[Epidemiological and clinical characteristics of the COVID-19 epidemic in Mexico: Quintana Roo case]. / Características epidemiológicas y clínicas de la epidemia COVID-19 en México: caso Quintana Roo.

Objective: Identify risk factors for severe outcome in Mexican patients with COVID-19 in the population of Quintana Roo. Material and methods: Study of 5,916 who met the criteria for suspected cases of COVID-19, 2,531 confirmed by qrTPCR-Sars-CoV-2 tests, of which 1,486 were positive, among which they were classified as hospitalized (severe COVID-19) and outpatients. Multivariate logistic regression analysis was performed to explore the factors associated with the severity of COVID-19 and death as clinical outcomes. The basic reproduction number (R0) was calculated Statistical analysis) Endorsement of the ethics committee 2301. Results: SARS-CoV-2 positive patients presented a high prevalence of hypertension 29.1%, diabetes 23.5%, obesity 24%, and 48.5% have at least one chronic disease. There is a high risk of severity for COVID-19 in patients with diabetes OR=3.14, hypertension OR=1.88, obesity OR=1.68, kidney disease OR=3.2, older than 65 years OR=13.6 and men OR=1.7. These factors also increase the risk of death up to 7.7 times. The maximum R0 during the epidemic was 2.4. Conclusion: Liver and kidney disease, diabetes, hypertension, and obesity are significantly associated with severe COVID-19 and death.

Objetivo: identificar factores de riesgo para desenlace a COVID-19 grave en pacientes mexicanos con de COVID-19 en población en Quintana Roo. Material y métodos: estudio de 5,916 quienes cumplieron criterios de casos sospechosos de COVID-19, 2,531 confirmados por pruebas qrTPCR-Sars-CoV-2 de los cuales 1,486 fueron positivos entre los cuales se clasifico en hosptializados (COVID-19 grave) y ambulatorios. Se realizó análisis de regresión logística multivariada para explorar los factores asociados con la gravedad de COVID-19 y defunción como desenlaces clínicos. Se calculó el número básico de reproducción (R0) Análisis estadístico) Aval del comité de ética 2301. Resultados: pacientes positivos a SARS-CoV-2 presentaron alta prevalencia de hipertensión 29.1%, diabetes 23.5%, obesidad 24%, y 48.5% tiene al menos una enfermedad crónica. Existe alto riesgo de severidad para COVID-19 en pacientes con diabetes OR=3.14; hipertensión OR=1.88, obesidad OR=1.68, enfermedad renal OR=3.2, mayores de 65 años OR=13.6 y hombres OR=1.7. Estos factores también incrementan el riesgo de defunción hasta 7.7 veces. El R0 máximo durante la epidemia fue de 2.4. Conclusión: la enfermedad hepática, renal, diabetes, hipertensión y obesidad se asocian significativamente a COVID-19 severo y defunción.

Calidad del sueño en pacientes con enfermedad renal crónica / Sleep quality in patients with chronic kidney disease

Introducción: los pacientes con enfermedad renal crónica (ERC), y en específico los que tienen tratamiento renal sustitutivo (TRS), se ven afectados en su ciclo circadiano y en su calidad del sueño. Objetivo: evaluar la calidad del sueño de los pacientes con enfermedad renal crónica que acuden al servicio de Nefrología de una unidad médica de segundo nivel de atención. Metodología: estudio comparativo en pacientes con ERC del servicio de Nefrología, clasificados en tres grupos, dos de ellos en terapia de reemplazo renal (diálisis peritoneal y hemodiálisis) y uno sin terapia de reemplazo renal (prediálisis). Para la calidad del sueño se utilizó la escala de Pittsburgh, se incluyeron datos sociodemográficos y parámetros bioquímicos. Los datos se analizaron median- te comparación de frecuencias con Chi cuadrada, medias con t de Student y ANOVA de un factor. Resultados: se formaron tres grupos: hemodiálisis (n = 75), diálisis peritoneal (n = 58) y prediálisis (n = 71). La edad media fue de 53.5 años; la calidad subjetiva del sueño fue buena en el 48% del total y en el 54.9% de los pacientes en prediálisis (p < 0.05). Al aplicar la escala de Pittsburgh, el 80.4% del total y el 84.5% de los pacientes en diálisis reportaron una calidad de sueño mala. De las siete dimensiones evaluadas, dos fueron diferentes en los tres grupos (p < 0.05). Conclusiones: la percepción del paciente sobre la calidad del sueño habitualmente se sobreestima, lo que indica una adaptación a un sueño ineficiente. Debido a las características de estos pacientes es importante mantener un control de sus parámetros bioquímicos, que también tienen un impacto en la calidad del sueño.

Introduction: In patients with chronic kidney disease (CKD) and specifically with renal replacement therapy (RRT), their circadian cycle and consequently their sleep quality are affected. Objective: To evaluate the quality of sleep in patients with chronic kidney disease attends at the nephrology service. Methods: Comparative study in patients with chronic kidney disease from the nephrology service classified into three groups, two of them had renal replacement therapy (peritoneal dialysis and hemodialysis) and one without renal replacement therapy (predialysis). For the quality of sleep we used the Pittsburgh Scale, sociodemographic data and biochemical parameters were included. Comparison of frequencies with chi-square, means with Student's t and Anova of one factor. Results: Three groups were formed: hemodialysis (n = 75), peritoneal dialysis (n = 58) and predialysis (n = 71). The mean age was 53.5 years; the subjective quality of sleep was "good" in 48.0% of the total and in 54.9% of predialysis patients (p <0.05). When applying the Pittsburgh scale, 80.4% of the total and 84.5 of the dialysis patients reported a "poor" quality of sleep. Of the seven dimensions evaluated, two were different in the three groups (p < 0.05) Conclusions: The patient's perception of the quality of sleep is regularly overestimated, which indicates an adaptation to this dream habit. Due to the characteristics of these patients, it is important to keep a check on their biochemical parameters, which also have an impact on the quality of sleep.

Conteo de carga viral en pacientes con VIH/SIDA usuarios de terapias alternativas o complementarias / Viral load count in patients with HIV/AIDS users of alternative and/or complementary therapies

Introducción: una alternativa para mitigar los efectos del virus de inmunodeficiencia humana (VIH) es la medicina complementaria, alternativa o integrativa (MCAI); sin embargo, esta puede tener una influencia negativa en los pacientes con VIH. Objetivo: estimar la relación entre la carga viral y el uso de MCAI en pacientes con VIH/SIDA. Metodología: estudio analítico con 232 pacientes de la clínica de VIH/SIDA de una unidad médica de segundo nivel de atención en Cancún, México. Previo consentimiento informado, a cada paciente se le aplicó un cuestionario para identificar el uso de la MCAI y simultáneamente se obtuvo el conteo de carga viral y el CD4 del expediente electrónico. Resultados: el 47.8% utilizaron herbolaria como tratamiento alternativo. No se encontró diferencia estadística entre la utilización de herbolaria y su conteo de carga viral (p > 0.646). La terapia cuerpo-mente, los suplementos vitamínicos, la homeopatía y la acupuntura se usaron del 5 al 24.6%, sin diferencia estadística (p > 0.05) entre los grupos. Por el contrario, el uso de sesiones de manipulación del cuerpo mostró diferencia en relación con quienes no las utilizaban (p < 0.05). Conclusiones: es importante que el profesional de la salud identifique los efectos adversos o benéficos de las terapias alternativas y complementarias, con la finalidad de orientar a sus pacientes y no afectar su tratamiento antirretroviral y, en consecuencia, su conteo de carga viral.

Introduction: An alternative to mitigate the effects of human immunodeficiency virus (HIV) is the complementary and alternative medicine (CAM); however, this could have a negative influence in patients with HIV. Objective: To estimate the relationship between viral load and the use of CAM in patients with HIV/AIDS. Method: Analytical study with 232 patients from the HIV/AIDS Clinic of a second-level healthcare unit in Cancun, Mexico. With prior informed consent, a questionnaire was administered to each patient to identify the use of CAM, and, simultaneously, the viral load and CD4 counts were obtained from their electronic file. Results: 47.8% used herbal medicine as an alternative treatment. No statistical difference was found between the use of herbal products and their viral load (p > 0.646). Body-mind therapy, vitamin supplements, homeopathy and acupuncture were used from 5 to 24.6% without statistical difference (p > 0.05) among groups. However, the use of massage therapy showed a difference in relation to those who did not use it (p < 0.05). Conclusions: It is important that health professionals identify the adverse or beneficial effects of alternative and complementary therapies, so that they can guide their patients and not affect their antiretroviral treatment and, consequently, their viral load.

Características clínicas, epidemiológicas y riesgo obstétrico de las pacientes con preeclampsia-eclampsia / Clinical, epidemiological and obstetric risk characteristics of patients with preeclampsia-eclampsia

Introducción: la preeclampsia es un trastorno multisistémico cuyos criterios clínicos no han cambiado en la última década. De acuerdo con la OMS, la incidencia de preeclampsia oscila entre el 2 y 10% del total de embarazos, y su prevalencia es siete veces mayor en los países en vías de desarrollo que en los países desarrollados. Objetivo: describir las características epidemiológicas, clínicas y antecedentes obstétricos de las pacientes con diagnóstico de preeclampsia-eclampsia de la unidad de cuidados intensivos adultos (UCIA). Métodos: estudio descriptivo transversal retrospectivo, se incluyeron 20 expedientes clínicos de las pacientes entre 13 y 45 años de edad, con embarazo ≥ 20 semanas de gestación de la unidad de cuidados intensivos adultos, con diagnóstico confirmado de preeclampsia-eclampsia. Se aplicó un instrumento diseñado para el estudio. Resultados: edad promedio de 28.45 ± 6.57 años. El 55% presentó preeclampsia severa y síndrome de HELLP el 60%. Con estancia en la UCIA de 2.4 ± 1.43 días. Conclusiones: aunque los datos no fueron suficientes para documentar, la proporción de pacientes con hipertensión arterial y antecedentes de preeclampsia, así como, hipertensión arterial de comorbilidad fue superior a lo referido en un estudio con embarazadas en Colombia de 12.4%.

Introduction: Preeclampsia is a multisystem disorder whose clinical criteria have not changed in the last decade. According to the WHO, the incidence of preeclampsia varies between 2% and 10% of all pregnancies, and its prevalence is seven times higher in developing countries than in developed countries. Objective: To describe the epidemiological and clinical characteristics and obstetric history of patients diagnosed with preeclampsia-eclampsia of the adult intensive care unit (ICU). Methods: A retrospective cross-sectional descriptive study, 20 clinical files were included of patients between 13 and 45 years of age, with pregnancy ≥ 20 weeks gestation of the adult intensive care unit, with a confirmed diagnosis of preeclampsia- eclampsia. An instrument designed for the study was applied. Results: Average age 28.45 ± 6.57 years. 55% presented severe preeclampsia and HELLP syndrome 60%. With a stay in the UCIA of 2.4 ± 1.43 days. Conclusions: Although the data were not enough to document, the proportion of patients with hypertension and a history of preeclampsia, as well as, comorbidity hypertension were higher than that reported in a study with pregnant women in Colombia of 12.4%.

[Intimate partner violence. Types and risk in primary care health users in Cancun, Quintana Roo, Mexico]. / Violencia de pareja: tipo y riesgos en usuarias de atención primaria de salud en Cancún, Quintana Roo, México.

OBJECTIVE: To identify the prevalence and type of intimate partner violence in women assigned at primary care health and estimates the risks for violence. DESIGN: Case (incident cases)-control. LOCATION: Primary health care unit in Cancun, Quintana Roo, Mexico. PARTICIPANTS: Women over 18years old living in couple at last 12months. MAIN MEASUREMENTS: Validated violence scale for Mexican population was evaluated: total partner violence, physical, psychological and sexual violence. History of violence and sociodemographic variables. Chi square for categorical variables and odds ratio (OR) for risk estimate was determined. RESULTS: The total intimate partner violence was 15.05%, psychological violence in 37.3%. Overall violence, age differences, socioeconomic status, marital status, history of violence and alcohol intake by the partner (P<.05) were observed. The risk increased in over 40 years old (OR: 2.09; 95%CI: 1.07 to 4.11), history of violence (OR: 5.9; 95%CI: 2.8 to 12.44) and alcohol intake by partner (OR=12.38; 95%CI: 2.15 to 29.59). Low socioeconomic status (OR: 0.384; 95%CI: 0.19 to 0.74) and free union (OR: 0.507; 95%CI: 0.27 to 0.95) were relation factors to lower intimate violence partner. CONCLUSIONS: Sexual violence predominated among users of primary health care and the risk that present this behavior increases with the consumption of alcoholic beverages in the couple and a history of violence, but the free union and socioeconomic status were possibility protected for violence.

Handcrafted Vacuum-Assisted Device for Skin Ulcers Treatment Versus Traditional Therapy, Randomized Controlled Trial.

BACKGROUND: Chronic lower limb ulcers constitute a public health problem, with important socioeconomic implications and high attention cost. This trial evaluates handcrafted vacuum-assisted therapy versus traditional treatment effectiveness for lower limbs ulcers. MATERIALS AND METHODS: It was a prospective randomized clinical trial conducted over 144 patients with lower limbs ulcers. Patients were randomized into two groups of 72 patients: Experimental group were treated with debridement, cure and a handcrafted vacuum-assisted device that was changed every 72 h. Control group was treated with debridement and cure with soap every 24 h. Ulcers were evaluated every 72 h and on 10th day. The presence of systemic inflammatory response, pain, granulation tissue and viability for discharge was registered and analyzed . RESULTS: After exclusion of 18 patients, 126 were included, 65.1% were men with an average of 58 years. Sole region ulcer by diabetic foot was the more frequent in both groups (73%). Leukocytes count, systemic inflammatory response and pain were significantly lower in experimental group (p < 0.05). Discharge criteria and granulation tissue were present earlier in experimental group (p < 0.05). CONCLUSION: Handcrafted vacuum-assisted system is a feasible and safe method to treat chronic ulcers. This system would benefit patients favoring earlier infection control, faster granulation tissue appearance and earlier discharge. Clinical trials registered in https://www.clinicaltrials.gov/ Number NCT02512159.

[Preclinical horizon of depression in adults]. / Horizonte preclínico de la depresión en adultos.

OBJECTIVE: Identify factors related to preclinical depression in healthy adults, their risk factors and concordance with family doctor diagnostic. MATERIALS AND METHODS: Case-control study in adult from family medicine consulting room. Beck inventory for depression was applied. The correlation between depression and the diagnosis by the family physician was evaluated. Odds ratio (OR) was determined. RESULTS: Involved 138 patients randomly from four family medicine units (FMU) in the Northern Region of Quintana Roo, Mexico. The mean age 34.9 ± 11.4 years, 55.8% women, prevalence for depression was 26.1%. Being male OR: 3.76; 95% CI: 1.69-8.36, under 30 years OR: 2.76; 95% CI: 1.27-5.99, low socioeconomic status (SES) OR: 2.11; 95% CI: 0.97-4.59 and be married OR: 3.22; 95% CI: 1.41.-7.36 had depression risk. Diagnosis by the family physician and inventory Beck. Kappa Index 0.2, 95% CI: -0057-0176; p = 0.05. CONCLUSIONS: Almost a third of young adults have some depression degree in family medicine consulting room, it is necessary a depression screening for male patients, low SES, married, and under 30 years old, attending medical consultation familiar, for a early diagnosis and improve prognosis.

[Breastfeeding, complementary feeding and risk of childhood obesity]. / Lactancia materna, alimentación complementaria y el riesgo de obesidad infantil.

OBJECTIVE: To evaluate the pattern of breastfeeding and weaning as a risk of obesity in pre-school children from a Primary Care Unit. DESIGN: Cross-sectional analytical study LOCATION: Cancun, Quintana Roo (Mexico). PARTICIPANTS: Children from 2-4 years of age from a Primary Care Unit. MAIN MEASUREMENTS: Duration of total and exclusive breastfeeding, age and food utilized for complementary feeding reported by the mother or career of the child and nutritional status assessment evaluated by body mass index (BMI) ≥ 95 percentile. Determination of prevalence ratio (PR), odds ratio (OR), chi squared (x2), and binary logistic regression. RESULTS: The study included 116 children (55.2% girls) with a mean age of 3.2 years, with obesity present in 62.1%, Exclusive breastfeeding in 72.4% with mean duration of 2.3 months, and age at introducing solids foods was 5.0 months. There was a difference for breastfeeding and complementary feeding by gender sex (P<.05). A PR=3.9 (95% CI: 1.49-6.34) was calculated for exclusive breastfeeding and risk of obesity. The model showed no association between these variables and obesity in children CONCLUSIONS: Exclusive breastfeeding of less than three months is associated with almost 4 more times in obese children. There was a difference in age of complementary feeding, duration of breastfeeding, and formula milk consumption time for obese and non-obese children.

[Epidemiological characteristics of depressed Mexican pregnant women]. / Depresión durante el embarazo. Epidemiología en mujeres mexicanas.

OBJECTIVE: To estimate the prevalence of depression in pregnant women, the epidemiological characteristics and associated factors. METHODS: A cross-comparison, with a sample of 220 pregnant women between 18 and 32 weeks gestation. We excluded patients with depression six months before the current pregnancy. RESULTS: Depressed women were 6.4 %, mean age 26 years and 21.4 % were adolescent. The majority women were high school students (50 %); 71.4 % belong to a low medium socioeconomic status; 21.4 % were without a partner; 35.7 % had depression history in the family and 28.6 % had a history of prior antidepressant treatment. CONCLUSIONS: The prevalence of depression in Mexican pregnant women was low. Risk factors associated to depression were young age, low socio-economical status, a lack of a partner, a history of depression in the family.

[Quality of life in patients with continuous ambulatory peritoneal dialysis]. / Calidad de vida en pacientes con diálisis peritoneal continua ambulatoria.

OBJECTIVE: To evaluate different aspects of the quality of life of patients with continuous ambulatory peritoneal dialysis, using the survey SF-36 (Medical Outcomes Study 36-Short Form Health Survey). METHODOLOGY: A cross-sectional study was carried out with patients older than 18 years having chronic renal failure and being registered in the continuous ambulatory peritoneal dialysis program in the last three months. A sample size of 48 patients was estimated. The version 1.1 of the SF-36 survey previously adapted for Mexican people was used to evaluate quality of life. RESULTS: Forty-eight patients were included, among which 52% were males, the mean of age was 45 years old. All eight domains of health were analyzed. The role limitations due to physical health showed the lower score (mean = 19.79; men: 13, women: 27.1) while mental health showed the higher (mean = 61.66; men: 59.68 women: 63.83).

[Acute asthma and its costs of care at an emergency service]. / Agudizaciones del asma y sus costos de atención en el servicio de urgencias.

BACKGROUND: The request in the urgency service for attention in acute asthma is determined by multiple factors as the medical handling, the constancy and the pursuance of the patient in the adequate follow up of the treatment, the climate, the food hygienic habits and the allergies. OBJECTIVE: To determine in one year period, the frequency, recurrence of medical attention for acute asthma and the cost in the hospital urgency service of second level in medical attention. MATERIAL AND METHODS: We made an analysis of a secondary study done in 1999 in pediatric patients younger than 16 years with diagnosis of acute asthma. RESULTS: From 6,912 consultations given in the pediatric emergency area, 2,586 were from acute asthma, the half was 5.2 years old patients, the minimal average time a patient had to stay in the hospital per month was of 7.36 hours in January and the maximum average time was of 22.10 hours in the month of September. Regarding the frequency of attendance in the service for a new event, the following distribution was found: from two to three 25.72%, from 4 to 6 10.1% and from 7 to 15 0.96%. The cost of the attention had a total cost of 5'787,494.82 pesos. CONCLUSIONS: The frequency of acute asthma was 41.58% and this figure was considered high in comparison to similar studies. The clinic evolution and the treatment response are related to the age, and, in the study results, the patients younger than 3 years had a longer stay in the hospital, also, there was an increase of patients in the rainy months. The frequency of patients who assisted between 2 or 3 times and the cost was 387,123.00 pesos. That frequency may be due to patients did not receive a long-term treatment provision, or because of ignorance in the initial rescue treatment, ignorance in the factors that raise the sickness, as well as patients not taking their treatment the way it was asked by the doctors. These factors increase the cost, which is feasible to be modifyied, if the patients and their families get acknowledge on the importance of respecting the instructions on the proper way of treating the acute asthma, and all the triggering factors of it.

Identificación de mecanismos de transmisión del virus papiloma humano en mujeres infectadas / Identification of transmission mechanisms for human papilloma virus (HPV) in infected women

Introducción: El virus del papiloma humano, es uno de los más frecuentes de trasmisión sexual y conocer los mecanismos de transmisión tiene vital importancia para el control de la incidencia de esta enfermedad. Objetivo: Evaluar el nivel de conocimientos de las pacientes con virus del papiloma humano, sobre los mecanismos de transmisión. Metodología: Se incluyeron 109 pacientes subsecuentes y de primera vez que acudieron a la clínica de displasias por diagnóstico de VPH. Para evaluar el nivel de conocimiento, se consideraron tres indicadores: Bueno (>20 aciertos), Regular (16-20 aciertos) y Malo (≤15 aciertos). El cuestionario fue validado por rondas de expertos. Resultados: Del total de pacientes 31.2% tuvo conocimiento bueno, 42.2% regulary 26.6% malo. De 109 pacientes47.7% son de estrato socioeconómico medio bajo, 49.5% con estudios de primaria, casadas 67%, con una pareja sexual 54.1%, con vida sexual activa 44% y 77.1 % no habían recibido pláticas informativas en relación al virus del papiloma humano. Conclusiones: Es evidente la necesidad de implementar nuevas y diversas estrategias dirigidas a la población afectada encaminadas al aprendizaje de los mecanismos de transmisión para incrementar su nivel de conocimiento y coadyuvar en el control de la propagación del virus.

Introduction: HPV is one of the most often sexual transmitted diseases, and knowing the transmission mechanisms is vital to control the incidence of this infection. Objective: To evaluate the level of knowledge regarding transmission mechanisms in patients with HPV infection. Methodology: 109 first timers and subsequent patients who showed up to the Displasias Clinic for diagnosis of HPV were included in the study. To evaluate the level of knowledge, three indicators were considered; good (>20 items answered correctly), regular (16-20 items answered correctly), and bad (= or < 15 items answered correctly). The questionnaire was validated by review of experts. Results: From the total, 31.2% patients had good, 42.2% regular, and 26.6% bad knowledge. 47.7% out of 109 patients are half low socioeconomic status; 49.5% with elementary school of education; 67% got married; 54.1% with a single sexual partner; 44% sexual actives; and 77.1% had not received any sort of information talks regarding HPV. Conclusions: It is evident the necessity of implementing new and diverse strategies lead to affected population through learning the transmission mechanisms to increase their level of knowledge and collaborate in the control of virus spreading.

[Correlation between the level of work satisfaction and professional burnout in family physicians]. / Nivel de satisfacción laboral y síndrome de desgaste profesional en médicos familiares.

OBJECTIVE: To determine the correlation between labour satisfaction and physician wear out. MATERIAL AND METHODS: There was a cross sectional study with all the family doctors from four Units of Family Medicine from Cancun (n = 102), with four or more years of medical practice. The questionnaire Red Font was used for labour satisfaction and Maslach Burnout Inventory for professional wear out, as well as the coefficient of correlation of Kendall. RESULTS: The predominant level of labour satisfaction was the medium (50.5%). the low level of wear out prevailed (50.5%). Medical doctors with medium or high satisfaction had low to medium wear out, and those who were reported with low satisfaction had moderate and high wear out. In the analysis bivariate between labour satisfaction and professional wear out the association was statistically significant, although there was not correlation (Kendall = -0.281). CONCLUSIONS: In contrast with other studies where they found an inversely proportional relationship, in this study any correlation was found. The ideal situation could be that all medical doctors develop high satisfaction and low professional wear of; however this didn't happen through this study. It is very important to study all the factors that have influence to elevate the professional wear of and dissatisfaction in our medical doctors to develop programs that allow to cope these problems.