of 12 units were formed to apply them different therapeutic procedures: G1 (saline solution), G2 (chlorhexidine 0.12%), G3 (nystatin in topical solution at 0.001ml/ul), G4 (0.005% methylene blue + diode laser with λ=660nm, 100mW, 32J/cm2) and G5 (0.01% methylene blue + diode laser with λ=660nm, 100mW, 321J/cm2). Results: a statistically significant difference was observed when comparing groups G4 and G5 with respect to G1 and G3 (p<0.05). Conclusion: the efficacy in reducing the number of viable C. albicans CFU was higher in the groups where laser radiation with a wavelength of 660nm was used with different concentrations of methylene blue. The use of nystatin and physiological saline had the lowest efficacy values

Miositis por Bartonella henselae: caso clínico en una adolescente / Bartonella henselae myositis: case report in an adolescent

La miositis de origen vírico o bacteriano es frecuente en la edad pediátrica. Causa dolor muscular y debilidad, con fiebre y malestar general. Una causa es la infección por Bartonella henselae, bacteria implicada en la enfermedad por arañazo de gato que, a veces, causa afectación multisistémica. Se presenta el caso de una adolescente que acudió al servicio de urgencias por mialgia intensa, malestar, adelgazamiento y esplenomegalia. En el labortorio se observaron parámetros inflamatorios elevados. Refería contacto con un gato. Entre los estudios realizados, la resonancia magnética (RM) de miembros inferiores mostró una imagen compatible con miositis inflamatoria bilateral. En la RM abdominal, se observaron tres lesiones esplénicas no detectadas previamente y el fondo de ojo mostraba una lesión compatible con oclusión arterial retiniana o vasculitis. Se indicó tratamiento antibiótico por vía intravenosa durante 21 días con cefotaxima y cloxacilina, tras los cuales desaparecieron los signos y síntomas, aunque los reactantes inflamatorios persistieron elevados. Con base en el cuadro clínico (miositis + coriorretinitis + absceso esplénico) se pensó en una posible infección por B. henselae y se inició tratamiento oral con azitromicina y rifampicina durante 14 días. Luego del tratamiento, los valores de laboratorio fueron normales, así como la RM de control, y se constató una IgG positiva para la bacteria

Infectious myositis, whether viral or bacterial, is frequent in pediatric age. It causes muscle pain and weakness, associated with fever and general malaise. One cause is Bartonella henselae, responsible for cat scratch disease, which sometimes causes systemic symptoms. We report the case of an adolescent who came to the emergency room with intense myalgia, malaise, weight loss and splenomegaly. Blood tests showed high inflammatory markers. She had been in touch with a cat. Studies were carried out including: lower limbs MRI suggestive of bilateral inflammatory myositis, abdominal MRI with three previously undetected splenic lesions and dilated fundus examination that showed possible retinal arterial occlusion or vasculitis. After 21 days of intravenous antibiotic therapy (cefotaxime + cloxaciline), she became asymptomatic, but inflammatory markers remained high. Suspecting Bartonella henselaeinfection (myositis + chorioretinitis + splenic abscess), oral azithromycin and rifampicin were prescribed for 14 days. Blood tests and control MRI became normal, and IgG was positive.

Adaptación y validación de la CBAS para la observación de climas motivacionales / Adaptação e validação do CBAS para assistir climas motivacionais / Adaptation and validation of the CBAS for observing motivational climates

El objetivo principal del estudio fue adaptar y validar el Coaching Behavior Assessment System (CBAS; Smith, Smoll y Hunt, 1977) para evaluar el clima motivacional que transmite el entrenador. La muestra empleada estuvo compuesta por un único monitor de actividad física dirigida, que trabajaba en el Servicio de Deportes de una universidad pública, tenía 27 años y dos años de experiencia. En primer lugar, se realizó un análisis del contenido de la CBAS por expertos, que propusieron la inclusión de nuevos ítems. En segundo lugar, se llevó a cabo el proceso de entrenamiento de cuatro observadores para evaluar con la adaptación creada de la CBAS. A continuación, los cuatro investigadores realizaron seis observaciones sistemáticas al mismo monitor durante diferentes sesiones elegidas al azar y se calculó el índice de concordancia. Los resultados del análisis de la fiabilidad entre los observadores mostraron valores superiores al 90 %, llegando a alcanzar en la última observación el 98,9 %. Se discuten los resultados en base a la importancia de tener una herramienta que nos facilite evaluar el clima motivacional que genera un entrenador a través de la observación sistemática (AU)

O principal objetivo do estudo foi adaptar e validar o Coaching Behavior Assessment System (CBAS, Smith, Smoll e Hunt, 1977) para avaliar o clima motivacional que transmite o treinador. A amostra utilizada consistiu em uma atividade física único monitor dirigido, que trabalhou no Esporte de uma universidade pública foi de 27 e dois anos de experiência. Em primeiro lugar, foi realizada uma análise de conteúdo de especialistas CBAS, que propôs a inclusão de novos itens. Em segundo lugar, realizou processo de formação de quatro observadores para avaliar a adaptação definir CBAS. Em seguida, os quatro pesquisadores realizaram observações sistemáticas durante seis sessões diferentes de forma aleatória e índice de concordância foi calculado. Os resultados da análise da fiabilidade entre observadores mostraram valores superiores a 90%, alcançando a última observação de 98,9%. Os resultados são discutidos com base na importância de ter uma ferramenta que nos facilita para avaliar o clima motivacional que gera um treinador por meio de observação sistemática (AU)

The main objective of the study was to adapt and validate the Coaching Behavior Assessment System (CBAS, Smith, Smoll & Hunt, 1977) to assess the motivational climate that conveys the coach. The sample used consisted of a single monitor physical activity directed, who worked at the Sports of a public university was 27 and two years of experience. First, a content analysis of CBAS experts, who proposed the inclusion of new items was performed. Secondly, held training process four observers to evaluate the adaptation set CBAS. Then, the four researchers performed six systematic observations during different sessions randomly and concordance index was calculated. The results of the analysis of the reliability between observers showed values above 90%, reaching the last observation 98.9%. The results are discussed based on the importance of having a tool that facilitates us to assess the motivational climate that generates a coach through systematic observation (AU)

Facilitadores del reintegro laboral en trabajadores con patología mental de origen laboral: una revisión sistemática / Return to work enablers for workers with work-related mental illness

Background: There is growing interest in the treatment and return-to-work of workers with labor related mental illnesses. Aim: To perform a systematic review of practices and interventions that improve return to work. Material and Methods: Systematic literature review. Thirty articles were selected for in- depth analysis. Results: Self efficacy perception, work motivation, a lower age and a better socioeconomic status were identified as worker-related return to work facilitators. Among work environment facilitators, good communication practices, supervisor support, a good assessment and modification of work load, adjustment of expectations, a good relationship between employers and employees and positive work experiences were identified. Treatment may improve return to work using a multidisciplinary approach, reducing stress and identifying psychosocial determinants of mental problems rather than symptoms and providing a timely health care. Conclusions: Return to work of workers with labor related mental illnesses requires a constant sharing of information between health care workers, employers and employees to identify common therapeutic objectives.

Reintegro laboral en trabajadores con problemas de salud mental: la perspectiva de los tratantes / Return to work in workers with mental health problems: attendants perspective

ANTECEDENTES: En los últimos años se ha observado un aumento en la prevalência de problemas mentales de origen laboral, incrementando significativamente el promedio anual de días de trabajo perdidos por reposo. Con respecto al posterior reintegro, la evidencia es categórica en afirmar la importancia de que este sea un proceso exitoso para la prevención de recaídas del trabajador. Asimismo, se constata que a nivel latinoamericano es casi inexistente la literatura e investigación en torno a intervenciones para el retorno laboral. OBJETIVO: Estudiar las condiciones de diagnóstico, intervención y retorno al trabajo que han mostrado efectividad desde la perspectiva y experiencias de tratantes de una mutualidad respecto de la intervención para el reintegro al trabajo en individuos con problemas de salud mental de origen laboral. MÉTODO: Se diseñó una investigación exploratoria-descriptiva, empleando metodología cualitativa. Se utilizaron grupos focales y entrevistas a seis psicólogos, tres psiquiatras y cuatro terapeutas ocupacionales que ejercen sus labores profesionales en una mutual en Chile. RESULTADOS: A partir de un análisis descriptivo, empleando el procedimiento de codificación abierta propuesto por el modelo de Teoría Fundamentada, emergieron cinco categorías centrales y dos fenómenos transversales: La comunicación tripartita y el proceso orientado al reintegro laboral. Ambos hacen referencia tanto al proceso de intervención para el retorno al trabajo como a los actores involucrados en este, ya sea de la mutualidad como también del contexto laboral inmediato de los trabajadores.

BACKGROUND: In recent years there has been an increase in the prevalence of work-related mental problems, significantly increasing the average annual working days lost because of leave sick. With respect to the later return-to-work, the evidence is categorical in affirming the importance of the successful of this process for the relapse prevention. Furthermore, we note that throughout Latin America the literature and research on interventions to return-to-work is almost absent. OBJECTIVE: To study the conditions of diagnosis, intervention and return to work that have shown effectiveness from the perspectives and experiences of professionals from a mutuality regarding the intervention to return to work in individuals with problems of mental health of occupational origin. METHOD: An exploratory-descriptive research was designed using qualitative methodology. Focus groups and interviews to six psychologists, three psychiatrists and four occupational therapists were used. RESULTS: From a descriptive analysis using the procedure of open coding proposed by the Grounded Theory model, five core categories and two transverse phenomena emerged: The tripartite communication and the process oriented by the return to work. The two refer to the process of intervention to return to work as the actors involved in this, whether mutuality or the workers' immediate labor context.

Divertículo uretral gigante / Giant urethral diverticulum

No disponible

Extravasación urinaria tras nefrolitotomía percutánea / Subcutaneous urinary extravasation after percoutaneous nephrolithotomy

No disponible

Rehabilitación endotelial del tejido cavernoso con sildenafilo 100 mg en pacientes sometidos a prostatectomía radical / Cavernous tisue rehabilitation whit sildenafil 100 mg in patients after radical prostatectomy

Objetivos: Comprobar si la terapia de rehabilitación cavernosa es eficaz en el tratamiento de la disfunción eréctil en pacientes sometidos a prostatectomía radical. Material y métodos: Estudio retrospectivo de ochenta casos; 80 pacientes sometidos a prostatectomía radical entre los años 2005-2008, y posteriormente tratados con sildenafilo 100mg en pauta de días alternos justo después de la cirugía, mas una dosis a demanda. Como medidas objetivas se emplearon el cuestionario validado IIEF-5 y la prueba de la rigidometria de inflexión digital pre y post cirugía, realizándose controles a los 3 y nueve meses. Resultados: los pacientes tratados con sildenafilo, en una pauta combinada de dosis fijas y a demanda, presentan erecciones satisfactorias en un 60% de los casos nueve meses después de la prostatectomía radical. Si se preservan las bandeletas, la tasa de éxito se acerca al 90%. Hasta el 20% de los pacientes sin conservación de bandeletas tuvieron erecciones satisfactorias a los nueve meses con el tratamiento. Conclusiones: nuestra experiencia muestra que la rehabilitación del cuerpo cavernoso puede ser un tratamiento eficaz para combatir la disfunción eréctil secundaria a prostatectomía radical, iniciada de forma precoz y a dosis fijas. La tasa de éxito para obtener una erección satisfactoria aumenta si se preservan las bandeletas nerviosas, y que el tratamiento mixto (dosis fijas y a demanda) de IPDE5 puede ser una buena alternativa en estos pacientes (AU)

Objetives: We try to figure out whether early penile rehabilitation ameliorates erectile dysfunction secondary to radical prostatectomy. Material and methods: Retrospective study of 80 cases of patients that were operated between 2005-2008; all of them went under radical prostatectomy and were treated with sildenafil 100mg every second day (Monday , Wednesday and Friday) plus 100mg on demand after the surgery. As objective measurements, we used validated questionnaire IIEF-5 and also axil penile rigidity before and after surgery in the third and ninth month. Results: Patients treated with sildenafil in fixed doses presented a 60% full erection recovery 9 months after radical prostatectomy. In the case where patients underwent bilateral or unilateral nerve sparing, they got a successful rate of almost 90%. Even 20% of those patients who did not have a nerve preservation got satisfactory erections. Conclusions: Our experience shows that early penile rehabilitation seems to be a good treatment for erectile dysfunction after radical prostatectomy with IPDE5 in fixed doses. Administration every other day plus on demand looks like also as an appropriate option (AU)