Accurate preoperative diagnosis of a Rathke cleft cyst with the aid of a novel classification for sellar cystic lesions and a diagnostic algorithm decision: Tools for differentiating cystic sellar lesions with a representative case.

Background: Rathke's cleft cyst (RCC) is a benign lesion in the sellar and suprasellar compartments. Similarly, pituitary adenomas can present with cystic morphology, making it a differential diagnosis when evaluating a patient with a cystic lesion in the sellar region. Surgical goals differ between RCCs and pituitary adenomas as the first can achieve remission of symptoms with cyst decompression in contrast to pituitary adenomas where complete resection would be the main goal. Imaging analysis alone may not be sufficient to define a preoperative surgical plan. The combination of imaging and conjoined use of validated tools may provide valuable insights to the clinician when defining a surgical approach. Case Description: We present a case of a 27-year-old male with a 3-month history of visual disturbances and headaches. Magnetic resonance imaging showed a cystic lesion in the sellar compartment with compression of nearby structures. The authors were able to accurately diagnose this sellar lesion as an RCC with the conjoined aid of two classifications proposed in the literature. Cyst evacuation was performed with relief of symptoms and improved visual outcomes at follow-up. Conclusion: While cystic adenomas can require total resection for cure, RCCs can show marked improvement with partial resection and evacuation of its contents. An accurate preoperative diagnosis can lead the surgeon to opt for the best surgical approach.

Mesenchymal stromal cells with chimaeric antigen receptors for enhanced immunosuppression.

Allogeneic mesenchymal stromal cells (MSCs) are a safe treatment option for many disorders of the immune system. However, clinical trials using MSCs have shown inconsistent therapeutic efficacy, mostly owing to MSCs providing insufficient immunosuppression in target tissues. Here we show that antigen-specific immunosuppression can be enhanced by genetically modifying MSCs with chimaeric antigen receptors (CARs), as we show for E-cadherin-targeted CAR-MSCs for the treatment of graft-versus-host disease in mice. CAR-MSCs led to superior T-cell suppression and localization to E-cadherin+ colonic cells, ameliorating the animals' symptoms and survival rates. On antigen-specific stimulation, CAR-MSCs upregulated the expression of immunosuppressive genes and receptors for T-cell inhibition as well as the production of immunosuppressive cytokines while maintaining their stem cell phenotype and safety profile in the animal models. CAR-MSCs may represent a widely applicable therapeutic technology for enhancing immunosuppression.

[Quality of health information in Mexico in the OECD context: 2017-2021]. / Calidad de la información en salud de México en el contexto de la OCDE: 2017-2021.

OBJECTIVE: To evaluate the health information system (HIS) of Mexico according to the information reported to the Organization for Economic Co-operation and Development (OECD). The ultimate goal is to identify the improvements that should be considered. METHOD: Health indicators published by the OECD (2017 to 2021) are analyzed according to 11 thematic groups. Coverage (quantity and type of indicators reported by thematic group) and quality of information were assessed, according to OECD guidelines. RESULTS: Mexico reported annually 14 of 378 indicators (3.7%), and discontinuously 204. In no group were all indicators reported annually, except for the two on COVID-19. Three out of 88 were reported annually on use of services; and none on health status, quality of care and pharmaceutical market. Twelve indicators (5.5% of those reported by Mexico, 3.2% of the full OECD set) had optimal quality and annual reporting. 57.7% of the reported indicators had at least one quality defect. CONCLUSIONS: Within the framework of the standards set by the OECD, of which Mexico is a member, the Mexican HIS presents significant deficits in coverage and quality of information. These results should be considered to implement improvement initiatives.

Simultaneous spine extradural and intradural teratomas in a pediatric patient: A rare presentation with insights in the flawed migration of germ cells theory.

Spinal teratomas are infrequent lesions in the pediatric population. These lesions can be extradural, intradural or intramedullary. We present a case of an 8-month-old boy that was assessed for underdevelopment of motor milestones. The neurologic examination revealed hyporeflexia, decreased sensation and flaccid paraplegia. MRI of the spine revealed two simultaneous and independent lesions in the extradural and intradural compartment. A laminectomy was performed for the T4-T7 vertebrae with total resection of both lesions. The histopathological analysis confirmed both lesions to be mature cystic teratomas. At the 1-year follow-up, the patient remained with no recovery of neurological function. A debate takes place regarding the etiology of formation of these lesions in the spine. The simultaneous presentation of two independent lesions in this patient could contribute to define the flawed migration of germ cells theory as the etiology for formation of teratomatous lesions in the spine.

Combined endoscopic transorbital and transnasal approach for the management of a solitary plasmacytoma of the sphenoid bone: A case report and literature review.

Background: Parasellar plasmacytomas are rare neurosurgical entities. Intrinsic characteristics of these tumors, such as adjacent bone erosion and symptoms resulting from invasion and mass effect, may lead to the possibility of a solitary extramedullary plasmacytoma (SEP) as a differential diagnosis. Case Description: We present the case of a 39-year-old male with a 1-month history of bilateral decreased visual acuity, retroocular pulsating pain, and chromatic vision loss. A computed tomography scan of the head revealed a parasellar lesion causing chiasmatic compression, as well as clival, orbital, sphenoidal, and ethmoidal invasion. A combined transorbital and endonasal endoscopic approach was found suitable, and gross total resection was achieved. Histological analysis of the lesion established the diagnosis of a SEP. After radiotherapy, a new magnetic resonance imaging was performed, revealing a recurrence of the lesion with a high grade of invasion. The patient was treated with palliative radiotherapy, as surgical resection did not seem feasible. Conclusion: Surgical resection and radiotherapy may achieve remission of these lesions; however, recurrence rates remain high despite any treatment modality. Patients with this condition must be followed up with a multidisciplinary team due to the high risk of multiple myeloma progression.

Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders.

BACKGROUND: Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021. METHODS: We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective. RESULTS: Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women. CONCLUSIONS: These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.

RESUMEN: ANTECEDENTES: La mala nutrición materno-infantil (MMI) representa un problema de salud pública en México. El primer nivel tiene la respondabilidad de introducir a mujeres y niños menores de 5 años al sistema de salud, detectar oportunamente las enfermedades y brindar servicios médicos incluido el farmacológico de ser necesario. Prestar estos servicios con calidad resulta elemental para mejorar la salud de la población materno-infantil. El objetivo de este estudio fue evaluar la calidad de la atención nutricional durante las etapas de preconcepción, embarazo, posparto, infancia y edad preescolar en centros de salud de seis estados de México entre 2020 y 2021. MéTODOS: Se realizó un estudio transversal con metodología mixta en 95 centros de salud la Secretaría de Salud de México para evaluar la calidad de la atención nutricional durante la preconcepción, el embarazo, el posparto, la infancia y la etapa preescolar. El nivel de calidad se calculó mediante el porcentaje de cumplimiento de 16 indicadores que a su vez integraron un Índice de Calidad de la Atención Nutricional Materno Infantil (ICANMI). El cumplimiento por indicador, etapa de vida y global fue categorizado utilizando los siguientes puntos de corte: mala calidad (≤ 70%), calidad insuficiente (71-89%) y buena calidad (≥ 90%). La percepción sobre las barreras y facilitadores que afectan la atención nutricional materno-infantil fueron identificadas a través de entrevistas semiestructuradas y grupos focales realizadas a profesionales de salud, usuarias y usuarios. Todos los instrumentos cualitativos fueron desarrollados con un enfoque de género e interculturalidad. RESULTADOS: La calidad de la atención nutricional materno infantil durante las cinco etapas de la vida evaluadas fue mala (cumplimiento: ≤12%), mientras que el ICANMI tuvo un cumplimiento de 8.3%. Las principales barreras identificadas para brindar una atención nutricional de alta calidad fueron la falta de conocimiento y capacitación de los profesionales de la salud, la escasez de equipos, medicamentos, personal y materiales, la desaparición del programa social de transferencias monetarias Prospera, la ausencia de una lengua indígena local, entre otros. Así como la persistencia de prácticas como el machismo y otras de control sobre las mujeres. CONCLUSIONES: Estos hallazgos subrayan la necesidad inmediata de implementar iniciativas que mejoren el estándar de atención nutricional en los centros de salud en Chihuahua, Estado de México, Veracruz, Oaxaca, Chiapas y Yucatán. Es necesario que el gobierno y las autoridades sanitarias, junto con diversas partes interesadas, diseñen, implementen y evalúen en colaboración políticas y programas orientados a mejorar la calidad de la atención nutricional, con perspectiva de género e interculturalidad. Este esfuerzo tiene como objetivo mitigar la prevalencia y aparición de diversas formas de desnutrición tanto en la población materna como infantil.

Calidad de la información en salud de México en el contexto de la OCDE: 2017-2021 / Quality of health information in Mexico in the OECD context: 2017-2021

Objetivo Evaluar el sistema de información en salud (SIS) de México según la información reportada a la Organización para la Cooperación y el Desarrollo Económicos (OCDE). El fin último es evidenciar las mejoras que se deberían considerar. Método Se analizan indicadores sobre salud publicados por la OCDE (2017 a 2021) según 11 grupos temáticos. Se valoraron cobertura (cantidad y tipo de indicadores reportados por grupo temático) y calidad de la información, según lineamientos de la OCDE. Resultados México reportó anualmente 14 de 378 indicadores (3,7%) y de forma discontinua 204. En ningún grupo se reportaron anualmente todos los indicadores, excepto los dos sobre COVID-19. Se reportan anualmente tres de 88 sobre utilización de servicios y ninguno sobre estado de salud, calidad de la atención y mercado farmacéutico. Con calidad óptima y reporte anual fueron 12 indicadores (5,5% de los reportados por México, 3,2% del set completo OCDE). El 57,7% de los indicadores reportados tuvieron al menos un defecto de calidad. Conclusiones En el marco de los estándares marcados por la OCDE, de la cual México es miembro, el SIS mexicano presenta déficits importantes de cobertura y de calidad de la información. Estos resultados deberían considerarse para implementar iniciativas de mejora. (AU)

Objective To evaluate the health information system (HIS) of Mexico according to the information reported to the Organization for Economic Co-operation and Development (OECD). The ultimate goal is to identify the improvements that should be considered. Method Health indicators published by the OECD (2017 to 2021) are analyzed according to 11 thematic groups. Coverage (quantity and type of indicators reported by thematic group) and quality of information were assessed, according to OECD guidelines. Results Mexico reported annually 14 of 378 indicators (3.7%), and discontinuously 204. In no group were all indicators reported annually, except for the two on COVID-19. Three out of 88 were reported annually on use of services; and none on health status, quality of care and pharmaceutical market. Twelve indicators (5.5% of those reported by Mexico, 3.2% of the full OECD set) had optimal quality and annual reporting. 57.7% of the reported indicators had at least one quality defect. Conclusions Within the framework of the standards set by the OECD, of which Mexico is a member, the Mexican HIS presents significant deficits in coverage and quality of information. These results should be considered to implement improvement initiatives. (AU)

Ectopic expression of DOCK8 regulates lysosome-mediated pancreatic tumor cell invasion.

Amplified lysosome activity is a hallmark of pancreatic ductal adenocarcinoma (PDAC) orchestrated by oncogenic KRAS that mediates tumor growth and metastasis, though the mechanisms underlying this phenomenon remain unclear. Using comparative proteomics, we found that oncogenic KRAS significantly enriches levels of the guanine nucleotide exchange factor (GEF) dedicator of cytokinesis 8 (DOCK8) on lysosomes. Surprisingly, DOCK8 is aberrantly expressed in a subset of PDAC, where it promotes cell invasion in vitro and in vivo. DOCK8 associates with lysosomes and regulates lysosomal morphology and motility, with loss of DOCK8 leading to increased lysosome size. DOCK8 promotes actin polymerization at the surface of lysosomes while also increasing the proteolytic activity of the lysosomal protease cathepsin B. Critically, depletion of DOCK8 significantly reduces cathepsin-dependent extracellular matrix degradation and impairs the invasive capacity of PDAC cells. These findings implicate ectopic expression of DOCK8 as a key driver of KRAS-driven lysosomal regulation and invasion in pancreatic cancer cells.

Establishing a core dossier for multiple regulatory submissions: a case study in the Latin America region.

The Latin America region comprises several countries that do not follow harmonized regulatory requirements for drug product (DP) marketing authorization applications (MAA), resulting in customized registration dossiers for each country. Here, we established a core dossier for multiple MAA in the Latin America region by examining the similarities between regulatory requirements and reconciling their potential discrepancies through discussions among all national regulatory representatives. The core dossier was used in the submission of a new small molecule, NME1, to nine markets. Assessment of the process included the time to submission; the timing, number, and complexity of questions received; and timing of final national regulatory agencies (NRA) evaluation decisions. The core dossier resulted in an accelerated submission timeline for most markets and earlier receipt of NRA queries from some markets, compared with projections. One round of queries of a low or medium complexity was received from all agencies. The receipt of final NRA evaluation decisions was also accelerated in most markets, compared with the best-case approval timeframes. The core dossier approach was also evaluated against the standard submission of a similar small molecule, NME2. In contrast to the core dossier submission of NME1, a second round of questions, and high-complexity questions were received from two markets for NME2. In conclusion, a core dossier has the potential to simplify the regulatory process for both reviewers and applicants in regions that do not share harmonized regulatory requirements, with a consequential acceleration of DP approvals.

The Cell Biology of Metastatic Invasion in Pancreatic Cancer: Updates and Mechanistic Insights.

Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer-related mortality worldwide. This is largely due to the lack of routine screening protocols, an absence of symptoms in early-stage disease leading to late detection, and a paucity of effective treatment options. Critically, the majority of patients either present with metastatic disease or rapidly develop metastatic disease. Thus, there is an urgent need to deepen our understanding of metastasis in PDAC. During metastasis, tumor cells escape from the primary tumor, enter the circulation, and travel to a distant site to form a secondary tumor. In order to accomplish this relatively rare event, tumor cells develop an enhanced ability to detach from the primary tumor, migrate into the surrounding matrix, and invade across the basement membrane. In addition, cancer cells interact with the various cell types and matrix proteins that comprise the tumor microenvironment, with some of these factors working to promote metastasis and others working to suppress it. In PDAC, many of these processes are not well understood. The purpose of this review is to highlight recent advances in the cell biology of the early steps of the metastatic cascade in pancreatic cancer. Specifically, we will examine the regulation of epithelial-to-mesenchymal transition (EMT) in PDAC and its requirement for metastasis, summarize our understanding of how PDAC cells invade and degrade the surrounding matrix, and discuss how migration and adhesion dynamics are regulated in PDAC to optimize cancer cell motility. In addition, the role of the tumor microenvironment in PDAC will also be discussed for each of these invasive processes.

Development and validation of a new set of indicators to assess the quality of maternal and child nutritional care at the primary care.

Introduction: Maternal and child malnutrition is a worldwide public health problem with short, medium, and long-term adverse consequences for both mother and child. In Mexico, maternal and child malnutrition represents a serious public health problem that must be urgently addressed. In this context, Primary Health Care (PHC) plays an important role in the prevention, detection, monitoring, and treatment of the different forms of maternal and child malnutrition. Assessing the quality of nutritional care offered at this level of care is necessary in order to improve it; however, there are no indicators for the evaluation of this quality. Therefore, this study aimed at developing a set of indicators to assess the quality of maternal and child nutritional care at PHC. Methods: We developed indicators for different stages of life: preconception, pregnancy, infancy, and preschool age. A systematic review of the literature on clinical guidelines for the prevention, diagnosis, and treatment of the different forms of malnutrition was carried out; the recommendations of the guidelines evaluated with good quality were extracted. Results: Based on these recommendations, 22 indicators were constructed. A pilot study was carried out to validate the indicators and 16 indicators were selected to assess the maternal and child nutritional care at PHC.

Potentially inappropriate prescribing in older adults in Mexico.

OBJECTIVE: To identify and quantify potentially inappropriate prescribing (prescripción potencialmente inapropiada, PPI) and other drug prescribing problems in public health care services in a population-based study at the three existing levels of complexity in Mexico. METHODS: Descriptive analysis of the Study on Satisfaction of Users of the Social Protection System in Health 2014-2016, prescription and drug supply section, to obtain the prevalence of PPI in older adults (≥ 65 years), based on Beers, STOPP, Prescrire and BSP listings using AM (older adults) prescription indicators, one for each listing. RESULTS: Most older adults (67%) were prescribed at least one medication, with a mean of 2.7 medications per prescription. The PPI prevalence was 74% according to the BSP criteria, 67% according to the STOPP listing, 59% with the Beer criteria, and 20% with Prescrire. The most frequent PPI prescriptions were NSAIDs, vasodilators and sulfonylureas. CONCLUSIONS: The use of PPIs in AM is high in Mexico. The higher prevalence found in this study may reflect the use of a source with population representativeness. The partial use and adaptations of the criteria make difficult comparing the studies; however, the STOPP criteria are the ones with the highest prevalence, as they cover a greater number of drugs and their use is more common in the first level of care.

Direccionalidad de la violencia en ambientes familiares de drogodependientes / Directionality of violence in family settings of drug addicts

La investigación tuvo el objetivo de determinar la direccionalidad de la violencia intrafamiliar en relación con el tipo de agresión, droga de inicio de consumo, nivel educativo, sexo, experiencias perturbadoras, grupo de edad y estado civil, en pacientes drogodependientes atendidos en la Unidad de Conductas Adictivas (UCA) del Instituto de Neurociencias de Guayaquil (INC), durante el periodo comprendido entre 2010 y 2016. Se realizó un estudio no experimental-correlacional mediante el análisis de las historias clínicas de 1015 (845 hombres y 170 mujeres) pacientes con perfil de violencia intrafamiliar consumidores de drogas y sustancias psicoactivas. Entre la población estudiada predominó el consumo de alcohol como droga de inicio (95%), el nivel escolar secundario (94%), el estado civil soltero(a) o divorciado(a), el grupo de edades comprendido entre 21 y 30 años (35%) y la experiencia perturbadora del divorcio. Los resulta-dos de la técnica del árbol CHAID reflejaron una conexión estadísticamente significativa con el tipo de droga de inicio y el nivel educativo en los participantes.

The objective of the research was to determine the directionality of intrafamily violence in relation to the type of aggression, drug of initiation of consumption, educational level, sex, disturbing experiences, age group and marital status. The research was conducted in a group of drug-dependent patients treated in the Addictive Behaviors Unit of the Guayaquil Institute of Neurosciences, during the period between 2010 and 2016. A non-experimental-correlational study was carried out by analyzing the medical records of 1015 (845 men and 170 women) patients with a profile of intrafamily violence who used drugs and psychoactive substances. Among the population studied, the consumption of alcohol as a starting drug prevailed (95%), the secondary school level (94%), the marital status of single or divorced, the age group between 21 and 30 years (35%) and the disturbing experience of divorce. The results of the CHAID tree technique reflected a statistically significant connection with the type of starting drug and educational level in the participants.

Toll receptors remodel epithelia by directing planar-polarized Src and PI3K activity.

Toll-like receptors are essential for animal development and survival, with conserved roles in innate immunity, tissue patterning, and cell behavior. The mechanisms by which Toll receptors signal to the nucleus are well characterized, but how Toll receptors generate rapid, localized signals at the cell membrane to produce acute changes in cell polarity and behavior is not known. We show that Drosophila Toll receptors direct epithelial convergent extension by inducing planar-polarized patterns of Src and PI3-kinase (PI3K) activity. Toll receptors target Src activity to specific sites at the membrane, and Src recruits PI3K to the Toll-2 complex through tyrosine phosphorylation of the Toll-2 cytoplasmic domain. Reducing Src or PI3K activity disrupts planar-polarized myosin assembly, cell intercalation, and convergent extension, whereas constitutive Src activity promotes ectopic PI3K and myosin cortical localization. These results demonstrate that Toll receptors direct cell polarity and behavior by locally mobilizing Src and PI3K activity.

Driving Force and Optical Signatures of Bipolaron Formation in Chemically Doped Conjugated Polymers.

Molecular dopants are often added to semiconducting polymers to improve electrical conductivity. However, the use of such dopants does not always produce mobile charge carriers. In this work, ultrafast spectroscopy is used to explore the nature of the carriers created following doping of conjugated push-pull polymers with both F4 TCNQ (2,3,5,6-tetrafluoro-7,7,8,8-tetracyanoquinodimethane) and FeCl3 . It is shown that for one particular push-pull material, the charge carriers created by doping are entirely non-conductive bipolarons and not single polarons, and that transient absorption spectroscopy following excitation in the infrared can readily distinguish the two types of charge carriers. Based on density functional theory calculations and experiments on multiple push-pull conjugated polymers, it is argued that the size of the donor push units determines the relative stabilities of polarons and bipolarons, with larger donor units stabilizing the bipolarons by providing more area for two charges to co-reside.

Potentially inappropriate prescribing in older adults in Mexico / Prescripción potencialmente inapropiada en adultos mayores en México

ABSTRACT OBJECTIVE To identify and quantify potentially inappropriate prescribing (prescripción potencialmente inapropiada, PPI) and other drug prescribing problems in public health care services in a population-based study at the three existing levels of complexity in Mexico. METHODS Descriptive analysis of the Study on Satisfaction of Users of the Social Protection System in Health 2014-2016, prescription and drug supply section, to obtain the prevalence of PPI in older adults (≥ 65 years), based on Beers, STOPP, Prescrire and BSP listings using AM (older adults) prescription indicators, one for each listing. RESULTS Most older adults (67%) were prescribed at least one medication, with a mean of 2.7 medications per prescription. The PPI prevalence was 74% according to the BSP criteria, 67% according to the STOPP listing, 59% with the Beer criteria, and 20% with Prescrire. The most frequent PPI prescriptions were NSAIDs, vasodilators and sulfonylureas. CONCLUSIONS The use of PPIs in AM is high in Mexico. The higher prevalence found in this study may reflect the use of a source with population representativeness. The partial use and adaptations of the criteria make difficult comparing the studies; however, the STOPP criteria are the ones with the highest prevalence, as they cover a greater number of drugs and their use is more common in the first level of care.

RESUMEN OBJETIVO Identificar y cuantificar la prescripción potencialmente inapropiada (PPI) y otros problemas en la prescripción de medicamentos en los servicios públicos de atención médica en un estudio poblacional en los tres niveles de complejidad existentes en México. MÉTODOS Análisis descriptivo del Estudio de Satisfacción de Usuarios del Sistema de Protección Social en Salud 2014-2016, sección de prescripción y surtimiento de medicamentos, para obtener la prevalencia de PPI en adultos mayores (≥ 65 años) con base en listados Beers, STOPP, Prescrire y BSP mediante indicadores de prescripción en AM, uno por cada listado. RESULTADOS Al 67% de los AM se les prescribió al menos un medicamento, con una media de 2.7 medicamentos por receta. La prevalencia de PPI fue del 74% según los criterios BSP, del 67% según el listado STOPP, del 59% con los criterios Beer y del 20% con Prescrire. Las prescripciones PPI más frecuentes fueron los AINES, vasodilatadores y las sulfonilureas. CONCLUSIONES El uso de PPI en AM es alto en México. La mayor prevalencia encontrada en este estudio puede ser reflejo de la utilización de una fuente con representatividad poblacional. La utilización parcial y adaptaciones de los criterios dificultan la comparabilidad entre estudios, sin embargo, los criterios STOPP son los que más altas prevalencias han presentado debido a que abarca un mayor número de medicamentos y su uso más habitual en el primer nivel de atención.

[Polypharmacy in Mexico: a challengefor prescription quality]. / Polifarmacia en México: un reto para la calidad en la prescripción.

OBJECTIVE: To analyze the prevalence of polypharmacy, as well as the factors that identify the groups with higher risk, in population study in Mexico. MATERIALS AND METHODS: Descriptive analysis of the Encuesta Nacional de Salud y Nutrición 2018-19 (Ensanut 2018-19), Utilization of services (medicine section) and Household questionnaires, to obtain prevalence of polypharmacy (simultaneous consumption ≥5 medicines). A logistic regression model was used to estimate the association of polypharmacy with sociodemographic and health care factors. RESULTS: Prevalence of polypharmacy: 18 years, 15.5%, and 65 years, 26.5%. Higher prevalence in: nephropathies (61.5%), heart disease (42.2%), chronic ob-structive pulmonary disease (38.5%), diabetes (29.3%) and hypertension (26.4%). Increased possibility in adults 65 years (OR:1.95), low schooling (OR:1.54), social security (OR:1.64), serviced in public services (OR:1.7) and chronic illness (OR:1.84). CONCLUSIONS: Polypharmacy is associated with chronic disease and some sociodemographic factors. Large area of opportunity to improve quality of care, particularly pharmacological prescription to identified population with higher risk.

OBJETIVO: Analizar la prevalencia de polifarmacia, así como los factores que identifican a los grupos con mayor riesgo, en un estudio poblacional en México. MATERIAL Y MÉTODOS: Salud y Nutrición 2018-19 (Ensanut 2018-19), cuestionarios de Utilización de servicios (sección medicamentos) y del Hogar, para obtener la prevalencia de polifarmacia (consu-mo simultáneo ≥5 medicamentos). Se utilizó un modelo de regresión logística para estimar la asociación de polifarmacia con factores sociodemográficos y de atención a la salud. RESULTADOS: Prevalencia de polifarmacia: ≥18 años, 15.5%, y ≥65 años, 26.5%. Prevalencias superiores: nefropatías (61.5%), cardiopatías (42.2%), enfermedad pulmonar obstructiva crónica (38.5%), diabetes (29.3%) e hipertensión (26.4%). Mayor posibilidad en adultos ≥65 años (OR:1.95), con baja escolaridad (OR:1.54), seguridad social (OR:1.64), atendidos en servicios públicos (OR:1.7) y enfermedad crónica (OR:1.84). CONCLUSIONES: La polifarmacia se asocia con tener enfermedad crónica y con factores sociodemográficos. Es una gran área de oportunidad para mejorar calidad de la atención, particularmente la prescripción farmacológica a la población identificada con mayor riesgo.

[Quality of care in type 2 diabetes, progressand challenges from 2012 to 2018-19 forthe Mexican health system]. / Calidad de la atención en diabetes tipo 2, avances y retos de 2012 a 2018-19 para el sistema de salud de México.

OBJECTIVE: To estimate changes in the quality of process of care and its association with glycaemic control in adults with type 2 diabetes. MATERIALS AND METHODS: Changes in compliance of 14 process of care indicators for 9 038 adults with type 2 diabetes and glycaemic control in a subsample were estimated. Averages, weighted changes and associations without or controlling for other factors were estimated us-ing statistical weights for the combined data (Ensanut 2012 and Ensanut 2018-19). RESULTS: From 2012 to 2018-19, glycaemic control doubled. Early detection of complications and increased insuline use improved, but identification and treatment of cardiovascular risk factors decreased. The overall quality of care was associated with optimal glycaemic control. CONCLUSIONS: There are areas of opportunity for improvement of quality of care, that deserve comprehensive strategies and continuous monitoring.

OBJETIVO: Estimar cambios en la calidad del proceso de atención y su asociación con control glucémico en adultos con diabetes tipo 2. MATERIAL Y MÉTODOS: cambio en el cumplimiento de 14 indicadores del proceso de atención en 9 038 adultos con diabetes tipo 2 y del control glucémico en una submuestra. Se estimaron promedios, cam-bios ponderados y asociaciones crudas y ajustadas utilizando ponderaciones estadísticas para datos combinados (Ensanut 2012 y Ensanut 2018-19). RESULTADOS: De 2012 a 2018-19, el control glucémico se duplicó. Mejoró la detección tem-prana de complicaciones y aumentó el uso de insulina, pero disminuyó la identificación y tratamiento de factores de riesgo cardiovascular. La calidad global de la atención se asoció con el control glucémico óptimo. CONCLUSIONES: Existen áreas de oportunidad para la mejora de la calidad en la atención que ameritan estrategias integrales y monitorización continua.

Studies on the bioactive flavonoids isolated from Azadirachta indica.

Two novel natural metabolites, 3-O-butyl-(-)-epicatechin (1) and 3-O-butyl-(-)-epigallocatechin (2), as well as several known substances, (-)-epicatechin (3), (+)-gallocatechin (4), (-)-epigallocatechin (5), azadirachtin A (6), trilinolein (7) and octadecanoic acid-tetrahydrofuran-3,4-diyl ester (8), were isolated from the bark of Azadirachta indica. The structures of all compounds were established by comprehensive and comparative spectroscopic analysis of NMR and ESI-HRMS data. The new metabolites 1 and 2 represent one of the few examples of natural compounds with a butyl ether group moiety. The acaricidal activity of the compounds was tested using a standard Shaw larval immersion assay. All the compounds, except 7, possess a LD50 value less than or equal to 7.2 mM.

Calidad de la atención en diabetes tipo 2, avances y retos de 2012 a 2018-19 para el sistema de salud de México / Quality of care in type 2 diabetes, progress and challenges from 2012 to 2018-19 for the Mexican health system

Resumen: Objetivo: Estimar cambios en la calidad del proceso de atención y su asociación con control glucémico en adultos con diabetes tipo 2. Material y métodos: Análisis del cambio en el cumplimiento de 14 indicadores del proceso de atención en 9 038 adultos con diabetes tipo 2 y del control glucémico en una submuestra. Se estimaron promedios, cambios ponderados y asociaciones crudas y ajustadas utilizando ponderaciones estadísticas para datos combinados (Ensanut 2012 y Ensanut 2018-19). Resultados: De 2012 a 2018-19, el control glucémico se duplicó. Mejoró la detección temprana de complicaciones y aumentó el uso de insulina, pero disminuyó la identificación y tratamiento de factores de riesgo cardiovascular. La calidad global de la atención se asoció con el control glucémico óptimo. Conclusiones: Existen áreas de oportunidad para la mejora de la calidad en la atención que ameritan estrategias integrales y monitorización continua.

Abstract: Objective: To estimate changes in the quality of process of care and its association with glycaemic control in adults with type 2 diabetes. Materials and methods: Changes in compliance of 14 process of care indicators for 9 038 adults with type 2 diabetes and glycaemic control in a subsample were estimated. Averages, weighted changes and associations without or controlling for other factors were estimated using statistical weights for the combined data (Ensanut 2012 and Ensanut 2018-19). Results: From 2012 to 2018-19, glycaemic control doubled. Early detection of complications and increased insuline use improved, but identification and treatment of cardiovascular risk factors decreased. The overall quality of care was associated with optimal glycaemic control. Conclusions: There are areas of opportunity for improvement of quality of care, that deserve comprehensive strategies and continuous monitoring.